18 YEAR FEMALE WITH WEAKNESS IN LOWER LIMBS
A 18 year old female came to causality on 8/7/21 with Cheif complaints of
- Weakness in both lowerlimbs.
- Unable to stand and walk.
18 year old female ,a daily wage labour,
H/o Seizure episode and weakness of both lower limbs
Was unable to walk without support till 6 years of age
Faced difficulty in studying and writing at 6 years
Was able to do work at home by 8 years since then unable to do heavy work
At 15 years attained normal growth and normal milestones
2 months back developed sudden onset of oedema which relieved on rest.
One morning ,went for urination & Suddenly she is unable to get her on her own ,on visiting local hospital diagnosed with Hypokalemic periodic paralysis.
Then she took herbal medicine for 10 days and able to get on her own with support,and developed nausea ,vomiting 2-3 episodes ,then on visiting hospital diagnosed with Dyselectrolytemia.
Then developed spasm of upperlimbs and profuse sweating.
No H/o fever/cold/cough
No H/o head trauma
No H/o seizure episodes after
No H/o chest pain,palpitations
No H/o abdominal pain and abdominal distension,
c/o abdominal pain squeezing type after consumption of food,relived after sometime on its own
No H/o outside food consumption
Outside MRI showing B/L Mild cerebellar & vermian atropy.
Treatment History:
Herbal medicine for 10 days
Personal History:
- Occupation: Daily wage labour
- Appetite: normal
- Diet: mixed
- Bowls: regular
- Micturition:normal
- No known allergies
- No addictions.
Family History:
- No H/o Diabetes,HTN,asthma,heart disease and other hereditary diseases.
Menstrual History:
- Age of menarche : 12 year
- Menstrual cycle :3/30
- And Regular
General examination:
- O/E
- Pallor: present
- Icterus: absent
- Cyanosis: absent
- Clubbing of fingers:absent
- Lymphadenopathy: absent
- Oedema of feet: absent
- PR : 82 bpm
- RR : 20 cpm
- BP : 110/70 mmHg
- Spo2 : 98% at room air
Systemic examination:
CNS:
- Tone :
Rt. Normal. Normal
Lt. Normal. Normal
- Cerebellar signs:
- Finger-nose in-coordination:No
- Knee-heel in-coordination : No
Provisional diagnosis:
Hypokalemic periodic paralysis
Investigations:
No sonological Abnormalities detected
Diagnosis:
Spastic paraperesis-secondary to perinatal insult
Peripheral neuropathy-Distal sensory motor
Hypokalemia is resolved by 10/7/21
Treatment plan:
On 8/7/21-
- Inj.Optineuron 1 amp in 100 ml NS/IV
- Tab. Pregaba m
- Tab. pcm 650 mg
- Tab.pan 40 mg.
- Inj. Optineuron 1 amp in 100 ml NS/IV
- Ivf. dns @75 ml/hr
- Tab.pcm 500mg /po/sos
On 10/07/21
O/E
- Pt.-c/c/c
- PR - 135 bpm
- BP - 90/70 mmHg
CVS : S1 & S2 heard
P/A : soft ,no organomegaly detected.
CNS:
- HMF - Intectual disability
- Motor- Rt. Lt
- Tone. UL N N
LL. Increased Increase
2. Power.
UL. 4/5. 4/5 LL prox. 4/5 4/5
Dist. 3/5 3/5
3. Reflexes
Biceps +1 +1
Triceps +1 +1
Supinator +1 +1
Knee - -
Ankle - -
Plantar F F
- Sensory
- Tem : + +
- Touch + +
- Pain + +
- Vibration UL. + + LL - -
- Joint position UL + + LL - -
- Cerebellar signs
Finger- nose incoordination
Heel- knee test-
- Romberg's test positive
- Gait -spastic
Treatment:
- Inj. Optineuron 1 amp in 100 ml NS/IV
- Ivf. dns @75 ml/hr
- Tab.pcm 500mg /po/sos
Further Investigations:
On 11/7/21
C/O - Dragging pain in both lower limbs
O/E
- Pt - c/c/c
- PR - 128 bpm
- BP - 110/70 mmHg
- RR - 18 cpm
- RS - Bilateral air entry present and clear
- CVS - S1 & S2 are heard
- A/p - soft
- CNS - Left handedness
Diagnosis state:
Spastic paraperesis secondary to perinatal insult
Peripheral neuropathy Distal >Proximal motor sensory
Hypokalemic periodic paralysis
Treatment:
- Ivf - dns @75 ml/hr
- Syp.Potchior 10 ml in 1 glass of water/po/OD
- Inj.Optineuron 1 amp in 100ml NS/IV/OD
- Tab. Clonazepam 0.25mg/po/sos
PR/Temp/BP charting 4th hrly.
On 12/7/21
C/O - Dragging pain in both lower limbs
O/E
- Pt - c/c/c
- Temp - 101 F
- PR - 84 bpm
- BP - 100/70 mmHg
- RR - 18 cpm
- RS - Bilateral air entry present and clear
- CVS - S1 & S2 are heard
- A/p - soft
- CNS - Left handedness
Investigative findings:
Diagnosis state:
Spastic paraperesis secondary to perinatal insult
Peripheral neuropathy Distal >Proximal motor sensory
Hypokalemic periodic paralysis
Treatment:
- Ivf - dns @75 ml/hr
- Syp.Potchior 10 ml in 1 glass of water/po/OD
- Inj.Optineuron 1 amp in 100ml NS/IV/OD
- Tab. Clonazepam 0.25mg/po/sos
PR/Temp/BP charting 4th hrly.
On 13/7/21
O/E
- Pt - c/c/c
- Temp - afebrile
- PR - 98 bpm
- BP - 110/70 mmHg
- RS - Bilateral air entry present and clear
- CVS - S1 & S2 are heard
- A/p - soft
- CNS - Low HMF
Motor -
- Tone : Rt. Lt. UL n n
LL. increased increased
2.Power: UL 4/5 4/5
LL prox. 4/5 4/5
Dist. 3/5 3/5
3.Reflexes
Biceps +1 +1
Triceps +1 +1
Supinator +1 +1
Knee - -
Ankle - -
Plantar F F
Diagnosis state:
Spastic paraperesis secondary to perinatal insult
Hypokalemic paralysis
Treatment:
- Inj.Optineuron 1 amp in 100ml NS/IV/OD
- Tab. Clonazepam 0.25mg/po/sos
- PR Monitoring 6th hrly.
On 14/7/21
O/E
- Pt - c/c/c
- Temp - afebrile
- PR - 108 bpm
- BP - 100/70 mmHg
- RS - Bilateral air entry present and clear
- CVS - S1 & S2 are heard ,no murmurs
- CNS - Low HMF
Motor -
- Tone : Rt. Lt. UL n n
LL. increased increased
2.Power: UL 4/5 4/5
LL prox. 4/5 4/5
Dist. 3/5 3/5
3.Reflexes
Biceps +2 +2
Triceps +2 +2
Supinator +1 +1
Knee +1 +1
Ankle +1 +1
Plantar F F
Diagnosis state:
Spastic paraperesis secondary to perinatal insult
Hypokalemic paralysis
1 episode of femur spike not associated with chills/rigor.
Treatment:
- Tab.MUT /po/OD
- Tab.PCM 500mg/po/sos
- Tab. Clonazepam 0.25mg/po/sos
- PR Monitoring 6th hrly.
- Thrombophobe ontiment ROR E/A.
On 15/7/21
O/E
- Pt - c/c/c
- Temp - afebrile
- PR - 112 bpm
- BP - 100/70 mmHg
- RS - Bilateral air entry present and clear
- CVS - S1 & S2 are heard ,no murmurs
- CNS - Low HMF
Motor -
- Tone : Rt. Lt. UL n n
LL. increased increased
2.Power: UL 4/5 4/5
LL prox. 3/5 3/5
Dist. 4/5 3/5
3.Reflexes
Biceps +2 +2
Triceps +2 +2
Supinator +1 +1
Knee +1 +1
Ankle +1 +1
Plantar F F
Diagnosis state:
Spastic paraperesis secondary to perinatal insult
Hypokalemic paralysis
Treatment:
- Tab.MUT /po/OD
- Tab.PCM 500mg/po/sos
- Tab. Clonazepam 0.25mg/po/sos
- PR Monitoring 6th hrly.
- Thrombophobe ontiment ROR E/A.
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