40 yr old male with B/L lower limb weakness since 3 days
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A 40 year old gentleman from South India who's a mason by occupation came to the clinic with the conplaints of weakness in the lower limbs which progressed to the upper limbs and was also associated with a tingling sensation in his feet, legs and hands.
He experienced difficulties in walking, sitting down and getting up from a seated position. He also finds it difficult to get up from the supine position, although he finds no difficulty in rolling over on his bed and also lifting his head.
He gives no history of trauma, no history of lower back ache or pain abdomen.
He gives no H/O headache, Loss of consciousness or involuntary movements.
He gives no history of shortness of breath, palpitations, giddiness.
He gives no history of fever, cough ,cold
He gives no history of pedal oedema.
He gives no history of similar complaints affecting him in the past.
His diet has remained the same although he reported increased frequency of urine during the last 2 days.
He is an occasional alcoholic who drinks toddy but reports to have stopped consumption about 2 months back.
He is not a known case of DM, HTN, TB, Asthma.
He has no known thyroid disorders or Cardiac disorders.
No similar complaints were noted in his family.
On General examination in the clinic, he was Afebrile, he had no signs of Pallor, Icterus, Cyanosis, clubbing or lymphadenopathy.
His Pulse was 84 bpm, B.P. was 110/80 mmhg, R.R. was 18 cpm and GRBS was 95 mg/dl.
On Systemic examination,
Resp- B/L AE(+), NVBS, no wheeze or crepitations were heard.
CVS- S1,S2 were heard, no murmurs or added sounds were heard.
GIT - P/A soft, non tender, no organomegaly or distended veins were noted.
CNS-
MMSE - Normal
Speech is normal
All cranial nerves are normal
Motor system -
Tone- normal
Power - U/L - Shoulder adduction, abduction, flexion and extension was -4/5
Elbow - flexion and extension B/L was -4/5
Hand grip bilaterally was at 30%.
Wrist - dorsiflexion and palmar flexion were B/L 3/5.
Lower limb - Generalised Hypotonia is noted B/L.
Power - Hip joint- abduction, adduction, flexion and extension were 2/5
knee flexion and extension were 2/5
Ankle dorsiflexion and plantar flexion were 2/5
Reflexes - biceps, Triceps, supinator, knee , ankle and plantar reflexes were absent at presentation.
The Gait was waddling type of gait.
Sensory - Lateral tracts - crude touch and pain were tested for and were B/L normal
Dorsal tracts - complete loss of vibration and fine touch in B/L lower limbs
A graded loss of fine touch was noted on the abdomen with the level starting at around T12 and improving at around T6.
No autonomic dysfunction was noted.
No small fibre deficits were noted.
Cortical sensations are normal on both sides.
Cerebellar functions are normal on both sides.
The following investigations were ordered by the treating doctors after admission to the hospital.
Serology (HbsAg, anti HCV antibodies and HIV 1/2 rapid test) were negative
ECG
CXR(PA view)
RBS
Hemogram
LFT
RFT
investigations ordered on the 2nd admission day
RFT
Urinary electrolytes
Serum Electrolytes
investigations ordered on 3rd day of admission
Serum Electrolytes morning
evening
investigations on 4th admission day
Serum Electrolytes
The following Treatment was prescribed for him:
1. Inj. OPTINEURON in 100ml NS IV/BD
2. Tab. PREGABALIN 75mg PO H/S
3. Physiotherapy of B/L lower limbs
4. Salbutamol nebulization with 4 respules only on the 1st day.
5. Free fluid restriction< 1 lit/ day
Course in Hospital : The patient is subjectively feeling better and is able to walk better than before and use his hands more easily for eating and picking up items, objectively there's an improvement in his lower limb muscle power that has become 3/5 from 2/5 but is still in hypotonia.
Provisional Diagnosis: Quadriparesis secondary to ?GBS
