case x - 62F with left hemiparesis



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 RWMA
Global hypokinesia 
Moderate AR, TR with PAH


RS : Bilateral Air entry present. B/L IAA crepts present.


Per abdomen : soft and non tender

CNS : 
Patient is conscious, oriented to time,place , person, cooperative.

HMF- normal

Cranialnerves : intact

Motor examination:


                                 Rt.        Lt.

1.Tone

Upper limbs. Normal     hypotonia

Lower limbs. Normal.    Hypotonia

2.power

Upper limbs. 4-/5.   0/5

Lowerlimbs. 4-/5.    0/5

Hand grip. 100%. 0%

3. Reflexes 

                                          Rt. Lt.

 1.Corneal Present. Present

 2. Conjunctival Present. Present

 3. Pharyngeal Present. Present

 4 Palatal. Present. Present 

  

  6. Biceps.            1 +  0 
 7. triceps               1 +   0
  8.supinator            1 +  0
  9. Knee.                  1 +   0
10. Ankle                  1+   0
11 . plantar.      Ext.       Ext

 Cerebellar examination : Normal

Sensory examination:Normal

Autonomic nervous system-Normal

 Spine examination: No tenderness.

Meningeal signs:

Neck rigidity,Kernigs and brudzinski signs -. Negative







Investigations : 

                                      CBP


CUE


RFT


                                    LFT



Treatment

Inj. Optineuron. 1amp OD
IVF 2 units NS , 1 unit RL OD
Tab Ecosprin 150mg po OD
Tab Clopitab 75 mg po OD
Tab Atocor 40mg po OD

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