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Question :

Posted On : 01 Apr 2018

a 12 year old boy presents with clumsiness and abnormal gait for 2 years. on examination, he is conscious, co-operative and intelligent child having decreased power, bulk and tone in both legs and loss of dorsiflexion in right foot. the examination of hands reveals contractures of 2 fingers of the left hand. deep tendon reflexes are decreased and there are tingling and burning sensation in both legs. the bowel and bladder functions are normal.

Expert Answer :

Answer Discussion :

D

DrRahul Patil

0

he detailed history. premature? NICU stay? I have seen similar presentation in premature babies and babies having prolong NICU stay. what I mean to say is there may be some perinatal cause. pediatric neurologist opinion will be helpful.

6 years ago

A

Adams

0

Vitamin b12 deficiency

6 years ago

K

kyourk diemirjyan

1

Muscular Dystrophy

6 years ago

E

e mfa

0

g b syndrome

6 years ago

A

Anoop K

1

from the history problem can be localized to spinal cord level. a definite motor level at L3/L4. since the reflexes ,tone and bulk of lower limb muscles are affected with no upper motor signs a nerve root or peripheral nerve disease has to be suspected. Since the motor finding is asymmetrical a extramural compressive lesson has to be suspected. Being a chronic course peripheral neuropathy may be considered as first possibility though rare in children

6 years ago

Answer 1

Since the deep tendon reflexes are decreased it suggests a lower motor neuron problem as also the tone is decreased. Since there are tingling and burning, it suggests more of radiculopathy. One may need to do nerve conduction studies and if there is evidence of radiculpathy then MRI of te spine may be required.

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