24 year old male was completely well till October 1998. He first
noticed a problem in walking in his right leg which gradually went on
increasing. The problem gradually progressed to involve the right hand,
it affected his hand writing and other fine activities. By January 1998
he was unable to write at all, and similarly was having difficulty tying
shoelaces or undoing buttons.
By April 1998, his speech began to be affected. At present he is unable
to swallow liquids but can manage solids fairly well.
His vision and hearing are not affected. There is no difficulty in
passing urine or stool. He is able to walk on even ground with
difficulty but requires help of one individual while negotiating stairs.
There is no family history of similar illness.
On clinical examination
Pulse 30 / min regular.
BP 120 / 70
CNS. Vision - Normal.
Pupils are equal and reacting well to light. Fundus examination is
normal on both sides. External ocular movements are normal. There is a
nystagmus on looking to the right. Speech is markedly dysarthric. There
is spontaneous laughter due to emotional liability.
There is spasticity in both upper and both lower limbs. Deep tendon
reflexes are exaggerated bilaterally. Abdominal reflexes are absent.
Plantor responses are bilaterally extensor. Sensory system examination
is normal. There is mild finger nose ataxia on the right side.
The differential diagnosis is as follows.
Demyelination
Neoplasm
He has received inhavernous methyl-prednisone 1gm * 5 days. He has also
received methotraxate and oral prednisolone.
Is their any treatment possible on this case ?
This male is from India. I am his brother writing this mail from UK. You
can reply me at
I can give more information if required.
Thanks,
Rahul
