CASE
Name :
Anupama
Age : 12 years
Sex : Female
Place : Vengeri
IP No : 392
D O A
: 8/7/2006 D O D
: 14/7/2006
Readmission
on 21/ 7/ 2006 D O D
: 5/ 8 / 2006
Presenting
Complaints
-
Fever (1 Week)
-
Weakness of
Lower limbs (1 Week)
-
Pain in the
Popliteal Fossae (1 Week)
-
Pain in
Abdomen (1 Week)
History of
Presenting Complaint
Complaint started
6 years back with fever, which continued for 6 months. Fever
used to come on especially in the evening along with upper
respiratory tract infection including cough and coryza. Then
she developed weakness in the lower limbs which is more on
walking for a long distance and which progressed so that the
patient feels weak even after walking for a short distance.
The weakness is better by rest. Patient used to fall down due
to weakness while walking. There was pain in the lower limbs,
especially on the Popliteal Fossae which increased on walking.
< On ascending stairs.
There was also
swelling of joints like wrist, elbow, fingers, ankle, knee
etc. which used to come recurrently and the joints would be
hot to touch with pain and difficulty in bending the joints.
The patient could not hold weight or write for longer
durations.
There was
puffiness of eyes also. < Morning, Better in the after noon.
Nerve conduction
test was done on 29/ 03/ 2001; diagnosed as Chronic
Inflammatory Demyelinating Polyneuropathy/ Guillain- Barre
Syndrome and was given Allopathic treatment for relief.
Now she has
weakness in the lower limbs since one week and is admitted in
GHMC.
Past History
Measles- 5 years
back
Urticaria in childhood
UTI- Two years back
Took Homoeopathic
treatment for all complaints and got relief.
Family History
Father has
tuberculosis
Personal History
Born and brought
up at Vengeri. Anupama is studying in 6th standard.
Her father is a painter and mother, a house wife. She has an
elder sister also.
Generals
Appetite -
↓
Thirst - ↓
Desires cold
drinks
Sleep- disturbed
by dreams; cries during sleep
Stool- regular
Urine- no
complaints
Desires- fish
Aversion- meat,
egg, milk
Thermal reaction-
chilly; she wants to cover the body always. Cannot bear cold
water application
Regionals
Scalp-
sensitiveness of scalp- cannot comb hair
Abdomen- Pain in
abdomen < eating
Eyes- Puffiness of
eyes < morning
Skin- Exfoliation
of skin in the palm
Mind
She is mild,
gentle, very active and enthusiastic in nature. She makes
friends easily and cannot bear to be alone. When her mother
goes out she is restless till she returns. She dislikes her
father as he is an alcoholic, returns home drunk and quarrels
with her mother. The patient cannot stand the rude behavior of
her father.
After she and her
sister were caught between a dog fight, the patient developed
a fear of dogs and she has recurrent dreams of dogs. The
patient is afraid of thunder storms since she was hit by a
lightning and is very sensitive and fastidious.
Physical
Examination
PR – 80/ mt
RR – 20/ mt
BP – 90/60 mm of
Hg
General Survey
Patient is
moderately built.
No pallor, No
cyanosis, No jaundice and no clubbing.
Cervical
lymphadenopathy present
Systemic
Examination
Examination of
Central Nervous system
Examination of
higher mental functions
Child is conscious
and alert, memory normal, no hallucination, delusion or
illusion.
Speech normal, no
dysarthria. Gait- Dragging (26/ 03/ 2001). Now normal steady
gait.
Examination of
Cranial nerves
Olfactory Nerve
No anosmia,
parosmia and hallucination of smell.
Optic Nerve
There is no
obstruction on the field of vision
Oculomotor Nerve, Trochlear
Nerve, Abducens
Ocular movements
are within normal limits
No nystagmus.
Pupil reacts to
light
Trigeminal Nerve
Sensation over
face is intact.
Corneal and
conjunctival reflexes intact.
Jaw jerk present
Facial Nerve
Eye closure,
frowning, raising the eye brow present.
Can blow, whistle
and show the teeth
Vestibulocochlear Nerve
No impairment of
hearing
Glosopharyngeal Nerves and
Vagus
Gag reflex
present.
Uvula centrally
placed.
Hypoglossal Nerve
:
Can move tongue in
all directions
Sensory System
With in normal
limit
Motor System
UL
LL
Bulk
N N
Power
G IV G IV
Tone
Hypotonic
Hypotonic
Beevor’s Sign
Negative
Superficial
Reflexes
The plantar
reflex: Flexor Plantar Response
Corneal
Reflex: Present
Signs of Meningeal
Irritation:
No signs of
meningeal irritation
Investigations:
26/03/06
Blood
Urine: RE
Albumin
- Nil
Pus cells -
1-2 HPF
Epithelial Cells-
0-1/ HPF
Lumbar puncture
done on 26/3/01
Normal CSF values
No cells seen
(Cells- 0-5/ mm³,
all lymphocytes)
Proteins-
213.4 mg%
(Protein- 15-45 mg/ dl)
Sugar- 52 mg% (Glucose- 48-86
mg/dl)
Albumino cytological
dissociation
Nerve Conduction
Test done on 29/ 3/ 2001
Probably
C/C inflammatory demyelinating
neuropathy (CIDP)
Nerve Conduction
Velocity Test done
There are
prolonged distal latencies (of CMPA) both in the nerves of
legs and upper limb. F waves are not obtained. The velocity
of conduction is reduced. The above features are
suggestive of severe demyelinating neuropathy.
Provisional
Diagnosis
Demyelinating Neuropathy/
Guillain- Barry Syndrome
Analysis of
Symptoms
|
Symptoms of
the patient |
Symptoms of
the Disease
|
|
Fear of
being alone |
Weakness of
lower limbs |
|
Fear of dogs |
|
Fear of
thunderstorm |
|
Desire to
work |
Stumble
while walking |
|
Fastidious |
|
Chilly
patient |
|
Sleep
disturbed |
Rise of
temperature |
|
Desires fish |
|
Desires cold
drinks |
Evaluation of
Symptoms
|
Mental
Generals |
Physical
Generals |
Particulars |
Common |
|
1.Fear of
dogs
2.Fear of
being alone
3.Fear of
thunder storm
4.Desire to
work
5.Fastidious
|
1.
Chilly patient; prefers
covering always
2.
Desires fish
3.
Desires cold drinks
|
1.
Evening rise of
temperature
2.
Pain in abdomen
< eating
3.
Pain in abdomen
<
morning
|
1.
Weakness of
lower limbs
2.
Stumble
while walking
|
Totality of
Symptoms
1.
Fear of being alone
2.
Fear of dogs
3.
Fear of thunder storms
4.
Fastidious
5.
Desire to work
6.
Sleep disturbed by dreams
7.
Chilly patient
8.
Desires fish
9.
Desires cold drinks
10.
Weakness of lower limbs
11.
Stumble while walking
12.
Evening rise of temperature
13.
Pain in abdomen< Morning
14.
Pain in abdomen< After eating
Miasmatic cleavage
|
symptoms |
psora |
sycosis |
syphilis |
