8/6/2019 Noon 1July2011
1/18
July 1, 2011
8/6/2019 Noon 1July2011
2/18
32 . .
8/6/2019 Noon 1July2011
3/18
1
8/6/2019 Noon 1July2011
4/18
15 ( 5)
5-6
8/6/2019 Noon 1July2011
5/18
. Enalapril,
ASA, Vit.B
1
.
8/6/2019 Noon 1July2011
6/18
IVDU , unsafe sex
8/6/2019 Noon 1July2011
7/18
40( 2-3 )
30 (?)
4
8/6/2019 Noon 1July2011
8/18
V/S : BT36.8oC, BP 123/79 mmHg,
PR 87 bpm, RR 18 /min
GA : A Thai male, fully concious
HEENT: Not pale conjunctivae, anicteric sclerae,superficial lymph node impalpable, no oral thrush
Heart : RegularS1S2, no murmur
Lung : Normal breath sound, no adventitious sound
Abdomen: Soft, not tender, liver and spleen not palpable Ext : Muscle atrophy both arms, forearm, intrinsic muscle
both hands
Muscle atrophy both thigh (calf muscle not atrophy)
No rash, no pitting edema, no point of tenderness
8/6/2019 Noon 1July2011
9/18
Neurological Exam:
- Fully conscious, normal speech
- Pupil 3mm RTLBE, VA normal both eyes- CN intact, no nystagmus, full EOM both eyes
- Intact pin-prick sensation and propioception
- DTR decrease (absent to 1+) all
- Clonus negative , BBK plantar flexion both
8/6/2019 Noon 1July2011
10/18
Motor Power Right Left
Deltoid I II
Biceps III III
Triceps III III
Wrist extension III IIIWrist flexion III III
Hand grip IV IV
Hip Flexion I I
Quadriceps II II
Hamstring II III
Tibialis anterior II III
Gastrosoleus II III
EHL II III
Toes flexion V V
8/6/2019 Noon 1July2011
11/18
Progressive symmetrical proximal muscleweakness
8/6/2019 Noon 1July2011
12/18
CBC
Hct 44.4 %
Hb 14.8 g/dL
WBC 7900 /ul (N 67%, L 20%, Mono 6%)
Plt 249,000 /ul
MCV 93.5 fl
RDW 13.9Normochromic Normocytic
8/6/2019 Noon 1July2011
13/18
Electrolyte
BUN /Cr 11.8/0.5
Na 138K 4.3
Cl 103
HCO3 27.8
Ca 10.2Mg 2.3
PO4 3.8
LFTTP 8.7
Alb 5.0Glob 3.7
Chol 174
TB/DB 0.4/0.1
AST 49
ALT 28
ALP 81
8/6/2019 Noon 1July2011
14/18
CK : 1514
Coagulation : PT 11.56
INR 1.12PTT 30.15
ESR : 13
HbA1C : 5.5
8/6/2019 Noon 1July2011
15/18
8/6/2019 Noon 1July2011
16/18
Chest X-Ray :No cardiomegaly, no pulmonary infiltration
Echocardiography :LV dilated with global hypokinesiaLVEF 22.8%, no valve lesionRA+RV+LA normalImp : DCM
8/6/2019 Noon 1July2011
17/18
progressive proximal muscleweakness.. Locate lesion LMN
muscle congenital vs acquired congenital muscular dystrophy distribution muscle involved
congenital muscular dystrophySummary: Becker delayed
onset pattern confirm muscle biopsy
8/6/2019 Noon 1July2011
18/18