45 YEAR OLD FEMALE WITH PARAPARESIS SECONDARY TO TRAUMA ASSOCIATED WITH DYSPHAGIA

 C/O Generalized weakness of lower limbs since 10 years


Difficulty in swallowing since 15 days 

HOPI:


Pt was apparently asymptomatic till 1999  then she delivered a baby(by c-section due to cord entanglement)  she also stated that she started  developed Generalized weakness ( due to low haemoglobin levels ) not associated with pain and was able to perform her daily activities


Her husband also left as she couldn't perform her daily activities.Her son currently stays in the hostel 




 She previously used to work as mandal officer.




And in 2012 she stopped going to work because she started developing weakness  insidious in onset , gradually progressive , associated with pain , Aggrevated with walking and relieved with rest. she could not walk for long distances and she managed to  to perform  daily activities


In 2023 Jan she alleged had h/o slippage in bathroom following which she was normal for 5 days 


Next day she couldn't get up from bed which is sudden in onset and non progressive and couldn't be able to perform her daily activities because of pain mainly and weakness of both the lower limbs.


Patient was taken to the nearby hospital and 


X ray was done which is told to benormal 


MRI was also done 


Patient then complained of anuria for which foleys catherisation was done the she was able to pass urine 


After 10 days she then developed difficulty in swallowing (more to solids ) associated with pain 


No h/o giddiness,LOC, head injury


No history of involuntary movements









PAST HISTORY 

N/k/c/o DM, HTN, thyroid disorders, CVA ,CAD, TB ,EPILEPSY



PERSONAL HISTORY 



diet: mixed



appettite: decreased 



bowel and bladder: regular



sleep: adequate



no addictions

DAILY ROUTINE: 

She used to get up daily @6.30 am and do all the house hold chores and send children to school and used to go to work around 9 am and used to visit few Villages and come home in the evening after And in 2012 she stopped going to work because she started developing weakness insidious in onset , gradually progressive , associated with pain , Aggrevated with walking and relieved with rest. she could not walk for long distances so she stopped working and used to the house hold chores with pain.

GENERAL EXAMINATION:

Patient is consious, coherent, and cooperative 

moderately built and moderately nourished 

Butterfly like rash present over the cheeks since 6yrs.
Pallor - present








Icterus-absent
Cyanosis - absent
Clubbing-absent

Lymphadenopathy -absent

edema -absent












vitals 

Temperature - Afebrile

Pulse - 83bpm

Blood pressure- 130/80 mmhg

Respiratory rate- 17 cycles per min

Spo2 - 99%





SYSTEMIC EXAMINATION 

CVS -s1s2 heard,no murmurs



RS-bae+,nvbs heard



P/A-soft,non tender,no organomegaly



CNS 

On examination . R.    L

TONE

UPPER LIMB.  N          N

LOWER LIMB. N.        N

POWER 

UPPER LIMB.          5/5       5/5


LOWER LIMB.  5/5.         5/5



REFLEXES 



                       Rt                Lt

B            +++         +++

 T                ++      ++

S.             +       +

K.            -            -

A.              -           -

P. Flexion Flexion

INVESTIGATIONS:














Fever chart 




Chest x ray 

PA view 






X ray of both the hips 








USG :


Previous MRI done on 15/03/23







ECG 









ORTHO REFERRAL DONE ON 2/6/23









Provisional diagnosis: 


SPONDYLOARTHROPATHY ASSOCIATED WITH CHRONIC PARAPARESIS WITH CKD STAGE -V ASSOCIATED WITH DYSPHAGIA 


S:
Lower limbs and joint pains 
Dysphagia reduced 




O: 
ON EXAMINATION:
Pt is c/c/c
TEMP:98.2F
PR:108bpm
BP: 100/60 mmHg @NA 4ml/hr
RR:19 CPM
CVS:S1S2+,no murmurs
RS: BAE+NVBS+
P/A: soft ,non tender,no organomegaly
GRBS: 139 mg/dl



A:
SPONDYLOARTHROPATHY ASSOCIATED WITH CHRONIC PARAPARESIS WITH CKD STAGE -V ASSOCIATED WITH DYSPHAGIA 


P:
1.INJ NORADRENALINE 2AMP IN 46ml NS @ 4 ml/hr to maintain MAP >65 mmHg

2.IV FLUIDS NS@75ml/hr 

3.SYP.LACTULOSE 15ML PO/TID 
 
4.TAB ULTRACET PO/SOS



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