Concluded Case

Acute Transverse Myelitis from C3 to D4

60 yr old male presented with acute onset of upper dorsal pain with weakness of left upper and lower limbs with early bladder involvement. Chief Complaints 60 yr ,M, Presented with pain in the upper interscapular region 1 week,left upper limb weakness and numbness 3days,difficulty to walk since2 days,hesitancy and precipitancy of micturition since 2 days.Developed abrupt onset of upper back pain about a week ago while getting up in the morning. Known case of type 2 DM ,10 yrs and hypertensive for the past 4 yrs. On exam BP 140/ 90 mmhg.Afebrile.Mo lymphnode enlargement. Neurological exam shows normal higher functions and cranial nerves including optic fundi.Motor system examination shows gr 4/ 5 power both upper and lower limbs ,both proximally and distally. Tone normal .Upper limbs Buceps ,triceps, supinator elicitable ,knee jerks hyperactive,ankle jerks just elicitable on reinforcement.Abdominal reflexes absent with 0 plantars bilaterally. Mild dulling of all modalities of sensations C5 to D1 on the left side and Cc8 T1 on the rt side Investigations All routein blood work up including blood biochemistry- normal. Vasculitis screening- normal. CSF study 11 lymphocytes with sugar 80 mg / dl ,protein 44mg / dl.X-ray chest ,US abdomen - normal.MRI brain - normal. CERVICAL MRI with screening of rest of spine done.Dorsal and LS spine - no significant abnormality detected Diagnosis Functional diagnosis: Acute Quadripatesis. Final diagnosis - For discussion. Management Started on appropriate medicine ,physio with gait training.Medicine for discussion. Discussions.60 yr old ,M, presented with acute onset of back pain followed by weakness of both upper and lower limbs. What abnormality in the MRI cervical spine? What is the Diagnosis? How will you treat the case? What is the prognosis?

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Concluded answer

Thanks Curofy and all others who answered the case. MRI shows altered T2wsignal from lower birder of C3 today level,centrally involving more than two third of the circumference with out cord expansion.Mild heterogeneous pist contrast enhancement noted in the cord and adjacent leptomeninges. Duagnosis : Acute Transverse Myelitis. Treatment: On Pulse dose of Methyl prednesone,physio and supportive care. prognosis : Good, patient started improving after the 3rd dose.

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Thanks Curofy and all others who answered the case. MRI shows altered T2wsignal from lower birder of C3 today level,centrally involving more than two third of the circumference with out cord expansion.Mild heterogeneous pist contrast enhancement noted in the cord and adjacent leptomeninges. Duagnosis : Acute Transverse Myelitis. Treatment: On Pulse dose of Methyl prednesone,physio and supportive care. prognosis : Good, patient started improving after the 3rd dose.

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Cervical degenerative disc disease Indentation of cord plus Myelomalacia possible cause of symptoms What is radiologist opinion ? Neurosurgery evaluation

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Quadriparesis is a condition characterized by weakness in all four limbs (both arms and both legs). It’s also referred to as tetraparesis. The weakness may be temporary or permanent. Quadriparesis is different from quadriplegia. In quadriparesis, a person still has some ability to move and feel their limbs. In quadriplegia, a person has completely lost the ability to move their limbs. Patients with acute BAO may present with sudden loss of consciousness, hemiparesis or quadriparesis or bulbar symptoms (dysarthria, anarthria, diplopia, vertigo, facial palsy, etc.). Another clinical presentation can be a stuttering course of brainstem symptoms (diplopia, dysarthria, vertigo, balance difficulty) progressing to a decreased level of consciousness. The progressive/stuttering course is often a result of severe basilar artery atherosclerotic disease. Prodromal (brainstem) symptoms may occur in up to 60% of patients who eventually present with BAO. Let us revisit the basilar artery syndromes. Quadriparesis can be caused by: an infection, like polio a neuromuscular disease, like muscular dystrophy damage to the nervous system due to an injury or another medical condition Treatment options Your treatment plan for quadriparesis depends on the underlying cause. For example, autoimmune or inflammatory conditions may be treated with immunosuppressive drugs. An electrolyte imbalance can be treated with medications that reverse the imbalance. Other treatments may include: surgery muscle relaxants pain medications physical therapy occupational therapy resistance training

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Looks like myelitis.

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Cervical mylopath

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