The Man Who Became Paralyzed In Two Days

 

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:

  1. What is the differential diagnosis of acute (or subacute) paralysis? What is the diagnosis in this patient?

  2. 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?

  3. What would be the appropriate treatment? If that treatment were not available, what else could you do?

  4. What would the EMG show on the day after admission and 4 weeks later?
Last updated by Webmaster on August 18, 2009

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