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Differential diagnosis 31

summer 2000

From nucleus - summer 2000 - Differential diagnosis 31 [p39]

Matthew 8:5,6: A centurion came to Jesus saying 'my servant lies at home paralysed and in terrible suffering'. Jesus healed him in response to his master's faith, but what was the diagnosis?

In this passage we find that the centurion is a man of action as well as a man of faith. If he were to tell his servant to do something then it would be done straight away. We can deduce that the centurion's servant was previously well and presume that the paralysis was not due to trauma, as no injury was mentioned. Though we have no idea as to the extent of the paralysis, we know that the patient was in much distress.

There are a large number of acute non-traumatic causes of paralysis. Periodic muscle weakness can occur due to electrolyte imbalance such as hypokalaemia, thyrotoxicosis, or hypoaldosteronism. If the patient had had recurrent episodes of paralysis associated with abdominal pain and seizures, then an acute porphyria episode must be suspected. Which three of the six types cause acute symptoms and which produce photosensitivity reactions, is known only for exams, but these are unlikely causes.

An acute infection or a spinal cord lesion would be the probable diagnosis. Spinal cord compression typically presents with impaired sensory loss at the level of the lesion, spastic paralysis or clumsy and stiff movement below the level, spinal or radicular pain, urinary hesitancy or frequency and reduced anal tone. Causes can be due to tumours, abscesses, and cervical or thoracic disc disease. Prompt investigation and treatment is needed.

Luke favours an infective cause like a tuberculous spinal abscess or viral infections such as the acute bulbar form of poliomyelitis, or the Guillain-Barré syndrome. The most horrific cause would be due to a rhabdovirus infection where one fifth of patients present with paralytic or dumb rabies. After the prodromal phase, a flaccid paralysis occurs with pain and fasciculation until several days' later when fatal paralysis of the respiratory muscles results.

Differential diagnosis 32

2 Kings 5:1 - The Hebrew word sara'at (translated as leprosy) is used in the Old Testament as a general term for skin diseases, so what could have been the cause of Naaman's ailment?

Luke's opinion in the next issue.

More from nucleus: summer 2000

  • Editorial
  • News review
  • Against the tide
  • Euthanasia
  • Dealing with the dying
  • More tales from Central Asia
  • Testimonies from medical school
  • Differential diagnosis 31
  • Know Your Bible 33
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