Concluded Case

? GBS ? Myasthenia gravis

K/c/o.T2 DM with HTN Chief Complaints One 56 yr old female c/o.B/L upper and Lower Limb weakness since 2 days progressive. History H/o.Loose motion multiple episode and after primary treatment pt feeling good but after 3day sudden dizziness and fall down due to Lower limb weakness, then after some time walking spontaneously but feeling numbness and tingling sensation in B/L upper and Lower Limb ,on and off vision problem after 4th day complaining above mentioned.

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Concluded answer

History is very vauge. Neurology case needs good history and physical findings. What about the physical findings? With out clinical exam ,how can one order MRI brain and spiine? This is not MYASTHENIA GRAVIS.IT SHOULD NOT INCLUDE IN THE DIFFERENTIAL DIAGNOSIS. From your history ,56 yr old female presented with acute onset of lower and upper limb weakness with out any bowel or bladder symptoms with the back ground history of diarrhea .1st thing is a good neurological exam and find out which part of nervous system is involved. In view of the numbness and tingling sensations in upper and lower limbs with weakness ,one should consider a peripheral nervous system / polyradiculoneuropathy.GBS is the first diagnosis. So your MRI brain ans spine are unnecessary investigations .Ideal thing is an urgent all four limbs NCV studies including F wave. This patient need emergency treatment,Kindly ref to the Neurologist for Starting IV Immunoglobulin (IGg)/ plasmapheresis. Needs CSF study ,vasculitis screening

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History is very vauge. Neurology case needs good history and physical findings. What about the physical findings? With out clinical exam ,how can one order MRI brain and spiine? This is not MYASTHENIA GRAVIS.IT SHOULD NOT INCLUDE IN THE DIFFERENTIAL DIAGNOSIS. From your history ,56 yr old female presented with acute onset of lower and upper limb weakness with out any bowel or bladder symptoms with the back ground history of diarrhea .1st thing is a good neurological exam and find out which part of nervous system is involved. In view of the numbness and tingling sensations in upper and lower limbs with weakness ,one should consider a peripheral nervous system / polyradiculoneuropathy.GBS is the first diagnosis. So your MRI brain ans spine are unnecessary investigations .Ideal thing is an urgent all four limbs NCV studies including F wave. This patient need emergency treatment,Kindly ref to the Neurologist for Starting IV Immunoglobulin (IGg)/ plasmapheresis. Needs CSF study ,vasculitis screening

Now ptn.On ventilator ,Bowel sound negative. NCV study with F wave -Axonal Demyelinative Polyneuropathy. And IVIG started.
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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