C/o alternated sensorium since 2 days pedal edema since 20 days
General examination:no pallor,
Icterus ,cyanosis ,clubbing lymphademopathy,Edema.
Cvs apex beat in 5th ICS medial to midclavicular line
pan systolic murmur+
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:present
right left orientation:present
finger agnosia :absent
simple and complex calculations normal
3.parietal non dominant
constructional skills:?
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 not elicited
9and 10 th nerve: uvula centrally placed11 th nerve: trapezieus normal sternocleidomastoid normal12 th nerve: tongue tone normal, no wasting, no fibrillations,no deviation of tongueMOTOR SYSTEMRight. LeftBulk: normal. NormalTone: ul. Normal. Normal
LL. normal normal
Power UL prox4/5. 4/5
distal 4/5. 4/5
LL.prox 4/5. 4/5
distal 4/5. 4/5
Reflexes.
Superficial reflexes
Right. Left
Corneal. P P
Conjunctival P. P
Abdominal. P. P
Plantar flexion flexion
Deep tendon reflexes
Right. Left
Biceps. +1. +1
Triceps. +1. +1
Supinator. - -
Knee +1- +1
Ankle. Cannot be elicited -
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- bidirectional+(Test of skew negative,head impulse ?present)
Intensional tremors - absent
Pendular knee jerk - absent
Coordination tests
dysdiadochokinesia absent
Tandem walking
MENINGIAL SIGNS
Neck stiffness - absent
Kernigns sign - negative
Brudzinkis sign - negative
Diagnosis AKI ON CKD SECONDARY TO UROSEPSIS / necrotising fasciitis
With uremic encephalopathy and anemia with chronic disorder
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