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Can Charcot Marie Tooth come on virtually overnight?

Discussion in 'General Issues and Discussion Forum' started by PODKMM, May 28, 2009.

  1. PODKMM

    PODKMM Active Member


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    I had a male patient in his mid 20's present this week, with a very significant left foot drop. He reports that he has yet to receive a diagnosis and reason for this occuring.
    He has reduced periphery sensation at the left anterior shin area, ankle reflex is absent and is unable to dorsi flex at the ankle joint.
    He reports that he suffers tingling in the left limb, left hip and also left hand.
    He reports that the foot drop basically occurred overnight about 6 -8years ago.
    Just wondering if anyone knows if CMT can occur virtually overnight? OR Does anyone have any other suggestions?
    Thanks
    Kirsti
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    It does not sound like CMT.
     
  3. Secret Squirrel

    Secret Squirrel Active Member

  4. admin

    admin Administrator Staff Member

    Foot drop

    Warning: Page using Template:Infobox medical condition (new) with unknown parameter "1 = thumb" (this message is shown only in preview).

    Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the common fibular nerve including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. Foot drop is characterized by inability or impaired ability to raise the toes or raise the foot from the ankle (dorsiflexion). Foot drop may be temporary or permanent, depending on the extent of muscle weakness or paralysis and it can occur in one or both feet. In walking, the raised leg is slightly bent at the knee to prevent the foot from dragging along the ground.

    Foot drop can be caused by nerve damage alone or by muscle or spinal cord trauma, abnormal anatomy, toxins, or disease. Toxins include organophosphate compounds which have been used as pesticides and as chemical agents in warfare. The poison can lead to further damage to the body such as a neurodegenerative disorder called organophosphorus induced delayed polyneuropathy. This disorder causes loss of function of the motor and sensory neural pathways. In this case, foot drop could be the result of paralysis due to neurological dysfunction. Diseases that can cause foot drop include trauma to the posterolateral neck of fibula, stroke, amyotrophic lateral sclerosis, muscular dystrophy, poliomyelitis, Charcot Marie Tooth disease, multiple sclerosis, cerebral palsy, hereditary spastic paraplegia, Guillain–Barré syndrome, Welander distal myopathy, and Friedreich's ataxia. It may also occur as a result of hip replacement surgery or knee ligament reconstruction surgery.

     
  5. Josh Burns

    Josh Burns Active Member

    Dear Kirsti,
    CMT does not occur 'overnight' or in a unilateral distribution. I suggest you investigate nerve compression on the affected side.
    Kind regards
    Josh

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
    Joshua Burns PhD, B App Sc (Pod) Hons
    NHMRC Australian Clinical Research Fellow
    Institute for Neuromuscular Research, The Children's Hospital at Westmead
    Locked Bag 4001, Westmead NSW 2145 Australia

    Conjoint Senior Lecturer, Discipline of Paediatrics and Child Health
    Sydney Medical School, The University of Sydney, Australia
    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
     
  6. Kirsti:

    Foot drop combined with left limb and left hand neurological findings makes one think first of cerebrovascular accident (CVA), even though this is not common in someone in the mid 20's. A fairly common cause of unilateral foot drop (without the upper extremity symptoms) is a tight and too high below knee cast that causes a compression neuropathy of the peroneal nerve at the superior fibula.

    This patient needed a neurological consult 6-8 years ago and probably still does. It is not likely Charcot-Marie Tooth Disease.
     
  7. posalafin

    posalafin Active Member

    The neurological signs involving both the arm & leg would tend to indicate a R) sided brain pathology, however in having said that you indicate that he has 'not yet had a diagnosis'. What assesments & testing has he had previously?

    Did all the symptoms appear at the same time i.e. did he start experiencing the tingling sensations in the leg & arm at the same time as the foot drop occurred? If not these may represent a distraction & may not necessarily be related to the footdrop. Also is the tingling constant or does it occur intermittently? Intermttent symptoms may possibly indicate a demyelinising syndrome such a multiple sclerosis.

    What happened 6-8 years ago when he first experienced the footdrop? I would explore the possibility of a compression neuropathy. Given he is now in his mid twenties that puts the time of onset about when he was 17 or 18 years old. I have seen several cases of patients who have had similar symptoms in their arms from lying in one position for a long period of time, usually with their arm compressed against something e.g compressed against the metal frame of a fold out bed. It tends to occur more commonly in patients who have been drinking heavily or have taken drugs (ilicit or prescription CNS depressents) which tends to put then in a very deep sleep (or significantly altered conscious state) & they tend to sleep / stay in the one position for many hours causing the nerve compression & subsequent damage. If he had fallen asleep with his leg against something (especially a hard surface) this may have caused the acute foot drop & other neuro signs in his leg. He is in the right age group when the symptoms first occurred for experimenting with illicit drugs & heavy (binge) drinking.

    If not already done I would make sure to press for a really thorough understanding of the exact circumstances behind the onset of the symptoms.

    Regards,

    David Kelly
     
  8. PODKMM

    PODKMM Active Member

    Thanks everyone!
    As you can all probably appreciate, getting a thorough history from this patient was quite difficult. From what was reported to me, he has had 2 different neurological assessments, MRI of his spine and other neurological tests (descriptions of these were vague).
    I have asked him to contact his GP and get a copy of reports from previous practitioners and hope he has them next week.
    I have explained AFO is the logical treatment, but he really is after a diagnosis.
    Craig,
    Wondering why you don't think it could be CMT?
     
  9. posalafin

    posalafin Active Member

    If MRI's; CT's etc are ok I would also consider a vascular problem such a vasculitis. Vascularitic neuropathy can occur asymetrically and affects the common fibular nerve in about 65-80% of cases causing foot drop. It can also affect the ular, median & radial nerves which may explain the neurological symptoms he is experiencng in his left arm.
     
  10. Deborah Ferguson

    Deborah Ferguson Active Member

    Hi
    I've been reading this discussion with interest and have just pulled out my medical textbook ( need some R & R after the trauma of the` Britains got Talent` final ) and this patients problems sound like a type of peripheral neuropathy/polyneuropathy?multifocal neuropathy. Tendon reflexes are often affected usually as a result of sensory loss rather than motor impairment and if the radial nerve is affected a wrist drop can occur. Were the lower limbs involved before the upper limbs? Is there any wasting or weakness or effect on pain/ temperature or touch and pressure sensation?

    Silly question but has the patient been screened for diabetes?
    Am very interested to know what final diagnosis turns out to be.
    Regards
    Deborah
     
  11. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Pretty much for the reason's that Josh gave.
    He is the CMT star :D
     
  12. PODKMM

    PODKMM Active Member

    Thanks
     
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