hello friends
i have a pt of tubercular arachnoiditis with
syringomyelia, i have a brief
history here.i would like to know about your opinion
about the orthotic
management of this case.pl give me an idea.
mucsles charting:
hip: lt rt
flexor 2+ 1
extensor 0 1
abdu 2+ 1
add 2+ 0
quad.
lumborum 5 5
knee.
ext 2+ 1
flx 0 0
Lt knee-spastic
Rt hip-ext rotation
BL TA TIGHT
Brief Case History:
Case of Dorsal tubercular arachnoiditis with
syringomyelia status
postoperative (mid & lower dorsal laminectomy and
decompression) ;
post TBM syrinx paraplegia-spasticity.
dat of birth: dec 10, 1974
Timeline:
March 1994:
-Suffered from TB meningitis in March 1994,
-administered ATT course for 18 months
-followed by a spinal surgery in July 1994 D4 to
D11 dorsal
laminectomy carried out for decompression &
removing extensive
arachnoiditis & sterile pus (T4-T11 laminectomy)
-improved gait post-op
-administered Tegratal, Diamox, Baclofen
Dec 1995
-noticed sensory impairment of right upper limb &
unsteadiness of gait
-MRI of thoracic spine showed showed a syrinx
Jan 1996 MRI report
-syrinx much more prominent extending from C5 to
T10. Several septae
compartmentalising the syrinx noted.
March 1996 MRI report
-Syrinx-dorsal cord with evidence of archnoiditis
April 1996
-patchy sensory loss C7 downwards
-muscle power 4/5
-hypertonia, hyper-reflexia in both lower limbs
-bladder control: near normal
-using a stick to walk
Following progressive deterioration in gait &
sensory impairment
in upper right & both lower limbs due to the formed syringomyelia – in septas, operated again on the spine in Aug 1997 Delhi ;from C2 to L1 -due to an extension in the syrinx from C5 to T10 – to decompress the syrinx by insertion of a syringo-peritoneal shunt leading into the abodomen, in an attempt to drain the excess CSF I
24 March 2001 MRI report
-syringomyelia seen extended from C6 to D12 just
sparing the tip of
conus medullaris. Syrinx most prominent at D6 to
D12 level.
Gradually & progressively deteriorated symptoms
(gait/ sensory)
continued (passive & assisted) physiotherapy; basic
stretching &
strengthning with baclofen & neurobion.
Aug 2000
– 1 vile BOTOX given at right gastro-solius
– temporary mionor effect
Presently, though clinically unchanged, my symptoms
have further
deterioted.
-I now use a walker to move & at times, a
wheelchair.
-Due to the extensive spasticity & clonus in my
legs (with diminished
sensation in my right leg, arm & hand) have
recently started hopping
on my left leg, with the right leg throwing itself
back – (the quads
are too weak & the hams, too tight/ loss of tone),
– both kness give way (unlock) when standing,
footdrop with extreme
spasticity/clonus
-Assisted orally with baclofen (upto 50 mg/day) &
tizanadine 2
mgx3/day(zanaflex)/ valium, neurobion vitamins &
occasionaly diazapem.
Suggested :
– IV methyl predisolone (solu medrol)
– baclofen pump (invasive)
– concentrated rehab
– nerve block (invasive)
– spinal cord/ nerve regeneration (whenever….)
__________________________________________________
Do You Yahoo!?
Yahoo! – Official partner of 2002 FIFA World Cup http://fifaworldcup.yahoo.com
