1601006024

Hall ticket : 1601006024.

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A 50 year old female, farmer by occupation, resident of Suryapet came with chief complaints of weakness of left upper and left lower limbs since 3 days.

HISTORY OF PRESENT ILLNESS :

The patient was apparently asymptomatic 3 days ago, then she had dizziness.

Then she developed weakness in her left upper and lower limbs followed by fall.

Weakness was sudden in onset and rapidly progressed to a state where she was unable to move her left side of the body.

Associated with drooping of angle of mouth on left side with speech difficulty and there was deviation of mouth to right side associated with drooling of saliva.

No history of loss of consciousness, memory loss, seizure activity, behavioural abnormalities, bowel or bladder incontinence or visual disturbances.

No history of fever, nausea, vomiting, headache, chest pain and dyspnea.

PAST HISTORY :

-No similar complaints in the past.

- She is a known case of hypertension and diabetes since 4 years which is under control by medication.

- No history of epilepsy, TB, asthma, cardiovascular diseases, thyroid diseases.

FAMILY HISTORY :

No relevant family history.

MENSTRUAL HISTORY :

She underwent hysterectomy 4 years back for fibroid uterus.

PERSONAL HISTORY :

- Diet - mixed

-Appetite - normal

- Sleep - adequate

-Bowel and bladder movements - regular.

- No addictions.

ALLERGIC HISTORY :

No known allergic history.

GENERAL EXAMINATION :

Consent obtained

Patient is conscious, coherent and cooperative.

Moderately built and nourished.

No pallor, icterus, cyanosis, koilonychia, lymphadenopathy and edema.

VITALS

- pulse : 75 BPM with regular rhythm and     charecter.

- RR : 17 CPM

- BP : 110/80 mm Hg

- Temperature : afebrile

SYSTEMIC EXAMINATION :

NERVOUS SYSTEM:

1. HIGHER MENTAL FUNCTIONS :

    - No loss of consciousness : person aware of         self and surroundings oriented to time,         place and person.

    - No loss of memory : immediate, recent and        longterm.

    - No behaviour abnormality.

    - No emotional disturbances.

    

2. CRANIAL NERVES :

    - Olfactory nerve : smell present on both               sides.

    - Optic nerve. : Visual acuity 6/6 , visual field,         color vision normal on both sides.

    - Oculomotor nerve : Intact on both sides, no          ptosis, direct light reflex, consensual reflex,          accomodation reflex present.

    - Trochlear nerve : Intact on both sides.

    - Trigeminal nerve : Intact on both sides. Pain,         temperature, light touch sensations                      present, no deviation of jaw on opening              mouth, corneal, conjunctival reflex present.

    - Abducens nerve : Intact on both sides.

    - Facial nerve : 

               - Nerve affected on left side.

               - Frowning present.

               - Deviation on mouth to right.

               - Absent nasolabial fold on left side.

               - Blowing and whistling absent.

               - Taste sensation on anterior 2/3rd of                    tongue present.

    - Vestibulocochlear nerve : Intact.

    - Glossopharyngeal nerve 

       Vagus nerve : Intact. Taste sensations        present on posterior 1/3 rd of tongue, palatal    reflex, gag reflex present.

  - Spinal accessory nerve : shrugging of shoulders present.

    - Hypoglossal nerve : no deviation of                 protruded tongue, no abnormal movements.

   

3. MOTOR SYSTEM :

   ★ Bulk - no wasting 

 ★ Tone :                      Right.              Left

      Upper limbs.            Normal.        Normal

      Lower limbs.            Normal.        Normal

 ★ Power :

      Upper limbs.             5/5.              0/5

       Lower limbs             5/5.              4/5

  ★ Reflexes :                    

       ~ Superficial reflexes.   Right.        Left

        - corneal reflex.         Present.    Present

        - conjunctival reflex.   Present     Present

        - Plantar reflex.           Normal.     Extensor

       

       ~ Deep reflexes.          Right.          Left

        - Biceps.                      +2.               +3

        -Triceps.                      +2.               +2

        - knee.                          +2.              +2

        - Ankle.                      Absent.          Absent

   4. SENSORY SYSTEM :

        - Superficial : fine touch , temperature, pain                                present

        - Deep.        : Position, vibration, two point                                 discrimination, stereognosis,                                graphesthesis present.

 

    5. CEREBELLAR FUNCTIONS :

          Normal

     

    6.  COORDINATION AND GAIT:

         Finger nose test, finger finger test , heel  knee test present.

         Gait : dragging type

     7. Signs of meningeal irritation absent

        OTHER SYSTEMS :

        

       CVS : S1, S2 heard

        RESPIRATORY: Bilateral air entry present

        GIT : per abdomen normal

       

      INVESTIGATIONS :

       CT - Normal

       

   

ECG:

PROVISIONAL DIAGNOSIS :

    

 Left UMN facial palsy with left sided  hemiparesis