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What's the diagnosis?

2K views 9 replies 8 participants last post by  Doctor Ali 
#1 ·
32 year old woman has 5 month history of progressive weakness in her hands and arms. Physical exam reveals decreased ability to distinguish sharp from dull stimuli in both arms. Vibration sensation is normal. Fasciculations can be seen in the upper arms. Sensory and motor examination of the legs are unremarkable. Which of the following is the likely cause of her findings?

A. ALS
B. Acute inflammatory demylinating polyradiculoneuropathy
C. Lambert Eaton myasthenic syndrome
D. Syringomyelia
E. None above
F. B & C
 
#9 ·
32 year old woman has 5 month history of progressive weakness in her hands and arms. Physical exam reveals decreased ability to distinguish sharp from dull stimuli in both arms. Vibration sensation is normal. Fasciculations can be seen in the upper arms. Sensory and motor examination of the legs are unremarkable. Which of the following is the likely cause of her findings?

A. ALS
B. Acute inflammatory demylinating polyradiculoneuropathy
C. Lambert Eaton myasthenic syndrome
D. Syringomyelia
E. None above
F. B & C
syringomyelia..If ALS i would expect some motor involvement in lower limbs.. Dorsal column intact makes it more likely...
 
#10 ·
Correct answer is D

Syringmyelia - cyst/cavitation of central canal of the spinal cord forms. It's more common at the cervical level. It associated with congenital Chiari type 1 malfunction in which the inferior cerebellum becomes displaced downward. Cyst begins centrally and the axons of anterior white commissure of spinal cord is destroyed; resulting in segmental loss of pain and temperature. If the cavitation extends anterolaterally, it may destroy lower motor neurons - causing weakness and fasciculations.
 
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