39 years old female with myelopathy

November 09, 2022

39 years old female with myelopathy

E-LOGS MEDICINE

Hi, I am Arefin Sadat, a final year MBBS student. This is an E-Log that depicts the patient-centered approach to learning medicine. This E-Log has been created after taking consent from the patient and their relatives. The links that were used by me for understanding the available data on the particular disease have been mentioned below in each post. I hope you learn valuable information after giving it a good read!

November 7, 2022

CASE OF A 39-YEAR-OLD FEMALE

This is a case of a 39-year-old female. She is a housewife and a mother of a twelve-year-old girl and a four-year-old boy. This de-identified blog was created after taking informed consent from the patient.

CHIEF COMPLAINTS

She has been suffering from boils on her left knee for almost 6 days
She cannot hold the toilet(both defecation & micturition) for nearly 20 years, but it got severe since 2015
She can not walk properly without support for nearly 30 years

History of Presenting Illness

The patient was reasonably well until the age of 8 years.

Though at the age of 9 months, she fell from the 2nd floor but was not injured at all. She was admitted to a hospital for 1 day, and then she was completely fine. After that, at the age of 8 years, she sprained her ankle while playing football. After a few days, the swelling in her leg went down but following this incident; she couldn’t walk properly without any support. Day by day, this got aggravated, and she used to fall while walking.

In the beginning, they took ayurvedic treatment for almost 1 year, but as the patient's condition didn’t improve, they went to Cooch Behar at the age of 9 years for treatment purposes. Unfortunately, she was mistreated due to the wrong diagnosis. The doctor treated her as a vit-D deficiency patient, which was later correctly diagnosed in Bhopal in 2004 as a neuropathic problem.

When the patient was 12 years old(1994), they went to Kolkata and did MRI, where she was told that there were no significant findings, though she was still suffering from her inability to walk properly.

At the age of 15(1995), her problem suddenly went away. She was pretty well for a long time & didn’t show any abnormal movement while walking. But after giving birth to her first child(2010), a cesarean section, she again started feeling weakness in her lower limb.

Later in 2012, they went to Bhopal, where they again did MRI, but this time she was diagnosed with a neuropathic problem. In Dec 2021, they went to Bengaluru, where they again did MRI & found the same findings as in Bhopal. There she was given medicine for 3 months course, and after taking that, she felt comparatively better, although all the problems still exist.

At present, she is gradually losing strength in both feet & can't stand up after sitting for a while or can't walk properly without any support. There is also severe body ache in the neck, back, and feet. She gave birth to her second baby in 2018, and following that pregnancy, the weakness in the lower limb was aggravated much more. The pain increases with work and walking.

She says that her second baby, who is now four years old, seldom speaks of 1/2 words or doesn’t talk at all with anybody.

She also complains that she cannot hold her defecation and micturition for almost 20 years, but it got severe since 2015. When her rectum or bladder becomes full, she loses control over it, and she can't hold it any longer. According to my patient's guardian, she has been suffering from this inability to hold the toilet since she sprained her leg, but this has become severe for the last 5/7 years.

She also added that for the last six days, she has been suffering from boils on her left knee. It is painful, itching in nature, and a slight discharge comes out of the spot. The site became swollen gradually and reddish. This aggravated her walking movements more severely. She also suffered from a fever(101F) 2 days back, which was subsided by medication.

This is not a known case of DM, TB, HTN, or Epilepsy.

Patient's Diet

-Breakfast: 9:30 am with tea, biscuits, puffed rice

-Lunch: 1.00 pm with rice, vegetables, meat/fish

-Dinner: 11.00 pm with roti/rice, vegetable, meat/fish

Family History:

Her father had a stroke in 2006 along with a little extent of paralysis and died in 2009, and her mother is hypertensive for almost 4 years.

Personal History :

Diet - Mixed. (non-vegetarian)

Appetite - Normal

Bowel- Normal and once a day

Bladder movements - Normal