A 22yr old female

A 22 yr old female farmer by occupation 

came  to the opd with 

Fever since  10 days

Head ache since 7  days 

Unable to pass the urine since  2 days . 

History of presenting illness: 

Patient was apparently asymptomatic  10 days

And developed  Gradual onset High fever with 

chills and rigor continuous  associated with 

nausea , relieved on medication 

she had c/o Headache , diffuse in 

region , occipital region predominantly, Gradual

 in onset , dragging type , radiating to neck , 

Aggravated on talking , rotating the head , 

relieved on medication 

c/o urinary retention ( acute )  for 2 days 

 Able to feel the fullness of bladder , not able to 

pass urine , relieved after passing foleys 

Had Weakness of lower limbs for 4 days . 

Spontaneously resolved . 

- patient was not able to walk on her own during

 the weakness episode 

- No seizures

Past History:

The patient had a similar episode one year back 

Past link https://vasishta175.blogspot.com/2022/02/admission-3-and-6-amc-bed-1-patient.html?m=1

She had  high grade fever  for one month gradual 

onset continuous type associated with head ache 

nausea weakness of the limbs and blurring of vision 

Symptoms relieved on medication 

5 days after the  onset of the fever patient  was 

unable to pass the urine  for 2 days and had an 

episode  of 

Altered Sensorium which lasted for 5 mins . Not 

able to recognise persons , place, time . 

Past history:- 

Not a k/c/o DM, Asthma , Epilepsy , HTN 

Personal history:- 

Married female 

Appetite - decreased , improved since yesterday 

Bowels- Constipation , relieved on medication 

Micturition- abnormal 

Addictions:- No addictions

Family history:-

Not significant 

General examination 










Patient is conscious coherent and coperative well oriented to time place and person.Moderately built and moderately Nourished.  

Vitals : 

Afebrile

BP 110/80mmhg

PR 84bpm

Respiratory rate 15 cpm

No icterus, clubbing, cyanosis, lymphadenopathy ,Pedal Edema.

Mild pallor was seen

Systemic examination : 

CVS system

No thrills
Cardiac sounds are heard
No cardiac murmurs

Respiratory system

No dyspnoea 
No wheeze
Trachea is centrally positioned 
Vesicular breath sounds
No adventitious sounds 

Abdomen 

Scaphoid shape abdomen 
No tenderness, palpable mass
Normal hernial orifices
Non palpable liver, spleen
No free fluid 
Bowel sounds heard

CNS examination:

Higher mental functions 

Oriented to time place and person 

Immediate memory:Intact

Short term memory:Intact

Longterm memory:Intact

No delusions and hallucinations.

Cranial nerve examination
Sensory examination:

                                 Right          Left

Spinothalamic

Crude touch              +                      +

Pain                          +                      +      

Temperature             +                      +

Dorsal column

Fine touch              Lost in bilateral soles

Vibration

Olecranon process          6s                        5s

Styloid process       7s                        10s

Tibia                        4s                        8s

Medial mallelous     6s                        10s

Motor examination:

Tone.       :-         Right.        Left

Upper limb.      Normal.  Normal

Lower limb.      Normal.   Normal

Power.             Right            Left

Upper limb.     5/5.               5/5

Lower limb.      5/5.              5/5

  

Reflexes.         :-      Right        Left

   Biceps.              +                 +

   Triceps             +                 +

  Supinator.           -                -

   Knee.                ++             ++

   Ankle.               ++             ++

   Plantar.         ++              ++


No knee - heel in coordination
No finger nose in coordination
 

Investigations:

Hemogram:

Hb: 9.3 gm%

TLC: 6700

PCV: 29.8

MCV: 71.0

MCH: 22.1

MCHC: 31.2

RBCs: 4.20 millions/cumm

PLT: 3.63 laks/cumm


Provisional Diagnosis:

LMN Type Neurogenic Bladder

?Recurrent Transverse Myelitis

?Neuromyelitis Optica Spectrum Disorder

 Treatment 

Ophthalmology opinion was taken for this patients.

Impression: Normal fundus study.

Advice: 

1.E/d LUBREX 5 times/day

2.Use glasses(Myopic glasses)


Neurology opinion was taken on 29/6/2023

and she adviced-

1.Inj.METHYLPREDNISOLONE 1gm in 100ml of NS once a day for 5 days.

2.Inj.Pantocid 40mg OD/BBF for 5 days at 8 AM

3.Tab.AZORAN 25 mg once daily at 2 PM

4.E/d LUBREX 5 times/day FOR 5 days  

progression 

We started giving 1gm METHYLPREDNISOLONE in 100 ml of NS under observation, And on the 3rd day she passed urine(Foley's catheter was removed)


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