Editor's quiz: GI snapshot
Occult gastro-intestinal cause of spastic paresis of the legs
1 Department of Gastroenterology, Bishop Auckland General Hospital, County Durham, UK
2 Department of Neurology, Newcastle Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
Correspondence to:
Dr A Dhar, Department of Gastroenterology, Bishop Auckland General Hospital, Cockton Hill Road, Co. Durham DL14 6AD, UK; anjan.dhar@cddft.nhs.uk
| The first 150 words of the full text of this article appear below. |
CLINICAL PRESENTATION
A 40-year-old man with diabetes presented with difficulty in walking and paresthesia affecting both feet. Examination revealed pes cavus (fig 1), lower limb hypertonia, sustained ankle clonus and symmetric hyper-reflexia. There was no muscle weakness and cerebellar signs were absent. Routine laboratory investigations were all normal except a low vitamin E level (6.2 µmol/l, normal 11.6–35.5 µmol/l) and other neurological investigations, including spinal magnetic resonance imaging, analysis of cerebral spinal fluid for oligoclonal bands, urine organic and amino acid analysis, human T-cell lymphotrophic virus-III (HTLV-III) serology, serum phytanic and very long chain fatty acids, were unremarkable excluding impairments of peroxisomal functions. He drank 40 units of alcohol a week.
Figure 1 (A) Pes cavus. (B) Abdominal computed tomography scan showing the calcified body and tail of the pancreas.
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The patient had a family history of Charcot–Marie–Tooth disease type 1a (CMT1a) in his sister but tested negative for CMT1a and had
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Gut 2008 57: 1080.[Extract] [Full Text] [PDF]
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