48 yr old male with fever ,paraperisis and altered sensorium
A 48yr old male patient ,resident of chityala came to the opd with cheif complaints C/C of
Fever since 10 days
Altered sensorium since 5 days
Weakness of bilateral lower limbs - 3days
H/o of oliguria - 3days
HOPI
Patient was apparently asymptomatic 1yr back then he developed decreased urine output for which they admitted in hospital and foleys was placed , then he was diagnosed with prostatomegaly with Rt renal calculi.
since 10 days patient have high grade fever on and off not associated with vomitigs/loose stools/cough
Altered sensorium since 5days
Since 3 days patient had bilateral lowerlimb weakness ,difficulty to move B/L lower limbs associated with decreased urine output since 3 days.
PAST H/O
No H/o of hypertension , diabetes , asthma, TB , epilepsy .
H/o HIV 10 YRS back
PERSONAL H/O
Diet - mixed
Appetite - normal
Bowel ,bladder movement- regular
Sleep - adequate
Regular smoker , alcoholic(occasionally 250ml)
FAMILY H/O
no relevant family h/o
GENERAL EXAMINATION
patient is conscious ,not coherent , not oriented to time place and person.
VITALS
Bp 130/90 temp 101°F PR -102 bpm spo2 - 98%
pallor - absent
Icterus - absent
Cyanosis - absent
Kiolonychia - absent
Lymphadenopathy - absent
Clubbing - absent
Oedema - absent
SYSTEMIC EXAMINATION
CVS
S1 s2 heard , no murmurs , no thrills
RESP
Bilateral air entry with normal vesicular breath sounds heard , no wheeze , no dyspnea , trachea is central.
ABDOMEN
Shape of abd - obese
No tenderness , Palpable mass ,tenderness, freefluid , bruit.
liver and spleen - not Palpable
Bowel sounds - present
CNS
incoherent
Neck stiffness , kernings sign +ve
Sensory - cannot be examined
Motor -
R L
Tone UL N N (normal)
LL decreased decreased
Power UL 5/5 5/5
L/L 1/5 1/5
REFLEXES
RT SIDED
biceps 2+ , triceps 2+ ,supinator 2+,knee absent, ankle absent
LT SIDED
biceps 1+, triceps 2 + , supinator 2+ , knee absent ankle absent
No cerebellar signs
PROVISIONAL DIAGNOSIS
altered sensorium secondary to meningoencephalitis ( infarct in splenium of corpus collosum )
INVESTIGATIONS
RBS , RFT, MRI ,CXRAY , CSF analysis
CSF 10-06-21
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