HELLO FRIENDS HERE IAM GIVING ABRIEF HISTORY OF ONE OF MY PATIENT NAMED AMIT
AS:
HIP EXT-2(BL)
FLX-2+(BL)
KNEE EXT-0 RT
-1 LT
FLX-1 BL
ANKLE PF-I
DF-0
KNEE FLX CONRE -RT
SEVERE SPATIC TYPE OF PARAPLEGIA.
>From: “ajmt”
>To:
>Date: Fri, 24 May 2002 09:13:00 +0530
>
> > 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….)
> >
>
>
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