Case problem

[srabiei]

A young lady with chief complaint of: Dysphonia and sever weight loss

Her problem had Started with sever hearing loss and vertigo and then severe weakness and gait problem (Negative M.gravis)

PTA (pure tone audiometry): Low frequency Sensory Neural Hearing loss as in Meniere's syndrome

In Indirect laryngoscopy: Bowing of True Vocal cord

Additional Findings:
Weak Cough
Frontalis muscle palsy
Severe Weakness

Help me for correct diagnosis and treatment

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[resxn]

A young lady with chief complaint of: Dysphonia and sever weight loss

Her problem had Started with sever hearing loss and vertigo and then severe weakness and gait problem (Negative M.gravis)

PTA (pure tone audiometry): Low frequency Sensory Neural Hearing loss as in Meniere's syndrome

In Indirect laryngoscopy: Bowing of True Vocal cord

Additional Findings:
Weak Cough
Frontalis muscle palsy
Severe Weakness

Help me for correct diagnosis and treatment

So you've got at least CN VII, CNVIII, CN X affected. Any imaging?

Also please provide age, PMHx of comorbid disease (autoimmune dz?), and any labs, etc

 

[Fah-Q]

Obviously a central neurological issue.

My list so far: bulbar palsy, MS, ALS, Guillian-Barre, brainstem mass

Get MRI and refer to neuro quick.

 

[dortianr]

I agree with resxn,CN VII, CNVIII, CN X were affected.
Maybe some deseases (pramary or secondary) affected cranial nerves or the brain,therefore,CT or MRI is needed to chek whether there is space occupying lesion in cavity of skull or bones of skull.

 

[srabiei]

Thank you for your kindness

Myasthenia gravis (MG) negative

MS negative

Brain mass negative (by MRI and CT)

AML Amyotrophic Lateral Sclerosis: Individuals with ALS lose their strength and the ability to move their arms, legs, and body. When muscles in the diaphragm and chest wall fail, individuals lose the ability to breathe without ventilatory support. The disease does not affect a person's ability to see, smell, taste, hear, or recognize touch, and it does not usually impair a person’s thinking or other cognitive abilities.

The pt had progressive weakness but now she can walk and not any progression of diseases

I think the patient had: AML with Meniere's disease

We are in challenging with Neurologist, I will inform you again.

Thanks for your reply