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Medical Student Corner
Ataxia
A 53 year old white male is seen in General Medicine
clinic for the chief complaint of inability to keep his balance, which
began suddenly upon awakening two months ago.
Symptoms are described as "feeling like I'm
always disoriented," "going around in circles," and "I
can't even drive anymore."
The patient denies hearing loss, visual changes,
tinnitus, motor or sensory defects, or fever. There are no other symptoms
other than disequilibrium and loss of balance.
No previous episodes are reported.
He now presents for further evaluation and management.
On exam, he appears well-developed and well-nourished.
Vital signs are unremarkable.
Head & neck, throat, chest, heart, abdomen, and
neuro exam are within normal limits.
Laboratory studies, including urinalysis, are normal.
Closer inspection of the patient's extremities
reveals the following:
What's going on?
Answer: Legg-Calve-
Perthes Disease
This man most likely has Legg-Calve-Perthes Disease,
a condition which is usually congenital, but may in some cases be acquired
in later life.
The presence of a mutiple leggs and calves in a patient
whose last name is Perthes is pathognomonic for Legg-Calve-Perthes Syndrome.
Typically, patients will present with disequilibrium
and inability to maintain balance, as the numerous leggs and calves rarely
function in tandem with one another. Often, the first symptom is a sudden
and unexplainable difficulty driving properly.
It is often difficult to detect the presence of multiple
leggs and calves without the use of special radiological equipment; therefore,
a strong clinical suspiscion is invaluable in making the diagnosis.
Treatment involves watchful waiting, as 60% of the
unnecessary leggs and calves will spontaneously remit within three to
five years. During this time, all means of transportation involving the
proper use of the lower extremities should be avoided.
Unfortunately, Legg-Calve-Perthes disease cannot
be cured, and the number of leggs and calves has been known to exceed
100 pairs in extreme instances.
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