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The patient came 02-Sptember-2006 complaining of weak four limbs .
The weakness started in both lower limbs 2 months ago and 2 weeks
ago noticed weak upper limbs. He was treated for "Guillain-Barre
syndrome" , but MRI of the brain and cervical spine revealed severe
compression at C3-4 level with malacia of the spinal cord at that
level with scattered lacunar infarcts both cerebral hemispheres.
On examination: the patient had neck pain when looking to the left,
upward with weak both deltoids 4/5 biceps brachii 3/5 and
triceps 3/5 and grip right hand2/5 and left hand 4/5 and extension
both hands 2/5, quadriceps femoris both 4/5 abduction and adduction
of the knees 4/5. dorsiflexion both feet 3/5 and planterflexion both
feet 4/5 with hypalgesia median distribution right upper limb
and C5 dermatome left upper limb and entire left lower limb and
above the ankle of the right foot with severe atrophy of the
interossii both hands and both gastrocnemius muscles both forelegs.
The patient sent another time for MRI cervical spine, which revealed
compression at C3-4 and C5-6.
Discectomy of C3-4 was performed and during that, there was a
feeling of instability, for what fusion was performed after
decompression at that level. Discectomy of C5-6 was done and check
for instability was negative.
Prompt postoperative recovery.
Comments:
1. The patient had severe atrophy of the interossii and the forelegs
muscles. This mean, that his pathological process was very old and
the clinical signs of functional failure got place as the patient
mentioning.
2. It was very surprisingly, that the patient got full power of his
four limbs, despite the fact, that his problem is an old one. There
are common rules, but there are exceptions and his case is an
exception. |
