Hi doctor,
The patient is a 50 year old woman with a history of polio in childhood and complains of paresthesia since a year. It started suddenly from the toes on both sides and it progressed to upper back (T4) in 20 days. She was hospitalized with post-polio syndrome and treated with intravenous immunoglobulin (IV Ig). She complained of bilateral tinnitus and seeing some flash of light in central vision after IV Ig therapy. She had paresthesia of fingers and both hands after two months. She was hospitalized again and treated. She lost left leg movement during hospitalization, which progressed to hemiplegia. She denies any trauma, fever or incontinence. Her medication includes Gabapentin, Vitamin D and B1, Duloxetine and Chlordiazepoxide. Past medical history includes polio and migraine. Family history includes father with Alzheimer's, mother with hypertension (HTN) and heart failure. She is married, monogamous with husband and adopted one child. On physical examination, pupil was normal and no nystagmus. Laboratory tests showed complete blood count (CBC) and differential nil, erythrocyte sedimentation rate (ESR) 40, CRP 25. Also, I have attached her magnetic resonance imaging (MRI) report.
Hi,
Welcome to icliniq.com. I do not quite agree with post-polio syndrome.Post-polio syndrome after these many years is quite rare. From a neurosurgical point of view, when I look at her MRI cervical spine (attachment removed to protect patient identity), there is a significant disc bulge present at C5-C6. There is compression from both anterior and posterior sides. Collective dynamic compression would be quite significant. This can explain her progressive symptoms even after IV Ig (intravenous immunoglobulin). Please repeat magnetic resonance imaging (MRI) cervical spine with T2 sagittal images in 30 degrees of flexion and extension. Also, get NCV (nerve conduction velocity) in all four limbs and SSEP (somatosensory evoked potential) studies for a clear diagnosis.
Was this answer helpful?
|Same symptoms doesn’t mean you have the same problem. Consult a doctor now!
If you have localized back pain with no other symptoms like radiating leg pain, and neurological symptoms like numbness, weakness, paresthesias, etc, then you can start with following recommendations for an initial period of Read full
I am suffering with disc bulge. Please get me a solution for it.Hi doctor, I am suffering from disc bulge at the level of L5-S1 ... You have mentioned from MRI findings as L5/S1 disc bulge, instability at L5/S1 level and pars defect of L5 with likely compress Read full
My little child has ataxia, hypotonia, seizures, and dysphagia. What could it be?.. gone through the images which you have sent (attachment removed to protect patient identity). There are a fluid signal intensity and a short segment abnormality in the cervicothoracic part of the spinal cord which is likely representing a syrinx betw Read full
Also Read Answers From:
Comprehensive Medical Second Opinion.Submit your Case
Also Read