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Here is a case i have seen:

62 yr old male came to the opd with c/o of tingling and numbness of both upper and lower limbs since 15 days .

Noticed weakness in both upper and lower limb since 3 to 4 days .

Patient was apparently well 15 days back and developed tingling sensation in left index finger which was insidious in onset and gradually progressive to hand 5 days later tingling and numbness started in right hand which was also insidious in onset and gradually progressive on increasing pattern they went to local medical shop and took some medication on not responding they went to nalgonda government hospital and then to a local rmp . Tingling and numbness progressed to both lower limbs after 2 days on still not responding to it they went to Ayurvedic doctor and later presented to opd  with C/o tingling and numbness in b/l upper limbs till MCP joint and upto ankle joint in both lower limbs.

There was a h/ o fall 3 days back on lifting heavy weight and was accompanied by his wife and son.


Past history:-

K/c/o of epilepsy on regular medication since 30 years 

Tab . Phenytoin 200 mg OD

Last seizure episode 6 months back 

Not a k/c/o of DM , HTN ,  asthma , TB 

Personal history:-

Diet : mixed

Sleep : adequate

Bowel and Bladder : regular

Occasional Alcoholic


On examination:-

Temp: Afebrile

PR : 68bpm, normal volume, regulad

BP : 110/70 mmhg

RR : 22/min

SpO2  99%on RA

CVS : S1 S2 +, NO MURMURS

RS : BAE+, NVBS

P/A : SOFT, NON TENDER

CNS :

orientated to time, place, person

Speech normal

Memory immediate+, recall+, recent+


Motor

Bulk normal

Tone increased in both upper and lower limbs

Power                R.           L

Upper limb.       3/5.        3/5

Lower limb.      - 4/5.       - 4/5

Reflexes  B   T.  S.     K.   A.    Plantar 

         UL.  3+. 3+. 3+. 3+  2+.    Mute.    

         LL.  3+. 3+. 3+. 3+  2+.    Mute

Pectoral reflex right 2+

                           Left 3+

Scapular reflex right 2+

                            Left 3+

Jaw jerk absent

Superficial:

                    Corneal present

                    Conjunctival present

                   

SENSORY

Posterior column

Proprioception right upper limb +

                                     Lower limb  -

                             Left upper limb   -

                                     Lower limb  -

Vibration sense lost in upper and lower limbs

                             Sternal present

                             Mastoid present

Anterior spinothalamic tract

Pain. Upper limb absent upto wrist on both sides

          Lower limb absent upto knee on both sides

Crude touch upper limb absent upto wrist on both sides

Lower limb absent upto ankle


Cortical stereognosis+


Cerebellum:

No finger nose in coordination

No finger finger incoordination

Dysdiadokinesia absent










Investigations:
Hb - 11.5
Tlc- 8500
Plt -2.22
Rbs- 89

RFT: 
Urea - 26, creat-1.0 uric acid -2.5,ca-10.1 ,Na-138, K -4.0 ,Cl-101

LFT ON 28/09
TB-0.44, DB-0.20,ALP-145 ,SGOT -18 ,
SGPT -16 , Alb-4.0 ,A/G - 1.41
Cue-
Puscells-2-3
Albumin - nil
Sugar - nil

MRI BRAIN





MRI CERVICAL SPINE



Xray





Ecg 



USG abdomen


Treatment :
1.inj optineuron 1amp in 100ml NS/IV/OD
2.inj pantop 40mg /IV/OD
3.BP /PR/SPO2 charting 6th hourly
4.GRBS charting 8th hourly
5.tab pregabalin 75mg H/S
6.tab eptoin 100mg /PO/OD

On examination:

Temp: Afebrile

PR : 68bpm, normal volume, regulad

BP : 110/70 mmhg

RR : 22/min

SpO2  99%on RA

CVS : S1 S2 +, NO MURMURS

RS : BAE+, NVBS

P/A : SOFT, NON TENDER

CNS :orientated to time, place, person

Speech normal

Memory immediate+, recall+, recent+

Motor

Bulk normal

Tone increased in both upper and lower limbs

Power                R.           L

Upper limb.       3/5.        3/5

Lower limb.      - 4/5.       - 4/5

Reflexes  B   T.  S.     K.   A.    Plantar  

 UL.           3+. 3+. 3+. 3+  2+.    Mute.   

  LL.          3+. 3+. 3+. 3+  2+.    Mute

Pectoral reflex right 2+

                             Left 3+

Scapular reflex right 2+

                              Left 3+

Jaw jerk absent

Superficial:   Corneal prsent 

                        Conjunctival present 

SENSORY

Posterior column

Proprioception right upper limb +

 Lower limb  -

Left upper limb   -   

 Lower limb  -

Vibration sense lost in upper and lower limbs

   Sternal present

  Mastoid present

Anterior spinothalamic tract

Pain. Upper limb absent upto wrist on both sides

          Lower limb absent upto knee on both sides







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