Description
The patient was a middle aged female seated up comfortably
in bed. She was of average height but looked underweight.
On examination of her lower limbs, the right lower limb
looked smaller than the left. It was shorter and thinner than the left. There
was no abnormality of the integument.
There was wasting of the muscles of the right lower limb.
There were no involuntary movements.
The tone of the muscles in the right lower limbs was
reduced (flaccid)
Power was decreased in all the muscles of the right lower
limb (grade 2)
Reflexes were absent in the right lower limb and there was
no change with reinforcement. Coordination was normal in the left lower limb it
was not tested on the right side.
There was no sensory loss.
Analysis
♥
The discrepancy in size of the two limbs suggests the lesion has
been present form childhood and has thus affected growth of the limb
(ACES for PACES Page
514)
ª
Flaccidity has multiple causes
(ACES for PACES Page 449). An unilateral long-standing lesion starting in childhood makes
a lower motor neurone lesion like poliomyelitis the most likely cause.
¨
Deceased muscle power in one lower limb is a further pointer to
the diagnosis being poliomyelitis
(ACES for PACES Page
450, 413)
§
Absent reflexes add further weight to this diagnosis
(ACES for PACES Page
453)
♥
The absence of any sensory loss is further evidence in favour of
our diagnosis. (ACES
for PACES Page 454)
Diagnosis
ª
Poliomyelitis in childhood
