PARAPERESIS

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current based inputs.

Chief complaints

Patient fell down when tried to stand up and hit her head to the ground 

Lack of appetite

Vomiting 

History of presenting illnesses 

Patient was apparently asymptomatic 5days back 

MONDAY

 she felt weakness and tremors

She was unable to grasp the water glass when tried to drink water

TUESDAY

she was unable to walk due to increased pain in legs

She fell down as soon as she tried to walk

History of past illness

Not a known case of diabetes, hypertension, thyroid, seizures

She underwent hysterectomy 2 months back

No blood transfusion recently

Personal History

Sleep - inadequate

Appetite - normal but causes nausea

Bowel and bladder moments - regular

Micturition - no burning sensation

No addictions

Family history

Not significant

On examination

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

Built - moderate

Nourishment - well nourished

Pallor : present 

Icterus: absent 

Lymphadenopathy : absent 

Clubbing: absent 

Cyanosis: absent 

Odema: absent 

Vitals

Temp:afebrile 

PR:88 beats per minute 

Rr:16 cycles/ min

Bp:140/70mmHg

Systemic examination

 CNS

Neurological examination 

patient is coherent and cooperative

Orientation to time and place is present

Normal speech

No memory loss

CRANIAL NERVE EXAMINATION

CN 1 - Sence of smell present

CN 2 -  field of vision - Normal

CN 3 4 6 -  Extraocular moments present

CN 5 -  Sensation on the face present and corneal reflex present     

CN 7 - 

Motor 

Nasolabial fold - present

Orbicularis occuli - good

Orbicularis oris - good

Buccinator - good

Sensory

Taste - normal

Reflexes - present 

CN 8 -  

Rinnes test - positive

Webers test - not lateralized

Nystagmus absent

CN 9 10 -  Reflexes present 

CN 11 - Sternocleidomastoid - good

CN 12 - Tongue protrusion - normal

Motor system 

Reflexes

Biceps jerk - +++

Triceps jerk  - +++ 

Supinator - +++

Knee jerk - ++

Ankle - +

Sensory system 

Touch- normal

Pain -normal

Temperature-  normal

Fine touch - normal

Vibration - normal

2 point discrimination - normal

Cerebellar sign

Finger nose in coordination - no

Knee heel in coordination - no

CVS- 

S1 S2 Sounds heard

No murmurs

Resp system

Normal vesicular sounds heard

Per abdomen - No organomegaly

CVS: S1,S2 heard, no murmurs heard 

Resp:NVBS heard 

Abdomen: 

Scaphoid in shape abdomen

Tenderness present,no palpable mass 

Bowel sounds present 

Provisional diagnosis

INVESTIGATIONS

Treatment 

Inj. Optineurin 1 amp in 100ml NS IV

Inj. Kcl 40 meq  in 500ml NS SLOW IV IN 5 TO 6

 HRS

Check vitals reqularly.