• A M A, 17 yrs old young man from Elgaa ,Northern Kordofan .admitted on 4 / 12 /2011 presenting with

- Lower & Upper 2 weeks

limbs weakness

- Change of voice 1 week

- Difficulty in swallowing

SOB 1 day

HPI

• Condition started 2 weeks PTA with lower limbs weakness started distally involving both limbs progress gradually within 2 weeks became unable to walk unsupported, one week following onset of illness in lower limbs , he developed upper limbs weakness that progress to the degree he couldn't lift a filled cup .

• Pt developed difficulty in swallowing more to liquids and also his voice was changed .

• No sphenteric disturbance .

• No double vision .

• No numbness or tingling sensation .

• Condition associated with neck & backache .

SYSTEMIC REVIEW

GIT

GUS

CVS no symptoms related to

MSS all these systems

PAST MEDICAL HISTORY

- PH of hospitalization 1 month ago because of upper respiratory infection .

- No PH of similar condition .

- Not known to be diabetic ,hypertensive or having any chronic illness .

SOCIAL HISTORY

• Single , basic study up to class 4 , then went to khalwa . .

• Live with family .

• Worked in farming. no health insurance .

• Not alcoholic , smoker or snuffer .

DRUG HISTORY

• Not known to be allergic to Penicillin or other drugs .

• Not on long term medication .

FAMILY HISTORY

• No F/H of DM ,HTN or BA .

• No F/H of similar condition .

SUMMARY

• 17 yrs man with a preceding URTI presented with ascending weakness and difficulty in swallowing and change in voice for 2 weeks prior to admission .

ONEXAMINATION

• Looks unwell, not pale , jaundiced or cyanosed , conscious and oriented to time , place and person .

• PR 88 b / m regular , normal volume , synchronous , no radiofemoral delay , peripheral pulses intact .

• BP 110 / 70 JVP not raised

• S1 ,S2 normal No added sounds or murmurs .

• CHEST

Normal vesicular breathing .

No added sounds .

• ABDOMEN

No area of tenderness

No palpable organs

MSS

No skin lesion or joints abnormality detected .

• CNS

Conscious ,oriented to time place & person ; intact memory , normal speech content with nasal tone

Cranial nerves

Bilateral 7th CN LMN weakness .

Bilateral 9 & 10 th CN weakness .

All other were normal

• No neck stiffness .

• Weakness in neck flexion .

• Back examination normal .

• Upper limb Rt Lt

Tone decreased decreased

Power shoulder G3 G3

hand G4 G4Reflex absent absent

Sensation intact intact

• Lower limb Rt Lt

Tone decreased decreased

Power hip&knee G3 G3

foot G4 G4Reflex absent absent

Sensation intact intact

Plantar response equivocal equivocal

Gait walking with support

CBC value

Hb 14.4 g/dl

T WBC 25700( NEUT 83) %

HCT 46

MCV 90 fl

MCH 28 pg

MCHC 32 g/dl

Platelet 242000

ESR 55

• Urinalysis

Protein +

Pus cells 3 - 5 RBC 0 - 1

BF for malaria -ve

RFT

B. urea 54 mg/dL

S. creatinine 0.8 mg/dL

S. Na 135 mmol/L S. k 3.9 mmol/L

Barium swallow

CT NASOPHARYNX

CT BRAIN

Nerve conduction study

• NCS revealed electrophysiological consistent with demyelination distal motor neuropathy .

• The associated clinical presentation intermingled with these finding might suggest AIDP .

ACUTE IMFAMATORY DEMYELINATING POLY

NEUROPATHY

( AIDP )

COURSE IN HOSPITAL

After hospital admission Pt developed fever which most probably due chest infection resulting from his bulbar weakness and barium aspirated during imaging .

Still in hospital , his condition is static no affection to respiratory muscles & no deterioration in power of other muscles groups .

Message to take home

• Drs’ ignorance to give their pts enough time while they are telling their diagnosis, still going on that pt pay its cost ,risk and complication .