case



 case history:
A 55 yr old male agricultural labourer from ramalingalagudam( Nalgonda )
Came with complaints of weakness of rt U/L and L/L and slurring of speech  since 3days 

HOPI : He was apparently asymptomatic one month back then had weakness in the rt upper limb (sudden paresis) unable to take food 
Followed by regain of power with in 24 hrs (?TIA)
Patient again experienced weakness 3days back rt upper limb followed by rt lower limb (u/l>l/l)  sudden paresis 
Also developed slurring of speech from 3days 
Deviation of mouth to left
Able to lift the head off the pillow
Roll over the bed and no difficulty in breathing
No thinning of muscles,pain, muscle cramps, fasciculations,tremors
He is able to feel the clothes
No neck pain, no back pain,no band like sensations, no unsteadiness on closing of eyes,no loc
Bowel and bladder: regular
Speech: slurring
No alterations of smell, blurring of vision,no double vision
Ability to chew food +
Ability to close eyes mouth+
Able to blow his cheeks
Frowning+

No h/o loss of hearing,tinnitus, vertigo

No palpitations,sweating fever vomitings ,neck stiffness,headache, diarrhea,calftenderness, chestpain
Past history:
There is a history of ?TIA
Not a known case of diabetes mellitus hypertension no CAD no TB no epilepsy

Personal history he is a non-vegetarian chronic alcoholic 90 ML of whiskey per day since 30 years 

Patient is conscious coherent cooperated moderately built and well nourished
No pallor no icterus no cyanosis no clubbing no lymphadenopathy no Edema
PR: 50bpm regularly irregular
BP: 150/100 mm of hg

CVS S1 S2 heard no murmurs

P/A of non-tender

CNS
 higher mental functions:
Pt is conscious and oriented to time place and person
Speech and language: dysarthria

Motor system:
                   Rt.        Lt
Bulk.  U/L. Normal. Normal
           L/L normal normal
Tone U/L.     Normal.  Normal
           L/L.  Normal.     Normal
Power
Shoulder
Deltoid.  4-/5   4+/5
Supraspinatus 4-/5.      4+/5
Infra spinatus    4-/5.     4+/5
Rhomboides4-/5.      4+/5
S. Anterior.  4-/5.    4+/5
P.major.        4-/5.     4+/5
Latismus dorsi.  4-/5.  4+/5
Elbow
Biceps.    4-/5.            4+/5
Triceps.    3/5.            4+/5
Brachioradialis3/5.     4+/5
Forearm and wrist:
ECR 0/5      4+/5
ECU 0/5      4+/5
ED.   0/5.      4+/5
FCR 0/5      4+/5
FCU 2/5      4+/5
EPB 0/5      4+/5
EPL 0/5       4+/5
FDP 0/5       4+/5
Abductor pollicis 0/5.   4+/5
Adductor pollicis 0/5.  4+/5
Opponens pollicis 0/5.   4+/5
Lumbricals        0/5.      4+/5

Hip girdle:
Iliopsoas 4-/5     4+/5
Adductor femoris 4-/5     4+/5
Gluteus medius 4-/5       4+/5
Gluteus  maximus4-/5.     4+/5
Hamstrings.         4-/5.       4+/5
Quadriceps femoris 4-/5.    4+/5
Tib. Anterior.        4-/5.          4+/5
Tib.posterior.         4-/5.         4+/5
Peritonei.             4-/5.           4+/5
Gastronemius.     4-/5.          4+/5
EDL.                      4-/5.           4+/5
FHL.                       4-/5.           4+/5
EDB
REFLEXES.    Right Left
Biceps --
Triceps - -
Supinator - -
Knee ++
Ankle - -
Plantar m m
Superficial reflex- abd ++
Corneal ++
Conjunctival ++

Sensory:-
pain + + 
Crude touch + +
Fine touch
vibration + + 
temperature + +
joint + +
Tactile localisation++
Two point discrimination++
Stereognosis++


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