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28 year old female with right upper and lower limb weakness


A 28 year old female came to OPD with chief complaints of weakness and pain in right lower limb and upper limb since 8 years.
HOPI:
Patient was apparently asymptomatic 8 years back then she developed weakness in right lower limb which is insidious in onset and gradually progressive,associated with pain.no tingling sensation.
Pain in right side of the back radiating to right lower limb and no tingling sensation.
Patient also had c/o headache which is on and off since 8 years.holicranial type,no tingling/numbness.no photophobia and no phonophobia.
Progressive weakness of lower limb 1st in thigh then extended upto feet.
Patient slowly developed difficulty in walking since then with changes in style of gait as weakness progressed in right lower limb.
H/o trauma 8 years back-fall from bicycle after which she developed these symptoms.
Past history:
Patient gives history of trauma due to fall at the age of 5-6 years and had injury to nose and she had epistaxis-last episode was after the delivery of 2 nd child(8 years back).
Not a k/c/o DM,htn,tb,epilepsy,cva,cad,thyroid
H/0 snake bite 3 years back.
H/0 tubectomy 8 years back.
Personal History -
Married
Occupation- Farmer
Diet: mixed
Appetite: normal
Bowel and bladder : Normal
Addictions: betel nut since 10 years

Family History -
No similar complaints in the family. 

General Examination -
Patient is examined in a well lit room with adequate exposure, after taking the consent of the patient.
She is conscious, coherent and cooperative.
Built & nourishment-Moderate
No pallor 
No cyanosis
No icterus
No clubbing
No edema
No lymphadenopathy.


Systemic examination:
CVS : 
S1 S2 present
No murmurs

RESPIRATORY SYSTEM;
B/l symmetrical chest
Trachea - Central
B/l air entry present
NVBS heard

ABDOMEN:
Shape of abdomen: scaphoid.
Soft, non tender, no organomegaly present.
No rigidity or guarding.

CNS :
Patient is conscious
Speech-normal 
Signs of meningial irritation
Neck stiffness- negative
Kernings sign-negative
Cranial nerves-intact
Motor system:
Power:
            R.                 L
UL.     4/5.             5/5
LL.      4/5.             5/5
 
Tone:
            R.                  L
UL.      Normal.      Normal
LL.       Incresed    normal
Sensory system: normal
Reflexes:
           Knee. Ankle. Biceps. Triceps supinator
Right    3+.     2+.        -              -            -
Left.     3+.     2+.        -             -           -
Plantar flexion seen.
No cerebellar signs 












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