33 yr old female with c/o tingling sensation of left lower limb associated with numbness since 3 days

 Unit5: admission on date 12/2/21 

Dr. Praveen naik ( associate professor) 

Dr.natasha mam (pg Y3)

Dr.zain alam (pg Y2) 

Dr. Shashi kala (pg Y1)

Dr. Shailesh patil(pg Y1) 

Interns 

Shriya reddy 

Anjali Vishwas 

Mourya

33 old female C/o tingling sensation of left lower limb associated with numbness since 3 days. 

C/o involuntary movements of b/l upper limbs and lower limbs since 3 days. 

C/o headache since 3 days 

H/o fever 20 days back. 

HOPI- patient was apparently asymptomatic 20 days back then developed fever which was gradual in onset associated with chills and rigor 

Present throughout the day subsided on taking medication from near by RMP. 

H/o involuntary movements of b/l upper and lower limbs (gtcs type) associated with frothing, uprolling of eyes. Post ictal confusion not associated with tongue bite, involuntary defecation/micturition lasting for 2 -3 mins ,aura+

H/o squeezing type of pain abdomen

H/o headache 3 days back diffuse type not associated with nausea, vomitings, diminished vison. 

Not a k/c/o htn, dm, TB,thyroid 

Past - similar history of seizures present in childhood (not on any medication).

General examination:

Pallor negative 

Icterus negative

No cyanosis ,clubbing lymphademopathy,Edema.



Cvs apex beat in 4th ICS medial to midclavicular line



Rs bae + nvbs hears


P/a soft ,nontender,bowels sound heard,


Cns  

HMF- patient conscious


 Lobar function tests

1.Frontal:social behaviour:normal

                 language:normal

                micturation:normal

2.parietal dominant: language, calculations normal,

 ideational apraxia absent 

orientation:present

finger agnosia : absent 

 simple and complex calculations normal

             

3.parietal non dominant

 constructional skills: normal 

4.Temporal:

 memory and language:normal

5.occipital

          visual memory:normal

          prosopagnosia:absent



speech- normal


MMSE-

28/30(No cognitive impairment)


cranial nerves-1st normal


2nd Counting fingers at 6mts both eyes normal

                                             rt         lf

3rd,4th,6th

                     pupil size.      N         N

                     DLR/CLR.       N.        N

NO pstosis, nystagmus.


5th sensory normal

motor normal

reflex corneal normal,conjuctival present


7th motor nasolabial fold normal

no deviation of mouth

reflex corenal and conjuctival normal

secretomotor moistness of eye and tongue normal,buccal mucosa normal


8 the nerve:Rinnes and Weber's  

Normal

9and 10 th nerve: uvula centrally placed


11 th nerve: trapezieus normal sternocleidomastoid normal


12 th nerve: tongue tone normal, no wasting, no fibrillations,no deviation of tongue


MOTOR SYSTEM 

                         Right.         Left

Bulk:               normal.      Normal

Tone: ul.        Normal.   Normal

           LL.       normal      normal

Power      UL  prox 5/5.         5/5

                       distal 5/5.       5/5

                  LL.prox 5/5.         5/5

                       distal 5/5.      3/5

Reflexes.  

   Superficial reflexes

                       Right.           Left

Corneal.        P                   P

Conjunctival P.                  P

Abdominal.   P.                  P

Plantar           flexion     flexion

    Deep tendon reflexes 

                     Right.             Left

Biceps.        2+                   2+

Triceps.       2+                  2+

Supinator.    2+                   2+

Knee              2+                   2+

Ankle.           2+                   2+

Involuntary movements - absent 

 

SENSORY SYSTEM 

                                 R.                 L

Pain.                        +.                 +

fine touch.              +.                  +

temp.                       +.                 +

vibration (decreased)

medial malleolus.  9sec 9sec

patella.                      9sec 9sec

upper limb.               9sec.   9sec     


propriception.         N     N

stereognosis.          N     N



CEREBELLUM

titubation - absent

Nystagmus- absent 

Intensional tremors - absent

Pendular knee jerk - absent 

Coordination tests

      dysdiadochokinesia absent

      finger nose test normal 

Tandem walking :Negative 

Rombergs:negative 


MENINGIAL SIGNS

Neck stiffness - absent

Kernigns sign - negative

Brudzinkis sign - negative

Diagnosis: sudden onset seizures partial complex seizures ? Todd’s palsy with temporal epilepsy





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