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Clinico pathologicoradiological meeting

Clinico pathologicoradiological meeting. 2-2-2012. BIODATA. Name-F O A Age -50 Male Admission date-7-1-2012. A known RVD on HAART On the continuation phase of antikochs Presented with hx of neck pains 6/12 Shoulder pains4/12 Bilateral lower limb weakness Upper limb weakness.

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Clinico pathologicoradiological meeting

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  1. Clinico pathologicoradiological meeting 2-2-2012

  2. BIODATA Name-F O A Age -50 Male Admission date-7-1-2012

  3. A known RVD on HAART • On the continuation phase of antikochs Presented with hx of • neck pains 6/12 • Shoulder pains4/12 • Bilateral lower limb weakness • Upper limb weakness

  4. Neck pain - dull continuous ache worse at night • Fever ,night sweats • weakness –progressive in nature from the foot cranially • 1/12 ago • Unable to move the lower limbs completely • Stool and urine incontinent

  5. Medical assistance at a private facility • Cervical spine x ray-C6-c7 collapse • Cxr-pleural effusion Started on atikochs12/10/2011 • Nerve conduction studies- central weakness With no evidence of GBS • MRI-C6,C7 destruction • CT scan brain - normal • Referred to KNH

  6. PMHX • Admitted before?when • Muscle tear-rt leg • No BT • No known allergies

  7. fshx • Married • 2 children • A meter connector with NWC • Smoked 1984-1987 • Occasssionally –alcohol • No hx of chronic illnesses

  8. Systemic enquiry • Rest of the systems -Non revealing

  9. o/e • Sick looking on a stretcher and on a hard cervical collar • No pallor • Nojaundice • No ln

  10. mss • Cervical examination 1.Inspection on a collar No obvious scars,blisters discoloration or skin lessions 2.Bony and soft tissue palpation -There was no regional lymph node enlargement -Thyroid was essentially normal -motion palpation-not performed was on a collar then

  11. mss • activeRotatory cervical compression test • Shoulder depression • Cervical hyperextension compression test All elicited tenderness Cervical percussion,auscultation Not done -collar

  12. Mss

  13. Sensory level-L4 • Anal wink-not clear • Anal tone- reduced • bulbocavenous reflex-non reactive

  14. CNS • GCS15/15 • PBERL • Cranial nerves-ok

  15. r/s • Vesicular breath sounds • No rhonchi • No crepitation

  16. Breast exam • Essentially normal

  17. P/A • Essentially normal • DRE – Anal tone- reduced prostate not enlarged Median sulcus felt Smooth Not adherent to the rectum

  18. Impression • C6,c7 collapse with cord compression In a pt who is on mx for potts disease and rvd Ddx-metastatic lession to the cervical spine - granulomatous spine lession - com -primary malignancy-?chordoma

  19. investigation • Hgm+esr • U/e/cs • Lfts • Biopsy- C6,C7 corpectomy -strut bone graft -anterior cervical plating

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