60 year old male came with complaints of tingling and numbness of both limbs.

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A 60 year old male electrician by occupation, resident of bodangiparthi, nalgonda district , came to casualty at 3.00 pm  on 5th December,  2022.

CHIEF COMPLAINTS:-

Tingling and numbness of both upper and lower limbs since 5 years.

Weakness of lower limbs since 5 days.

HISTORY OF PRESENTING ILLNESS:-

 Patient was apparently asymptomatic 10 years back then he got shock  due to electric current while he was doing his work on the right side of leg above knee. Then he went to local RMP and was given some medication.(which was not known).

•Then 5 years back , he complained of tingling and numbness in the right leg .

•3 years back their attender's observed that he was speaking nonrelevant speech and was unable to talk, had blurring of vision for which they went to hospital and they were said that there was some clot in the brain on the left side.(no documents available)

•There was history of paralysis 2yrs back

•18 months back he developed tingling and  numbness in the left leg .

•1 month back he also started developing numbness and tingling in both palms.

•5 days back he complained of weakness of 

Lowerlimb.

There was no sensations present in both lower limbs.

No deviation of mouth, difficulty in swallowing.

PAST HISTORY:-

Known case of Diabetes since 4 years and is on medication metformin 500mg + glimeperide 1mg.

History of CVA??

Not a Known case of hypertension, asthma, TB, epilepsy.

Not a Known case of CAD.

PERSONAL HISTORY:-

 •Appetite:-normal

•Bowel and bladder :-regular

•Diet:-mixed

•Sleep:-adequate.

•Addictions:-

       ○Daily intake of alcohol of 90 ml since 15 years

        ○Cigarette 1 packet daily since 10 years

•Allergies:-nil

Family history:-no significant family history.

GENERAL EXAMINATION:-

Patient is conscious, coherent, cooperative and well oriented to time , place and person, moderately built and moderately nourished.

No pallor

No icterus 

No cyanosis

No clubbing

No lymphadenopathy 

No edema.

Vitals :- 

Temperature:- afebrile

RR:-18cpm

BP:-130/80 mmhg

HR:- 112 bpm

  

SYSTEMIC EXAMINATION:-

CNS:-

•Higher mental functions intact.

•Gait:- normal

●CRANIAL NERVES: INTACT

•Power

Rt UL-5/5. Lt UL-5/5 

Rt LL-4/5. Lt LL-4/5 

•Tone-

Rt UL -N,Lt UL-N

Rt LL-N,Lt LL-N

•Reflexes:. RIGHT LEFT

Biceps ++ ++

Triceps ++ ++

Supinator ++ ++

Knee. -- --

Ankle:- -- -- 

•SENSORY

crude touch normal in upper limbs, decreased in lower limbs.

Fine touch :- + + 

Pain N N

Temperature N N

Vibration:- not felt

Joint position:- negative.

Stereognosis:- negative.

Romberg test:-positive (falling on right side).

Cerebellum functions:-

Finger finger test:-+

Finger nose test:-+

Dysdiadokinesia:-not present.

Heel knee test:- negative

Straight leg walking test:-positive.

ABDOMINAL EXAMINATION:-

•Inspection :- no scars

•Palpation :- soft,non tender.

☆CVS:S1,S2 heard,no murmurs

☆RESPIRATORY SYSTEM:

•trachea central in position

•Normal vesicular breath sounds heard

•BAE ++

Provisional diagnosis:- 

Diabetes mellitus with Peripheral neuropathy.

INVESTIGATIONS:-

  Report on 

Fasting blood sugar:-126mg/dl

Post lunch blood sugar:-212mg/dl

 

●Reports on 23/6/22:-

     Fasting blood sugar:- 318mg/dl

      Post lunch blood sugar:- 440mg/dl

Medications:-

Glycomet gp3/850

Benten gold

Zevert MD 16

Stemetil MD 5

●Reports on 6/7/22:-

      Fasting blood sugar:- 90mg/dl

       Post lunch blood sugar:- 132mg/dl

       Sr. Creatinine:- 1.1 mg/dl

Medications:-

Glycomet GP 3/850

Benten gold

Stuzen Forte.

●Report on 6/11/22:-

Random blood sugar:- 167mg/dl

Nerve conduction studies:-

CT brain on 6/11/22:-

ECG:-

Haemogram:-

Blood sugar:-

Complete Urine examination:-

Blood urea:-

Serum creatinine:-

ESR:-

Liver function tests:-

Serum electrolytes:-

Chest x ray:-

Medical treatment:-..

• glycomet gp

• vertin 16mg.