A 45 YEAR OLD FEMALE WITH PARAPARESIS SECONDARY TO TRAUMA ASSOCIATED WITH DYSPHAGIA

C/O Generalized weakness of lower limbs since 10 years

Difficulty in swallowing since 15 days 

HOPI:

Pt was apparently asymptomatic till 1999  then she delivered a baby(by c-section due to cord entanglement)  she also stated that she started  developed Generalized weakness ( due to low haemoglobin levels ) not associated with pain and was able to perform her daily activities

Her husband also left as she couldn't perform her daily activities.Her son currently stays in the hostel 


 She previously used to work as mandal officer.


And in 2012 she stopped going to work because she started developing weakness  insidious in onset , gradually progressive , associated with pain , Aggrevated with walking and relieved with rest. she could not walk for long distances and she managed to  to perform  daily activities

In 2023 Jan she alleged had h/o slippage in bathroom following which she was normal for 5 days 

Next day she couldn't get up from bed which is sudden in onset and non progressive and couldn't be able to perform her daily activities because of pain mainly and weakness of both the lower limbs.

Patient was taken to the nearby hospital and 

X ray was done which is told to benormal 

MRI was also done 

Patient then complained of anuria for which foleys catherisation was done the she was able to pass urine 

After 10 days she then developed difficulty in swallowing (more to solids ) associated with pain 

No h/o giddiness,LOC, head injury

No history of involuntary movements



PAST HISTORY 

N/k/c/o DM, HTN, thyroid disorders, CVA ,CAD, TB ,EPILEPSY


PERSONAL HISTORY 


diet: mixed


appettite: decreased 


bowel and bladder: regular


sleep: adequate


no addictions

DAILY ROUTINE: 

She used to get up daily @6.30 am and do all the house hold chores and send children to school and used to go to work around 9 am and used to visit few Villages and come home in the evening afterAnd in 2012 she stopped going to work because she started developing weakness insidious in onset , gradually progressive , associated with pain , Aggrevated with walking and relieved with rest. she could not walk for long distances so she stopped working and used to the house hold chores with pain.

GENERAL EXAMINATION:

Patient is consious, coherent, and cooperative 

moderately built and moderately nourished 

Butterfly like rash present over the cheeks since 6yrs.

Pallor - present





Icterus-absent




Cyanosis - absent




Clubbing-absent




Lymphadenopathy -absent

edema -absent












vitals 

Temperature - Afebrile

Pulse - 83bpm

Blood pressure- 130/80 mmhg

Respiratory rate- 17 cycles per min

Spo2 - 99%



SYSTEMIC EXAMINATION 

CVS -s1s2 heard,no murmurs


RS-bae+,nvbs heard


P/A-soft,non tender,no organomegaly


CNS 

On examination.            R.                     L

TONE

UPPER LIMB.                     N.                    N

LOWER LIMB.                    N.                    N

POWER 

UPPER LIMB.                        5/5.                 5/5

LOWER LIMB.                       2/5.                 2/5


REFLEXES 


               Rt                       Lt

B           +++                     +++

T           ++                        ++

S.            +.                          +

K.             -                           -

A.              -                           -

P.         Flexion             Flexion

INVESTIGATIONS:










Chest x ray 
PA VIEW 


X RAY OF BOTH THE HIPS 




ECG 


                                   USG 


Previous MRI done on 15/03/23









Provisional diagnosis: 

CHRONIC PARAPARESIS WITH DYSPHAGIA UNDER EVALUATION .



Comments

Post a Comment

Popular posts from this blog

19 year old male with fever and lower back pain

Image
19 Year old male with fever and lower backache December 01,2022  This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan This is a case of 19 year old male from mirylaguda who is intermediate second year student came to general medicine OPD with chief complaints of :
Read more

A 25 YEAR OLD MALE PATIENT WITH YELLOWISH DISCOLORATION OF EYES AND URINE, ABDOMINAL DISTENSION AND SOB

Image
 A 25 year old male who is a resident of yadagirigutta Mason by occupation came to casualty with chief complaints of :  *DISTENSION OF ABDOMEN SINCE 6 DAYS  *SHORTNESS OF BREATH SINCE 6  DAYS   *YELLOWISH DISCOLORATION OF EYES AND URINE SINCE 6 DAYS  •HISTORY OF PRESENTING ILLNESS  : Patient is apparently asymptomatic 3 months ago he then developed abdominal distension which is insidious in onset and gradually progressive associated with shortness of breath 3 months back which is of grade 2 and it progressed to grade 3 over 3 months .He also has yellowish discoloration of eyes and urine 6 days back .He also has similar complaint 4 months ago for which he took herbal medication for a week and the symptoms subsided and  he also  stopped drinking for 7 days after that he continued drinking .He also complaints of fever 3 months back which is intermittent which is not associated with chills and rigors for 2- 3 days  And cough which is non productive 10 days back .  Vomiting 2to 3 episodes p
Read more