45 yrs old female with paraparesis since 15 days

C/O Generalized weakness of lower limbs since 10 years

Difficulty in swallowing since 15 days 

HOPI:

Pt was apparently asymptomatic till 1999  then she delivered a baby(by c-section due to cord entanglement)  she also stated that she started  developed Generalized weakness ( due to low haemoglobin levels ) not associated with pain and was able to perform her daily activities

Her husband also left as she couldn't perform her daily activities.Her son currently stays in the hostel 


 She previously used to work as mandal officer.


And in 2012 she stopped going to work because she started developing weakness  insidious in onset , gradually progressive , associated with pain , Aggrevated with walking and relieved with rest. she could not walk for long distances and she managed to  to perform  daily activities

In 2023 Jan she alleged had h/o slippage in bathroom following which she was normal for 5 days 

Next day she couldn't get up from bed which is sudden in onset and non progressive and couldn't be able to perform her daily activities because of pain mainly and weakness of both the lower limbs.

Patient was taken to the nearby hospital and 

X ray was done which is told to benormal 

MRI was also done 

Patient then complained of anuria for which foleys catherisation was done the she was able to pass urine 

After 10 days she then developed difficulty in swallowing (more to solids ) associated with pain 

No h/o giddiness,LOC, head injury

No history of involuntary movements















vitals 

Temperature - Afebrile

Pulse - 83bpm

Blood pressure- 130/80 mmhg

Respiratory rate- 17 cycles per min

Spo2 - 99%





SYSTEMIC EXAMINATION 

CVS -s1s2 heard,no murmurs



RS-bae+,nvbs heard



P/A-soft,non tender,no organomegaly



CNS 

On examination. R. L

TONE

UPPER LIMB. N. N

LOWER LIMB. N. N

POWER 

UPPER LIMB. 5/5. 5/5

LOWER LIMB. 2/5. 2/5



REFLEXES 



               Rt Lt

B +++ +++

T ++ ++

S. +. +

K. - -

A. - -

P. Flexion Flexion

INVESTIGATIONS:









Chest x ray 
PA VIEW 


X RAY OF BOTH THE HIPS 





Provisional diagnosis: 

CHRONIC PARAPARESIS WITH DYSPHAGIA UNDER EVALUATION .


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