She has progressive unilateral (UL&LL) + jaw tremor, generalized weakness and weight loss for 6 months.
She has no headache, no visual changes, no urinary/stool incontinence, no symptoms of thyrotoxicosis
O/E: She looks well,
She has muscle wasting (temporal & limbs )
Jaw tremor with abnormal voice, action tremor of both right UL & LL.
Muscle power 2/5 of both right UL & LL.
Reflexes can`t be evaluated due to the effect of tremor.
Chest, CVS &Abdomen all are normal.
What is your approach to this patient? DDx? Investigations?
Good day, Osaid
It may be hemiatrophy hemiparkinsonism syndrome
http://www.ncbi.nlm.nih.gov/pubmed/23986429
http://www.ncbi.nlm.nih.gov/pubmed/20399008
I think diagnostic of it you may read in any neurology manual
Hello,
very interesting, it could be hemiatrophy hemiparkinsonism syndrome, but it is very rare syndrome. Additionally, if I understand it right, she has generalized muscle wasting. First should one think what level of CNS is affected (central? - brain, medulla, periphery?, muscle?) or maybe mixed. I think also that if tremor is action tremor it could be possible to check reflexes and pyramidal signs. What about cerebellar functions? Sensory system?
Do you have some laboratory rapport? (i.e CK?). Medication? Nevertheless I think she need brain imaging.
Let us know more details :)
Hello,
I think similiar to Luiza Jadwiga. The problem is probably in the CNS, some kind of ataxia? You need a MRI to asses her brain.
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