An Acute Evolving Flaccid Quadriparesis in an Elderly Woman 英文参考文献.docVIP

Learning Forum An Acute Evolving Flaccid Quadriparesis in an Elderly Woman Rebecca Lim, Sivakumar Sathasivam, Andrew J. Larner * D E S C R I P T I O N o f C A S E Box 1: Differential Diagnosis of Acute Evolving Flaccid Quadriparesis A stand or walk. She was previously healthy, accustomed 72-year-old woman was admitted with progressive lower limb weakness, such that she was unable to Myelopathies: sè #OMPRESSIVEèMYELOPATHY sè 4RANSVERSEèMYELITISèBRAINSTEMèENCEPHALITIS sè .ECROTISINGèMYELOPATHY to play tennis twice a week. Five days prior to admission she had developed low back pain radiating to the legs without a history of trauma. The pain was followed by numbness in the legs, beginning distally and then ascending over two or three days. The patient also experienced weakness that became progressively worse, initially making it difficult to climb stairs and then to walk and stand. Although she had no difficulty passing urine, she did complain of impaired sensation of bladder filling. She had noted some difficulty picking up objects with her hands but had no complaint of upper limb numbness or weakness at the time of admission. sè )NFECTIONèPOLIOMYELITISèENTEROVIRUSèFLAVIVIRUSES Neuropathies: see Box 2 Neuromuscular junction transmission disorder: sè -YASTHENIAèGRAVIS sè ,AMBERT %ATONèMYASTHENICèSYNDROME sè OTULISM sè 6ENOMèSNAKEèSEAèURCHIN Myopathies: Eighteen months earlier she had been diagnosed with diabetes mellitus, which was controlled with diet and an oral hypoglycaemic agent. There was a long-standing history of hypertension controlled with valsartan and felodipine. There was no recent history of travel overseas. No similar clinical problems were known in close family or friends. sè !CUTEèINFLAMMATORYèMYOPATHIES Others: sè #ONVERSIONèDISORDERFACTITIOUSèDISORDER sè RAINSTEMèINFARCTIONèLOCKED INèSYNDROME General medical examination at the time of admission was unremarkable, aside from a palpable bladder, and she was apyrexial. Examination of the n