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Help needed with unusual case

Micky Micky at mabtexspam.nodemon.co.uk
Sat Mar 13 10:32:16 EST 1999

Can anyone offer any illumination on the following case:

Female patient (40) initially presented with weakness, stiffness and
painful spasms of hip-girdle and legs, and fatigue. There has been
limited response to Baclofen (20mg q.i.d) and NSAIDS. Pain level now
increasing. Arms and hands becoming stiff and weak.

Tests and results as follows:

Blood ck (normal limits), thyroid blood studies (normal limits with
thyroxine medication), ESR ( high, 22 - normal range 03-10),  VEP
(normal), MRI - brain, cervical and dorsal spine (normal), nerve
conduction study of ulnar nerve ( mild bilateral neuritis), needle EMG
of right deltoid (showed small motor units) and right biceps (normal),
muscle biopsy of right deltoid (inconclusive - some pynotic muscle and
endomysial macrophages). Negative blood autoantibodies.

No demylination, no evidence of neuromuscular junction transmission

Patient has the following disorders: hypothyroidism (post-thyroidectomy
for hyperthyroidism, 225 mcg), b12 deficiency (hydroxocobalamin inj 1000
mcg), hypertension (Atenolol 100 mg).

Any ideas anyone?


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