Complex integrative etiological (possibly encephalomyelitis) , clinical, paraclinic and therapeutic aspects in a patient with quite light spastic paraparesis and sensitivity disorders, old objected by medullar mitigation at vertebral level T5-T7 – Case report

• Main Authors: Irina Raluca Petcu, Mihaela Mandu, Nicoleta Chiriloi, Anca Chiralidis, Mihai Băilă, Doroteea Teoibaș-Șerban, Simona Izabelle Stoica, Gelu Onose
• Format: Article
• Language: English
• Published: Romanian Association of Balneology, Editura Balneara 2018-09-01
• Series: Balneo Research Journal
• Subjects: : spastic paraparesis; neuro-rehabilitative therapy
• Online Access: http://bioclima.ro/Balneo197.pdf
• ISSN: 2069-7597; 2069-7619

Introduction: This paper presents an extremely complex case of quite light spastic paraparesis, with a medical history from childhood (at 12 years), encephalomyelitis (remission?), which in adulthood (at 22 years) was diagnosed and treated as multiple sclerosis 1 year and 6 months (this diagnosis has been subsegmently deniend with IRM in 2017: reducing the size of the medullary cord in the vertebrae plane T5-T7 sequelae aspect) and the afferent neuro-rehabilitative actual management approach, respectively. Materials and methods: 43 year old female patient admintted in our Clinic s Division for a AIS/ Frankel D motor deficiency, pain with mechanical carcass at the spine, disturbances of balance , bladder dysfunction (incontinance), dorsal plantar flexion deficit bilateral (left > right), gait with a broad base of support with external unilateral support, with hip flexural , knee flexion, and dorsal flexion deficiency while walking, attack digitigrad (left > right), and sensibility impairment from T12 level downwards. The patient was clinical and functionally evaluated, according to the standard implemented protocols of our Unit , through the following measurament evalution scales: AIS, Functional Independence Measure (FIM), QQL (Quality of life), Ashworth, Penn, FAC International Scale, and investigate paraclinic: IRM brain, cervical and thoracic spine, radiographic cervical spine , abdominal ecography. Results: Following optimal treatment including pharmacological, and complex neuro-rehabilition program the patient had a favorable evolution with increased values of the measurament scales (motor AIS with 4 points, FIM motor with 5 points, QQL with 6 points, and FAC with 2 points) ), remission of ataxic / vertiginous phenomena, quaremision of urinary incontinence (controlling micturitions for at least 10 minutes after urge to urinate); in addition and also very important: diminished spasticity and significantly improved of the gait pattern.Now shie can walk without support on short / medium distances and also very important it can rise without sitting support (in a relatively low position) to orthostatism, and also climbs and descends stairs with the support of the bar and only with the supervision of another person. Conclusion: From the etiologic point of view, multiple sclerosis, uterine apoplexy as well arterio-venous malformation has been recently refuted. The present case represents the importance of building a complete diagnosis (etiologic and of stage) and particular neuro-rehabilitative therapy approuch with both clinical, psihological and scientific impact.