25M muscular dystrophy

25 year Old student ,resident of annareddy gudem is brought to the opd with cheif complaints of 
Cough since 1 month
Fever since 1 month

Patient was apparently asymptomatic 1 month back then he developed 
Cough 
Duration 1month
Onset insidious, 
Occasional - 5-6 bouts /day
Non productive
Non barking type
Non paroxysmal cough
Associated with fever 
No post tussive vomiting

Fever-
Low grade , intermittent, not associated with chills and rigors,
No diurnal variation
Not associated with burning micturition, loose stools,vomiting ,pain abdomen

Past history-
 2009-10‐-> 
Patient developed weakness of lower limbs, difficulty in walking 
Was taken to private hospital for the same 

Weakness of the limbs--
Insidious onset, gradually progressive, paresis
Weakness begun in the lower limbs gradually progressed to upper limbs over 4- 5 months
Weakness distal to proximal progression
With tipping of tors, slippage of chappals
Later patient developed difficulty in getting up from sqatting and difficulty in sitting position

UL- difficulty in feeding himself and mixing food present 

No difficulty in lifting head off pillow , rolling over bed,breathing difficulty,diurnal variation

2010-11
Wasting and thinning of muscles present progressive 
Initially lower limbs f/b upper limbs 
Not associated with pain, fatigue,muscle cramps,Involuntary movements

Patient had clumsiness of hands ,unsteadiness gait with swaying 

Sensory involvement-- not seen
Hmf - bowel,bladder,sleep,mood --normal
Cranial nerve-- normal
Cerebellar--spilling food+
Autonomic--sweating,Palpitations  -

2013-14-
Patient couldn't walk due to the progressive Weakness
And is bed ridden since then

Developmental milestones- 
Allegedly normal 

Personal history-
Unmarried, mixed Diet, no Addictions,
Regular bowel and bladder movements ( bowel 1 every 2 days)

Family history-
1st child born out of Non consanguinous marriage
No relevant family history 

Treatment history-
Initially used few supportive medications for few months In 2010 to 13 

General examination:

25 year old male conscious ,coherent ,cooperative
Well oriented to time,place,person
Thin built ,poorly nourished
Afebrile to touch
No Pallor,icterus,clubbing,cyanosis,lymphadenopathy, edema

Neurocutaneous markers ? Absent 


Vitals-
Bp- 110/ 70 mm hg rt ul supine position
Pr- 89 bpm, regular rate ,rhythm, volume 
Rr- 24 cpm ,thoraco abdominal type
Temp- 99F 


Neurological examination--

HMF-
Conscious
Speech - normal ( difficulty while speaking fast)
Memory intact
MMSE- 28/30

MOTOR- 

                         RT.                 LT.  
BULK-      UL    wasting.       Wasting 
                 LL.    Wasting.     Wasting 

Palpation- 


TONE--
               UL.      N.              N
               LL.      Hypo.       Hypo

POWER--
         UL  
        Shoulder bilateral Flexion, Extension,                lateral ,medial rotation,abduction,                      adduction --4/5

        LL
         Hip
         Flexion -- 3/5.    3/5. 
         Extension-
         Abduction--4/5.   4/5
         Adduction--3/5.    3/5
   Lateral rotation -3/5.  3/5
   Medial rotation - 3/5.  3/5
 knee F,ext-- 4/5.  4/5. 
Ankle--
Dorsiflexion.   --       --
Plantarexion.   --      --
Inversion.         --      --
Eversion.          --      --
Trunk muscles.  --
Brevors sign---

Superficial reflexes -- intact ( Corneal, conjunctival,abd)

DTR
Jawjerk -- absent
Biceps.  +     +
Triceps. +     +
Knee.      -      -
Ankle.    -      -

Cerebellar--
Essential tremor+
Titubation, finger nose, finger Heel, dysdiadokinesia -

Sensory --





Investigations-


         



Comments

Post a Comment

Popular posts from this blog

Residency dairies!

Image
It's our day 1 in the residency programme to attend the district residency in nagarjunasagar It started with zero expectation towards it With the questions popping my head , How will I matter? Will I be able to make difference to the people here? Will I change ? With no answers to these questions the journey of residency begun! Hoping the journey unveils it's own beauty and answers to these questions! This blog is journey dwelling these questions ! Day1 As the day begun started our journey to the nagarjuna sagar  Lovely weather and people with warm welcoming hearts showered us purest forms of love  Innocence and warmth of the people made me realise the value of communication  As the day passed with few opd  Cases dealt with no boundaries to the subject /system but the person as a whole No limitations to the branch or system!  Evening walk on the roads of sagar dam  With beautiful panoramic view of the nature made me realise the value of peace   Exploring nature and the beautif
Read more

45 Y/O female with rash

Image
 A 45-year-old female tailor by occupation came to the hospital on 2/6/22 with C/O fever on and off, associated with generalized body pains, loss of appetite for 3 months  C/O  facial rash since 4-5 days  HISTORY OF PRESENT ILLNESS: Patient was apparently asymptomatic 10 years back then she developed joint pains, the fleeting type associated with morning stiffness for 10 min , not associated with swelling for 2 months for which she was treated at a private hospital and found to have?RA factor positive  patient was asymptomatic until 8 months back then she developed joint pains? post covid vaccination was treated at a private hospital with medications. 2 months back- c/o dryness and burning sensation of eyes Difficulty in eating solid food, decreased salivation seen 1 month back patient was having an episode of loss of consciousness with cold peripheries with sweating [grbs 7mg/dl] after taking Tab Glimi M2 prescribed by a local practitioner for high sugars?250mg/dl 10 days back patient
Read more

Diaries worth sharing

Sometimes I didn't realise the value of appreciating the nature or natural phenomena that goes through be it our body or the universe I've always been fond of nervous system it's uncertainty and its beautiful feature of plasticity,the way it naturally tries to mold to adjust and make us the better ones  Could we really be any btr without its plasticity ?!! Few patient's have taught us how life happens and takes a sudden course of downhill , how some go uphill y is d life so uncertain. Could we as physicians bring any difference to their or so called our lives!!? When do we know if it's early or late ?! Who could decide this for?! I've had few cases not just academically but has taught me life worth lessons 1- A case of elderly male with diagnosis of multiple myeloma,  journey to the diagnosis made me realise how uncertain ones lives are and how unpredictable course could be  In the beginning we tried ruling out infective cause--- but then still q remained the sa
Read more