Thread by @hyderabaddoctor

Examining pulse of a patient with “MOTOR NEURON DISEASE” helped me find a cure
1.Motor neuron disease (MND) or amyotrophic lateral sclerosis (ALS), is a progressive neurological disease causing severe weakness and wasting of muscles. It has no cure and results in death in most.

2. A 50-year old man consulted me 6 months ago for a second opinion. He had complaints of difficulty in swallowing, slurred speech, weakness and wasting of muscles of arms and legs, which had progressed over previous 9 months.
#MedTwitter #neurotwitter #ALS #MND

3. He was seen by neurologist and after needle electromyography; diagnosis of ALS was made. In view of grave prognosis, patient wished for second opinion. On examination, he had muscle fasciculation, wasting of tongue, arms and leg muscles. Deep tendon reflexes were exaggerated.

4. General appearance showed an anxious man. Palms were sweaty and pulse rate was high (120/minute). This could have been passed off as anxiety related to illness; however, I decided to further quiz him. He reported 6 kg #weightloss despite eating well and episodes of #diarrhoea.

5. Based on these symptoms, I ordered for #thyroid function tests. Reports showed low thyroid stimulating hormone (TSH), high T4 and T3 levels, confirming my suspicion of #hyperthyroidism (an excess of thyroid hormone production).
#Endotwitter

6. I referred him to an #endocrinologist and patient was started on anti-thyroid medications. Patient showed remarkable improvement at 6 week follow up and most of his symptoms had subsided after three months of anti-thyroid medications.

7. Take home message:
MND (or ALS) carries grave prognosis. Every attempt should be made to look for MND-mimicker. Diagnosis of an MND-mimic can transform the life of someone labelled as MND.
The oldest method of examining pulse of a patient can be valuable in 21st century too.