Neurological Disorders: A Case Study of Sensory Loss in a Young Girl - Neurosurgery

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Loss of sensation in the body?


A 12-year-old girl experienced an unexplained fall down the stairs at the beginning of January this year, initially reporting only back pain.
Two hours later, she began to feel numbness in her toes.
After being taken to the emergency room, she was diagnosed with spinal cord injury by a neurosurgeon three days later, as she developed loss of sensation below the nipples, weakness in her limbs, and underwent steroid treatment and rehabilitation.
By early April, she had only lost sensation below the right hip joint but could move normally, although she occasionally experienced sudden weakness in her legs and a tingling sensation in her feet when standing.
About two months later, this sensation disappeared completely, resulting in total numbness.
By the end of August, she suddenly lost sensation in her left big toe, which progressively extended upwards.
During this period, she received high-dose steroid treatment (1000 mg) at Chang Gung Memorial Hospital and Taipei Veterans General Hospital, along with nerve conduction studies, electromyography, MRI of the head and neck, lumbar puncture, blood immune tests, urinalysis, heavy metal testing, and evoked potential tests, all of which showed no significant issues except for nerve conduction problems above the lumbar region.

She was hospitalized for a month in two different hospitals for further examination.
During her hospitalization, she had complete loss of sensation below the clavicles (no pain, touch, temperature, or deep sensation), but she retained sensation from her shoulders to her fingertips and had some sensation in the upper back.
The doctor at Chang Gung diagnosed her with neuropathy, while the doctor at Taipei Veterans General Hospital noted abnormal sensations in the lower limbs.
However, since her discharge on September 28, her condition has worsened significantly.
Currently, she has complete loss of sensation below the neck, with no sensation in the back of her neck, and her scalp has a sensation of warmth in some areas while feeling cold.
A small area near her right ear is also numb.
Both legs (below the hip joint) frequently become immobile for periods throughout the day, and her lower back experiences similar episodes, though less frequently.
The duration and frequency of these episodes are increasing.
In the past two days, her hands have also started to experience episodes of immobility several times a day.
During these episodes, she does not feel weak but rather stiff, maintaining a fixed posture; for example, if she is writing and I move the table, her hand remains in the writing position like a statue.
However, if I help her make a "Y" gesture, she can hold it until she is almost able to move again.
Additionally, three notable occurrences have happened: 1.
After her recent discharge, she reported feeling a slight electric current traveling down her spine to the area that becomes numb before losing sensation, although she has not mentioned this when the area above her neck is numb.
2.
Once, when I went out to buy groceries for about an hour, I returned home at 12:35 PM to find her slumped on the floor in a sitting position.
She did not respond when called, turned her head with her eyes open but not focused, and after a second, she seemed to "wake up." When asked about the previous half hour, she had no memory of it, only recalling that her legs were immobile at 12:03 PM (as I had instructed her to note any changes).
She then continued to play with nail polish but had capped it without being aware.
3.
On National Day, around 7 PM, she was standing but unable to move her neck or anything below it for a few seconds.
She has a history of being physically weak, with frequent upper respiratory infections requiring hospitalization, and once had a fever of 43 degrees Celsius during a hospital stay, although she did not suffer any apparent sequelae.
In third grade, she fainted at school, describing her vision as resembling a black-and-white television before losing consciousness.
When she woke up, she was already in the nurse's office.
She has experienced several episodes of black-and-white vision and dizziness since then.
Due to her previous fainting incidents, the school allowed her to rest whenever needed, attributing it to low blood pressure, although she had not yet entered puberty and was not ill at the time.

Could there be a connection between her past fainting episodes and her current condition? Where should I take her for further evaluation? Have you encountered similar cases before? I have provided as much detail as possible, and I would greatly appreciate your advice.
Thank you sincerely.

Binlin Bengkuai de Mama, 40~49 year old female. Ask Date: 2016/10/11

Dr. Zhang Junwei reply Neurosurgery


This case is complex, and Taipei Veterans General Hospital and Chang Gung Memorial Hospital are already the best hospitals in the country.
I'm not sure how to proceed with the treatment, I apologize!

Reply Date: 2016/10/11

More Info


The case you presented regarding the 12-year-old girl who experienced sensory loss and other neurological symptoms following a fall is indeed complex and concerning. Based on the symptoms described, it appears that she may be experiencing a combination of neurological issues that could stem from her initial spinal injury, as well as potential underlying conditions that have not yet been fully diagnosed.


Understanding the Symptoms
1. Sensory Loss: The loss of sensation below the nipple line and the progressive loss of feeling in her limbs suggest a possible spinal cord injury or a neurological disorder affecting the peripheral nerves. The fact that she initially had sensory loss in her lower extremities and now is experiencing loss in her upper body indicates a potential progression of the condition or a secondary issue that needs to be addressed.

2. Motor Dysfunction: The episodes of her legs and arms being unable to move, described as a "stiffness" rather than weakness, could indicate a neurological phenomenon known as "catatonia" or a form of dystonia, where the muscles become rigid and unresponsive. This could also be related to her spinal injury or a separate neurological disorder.

3. Memory Loss and Unresponsiveness: The episodes where she appears unresponsive and has no memory of events can be indicative of dissociative episodes or seizures. The description of her experiencing a "current" sensation before losing feeling in a body part is particularly concerning and may suggest a neurological event occurring prior to the loss of sensation.

4. Previous Medical History: Her history of fainting spells and respiratory infections could be relevant. The fainting episodes, especially if they were accompanied by visual disturbances, might suggest a predisposition to neurological issues or autonomic dysfunction.


Recommendations for Further Evaluation
Given the complexity of her symptoms and the potential for serious underlying conditions, it is crucial to seek specialized medical care. Here are some recommendations:
1. Neurology Consultation: A pediatric neurologist should be consulted as they specialize in diagnosing and treating neurological disorders in children. They can perform a comprehensive evaluation, including advanced imaging studies (MRI of the brain and spine) and possibly a lumbar puncture to analyze cerebrospinal fluid for any signs of infection or autoimmune conditions.

2. Neuropsychological Evaluation: Given her memory lapses and episodes of unresponsiveness, a neuropsychological assessment may be beneficial. This can help determine if there are cognitive deficits or other psychological factors contributing to her symptoms.

3. Physical Rehabilitation: Engaging in a structured physical therapy program may help improve her motor function and address any physical limitations resulting from her condition. Occupational therapy may also be beneficial to help her regain independence in daily activities.

4. Multidisciplinary Approach: Involving a team that includes neurologists, physical therapists, occupational therapists, and possibly psychologists will provide a comprehensive approach to her care. This can ensure that all aspects of her health are addressed, including physical, cognitive, and emotional well-being.

5. Monitoring and Support: Continuous monitoring of her symptoms and providing emotional support is essential. Keeping a detailed log of her symptoms, including when they occur and any potential triggers, can be helpful for her medical team in understanding her condition better.


Conclusion
The situation you described is indeed alarming and requires immediate and thorough medical evaluation. The combination of sensory loss, motor dysfunction, and memory issues suggests that there may be a significant underlying neurological condition that needs to be diagnosed and treated promptly. Please ensure that she receives the appropriate referrals to specialists who can provide the necessary care and support. Your proactive approach in seeking help for her is commendable, and with the right medical intervention, there is hope for improvement in her condition.

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