Ataxia

October 4, 2000

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.

Remember: Quality Without The Q Is Just Uality!