NEUROANATOMY case study(report)


 NEUROANATOMY case study(report)



CASE REPORT


A case of 17 year old male was admitted due to weakness in both lower extremities with inability to walk.

The patient was having productive cough associated with on and off evening rise of temperature, 6 months prior to consultation. He had loss of appetite and was noted to lose weight.

A month prior to consultation he was noted to have complaints of low back pain and numbness on both lower extremities. 

 Weakness persisted associated with inability to walk which prompted him to seek admission. Vital sign were normal.
POTT’S DISEASE


vSTARRING POINTS…
üIntroduction
üEpidemiology
üPathogenesis
üClinical Findings
üDiagnosis
üTreatment


vWHAT IS POTT’S DISEASE?
•also called “Tuberculous spondylitis” or “Spinal Tuberculosis”.
•caused by an infection of the spinal column Or vertebral column by the Mycobacterium tuberculosis.


Epidemiology

 qWhat causes Pott’s Disease ?


•Tuberculosis begins in the lungs when one inhale air contains mycobacterium tuberculosis, this can develop in the Pott’s disease if the infection spread from the lungs to the spine.

•The vertebrae become soft and collapse as may be the bone is destroyed.





»The person often develops a pronounced curvature in the upper or lower back often referred to as Pott’s curvature.


»An individual may also develop paralysis, referred to paraplegia.


Pathogenesis


»Pott’s disease is usually secondary to an extraspinal source of infection.
»Anterior aspect of vertebral body adjacent to subchondral plate is usually affected.
»Tuberculosis may spread from the area to adjacent intervertebral discs which is secondary to spread of infection from the vertebral body.



»Progressive bone destruction leads to vertebral collapse (kyphosis).
»The spinal canal can be narrowed by abscesses, granulation tissue or direct dural invasion, leading to spinal compression.


Step 1

•Bacilli from primary focus through blood stream reach disc space.


Step 2

•Once infected, soft nucleus center & fibrous annular wall weakens, decays and collapse.
•This caused the disc to close, squeezing down on nerve root causing pain.


Step 3

•The infection spreads to vertebral bodies above and below the disc.


Step 4

•The bone weakened by infection collapses under the weight of human body.


Step 5

•The deformed spinal column compresses spinal cord producing functional impairment.


Step 6

•Over time, the deformed vertebrae heal and fuse.
•This may further compress nerve roots causing pain & neurological deficit.
Clinical Findings:





»Weakness in both lower extremities with inability to walk due to paraplegia.

»Pain and numbness on both lower extremities.

»Severe back pain with difficulty standing.
»Anorexia (Loss of appetite).
»Weight loss.
»Night sweat.

 Diagnosis:


»MRI
»CBC
»CT Scan
»ESR
»PCR


Laboratory results:



»High WBC Count.
»High Neutrophil Count.
»ESR may be markedly elevated.

 Differential Diagnosis:


Infection

•Blastomycosis
•Candidiasis
•Histoplasmosis

Cancer

•Metastatic lesions
•Spinal tumors

 Treatment:


Oral treatment
»Antibiotics
•Four drug therapy (isoniazid, rifampin, pyrazinamide, ethambutol).
•At least six months of therapy.

Surgical treatment
•Abscess drainage

 Laminectomy:


Costotransversectomy
(In tense Paravertebral abscess)


vCreated by...
•Patel Samay
•Patel Purav
•Patel Riya
•Pious Ajilmon
•Puthan Kudiyan Dheeraj Krishna
•Patel Priyank
•Patel Yatin
•Patel Mayank
•Puthenpurayil James Abhishek
•Das Suchismita
•Mistri Rittwik


•Mistri Rupsha


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