[A 79-year-old man with rapidly progressive tetraparesis].
We report a 79-year-old man who developed progressive gait disturbance and sensory loss. He had been doing well except for hepatitis B virus hepatitis until 72 years of age when he developed angina pectoris for which aorto-coronary bypass operation was performed when he was 73-year-old (1986). In 1990, he developed pulmonary fibrosis for which prednisolone was prescribed. His liver function deteriorated, and the liver function tests suggested liver cirrhosis. He noted an onset of gait disturbance in the middle of June in 1992 when he was 79-year-old. His gait disturbance deteriorated progressively, and he developed edema and loss of sensation in his both legs. He became unable to walk unassisted in the beginning of July. He fractured his right external malleolus after falling down from a chair. He became unable to stand by himself, and he was admitted to the cardiology service of our hospital on July 18, 1992, and the neurology service was asked to see the patient on July 30 of the same month. The patient was well developed and well nourished man in no acute distress. General physical examination revealed slight jaundice, left carotid bruit, and slight pitting pretibial edema. His temperature was 37.3 degrees C. On neurologic examination, he was alert and mentally sound without dementia. He showed a slight weakness in the facial muscles bilaterally and mild dysarthria and dysphagia, however, the other cranial nerves appeared intact. He was unable to stand unassisted. The muscle tone was hypotonic, however, no focal muscle atrophy was noted, nor was observed fasciculatory twitches.(ABSTRACT TRUNCATED AT 250 WORDS)
Ishigaki
Y
Y
Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
Hironishi
M
M
Toganou
T
T
Matsumoto
T
T
Ohta
S
S
Suda
K
K
Nishi
K
K
Yamaguchi
H
H
Mizuno
Y
Y
D000368:Aged; D002908:Chronic Disease; D003711:Demyelinating Diseases / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D005727:Ganglia, Spinal / Q000473:pathology; D006801:Humans; D008297:Male; D011129:Polyradiculoneuropathy / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D011782:Quadriplegia / Q000209:etiology*; D013116:Spinal Cord / Q000473:pathology