ALANGIUM460SALVIFOLIUM(02),,,A20 year old male suffering from Qudriplegia since 4 months...

This is a HIPAA de-identified open-online-patient-record with initial information in duty-doctors notes as well as patient's voice, posted here summer 2016 after collecting informed patient consent (form downloadable here) by Dr. Madhavi Rawat.

C/O=> headache since  3days
             Anable to walk since 4 month
            Bed soarce since 2 months
           No sensation for passing stool& urine since  4 months...

Medical  Past History=> not significant

Surgical Past History=> spinal surgery  4 month ago.

Patient history in patient Voice=>
 A

B

Clinical Images

Soft sensation loss marked area

Bedsore:-- a

• OBJECTIVE EXAMINATION:--
 - Posture-- pt in supine
-Gait-- Anable to walk
Sclera-- normal
Tongue-- whitish in colour& normal size

° Muculo-skeletal Examination:--
~ MUSCLE PWER by MMT
1. U.L= both side grade 5 ,,Except wrist B/L - grade 1

2. L.L= both side rt& Lt grade -0

~ MUSCLES TONE--

U.L= both side approx normal..

L.L= both sides flassidity

° SENSARY EXAMINATION:--
U.L-- light touch WNL except lateral compartment of both palmer area.

L.L-- light touch absent in both lower limb

- Tow point discrimination:- absent in forearm and foot area
- Proprioception :- absent both UL& LL
- sharp& dull:- present both limb
- Hot& Cold:-

° DTR:--both UL& LL
- Biceps:- o2 normal
-Triceps:- 02 normal
- patella:- 01 diminish
- achillis:- 01 diminish

° Mental status= WNL
° Memory & concentration= everything is good.





INVESTIGATION