11-17-2014, 05:43 AM
A 10 y/o boy was admitted for weakness of all four limbs. Initially, he had frequent falls and an unsteady gait due to weakness of the distal muscles of his lower limbs. Within two weeks, there was rapid progression of the weakness to involve his proximal and trunk muscles so that he could neither move his limbs nor get up from his bed. He was anorexic, lethargic and not conversing. The bladder and bowel functions were normal. There was no history of preceding trauma, fever or seizures. The child appears developmentally normal and well nourished. Upon asking about the diet, the mother bursts out crying saying she is doing her best and even feeding him raw eggs every alternate day for the past one year for "extra nutrition".
On examination, the child appeared dull and had mask like facies. He had emotional lability and responded only to painful stimuli. The cranial nerves and optic fundii were normal. He had generalized hypotonia for the first two days followed by rigidity. Deep tendon reflexes were exaggerated. Ankle clonus and Babinski’s sign were noted bilaterally. His sensory system was normal. Examination of the other systems including the skin was normal.
Hb 11.8 g/dL,
TLC 13,300 × 103/µL,
Differntials:
Neutrophils 55%
Lymphocytes 42%
Monocytes 1%
Eosinophil 2%
This is his MRI
http://imgur.com/cq4dzP5
Diagnosis?
Managment?
On examination, the child appeared dull and had mask like facies. He had emotional lability and responded only to painful stimuli. The cranial nerves and optic fundii were normal. He had generalized hypotonia for the first two days followed by rigidity. Deep tendon reflexes were exaggerated. Ankle clonus and Babinski’s sign were noted bilaterally. His sensory system was normal. Examination of the other systems including the skin was normal.
Hb 11.8 g/dL,
TLC 13,300 × 103/µL,
Differntials:
Neutrophils 55%
Lymphocytes 42%
Monocytes 1%
Eosinophil 2%
This is his MRI
http://imgur.com/cq4dzP5
Diagnosis?
Managment?
