Pain And Paralysis: How A Former Extreme Athlete Lost His Ability To Walk

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Pain And Paralysis: How A Former Extreme Athlete Lost His Ability To Walk - Page #3

Lab Studies: Complete blood count (CBC), Comprehensive metabolic panel (CMP), Magnesium, troponin, Hemoglobin A1c, lipids: Within normal limits (WNL) Nasopharyngeal swab: Negative for COVID and other viruses Protein C&S, cardiolipin antibodies, Factor V Leiden, prothrombin gene: WNL/negative Thrombophilia testing: No thrombotic diathesis Cerebral spinal fluid (CSF): Protein, glucose, RBCs, WBCs: WNL; culture: no growth; Lyme polymerase chain reaction (PCR), IgG, Oligo-clonal bands: WNL/negative HIV, syphilis: Negative Tick-borne: Acute PCR panel: negative; Lyme western blot antibodies: positive IgG x7 bands (pre-existing from 2015), IgM negative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), Angiotensin converting enzyme (ACE), Myelin oligodendrocyte glycoprotein antibodies (MOG), Neuromyelitis optica / aquaporin 4 antibodies (NMO / AQP4) antibodies, Anti–Sjogren's-syndrome-related antigen A antibodies – RO (SSA-RO), SSB-LA: WNL/negative Other Studies: EKG: Normal sinus rhythm (NSR), normal PR & QT intervals CXR: Negative CTA chest: No evidence of PE, aortic dissection or aneurysm Initial ED MRI C-spine w/o contrast: Unchanged from previous MRIs in the past Case Photo #1 MRI brain w/ & w/o contrast: No acute infarct or mass Follow-up MRI C-spine and thoracic spine (T-spine) w/o contrast diffusion weighted on hospital day (HD) #1: New increased T2 and STIR signal intensity from the inferior endplate of C6 Case Photo #2 extending to the level of T6 Case Photo #3 . At the C6 level it predominantly involves the anterior third of the cervical cord Case Photo #4 that extended into the thoracic cord to varying degrees. Transthoracic echocardiogram (TTE): Normal biventricular size and function, no significant valvular abnormalities and no evidence of intra-arterial communication per bubble study Consultations: Neurology Physical Medicine and Rehabilitation (PMR) Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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