DISSERTATION 2020-2022.

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 myelopathy.(3)

 

 4) In neurological rehabilitation, patients can be presented with diverse combinations of physical, cognitive, communicative and behavioural impairments, which may impact on rehabilitation potential.(4)

 

5) A standardised assessment of neurological impairment may provide an opportunity to control differences in case-mix and so assist interpretation of functional gains in different populations.(5)

Outcomes of motor paralysis/weakness usually are Normal function, affecting high level functions only, significant limitation but some useful function and little or no useful function(5)

 

6.2  Aims and objectives of the study

 AIM OF THE STUDY 

1.To study the clinical Features and radiological features of the patient with motor Weakness 

OBJECTIVES OF THE STUDY

1. To study the Risk factors in patients with motor Weakness

 2. To study the outcome of the Patient with motor Weakness 

  

6.3 Study design of the topic

Non experimental, Qualitative Study 

 

  Inclusion criteria

 1.All patients with Motor Weakness

 2.All age groups more than 18years

 3.Patients of Both Genders

Exclusion criteria

 AGE GROUP LESS THAN 18 YEARS

 

Sample size and duration of the study

 Proposed No. of cases to be studied = 50

November 2020- October 2022

 

MATERIALS  &  METHODSS

Sourceof the data :

Department of General Medicine

Kamineni institute of medical sciences,

Narketpally, Nalgonda(Dist), Telangana.  

 

  Investigations Required

 1. Complete blood picture

2. Complete urine examination 

3. Chest x ray

4. ECG 

5. MRI/CT SCAN

6. Fasting blood sugar (in selected Pt’s)

7. Post prandial blood sugar (in selected Pt’s)

8. Serum Electrolytes 

9. Fasting Lipid Profile (in selected Pt’s)

10.HbA1C (in selected Pt’s) 

11.2D-ECHO

12.Carotid artery Doppler

LINK FOR MASTER CHART : 

master chart

PATIENT INFORMATION SHEET

English:

English consent form

Telugu:

Telugu consent form

Template of this "patient information sheet" is borrowed from this website:

https://www.ncbi.nlm.nih.gov/books/NBK261334/

And modified accordingly to my thesis topic.

OBSERVATIONS

 

A total of 50 patients with motor weakness and their clinical features, radiological features, risk factors and outcomes were included in the study.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table No.1 : ANALYSIS OF MOTOR WEAKNESS CASES BASED ON AGE (n=50)

 

 

AGE (in years)	Frequency	Percentage(%)
18-29	10	20%
30-39	04	8%
40-49	05	10%
50-59	12	24%
60-69	13	26%
70 and above	06	12%
Total	50	100%

 

 

 

Table No.2 : ANALYSIS OF CASES BASED ON GENDER (n=50)

 

 

Gender	Frequency	Percentage(%)
Male	31	62%
Female	19	38%
Total	50	100%

 

 

Between Nov 2020 and Oct 2022, 50 patients with motor weakness/paralysis admitted at Kamineni Institute of Medical Sciences, Nalgonda were studied. The male to female ratio was 1.6:1 (n=50, Males-31: Females-19). Out of these patients only 38% (n=19) were ≤49 years and 62% (n=31) were >49 years. The maximum frequency of motor weakness was found for ages more than 49 years.

 

Table No.3 : ANALYSIS OF CASES BASED CLINICAL PROFILE (n=50)

 

CLINICAL PROFILE	Frequency	Percentage
RIGHT HEMIPARESIS	16	32%
LEFT HEMIPARESIS	11	22%
PARAPARESIS	08	16%
QUADREPARESIS	07	14%
MONOPARESIS	04	8%
CRANIAL NERVE (III / VII)	04	8%
TOTAL	50	100%

 

 

 

 

 

In our study, Most common clinical feature was hemiplegia/hemiparesis. Fifty four percent (54%) patients had hemiplegia/hemiparesis. Among these left sided weakness was more common (59% patients had left sided hemiplegia/hemiparesis).

 

Table No.4 : ANALYSIS OF CASES BASED ON VASCULAR INVOLVEMENT (n=50)     

 

ETIOLOGY	Frequency	Percentage(%)
Cerebrovascular accidents	34	68%
Non Vascular causes	16	32%
Total	50	100%

 

 

 

Table No.5 : ANALYSIS OF CASES BASED ON PREVIOUS HISTORY OF STROKE/TIA (n=50)

 

Previous H/O stroke	Male	Female	Frequency
Present	8 (26%)	5  (26.4%)	13 (26%)
Absent	23 (74%)	14 (73.6%)	37 (74%)
Total	31 (62%)	19 (38%)	50 (100%)

 

 

 

In our study, most common cause of motor weakness was cerebrovascular accidents (CVA). Sixty Eight percent (68%) patients had cerebrovascular accidents (CVA). Among these 26% (n=13) patients had past H/O of stroke/TIA.

 

Table No.6 : ANALYSIS OF CASES BASED ON DIABETES & HYPERTENSION AS RISK FACTORS  (n=50)

 

 

	Male	Female	Frequency	Percentage
Diabetes only	1	1	2	4%
Hypertension only	6	2	8	16%
DM & HTN	5	3	8	16%
No DM & HTN	19	13	32	64%
Total	31	19	50	100%

 

References

reference links ( Vancouver style )

OBSERVATIONS & RESULTS ( DOCUMENT)

observations and results

1)     Katoh S, el Masry WS. Motor recovery of patients presenting with motor paralysis and sensory sparing following cervical spinal cord injuries. Paraplegia. 1995 Sep;33(9):506-9. doi: 10.1038/sc.1995.110. PMID: 8524602.

 

2)     Peckham PH, Kilgore KL. Challenges and opportunities in restoring function after paralysis. IEEE Trans Biomed Eng. 2013 Mar;60(3):602-9. doi: 10.1109/TBME.2013.2245128. Epub 2013 Mar 7. PMID: 23481680; PMCID: PMC4046583.

 

3)       Kumar, P. S., & Kalpana, R. Y. (2015). Clinico-radiological correlation in a cohort of cervical myelopathy patients. Journal of clinical and diagnostic research : JCDR, 9(1), TC01–TC7. https://doi.org/10.7860/JCDR/2015/10850.5378

 

 

4)     https://www.kcl.ac.uk/cicelysaunders/resources/tools/nis

 

5)     Asefa G, Meseret S. CT and clinical correlation of stroke diagnosis, pattern and clinical outcome among stroke patients visting Tikur Anbessa Hospital. Ethiop Med J. 2010 Apr;48(2):117-22. PMID: 20608015.

 

 

Links To Patients E-log:

BLOG LINK

1. http://srujanareddykondamadugula.blogspot.com/2020/08/unit-3-general-medicine-case.html

2. https://vsupriyareddy35.blogspot.com/2020/09/23yr-old-acute-infarct.html

3. https://sreejaboga.blogspot.com/2020/09/is-online-e-log-book-to-discuss-our.html

4. https://pamardeepika24.blogspot.com/2020/09/65-yr-old-male-with-acute-onset-of.html

5. https://mahathireddybandari.blogspot.com/2020/09/55-f-with-right-sided-weakness-and.html

6. https://drkulkarnithesis.blogspot.com/2020/10/65m-with-recurrent-cva-with-visual.html

7. https://pravalikachithanuri.blogspot.com/2020/10/this-is-online-e-log-book-to-discuss_9.html?m=1

8. https://harikachindam7.blogspot.com/2020/12/26-year-old-female-with-complaints-of.html

9. https://mohithak.blogspot.com/2021/01/27year-old-male-with-ankylosing.html?m=1

10. https://navyamallempalli.blogspot.com/2021/02/60-year-old-male-who-is-band-drummer.html

11. http://jessusanjay.blogspot.com/2021/02/75-yrs-old-female-with-cva.html

12. https://supriyareddy2396.blogspot.com/2021/02/55-yr-old-with-weakness-of-left-upper.html

13. http://soumya9814.blogspot.com/2021/02/this-is-online-e-log-book-to-discuss.html

14. http://nikhilreddykooluru.blogspot.com/2021/03/this-is-online-e-log-book-to-discuss.html

15. https://archanareddy07.blogspot.com/2021/03/60m-with-cva.html

16. https://sravyakandala.blogspot.com/2021/02/16-yo-male-with-lmn-facial-palsy.html

17. https://swathibogari158.blogspot.com/2020/11/a-60-yer-old-female-cva-with-left.html?m=1

18. https://swathibogari158.blogspot.com/2020/10/37-yr-old-male-came-with-co-tingling.html?m=1

19. https://sushma29.blogspot.com/2020/10/acute-hemorrhagic-strokert-sided.html?m=1

20. https://galinagajyothi.blogspot.com/2020/12/this-is-online-e-log-book-to-discuss_26.html?m=1

21. https://chownikareddy.blogspot.com/2020/12/65-m-with-altered-sensorium-and-right.html?m=1

22. https://shirisha19.blogspot.com/2020/12/18-year-old-man-from-singaram-presented.html?m=1

23. https://nikhilreddykooluru.blogspot.com/2021/03/this-is-online-e-log-book-to-discuss_15.html?m=1

24. https://amishajaiswal03eloggm.blogspot.com/2021/05/a-50-year-old-patient-with-cervical.html 25. https://caseopinionsbyrollno05.blogspot.com/2021/06/case-of-38-year-old-male-with-acute-cva.html