GBS:

CHIEF COMPLAINTS:-
A 59yr male , who's Right handed individual who works as office subordinate at government degree college presented with a chief complaints of
1. Numbness of both palms since 10 days 
2. Weakness of both lower limbs since 3 day's

HOPI:-
Pt was apparently normal 10 days back on Saturday Afternoon after finishing duty he reached home & at evening when he is walking in corridor noticed then he noticed numbness of both palms sudden in onset, continuous, non progressive in nature however he's able to do all his daily routine activities without any Difficulty. After 1 week on Friday night he had dinner and then he went out for a walk which he does regularly then he noticed mild difficulty in walking, later he returned home and slept. The next morning when he tried to get up from bed he noticed difficulty & was unable to get down by himself then he called his wife with her support he's able to walk but has occasional buckling of knees and had difficulty in getting up from squatting position, climbing stairs however he's able to wear chappals , feel it and hold them while walking. Over the next two days the weakness increased and he was unable to sit or roll in bed without support and even with two people's support he was unable to walk. Meanwhile he also noticed mild difficulty in placing food into the mouth & difficulty in button unbutton shirts, comb his hair.
He's able to feel hot and cold sensation throughout all the body without any difference.
No h/o fluctuations in weakness 
No H/o Fever or Rash / Headache/vomiting/Abdominal pain / seizure/ speech abnormality/alteration in behaviour.
No H/o vision blurring 
No H/o Difficulty in chewing or swallowing/ Odynophagia.
No H/o consumption of outside food.
No H/o myalgias or bladder & bowel disturbances 
No H/o Back pain or band like sensation.
No h/o palpitation/postural dizziness/ loss of sweating.
No h/o any impairment in vision/ hearing/ speech/ chewing & swallowing.
No h/o skin rash,oral ulcers, alopecia, dryness of mouth.
No h/o wt gain ( Hypothyroidism) or loss ordecreased appetite, ( For immunocompromised state.
No h/o or contact to TB
No h/o recent vaccination / bleeding diathesis.
No h/o trauma In back

PAST HISTORY:-
H/o Mild Dry cough 15days back which subsided after taking Medication for 5 days 
H/o CAD 20yrs back S/P PTCA on T.Rosuvas Asp, T.Tide 5mg , T.Bisoprolol 2.5mg, 
K/c/o HTN since 5yrs on T.Telma H 40/12.5
No h/o DM2 / Asthama/ 
No h/o Animal bite/ vaccination
No h/o similar complaints in past 

FAMILY HISTORY:-
No h/o similar complaints in family members

PERSONAL HISTORY:-
Diet- vegetarian , Takes egg🥚
Sleep- Adequate
B×B - Normal
No addictions /high risk behaviour

SUMMARY:-
A 59yr old male who is a k/c/o HTN, CAD S/p PTCA developed Rapidly progressive LMN type Quadriparesis, Lower limb > upper limb ( proximal > distal ) associated with Numbness in palms with normal pain, Temp in All Limbs Without bladder & bowel & clinical cranial nerve or Autonomic involvement.

GENERAL PHYSICAL EXAMINATION:-
Pt is conscious/ alert/ cooperative
Facies- Normal
Built- Obese
Nutrition- BMI- 30kg/m2
Decibitus- Legs extended at Hip, knee & plantar flexed
PICCLE - Absent
PR- 86bpm, regular, normal volume, no radio radial or radio femoral delay
BP- 130/80mmhg in supine
RR- 16cpm, Abdomino thoracic type
Temp- 98.6f
No oral ulcers.
Cranium & spine normal, No vertebral tenderness noted.

HIGHER MENTAL FUNCTIONS:-
Pt is rt handed 
GCS- 15/15
Conscious/ well Oriented to time place & person.
Memory- Immediate, recent, remote intact.
Speech- Normal

CRANIAL NERVES:-
2,3,4,6,7 CN Normal
Sensation on face - N

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 

TONE-
According to modified ashworth scale
U/L - Normal
L/L - Hypotonia

POWER-
Neck flexor & extensor muscles - 5/5
Truncal muscles - 
A)Unable to get up from lying down position ( Rectus Abdominus is weak)
B)Difficulty in turning side to side
( Oblique muscles are weak )

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

Small muscles of both hands - Grip Normal

LOWER LIMB-                  
                             Rt. Lt
HIP
 Abduction. 3/5. 3/5
 Adduction. 3/5. 3/5
 Flexion. 3/5. 3/5
 Extension. 2/5. 2/5

KNEE
 Flexion.              3/5.               3/5.
 Extension.         3/5.                3/5.

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

Small muscles of foot- 4+/5

REFLEXES:-
Superficial
Corneal, Conjunctival - present
Abdominal - absent
DTR'S
                  Rt. Lt
B. - -
T. - -
S. - -
K. - -
A. - -
PLANTAR B/L - Flexor

SENSORY:-
spino thalamic
Crude touch,Pain,Temperature
Normal in all limbs

Post.column:-
Fine touch, Vibration,Proprioception- 
Normal in all limbs

CEREBELLUM:-
No nystagmus, giddiness, FNF- normal
HKT- couldn't be tested

GAIT- couldn't be tested since even with 2 people support he couldn't walk & there is buckling of knees

MENINGEAL SIGNS:-
Absent

ANS:-
No Resting tachycardia, abnormal sweating or bowel and bladder disturbances.

OTHER SYSTEMS:-
CVS:- Apex beat in left 6th ICA 1cm medical to mid clavicular line
S1S2 heard no murmers
No raised jvp, engorged veins
RS:-
Bae+, Nvbs, No added sounds
ABDOMEN:-
Soft, non tender, no organomegaly

Functional Diagnosis:-
An Elderly male with Acute progressive LMN type paraparesis proximal > distal with Numbness in both palms with Normal Pain, Temperature, vibration & joint position sense without HMF,CN, Cerebellum & B&B Involvement.

Anatomical Diagnosis:-
Acute onset lower limb LMN Quadriparesis - motor radicles ( LL > UL ) Proximal > distal 
Numbness in palms - Few large fibre of upper limbs.

Pathological diagnosis:-
Acute rapidly progressive nature- probably Demyelination

Etiological diagnosis:-
Gullian barre syndrome
Probably AIDP VARIANT

Other differentials:-

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