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A 19-year-old woman living in a region of Africa in the midst of a severe drought develops leg weakness that progresses over the course of a day to complete inability to move her legs. Examination is notable for cachexia and spastic paraplegia with normal sensory function. Which of the following is the most likely cause of her paraplegia?
Explanation
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Prolonged consumption or insufficiently processed cassava root in the setting of a diet deficient in protein can cause konzo, characterized by the abrupt onset of irreversible spastic paraparesis with sparing of sensory and genitourinary function. Outbreaks continue to occur in rural areas in Africa, particularly regions of agricultural crisis precipitated by drought or war. The myelopathy associated with folate deficiency or HIV infection typically has a subacute time course. Myelopathy is not associated with thiamine deficiency.
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Reference
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Page 93, Goodman BP. Metabolic and toxic causes of myelopathy. Continuum (Minneap Minn). 2015 Feb21(1 Spinal Cord Disorders)84-99. doi 10.121201.CON.0000461086.79241.3b. PMID 25651219.
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Option 1
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Is Correct (Option 1):
Cassava toxicity
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Option 2
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Is Correct (Option 2):
Folate deficiency
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Option 3
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Is Correct (Option 3):
HIV infection
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Option 4
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Is Correct (Option 4):
Thiamine deficiency
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