A 43 old male patient resident of nalgonda ,farmer by occupation ,presented to casualty with complaints of :
Low grade Fever since 1 year .
Cough with sputum since 1 year
Complaints of neck pain since 6 months
Weakness of all both lower limbs since 6 months .
HOPI :
Patient was married at age of 25 and have 3 children , one son and two daughters . He is farmer by occupation . He is occasional alcoholic and chronic smoker (1-2 packs/day) since 20 years . He was apparently alright till 33 years of age , then in view of generalised weakness pt went for routine evaluation and got diagnosed with diabetes mellites- type 2 and is using OHA since 10 years . He takes his medication regularly .
Patient had history of fever since 1 year which was low grade not associated with chills and rigors, intermittent, associated with diurnal variation and night sweats.
He also complains of cough with scanty white color ,mucoid expectorant since 1 year, non foul smelling, non blood tinged . No diurnal variation of cough and no chest pain .
He went to local rmp and got symptomatic treatment .
He later developed neck pain , which was sudden in onset gradually progressive . No history of trauma .No radiation .
He then developed weakness of both lower limbs which was insidious in onset ,gradually progressive in nature over 6 months . He had difficulty in standing and walking .No history of upper limb weakness .
Past history:
No h/o similar complaints in past.
K/C/O DM-2 since 10 years on Glimi -m1 tablet .
Not a known case of HTN/EPILEPSY/CVA/CAD/TB
Personal history:
Mixed diet with normal appetite and normal bowel/bladder movements
H/o alcohol consumotion since 90ml weekly twice since 20 years.
H/o smoking (1-2 pacs per day ) since 20 years .
General Examination:
He is a thin built man, who was conscious, coherent
PR of 80bpm ,regular ,normovolemic .
Bp - 110/80mmhg
Temp - 98.3 F
SpO2 - 99%
RR - 20 cpm
GRBS - 120 mg/dl.
Head to toe examination:
Hair - Black, thick, non easily pluckable. No lesions over the scalp.
Eyes - No pallor, no icterus.
General head & neck examination - No abnormalities. No lymphadenopathy.
Axial- Tenderness over cervical spine +
Fingers & Nails - Clubbing +
Lower limbs - No pedal edema .
1. CRANIAL NERVES
|
CRANIAL NERVE |
TEST |
RIGHT |
LEFT |
|
I |
Sense of smell i)
Coffee ii)
Asafoetida |
+ + |
+ + |
|
II |
i) Visual
acuity – Snellens Chart ii) Field of
vision – Confrontation test iii) Colour
vision – Ishihara chart iv) Fundus |
6/6 Normal Normal Normal |
6/6 Normal Normal Normal |
|
III, IV, VI |
i)
Extra-ocular movements ii)
Pupil – Size iii)
Direct Light Reflex iv)
Consensual Light Reflex v)
Accommodation Reflex vi)
Ptosis vii)
Nystagmus viii)
Horners syndrome |
full 4mm Present Present Present Absent Absent No |
full 4mm Present Present Present Absent Absent No |
|
V |
i) Sensory
-over face and buccal mucosa ii) Motor –
masseter, temporalis, pterygoids iii) Reflex a.
Corneal Reflex b.
Conjunctival Reflex c.
Jaw jerk |
Normal Normal
Present Present Present |
Normal Normal
Present Present Present |
|
VII |
i) Motor – nasolabial
fold hyeracusis occipitofrontalis orbicularis
oculi orbicularis
oris buccinator platysma ii) Sensory – Taste of
anterior 2/3rds of tongue(salt/sweet) Sensation over
tragus iii) Reflex – Corneal Conjunctival iv) Secretomotor
– Moistness of
the eyes/tongue and buccal mucosa |
Present Absent Good Good Good Good Good
Normal
Normal
Present Present
Normal |
Present Absent Good Good Good Good Good
Normal
Normal
Present Present
Normal |
|
VIII |
i) Rinnes Test ii) Webers
Test
iii) Nystagmus |
Positive Not lateralised
Absent |
Positive
Absent |
|
IX, X |
i) Uvula,
Palatal arches, and movements
ii) Gag reflex iii) Palatal
reflex |
Centrally placed and symmetrical
Present Present |
Present Present |
|
X1 |
i) trapezius ii) sternocleidomastoid |
Good Good |
Good Good |
|
XII |
i) Tone ii) Wasting iii) Fibrillation iv) Tongue
Protrusion to the midline and either side |
Normal No No Normal |
Normal No No Normal |
FINAL DIAGNOSIS :
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