Subjective
Mr. X is a 45-year-old man who came to the clinic with numbness on his left leg when working on his farm for 5 hours. After a few hours, the pain developed. The pain was pricking and increased muscle activity. It radiated towards the upper body by the minute and was associated with the numbness. The numbness also increased in intensity from the lower limbs up to the thighs. After around 7 hours of onset, he developed weakness of the limbs and was brought to the hospital immediately. The weakness was bilateral. He has since been admitted for one day in the hospital. He has no allergies. He doesn’t smoke but drinks gin once every two days. He claims he has no respiratory infection but accounts for onset of acute gastroenteritis one week ago. He ate his food from a nearby restaurant. Finally, there is no history of trauma. Objective
Vitals signs were 129/92; the temperature was at 38, R.R. at 22, H.R. at 87, height, 6ft, weight at 180lbs.
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Other systems-non remarkable
Central nervous system findings:
Lower limb findings-Mr. X was well oriented in place time and person. Memory and intelligence were intact, cranial nerves normal, reduced weakness in the lower limbs power(3), difficulty standing, deep tendon reflexes were absent in the lower limbs, fine and crude touch were also intact. Sensations were intact too. Muscle bulk was intact. However, the tone reduced.
The Upper limbs and cerebellar signs were non-remarkable.
Assessment
Guillan Barre syndrome is a lower motor neuron lesion that is characterized by a proceeding respiratory or G.I.T. infection by viruses and bacteria such as H. influenza and C. Jejeuni. The body triggers an immunological reaction that ends up attacking the body’s neurons instead, leading to the neuropathy (Willison & Jacobs & Doorn, 2016). Another characteristic feature is the assenting symmetrical weakness, hypotonia, and hyporeflexia.
Transverse myelitis is a condition caused by inflammation of the spinal cord that traverses the whole width. It also presents with the same symptomatology as G.B.S., alongside bladder atony. Organisms such as Campylobacter jejeni and H. influenza have also been reported.
Myasthenia gravis is a condition characterized by activation of the immune system, affecting the neurons that innervate the voluntary muscles. It affects the arms, face, or legs. An overactive thymus a gland that produced IgG antibodies has been highly associated with it (Pasnoor et al., 2018)
Spinal cord compression is a diagnosis where a swelling such as a tumor, compresses the cord leading to numbness, pain. The compression of the resulting nerves would have these effects (Ropper & Ropper, 2017).
Alcohol neuropathy has been known to affect the assimilation of various vitamins such as thiamine, vitamin E, and B6. These nutrients are essential for neuron development and maintenance, and hence their absence could lead to conditions such as Wernicke’s neuropathy and neuropathies. Mr. X is a heavy consumer of alcohol (Julian et al., 2019).
Tests
Blood profile and Liver function tests: A blood profile taken from the patient will indicate high neutrophil or lymphocyte counts in cases of viral and bacterial infections. These infections precede autoantibody reactions.
Electron myography test is a marker for nerve conduction. Reduced counts are expected in the first four differentials (Proot, P. (2018).
M.R.I is an imaging technique that can be used to check the spinal cord for cord compression.
Lumbar puncture tests for C protein analysis: Is a marker for indicating inflammation. In cases such as transverse myelitis, the marker would be high. IgG screening- An increase could point out Guillan Barre syndrome and myasthenia gravis due to autoantibody response.
References
Julian, T., Glascow, N., Syeed, R., & Zis, P. (2018). Alcohol-related peripheral neuropathy: a systematic review and meta-analysis. Journal of neurology , 1-13.
Pasnoor, M., Dimachkie, M. M., Farmakidis, C., & Barohn, R. J. (2018). Diagnosis of myasthenia gravis. Neurologic clinics , 36 (2), 261-274.
Proot, P. (2018). EMG APPROACH TO POLYNEUROPATHY. Neurologijos Seminarai , 22 (3).
Ropper, A. E., & Ropper, A. H. (2017). Acute spinal cord compression. New England Journal of Medicine , 376 (14), 1358-1369.
Willison, H. J., Jacobs, B. C., & Van Doorn, P. A. (2016). Guillain-barre syndrome. The Lancet , 388 (10045), 717-727.
