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1、NeurologicalcasepresentationDr.ZhangDanNeurologyDept.SirRunRunShawHospitalHistory-1A55-year-oldlefthanddominantmanisevaluatedformusclepainandweakness.Hewasinhisusualstateofhealthuntilfourmonthspriortohisinitialclinicvisitwhenhefirstnotedstiffnessandpaininhiscalve
2、s,thebackofthekneesandlowerthighs.History-2Thepainwasintermittent,lasting10to15secondswithspontaneousresolution,andwasmostprominentintheevenings.Overthenexttwomonths,thepatientbegantohaveincreasingweaknessinhisarmsandlegsinadditionto“achingpain”inhismuscles.Hehad
3、difficultyliftingobjects,openingjars,andtyping.Healsohadincreasingdifficultyclimbingstaircaseandstandingforprolongedperiods.History-3Hissymptomswerepresentthroughoutthedayandwouldwaxandwanewithnoidentifiableprovocativeoralleviatingfactors.Themusclepainandstiffnes
4、sgraduallybecamemorediffuseandspreadtoinvolvehistrunk.Itwasexacerbatedbyphysicalactivityandimprovedwithprolongedrest.Hismusclesweretenderwithpalpationandheevenexperiencedmildchestdiscomfortwhenlyingonhischest.History-4Onemonthpriortohisclinicvisit,hebegantohavein
5、creasedswellingofhislimbsespeciallyinhisfeet,calves,handsandforearms.Hegainedover15poundsovertwoweekspriortohisclinicvisit.Ofnote,thepatientwasevaluatedbyacommunityphysicianwhoperformedserologicstudies,includingserumCPK,whichwereallnormal.History-5Hiselectrodiagn
6、osticstudieswerefelttobesuggestiveof“inflammatorymyositis”andhewasreferredtotheNeuromuscularClinicforfurtherevaluationofpossibleinflammatorymyopathy.History-6Hedeniedhavingfever,chills,nightsweats,jointpainorrash.Hedidnothavediplopia,dysarthria,dysphagia,neckweak
7、ness,lossofmusclebulk,numbness,paresthesia,incoordination,orbowelorbladderincontinence.Hedidhaveaburningsensationonhisforearms,rightmorethanleft,mostnoticeablyintheevenings.ReviewofSystemHedeniedhavingotherrespiratory,cardiovascular,gastrointestinalorurinarysympt
8、oms.PastMedicalHistoryHehadnopriormedicalproblemsRenalcalculiremoval.Traumaticamputationoftheleftindexfingerrequiringsurgicalrepair.Noknowndrugallergies(NKA)So
