Case history-04

 This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

40 year old male farmer by occupation was brought to opd with chief complaints of weakness of b/l lower limbs and upper limbs since 4 days

Unable to walk since 2 days. 

HISTORY OF PRESENT ILLNESS 

Patient was apparently asymptomatic 4 days back and then while he was dancing in Ganesh nimarjanum he suddenly fell down due to weakness of B/L lower limbs which was sudden in onset, progressive in nature ( initially walked with support, now can't move.) 

weakness now progressed to B/L upper limbs. 

No h/o loss if sensations

No h/o headache, giddiness, slurred speech, deviation of mouth or involuntary movements 

No other complaints 

HISTORY OF PAST ILLNESS 

There is no history of hypertension,diabetes mellitus,tuberculosis,asthma.

PERSONAL HISTORY 

Diet is mixed 

 Sleep is adequate 

 Bowel movements are regular and micturition is normal 

 Normal appetite

 No allergy to known drugs, 

habits of alcohol consumption and smoking since 10 years 

FAMILY HISTORY   

There is no history of similar complaints in the family members

GENERAL EXAMINATION 

The patient is conscious, coherent and cooperative.

she is well oriented to time,place and person. Moderately built and nourished. 

No pallor 

Clubbing is seen as grade 3

No icterus 

No cyanosis 

No lymphadenopathy

No signs of dehydration      

VITALS : BP - 120/70 MMHG. 

                PR - 85 BPM. 

               TEMP - afebrile.

                Spo2 - 98% at RA.

                GRBS - 102.

SYSTEMIC EXAMINATION:

CENTRAL NERVOUS SYSTEM 

Pt is conscious, coherent and cooperative with well orientation to time, place and person.

- HMF : intact.

Motor system:

- POWER:     

                R    L              R     L

       UL. 3/5. 3/5    LL: 1/5. 1/5

- HAND GRIP: Right - 30%. Left - 30%

- TONE: Normal

- ALL REFLEXS WERE ABSENT.

Sensory system: Normal

Cranial nerves : Intact

Cerebellum : Intact

CVS:

Elliptical & b/l symmetrical chest

No visible pulsations/engorged veins/ scars/sinuses on the chest wall

Apex beat palpable at 5th intercostal space medial to midclavicular line 

S1 , S2 heard

No murmurs

RS: 

Elliptical & b/l symmetrical chest

Trachea appears to be central

Expansion of chest equal on both sides

B/l air entry +, normal vesicular breath sounds

P/A:

Scaphoid abdomen

No visible pulsations/engorged veins/scars/sinuses

Soft , no organomegaly

No free fluid in the abdomen

Bowel sounds present

INVESTIGATIONS:

Chest x - ray

ECG:

MRI CERVICAL SPINE WITH WHOLE SPIME SCREENING

 TREATMENT: 

DAY 1 

-IVF lamp optineuron in 10NS IV/OD 

- tab Pan 40mg PO/ OD

- Monitor vitals 4th hourly 

- syp potchlor 10ml PO/OD 

- -inj lampker( 20MEq ) in 10NS over 4- 6 hours 

- tab ultracet PO/ QID 

- -inj thiamine lamp 100ml NS/ IV / TID 

DAY 2 

IVF lamp optineuron in 10NS IV/OD 

- tab Pan 40mg PO/ OD

- syp potchlor 10ml PO/OD 

- tab ultracet PO/ QID 

-inj thiamine lamp 100ml NS/ IV / TID 

DAY 3 

IVF lamp optineuron in 10NS IV/OD 

- tab Pan 40mg PO/ OD

- syp potchlor 10ml PO/OD 

- tab ultracet PO/ QID 

-inj thiamine lamp 100ml NS/ IV / TID 

                                                                                      Questions:     

1. How does potassium levels  affect quadriparesis?

2.what are the causes of quadriparesis ?

3.how do you assess gbs ?                                           4.How do you cure gbs?

5.what are the clinical manifestations of gbs?