ACUTE QUADRIPARESIS PROXIMAL DOMINANT MOTOR ( LL > UL ) rajkanaka

COMPLAINTS-
A 39yr male with complaints of Difficulty in walking since morning
HISTORY OF PRESENTING ILLNESS-
A 39 yr male who was apparently asymptomatic till mid night 1am when he tried to woke up for passing urine noticed he is unable to get down bed however he managed to get down and walk to washroom and come back by himself. From Mrng  he is unable to sit or get down bed and walk. For which he reached to a local hospital where blood routines were done & pt is referred to our hospital. No h/o fever, urti ,diarrhoea, paresthesias  of limbs, band like sensation over chest, bowel & bladder disturbances, drug usage , Diplopia ,dysphasia or similar complaints in past or among his family members. No h/o HTN/DM/ASTHMA/THYROID DISORDERS/EPILEPSY.

PAST HISTORY-
No h/o similar complaints in past or in family members
PERSONAL HISTORY-
No h/o recent heavy work or consumption of excessive sweets
Cement sculpture by occupation ,non alcoholic & non smoker
Diet mixed ,appetite is normal , sleep -adequate 
DRUG HISTORY-
No known drug allergies
SUMMARY-
39 yr old male with out any pre existing comorbidity developed acute progressive Quadriparesis ( LL > UL ) with out sensory , bladder & bowel & clinical cranial nerve involvement.

GENERAL PHYSICAL EXAMINATION- NORMAL
HIGHER MENTAL FUNCTIONS- NORMAL 
CRANIAL NERVES- NORMAL 
MOTOR-
Muscle bulk preseved in all limbs.
No fasciculations/ wasting seen.
Attitude-
Pt lying supine position with attitude of both lower limbs extended at Hip , knee & flexed at ankle
Both arms placed at sides 
POWER-
UPPER LIMB-.                    
                             Rt.                   Lt
Shoulder
 Abduction.         4+/5.                4+/5
 Adduction.         4+/5                4+/5
 Flexion.              4+/5                4+/5
 Extension.          4/+/5                4+/5

Elbow
 Flexion.               4+/5                4+/5

 Extension.           4+/5                4+/5

Wrist
 Dorsiflexion.       4+/5                4+/5

 Palmar flexion.   4+/5                4+/5


LOWER LIMB-                  
                             Rt.                  Lt
HIP
 Abduction.          4/5.              4/5
 Adduction.          4/5.              4/5
 Flexion.               4/5              4/5
 Extension.          4/5.               4/5

KNEE
 Flexion. 4/5. 4/5

Extension. 4/5. 4/5

ANKLE
 Dorsiflexion. 4/5. 4/5
 Plantar flexion. 4/5. 4/5

Small muscles of foot- 4/5

REFLEXES:-
                  Rt.            Lt
B.              2+.           2+
T.              2+.           2+
S.              2+.           2+
K.              2+.           2+
A.              2+.           2+
PLANTAR B/L flexor

Sensory- normal

Cerebellar -intact 

LABORATORY-
Hb- 14.6gm/dl
TLC- 5500
Plt-3.2 lakh

Na- 136
K- 3.8
Cl- 101

Creatinine- 1.2
Urea- 30

Discussion-
Acute onset quadriparesis resolving 























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