22Y M WITH INVOLUNTARY MOVEMENTS OF HEAD AND UPPER LIMBS
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This is a case of 25 Y Male with
Complaints of involuntary movements of neck since 4 years
involuntary movements of upper limb since 1 year
HOPI
Patient was apparently normal 4 years back then he developed involuntary movements of Neck since 4 years which was insidious in onset and gradually progressive, initially started as fine movements/ tremors. And intensity increased gradually.
He also develop involuntary movements of upper limbs since 1 year insidious in onset and gradually progressive initially left upper limb and then progressive to right upper limb
Complaints of increase in intensity of movements since one week.
No complaints headache seizures, loss of consciousness,Giddiness vision disturbances,fever, vomitings
Tremors are seen only while doing working and relieved in resting state.
H/o liver Abscess 1 year back drained and advised for alcohol abstinence.
Alcohol stopped 15 days back.
Personal history:
Diet: mixed
Appetite: normal
Sleep: Adequate
Bowel and bladder: Regular
No addictions and allergies
GENERAL EXAMINATION:
Vitals:
PR-54bpm
RR- 22cpm
Temp-98.5
Bp-100/60 mmhg
Spo2-98 RA
GRBS-92 mg/dl
No pallor,No icterus, cyanosis, clubbing, lymphadenopathy.
SYSTEMIC EXAMINATION ::
GIT
INSPECTION :
Abdomen - scaphoid
Umbilicus - inverted
Movements - all quadrants are equally moving with respiration
No scars and sinuses
No visible peristalsis
No engorged veins.
PALPATION:
No local rise in temperature and no tenderness in all quadrants
LIVER: no hepatomegly
SPLEEN- not enlarged
KIDNEYS - bimanual palpable kidneys
PERCUSSION :
no shifting dullness
AUSCULTATION :
Bowel sounds are heard and are normal
No bruit
Respiratory system:
Inspection:
No tracheal deviation
Chest bilaterally symmetrical with pectum excavatum
Type of respiration: thoraco abdominal.
No dilated veins,pulsations,scars, sinuses.
No drooping of shoulder.
Palpation:
No tracheal deviation
Apex beat- 5th intercoastal space,medial to midclavicular line.
Tenderness over chestwall- absent.
Vocal fremitus- normal on both sides.
Percussion:
Supraclavicular
Infraclavicular.
Mammary
Axillary
Infraaxillary
Suprascapular
Infrascapular
Interscapular
Right side and left side- resonant in above areas.
Auscultation:
Bilateral Airway entry - present
Cardiovascular system:
Inspection : no visible pulsation , no visible apex beat , no visible scars.
Palpation: all pulses felt , apex beat felt.
Percussion: heart borders normal.
Auscultation:
Mitral area, tricuspid area, pulmonary area, aortic area- S1,S2 heard.
Central Nervous system:
Higher motor functions- Intact
Speech: slurred
Cranial nerve functions - Normal
Sensory system-Normal
Motor system Right Left
Power- UL 4/5 4/5
LL 4/5 4/5
Neck Normal
Trunk muscles Normal
Tone- UL Normal Normal
LL Normal Normal
Reflexes-
Superficial reflexes - Intact
Plantar flexion flexion
Deep tendon reflexes -
Biceps - -
Triceps - -
Supinator - -
Knee + +
Ankle - -
INVESTIGATIONS:
USG(7/5/23)
DIAGNOSIS :
TREMOR PLUS SYNDROME
SPASTIC CEREBELLAR ATAXIA
?GENETC
TREATMENT:
IV FLUIDS @75 ML/HR
INJ.METHYLCOBALAMIN 1500MCG IV/OD IN 100ML NS FOR 1 WEEK
TAB.TETRABENZINE 12.5MG PO/OD
CAP.BETACAP TR 40 X DAILY
TAB.EVION X DAILY
TREMOR PLUS SYNDROME
25 Y Male with Complaints of involuntary movements of neck since 4 years
involuntary movements of upper limb since 1 year
Patient was apparently normal 4 years back then he developed involuntary movements of Neck since 4 years which was insidious in onset and gradually progressive, initially started as fine movements/ tremors. And intensity increased gradually.
He also develop involuntary movements of upper limbs since 1 year insidious in onset and gradually progressive initially left upper limb and then progressive to right upper limb
Complaints of increase in intensity of movements since one week.
No complaints headache seizures, loss of consciousness,Giddiness vision disturbances,fever, vomitings
Tremors are seen only while doing working and relieved in resting state.
H/o liver Abscess 1 year back drained and advised for alcohol abstinence.
Alcohol stopped 15 days back
Past history :Liver Abscess drained 1 yr back.
Course in hospital :
Patient was investigated further and Neurology referral was done where MRI Brain was advised.He's being discharged and asked to follow with the report.
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