45F with weakness in all limbs

Hello all this is G Jagadeesh,a eight semester student.This E Log depicts the patient centered approach to learning 

This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

Note : This is an on-going case and will be updated as and when I receive any information. 

A 45 YEAR OLD FEMALE WITH WEAKNESS IN BOTH UPPER AND BOTH LOWER LIMBS

PRESENTING COMPLAINT 

 Excessive weakness and fatigue in both her legs and also her upper limbs since 4 days. 

ASSOCIATED COMPLAINT

 Loss of appetite and feeling of nausea when she tried eating since 4 days. 

HISTORY OF PRESENTING ILLNESS

Patient was apparently asymptomatic 5 days back.4 days back, on Monday (29/05/23) 

She had an acute onset of weakness in her legs which started in the morning and gradually increased through the day. 

She also had no appetite.

 When she was forced to eat, she felt nauseous. 

She was able to do her normal household work despite the pain and weakness but... 

On Tuesday, ( 30/05/23) morning.. 

She tried walking despite her weakness but fell down and hit her head on the floor.

She has no history of and deviation of angle of mouth, blurring of vision, dribbling of water from mouth, numbness or tingling sensation. 

She has no history of slurring of speech, loss of consciousness, no bowel and bladder inconveniences. 

Her symptoms improved at the time of examination. 

DAILY ROUTINE OF THE PATIENT BEFORE ILLNESS :

She wakes up everyday, by 6am in the morning , freshens up and starts her day immediately with her work after a little bit of her daily chores( saree weaving). 

By 10am she has her breakfast and continues with her work again. 

Then takes a break for lunch around 1 am followed by a small nap. 

Then she resumes her work again till 8pm, has dinner, spends time with her family and then goes to sleep. 

HISTORY OF PAST ILLNESS

No history of similar complaints in the past

No h/o diabetes, hypertension, epilepsy, thyroid, asthma, TB

History of Renal calculi

SURGERY HISTORY

Patient underwent hysterectomy 2 months back. 

No history of blood transfusions

PERSONAL HISTORy

Married

Mixed diet

Adequate sleep till 5 days back. Couldn't sleep from monday due to pain

Loss of appetite since 4 days

Normal bladder

Normal bowel

No burning micturition

No addictions

No allergies

DRUG HISTORY

Took tablets for 4 weeks after her hysterectomy surgery. And then stopped( patient couldn't name the medicine or show us a sample) 

FAMILY HISTORY

no similar family history of weakness, fatigue and pain. 

No dm 

No htn

No thyroid

No asthma epilepsy tb cad

PHYSICAL EXAMINATION

Patient was 

Conscious, coherent and cooperative

Well oriented with time, space and person

Moderately built and nourished

Pallor - present

No icterus

No central cyanosis

No peripheral cyanosis

No clubbing of fingers

No lymphadenopathy

No edema

VITALS

Bp - 108/95

Repiratory rate - 26 /min

Temperature - afebrile

SYSTEMIC EXAMINATION

CNS :

Patient is conscious

Speech - normal

No signs of meningeal irritation

CVS :

S1 and S2 heard

No murmurs

RS :

Normal vesicular breath sounds heard

No wheeze

No dyspnoea

Trachea - central in position

P/A :

Abdomen - scaphoid in shape

No scars, bruits, free fluid

Liver and spleen - not palpable

Bowel sounds heard

PROVISIONAL DIAGNOSIS

Quadriparesis under evaluation

TREATMENT

injection KCL 40 Meq in 500 ml normal saline

Injection Optineuron 1 ampule in 500 ml normal saline I. V O D

Monitor vitals