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A 45 year old female, resident of miryalaguda, farmer by occupation was presented to the casualty with chief complaint of
CHIEF COMPLAINTS:
- Abdominal, tightness and distension since 1 day
- Decreased sensation and weakness in both legs
- Decreased urine output
The patient was apparently asymptomatic 1 year ago when she developed fever and severe stabbing type of pain in the back for which she visited a hospital in khammam, where she was told to have a spinal cord problem and that she needed a surgery, but due to covid situations and lockdown, surgery couldn’t not be done and she was sent back. Within 1 month all her symptoms subsided and she was alright.
4 days ago she developed fever, headache, burning micturition, and decreased urine output. She also had 5-6 episodes of vomitings.
PAST ILLNESS:
H/o hysterectomy 15 years ago
Not k/c/o DM
Not k/c/o HTN
PERSONAL HISTORY:
Diet mixed
No h/o alcohol consumption
No h/o smoking
Appetite: decreased since 1 year
Sleep: inadequate since 1 year
FAMILY HISTORY:
No significant family history
EXAMINATION :
General examination:
Patient is conscious coherent and co operative
Patient is moderately build and nourished
No pallor
No cyanosis
No clubbing
No lymphadenopathy
No icterus
No oedema
Vitals
BP 110/80mmhg
PR 74 bpm
Temperature 99 F
Respiratory rate 18 per min
SYSTEMIC
CVS
no thrills
S1 s2 heard
No murmers
RESPIRATORY
Position of trachea central
No dyspnoea
No wheeze
Breath sounds - vesicular
ABDOMEN
Obese
Tenderness present, diffuse
No palpable mass
No free fluid
Liver and spleen non palpable
CNS
Power in both lower limbs 2/5
Reflexes
Knee -ve
Ankle -ve
INVESTIGATIONS
PROVISIONAL DIAGNOSIS
Paraperesis secondary to L4L5 lumbar canal stenosis
TREATMENT
Inj Methyl prednisolone 1gm/IV/OD
Inj optineuron 2g / IV/ BD
IVF NS RL @100ml/hr
Inj pan 40mg IV/OD
INJ ZOFER 4mg / IV/Sos
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