Case : Myogenic jerks and altered sensorium

26 February 2022

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THIS IS A CASE OF 75YR OLD FEMALE CAME TO HOSPITAL on 22/02/2022 WITH COMPLAINTS OF INVOLUNTARY MOVEMENTS OF HANDS  AND BURNING MICTURITION since few days .

CHIEF COMPLAINT  :

Case of shivering with pain and swelling of right knee .

PATIENT HISTORY : 

Patient was asymptomatic 10days back and developed fever  and took medication

The patient had trauma to right knee few years back followed by ulceration of wound. After few days patient was planned for skin grafting where she was diagnosed with Diabetes mellitus and started on medication 4years back patient had giddiness and then diagnosed with hyperstension  .3years back developed low back ache and was told that that she had some kidney problem using medication regularly. 

Has heart related problem where narrowing of vessels was seen and is  using medication regularly.

PRESENT ILLNESS HISTORY  :

She is now presented with burning micturition since 1 week , decreased responsiveness and shivering . No fever , no neck stiffness.

Frequent episodes of micturition seen inspite of using medication.

She was active till morning on the day of joining the hospital.

She had a knee injury when she slipped from climbing steps 13years back. Skin grafting was done unhealing of wound.

When checkup is done she was diagnosed with Diabetes  and Hypertension and is on regular medication .

Had heart related problem and using medication

ROSUVASTATIN AND CLOPIDOGREL ASPIRIN COMBINATION USED.

NO COMPLAINTS OF CHEST PAIN AND BREATHELESSNESS

PAST HISTORY: 

Was diagnosed with Hyperstension and diabetes mellitus 13years back and is on regular medication .

DRUG HISTORY : 

Metformin 500mg

Cefixime

Paraacetomol

Nodosis

Asprin

FAMILY HISTORY : 

None

PERSONAL HISTORY:

Married

Appetite: Normal

Bowels: Regular

Micturition: Abnormal

No habits or addictions

PHYSICAL EXAMINATION :

Temperature: 97.4F

Pulse rate:92/min

Respiration rate:22/min

BP:160/100

SYSTEMIC EXAMINATION : 

CVS :

CARDIAC SOUNDS : S1 S2 are heard

ABDOMEN:

Shape of abdomen : Obese

No tenderness

Bowel sounds : Yes

CNS : 

Level of consciousness: Drowsy

Speech : Normal

REFLEXES: 

                               right              left 

Biceps                     +                     +

Triceps                    +                     +

Supinator                +                     +

Knee                        +                     +

Ankle                       +                     +

PROVISIONAL DIAGNOSIS :

Myoclonic jerks and Altered sensorium 

Investigations: 

Hb : 7.6

Total leukocyte count: 13,600

Neutrophil :  90

Leukocyte : 05

Impression : Normocytic hypochromic anemia with neutrophil leukocytosis .

Opthamology referral : 

ECG : 

MRI : 

23/02/2022 :

Temparature : 97.4 

BP : 130 / 70

Prescription: 

Inj PAN 40mg IV

Inj Thiamine

Inj levipill 500mg

Monocef

 

25/02/2022

Right knee joint pain 

Temperature : 98.2

BP : 160/ 90

Burning micturition 

  

Was put in ICU 

PRESENT TREATMENT : 

INJ.Levipill 500mg

Tab Neurokind

Tab Metformin 500mg

BP AND PULSE RATE ARE BEING MONITORED.

DISCUSSIONS: 

Myoclonic jerks caused by any disturbance to brain or spinal cord or any injury to the peripheral nerves.