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    Suggest treatment for sudden onset of weakness in legs

Posted on Fri, 3 Jun 2016 in General Health
Question: My Dad has weakness in both his legs and when he tries to stand unaided he falls. He has literally gone overnight from a normal walking person to using a zimmer frame and aides by one person to walk. Blood tests CT scan have all been reported as normal. He has had a hospital stay with many tests and all tests are normal. Any ideas please my dad is only 68 and I hope he can get his mobility back and drive again. The falls worry me as he keeps hurting himself. He says his legs ache and feel very weak examination shows power 4/5 right leg and 3/5 left leg. He can sit and move leg on his own his thigh is tender like muscular (been told this is like muscle wasting) ands says his knee feel like it gives way but not sure if it is his knee or leg he cant pinpoint it. Knee xray shows mild osteoarthritis nil else and doppler scan is entirely normal. Physio is not helping. Please please help I just want my dad back what else can I do? Stroke has been ruled out. I am worried sick it is something like motor neurone disease please help me. Physio says he has quadriceps problems weakened and muscle tone weak
Answered by Dr. Ishu Bishnoi 4 hours later
Brief Answer:
Diagnosis and management of paraparesis

Detailed Answer:
Hi XXXXXXX thanks for asking from HCM.

I can understand your concern. Sudden progressive weakness in both legs could be due to
:Spinal cord compression due to bleed (hematoma) or pus (abscess) or acute disc - You have not mentioned about back pain. If he is having severe back pain, it could be the cause. Back pain due to compression is sharp, shooting, radiates to lower limb, current like sensations.
If he is having pain, match his symptoms. To diagnose, consult neurosurgeon and get MRI spine (thoracic-lumbar region). Treatment includes urgent decompression of spine.
From your question, I can understand that no MRI spine was done. You must stress on getting it done.

: Metabolic cause like potassium abnormality (hyperkalemia or hypokalemia) can cause acute weakness. It can be confirmed by monitoring serum potassium level for few days.
Consult doctor for it. He will evaluate his heart, kidney and liver function to find out the cause of potassium abnormality. Treatment is medical only by treating underlying cause.

: Proximal myopathy acute exacerbation - It is a disease of progressive muscular damage which is usually a slow disease. But sometimes it cause acute exacerbation. It presents as mild pain in limbs, thinning of muscles, low or normal tone in muscles, no pain in back, more weakness in thighs than legs.
If your father has symptoms like above, kindly consult doctor and get electromyography of weak muscles and nerve conduction velocity (NCV) of nerves. Final confirmation is by biopsy of muscle.
It is treated by medical management and treatment of underlying pathology. Physiotherapy of all muscles is must.

Regarding motor neuron disease, it is less likely as it is almost slowly progressive disease. It can be suspected if your father is having diabetes, history of chronic alcohol intake, vitamin deficiency. Diagnosis is confirmed by NCV and nerve biopsy.

Your father has undergone few investigations only. Kindly consult a doctor who can examine him completely like examination of all his sensations, lower limb power/reflexes/tone, local examination of back, his bladder and bowel function. After that something can be suspected.
In case of diagnostic dilemma, get MRI spine, MR angiography of spinal vessels, blood sugar, Vitamin B12 level. The doctor shall be able to reach unto some conclusion after it.

Hope it will help him. Thanks. take care
Above answer was peer-reviewed by : Dr. Sonia Raina
Follow up: Dr. Ishu Bishnoi 3 hours later
Dad does have type 2 diabetes insulin dependent but now under control and has been for past 6 months. Dad has had spinal osteomyelitis in the past. Dad does have lower back pain but I think this is long standing from the osteomyelitis. Dad has be have trouble with very low blood pressure and dizziness I was wondering if it is something like Addisons Disease. All the above you mention can dad get his mobility back?
Answered by Dr. Ishu Bishnoi 1 hour later
Brief Answer:
Prognosis and management

Detailed Answer:
Hi, thanks for asking.

It is good that his diabetes was under control for last 6 months. But still, you should get his HbA1c level to know about sugar control. If its value remains below 5.5%, it means good control for long time and if value higher than 7%, it means severe sugar derangement for long time. Sugar derangement can lead to daibetic neuropathy and weakness.

Now coming to osteomyelitis of spine, it should be re-evaluated by getting CT spine of that area and look for any collapse of vertebrae/deformity affecting cord and nerves. Consult doctor for it. If he finds it active, get MRI spine also to know about cord/nerve status and any pus collection. You also mentioned that his backpain was mild. It can be mild in long standing illness. Sudden paraparesis can occur due to spine deformity. You can also ask for NCV and EMG of involved nerve and muscle which correlate it with osteomyelitis level. Thereby we can confirm diagnosis.
Treatment may be surgical if compression or spinal instability.

i dont know the reason why you are suspecting XXXXXXX disease. Did your father have tubercular osteomyelitis or prolonged streoid intake followed by abrupt withdrawl? If yes, it can be suspected if along with weakness, he is losing weight/low BP (present in him)/pigmentation over body/malaise/low sugar/loss of appetite.
You can consult endocrinologist for it as soon as possible as it can cause "addisonian crisis" which is a life threatening condition. Treatment is replacement of steroid and gradual tapering after full recovery.

Mobility recovery depends upon diagnosis confirmation. All the above mentioned conditions are reversible (duration varies) and recovery is almost 70 to 80%. For maximum recovery, physiotherapy is must (both active and passive).

Hope it will help you in further understanding. Thanks.
take care.
Above answer was peer-reviewed by : Dr. Sonia Raina
Follow up: Dr. Ishu Bishnoi 6 hours later
Been to Neurologist today Dads legs are related to his Diabetes and Previous Spinal Osteomyelitis. They say Dad has Peripheral Neuropathy. Will Dads legs gain mobility and if so what can we do to help. All Neurologist said was continue with Physio!
Answered by Dr. Ishu Bishnoi 39 minutes later
Brief Answer:
Treatment options and prognosis

Detailed Answer:
Hi, thanks for asking.

Diabetic neuropathy is a chronic process and there is always permanent damage to nerves. However some functional recovery is always possible. I am providing some information regarding recovery
: Tight blood sugar control is must. It can also increase chances of hypoglycemia. So ask your dad to keep some sugar with him.
: Physiotherapy which everyone is stressing. It will increase his muscle strength, flexibilty, prevent contracture and wound formation
: Maintain hygiene to prevent any cracks, infection.
: You can give him nerve specific vitamin like B12, B6, pyridoxine for recovery. Consult doctor for it.
: you can give him zinc sulfide after consulting doctor.
; For pain, you can give him gabapentine or pregabaline after proper prescription.
: Recovery from acute weakness will definitely occur. It can take 3 to 6 months for recovery.

Hope it will help you. Thanks. take care.
Still in doubt, please let me know.
Above answer was peer-reviewed by : Dr. Deepak
Follow up: Dr. Ishu Bishnoi 3 minutes later
Thank you so much
Answered by Dr. Ishu Bishnoi 12 minutes later
Brief Answer:

Detailed Answer:

Thanks for the appreciation.
Above answer was peer-reviewed by : Dr. Yogesh D
Answered by
Dr. Ishu Bishnoi

Neurologist, Surgical

Practicing since :2007

Answered : 830 Questions


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