Hall ticket : 1601006014 LONG CASE
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CASE
A 50yr old female,farmer by occupation, resident of suryapet came with chief complaints of weakness in left upper and lower limbs since 3 days.
History of present illness:
Patient was apparently asymptomatic 3 days back ,then she developed dizziness which was sudden in onset .Then she developed weakness in her left upper and lower limbs followed by fall.Weakness was sudden in onset and progressed rapidly to a state where she was unable to move her left lower limb and left upper limb.It was associated with drooping of angle of mouth on left side ,with speech difficulty and there was deviation of mouth to the right side, associated with drooling of saliva .
It was not associated with loss of consciousness,loss of memory ,seizure activity, behaviour abnormalities,bowel or bladder incontinence or visual disturbances.
No H/o fever ,nausea ,vomiting,headache,chest pain and dyspnea.
Past history:
No similar complaints in the past .
She is a known case of Diabetes and hypertension since 4 years .
No H/o of Tuberculosis , asthma , epilepsy , thyroid disease, cardiovascular diseases.
Family history: no relevant family history
Menstrual history:
She had undergone Hysterectomy 4 years back for fibroid uterus.
Allergic history : No known allergic history.
Personal history :
Diet - mixed
Appetite - Normal
Sleep - Adequate
Bowel / bladder movements - Regular
No addictions
General Examination :
Consent obtained
Patient was conscious , coherent and cooperative,well built and well nourished.
No pallor , icterus , cyanosis , clubbing, koilonychia, general lymphadenopathy and edema.
VITALS :
Pulse - 75bpm with regular rhythm and character
Respiratory rate - 15cpm
Blood pressure - 110/80mm Hg
Temperature - Afebrile
Systemic Examination :
Central nervous system examination-
1. Higher mental functions -
Patient is conscious ,oriented to time,place and person.
Emotionally stable
No loss of memory
No behaviour abnormalities
Speech normal
2. Cranial nerve Examination -
Olfactory nerve - smell present on both sides
Optic nerve - visual acuity 6/6, visual field ,color vision normal on both sides
Cranial nerves 3,4,6 - intact on both sides
Trigeminal nerve - intact on both sides
Facial nerve
Nerve affected on the left side
- deviation of mouth to the right side
- frowning present
- absent nasolabial fold on left side
- blowing and whistling absent
Taste sensation on anterior 2/ 3 rd of tongue is present.
Corneal reflex - present on both eyes
Vestibulocochlear nerve - intact on both eyes
Glossopharyngeal and vagus nerve - intact
Spinal accessory nerve - shrugging of shoulder present
Hypoglossal nerve - tongue movements normal.
3.Motor system
A)Bulk - no wasting
B)Tone - Right left
UL - N N
LL - N N
C)Power: Right left
UL. 5/5. 0/5
LL. 5/5. 4/5
D) Reflexes:
Superficial. Right. Left
Corneal present present
Conjunctival Present present
Plantar. Flexor Extensor
Deep. Right. Left
Biceps +2. +2
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 ,S 2 heard
Respiratory - Bilateral air entry present
GIT - normal
Investigations :-
CT - normal
Provisional diagnosis :-
Left UMN facial palsy with left sided hemiparesis.
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