scholarly journals Thyrotoxic Periodic Paralysis

2020 ◽  
Author(s):  
Suresh Sinha ◽  
Nagarajan Raghupathy
Keyword(s):  
Sudden Onset ◽  
Periodic Paralysis ◽  
Lower Limbs ◽  
Limb Weakness ◽  
Thyrotoxic Periodic Paralysis ◽  
Asian Origin ◽  
Sodium Potassium ◽  
Lower Limb Weakness ◽  
History Of ◽  
Hormone Sensitive

Thyrotoxic periodic paralysis is not uncommon in people of Asian origin. It presents as sudden onset paralysis resulting from hypokalemia due to intracellular shift of potassium because of thyroid hormone sensitive Sodium-Potassium ATPase. A 34-year-old male with history of weight loss, palpitation and increased sweating for three months presented with sudden onset weakness of both lower limbs, two hours post-dinner. On investigation, he was found to be having hypokalemia as well as thyrotoxicosis. His potassium was corrected and was put on non-selective beta blocker and carbimazole. The patient improved within 24 hours and was discharged with advice to continue with Inderal and Carbimazole and report after one month. Hyperthyroidism should be included in differential diagnosis of sudden onset lower limb weakness.

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 Graves’ Disease Presenting with Periodic Paralysis to the Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Nick Si Rui Lan ◽  
P. Gerry Fegan
Keyword(s):  
Emergency Department ◽  
Muscle Weakness ◽  
Sudden Onset ◽  
Periodic Paralysis ◽  
Lower Limbs ◽  
Graves Disease ◽  
Antibody Testing ◽  
Thyrotoxic Periodic Paralysis ◽  
Electrolyte Replacement

Thyrotoxic periodic paralysis is an infrequent manifestation of hyperthyroidism and an uncommon cause of muscle weakness in western countries. The diagnosis should be considered in the differential when a patient presents with transient and recurrent weakness associated with hypokalaemia. We present a case of a 26-year-old Asian male presenting with sudden onset muscle weakness affecting predominantly his lower limbs on a background of weight loss. Physical examination demonstrated symmetrical proximal muscle weakness with normal sensation and reflexes. Initial biochemical investigations revealed hypokalaemia, hypomagnesaemia, and hyperthyroidism. Intravenous electrolyte replacement was administered in the emergency department. The patient’s symptoms resolved during inpatient admission. Subsequent TSH receptor antibody testing and radionuclide thyroid scan confirmed a diagnosis of Graves’ disease. The patient was discharged on antithyroid medication with no further episodes of weakness on follow-up. Therefore, thyrotoxic periodic paralysis can be the presenting feature of previously undiagnosed Graves’ disease and should be considered in the differential diagnosis in patients presenting with weakness.

scholarly journals Weight Loss-Based Nutraceuticals

2021 ◽  
Vol 16 (2) ◽  
pp. 49-54
Author(s):  
Shirley Shuster ◽  
Caitlyn Vlasschaert ◽  
Sara Awad
Keyword(s):  
Weight Loss ◽  
Periodic Paralysis ◽  
Intravenous Fluids ◽  
Limb Weakness ◽  
Thyrotoxic Periodic Paralysis ◽  
Potassium Supplementation ◽  
Lower Limb Weakness ◽  
Service Des Urgences ◽  
Laboratory Investigations ◽  
Initial Blood

Thyrotoxic periodic paralysis (TPP) is characterized by muscle weakness, areflexia, and hypokalemia in the setting of thyrotoxicosis. We present the case of a 32-year-old male with multiple presentations to the emergency department for lower limb weakness, tremors, diaphoresis, and tachycardia. His initial blood work revealed T3-toxicosis and hypokalemia, and he was treated for TPP with intravenous fluids and potassium supplementation. He had been ingesting weight loss supplements containing iodine, kelp, licorice, and likely undeclared thyroid hormones or mimics. Following discontinuation of supplements, all laboratory investigations normalized and thyrotoxicosis symptoms resolved. This case illustrates that ingestion of thyroid hormone-based nutraceuticals should be considered as a cause of thyrotoxicosis and TPP. RésuméLa paralysie périodique thyréotoxique (PPT) se caractérise par de la faiblesse musculaire, une aréflexie et une hypokaliémie dans le contexte de la thyréotoxicose. Nous exposons le cas d’un homme de 32 ans qui s’est présenté au service des urgences pour de multiples symptômes, soit une faiblesse des membres inférieurs, des tremblements, une diaphorèse et une tachycardie. Son bilan sanguin initial a révélé une toxicose-T3 et une hypokaliémie, et il a été traité contre la PPT par des solutés intraveineux et une recharge en potassium. Il ingérait des suppléments pour la perte de poids contenant de l’iode, de la laminaire, de la réglisse et probablement des hormones thyroïdiennes ou leurs analogues non déclarés. Après l’arrêt des suppléments, tous les examens de laboratoire sont revenus à la normale et les symptômes de thyréotoxicose ont disparu. Ce cas montre que l’ingestion de nutraceutiques à base d’hormones thyroïdiennes devrait être considérée comme une cause de la thyréotoxicose et de la PPT.

scholarly journals Making weight: acute muscle weakness and hypokalaemia exacerbated by thyrotoxicosis factitia in a bodybuilder

2021 ◽  
Vol 2021 ◽  
Author(s):  
Clare E Bonnar ◽  
John F Brazil ◽  
Julie O Okiro ◽  
Louise Giblin ◽  
Yvonne Smyth ◽  
...  
Keyword(s):  
Muscle Weakness ◽  
Past History ◽  
Periodic Paralysis ◽  
Beta Agonist ◽  
List Type ◽  
Thyroid Function Tests ◽  
Mass Generation ◽  
Limb Weakness ◽  
Thyrotoxic Periodic Paralysis ◽  
History Of

Summary A 32-year-old Caucasian male presented to the emergency department with a one-day history of acute severe bilateral lower limb weakness, three days after competing in a bodybuilding competition. He consumed large quantities of carbohydrate-rich foods following the competition. His past medical history was significant for anxiety, and family history was non-contributory. Examination was normal except for reduced power and hyporeflexia in both legs, despite his muscular physique. He was noted to have severe hypokalaemia (K+= 1.9 mmol/L). His thyroid function tests were consistent with thyrotoxicosis. He reported taking thyroxine and several other agents to facilitate muscle mass generation before the bodybuilding competition. His presentation was reminiscent of thyrotoxic periodic paralysis, albeit uncommon with Caucasian ethnicity. He also had transient hyperglycaemia at presentation with concomitant hyperinsulinaemia, which could be attributed to the carbohydrate load and may have exacerbated his hypokalaemia through a transcellular shift. Urine toxicology screen subsequently ruled out the use of diuretics but confirmed the presence of a long-acting beta agonist (clenbuterol) which, along with other substances, may have aggravated the hypokalaemia further. After 12 h of i.v. replacement, the potassium level normalised and leg weakness resolved. The patient agreed to stop taking thyroxine and beta agonists and was well during the clinic visit at one month follow-up. This case highlights the potential for thyrotoxicosis factitia to exacerbate hypokalaemia and muscle weakness from other causes in bodybuilders presenting with acute severe weakness, irrespective of ethnicity. Learning points In patients presenting with muscle weakness and hypokalaemia, early consideration of thyrotoxicosis is essential, even in the absence of a past history of thyroid disease or specific symptoms of thyrotoxicosis, in order to allow prompt initiation of appropriate treatment and to prevent recurrence. Bodybuilders may constitute a uniquely ‘at-risk’ group for thyrotoxic periodic paralysis secondary to thyrotoxicosis factitia, especially where there is concomitant use of beta-adrenergic agonists, even in the absence of diuretic use. Although rare and usually described in patients of Asian or Polynesian ethnicity, this case highlights that thyrotoxic periodic paralysis secondary to thyrotoxicosis factitia can also occur in patients with Caucasian ethnicity. We speculate that consuming large quantities of carbohydrates may induce hyperinsulinaemia, which could theoretically contribute to worse hypokalaemia, though mechanistic studies would be needed to explore this further.

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.

scholarly journals Vermal cerebellar hemorrhage as the initial manifestation of undiagnosed hypertension

2016 ◽  
Vol 5 (1) ◽  
pp. 357 ◽  
Author(s):  
Alagoma Iyagba ◽  
Arthur Onwuchekwa
Keyword(s):  
Sudden Onset ◽  
Lower Limbs ◽  
Neck Stiffness ◽  
Cerebellar Haemorrhage ◽  
Initial Manifestation ◽  
Truncal Ataxia ◽  
Accident And Emergency ◽  
Undiagnosed Hypertension ◽  
History Of ◽  
Clonic Seizures

Vermal cerebellar haemorrhage is bleeding affecting the midline region of the cerebellum. It is uncommon, accounting for 5-13% of all intracerebral haemorrhages. It is a grave condition with a high mortality. The diagnosis must be made early, if not, most patients would die within 48 hours. A 70-year-old lady presented to the accident and emergency department with a six hours history of sudden onset generalized tonic-clonic seizures following activity and loss of consciousness. She was unconscious with a Glasgow coma score of 3/15 with neck stiffness, generalized hypotonia and globally diminished reflexes. Her blood pressure was 240/120 mmHg with a mean arterial pressure of 160 mmHg. The brain computerized tomographic scan showed a hyperdense area in the cerebellar vermis with extension to both hemispheres and fourth ventricle. Consciousness was regained after three weeks of conservative management following which she became extremely restless and noticed to have developed titubations with nystagmus of both eyes. She also developed intention tremors, scanning dysarthria, generalized hypotonia, dysmetria, dysdiadochokinesia and intentional bilateral tremors. Her recovery was slow and gradual. Once she was able to stand with support, she was noticed to have florid truncal ataxia, lower limbs ataxia, and titubations.

scholarly journals Dilemma in the Management of Duchenne Muscular Dystrophy in a Resource Limited Settings

2019 ◽  
Vol 38 (2) ◽  
pp. 122-124
Author(s):  
Ahmadu Baba Usman ◽  
Pembi Emmanuel ◽  
Ovansa Emmanuel Onimisi ◽  
Adewale O. Oyinloye ◽  
Apollos Nachanuya ◽  
...  
Keyword(s):  
Muscular Dystrophy ◽  
Genetic Disorder ◽  
Lower Limbs ◽  
Financial Constraint ◽  
Limb Weakness ◽  
Progressive Muscle Weakness ◽  
Resource Limited ◽  
Duchene Muscular Dystrophy ◽  
History Of ◽  
Great Burden

Duchene muscular dystrophy is an x-linked recessive genetic disorder which present with progressive muscle weakness in children. It is often complicated by child becoming wheelchair bound by age 12. This limitation on the child and lack of cure is a great burden on the child, family and the community. We present a case of an 11-year old boy who presented with a seven years history of progressive limb weakness. Examination revealed hyper-lordosis of the thora-columbar spine, hypertrophied calf muscles, weak lower limbs and waddling gait. Due to financial constraint, only histology was relied on for definitive diagnosis. He was counselled, placed on prednisolone and commenced physiotherapy. This case portrays the challenges associated with the management of a rare disease in resource constraint settings.

scholarly journals Spinal cord compression secondary to vertebral echinococcosis

2016 ◽  
Vol 7 (01) ◽  
pp. 143-146 ◽  
Author(s):  
Abat Sahlu ◽  
Brook Mesfin ◽  
Abenezer Tirsit ◽  
Knut Wester
Keyword(s):  
Muscular Strength ◽  
Cord Compression ◽  
Lower Limbs ◽  
Resonance Imaging ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Anterior Plating

ABSTRACTWe describe a patient with progressive lower limb weakness and paresthesia 3 days after falling from a considerable height. Magnetic resonance imaging and computed tomography revealed collapsed Th2 and Th3 vertebrae. A tuberculous (TB) spondylitis was suspected, and anti-TB medication was started however with no clinical improvement. She was referred to our center and operated. A 3 level discectomy and 2 level corpectomy were performed with iliac bone grafting and anterior plating via an anterior cervical approach. The patient developed an esophagocutaneous fistula that was repaired and cured. The biopsy specimen showed a hydatid cyst of the vertebra as the cause of the lesion. After the result, she was started on oral albendazole. At follow-up nearly 4 months after surgery, the patient had regained significant power in her lower limbs with a muscular strength of 5/5 in both legs, thus making it possible to walk without support.

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