2. • Khubaib 37-years-old male married muslim
resident of melsi presented with complaint of;
Back pain for last 3 moths
B/L lower limb weakness for last 16 days
3. HOPI
• Patient was in his usual state of health 3
months back. When he felt pain in back at mid
thorax which was sudden in onset after lifting
heavy weight, it was localized not radiating,
severe in intensity,increased with activities,by
lifting heavy weight and on movements or
change in position.
Pain was relieved by pain killers.
4. • He also noticed weakness in both lower limbs
for last 16 days,which is sudden in onset,
progressive in nature with no specific
aggravating or relieving factors.
• Initially he was walking with the help of
walking aids and with the help of others and
he was able to perform his usual activities on
his own (like going to toilet etc).
5. `
• For the last 7 days he is bound to bed and
wheel chair and cannot do activities even with
the help of others.
• There is no preceding history of trauma, flue
or diarrhea , vaccination , fever with evening
rise, chronic cough, hemoptysis, weight loss.
• There is no worsening of weakness with
activity and no any diurnal variation.
6. • No visual impairment, palpitations and foot
deformity.
• Patient is having good dietary habits and eats
meat regularly .
• There is no preceding history of heavy meal
and canned food.
• There is no H/O such illness in his family.
7. • There is no H/O headache, vomiting, fits,
cough, hemoptysis, joint pain, rashes.
• Burning micturation , urinary retention,
constipation and he has no such events
earlier.
8. • Past medial history :
He has not been hospitalized for any chronic
disease like CLD,CKD,ASTHMA,TB,IHD.No h/o HTN
and DM
• Past surgical history :
not significant.
• Personal history: Normal bowel and Bladder
habits. Normal sleep cycle.
No H/O smoking, alcohol or other addictions.
9. • Family History:
There is no chronic disease in his family
• Socioeconomic status:
Middle class (Imam Masjid by profession.)
10. Differential Diagnosis
• Cord Compression due to :
Disc prolapse
Tumor
Tuberculosis
• Transverse Myelitis.
• MS
• Occlusion of ASA
• SCD
11. GPE
• A younge Patient of normal built, average
nutrition well oriented in Time, place, and person
lying on bed and answering to my questions
clearly, With following vitals.
• Pulse: 78 bpm regular in rhythm.
• B/P 110/70,
• Temp is Normal
• R/R: 18/M
12. • No pallor, cyanosis, clubbing, koilonychia,
leukonychia, jaundice,
lymphadenopathy,sternal tenderness and JVP
is not raised.
• Skin complexion is normal.
14. Motor System of Lower Limb
• Inspection: There is no atrophy, hypertrophy,
wasting of muscles and Fasciculations.
• Muscle Tone:
Increase in both lower limbs.
• Power:
Reduced (grade 3/5) in both lower limbs.
15. • Reflexes:
Plantars Extensor
Ankle Exagerated (grade 3)
Knee Exagerated (grade 3)
• Coordination:
Could not be done due to weakness.
• Cerebellar Function is Intact.
16. • Gait: Could not be evaluated.
• Involuntary movements: Absent.
• Sensory system: Sensory level at T10.
• Spinal cord: no tenderness and gibuss
• Examination of Upper Limb:
Unremarkable.
17. CVS
• Pericardium:
Pulse :78BPM,regular, normal volume no
radio radial and radio femoral delay.
Inspection:pericardium is normal
Palpation: Apex beat in 5th intercoastal space
medial to MCL. Normal in character.
Auscultation: 1st and 2nd Heart sounds are
normal in character and intensity with no
added sounds.
18. Respiratory System
• Inspection: Chest is normal in shape, Moving
equally on both sides at R/R of 18/m. No scar
marks, bulge, prominent veins and visible
pulsations.
• Palpation: Temp is normal, No tenderness
Trachea is central with normal cricosternal
angle. Apex beat is in 5th ICS medial to MCL.
Chest movement are equal on both sides with
chest expansion of 5 cm.
19. • Percussion: Percussion note is resonant and
equal on bothside. Upper border of liver is in
5th ICS.
• Auscultation: There is NVB with no added
sounds.
Vocal resonance is normal and equal on both
side.
20. GIT
.Inspection;
Abdomen is protuberant ,moving with
respiration with central inverted
umbilicus.There are no scar marks, prominent
veins, striae, bulge or prominent pulsations.
Palpation;
There is no tenderness on superficial and deep
palpation and no visceromegaly. Paraortic LNs
are not palpable
21. • There is no evidence of fluid thrill or shifting
dullness.
• Auscultation;
bowel sounds are audible.
Hernial orifices are intact
22. Differential Diagnosis
• Cord Compression due to :
Disc prolapse
Tumor
Tuberculosis
• Transverse Myelitis.
• MS
• Occlusion of ASA
