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Paraparesis case 1

Hello I am G RITEESH ROLL NO 56  final year mbbs student 
I was given this case of paraparesis
The entire details of the case are given in link below. Please go through the link before reading  how I came to the diagnosis 


The points to be understood before going in to the diagnosis are:
1. His age 18 years
2.sex male
3.complaints. That is bilateral lower limb weakness
4.other complaints like Edema non pitting type
5.difficulty in squatting and getting back to his standing position 
6. Difficulty in wearing chappals 
7.abnormals findings in investigations are:
                      CUE .albumins  positive  
                                                Pus cells 3to4 cells
                       RFT:elevated urea, creatinine, Uris acid, phosphorus, Chloride
                       HEMOGRAM: normocytic and  normochromic with lecucocytosis
                        MUSCLE BIOPSY:few chronic inflammatory cells between muscle fibres and evidence of atrophy and necrosis

8. On CNS examination there is absent reflexes in both lower limbs

   
With the above positive data we will now find a diagnosis
Bilateral weakness is either due to nerve involvement or muscle or both neuromuscular involvement 
In the given data his CNS function is good , and ELECTERMYOGRAPHY is show no involvement of neuromuscular junction.where as his muscle biopsy shows chronic inflammatory cells in muscle fibres and there is evidence of atrophy and necrosis which now changed our direction to muscle involvement that is myopathy
With other investigations there is evidence of kidney involvement.  So when a muscle damage occurs it releases myoglobin which enters blood circulation causing Damage to heart and kidney hence we observed there is RFT changes 
With considering his age and sex it could be a genetic cause of muscular dystrophy 

 If we think of duchenne muscular dystrophy the patient will have symptoms in early age that is 5 years but where as in Becker’s muscular dystrophy symptoms could be seen from his age 10 to 20.

To know the difference between duchenne muscular dystrophy and Becker’s muscular dystrophy use this link 


TREATMENT:

There is no cure yet for MD. There are some treatments that can improve symptoms and quality of life. One of the targets for recent new therapies has been to improve muscle strength. For several years prednisone has been used for this purpose. Prednisone is a medication that decreases inflammation in the body. Prednisone has serious and common side effects, however, including weight gain, cataracts, diabetes, high blood pressure, and osteoporosis (weakening of the bones). These side effects limit the use of prednisone to treat MD

 NEWER TREATMENTS under research and trials are given in the link


Reference. Marrow videos, you tube Videos ,and my own interpretation 

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