A 65 year old male with decreased movement and appetite
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A 65 year old male goldsmith by occupation was brought to casuality with complain of
Unbalanced gait since 1 year
Neurogical dis since 6 months
-unable to walk since 3 months
-stiffness of limbs since 20 days
-decreased appetite since 15 days
-un responsiveness since 3 days
HOPI:
Patient was apparently asymptomatic 1 yr back
Then he developed unbalanced gait,insidious in onset and visited a hospital ,6 months ago and was said to be having a neurological disease (no documents available) and have been using medication since then(not known)and was having generalised weakness on and off since 6 months and due to fear of falling and as he is feeling pricking sensation over the sole,and due to decreased power in his limbs and generalised weakness he completely stopped walking and was bed ridden since 2 months(he didn’t tried walking even with support)visited a hospital again 1 month back,MRi brain was done,showing hydrocephalus and early parkinsons changes
2 months back he used to eat himself(by mixing the food himself,and buttoning his shirt)and since ,2 months his wife is making him eat food
1 month ago he once passed urine on his bed,soon after which, they placed a foleys and changed after each weak.
since 15 days he had flexion contracture of his left upper and lower limb
since 10 days,and he was not responding to commands since 3 days and fever which is of high grade not associated with chills and rigors since 2 days,releived on taking medication
Past history -
Patient is a known case of hypertension since 4 years
Known case of diabetes mellitus since 3 and 1/2 years ,on tablets glimeperide 2 mg and tablet metformin 500 mg
No history of epilepsy, thyroid, asthma , or any previous surgery.
Personal history -
Appetite - decreased
Irregular bowl and bladder movement
Mixed diet
Addiction -alcoholic since 35 yrs
No allergies
:Family history - not significant
GENERAL EXAMINATION:
Patient was conscious, non cooperative,not oriented to time person place
, poorly built, and mall nourished ,dehydrated
Bp - 110/80 mmHg
PR - 96bpm
RR - 22
Temp - afebrile
Pallor - absent
Icterus - absent
Clubbing - absent
Lymphadenopathy - absent
Edema - absent
CVS-S1,S2 +, no added sounds
P/A-Soft,NT
RS- BAE ,trachea is central on palpation.
:CNS examination --
1.weakness of limbs - insidious in onset , gradually progressive , duration - since 3 months
All limbs are flexed and rigidity present
2.spinomotor system -
Muscle wasting present
No muscle cramps
No muscle twitching
No involuntary movement
3. Sensory system -- not elected
4.higher mental functions --
Consciousness - partial
Unable to speak , unable to read and write
5.cranial nerve examination - not elected
6.motor system -
Tone hypertonia in all 4 limbs
Both limbs UL & L.limb were flexed
Superficial reflexes : Corneal reflex , conjunctival reflex ,abdominal and plantar reflex present
Deep tendon Reflex- biceps ,triceps , knee Jerk, jaw jerk reflex present
No sign of meningitis ,gait - walking couldn't be assessed , reduction of arm swing
:Glassgow coma scale -
Eye opening - to speach - 3
Verabal response - no response -1
Motor response- Norma flexion - 4
Total - 8
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