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Diagnosis Of Neurological Disease Causing Difficulty Walking And Knee Pain?

Posted on Tue, 11 Mar 2014

Question: Hi Sir, I have query for my younger brother XXXXXXX . He is suffering from knee join pains since last three month. On investigation, It has turned into Some Neuro diease due to some nodes in various body places including brain. He is having problem in walking and his legs and hand do shiver as well. MRI Thoracic spine: opinion small heterogeneous peripherally enhancing intramedullary systic lesion in thoracic cord opposite T7-8 vertibral levels with perilesional oedema. Possibilities are 1) Neoplastic ( ? Astrocytoma ? Ependymoma) 2) Granulomatous (? Neurocysticercosis) MRI scan of Brain plan and brain contrast: Opinion 1. small non enhancing focal lesion in dorsal aspect of medulla - ? Demyelinating It would be really helpful you can suggest: 1. current treatment is correct. 2. What is this disease 3. Treatment for the same. 4. How much time it would take for curing 5. Best Doctor and hospital suggestion India (preferable in Jaipur / Delhi / Bangalore) Please Reply urgent. If needed please share me your email-id to send soft copy of all MRI, x-ray and other reports. Thanks, XXXX

Answered by Dr. Sudhir Kumar (1 hour later)

Brief Answer: Your brother needs further evaluation. Detailed Answer: Hi, Thank you for posting your query and informing about your brother's health condition. I have gone through the medical reports of your brother. He has disease in brain as well as spinal cord. In this situation, there are three main possibilities: 1. Infection (such as as tapeworm-neurocysticercosis and tuberculosis) 2. Demyelinating illness (such as ADEM), 3. Cancer (such as lymphoma, etc) The only method of 100% confirmation of diagnosis would be by doing a biopsy of the lesion (either brain or spinal cord or under the skin). However, there may be small risk of the biopsy procedure, as involves operation. So, we usually start empirical (guess) treatment based on the patient's symptoms and most likely possibility. This kind of treatment often involves steroids (already started by Dr XXXXXXX at Jaipur) and anti-infective treatment (such as TB or tapeworm medicines). As of now, the treatment approach is correct and you can continue treatment under care of Dr XXXXXXX Good neurologists at Bangalore are Dr XXXXXXX XXXXXXX (Manipal), Dr XXXXXXX (Columbia Asia), Dr XXXXXXX Iyer (Vikram Hospitals). At New Delhi, good Neurologists are Dr XXXXXXX XXXXXXX (Apollo), Dr Rajshekher Reddi (Max, Saket), Dr XXXXXXX XXXXXXX (Medanta, Gurgaon). Curing may take a few months. I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (2 days later)

Hi Dr. XXXXXXX I really appreciate your quick response towards my query. My brother was admitted in SMS on Saturday 15th Feb and Biopsy was done today which means 4th day. Do you think that this delay in identifying 100% accurate cause may do some adverse effect to my brother's health. Further, you have already suggested good Doctors in Delhi and Bangalore. If I plan to go to Delhi then which Doctor you would suggest among those 3. Or if you suggest in Jaipur then which Doctor? Based on your experience and reports which you have already gone through, do you think that this disease can be cured 100% and after taking treatments for few months he would be able to live his life normally. I understand that you do not have biopsy report but based on current report status I am asking. Thanks in advance for your precious suggestion. Thanks, XXXX

Answered by Dr. Sudhir Kumar (7 minutes later)

Brief Answer: Your brother would improve well. Detailed Answer: Thank you for getting back. It is good to note that biopsy has been done and we should wait for the biopsy report to decide the best treatment and predict the outcome. There are very good chances that your brother would improve well with treatment and a few days delay would not adversely impact his outcome. At Delhi, Dr XXXXXXX XXXXXXX at Apollo would be the best. At Jaipur, SMS is the best. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar