yutaro
Forum Newbie
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A 19 year-old female patient comes to emergency room for muscle weakness of legs and feet that began about half a day ago and gradually get worse. Her family history and past history is not remarkable except she caught a cold a week ago. She sometimes uses NSAIDs for painful mense.
Physical exams show BT 37.1C, BP120/80, pulse 72 regular,RR12 and SpO2 98% and normal mental status. Chest and abdomen are not remarkable.
Careful neurological exams show both positive Babinski signs, both legs and feet muscle weakness. Right abodomen, right lower extrimity and right low back have every sensory loss(pain,vibration and touch). There is no sensory loss on her left side. Which treatment should you provide for this ?
a) Prepare for incubation and respirator.
b) Check electolyte,BUN,cre and its correction.
c) IV steroids
d) consult a neurosurgoen
e) consult a orthopredician
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| SA
Forum Elite
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I will go for c and then investigate the patient and then refrel if needed
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| Ahab
Forum Elite
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GBS so the answer would be A
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| mash
Forum Fanatic
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its GBS so, ans is A
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| msashraf
Forum Senior
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it is GBS but why should we intubate the pt when there are no signs of involvement of respiratory muscles?
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| yutaro
Forum Newbie
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This is a very hard case I experienced.
She had left-sided sennsory loss below level Th8 or around.
At this point, we should think of spinal cord damage.
It was acute transverse myelitis comfirmed by MRI.
Right spinal cord except anterior horn was spared.
Sorry for difficult case.
Do you know ADEM?
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| mikyro
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A 19 year-old female patient comes to emergency room for muscle weakness of legs and feet that began about half a day ago and gradually get worse. Her family history and past history is not remarkable except she caught a cold a week ago. She sometimes uses NSAIDs for painful mense.
Physical exams show BT 37.1C, BP120/80, pulse 72 regular,RR12 and SpO2 98% and normal mental status. Chest and abdomen are not remarkable.
Careful neurological exams show both positive Babinski signs, both legs and feet muscle weakness. Right abodomen, right lower extrimity and right low back have every sensory loss(pain,vibration and touch). There is no sensory loss on her left side. Which treatment should you provide for this ?
a) Prepare for incubation and respirator.
b) Check electolyte,BUN,cre and its correction.
c) IV steroids
d) consult a neurosurgoen
e) consult a orthopredician
This is definitively not GBS :!:
:idea: Very acute onset (half a day ago)
:idea: serious sensory loss (as far as I remember, GBS is accompanied my mild sensory loss) - at any rate, not all types of sensation are lost in GBS
The picture is classical for acute myelopathy :idea: (+ Babinski, motor and sensory loss below lesion) - so, the very first thing is to give iv steroids (to decrease spine edema) and then consult a neurosurgeon.
So first: C and next D
This case is easy. More please, Yutaro.
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| mikyro
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ADEM = acute disseminated encephalomyelopathy? 
Yes, I know sth about it :wink: .
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| mikyro
Forum Junior
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Yutaro, since your case was an interesting one, I'd like to give you an algorithm for suspected acute myelopathy:
First: give iv steroids - decrease spinal edema
Next: Ask for a neurosurgeon consult. In the meantime, order an MRI - the most sensitive diagnostic tools for spinal pathology;
You have some possibilities now:
Spinal trauma / shock
Spinal bleeding (AVM, tumor, trauma, wrong LP)
Vertebral rupture (trauma / MTS)
Acute infection (serology for screening)
The MRI will generally show you the possible etiology, except the infection. You need to confirm a possible infection through serology (usually viral in nature)
Hope it helped.
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| yutaro
Forum Newbie
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spinal cord infarction:
anterior infarction spares posterior columm(vibration)
posterior infarction spares motor.
hemorrhage indicates acute onset.
Half a day onset and having had a cold is the key!
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