Ciencias de la Salud

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Author: search.filters.author.Marín Tabares, Adriana PaolaSubject: search.filters.subject.NERVIOSOS_CENTRAL

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    “Dificultades en el diagnóstico de mielitis transversa”
    (Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-04-01) Marín Tabares, Adriana Paola; Dr. Lana Saavedra, Héctor Enrique
    The present clinical case corresponds to a 53 years old male patient whit personal clinical pathologic antecedents of pain and paresthesia of the lower members, he has an surgical treatment antecedents of left saphenectomy during two times. Left inguinal hernioplasty from one year ago. He is attended because he presents a picture of progressive and generalized asthenia of three years of evolution, that seven hours previous to the entrance, he is exasperated provoking difficulty of moving, accompanied of sporadic paresthesia of the lower members. At the moment in the physical exam, he presents TA: 110/60, FC: 61 LPM, FR: 18RPM, SAT O2: 97% AA, T: 36.70C, WEIGTH 68Kg HEIGTH 165 cm, IMC 25 m/kg, the patient is awake, conscious, febrile, hydrated, algid, normocefalic head, without apparent pathology, eyes pupils of 2mm. isochoric, norm reactive to the light and to the accommodation, normal hearing, permeable nostrils, humid oral mucous, normal oropharynx, not painful to the palpation and movement, OA thyroid, preserved thorax expansibility, lungs with vesicular whisper kept without over added noise, heart with cardiac rhythmic noise, without blowing, soft abdomen, depressible, non-painful to the palpation, hrydroaerial noises present, scar of an hernioplasty in the left region, painful lumbar region to the digital pressure at the level of L1-L2, lower members with decreased strength 1/5, tone preserved, tactile sensibility abolished ( sensitive levels until hips region T12-L1, reflexes osteotendinous Rotuliano and Aquileo (hiperreflexia), Babinski negative, Lasegue negative, Neurological exam: Patient orientated in time, space and person, Glasgow 15/15 higher mental functions preserved, cranial pairs preserved. Motor exam: The patient remains in dorsal decubitus, it is not possible to value the progress, the sensibility of higher members preserved, the lower members abolished. Complementary exams: Thyroid profile, Prostatic and Lipidic : Normal Reactive Protein C: negative, Procalcitonin: 0.08, Hematic Biometry: Normal, Antibodies: Normal, Anticardiolipin: 3.9, Anticardiolipin 1GM: 1, Cardiolipin Beta2: 1.6, Antinuclear Antibodies: 0.04, Glucose: 97.70, Urea in serum: 62.4, Creatinine: 0.9, Na 139, K 4.2, Speed of erythrocyte sedimentation: 3, Latex: Negative, VDRL: Not reactive, Cytomegalovirus IGG: > 500.00, IGM: 0.252, Hepatitis C: 0.067, Herpes I-IGG: 44.42, Folic Acid 11.42, Albumin: 3.9 The patient enters to the service of neurology with the diagnostic of paraplegia in study; is not possible to establish a clear diagnostic based on the clinical history data. He stays in observation with therapy for the pain, complex B and physiotherapy. Complementary exams are taken with the purpose of establishing the etiology. After the corresponding exams, the results are within the normal parameters; during the hospitalization he presents favorable clinical evolution and progressive increase in the motor activity of the lower members, showing muscular strength of 3/5 and evident sensibility until S2 and S3. He can stay standing on foot and starts his ambulation; for that reason it is considered as a clinical picture of Transverse Myelitis and it is decided his exit from the hospital with the corresponding pursuit from the part of physiatrist. Until now he has reached a high progress in his motor activity, allowing him walking in short steps without help, but he continues receiving physiotherapy.