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….)
>
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