CASE : 18 YR OLD MALE WITH WEAKNESS OF BOTH LOWER LIMBS.

Case : 18 yr old with weakness of both lower limbs as chief complaint. 

I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan. 

You can find the entire real patient clinical problem in this link here made by our interns

https://hitesh116.blogspot.com/2020/05/12may-2020-elog-medicine-intern.html?m=1

https://srianugna.blogspot.com/2020/05/hello-everyone.html

CHIEF COMPLAINTS :

 - Weakness of both lower limbs since 20       days. 

- History of difficulty in squatting position    and getting up from same position. 

- History of difficulty in wearing and              holding slippers. 

EXPLANATION :

- Weakness initially started in the proximal     and gradually progressed to distal               region of lower limbs. 

- On examination there is areflexia. 

- This is suggestive of LMN lesion. 

ANATOMICAL LESION :???? 

- Anterior horn cell

- Ganglion 

- Spinal nerve root

- Plexus

- Peripheral nerves

- Neuromuscular junction

- Muscle

The anatomical location is MUSCLE as it is completely symmetrical, affecting lower limb progressing from proximal to distal. No wasting present and there is increase in creatinine kinase levels. 

As the weakness is persistent, it is suggestive of MYOPATHY. 

Myopathies may be - Inherited or Acquired. 

INHERITED : 

  - DUCHENNE MUSCULAR DYSTROPHY. 

  - BECKERS MUSCULAR DYSTROPHY. 

ACQUIRED :

  - INFLAMMATORY MYOPATHY. 

  - DRUG INDUCED MYOPATHY. 

  - HYPOTHYROIDISM INDUCED                        MYOPATHY. 

The probable diagnosis of this patient is 

BECKERS MUSCULAR DYSTROPHY. 

It is X-linked recessive. 

Onset of disease is variable : 5 - 60 yrs. 

No mental retardation. 

No contractures.

TREATMENT :

 - Symptomatic treatment : steroids.

 - No cure.