A 20 years old female came with complaints of headache, vomiting and decrease in movement of right leg. In the past, she had episodes of violent and aggressive behaviour and abdominal pain. Which of the following is the most probable diagnosis?
(A) Conversion disorder (B) Mitochondria disorder (C) Acute inflammatory demyelinating, paralysis (D) Acute intermittent porphyria
(D) Answer- D. Acute intermittent porphyriaPeriodic abdominal pain (GI symptoms), peripheral neuropathy, headache (neurological symptoms) and psychiatric disorders (aggressive behavior) is highly suggestive of acute intermittent porphyria.Asymptomatic in majority of patients prior to pubeyMC symptom: Abdominal painIleus, abdominal distention & decreased bowel sounds are common.Nausea; vomiting; constipation; tachycardia; hypeension; mental symptoms; pain in limbs, head, neck, or chest; muscle weakness; sensory loss; dysuria; and urinary retention are characteristic.Tachycardia, hypeension, restlessness, tremors & excess sweating are due to sympathetic overactivity.Peripheral neuropathy is due to axonal degeneration and primarily affects motor neurons.Motor neuropathy affects the proximal muscles initially, more often in the shoulders & arms.Mental symptoms: Anxiety, insomnia, depression, disorientation, hallucinations, paranoia & seizures