Saturday june 6th 2020

 Medicine intern log

Hello everyone,im a medical intern,and recently started my medicine posting.this blog is to share my medicine experiences and cases i come across during this period.

CASE

A 57 year oldfemale patient came with complaints of weakness of both lower limbs Since 3 months.

   

         Patient was apparently asymptomatic 3 months back when she is doing her routine daily work,she developed weakness of bilateral lower limbs which was sudden in onset.she went to a local hospital and treated by a local doctor but their was no improvement.sensory system is lost in both lower limbs from below the nipple.both the upper limbs are normal

No h/o upperlimb involvement

No h/o deviation of mouth

No h/o slurring of speech

No h/o urinary incontinence,

No h/o fever,loose stools

Past history:

she had a h/o thyroid surgery 4 years back

No h/o hypertension,diabetes mellitus

Personal history: diet is mixed
                              Appetite is regular
                            Bowel and bladder are regular
No significant family history 

GENERAL EXAMINATION:
Patient is c/c/c and oriented.
Thin built and moderately nourished
Temperature:afebrile
Pallor-absent
Icterus-absent
No cyanosis,clubbing and lymphadenopathy
Bp:90/60mmhg
PR:75 bpm
CVS:S1 and S2 heard,no murmurs
RS:BAE present NVBS
P/A:soft and nontender,bowel sounds heard.

CNS EXAMINATION:
 Speech is normal
Cranial nerves are intact

Motor examination
                     Right                     Left
BULK                    
UL.                 N.                        N
LL.              Decreased         Decreased

TONE
UL.                N.                         N
LL.            Decreased.            Decreased

POWER
UL.             5/5                          5/5
LL.            1/5                           1/5

REFLEXES
Superficial reflexes
Abdominal.      -
Deep tendon reflexes
Biceps.      1+.                         1+
Triceps.     1+.                         1+
Supinator.  1+.                         1+
Knee.         -                             -
Ankle.        -                             -
Plantar.      -                             -

Sensory
LL
Pain.          -                             -
Crude touch-                             -
Temperature. -                           -
Fine touch.     -                          -
Vibration.       -                          -
Diagnosis: paraplegia under evaluation 
 Investigations:ECG

MRI SPINE dorsolumbar region

                     Videos of reflexes power and tone

Diagnosis : paraplegia secondary to metastasis
 Patient refused to get admitted even after the patients condition was explained and discharged by LAMA