15yr Adolescent girl with Fever & Focal Neurological Deficit ( ADEM )

Chief complaints :-
C/o Fever since 10days
C/o Weakness of Left U/L & L/L since 4 days.
HOPI:-
Patient is a/a 10 days back then she had fever which is on & off with moderate to high grade in Severity Which is reliving with medications. Since 4 day's patient noticed weakness of left LL which is sudden in onset & gradually progressive in nature & is associated with difficulty in walking in the form of difficulty in wearing chappals how ever she's able to walk , Stand  from sitting position without support & Next day she noticed weakness in left U/L Predominantly she's unable to hold glass of water, Pen, Mix food how ever she's able to lift the limb over the head.
H/o headache Predominantly in frontal region during fever episodes.
No h/o vision / sensory symptoms
No h/o vomitings, ear discharge 
No h/o seizures, LOC, altered behaviour 
No h/o B× B symptoms
No h/o bleeding Manifestations.
Past history:-
No h/o similar complaints in past. 
8 yrs back admitted & treated for dengue illness.
Family history:-
Born to NCM parents , she has an younger brother.
No similar complaints in family members. 
General physical examination:-
Pt is conscious/ alert/ cooperative
Facies- Normal
Built- Normal 
Weight:- 46kgs
Nutrition- BMI- 19.6kg/m2
Decibitus- Legs extended at Hip, knee & plantar flexed
PICCLE - Absent
PR- 86bpm, regular, normal volume, no radio radial or radio femoral delay
BP- 110/80mmhg in supine
RR- 16cpm, thoraco abdominal type
Temp- 98.6f
No rash on face or trunk.
Cranium & spine normal.
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:-
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 
Tone:-
Hypotonia at distally in left U/L & L/L
Power:-
Rt U/L & LL :- 5/5
Lt U/L - proximal - 5/5 , Distal - 3/5
Lt L/L - proximal - 5/5 , Distal - 3/5
DTR:-
REFLEXES:-
     Rt. Lt
B. 2+. 2+
T. 2+. 2+
S. 2+. 2+
K. 2+. 2+
A. 2+. 2+
PLANTAR :- Left extensor , Rt Flexor.
Abdominal reflex:- absent

SENSORY:- Normal 
Blood investigations:-
 MRI BRAIN WITH SPINE SCREENING:-
Treatment Given: 
IVF 1/2 DNS PLUS 5 CC KCL,AT 50 ML PER HOUR, 
TAB DOLO 650 MG SOS,
INJ METHYL PREDNISOLONE 1 GRAM IN 500 ML NS OVER 4 HOURS, 
INJ CEFTRIAXOME 1.5 GRAM 1-0-1, 
INJ PANTOP 40 MG 0-1-0, 
GELUSIL MDS 5 ML 1-1-1, 
TAB COMBIFLAM SOS, 
TAB ETILAAM PRO 20 1/2 TAB 0.5- 0- 0.

Discharge medication:-
TAB PREDNISOLONE X 6WEEKS 
TAB ETILAAM PRO 20 1/2TAB SOS REVIEW AFTER 15 DAYS 
REVIEW SOS CONBTINUE PHYSIOTHERAPY 

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