In this online e-logbook, we upload our patients de-identified health data shared after taking his/guardian's signed informed consent. Here we discuss our individual patient problems through series of inputs from an available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence-based inputs.

               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


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