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  #1  
Old 03-19-2012
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CT Scan Mr Pepito Brain CT Scan!

Mr. Pepito comes to see the doctor because of muscular weakness. He refers that his last Dr. was unable to diagnose his disease and that made him spend a lot of money in an useless CT (He shows you the CT). Physical evaluation reveals small, local involuntary muscle contractions and DTR 4/5. He is able to localize pain and the two point discrimination is unremarkable. According to the physical evaluation and the CT, what is the most likely diagnosis of Mr. Pepito?

1. Werding-Hoffman disease
2. Poliomyelitis
3. Spinal cord lesion
4. Lou Gehrig's disease
5. Rabies
6. Friedrich's ataxia
7. Brown-Sequard syndrome

Mr Pepito Brain CT Scan!-f1.large.jpg
Click image to enlarge
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Old 03-19-2012
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i'll risk to get completely demoralized (as my exam is in 7 days):

what a weird CT...i have never seen anyone like this but thinking about it brought me to this:

1.werding hoffman: infantile spinal muscleatrophy -> i think mr pepito is too old for that
3. - 7.wrong symptoms

so i'm left with 2. which makes sense (in my small sick world) when looking at the atrophy at the CT

any other ideas? (please be nice...i freaking out anyway)
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Old 03-19-2012
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Umm Poliomyelitis?
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Originally Posted by vna.rao22 View Post
Umm Poliomyelitis?
is that critisism or your guess? sry i'm so sensitive at the moment
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Old 03-19-2012
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I was just guessing.. we actually replied at the same moment.. so.. You did great with the explanation btw!
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I was just guessing.. we actually replied at the same moment.. so.. You did great with the explanation btw!
nice thing of you to say, thank you
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Old 03-19-2012
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Ok my best guess is amyotrophic lateral sclerosis also called lou gherig syndrome w/e the eponym is

Its mostly missed on diagnosis in the clinics and thats what triggered me to the ans.

Correct me if i am wrong
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Old 03-19-2012
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i always think LG's disease is MS *facepalm*
small localized muscle twitches sounds like ALS....but i saw a case once where the patient hat this late-polio-thing with localized twitches....hmmm....
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Quote:
Originally Posted by MedPharm View Post
i'll risk to get completely demoralized (as my exam is in 7 days):

what a weird CT...i have never seen anyone like this but thinking about it brought me to this
Then I'm glad I can help you... Actually is No. 4 ALS. Me too, I've never seen an image of ALS before so I went to look for one.

If you see, Mr. Pepito has hyperreflexia (UMN), fasciculations (LMN) and weakness (UMN and LMN). I have to say that the image is a MRI not CT (sorry).
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Quote:
Originally Posted by MedPharm View Post
i always think LG's disease is MS *facepalm*
small localized muscle twitches sounds like ALS....but i saw a case once where the patient hat this late-polio-thing with localized twitches....hmmm....
Boards are very straight forward they wont ask u a complicated late phase polio case in a step 1
When the same can be asked by a simple ALS question stem
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Originally Posted by bunny View Post
Its mostly missed on diagnosis in the clinics and thats what triggered me to the ans.

Correct me if i am wrong
That was not on purpose, but is true... Actually, I just wanted to add some drama to the Q and give it some special effects.
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Originally Posted by Dr. Mexito View Post
Then I'm glad I can help you... Actually is No. 4 ALS. Me too, I've never seen an image of ALS before so I went to look for one.

If you see, Mr. Pepito has hyperreflexia (UMN), fasciculations (LMN) and weakness (UMN and LMN). I have to say that the image is a MRI not CT (sorry).
thx for the picture knowing the picture makes is a more-than-obvious-q
i have to 'get rid of' my clinical exp....it always makes me think: it could be the zebra not the horse....
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I would go with ALS.

i'm not sure about the answer but here's the path which has lead me to als.

the patient has fasciculations and weakness, what suggests LMN lesion.
Patient is able to localize pain and the two point discrimination is unremarkable so no sensory deficit.

I think that these symptoms are the very early ones in ALS. if he stays undiagnosed we can expect UMN lesions to confirm lou gherig
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I would go with ALS.

i'm not sure about the answer but here's the path which has lead me to als.

the patient has fasciculations and weakness, what suggests LMN lesion.
Patient is able to localize pain and the two point discrimination is unremarkable so no sensory deficit.

I think that these symptoms are the very early ones in ALS. if he stays undiagnosed we can expect UMN lesions to confirm lou gherig

I was typing this about 5 minutes meanwhile the answer was given
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Quote:
Originally Posted by beka-CTS View Post

I was typing this about 5 minutes meanwhile the answer was given
same happened with me
when i opened the post it was empty and after i submitted 4 posts were already there above mine
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  #16  
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same happened with me
when i opened the post it was empty and after i submitted 4 posts were already there above mine

Did I gave away the answer to fast?
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Quote:
Originally Posted by bunny View Post
same happened with me
when i opened the post it was empty and after i submitted 4 posts were already there above mine

funny situation
i knew the correct answer just after 00.00 second after i posted my opinion
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Originally Posted by Dr. Mexito View Post
Did I gave away the answer to fast?

question is posted about an hour.
i think i have to be faster in cases like this. i was trying to make my opinion understandable and thought about 5-6 minutes about how to write it
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Originally Posted by beka-CTS View Post
question is posted about an hour.
i think i have to be faster in cases like this. i was trying to make my opinion understandable and thought about 5-6 minutes about how to write it

Okay, sorry sorry... I just get too excited and is hard for me to wait for a long time. I get anxious when I see the correct answer popping up.... I just can't control myself
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Originally Posted by Dr. Mexito View Post
Okay, sorry sorry... I just get too excited and is hard for me to wait for a long time. I get anxious when I see the correct answer popping up.... I just can't control myself

Same situation with me

Btw great question. where did you get it?
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  #21  
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Same situation with me

Btw great question. where did you get it?
Thank you. Actually I made it up... I was reading UW and I found a Q regarding ALS. UW mentioned precentral gyrus atrophy and I was like a ... so then I googled precentral gyrus atrophy and when I found a CT with precentral gyrus I went like ... So I though to share my and with you guys.
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Default precentral gyrus

Quote:
Originally Posted by Dr. Mexito View Post
Thank you. Actually I made it up... I was reading UW and I found a Q regarding ALS. UW mentioned precentral gyrus atrophy and I was like a ... so then I googled precentral gyrus atrophy and when I found a CT with precentral gyrus I went like ... So I though to share my and with you guys.
precentralgyrus atrophy would produce UMNL due to lesoin in the motor homoculus wich doesn't go along with the contractions in localized group of muscles seen with LMNL
regarding ALS ;
there will be both flacid paralysis of the group of muscles supplied by the ventral horn of the segment below that there will be spastic pralysis due to lateral horn (corticospinal lesion) >>>> so about your questions u said that there is localized contracion in localized group of muscles wich consides with LMNL but other part isn't included in order to say it's ALS .......
what u think guys ?

Last edited by mohammedT; 03-19-2012 at 06:37 PM.
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Default dear mixito

About the deep tendon reflex if it's in a level below the level of the muscles with fasciculation which is (exaggerated) that would be ALS but the question should include the levels I think
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Quote:
Originally Posted by Dr. Mexito View Post
Thank you. Actually I made it up... I was reading UW and I found a Q regarding ALS. UW mentioned precentral gyrus atrophy and I was like a ... so then I googled precentral gyrus atrophy and when I found a CT with precentral gyrus I went like ... So I though to share my and with you guys.

........... it didnt know about precentral gyrus atrophy , neither have written about it in my notes , thanks alot buddy .........

I got its ALS but forgot what even happens in . Werding-Hoffman disease ...........

May be you should join the usmle guys and make a few Qs ... and tell us in advance about them so that we can score 99's
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