50 year old male with weakness of both lower limbs and slurred speech
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CASE
50 year old male with
▪weakness of both lower limbs
and slurring of speech since 5 days
HISTORY OF PRESENTING ILLNESS
Patient had a history of fall 1 year ago and he did not take any treatment for it and was alright for 8 months then 4 months back he had pain in right hip which was insidious in onset and gradually progressive in nature
since 1month there was change in the gait of patient which was noticed by his relatives and there is hematuria for 5 days which he has neglected
For which he consulted local doctor and diagnosed avascular necrosis of of femur for which he has given medication
After taking medication he developed weakness of both lower limbs but more on right side where he could not walk , stand and eat and he need assistance for these activities
PAST HISTORY
Known case of diabetes since 12 years and takes insulin daily 2 times ( 15 U before breakfast, 10 U in the evening)
not a known case of hypertension, asthma , TB, epilepsy
PERSONAL HISTORY
Diet- mixed
Appetite- normal
Sleep - Adequate
Bowel and bladder movements- regular
Addiction- smoker since 12 years takes 1 beedi per day and stopped for 4 years and again started smoking from 1 year
consumed alcohol nearly for 20 years and stopped taking it
FAMILY HISTORY
Insignificant
GENERAL EXAMINATION
Patient is conscious coherent cooperative, well oriented to time place person
Moderately built and moderately nourished
Pallor- mild
icterus- absent
cyanosis- absent
clubbing- absent
Lymphadenopathy - absent
Edema- present
On 02/06/2022:
Bp - 120/80mmhg
PR - 92bpm
RR -17cpm
SpO2 -97%
GRBS - 150mg/dl
systemic examination
▪CVS-- s1 ,s2 heard no murmurs
• Respiratory system- normal vesicular breath sounds heard
• Abdomen- no tenderness no. . palpable mass , not distended
c/c/c and afebrile
CVS - S1 S2+
CNS - Sensorium improved
P/A - soft and non tender
On 04/06/2022:
c/c/c and afebrile
BP - 120/80mmhg
PR - 88bpm
CVS - S1 S2+
CNS - Sensorium improved
On 05/06/2022:
c/c/c
BP - 100/60mmhg
PR - 92bpm
CVS - S1 S2+
CNS - Sensorium improved
R/S - BAE + and LT CREPTS +
P/A - soft and non tender.
On 07/06/2022:
BP - 120/80mmhg
PR - 92bpm
Atrophy of right calf region
sensations of both limbs - intact
absence of mobility of both limbs
Provisional Diagnosis:
Hypokalemic periodic paralysis
INVESTIGATIONS
29/5 /2022
Rt kidney - 8.8 * 4.2 cm
Lt kidney - 10*3.6 cm
Size is normal but increased echotexture
CMD - partially maintained
Spleen - 12.9cm (increased)
Multiple intraductal and parenchymal calcification noted in pancreas involving and head and pancreas.
8mm calculus noted in inferior pole of left kidney.
Distended gall bladder with calcification noted of 6mm.
IMPRESSIONS ON USG
• Cholelithiasis with GB sludge
• chronic pancretitis
• left renal calculus
• mild
splenomegaly
• B/L grade - II RPD changes
• minimal ascitis
4/06/2022
5/06/2022
ECG Reports:
On 02/06/2022
On 06/06/2022:
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