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Neurology (Expert Forum)
Re: Muscle Weakness
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Re: Muscle Weakness
by cf-MD, Jan 01, 1995 12:00AM
Posted By ccf MD on August 20, 1997 at 12:18:22:
In Reply to: Muscle Weakness posted by Mrs. Sorenson on August 19, 1997 at 20:50:01:
: My granddaughte, Stacy, age 15, started experiencing weakness in her left leg a couple weeks ago. I noticed that she had been sortof dragging her left leg and mentioned it to her. She said that she sits on that leg alot. She also said she noticed that she is has a hard time pointing her toes back towards herself on the left foot, which she can do with her right foot. My daughter took her to a pediatrician who took a sample of blood for Lymes Disease which came back negative, but started her on antibiotic anyway as a precautionary measure. He also referred her to a Neurologist here in Minneapolis. She had an EMG in preparation for seeing the Neurologist and will receive the results of that test when she has her initial visit with him this coming Thursday, 8/21. Also, when she marches in band, she said she has a hard time putting her heel down first as the band director wants them to do when marching. She had not had any other symptoms that we can remember besides this foot weakness - no flu symptoms, etc. and is otherwise a very normal, bright, intelligent teenager. (The pediatritian she saw initially also said that the weakness was mostly in her left leg, but that it exists also in the right leg to a lesser degree.) I would very much appreciate your evaluation of her condition and suggestions on follow-up.
Thank you!
Mrs. Sorenson
Interesting case. It sounds like seeing a neurologist is the correct thing to
do at this point. The history and examination are very important here to document
the exact onset of problems and how localized a problem it is. From your story
it sounds like she has a foot drop which may represent a peroneal neuropathy.
This can be caused by compression of the peroneal nerve as it crosses the knee.
It could also represent a more proximal problem with the nerve but the exam can
be very helful in deliniating that. The EMG is the correct test but I have some concerns
about the timing. The onset of symptoms to time of EMG is best after 3 weeks. You can get information earlier but it may not be complete.
You can discuss this with the neurologist. If she has what is termed "conduction block"
related to leg crossing then recover should be very good. She may need a foot orthotic to
help with the foot drop and also some physical therapy. There can be other causes
of foot drop and if it is in both legs the differential diagnosis must be expanded.
Please update us on the EMG and neurologist finding Thursday - it always helps
to get feedback. Good luck.
In Reply to: Muscle Weakness posted by Mrs. Sorenson on August 19, 1997 at 20:50:01:
: My granddaughte, Stacy, age 15, started experiencing weakness in her left leg a couple weeks ago. I noticed that she had been sortof dragging her left leg and mentioned it to her. She said that she sits on that leg alot. She also said she noticed that she is has a hard time pointing her toes back towards herself on the left foot, which she can do with her right foot. My daughter took her to a pediatrician who took a sample of blood for Lymes Disease which came back negative, but started her on antibiotic anyway as a precautionary measure. He also referred her to a Neurologist here in Minneapolis. She had an EMG in preparation for seeing the Neurologist and will receive the results of that test when she has her initial visit with him this coming Thursday, 8/21. Also, when she marches in band, she said she has a hard time putting her heel down first as the band director wants them to do when marching. She had not had any other symptoms that we can remember besides this foot weakness - no flu symptoms, etc. and is otherwise a very normal, bright, intelligent teenager. (The pediatritian she saw initially also said that the weakness was mostly in her left leg, but that it exists also in the right leg to a lesser degree.) I would very much appreciate your evaluation of her condition and suggestions on follow-up.
Thank you!
Mrs. Sorenson
Interesting case. It sounds like seeing a neurologist is the correct thing to
do at this point. The history and examination are very important here to document
the exact onset of problems and how localized a problem it is. From your story
it sounds like she has a foot drop which may represent a peroneal neuropathy.
This can be caused by compression of the peroneal nerve as it crosses the knee.
It could also represent a more proximal problem with the nerve but the exam can
be very helful in deliniating that. The EMG is the correct test but I have some concerns
about the timing. The onset of symptoms to time of EMG is best after 3 weeks. You can get information earlier but it may not be complete.
You can discuss this with the neurologist. If she has what is termed "conduction block"
related to leg crossing then recover should be very good. She may need a foot orthotic to
help with the foot drop and also some physical therapy. There can be other causes
of foot drop and if it is in both legs the differential diagnosis must be expanded.
Please update us on the EMG and neurologist finding Thursday - it always helps
to get feedback. Good luck.
