ABSTRACT
A delayed syndrome of progressive weakness has been described in survivors of paralytic poliomyelitis - "Post-Polio Muscular Atrophy (PPMA)". One proposed etiology is a drop-out of motor neurons due to increased metabolic demands of an enlarged motor unit territory. We report a patient with slowly progressive lower extremity weakness 20 years after recovery from an episode of myelopathy involving the lower lumbar and sacral segments of the spinal cord. Delayed progressive amyotrophy may complicate any significant injury to anterior horn cells.
Subject(s)
Muscular Diseases/etiology , Postpoliomyelitis Syndrome/complications , Adult , Electromyography , Humans , Magnetic Resonance Imaging , Male , Muscular Diseases/pathology , Neural Conduction/physiology , Postpoliomyelitis Syndrome/pathologyABSTRACT
A 56-year-old female presented with mild low back pain. Examination revealed severe, selective atrophy of the thoracic and lumbar paraspinal muscles. Fibrillations were seen in the paraspinal muscles on EMG. Limb EMG was normal. Biopsy of the gluteus maximus was normal. Paraspinal muscle biopsy revealed neurogenic features. Atrophy of the thoracic and lumbar paraspinal muscles was noted on magnetic resonance imaging. This patient has selective amyotrophy of the thoracic and lumbar paraspinal muscles. This may be an addition to the spectrum of 'benign focal amyotrophy'. The differential diagnosis of paraspinal muscle weakness is discussed.
Subject(s)
Muscle, Skeletal/physiopathology , Muscular Disorders, Atrophic/diagnosis , Biopsy , Diagnosis, Differential , Electromyography , Female , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Magnetic Resonance Imaging , Middle Aged , Muscle, Skeletal/pathology , Muscular Disorders, Atrophic/complications , Muscular Disorders, Atrophic/pathology , Muscular Disorders, Atrophic/physiopathologyABSTRACT
Domiciliary assisted ventilation has been used to prolong life in patients with neuromuscular diseases. Although earlier studies suggest that the majority of patients are satisfied with their lives, the physician's perception of a patient's poor quality of life on assisted ventilation is a major reason for discouraging assisted ventilation. In this study, the quality of life was assessed in 19 patients with neuromuscular diseases on domiciliary tracheal intermittent positive-pressure ventilation for a mean duration of 54 months. An attempt was made to compare the quality of life of Duchenne muscular dystrophy patients with that of amyotrophic lateral sclerosis patients. More than two-thirds of patients were satisfied with their lives. Eighty-four percent thought they had made the right choice. Patients with amyotrophic lateral sclerosis were somewhat more negative or ambiguous toward assisted ventilation and had lower life satisfaction scores as compared with Duchenne muscular dystrophy patients. Financial stresses were significant. Assisted ventilation should be offered as a viable option to patients with neuromuscular diseases. Larger studies may be useful in influencing insurance companies to make expenses associated with assisted ventilation reimbursable.
