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School of Medicine >
Department of Neurology >
Medical Student Cases and Questions >
The Man Who Became Paralyzed In Two Days
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A 24 y.o. male medical student came to the ER because of rapidly progressing weakness. He had started to
notice difficulty the day before admission when he awoke with parasthesias
in the soles of both of his feet. During that day, the parasthesias progressed
up his legs to his hips. When he awoke on the day of admission his lower
extremities were numb and very weak. In the ER, his exam was normal except
for a pulse of 104 and marked weakness of his lower extremities. He had
diminished appreciation of all sensory modalities below his neck more pronounced
distally than on his trunk. His deep tendon reflexes were absent. There
was no plantar response to sltimualtion of the sole on either side. His
blood pressure began to fluctuate. A vital capacity measurement was 0.8
liters. A lumbar puncture had a normal opening pressure and no cells, however
the protein was elevated to 95 mg%.
Questions:
- What is the differential diagnosis of acute (or subacute) paralysis?
What is the diagnosis in this patient?
- If you did not have a LP result and a tick had been found on the
patient, what diagnosis would you think of? If the patient had only
sensory signs, no tick, and the same LP findings, what diagnosis
would you consider?
- What would be the appropriate treatment? If that treatment were
not available, what else could you do?
- What would the EMG show on the day after admission and 4 weeks later?
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