21 years female with ascending weakness ( ? GBS, AMSAN)
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CASE PRESENTATION
21 year old female resident of farmer by occupation came with c/o
-weakness of B/L L/L since 10 days
-unable to stand and walk since 10days
Pt was apparently asymptomatic 5 months back. As she recalls when she was walking through the fields as her daily routine noticed thorn prick to her hand which eventually led to itching of the both hands and later to both the legs which later caused pedal edema in a span of 4 months they went to local traditional healer and used their medication which on not subsiding they went to dermatologist 10 days back after which pedal edema was reduced and then later she noticed weakness of both L/L starting with tingling sensation progressing to numbness which eventually landed in weakness . On further asking the pt complained about tingling sensation in pt U/L . She also gives a H/O feeling of constriction in the upper chest region
No H/O fever,cough, cold, sore throat, nausea,vomiting, loose stools, giddiness
Past history - no H/O DM , HTN, asthma , epilepsy, TB.
Personal history -
Normal appetite
Mixed diet
Bowel and bladder regular
No addictions
GENERAL EXAMINATION:
Patient is conscious, coherent, cooperative and oriented to time, place and person. moderately built and nourished
No pallor,icterus,cyanosis,clubbing,lymphadenopathy ,koilonychia,pedal edema
VITALS:
Temperature-AFEBRILE
BP:120/70mmhg
PULSE:88bpm
RR:22cpm
Spo2:98% on RA
GRBS:126mg/dl
CVS:S1 S2 heard, no murmurs
RS: BAE clear, normal vesicular breath sounds heard,no added sounds
PER ABDOMEN:O/E soft, non tender, bowel sounds heard,umbilicus: inverted
CNS:
Higher mental function
Speech- normal
MMSE - 30/30
Memory - intact
Spine - no abnormality and no local tenderness
Cranial nerves - intact
Motor system Right left
Bulk.
U/L. arm. 25cms. 25cms
Forearm. 19 Cms. 19cms
L/L. Thigh. 43 cms. 43 cms
Leg. 25cms. 25 cms
Power. Rt. Lt
U/L. 4/5. 4/5
L/L. 3/5. 3/5
TONE
U/L. N. N
L/L. D. D
Hand grip. 80% 80%
Reflexes - deep tendon reflexes were absent
Plantar reflex is flexor on both sides
SENSORY EXAMINATION:
Spinothalamic tract. Rt. Lt
Crude touch. N. N
Pain N. R
Temp. N. R
Posterior column
Fine touch. N. Abnormal
Vibration. N. Abnormal
Position sense. Abnormal. Abnormal
Cortical
2 point discrimination - abnormal
Graphesthesia - +
Stereognosis - +
Cerebellar examination
Finger nose test. N. N
Finger nose finger. N. N
Dysdiadokinesia. N. N
Heel knee test. Abnormal. Abnormal
Tandom gait. - impaired
INVESTIGATIONS:
TREATMENT:
For potassium correction
1. Nebulisation with salbutamol 4 respules/stat
2. Inj human actrapid insulin 8 units in 25%D/IV/over 30 mins /stat
3. Inj calcium gluconate 10%, 10 ml/IV over 2-3 mins/stat
Inj optineuron 1 amp in 1 unit NS/iv @50 ML/hr
Inj panto 40 mg/iv/OD
Inj Zofer 4mg/iv/sos
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