47 year old male with choreoathetoid movements

 

NOTE: THIS IS AN ONLINE E LOGBOOK 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 A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT


Thanks to Sanjana for her inputs -

CHEIF COMPLAINTS:

blog link

-https://96sanjanapalakodeti.blogspot.com/2022/09/47m-with-uncontrolled-hand-movements.html


HISTORY OF PRESENT ILLNESS:


WEAKNESS OF LIMBS

a.       Weakness of all 4 limbs present 

b.      Onset -insidious

c.       Duration from 2 years , gradually increased 

d.      Severity – paresis

e.       Progresion – simultaneous involvement of all 4 limbs

f.     

1.      Upper limbs

i)                    Proximal –  no diificulty  in combing the hair, taking the food to the mouth

ii)                  Distal – no difficulty in buttoning the shirt, mixing the food

2.      Lower limbs

i)                    Proximal –  difficulty in squatting and getting up from the squatting position, climbing stairs up and down

ii)                  Distal –  no slipping of chappals, tripping of toes

g.                       No difficulty in lifting the head off the pillows

h.      No difficulty in Rolling over the bed, getting up from the bed

i.          No Difficulty in breathing

j.        No Diurnal variation in the weakness of the muscles

 

2. SPINOMOTOR SYSTEM

a.       Wasting of hands, lowerlimbs since 1year

b.      Pain at lowerback 

c.       Fasciculations/muscle twitchings

d.      Involuntary movements – chorea?athethoid?

 

3. SENSORY SYSTEM

a. sensory deficit – able to feel clothes, feeling hot and cold water while bathing

b. numbness/pins and needle sensations, sensation of walking on cotton wool

c. root pain/neck pain/back pain

d. band like sensation/girdle like sensation

e. unsteadiness on closing the eyes/washbasin sign/able to walk in the dark

f. Lhermitte’s symptom

 

 

4. HIGHER MENTAL FUNCTIONS

a. Loss of consciousness/alteration in sensorium – duration, complete/partial, aura, associated with fits, bladder/bowel disturbances, recovery and frequency of occurrence/fits

b. Speech disturbances – aphasia, slurring of speech(cerebellum), slowness of speech(extrapyramidal system)/memory/sleep disturbances

c. Delusions/ Hallucinations/emotional disturbances



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