45 yr /F Paraparesis secondary to Trauma with disphagia

 C/O Generalized weakness of lower limbs since 10 years


Difficulty in swallowing since 15 days 

HOPI:


Pt was apparently asymptomatic till 1999 then she delivered a baby(by c-section due to cord entanglement) she also stated that she started developed Generalized weakness ( due to low haemoglobin levels ) not associated with pain and was able to perform her daily activities


Her husband also left as she couldn't perform her daily activities.Her son currently stays in the hostel 




 She previously used to work as mandal officer.




And in 2012 she stopped going to work because she started developing weakness insidious in onset , gradually progressive , associated with pain , Aggrevated with walking and relieved with rest. she could not walk for long distances and she managed to to perform daily activities


In 2023 Jan she alleged had h/o slippage in bathroom following which she was normal for 5 days 


Next day she couldn't get up from bed which is sudden in onset and non progressive and couldn't be able to perform her daily activities because of pain mainly and weakness of both the lower limbs.


Patient was taken to the nearby hospital and 


X ray was done which is told to benormal 


MRI was also done 


Patient then complained of anuria for which foleys catherisation was done the she was able to pass urine 


After 10 days she then developed difficulty in swallowing (more to solids ) associated with pain 


No h/o giddiness,LOC, head injury


No history of involuntary movements


PAST HISTORY 

N/k/c/o DM, HTN, thyroid disorders, CVA ,CAD, TB ,EPILEPSY


PERSONAL HISTORY 


diet: mixed


appettite: decreased 


bowel and bladder: regular


sleep: adequate


no addictions

DAILY ROUTINE: 


GENERAL EXAMINATION:

Patient is consious, coherent, and cooperative 

moderately built and moderately nourished 

Butterfly like rash present over the cheeks since 6yrs.

Pallor - present

Icterus-absent

Cyanosis - absent

Clubbing-absent


vitals 


Temperature - Afebrile

Pulse - 83bpm

Blood pressure- 130/80 mmhg

Respiratory rate- 17 cycles per min

Spo2 - 99%


SYSTEMIC EXAMINATION 


CVS -s1s2 heard,no murmurs

RS-bae+,nvbs heard

P/A-soft,non tender,no organomegaly

CNS 


On examination.               R                  . L


TONE


UPPER LIMB.                     N                 . N


LOWER LIMB.                     N.                  N


POWER 


UPPER LIMB.                 5/5.            5/5


LOWER LIMB.                2/5                 2/5




REFLEXES 


                                       Rt              Lt


B                                   +++              +++


T                                   ++                 ++


S                                  +                    +


K                                _                        _


A.                              _                          _


P.                           Flexion           Flexion


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