70 YAER OLD MALE WITH QUADRIPARESIS.

                             AFRIN. SK

                       ROLL. NO : 125 

    

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CASE: 

70 year old male, who was an farmer by occupation but has stopped working since 4 years ,came to the hospital with chief complaints of weakness in the both upper and lower limbs since 1 week and  unable to carryout routine activities of daily living. 

HISTORY OF PRESENT ILLNESS : 

Patient was apparently normal 1 week ago and he developed weakness in both upper and lower limbs which was insidious in onset and gradually progressive. 

C/O neck pain. 

No C/O headache, vomiting,  blurring of vision ,deviation of mouth.  

No C/O pedal edema, facial puffiness.

Mild SOB -grade-3 

Decreased urine output 2 days before onset of paralytic episode. 

 Patients wife died on Friday on next day morning  he developed weakness in all four limbs  unable to stand ,brushing, eating and other daily activities and then  admitted in hospital.

PAST HISTORY : 

Know history of Hypertension since 10 years 

 N/K/C/O diabetes, tuberculosis, coronary artery disease, epilepsy, asthma, no other illness. 

PERSONAL HISTORY : 

Diet : mixed 

Appetite : reduced since 3 months. 

Sleep : adequate 

bladder movements : regular 

Bowel : constipation ( passes stools in every 2 days)  

No allergies 

Addictions :  alcohol on alternate days (360ml / sitting)  

FAMILY HISTORY : 

Wife died on Friday .

Son committed suicide 10 years ago. 

Osteoarthritis since 2 years .

TREATMENT / SURGICAL HISTORY : 

He underwent hernioplasty 15 years ago. 

And cataract surgery 6 years ago in right eye and 3 years ago in left eye. 

Antihypertensive drugs  since 10 years.

            PHYSICAL EXAMNINATION 

GENERAL EXAMINATION : 

I have examined patient in a well lit room and by taking patients prior consent.

patient is conscious, coherent, well oriented to time ,place and person .

No pallor, icterus, cyanosis ,clubbing, koilonychia,  lymphadenopathy .

VITALS : 

Temperature :afebrile.

Bp: 140/80mm of Hg 

PR : 80bpm

RR : 18cpm.

SYSTEMIC EXAMINATION: 

CVS : S1,S2 heard,  no murmurs. 

RS : BAE+ 

No additional sounds heard. 

P/ A : 

A soft palpable abdominal mass present .

CENTRAL NERVOUS SYSTEM  :

 patient is conscious, coherent well oriented to place time and person. 

CRANIAL NERVE : 

cranial nerves:             right.            Left 

 1 ( sense of smell)          +                   + 

2. ( visual acuity, field)   N.             N 

3,4,6 carnial nerves.       Intact.       Intact 

5 cranial nerve.              Intact.        Intact 

7 CN ( facial symmetry )    +              + 

8,9,10,11,12 CN.                  Intact.       Intact 

   

MOTOR SYSTEM : 

                                      Right.              Left. 

* Bulk :                       Normal.          Normal 

* Tone :                          N.                    N 

* power :                     

UL.                             Grade 4              Grade 4 

LL.                              Grade 4.             Grade 4

 * Deep tendon reflexes : 

Biceps.                          +3                   +3

Triceps.                         +3.                 +3

Supinator 

Knee.                             +3.                  +3

Ankle.                            +3.                 +3 

Plantar.   

Babinski sign. - 

Left biceps reflex :

Right biceps reflex :

Babinski sign: