SPASTIC QUADRIPARESIS-MND vs MYELOPATHY

A 45 year old male patient,agricultural labourer by occupation presented to the KIMS General Medicine OPD with the complaints of difficulty in standing up from sitting position since 6 months and history of weakness in the upper limbs hindering his daily activities since 5 months.

He was apparently asymptomatic 6 months back then he developed proximal muscle weakness in the lower limbs,initially in the right lower limb followed by left lower limb. He had difficulty in getting up from sitting posture and he also complained of tightness initially in the right lower limb followed by the left.
After a month, he had difficulty in performing his daily activities with both his hands such as holding the instruments for work on the field. He says this was followed by his inability to lift his left hand above his head initially followed by weakness even in the right hand.
He gives history of slippage of footwear since 3-4months and also He is unable to button and unbutton his shirt since 2 months.
He doesnt give any history of loss of consciousness, seizures, giddiness, bowel/bladder incontinence,cranial nerve anbormalities,paresthesias in the limbs.

Past history:Not a k/c/o Hypertension,Diabetes mellitus,Thyroid disorders,pulmonary kochs,epilepsy,asthma.

Family history:No history of similar complaints in the family.
Not a k/c/o Hypertension,Diabetes mellitus,Thyroid disorders,pulmonary kochs,epilepsy,asthma.

Personal history:
Mixed diet
Appetite adequate.
Bowel and bladder regular
No sleep disturbances present.
Chronic alcoholic since 10 years.
Non smoker

General physical examination-
Patient is lying supine on the examination couch.
Temp-98.6F
Heart rate- 60bpm,regular on right radial artery
Blood pressure: 120/80mmhg in supine posture on right arm
No pallor,icterus,cyanosis,lymphadenopathy,clubbing,koilonychia,pedal edema.
All the peripheral pulses felt.

General systemic examination:

Central nervous system examination:

Patient is a right handed person and has a wide based stance.
Gait is noted to be a Scissoring gait.

Higher intellectual function are intact.

All the cranial nerves are intact.

 Motor system:

 NUTRITION:
Wasting of thenar and hypothenar muscles in both the upper limbs.

 TONE:
Hypertonia in both the upper and lower limbs.

 POWER:
4/5 in the upper limbs.
3/5 in the lower limbs.

 REFLEXES:
Superficial reflexes: Corneal and conjunctival reflexes present.
                                 Abdominal and Cremasteric reflexes absent.
                                 Anal reflex present.
Deep tendon reflexes: Biceps,triceps,supinator,knee,ankle exaggerated(++++)
Plantae reflex: Not elicitable
Hoffmann's and Wartenburg's sign:Present.

 Patellar clonus:Present

 Ankle clonus:Present.

 Fasciculation seen.

Sensory system:Intact

Cerebellar system:
Finger-nose test:Able to do
Finger-finger test:Able to do
Dysdiadokinesia:Able to do
Romberg's test: Positive

Other systems examination:
Cardiovascular:S1S2 heard,No murmurs.
Respiratory system:Bilateral air entry present,Normal vesicular breath sounds heard.
Per abdomen: Soft,Non tender.
                       No organomegaly,Bowel sounds heard.

Provisional Diagnosis: SPASTIC QUADRIPARESIS UNDER EVALUATION.

 He then underwent all the necessary investigations.






MRI Cervical spine with Whole spine screening was done for this patient.




**Blood samples for Vitamin B12 levels were sent which was 851pg/ml**

**ECG was done which was normal**



Your valuable inputs on this case are highly appreciated

Comments

Post a Comment

Popular posts from this blog

FEVER WITH ABDOMINAL LYMPHADENOPATHY IN A MALE

Image
A 48 yrs old male patient by occupation carpenter belongs to lower middle socioeconomic status came to the hospital on 16/4/19 with chief complaints of HIGH GRADE FEVER FOR 3 MONTHS, DECREASED APPETITE FOR 3 MONTHS, WEIGHT LOSS FOR 3 MONTHS Patient was apparently asymptomatic 3 months back, then in February he developed fever which was of high grade , intermittent in nature , associated with chills and rigors , relieved on medication. This continued for 2 days after which he went to a quack who treated him as having Typhoid fever with medications for 1 week. This fever was not a/w Burning micturition, ear pain, headache, rashes, generalised body pains, cough, cold, sorethroat,chest pain,palpitations,swelling of both lower limbs. With this the patient didnt have any fever episodes for the next 15 days. During this period the patient continued to have alcohol daily. After 15 days he had another episode of High grade fever. The patient was sent to a doctor this time in
Read more

Thesis case-T2DM with LEFT LOWER LIMB CELLULITIS.

A 47 year old male patient, shopkeeper by occupation and resident of nalgonda presented in the casuality with the chief complaints of -Fever for 2 days -Bleeding per rectum for 2 days. He was apparently asymptomatic 2 days back, then he developed fever, of high grade, a/w chills and rigors, headache and intermittent in nature. He gave history of bleeding per rectum,frank blood on the sqatting pan,not a/w any pain while defecation. He had Pain abdomen in the periumbilical region,squeezing before passing stools and subsides after thet. History of loose stools for 2 days,watery in consistency and 4-5 times per day. History of giddiness present. No history of nausea/vomitimgs/giddiness/burning micturition/cough/sore throat/generalised body pains/breathlessness. Past history- No history of similar complaints in the past. He is known case of type2 diabetes mellitus since 4 years and on regular medication(Tab.Metformin 500mg and Glimeperide 1mg once daily). Not a k/c/oHypertens
Read more

RECURRENT STROKE IN A 69 YEAR CHRONIC ALCOHOLIC

Image
69 year old male patient presented to our OPD with complaints of WEAKNESS OF RIGHT LOWER LIMB FOR 4 DAYS SLURRING OF SPEECH FOR 4 DAYS Patient was apparently asymptomatic 3yrs back then all of a sudden developed Loss of speech  following binge of alcohol without any limb weakness , had a Seizure episode, then he consulted a doctor where Neuroimaging was done(CT scan), He was given Treatment accordingly. He improved and was discharged. After discharge he took medicine for 5 months. An year he had similar complaints of loss of speech following binge of alcohol , was taken to the hospital improved with glucose drip( according to the patient ). Six months back patient he developed Weakness of all four limbs  associated with Loss of speech. He was admitted in our hospital this time.He also had Seizure episodes,irritable behaviour and recovered within 5 days and got discharged , was put on medication. The evaluation included following- He used the medication for a while and t
Read more