LOWERLIMB WEAKNESS IN A YOUNG FEMALE

A 2o year old female patient, labourer at construction site by occupation and resident of nalgonda district camw with the chief complaints of
-Difficulty in walking for 10 days
-Difficulty in standing up from sitting position since 10days

Patient was apparently asymptomatic 10 days back,then she developed difficulty in walking(says she has the fear of falling down while walking), insidious in onset, progressed to the present stage. She also has difficulty in standing up from sitting position since 10 days. 10 days back she consulted a doctor at local hospital for this illness and she says she got treated in v/o low potassium levels, but she couldnt find any improvement even after her potassium levels got corrected.
She doesnt give any history of difficulty in combing her hair/ mixing food while eating/ slippage of footwear.
There is no history of any headache/bowel and bladder incontinence/seizures/fever/ giddiness.
No history. dysphagia/dysarthria/ any history suggestive of cranial nerve abnormalities.
No history any difficulty in respiration.
No history of any loose motions prior to the illness.

Past history-
No history of similar complaints in the past.
Marital status- Got married when she was 15years old.
She had LSCS done an year back in v/o decreased fetal movements and delivered a female baby who is now 1 year old-Postpartum difficulty in lactation as she couldnt produce breast milk.
Not a k/c/o Hypertension/Diabetes mellitus/ Thyroid disorders/ Epilepsy/ Bronchial asthma/ Cerebrovascular accidents/ CAD.

Family history-
She has an elder sister who has poliomyelitis.
No history of similar complaints in the family.
No history of any hypertension/ diabetes mellitus/  thyroid disorders in the family.

Personal history-
Mixed diet.
Appetite normal.
Bowel and bladder regular.
No sleep distirbances.
No addictions/allergies to any drugs.

General examination:
Patient is conscious,oriented.
No pallor/icterus/cyanosis/clubbing/koilonychia.lymphadenopathy/edema of feet.

Vitals-
Afebrile.
Pulse- 86 bpm,regular on right radial artery.
Blood pressure- 110/80mmhg in supine posture on right arm.
Respiratory rate- 14 cpm
Cardiovascular system-S1S2 heard,No murmurs.
Respiratory system-Bilateral air entry present, Normal vesicular breath sounds heard.
Per abdomen- Soft,Non tender

Central nervous system examination-
Posture and stance- Normal
Gait- Cautious gait.
Higher mental functions intact.
Cranial nerve examination normal.

Motor system-
Tone-Normal in both upper limbs.
         Increased tone in both lower limbs.

Power-4/5 in both upper and lower limbs.
Reflexes-
DTRs:
2+ in upper limbs.
4+ knee reflex in both limbs.
3+ in ankle in both limbs.

Extensor plantar response in both limbs.

Sustained Patellar clonus seen in both lower limbs.
Ankle clonus-ill sustained.

Fasciculations seen initially.

Sensory system-Couldnt assess properly as patient is not answering if she can aprreaciate the touch,vibrations, joint position sense.

Cerebellar system-
Dysdiadokinesia-Able to do.
Finger nose test-Able to do.

Investigations will be uploaded soon.
Your valuable inputs are highly appreaciated.

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