scholarly journals Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India

2015 ◽  
Vol 9 (11) ◽  
pp. 1289-1293 ◽  
Author(s):  
Kavitha Saravu ◽  
Rajagopal Kadavigere ◽  
Ananthakrishna Barkur Shastry ◽  
Rohit Pai ◽  
Chiranjay Mukhopadhyay
Keyword(s):  
Lower Limb ◽  
Corticosteroid Treatment ◽  
Conus Medullaris ◽  
Subdural Empyema ◽  
Lower Limbs ◽  
High Dose ◽  
Limb Weakness ◽  
Subdural Collection ◽  
Lower Limb Weakness ◽  
Left Lower Limb

Two distinct and potentially deceitful cases of neurologic melioidosis are reported. Case 1: A 39-year-old alcoholic and uncontrolled diabetic male presented with cough, fever, and left focal seizures with secondary generalization. An magnetic resonance imaging (MRI) brain scan revealed a small peripherally enhancing subdural collection along the interhemispheric fissure suggestive of minimal subdural empyema. Blood culture grew Burkholderia pseudomallei. Patient was diagnosed with disseminated bacteraemic melioidosis with subdural empyema. He was successfully treated with ceftazidime-cotrimoxazole-doxycycline. Case 2: A 45-year-old male presented with left lower limb weakness, difficulty in passing urine and stool, and back pain radiating to lower limbs. Neurological examination revealed flaccid left lower limb with absent deep tendon reflexes and plantar reflex. Spinal MRI showed T2 hyperintensity from D9 to L1 suggestive of demyelination. Patient was treated with high dose methylprednisolone. By day 3 of steroid treatment, lower limb weakness progressed. Subsequent MRI showed extensive cord hyperintensity on T2 weighted sequence extending from C5 to conus medullaris consistent with demyelination. Cerebrospinal fluid (CSF) culture grew B. pseudomallei, and the patient was given meropenem-cotrimoxazole. After three weeks of parenteral treatment, the lower limbs remained paralyzed. Patient was discharged on oral cotrimoxazole-doxycycline. Conclusions: Melioidosis should be considered as a differential in focal suppurative central nervous system (CNS) lesions, meningoencephalitis, or encephalomyelitis in endemic areas. CNS infections must be ruled out prior to steroid administration. The role of corticosteroids in demyelinating CNS melioidosis has been refuted. This is a rare documentation of effect of unintentional corticosteroid treatment in melioidosis.

ORGANOPHOSPHATE INDUCED DELAYED NEUROPATHY-A CASE REPORT

2021 ◽  
pp. 31-32
Author(s):  
Sarita J. Parmar ◽  
Harsh A. Patel ◽  
Vraj Rathod ◽  
Kapil Parmar ◽  
Minakshi Chauhan ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Lower Limb ◽  
Electrophysiological Study ◽  
Lower Limbs ◽  
Limb Weakness ◽  
Axonal Polyneuropathy ◽  
Lower Limb Weakness ◽  
Severe Motor ◽  
History Of ◽  
Indian Male

Organophoshate induced delayed polyneuropathy (OPIDP) is a rare clinical condition associated with ingestion of organophosphate. Clinically the patient presents with distal lower limb weakness mainly along with paraesthesia and other symptoms of neuropathy. Nerve conduction study shows motor axonal neuropathy.Here, we are presenting a case of 23 years old INDIAN male who presented with pain and tingling sensations in lower limbs along with bilateral upper limb and lower limb paresis with difculty in getting up and walking. He had history of Dichlorvos based organophosphate ingestion around 45 days before. Electrophysiological study suggestive of Severe motor axonal polyneuropathy affecting all four limbs. No central nervous system signs were present.

scholarly journals 055 An unusual presentation of SOD1-ALS: a case report

2019 ◽  
Vol 90 (e7) ◽  
pp. A18.1-A18
Author(s):  
Allycia MacDonald ◽  
Jason Dyke ◽  
Simon Khangure ◽  
Andrew Kelly
Keyword(s):  
Lower Limb ◽  
Nerve Root ◽  
Neuronal Degeneration ◽  
Case Reports ◽  
Cauda Equina ◽  
Lower Limbs ◽  
High Dose ◽  
Initial Examination ◽  
Limb Weakness ◽  
The Right

IntroductionApproximately 10% of amyotrophic lateral sclerosis (ALS) cases are inherited, of which 20% are due to mutations in the superoxide dismutase-1 gene (SOD1). MRI abnormalities are not uncommon in ALS, and there have been previous case reports of peripheral nerve enhancement in patients with SOD1 mutations, typically attributed to rapid neuronal degeneration.CaseA 31-year-old previously well Malaysian woman presented with a 3 month history of progressive lower limb weakness, initially involving the right lower limb but progressing to involve the left, requiring the use of a walking aid. Initial examination demonstrated asymmetric upper and lower motor neuron signs in bilateral upper and lower limbs. EMG findings were of a severe pure motor axonal process. CSF examination revealed elevated protein without significant elevation of white cells. MRI brain and spine demonstrated smooth cauda-equina ventral nerve root thickening and enhancement. Treatment with intravenous immunoglobulin and high dose corticosteroid was commenced for a presumed inflammatory process, with no clinical improvement. A cauda-equina nerve root biopsy was performed, demonstrating features consistent with an immune-mediated demyelinating neuropathy. The patient continued to deteriorate, developing flaccid upper limb weakness and facial involvement. Plasma exchange, azathioprine, cyclophosphamide, and rituximab were sequentially administered over the following two months without altering the rate of disease progression. Genetic testing returned a positive SOD1 heterozygous gene mutation, confirming the diagnosis of ALS.ConclusionsWe present a case of SOD1-ALS with atypical features on imaging and histopathology suggesting an underlying demyelinating process, expanding the known clinical spectrum of this mutation.

scholarly journals Corpus callosum infarction: a case report

2020 ◽  
Vol 7 (11) ◽  
pp. 1751
Author(s):  
Ziyad Almushayti
Keyword(s):  
Magnetic Resonance Imaging ◽  
Corpus Callosum ◽  
Lower Limb ◽  
Case Reports ◽  
Resonance Imaging ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Left Lower Limb ◽  
History Of ◽  
Artery Disease

Infarctions of corpus callosal are rare due to an abundant collateral blood supply. Few case reports published in the literature regarding the corpus callosum infarction. We present a case of corpus callosum infarction in a 66-year-old man with a history of diabetes mellitus, hypertension, and coronary artery disease who presented to the emergency room with left lower limb weakness. Diagnosed was made based on magnetic resonance imaging and treated conservatively.  

scholarly journals P039 Muscle wasting & weakness: a rare presentation of sarcoidosis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Clare Tomlinson ◽  
Asim Khan ◽  
Debashish Mukerjee ◽  
Naveen Bhadauria
Keyword(s):  
Lower Limb ◽  
Muscle Wasting ◽  
Correct Diagnosis ◽  
Lower Limbs ◽  
High Dose ◽  
Rare Presentation ◽  
Multisystem Disease ◽  
Limb Weakness ◽  
History Of ◽  
Noncaseating Granulomas

Abstract Background/Aims  Sarcoidosis is a rare multisystem disease characterised by the presence of noncaseating granulomas. It most commonly affects the lungs though can affect any other organ system. Rarely, it can manifest as an acute myopathy. We describe a case of a patient presenting with muscle weakness and constitutional symptoms who was eventually diagnosed with sarcoidosis. Methods  A 48-year-old male with a background of lumbar spondylosis and BPH, presented with a 6-week history of progressive upper and lower limb weakness, myalgia and reduced mobility. He also described an 18-month history of progressive fatigue, drenching night sweats and 10-kilogram weight loss. His symptoms meant he was unable to work as a firefighter. Examination demonstrated profound muscle wasting and reduced power in the proximal muscles of his upper and lower limbs. There was no evidence of rash, synovitis or lymphadenopathy. Blood tests showed a normocytic anaemia (Hb 100 g/L) and raised C-reactive peptide (180 mg/L) and erythrocyte sedimentation rate (100 mm/hour). The creatine kinase ranged between 20-42 units/litre. He had a weakly positive anti-nuclear antibody (1:80). The remaining autoantibody screen was negative including ENA, DSDNA, ANCA, rheumatoid factor and anti-CCP. Complement proteins were unremarkable. Furthermore, an extended myositis panel revealed no myositis-specific or myositis-associated antibodies. Serum calcium and angiotensin-converting enzyme (ACE) levels were normal. Blood cultures and virology screen including for HIV, hepatitis B, hepatitis C, CMV, EBV, COVID-19 and respiratory viruses were all negative. A chest radiograph was also unremarkable. Results  He subsequently underwent electromyography which revealed generalised myopathy. An MRI of the lower limb proximal musculature showed evidence of muscle oedema worse on the right-side but no definitive evidence of myositis. A PET-CT followed revealing FDG-avid generalised lymphadenopathy and polyarticular uptake, but little uptake in the skeletal muscles. He underwent an external iliac lymph node core biopsy which demonstrated multiple noncaseating granulomas and lymphadenitis. Cultures for Tuberculosis were negative and there was no evidence of a lymphoproliferative disorder. A muscle biopsy was desired but not possible due to lack of availability because of the COVID-19 pandemic. The patient was diagnosed with sarcoidosis and commenced on three pulses of intravenous methylprednisolone followed by a weaning regimen of high-dose oral prednisolone and subcutaneous methotrexate. This resulted in a sustained improvement in his symptoms and normalisation of inflammatory markers. Conclusion  Symptomatic myopathy is present in only 0.5-2.5% of sarcoidosis patients. This unique case highlights the heterogeneity of this disease and the vital role different diagnostic modalities play in achieving the correct diagnosis. It is also pertinent that the lymphadenopathy, found incidentally via imaging, led to the diagnosis. Although notoriously a diagnosis of exclusion, this case emphasises the importance of considering sarcoidosis even in the absence of respiratory symptoms, a raised ACE or hypercalcaemia. Disclosure  C. Tomlinson: None. A. Khan: None. D. Mukerjee: None. N. Bhadauria: None.

scholarly journals Rare Atypical Presentation of a Neuroblastoma of Posterior Mediastinum

2021 ◽  
Author(s):  
Vishal Singh ◽  
Lamkordor Tyngkan ◽  
Abdul Rashid Bhat
Keyword(s):  
Spinal Cord ◽  
Lower Limb ◽  
Mediastinal Tumor ◽  
English Literature ◽  
Posterior Mediastinum ◽  
Lower Limbs ◽  
Limb Weakness ◽  
Presenting Symptoms ◽  
Lower Limb Weakness ◽  
Posterior Mediastinal

Abstract Introduction Neuroblastoma is the third most common malignancy and one of the most common neurogenic tumors of posterior mediastinum in the pediatric age group. A posterior mediastinal tumor causing spinal cord compression is an important example of an oncologic emergency arising from a neurogenic tumor. We present a rare case of posterior mediastinum neuroblastoma, with exclusive lower limb weakness presenting at an unusually older age. Case Presentation A 6-year-old girl reported with upper back ache and sudden onset progressive bilateral lower limb weakness, with difficulty in urination for 10 days. The weakness had progressed to paraplegia on the day of presentation. On examination, the child was observed to have loss of tone and power in both lower limbs and bilateral extensor plantar reflex. Chest X-ray showed heterogeneous opacity involving most of the left lung. Contrast-enhanced MRI showed posterior mediastinal tumor, extending into spinal canal. Patient underwent D3 to D6 laminectomy with subtotal tumor excision and spinal decompression. Crush biopsy showed round cell tumor, and final histopathological examination revealed poorly differentiated neuroblastoma, which was strongly positive for neuron-specific enolase on immunohistochemistry. The surgery was followed by chemotherapy, and the patient remained symptom free on 2-year follow-up. Discussion The presenting symptoms in case of thoracic neuroblastoma may include airway obstruction and chronic cough. Sometimes, it may present with weakness, limping, paralysis, and bladder and bowel disturbances in case of spinal cord involvement. Posterior mediastinal neuroblastoma presenting with paraparesis is uncommon. In our case, the child presented with isolated lower limb flaccidity with no other classical symptoms. To the best of our knowledge and thorough study, only four cases of posterior mediastinum neuroblastoma presenting with lower limb paralysis has been published in the English literature to date. Conclusion Tumor usually presents with pressure symptoms, caused by the mass in the posterior mediastinum, but it’s almost exclusive occurrence in the pediatric population warrants a thorough investigation in patients presenting with not only a symptomatic mass but also exclusive lower limb neurological symptoms.

scholarly journals Spontaneous spinal epidural hematoma: a case report

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ooi Chin Sheng ◽  
Ren-Chieh Wu ◽  
I-Hsin Chang
Keyword(s):  
Lower Limb ◽  
Epidural Hematoma ◽  
Lower Limbs ◽  
Spinal Epidural Hematoma ◽  
Limb Weakness ◽  
Female Ratio ◽  
Spontaneous Spinal Epidural Hematoma ◽  
Lower Limb Weakness ◽  
Bilateral Lower Limb ◽  
Spinal Epidural

Abstract Background Spinal epidural hematomas usually occur under certain conditions; they rarely occur spontaneously. The prevalence of spontaneous spinal epidural hematoma is ~ 0.1 per 100,000, and the male-to-female ratio is approximately 1.4 to 1. Herein, we describe a rare case of spontaneous spinal epidural hematoma. Case presentation A 63-year-old Taiwanese woman, with underlying hypertension, anemia, and a history of cardiovascular accident without sequela, was admitted to our emergency department with a chief complaint of sudden bilateral weakness in the lower limbs. Magnetic resonance imaging revealed a spontaneous epidural hematoma. The patient underwent emergency surgery to remove the epidural hematoma and laminectomy for decompression. The bilateral lower limb weakness was alleviated immediately after the surgery. Conclusion In patients with no risk factors related to spinal epidural hematoma, symptoms of bilateral lower limb weakness must be investigated carefully because this condition may occur spontaneously.

scholarly journals Postpartum femoral neuropathy: managing the next pregnancy

2019 ◽  
Vol 12 (12) ◽  
pp. e232967 ◽  
Author(s):  
Cathy Rowland ◽  
Daniel Kane ◽  
Maeve Eogan
Keyword(s):  
Caesarean Section ◽  
Motor Function ◽  
Lower Limb ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Primiparous Woman ◽  
Limb Weakness ◽  
Femoral Neuropathy ◽  
Lower Limb Weakness ◽  
Spontaneous Labour

A 34-year-old primiparous woman presented in spontaneous labour and had an unassisted vaginal birth of a 3.5 kg infant. Postnatally, the patient experienced lower limb weakness and was unable to mobilise unassisted. A diagnosis of postpartum femoral neuropathy was made. Full recovery of normal motor function was not achieved until 5 months postpartum. She returned in her next pregnancy, seeking advice on how to avoid this complication from reoccurring. It was decided that an elective caesarean section was an appropriate mode of delivery, which she underwent at 39 weeks without complication and without recurrence of the femoral neuropathy.

Improving sit-to-stand transition by the saddle-assistive device in the spinal cord injury: A case study

2021 ◽  
pp. 095441192110033
Author(s):  
Akbar Hojjati Najafabadi ◽  
Saeid Amini ◽  
Farzam Farahmand
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Lower Limb ◽  
Reaction Force ◽  
Assistive Device ◽  
Limb Weakness ◽  
Sit To Stand ◽  
Lower Limb Weakness ◽  
Wide Range ◽  
Cord Injury

Physical problems caused by fractures, aging, stroke, and accidents can reduce foot power; these, in the long term, can dwindle the muscles of the waist, thighs, and legs. These conditions provide the basis for the invalidism of the harmed people. In this study, a saddle-walker was designed and evaluated to help people suffering from spinal cord injury and patients with lower limb weakness. This S-AD works based on body weight support against the previously report designs. This saddle-walker consisted of a non-powered four-wheel walker helping to walk and a powered mechanism for the sit-to-stand (STS) transfer. A set of experiments were done on the STS in the use of the standard walker and the saddle-assistive device(S-AD). A comparison of the results showed that this device could reduce the vertical ground reaction force (GRF) of the legs up to 70%. Using this device could help a wide range of patients with lower limb weakness and SCI patients in changing from sitting to standing.

Sign in / Sign up

Export Citation Format

Share Document