55M with Rt upper limb & lower limb weakness with k/c/o DM and HTN.

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 


Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 


This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. 


55 years old male presented with complaints of weakness of right upper limb and lower limb since 1 day and tingling & numbness of right upper limb and lower limb since 1 day.

Patient was apparently a symptomatic one day back when he suddenly after getting up from bed, patient felt difficulty in walking, right-sided weakness of upper & lower limbs associated with tingling and numbness which is acute onset non-progressive with deviation of mouth to left.

no loss of consciousness 

no seizures no difficulty in swallowing 

no bowel and bladder abnormalities 

able to do these activities like combing hair, buttoning & unbuttoning Of shirt, climbing stairs, rolling over bed, slippage of chapel was present 

no history of fever,trauma,vomitings and diplopia.

K/c/o HTN since 8 years on T. Telma AM 40/5mg OD 

K/c/o DM since 3 months on Glimi-M1 OD 

N/k/c/o CVA,CKD,Asthma


O/E: 

Pt c/c/c

Bp 140/80mmhg

PR : 78bpm

Pedal edema +





CVS : S1,S2 heard, apex beat Lt 5 ICS midclavivular, no murmurs.

Rs : BAE+, all lung zones are clear on auscultation.

P/A : soft & non tender, no organomegaly, bowel sounds+

CNS: 

HMF INTACT, oriented to time,place,person.

B/L pupils reactive to light.

Palmer grip 100% in both hands.

                             Rt                         Lt

Tone  UL              N                          N

          LL               N                         N

power   UL           5/5                       5/5

             LL           4/5                       5/5

Reflexes 

Biceps       3+             2+

Triceps      2+             2+

Supinator   2+             2+

Knee          3+             3+

Ankle         1+             1+

Planter        ?E             F

No cerebellar signs

No meningial signs

Sensory system intact.


CBP : 





CUE : 




USG ABDOMENM 




Sr. Electrolytes:



Sr. Creatinine :





Hba1c : 



ECG :



Graphical time line : 


CT BRAIN (OUTSIDE)



Treatment: 


Inj. Optineuron 1amp in 100ml NS iv OD 


Tab. PAN 40 mg OD


Tab. Metformin 500mg OD 


Tab. Telma-am 40/5 mg OD 


Tab. Clopitab-A 75/150 mg OD HS


Tab. Atorvas 4omg HS


Physiotherapy of Rt upper limb & lower limb.


Vitals & grbs monitoring.



Comments

Post a Comment

Popular posts from this blog

DISSERTATION 2020-2022.

Image
DISSERTATION  Dr. Saicharan Kulkarni pgy1 ( 2020 ) TITLE OF THE TOPIC :   CLINICO-RADIOLOGICAL PROFILE, RISK FACTORS AND OUTCOMES IN PATIENTS WITH MOTOR WEAKNESS BRIEF RESUME OF THE INTENDED WORK Problem Representation  1)The repercussions of paralysis/weakness are enormous, both personally to the individual and to their family; and have huge economic costs to society. Paralysis takes many forms with multiple disorders causing paralysis, and multiple body systems often affected. (1,)   2) Motor learning is considered crucial for rehabilitation in general. In stroke, motor learning does not refer to the acquisition of new skills, but to the re-learning process of a previously acquired movement pattern .(2)   3) 3.  Though both clinical evaluation and MRI are complimentary in detection and precise localization of the level of lesion in patients with cervical myelopathy, there is paucity of data comparing segment specific clinical features with the MRI abnormalities in cervical myelopath
Read more

case x - 62F with left hemiparesis

Image
62 F brought to casuality with 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. 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..  No H/o altered sensorium No seizures No loss of consciousness No Headache and neck pain Not a known diabetic, hypertensive, CKD, asthmatic, epileptic 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
Read more

Case 27 15 yr boy with Paraplegia and a history of Fever

Image
  This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. Here is a case i have seen: A 15 year old boy presented to the Opd at 2pm with the complaints of Slippage of footwear since 6 months Difficulty in walking since 6 months  Difficulty to get up from bed since 6 months Patient is in his 8th grade at a government school at a local village.  His parents work as Masons at a local village. He has an elder brother who is studying degree and a younger sister who is in her 10th grade. He was apparently completely alright 6 year
Read more