1701006039 - LONG CASE

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A 36yrs old male patient came to OPD with 

CHEIF COMPLAINTS -

patient alleged to have fallen on 7/03/2023

c/o 

1. Weakness in the B/L upper and lower limbs - 3 weeks

2. Retention of urine - 3 weeks

3. decreased sensations in B/L upper and lower limbs - 3 weeks

HOPI-

Patient was asymptomatic 3 months back then he had fallen from bike on 7/03/2023 and had injuries to the back and to head . From then he had b/l weakness in both upper and lower limbs,

Retention of urine is seen.

Patient has history of loss of consciousness for 1 day following fall from bike. No any other h/o weight loss , burning micturition, orthopnea, pnd , chestpain , palpitations, change in voice , seasonal variations of symptoms 

H/O PAST ILLNESS -

From 3 months patient is on foley’s catheter - changes weekly. 

C/o loss of sensations and decreased sensation in b/l lower limbs

No h/o DM , HTN , CAD , THYROID , SEIZURES

TREATMENT HISTORY - 

no specific past treatment history

PERSONAL HISTORY - 

patient - married 

Occupation - fish seller

Appetite- normal 

Bowel and bladder movements -  irregular 

Micturition- abnormal  - unable to pass urine from 3 months

Allergies - no

Addictions - 

1. Alcoholic - 3 to 4 quaters per day

2. No smoking

3. Chewable - pan chewing 

FAMILY HISTORY -

No significant family history pertaining to the case

PHYSICAL EXAMINATION :

GENERAL EXAMINATION -

Patient is conscious, coherent and cooperative 

No - h/o pallor , icterus , cyanosis , clubbing , lymphadenopathy, oedema, malnutrition, dehydration 

Temp : 96.8 F

Pulse rate : 85 beats/min

Resp rate : 18 cpm

Spo2 : 98%

Grbs : 103%

SYSTEMIC EXAMINATION -

CVS :

no thrills

S1 and s2 sounds heard

No cardiac murmurs

RS :

dyspnea- no

Wheezing - no

Position of trachea - central

Breath sounds - vesicular 

Adventitious sounds - Rhonchi

ABDOMEN :

shape - scaphoid

Tenderness- no

Palpable mass - no

Liver - not palpable

Spleen - not palpable

Bowel sounds - yes

Genitals , speculum , pv , p/r examinations - not done

CNS : 

1. Level of consciousness: conscious

2. Speech - normal

3. Signs of meningial irritation- no neck stiffness and

 no kerning’s sign

4. Cranial nerves - intact and normal

                                          RIGHT.                 LEFT

     a. CN I                      NORMAL.                NORMAL

     b. CN II.                    NORMAL.                NORMAL

     c. CN III, IV , VI.              N.                       N

     d. CN V.                            N.                        N

     e. CN VII.                         N.                        N

      f.CN VIII.                        N.                        N

     g. CN IX.                          N.                        N

     h. CN X.                          N.                         N

     I. CN. XI.                         N.                         N

     j. CN XII.                         N.                          N

5. Motor system - 

                                         Right.                               Left 

a. Power       UL                5/5                                   5/5

                       L/L               4/5                                   4/5

b. Tone         U/L            Hyper                                Hyper

                       L/L             Hyper                               Hyper

6. Sensory system

                                                  R.                           L

                               UL.            LL.              UL.                LL

a. Touch.                P.                P.                P.                 P

b. Pain.                   P.                P.                P.                 P. 

c. Temp.                 P.                P.                P.                 P. 

d.vibrations.         P.                P.                 P.                P 

e. Stereognosis.    P.               P.                P.                P. 

f. Propiorecepion. P.              P.               P.                 P

7. glassgow scale : E4 V5 M6

8. Reflexes : 

                                  Right                                    Left

a. Biceps                     3+                                          3+

b. Tricpes                   3+                                           3+ 

c. Supinator               3+                                           3+

d. Knee                       4+                                           4+

e. Ankle                     3+                                           3+

Plantar - b/l extensor

Links of above reflexes: 

https://youtu.be/RJsmK-7Mo5Y

https://youtube.com/shorts/cCU4sxFRjsE?feature=share

https://youtu.be/v04CRwrkgo4

https://youtube.com/shorts/d0NgzFw008A?feature=share

https://youtube.com/shorts/S2Ocr2hXPJc?feature=share

https://youtu.be/Cxi5XGbjnck

9 cerebellar signs : 

a. Finger-nose - in coordination -  no

b. Knee- heel - in coordination - no

c  gait -  scissoring gait

INVESTIGATIONS : 

EXAMINATION OF ENT , TEETH AND ORALCAVITY - NORMAL

EXAMINATION OF HEAD AND NECK - NORMAL

PROVISIONAL DIAGNOSIS: 

QUADRIPARESIS SECONDARY TO TRAUMA.

TREATMENT - 

Treatment plan for quadriparesis depends on the underlying cause.

 For example,

 autoimmune or inflammatory conditions may be treated with immunosuppressive drugs. 

An electrolyte imbalance can be treated with medications that reverse the imbalance.

Other treatments may include:

surgery

muscle relaxants

pain medications

physical therapy

occupational therapy

resistance training