Weakness (Full Version)

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MPT -> Weakness (September 25, 2007 9:31:07 PM)

I have recently seen two men with similar symptoms. Mid 40s to early 50s, male with general lower and upper extremity weakness (lower more prominent than upper). Slowly progressive over the last several years with no other symptoms.  One came in for treatment of the weakness and the other came in for knee pain.  Neither could get out of a chair without significant use of their UEs (no pain, just weakness).  The patient who orignally came in for knee pain had his doctor tell him it was normal weakness and maybe it was because he was alittle over wieght.  I talked with him about it and told him about the 90 year old who weighted more than him and she could do 4 sit to stands.  So long story short, I was wondering what the differential diagnosis is? I can come up with a few but I wanted to see what others could come up with. Also what tests would you want?

One of the patients had been worked up pretty thoroughly and all was negative (blood work, head MRI, EMG--i think). I talked to him about a muscle biopsy and he said they were planning on doing that next.



Thanks 



bonez -> RE: Weakness (September 26, 2007 1:18:58 AM)

Well from a differential dx point of view start by sub dividing the obvious myo vs neuro. Neuro you then need to further divide central vs local. They are a little old for the musculodysthropy thing to just appear. So myo would be likely something more metabolic and muscle biopsy is one of the calls. Could the be on anything that could contribute?
Neuro you could look some things you could break apart your self. How was their balance, did they have good vibration sense? Just wondering what you found that might point to say early stenosis/myleopathy. Were they intact wrt. dtr's and long tract signs. There are several simple in clinic tests that can point to more central causes. The following list is by no means inclusive. Vibration sense in upper and lower limbs, rhombergs tests two point discrimination ,temperature, balance, response to physical demand ie do leg symptoms get worse after walking distances. just a few thoughts.



MPT -> RE: Weakness (September 26, 2007 7:35:41 AM)

General neuro exam was normal.  Decreased balance (unable to single leg stance), some increased fatigue in legs after long walks but nothing major. I did not test vibration sense but temp sense seemed normal with gross testing (could feel hot and cold). I could find no signs of chord compression and did not do a rhombergs.


Thanks   



Dr.Wagner -> RE: Weakness (September 26, 2007 10:12:55 AM)

Trying not to be a "debbie downer", but psychiatric vs volitional abnormalities cross my mind.  As, I would guess, have crossed yours. 



Shill -> RE: Weakness (September 27, 2007 9:34:33 AM)

Are these gentlemen on any statin drugs for hypercholesterolemia?  I have seen a few patients who have the same complaints, and improve over time after getting off these meds.  If they are, call the MD and see what he or she thinks. 




MPT -> RE: Weakness (September 27, 2007 10:29:45 AM)

I guess anything is possible but both of these guys seem pretty legit. One is a pharmacist who owns his own business and the other is an executive at some company.  The pharmacist works his butt off during treatment, the other guy stopped treatment for further testing.
 
The pharmacist does have diabetes which may be related and neither of them are on statins.  
 
Thanks for the help.
 



FLAOrthoPT -> RE: Weakness (September 27, 2007 1:34:52 PM)

Diff Dx:
Stress



Dr.Wagner -> RE: Weakness (September 27, 2007 6:15:05 PM)

1.  Without seeing any of these tests or seeing the results, it is REALLY difficult to give an educated opinion.
2.  People of all occupations have psychiatric illness.



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