Concluded Case

Left upper limb weakness- Diagnosis?

An 16 years old male is having weakness of left upper limb with wasting over a period of last 6 months. Also gives history weaked grip of left hand . Apparently everything looks normal as no other symptoms What next should be done for further evaluation of this case

17 Likes

LikeAnswersShare
Concluded answer

Very interesting case Important points to be noted in this case are 1) This patient has weakness in left upper limb and weakened grip of left hand 2) There is muscular wasting of left hand Muscules What do these finding tells us? It tells up that it is a disease affection motor nerves and sensory nerves are specifically spared Another important thing it tells us that it is a lower motor neurons are affected. In affection of lower motor neuron muscular wasting is observed, upper motor neuron affection results in stiffness of muscle. Because sensory nerves are not involved - few disease which cause muscle wasting and lower motor neuron affection are ruled out - these diseases are - Carpal tunnel syndrome, compression of nerves in cervical spine because of cervical spondylosis or disc prolapse, compression of nerves by cervical rib. Now what are differential diagnosis?? 1) Amyotrophic lateral sclerosis 2) Spinal muscular atrophy 3) Multiple sclerosis 4) Myasthenia Gravis Other condition which affect purely motor nerves - Guillian Barre syndrome is ruled out because - it is a rapidly progressive disease, starts with affection of lower limb and affect both sides symmetrically Investigation Nerve conduction study Electromyography MRI of brain and cervical spine They will further aid in confirming the diagnosis

All Answers

Very interesting case Important points to be noted in this case are 1) This patient has weakness in left upper limb and weakened grip of left hand 2) There is muscular wasting of left hand Muscules What do these finding tells us? It tells up that it is a disease affection motor nerves and sensory nerves are specifically spared Another important thing it tells us that it is a lower motor neurons are affected. In affection of lower motor neuron muscular wasting is observed, upper motor neuron affection results in stiffness of muscle. Because sensory nerves are not involved - few disease which cause muscle wasting and lower motor neuron affection are ruled out - these diseases are - Carpal tunnel syndrome, compression of nerves in cervical spine because of cervical spondylosis or disc prolapse, compression of nerves by cervical rib. Now what are differential diagnosis?? 1) Amyotrophic lateral sclerosis 2) Spinal muscular atrophy 3) Multiple sclerosis 4) Myasthenia Gravis Other condition which affect purely motor nerves - Guillian Barre syndrome is ruled out because - it is a rapidly progressive disease, starts with affection of lower limb and affect both sides symmetrically Investigation Nerve conduction study Electromyography MRI of brain and cervical spine They will further aid in confirming the diagnosis

Valuable opinion
1

View 8 other replies

Suspected Monomelic Amyotrophy/ Hirayama disease

Valuable opinion
2

View 1 other reply

I thank all curofy doctors who gave opinions in this case with best possible explanations of diagnosis. Since it was a complex case for me to diagnose as patient has not been properly attended by neurologist and taken it to be a normal finding .I Thank Dr Jayesh and Dr Reddy as both are surgeons belonging to my specialty , but interest in other specialities as well - which as surgeon I think is a Healthy trend . I also thank Dr Krishnan Pichumani , Dr Mansukh Shah , Dr Sunil Yadav and Dr Bhushan Patil for their opinions in this case . After going through the above discussion- I agree with Dr.Nihar Ranjan Mohanty for his diagnosis as SUSPECTED MONOMELIC AMYOTROPHY ALSO CALLED HIRAYAMA DISEASE. I thank Dr Mohanty for giving me a clue for further evaluation. I will let my colleagues know what is the diagnosis as MRI scan of neck can diagnose Hirayama disease which is a benign lower motor neuron disease. THANKS

Thank You Sir for your kind words ☺
1

View 3 other replies

??? Thoracic outlet syndrome Compression of lower trunk of brachial plexus (ulnar nerve) by cervical rib. Pain along the medial side of forearm,arm , tingling sensation,wasting over the ulnar nerve supplying area. Investigations....Chest X ray, CT neck and thorax, Angiogram... Further Management depends on the reports ...either conservative /surgical approach.

Thank you doctor
0

D/D:- 1)Carpel tunnel syndrome 2) ulnar neuropathy 3) Saturday Night palsy Adv:- 1)Nerve Conduction Study 2) CT cervical region T/T:- 1) anti-inflammatory medication along with muscle relaxant. 2) Physiotherapy 3) body massage with बला तैल helpful.

Tendons on dorsal aspect of left hand are prominent, indicating interossrous wasting. Chronic ulnar nerve compression DD HANSENS Tardy ulnar palsy due to old elbow fracture Spinal pathology, like cervical spondylosis, canal stenosis, syringomylia

Thank you doctor
0

* Brachial Plexus conduction affecting muscle power ** Blood supply partial obstruction to hand Cerebral condition effecting function of lt hand *Monomelic Amyotrophy Needs MRI brain ,nerve conduction,dopplar test to conclude.

Thank you doctor
0

View 2 other replies

Investigation for weaknesses of lt upper limb check ulnar nerve thickened it is Henson's cervical lt rib syndrome dd brachail plexsus syndrome dd any pathology in rt brain do mri brain with spine with angio EMG upperlimb

Thank you doctor
0

Loss of power in unilateral upper limb with wasting of muscle Lower motor neuron disease Likely thoracic outlet syndrome 2 cervical rib syndrome 3 brachial plexus compression

Thanx dr Ashok Leel
0

View 1 other reply

Nerve conduction study first If not conclusive,MRI cervical spine Opinion of a neurologist before proceeding

Valuable opinion
0
Load more answers

Cases that would interest you