This is a case of neurology . Please give treatment and prognosis.

A 62 year female having c/o imbalance while walking. Difficulty in swallowing sometime. Swelling on both leg Since 2 year. Complain gradually started from leg then all over body. Complain more on lower limb than upper limb. No DM / No HTN/ vitally stable/ BP -130/80/ Rbs-94/ Spo2-98/ HR- 78 Eye response- normal/ verbal Response- normal Motor Response - pain while flexion and extension Pt is on Multivitamin and do regular exercise - walking on stairs also. I have attached MRI reports and other lab reports. Please give valuable opinion And suggest treatment and prognosis .

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From the history two things,intermittent swallowing difficulty with unsteadiness. Swallowing difficulty for solid or liquid? Swelling in the leg is at what time,is she getting up in the morning with swelling or she has swelling while standing longer time .Some drugs also can produce swelling. Intermittent swallowing difficulty can occur in myasthenia,but the history is not flavoring .2yrs history is not going with myasthenia.. MRI brain shows small vessel disease of brain which can produce mold unsteadiness, for which she needs single anti platelet drug, Prognosis is favourable.

? GERIATRIC SYNDROME.. ? AGING..CEREBRAL ATROPHY..WITH.. LS..SPINES PATHOLOGY..DEGENERATIVE CHANGES WITH..ASSOCIATED..COMPLICATIONS..

Ksheerabala soft gel cap or Ksheerabala taila (101 avarti) 4 to 5 drops with ½ glass of hot water Vishatinduka vati Ashtavarga or Balasahacharadi kashaya Brihat vata chintamani rasa with swarna Advised kati basti with Vishagarbha taila and Karpooradi taila followed by Naadisweda

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Chandroday 5gram Tamra bhasam 5 gram Ratnakar ras 5 gram Bhawana kutati kwath 21 times /500mg b.d. Balarist 20ml b.d. Punarnava mandoor 2 tab b.d. Nursing churan 3gram b.d. Before starting treatment we should do panchkarm of patient

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If mind indicate go for Causticum

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Stramonium 200

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Alzheimer's disease

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Ledum pal 1 M monthly × 3 dose Bryonia Alb 30 TDs

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Argentum nit. Rhus tox, Hypericum may be helpful

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Causticum 1M weekly 1 dose. Advice to take walnuts.

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