Clinicopathological Case: Progressive Weakness and Sensory Loss in a 35-year-old Female
Mrs. X, a 35-year-old female, presents with gradually progressive asymmetrical weakness and sensory loss in both lower limbs. No history of higher function abnormalities. Past history of TB meningitis. Examination reveals increased tone, muscle weakness, absent reflexes, and sensory abnormalities. Provisional diagnosis pending. Detailed clinical findings discussed.
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Presentation Transcript
Mrs.X 35 year old Female
Presenting complaints Gradually progressive asymmetrical weakness of both lower limbs(Right>Left). Sensation of gradual stiffening of both lower limbs. Associated with sensory loss in the form of decreased pain, touch and temperature in both lower limbs.
No history of higher function abnormalities No h/s/o cranial nerve involvement. No autonomic symptoms. No h/o fever, infection, vaccination or recent covid infection.
Past history H/o TB meningitis ; took full course of ATT. No other significant past medical or surgical history.
General examination: NAD Vitals: stable Head to foot examination: NAD
System examination NERVOUS SYSTEM Higher mental functions: normal Cranial nerves: normal
Motor system: Bulk: normal bilaterally Tone: increased bilateral upper and lower limbs, more in lower limbs. Power : grade 4/5 bilateral UL; grade 1/5 right LL; grade 3/5 left LL
Superficial reflex Abdominal reflex: absent in all four quadrants. Plantar: bilateral extensor Deep tendon reflexes: hyperreflexia with sustained ankle clonus
SENSORY SYSTEM Loss of pain and temperature up to ASIS Impaired vibration and position sense up to ASIS Upper limb sensations: normal
Lhermittes sign positive No vertebral tenderness
