CNS CASE

 

 Preliminary details 

Name: Mangamma

Age: 45

Sex: Female

Occupation: handloom business 

Address: Bogaram

Chief complaints

Weakness in both legs

Fell down when tried to standup and hit her head to ground

Vomiting

History of present illness

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

Family history

Not significant

Personal history

Sleep - inadequate

Appetite - normal but causes nausea

Bowel and bladder moments - regular

Micturition - no burning sensation

No addictions

GENERAL EXAMINATION

Built - moderate

Nourishment - well nourished

Pallor : present 

Icterus: absent 

Lymphadenopathy : absent 

Clubbing: absent 

Cyanosis: absent 

Odema: absent 

Vitals:

Bp: 140/70 mmhg

RR: 16 cycles / min

Temp: Afebrile

Pulse rate: 88 per min

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

Provisional diagnosis

Paraperesis 

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.

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