A 23 year old male with lower limb weakness

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G sai  tejaswini
Roll no 61

Ihave been given this case to solve in an attempt to understand the topic of parient clinical data analysis to develop my competency in reading and comprehending clinical data including history,  investigation
 And come up with a diagnosis and treatment plan
Entire real patient clinical data is here:
https://vaish7.blogspot.com/2020/05/medicine.html?m=1

COMPLAINTS :
Bilateral lower limb weakness and sudden fall.
Vomiting
Gluteal, scrotal abscess(operated).

ANALYSIS:
Bilateral lower limb weakness since 5days associates with tingling , numbness.
There was history of sudden fall.

Causes may be
Trauma:ruled out no history  given
Vitamin deficiency-no features suggestive.

Sudden fall , numbness,tingling sensation may occur due stroke (tuberculosis)

Peripheral Neuropathy can be ruled out by nerve conduction studies.

Spondylodiscitis due infections (mainly TB )
Can be ruled out by mri ,  biopsy , pcr .

It may occur due to  tumors(meningiomas,gliomas,) ruled out by MRI, CT, ICP monitoring ,CSF analysis.

Spinal cord injury-sensory loss, bowel bladder incontinency,numbness and tingling. Which are ruled out by MRI,CT.

INVESTIGATIONS:  MRI OF BRAIN



 By this its shows there is significant enhancement representing meningeal enhancement or exudates and following regions with mri with multiple nodules in pulmonary apices  suggestive of pulmonary kochs, disseminated tuberculosis.

Vomitings occured 3days back ,
It may occur due to infections, drug intake toxins intake these all are ruled out because no history mentioned.
 Vomitings may be caused due increased intracranial tension caused due to tumors , infections.
 Gluteal abscess- which was operated 5months back.
Scrotal abscess-10 days back operated.


He has  history of multiple sexual parteners
Hiv testing-negative.

  Patient i found to have tuberculosis but didnt have classical findings.

FURTHER ANALYSIS: As the patient  found to have disseminated tb (mri) so  potts disease of spine should be evaluated.
It is important to rule out spondylodiscitis(main organism-mycobacterium tuberculosis).

ANATOMICAL SITE: lumbar vertebrae,(L4, L5), vertebral discs.

PHYSIOLOGICAL DISABILITY: bilateral lower limb weakness.

PATHALOGY: any infections spread to vertebrae through hematogenous or lymphatic spread cause damage to bones leading to compression  of nerves are damages leading to paralysis.(L4,L5 vertebrae) involvment.
As investigations suggusting disseminated  TB. So this infectionby hematogenous route  lead to involve ment of disc of vertebrae leading to destruction of surrounding structures (psoas abscess).
https://www.slideshare.net/mobile/wikadkaur/potts-disease-ppt
 TREATMENT:  anti tubercular treatment,   rest , physiotherapy.

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