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What Does My Lab Test Report Indicate?
Question: Please find below the letter received from hospital. Is there really nothing we can do I would like your opinion please as I feel my Dad has been written off;
Diagnosis: likely diabetic motor sensory neuropathy
Thank you for referring this 68 year old right handed gentleman to the Neurology clinic. He has had diabetes since 2000. His control was previosuly poor though has improved in the last 9 months. Mr Bridge has a previous history of osteomyelitis for which he was treated long term antibiotics. He now describes a 3 month history of progressive weakness of both legs. Although he can stand he feels unsteady and his legs quite often give way. He also described numbness in the legs. His arms bowel bladder speech and swallowing is unaffected.
On examination today his cranial nerves were unremarkable. Examination of limbs revealed normal tone. Power was normal in both arms and legs. Hip flexion was reduced to 3/5 bilaterally. Reflexes were absent in the legs but present in the arms. Sensation to pinprick was reduced distally in the legs but was present in the arms. Vibration sense was absent up to the hips. There were no fasiculations visible.
I suspect this gentleman has quite a severe axonal motor sensory neuropathy secondary to his diabetes. I have explained that this is not a treatable condition but we need to do some further investigations to exclude any more treatable causes. I am areanging MRI scan of lumbar spine to make sure there is no cord pathology or nerve root compression and some nerve conduction studies to quantify the extent of his nerve damage. I will write with the results once they are available.
Please help me there must be something I can do to help my dad I am really upset
Dad has lost all mobility in 3 months
Diagnosis: likely diabetic motor sensory neuropathy
Thank you for referring this 68 year old right handed gentleman to the Neurology clinic. He has had diabetes since 2000. His control was previosuly poor though has improved in the last 9 months. Mr Bridge has a previous history of osteomyelitis for which he was treated long term antibiotics. He now describes a 3 month history of progressive weakness of both legs. Although he can stand he feels unsteady and his legs quite often give way. He also described numbness in the legs. His arms bowel bladder speech and swallowing is unaffected.
On examination today his cranial nerves were unremarkable. Examination of limbs revealed normal tone. Power was normal in both arms and legs. Hip flexion was reduced to 3/5 bilaterally. Reflexes were absent in the legs but present in the arms. Sensation to pinprick was reduced distally in the legs but was present in the arms. Vibration sense was absent up to the hips. There were no fasiculations visible.
I suspect this gentleman has quite a severe axonal motor sensory neuropathy secondary to his diabetes. I have explained that this is not a treatable condition but we need to do some further investigations to exclude any more treatable causes. I am areanging MRI scan of lumbar spine to make sure there is no cord pathology or nerve root compression and some nerve conduction studies to quantify the extent of his nerve damage. I will write with the results once they are available.
Please help me there must be something I can do to help my dad I am really upset
Dad has lost all mobility in 3 months
Brief Answer:
Clinical evaluation & Investigation
Detailed Answer:
Dear
Thanks for contacting with your health concern and after reviewing the letter received from hospital:
1. Acute motor and sensory axonal neuropathy [AMSAN]: which is recently described as subtype of GBS [guilliane barre syndrome] should be excluded which is characterized by distal weakness, loss of deep tendon reflexes and sensory symptoms [present in history].
2. recently one case has been published where a serious case of AMSAN was due to acute hepatitis A infection [thus one should go for immunoglobulin M antibodies against hepatitis A in blood and cerebrospinal fluid]
3. the best you can do for the improvement is: treatment with intravenous immunoglobulins, high-dose methylprednisolone, and a combination of gabapentin, antidepressants, and an oral morphine under strict medical supervision.
Dr. Munish
Naimittika
Clinical evaluation & Investigation
Detailed Answer:
Dear
Thanks for contacting with your health concern and after reviewing the letter received from hospital:
1. Acute motor and sensory axonal neuropathy [AMSAN]: which is recently described as subtype of GBS [guilliane barre syndrome] should be excluded which is characterized by distal weakness, loss of deep tendon reflexes and sensory symptoms [present in history].
2. recently one case has been published where a serious case of AMSAN was due to acute hepatitis A infection [thus one should go for immunoglobulin M antibodies against hepatitis A in blood and cerebrospinal fluid]
3. the best you can do for the improvement is: treatment with intravenous immunoglobulins, high-dose methylprednisolone, and a combination of gabapentin, antidepressants, and an oral morphine under strict medical supervision.
Dr. Munish
Naimittika
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
So you do think we can improve things after all tests
Brief Answer:
long term prognosis and recovery pattern in AMSAN
Detailed Answer:
Dear
Thanks for reverting back
1. In AMSAN the antibodies attack the motor neurons without causing loss of myelin and does not affect sensation despite loss of movement. [present in history] thus one should go for EMG [Electromyography] studies.
PS. Pathological studies have established it to be a non inflammatory axonopathy without demyelination where antibodies attack the coating of the motor neurons without causing inflammation or loss of myelin. It does not affect sensory neurons, so sensation remains intact despite loss of movement.
2. In the paper published in: Neurol Neurosurg Psychiatry 2005;76:719-722 doi:10.1136/jnnp.2004.051136
Paper
Recovery patterns and long term prognosis for axonal Guillain–Barré syndrome:
RESULTS: Most of the affected patients WITH AMSAN had received plasmapheresis or immunoglobulin therapy and almost all the severe AMSAN patients who had slow recoveries over the first six months could eventually walk independently, although some required several years.
Dr. Munish
Naimittika
long term prognosis and recovery pattern in AMSAN
Detailed Answer:
Dear
Thanks for reverting back
1. In AMSAN the antibodies attack the motor neurons without causing loss of myelin and does not affect sensation despite loss of movement. [present in history] thus one should go for EMG [Electromyography] studies.
PS. Pathological studies have established it to be a non inflammatory axonopathy without demyelination where antibodies attack the coating of the motor neurons without causing inflammation or loss of myelin. It does not affect sensory neurons, so sensation remains intact despite loss of movement.
2. In the paper published in: Neurol Neurosurg Psychiatry 2005;76:719-722 doi:10.1136/jnnp.2004.051136
Paper
Recovery patterns and long term prognosis for axonal Guillain–Barré syndrome:
RESULTS: Most of the affected patients WITH AMSAN had received plasmapheresis or immunoglobulin therapy and almost all the severe AMSAN patients who had slow recoveries over the first six months could eventually walk independently, although some required several years.
Dr. Munish
Naimittika
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Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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