Diagnosis: motor neuron disease.
The patient is a 71 year old lady who developed progressive speaking difficulties since June of 2008. More recently, she developed progressive swallowing difficulties as well.
In December of 2008 was seen by Dr. X, neurology specialist in Milan. He describes her speech difficulty as “Spastic dysarthria with slow and nasal speech”. He notices decreased mobility in the tongue and palate with no other neurological signs on exam.
Multiple investigations including blood work, brain MRI and electro diagnostic studies were performed, the results are summarized below.
Rilutek 50 mg twice a day was started on January 22nd 2009.
- Blood work: Complete blood count, chemistry, glucose, CK levels, liver function tests, thyroid function tests, serum protein electrophoresis (SPEP) were all within normal limits. SPEP with immunofixation was performed, but the report is unclear.
- Brain MRI (1/2008) revealed evidence of cortical cerebral atrophy with possible periventricular white matter changes. There were no other intracranial lesions. The actual MRI images were not available for review.
- EMG (French) in January 2009: Nerve conduction studies revealed bilateral median neuropathy across the wrists, worse on the left. Ulnar sensory and motor responses were within normal limits on both sides. Tibial nerve motor responses were within normal limits on both sides. F-wave responses of right and left ulnar and tibial nerves were within normal limits. Repetitive nerve stimulation of the left spinal accessory and right facial nerves were within normal limits. Single fiber EMG was normal. Needle EMG study revealed abnormal spontaneous activity in the left orbicularis oris, right FDI and right biceps. It also revealed evidence of chronic denervation in the right and left tibialis anterior. Left FDI and Glossus muscles were normal.
- Transcranial magnetic stimulation (French) in January 2009: within normal limits.
Past medical and family history is not available.
Social and occupational history is not available.
Current list of medication is not available.