50/F WITH BACKACHE SINCE 20 DAYS AND INABILITY TO USE ALL FOUR LIMBS SINCE 10 DAYS.
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Unit 6 admission:
Interns
K. Nikhil reddy
K.Divya
M. Swarna
B.Manivarma
Juveria
Dr. Manasa(pgy1)
Dr. Rashmitha (pgy2)
Dr. Sai Radha(pgy3)
Dr. Arjun kumar (asst.prof.)
Dr.Rakesh Biswas (HOD)
A 50 year old female , labourer by occupation, came to casuality with Chief complaints of backache since 20 days, inability to use all four limbs since 10 days.
Patient was apparently asymptomatic 2 months back, later she developed backache, sudden in onset, gradually progressive for which she went to local hospital and relieved with medication.Now again ,she complaints of backache since 20 days, took some medication and didn't get relieved.
H/o proximal Lowerlimb weakness since 10 days,sudden in onset, gradually progresed in order--proximal lower limbs -distal lower limbs-proximal upper limbs -distal lower limbs.D
Difficultyin combing of hair ,taking food to mouth.
Difficulty in buttoning and unbuttoning, mixing of food.
Difficulty in squatting, getting up from squatting position,climbing stairs up and down .
Difficulty in wearing of chappals+,tripping of toes+.
Difficulty in lifting the head off the pillows +.
Difficulty in rolling over bed, getting up from bed+.
No difficulty in breathing.
No diurnal variation of weakness, but gets relief after tramadol injection for 2 hours.
Past history:
Not a k/c/o DM,HTN, TB, asthma, epilepsy, CAD, CVA.
H/o Total abdominal hysterectomy with bilateral salpingo-oophorectomy due to DUB UNDER SA in 2009.
General examination:
Nno pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema.
Vitals:
Temperature:99F
BP:110/80mmHg.
PR:78 bpm
RR:30 cpm
Spo2:98%at room air
GRBS:100 mg/dl.
Systemic examination:
CNS:
Patient is conscious, oriented to time,place , person, cooperative.
HMF- normal
Cranialnerves : intact
Motor examination:
Rt. Lt.
1.Tone
Upper limbs. Normal Normal
Lower limbs. Normal. Normal
2.power
Upper limbs. 4-/5. 4-/5
Lowerlimbs. 4-/5. 4-/5
Hand grip. 100%. 100%
3. Reflexes
Rt. Lt.
1.Corneal Present. Present
2. Conjunctival Present. Present
3. Pharyngeal Present. Present
4 Palatal. Present. Present
5.plantar Flexor flexor
6. Biceps 2+ 2+ 7. triceps 2+ 2+
8.supinator. 2+ 2+
9. Knee. 2+ 2+
10. Ankle 2+ 2+
11 . plantar. Flexor. Flexor.
Cerebellar examination : Normal
Sensory examination:Normal
Autonomic nervous system-Normal
Spine examination: No tenderness.
Meningeal signs:
Neck rigidity,Kernigs and brudzinski signs -. Negative.
CVS: S1, S2HEARD, no murmurs.
RS: BAE+,NVBS HEARD.
P/A: SOFT, NON TENDER, BOWEL SOUNDS+.
Investigations:
ECG
HMF- normal
Cranialnerves : intact
Motor examination:
Rt. Lt.
1.Tone
Upper limbs. Normal Normal
Lower limbs. Normal. Normal
2.power
Upper limbs. 4-/5. 4-/5
Lowerlimbs. 4-/5. 4-/5
Hand grip. 100%. 100%
3. Reflexes
Rt. Lt.
1.Corneal Present. Present
2. Conjunctival Present. Present
3. Pharyngeal Present. Present
4 Palatal. Present. Present
5.plantar Flexor flexor
6. Biceps 2+ 2+ 7. triceps 2+ 2+
8.supinator. 2+ 2+
9. Knee. 2+ 2+
10. Ankle 2+ 2+
11 . plantar. Flexor. Flexor.
Cerebellar examination : Normal
Sensory examination:Normal
Autonomic nervous system-Normal
Spine examination: No tenderness.
Meningeal signs:
Neck rigidity,Kernigs and brudzinski signs -. Negative
RS:BAE+, NVBS HEARD
CVS: S1, S2 heard, no murmurs.
P/A:soft, non tender, no organomegaly.
HMF- normal
Cranialnerves : intact
Motor examination:
Rt. Lt.
1.Tone
Upper limbs. Normal Normal
Lower limbs. Normal. Normal
2.power
Upper limbs. 4-/5. 4-/5
Lowerlimbs. 4-/5. 4-/5
Hand grip. 100%. 100%
3. Reflexes
Rt. Lt.
1.Corneal Present. Present
2. Conjunctival Present. Present
3. Pharyngeal Present. Present
4 Palatal. Present. Present
5.plantar Flexor flexor
6. Biceps 2+ 2+ 7. triceps 2+ 2+
8.supinator. 2+ 2+
9. Knee. 2+ 2+
10. Ankle 2+ 2+
11 . plantar. Flexor. Flexor.
Cerebellar examination : Normal
Sensory examination:Normal
Autonomic nervous system-Normal
Spine examination: No tenderness.
Meningeal signs:
Neck rigidity,Kernigs and brudzinski signs -. Negative
RS:BAE+, NVBS HEARD
CVS: S1, S2 heard, no murmurs.
P/A:soft, non tender, no organomegaly.
HMF- normal
Cranialnerves : intact
Motor examination:
Rt. Lt.
1.Tone
Upper limbs. Normal Normal
Lower limbs. Normal. Normal
2.power
Upper limbs. 4-/5. 4-/5
Lowerlimbs. 4-/5. 4-/5
Hand grip. 100%. 100%
3. Reflexes
Rt. Lt.
1.Corneal Present. Present
2. Conjunctival Present. Present
3. Pharyngeal Present. Present
4 Palatal. Present. Present
5.plantar Flexor flexor
6. Biceps 2+ 2+ 7. triceps 2+ 2+
8.supinator. 2+ 2+
9. Knee. 2+ 2+
10. Ankle 2+ 2+
11 . plantar. Flexor. Flexor.
Cerebellar examination : Normal
Sensory examination:Normal
Autonomic nervous system-Normal
Spine examination: No tenderness.
Meningeal signs:
Neck rigidity,Kernigs and brudzinski signs -. Negative
RS:BAE+, NVBS HEARD
CVS: S1, S2 heard, no murmurs.
P/A:soft, non tender, no organomegaly.
HMF- normal
Cranialnerves : intact
Motor examination:
Rt. Lt.
1.Tone
Upper limbs. Normal Normal
Lower limbs. Normal. Normal
2.power
Upper limbs. 4-/5. 4-/5
Lowerlimbs. 4-/5. 4-/5
Hand grip. 100%. 100%
3. Reflexes
Rt. Lt.
1.Corneal Present. Present
2. Conjunctival Present. Present
3. Pharyngeal Present. Present
4 Palatal. Present. Present
5.plantar Flexor flexor
6. Biceps 2+ 2+ 7. triceps 2+ 2+
8.supinator. 2+ 2+
9. Knee. 2+ 2+
10. Ankle 2+ 2+
11 . plantar. Flexor. Flexor.
Cerebellar examination : Normal
Sensory examination:Normal
Autonomic nervous system-Normal
Spine examination: No tenderness.
Meningeal signs:
Neck rigidity,Kernigs and brudzinski signs -. Negative
RS:BAE+, NVBS HEARD
CVS: S1, S2 heard, no murmurs.
P/A:soft, non tender, no organomegaly.
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