Thursday, 20 July 2023

75 year old male patient with quadriparesis

 I am Saranya ,currently an intern posted in the department of General Medicine 

Greetings to all my readers;

This is an elog documenting the patients that I witness during my Rotatory Internship Postings to enforce a greater patient centered learning

 DEIDENTIFICATION : 

The privacy of the patient is being entirely conserved. No identifiers shall be revealed through out the piece of work whatsoever.

 

CONSENT : An informed consent has been taken from the patient in the presence of the family attenders and other witnesses as well and the document has been conserved securely for future references. 

 

ACKNOWLEDGMENT 

I convey my regards to  Dr. Lohith  and Dr.Narsimha Readdy ( Resident , Department of General Medicine )  for guiding me regarding the case .

 


Documentation :

is being done on 20th July 2023

(Updates will be done later in the future with dates mentioned for the same.)

 

INTRODUCTION :

My patient  is a 75 year old man , resident of a rural district of South India

 

CHIEF COMPLAINTS :


A 75 yearold male came to casualty with chief complaintsof weakness of left upperlimb and lowerlimb since 2 days

Clinical pictures

Lateral and Front profile 




Conjunctiva


? Frank Sign





HOPI:

Patient was apparently normal 2 days back he then developed weakness of left upperlimb and lowerlimb which was insidious in onset and gradual in progression.

No C/O deviation of mouth

Neck pain+

No C/O headache, vomiting, blurring of vision

C/O constipation-passes stool in every 2days

Decreased urine output since 2 days

No pedal edema, facial puffiness

Mild SOB grade2


Biopsychosocial Corelation:


 Patient used to live in their village house with his wife ,son ,daughter in law and grandson

Until 6 months from today, he used to go to his fields everyday for ploghing and seed sowing work but his wife began falling sick, she developed paresis ,inability to move and became completely confined to the bed .

To support her and also carry out certain chores ,he stopped going to the fields and stayed at home the entire time ,taking care of the wife. 

His wife passed away 5 days back which left a big mark on him and he kept complaining that he wasn't feeling fine since then , after which his situation worsened and 1 day back he was brought to our medical institution 


USUAL DAILY ROUTINE AND DERANGEMENT DUE TO DISEASE

He would get up 6 am in the morning, freshen up, have breakfast at 7 am and go off to the agricultural fields for work, he would come back home for lunch at 1 pm ,take some rest and go back to his fields for another hour or two at around 3 pm.

Evenings usually he used to spend time with his family and neighbours ,have his dinner at around 7 pm and go to bed.

Although the patient has been experiencing these symptoms from around 1 week back but it has severely deranged his daily life, unlike before he is unable to any of this daily work independently and needs help all round the clock.


PAST HISTORY:

Patient was diagnosed as hypertensive 3 days back but not put on any medication

N/K/C/O DM, TB, epilepsy, CVA, CAD, thyroid disorders and bronchial asthma


EXAMINATION:

Patient is conscious and oriented

PR:96bpm

BP:120/80mmHg

RR:14cpm

RS:BAE +no added sounds

CVS:S1, S2 heard. No added sounds

P/A:soft, nontender


Cns examination : 

Patient is conscious , coherent and oriented to time ,place and person.


Higher mental functions are intact.


Patient has neurogenic bladder which was releived after insertion of foleys catheter.


Tone -normal in all four limbs

Power      rt     lt

             4-/5  4-/5

            4-/5    4-/5

Reflexes

B    T    S   K     A P

++ ++ + + + Flexion

++ ++ + + + Flexion


Neurogenic bladder


Note : on 19/7/23 evening , Patient accidentally hit the wall and suffered a laceration in the frontal region of the head.

Suturing and wound care was done for the same.

Wound before suturing 

Sutures secured


Electrophysiological study


Radioimaging









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