General medicine case 4

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A 40year old male farmer by occupation  was brought to opd with chief complaints of weakness of B/l lower limbs and upper limbs since 4 days 

Unable to walk since 2 days 

HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic 4 days back and then  while he was dancing in ganesh nimarjanum  he suddenly fell down due to weakness of B/l lowerlimbs  which was sudden in onset , progressive in nature( initially walked with support, now can't move ) 

 Weakness now progressed to B/ l upper limbs 

No h/ o loss in sensations 

No h/o headache,giddiness, slurred speech, deviation of mouth or involuntary movements 

No other complaints

HISTORY OF PAST ILLNESS :

 There is no history of hypertension, diabetes mellitus , asthma, tuberculosis 

PERSONAL HISTORY:

 Diet is mixed 

Appetite is normal 

Sleep is adequate 

Bowel movements are regular and micturition is normal 

No allergy to known drugs 

Habit of alcohol consumption and smoking since 10 years 

FAMILY HISTORY:

There is no history of similar complaints in the family members 

GENERAL EXAMINATION: 

The patient is conscious , coherent , cooperative , well oriented to person place and time 

Moderately built and nourished 

Clubbing is seen as grade 3 

No icterus 

No pallor 

No cyanosis 

No lymphadenopathy 

No signs of dehydration 

Vitals : 

Temp:  afebrile 

PR: 85bpm 

RR: 20cpm 

BP: 120/70mmHg 

Spo2 : 98% at RA

GRBS : 102mg/dl 

SYSTEMIC EXAMINATION : 

Central nervous system:

Patient is conscious , coherent ,cooperative and well oriented to person place and time 

- HMF : intact 

Motor system: 

- power : 

             R   L                  R     L

UL : 3/5   3/5        LL: 1/5   1/5

- Hand grip : Right - 30%  Left - 30%

- Tone is normal 

- All Reflexes were absent 

- sensory system: normal 

- cranial nerves : intact 

- cerebellum: intact 

CVS :

Elliptical and B/ l symmetrical chest 

No visible pulsations /engorged veins / scars / sinuses on the chest wall 

Apex beta palpable at 5th intercostal space medial to mid clavicular line 

S1 S2 heard 

No murmurs 

RESPIRATORY SYSTEM:

Elliptical and B/l symmetrical chest 

Trachea appears to be central 

Expansion of chest equal on both sides 

B/ l air entry + , normal vesicular breath sounds 

P/A : 

Scaphoid abdomen 

No visible pulsations /engorged veins / scars/ sinuses 

Soft , no organomegaly 

No free fluid in the abdomen 

Bowel sounds present 

PROVISIONAL DIAGNOSIS :

-GBS 

- AIDP 

INVESTIGATION: 

Chest x-ray :

ECG 

Complete blood picture : 

Hemoglobin: 12. 1 gm/ dl 

Total count :8100 cell/cumm

Neutrophils :57% 

Lymphocytes: 30% 

Eosinophils: 05% 

Monocytes: 08% 

Smear : Normocytic normochromic with thrombocytopenia 

MRI CERVICAL SPINE WITH WHOLE SPINE SCREENING 

TREATMENT: 

DAY 1 

-IVF lamp optineuron in 10NS IV/OD 

- tab Pan 40mg PO/ OD

- Monitor vitals 4th hourly 

- syp potchlor 10ml PO/OD 

- -inj lampker( 20MEq ) in 10NS over 4- 6 hours 

- tab ultracet PO/ QID 

- -inj thiamine lamp 100ml NS/ IV / TID 

DAY 2 

IVF lamp optineuron in 10NS IV/OD 

- tab Pan 40mg PO/ OD

- syp potchlor 10ml PO/OD 

- tab ultracet PO/ QID 

-inj thiamine lamp 100ml NS/ IV / TID 

DAY 3 

IVF lamp optineuron in 10NS IV/OD 

- tab Pan 40mg PO/ OD

- syp potchlor 10ml PO/OD 

- tab ultracet PO/ QID 

-inj thiamine lamp 100ml NS/ IV / TID 

- What can cause quadriparesis

- is quadriparesis same as quadriplegia 

- How is GBS diagnosed 

- Which cranial nerves symptoms are typical in GBS