MYELONEUROPATHY
A 65 year old male presented with the following complaints -
- Weakness of both limbs since 15 days
- He reported exceptional pounding palpitations associated with heaviness of chest which subsided on taking rest In early 30s. The symptoms kept progressing over years. At the age of 60 he had is first episode of nocturnal dyspnea. No Orthopnea or pedal edema.
- Pain in knees and lower Back which progressed over years. Severe aching pain more on left.
- Difficulty in getting up from bed since 15 days. Absolutely unable to get up since 4 days. No sensory symptoms were found.
On examination,
Duroziez’s sign +ve - indicates aortic insufficiency. (Audible diastolic murmur over femoral artery.)
Pulsus bisferens
Power in lower limbs is slightly reduced
Ankle reflexes are absent.
Beevors sign +ve - indicates lower abdominal muscle weakness. (Characteristic of spinal cord injury)
Loss of vibration and proprioception.
Extensor plantar response.
From the above history and examination, a MYELONEUROPATHY was suspected.
ECG and chest X-ray were normal without any significant findings.
2D echo showed dilated IVC and right atrium. With mild tricuspid regurgitation, ,mild pulmonary HTN, trivial aortic regurgitation with normal ejection fraction.
Complete urine examination showed pus cells and USG showed grade 2 prostatomegaly. Digital rectal examination was done to reveal a flat and non nodular prostrate.
RPR was done and tabes paresis is ruled out.
MRI revealed a T8 T10 L2 vertebral lesions causing cord compression.
Treatment -
Supplements.
Myeloneuropathy is characterized by simultaneous damage of the tracts of the spinal cord and peripheral nerves in the lower limbs. Clinical manifestations of myeloneuropathy include difficulty in walking, weakness of lower limbs, ataxic gait, and sensory manifestations in glove and stocking distribution.
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