Question:medium
A 55-year-old patient from Chattisgarh presents with progressive muscle weakness, stiffness of both lower limbs, and complete paralysis. What is the most important history to ask?
A 55-year-old patient from Chattisgarh presents with progressive muscle weakness, stiffness of both lower limbs, and complete paralysis. What is the most important history to ask?
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Consider an endemic neurological disease in Chattisgarh linked to consumption of a specific drought-resistant legume.
Updated On: Jun 23, 2026
- Dietary history
- Medical history
- Present illness
- Socioeconomic history
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The Correct Option is A
Solution and Explanation
Geographic and dietary clue approach:
The clinical triad here is: Chattisgarh + lower limb spastic paraplegia + progressive course. This is the classic presentation of Neurolathyrism.
Pathophysiology:
Why dietary history is the key question:
Unlike medical conditions that require detailed past medical or drug history, neurolathyrism is diagnosed almost entirely by establishing prolonged dietary exposure to $Lathyrus sativus$. No specific lab test confirms it; the diagnosis rests on: (1) endemic area, (2) characteristic diet, and (3) clinical features.
Prevention is by reducing lathyrus content in diet and detoxifying the seeds.
\[\boxed{\text{Dietary history}}\]
The clinical triad here is: Chattisgarh + lower limb spastic paraplegia + progressive course. This is the classic presentation of Neurolathyrism.
Pathophysiology:
- Causative food: $Lathyrus sativus$ (khesari dal, grass pea) -- a cheap, drought-hardy legume consumed heavily during famines
- Toxin: ODAP (beta-N-oxalyl-amino-L-alanine) -- a structural analogue of glutamate; causes excitotoxic damage to upper motor neurons (corticospinal tract)
- Result: Spastic paraplegia with preserved sensation and sphincter control (pure upper motor neuron disease)
Why dietary history is the key question:
Unlike medical conditions that require detailed past medical or drug history, neurolathyrism is diagnosed almost entirely by establishing prolonged dietary exposure to $Lathyrus sativus$. No specific lab test confirms it; the diagnosis rests on: (1) endemic area, (2) characteristic diet, and (3) clinical features.
Prevention is by reducing lathyrus content in diet and detoxifying the seeds.
\[\boxed{\text{Dietary history}}\]
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