31year old male with numbness and weakness of left upper limb and lower limb

Interns

Dr Mohitha
Dr supriya
Dr Sanjay
Dr Soumya
Dr Amrutha

Dr Durga krishna PGY1
Dr Ajith Kumar PGY2
Dr Laxma Reddy PGY3
Dr Manasa PGY3
Dr Vijayalaxmi (asst proff)

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Here is a case i have seen:

31 old male who is a water supplier by occupation came to casuality at 10pm on 8/3/21 with
C/o numbness of left upper and lower limb since yesterday 7pm
C/Oweakness of left upper limb and lower limb since yesterday 7pm

Patient was apparently asymptomatic 1 day back,later at 7pm yesterday night while driving bike he developed numbness of left upper limb and lower limb at 7pm and then he developed weakness of left lower limb which which gradually progressed to left upper limb within 5min.
He was unable to change the gear ,so he stopped his bike and called his friends
He had slurring of speech while talking to his friends on call for just 15min and then resolved
He was taken to private hospital by his friends and was given IVF and later was brought to our hospital for further evaluation

No h/o fever,headache,ear discharge,blurring of vision,diplopia,photophobia,head injury,involuntary movements

Past history

Not a k/c/o HTN ,DM,TB, ASTHMA,CVD,epilepsy

Family History
H/o DM and HTN since 10years and on medication
No h/o

Personal History
Mixed diet
Appetite normal
Sleep adequate
Bowel and bladder movements - regular
H/o alcohol intake since 18yrs 500ml alternate days
H/o smoking -since 18years -4-5cigarettes/day

No drug and allergic history

General examination
Patient is conscious,coherent ,cooperative
Height-167cms

weight-115kgs

BMI-41.2kg/m2

No pallor,icterus,cyanosis,clubbing,generalised lymphadenopathy,pedal edema

TRUNKAL OBESITY

HESITATION CUTS

ACANTHOSIS NIGRICANS

Vitals
Bp-130/90mmhg
PR- 84bpm
RR-18cpm
Temp- afebrile
SpO2-99%at RA

Systemic examination

CVS- s1 s2 +
RS- BAE+
PA- Obese ,soft,non tender

CNS

HIGHER MENTALFUNCTIONS:

GCS- 15/15

Speech- normal
Memory- intact
Cranial nerves- intact
Motor system
                              Right              left
                                UL                   UL
Tone                  normal          hypotonia
                                 LL                   LL
                           Normal          hypotonia
Power
                                                  Rt.                Lt.
1.Shoulder:
Flexors-extensors.              5/5 4-/5
Adductors.                           5/5 4- /5
Abductors.                           5/5 4- /5
Lateral and medial rotators 5 /5 4- /5
2.Elbow:
    Flexors-extensors.              5/5 4- /5
3. Wrist:
Dorsi flexors-palmar flexor.   5/5 4- /5
Abductors-adductors.           5/5 4- /5
Pronators - supinators.       5 /5 4- /5
4. Hand grip.                        100%.
5. Hip:
    Flexors-extensors. 4- /5
Abductors-adductors.          5/5. 4- /5
6. Knee:
Flexors-extensors.              5 /5. 4- /5
7. Ankle:
Dorsi flexors-withdrawal plantar response
Reflexes Rt.                Lt.
1.Corneal Present.      Present
2. Conjunctival Present.      Present
3. Pharyngeal Present.      Present
4 Palatal. Present.      Present
5.plantar flexor Flexor
6. Biceps                                  -                  -
7 triceps                                      -                -
8.supinator.                              -                 -
9. Knee.                                  -                   -
10. Ankle                                 -                  -
Cerebellar examination : Normal