A 45-year-old female presents to the outpatient clinic with symptoms of pain, fatigue and weakness in both lower limbs. She gives history of paralysis affecting both lower limbs in childhood from which she made good functional recovery. Which of the following is the most likely suspected diagnosis:
Answer is A (Post Polio syndrome): Development of muscle pain, fatigue and weakness after several years of having probably suffered from paralytic polio is classically seen in Post-polio-syndrome. Post-polio syndrome is characterized by debilitating fatigue, muscle pain and new muscle weakness typically occuring in muscles previously involved in acute poliomyelitis (although it may also occur in unaffected muscles). A diagnosis of PPS is suggested by history ofprevious paralytic polio from which the patient makes paial or fairly complete function recovery and which typically stays stable for greater than 15 years before worsening and presenting with gradual onset of new weakness, pain and muscle fatigue. Consensus Workshop Diagnostic Criteria for Post-Polio Syndrome History of paralytic polio with paial or fairly complete neurologic and functional recovery. A period of neurological and functional stability of at least 15 years. Development of new muscle dysfunction (After a period of functional stability of at least 15 years) - Muscle weakness Muscle atrophy - Muscle pain - Fatigue Neurological examination compatible with prior poliomyelitis - Lower motor lesion - Decreased or absent tendon reflexes - No sensory loss Compatible findings on electromyogram and/or magnetic resonance imaging Taken from Diagnostic Criteria in Neurology' (Humana Press) 2006/195 (table 21) Signs and Symptoms of PPS Fatigue that may be debilitating and worsens as the day progress New joint and muscle pain New weakness in muscles affected by polio; unaffected muscles are also affected. (The new weakness may be more prominent on one side of the body). New dyspnea and other respiratory problems Severe cold intolerance, even with mild cold exposure. This causes the muscle weakness to worsen, the arms or legs to become pale or cyanotic, and the extremities to feel cold to touch. The patient may say, "It's so cold it hus". Muscle spasms and cramps that are sometimes severe and painful Difficulty swallowing and increased risk of choking Difficulty falling asleep and waking frequently during the night Anxiety, anger, frustration, and emotional outbursts due to loss of ability Disturbed sleep, sleep apnea
Post Polio syndrome
Polymyositis
Muscular Dystrophy
Neuropathy