Total flaccid paralysis of quads on one side

[Diane]

I had never seen this before quite so strarkly, but have now, in a woman in her late 70's who looks quite strong and healthy. She came to me with thigh and knee pain, and a history of falling unexpectedly, a total of 14 times, on the street, needing help to get back up, and no broken bones, at least not so far! She said she doesn't take any medication for the knee ache, it goes away if she drinks a coffee! (Sound circulatory?)

She walks fine on the level, but needs a walker for stability (which I needed to adjust to the right height... deja vu! Reminded me of the good old days in hospital..). Her quads are completely non-functional on the left. No reflex. Nada. Insidious onset over the last year. Her MD is checking it out. Keep a reflex hammer in your drawer for just such occasions. :thumbs_up . The pain mopped up well for now but nothing works motor wise. I found this link. (http://www.pain.com/sections/professional/cme_article/articlefull.cfm?id=256) Can't be good. Is it diabetes, an anurysm of some kind, or a tumor?

Meanwhile, she has done her own side study, a sociological eval of the helpfulness of strangers, which is quite interesting. Women are more helpful than men; men just stand there until she asks them to help her, whereas women tend to simply and instinctively rush in to pick her up no matter how tiny, frail or old and incapable they may be themselves.

[nari]

Diane

Does she have any awareness of her (L) thigh/knee other than the ache?
Doesn't sound diabetic, really, but a SOL is a possibility.
If it is that, what do you think her options are re surgery?

Coffee cures all sorts of things. ;)

Funny about her social survey. In the health centre where I worked, people did fall, primarily the elderly, because of dislodged pavers from tree roots. In all cases, it was the men who ran to help; and women assisted, or went inside to see the receptionist while the man stayed with the fallen person.
One man actually rushed down from the opposite building after a 85 yo woman fell and was most concerned - we found out he was a lawyer.

Nari

[rajulvasa]

Hi diane
This apparently strong lady with no reflex on left knee Quads:
How good or bad is the muscle wasting? compared to the right side?
How about local sensation?
Patient with zero Quads as in poliomyelitis can walk by locking the knee thro' gravity & compensatory actions? how does she compensate when at home? & on outdoor?
her main concern is pain or falls while seeking help from you?
Any EMG report? & any SOL confirmation?

[Diane]

Nari, Does she have any awareness of her (L) thigh/knee other than the ache? Yes. No numbness that I noticed. Just motor.
Doesn't sound diabetic, really, but a SOL is a possibility.
If it is that, what do you think her options are re surgery? I think quite good, she seems healthy, older but not yet frail.

Rajul, This apparently strong lady with no reflex on left knee Quads:
How good or bad is the muscle wasting? compared to the right side? Her quads look about the same, maybe left slightly less fluffy.
How about local sensation? It seems ok, I didn't do formal testing with a cotton ball, or pin prick though.
Patient with zero Quads as in poliomyelitis can walk by locking the knee thro' gravity & compensatory actions? how does she compensate when at home? & on outdoor? She walks fine on a flat surface doing what you describe. She can't do curbs or inclines with out her knee buckling. Since this weakness is recent onset she likely hasn't mastered the deliberate locking and compensation used by polio people.
her main concern is pain or falls while seeking help from you? She came to see me about pain (the pain down the outside of the thigh that coffee didn't help..). I don't do electrotherapy etc. anymore, so won't be treating the paralysis. Any EMG report? & any SOL confirmation? Not yet.