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Dear Colleges
I have admitted 12years old child with fever(t=3D39oC),severe muscule =
pain all over the body but predominantelly in the neck,shoulders and =
popliteal fossa.Also anuria 1 day duration and generalised weakness.
In past history no other illness.Completelly vaccinated.
On admission,conscious,alert,weak,febrile,limitted moevements of the =
limbs due to the pain.Auscultatory findingson the lungs and the heart =
normal.Abdomen,soft but deffusely painful.Liver and splen not palpabile.
Neck rigidity present,no other meningeal signs,deep reflexes couldn't be =
ellected.No sensory loss demonstrable.Plantar reflex normal.Babinky =
negative.No cranial nerve involvement.
Second day the child became somnolent,still complaining of pain,sensory =
loss on lower limbs (superficial and deep),movemenents limited only on =
some fine movements of the fingers.
Third day the general conditiones worsing,somnolent =
febrile,paraplegia,still retention of urine and stool(anal sphincter =
open),upper limbs paretic but no sensory loss.These conditions remained =
same 5 days.6-th day general coditionimproving,afebrile,movements of the =
arms,but limited by still persisting shoulders and back pain,after =
desplacing of the urinary catheter,stared spontaneous =
urinating,spontaneous defecation.Today is 12-th day from the bigining of =
the illness,and still persistent pain in the back,legs shoulders and =
hips.The right leg movements are posible but limited with the pain of =
the hips.The left leg is still paralised.
Lab.anal:Hb-7.5mmol/l;L-11.2x109/l(basofil 1,metamyeolocites =
1,nonsegmented 21,segmented 17,lymphocit 57,mono 3%)SE 28mm,urine =
sediment no abnormalities,bl.sugar 5mmol/l,ureum =
3,7mmol/l,alkalphosphatasa 114U/l,total protein 80g/l albumen 45g/l,GOT =
28U/l,GPT 10U/l,LDH 459U/l,creatinin 64mmol/l,CPK =
375U/l(ref.<70),Diastasa 16U/l,blood gases normal.
CSF:cells 135x10*6/l(polimorphon 27%,monocites 73%)
CSF culture-no growth.
CT-SCAN didn't show any abnormalities
EEG slow vawes
Serological test for Dengue-waiting for the result
Stool for Poliomyelitis-waiting for result
Working Dg.Encephalomyeliti
D.Dg.Polyomyelitis,Polyomyositis,Guillain-Barre Syndrome
 
Please for someoneelse opinion(Dg.? treatement? Corticosteroids)
As these is Thrd World Country,no other investigation are available.
Thanks  Dr.Gordana Ruscuklic
 
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<DIV><FONT color=3D#000000 size=3D2>Dear Colleges</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>I have admitted 12years old child =
with=20
fever(t=3D39oC),severe muscule pain all over the body but =
predominantelly in the=20
neck,shoulders and popliteal fossa.Also anuria 1 day duration and =
generalised=20
weakness.</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>In past history no other =
illness.Completelly=20
vaccinated.</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>On=20
admission,conscious,alert,weak,febrile,limitted moevements of the limbs =
due to=20
the pain.Auscultatory findingson the lungs and the heart =
normal.Abdomen,soft but=20
deffusely painful.Liver and splen not palpabile.</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>Neck rigidity present,no other =
meningeal=20
signs,deep reflexes couldn't be ellected.No sensory loss =
demonstrable.Plantar=20
reflex normal.Babinky negative.No cranial nerve =
involvement.</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>Second day the child became =
somnolent,still=20
complaining of pain,sensory loss on lower limbs (superficial and=20
deep),movemenents limited only on some fine movements of the=20
fingers.</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>Third day the general conditiones=20
worsing,somnolent febrile,paraplegia,still retention of urine and =
stool(anal=20
sphincter open),upper limbs paretic but no sensory loss.These conditions =
 
remained same 5 days.6-th day general =
coditionimproving,afebrile,movements of=20
the arms,but limited by still persisting shoulders and back pain,after=20
desplacing of the urinary catheter,stared spontaneous =
urinating,spontaneous=20
defecation.Today is 12-th day from the bigining of the illness,and still =
 
persistent pain in the back,legs shoulders and hips.The right leg =
movements are=20
posible but limited with the pain of the hips.The left leg is still=20
paralised.</FONT></DIV>
<DIV><FONT color=3D#000000 =
size=3D2>Lab.anal:Hb-7.5mmol/l;L-11.2x109/l(basofil=20
1,metamyeolocites 1,nonsegmented 21,segmented 17,lymphocit 57,mono 3%)SE =
 
28mm,urine sediment no abnormalities,bl.sugar 5mmol/l,ureum=20
3,7mmol/l,alkalphosphatasa 114U/l,total protein 80g/l albumen 45g/l,GOT=20
28U/l,GPT 10U/l,LDH 459U/l,creatinin 64mmol/l,CPK =
375U/l(ref.&lt;70),Diastasa=20
16U/l,blood gases normal.</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>CSF:cells 135x10*6/l(polimorphon =
27%,monocites=20
73%)</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>CSF culture-no growth.</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>CT-SCAN didn't show any=20
abnormalities</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>EEG slow vawes</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>Serological test for Dengue-waiting =
for the=20
result</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>Stool for Poliomyelitis-waiting for=20
result</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>Working =
Dg.Encephalomyeliti</FONT></DIV>
<DIV><FONT color=3D#000000 =
size=3D2>D.Dg.Polyomyelitis,Polyomyositis,Guillain-Barre=20
Syndrome</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT color=3D#000000 size=3D2>Please for someoneelse opinion(Dg.? =
treatement?=20
Corticosteroids)</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>As these is Thrd World Country,no =
other=20
investigation are available.</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>Thanks&nbsp; Dr.Gordana=20
Ruscuklic</FONT></DIV></BODY></HTML>
 
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