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sudden weakness in muscles of a 14 year old male.

sudden weakness in muscles of a 14 year old male.

Presentation : Difficulty in passing stool for one week
14 year old presents with week duration of sudden onset of inability to walk.  This was preceeded by 4 days duration of fever , headache ,, joint pains for which patient was admitted at a district hospital and treated for malaria. A week into his illness patent claimed he was feeling better. Patient on attempting to get of his bed fell down and then realised his lower limbs were  numb.  Numbness progressed to involve the upper limbs. Subsequent attempts to walk proved futile. He declines any history of diarrhoea, trauma. Patient also realised he had difficulty in passing stools and urine . He later recovered the ability to urinate without difficulty and subsequently, the ability to pass stools. Child occasionally complains of severe headache. He had a single episode of epistaxis
Examination : well hydrated , afebrile . Abdomen soft , not distended, non tender,normal spinal exams.
Restless legs, altered sensation at plantar aspects of both feet. Power is 4/5 in both lower limbs . Power is normal in upper limbs with altered sensation in palms . Patient however has difficulty in using the intrinsic muscles of the hand. He palms objects, compensates grip with forearm muscles. He is currently unable to hold and use a pen, a feat he previously did with ease. He has moderate difficulty in rising from a squatting position. There is no clear sensory level
Patient has partial ptosis and double vision in the left eye, no difficulty in swallowing, speech, breathing.
Diagnosis :   1. Intracranial space occupying lesion
2.   motor neuron disease
Investigations :
Full blood count is normal,
Chest and L/S spine xrays normal
Contrast enhanced head CT scan Iis normal
There is currently no consensus on the diagnosis by the neurosurgeon. He is awaiting fundoscopy and Mantoux test


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