Case 02

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               A 62 year old female patient presented to OPD with chief complaints of  sudden onset Left upper and lower limb Weakness since 3 days. Burning and tingling sensation of lower limbs. Difficulty in getting up from bed. bowel and bladder incontinence. No sleep since yesterday.

HISTORY OF PRESENT ILLNESS:-

              Patient was apparently asymptomatic 3days back then she developed sudden onset weakness of both left upper limb and lower limb associated with difficulty in getting up from bed.then she told she could feel the sence of fullness of bowel and bladder but can not control till the attenders lift her to cammod.

She has pain in left lower limb since 2 years and she walks with a stick. She is on medication for that pain.

-Her attender has said that on 3/11/2021 she had a journey of 2 hrs from miryalaguda to narkatpally then the next day she had this weakness.

Her daily routine before this was she daily wakes up by 6.30am in the morning does her household chores and takes her breakfast by 9am and lunch by 2pm and dinner by 8.30pm ,sleeps by 9 or 9.30pm.

No H/o altered sensorium

No seizures

No loss of consciousness

No Headache and neck pain

Not a known case of diabetic, hypertensive, CKD, asthmatic, epileptic

PAST MEDICAL HISTORY:-

She has undergone hysterectomy 20years ago.

She is currently under medication for the pain in lower limb. She is using Predinosolone 5mg,Aceclofenac,Zintac since 2yrs.

GENERAL EXAMINATION:-

On examination : 

Patient conscious, oriented

Bp 130/80mmhg

Pr 88bpm

Spo2 98% on RA

GRBS 319mg/dl

attitude of the left limb externally rotated to left. Deformed Rt ankle.

deformed and swollen joints .

CVS : S1, S1 Heard. No murmurs

2D echo : 

No RWMA

Global hypokinesia 

Moderate AR, TR with PAH

RS : Bilateral Air entry present. B/L IAA crepts present.

Per abdomen : soft and non tender

CNS : 

Patient is conscious, oriented to time,place , person, cooperative.

HMF- normal

Cranialnerves : intact

Motor examination:

                                 Rt.        Lt.

1.Tone

Upper limbs. Normal     hypotonia

Lower limbs. Normal.    Hypotonia

2.power

Upper limbs. 4-/5.   0/5

Lowerlimbs. 4-/5.    0/5

Hand grip. 100%. 0%

3. Reflexes 

                                          Rt. Lt.

 1.Corneal Present. Present

 2. Conjunctival Present. Present

 3. Pharyngeal Present. Present

 4 Palatal. Present. Present 

  

  6. Biceps.            1 +  0 

 7. triceps               1 +   0

  8.supinator            1 +  0

  9. Knee.                  1 +   0

10. Ankle                  1+   0

11 . plantar.      Ext.       Ext

 Cerebellar examination : Normal

Sensory examination:Normal

Autonomic nervous system-Normal

 Spine examination: No tenderness.

Meningeal signs:

Neck rigidity,Kernigs and brudzinski signs -. Negative

Investigations : 

                                      CBP

CUE

RFT

                                    LFT

Treatment

Inj. Optineuron. 1amp OD

IVF 2 units NS , 1 unit RL OD

Tab Ecosprin 150mg po OD

Tab Clopitab 75 mg po OD

Tab Atocor 40mg po OD

Tab pregabalin 75mg H/S

Images are taken from:-

http://drkulkarnithesis.blogspot.com/2021/11/case-x-62f-with-left-hemiparesis.html