neglect

1K Member
15+ Year Member
Sep 2, 2003
8,938
3,802
CT
Status (Visible)
Two years ago this 75 year old man experienced a poorly defined illness that left him using a cane. His doctor told he had the flu, but the cane never left, despite him getting better. Within two years he was nearly normal, walking with a cane for safety.

He got a pneumonia, clearly seen on chest XR, and was sent to the ICU because of worsening airway. Intubated. Fails to wean within the day. When I was initially consulted I was ho hum, another critical care case of neuropathy/myopathy, and he's got no reflexes, 4/5 all, MS nl.

All nerves studied are low amplitude with greater than 20% slowing in forearm segments of the median and ulnar motor. SNAPs are slowed into the 30s. No sural, low amplitude on LE motors. EMG shows huge MUs, all chronic reorganization and no spont. activity.

How would you put this case together? Then I'll tell you how I did.
 

neglect

1K Member
15+ Year Member
Sep 2, 2003
8,938
3,802
CT
Status (Visible)
OK. So I think this guy had GBS two years ago, has persistent slowing since then, and then got a pneumonia, got clinically worse. This was not critical care neuropathy/myopathy.
 

PMR 4 MSK

Large Member
10+ Year Member
5+ Year Member
Oct 2, 2007
4,182
30
Status (Visible)
  1. Attending Physician
Sorry no one replied. I wonder if we were all a little too chicken to speak up. I think you are absolutely correct. Good case!
 
About the Ads
This thread is more than 13 years old.

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.