gbs case presentation
DESCRIPTION
TRANSCRIPT
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• A M A, 17 yrs old young man from Elgaa ,Northern Kordofan .admitted on 4 / 12 /2011 presenting with
- Lower & Upper 2 weeks
limbs weakness
- Change of voice 1 week
- Difficulty in swallowing
SOB 1 day
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HPI
• Condition started 2 weeks PTA with lower limbs weakness started distally involving both limbs progress gradually within 2 weeks became unable to walk unsupported, one week following onset of illness in lower limbs , he developed upper limbs weakness that progress to the degree he couldn't lift a filled cup .
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• Pt developed difficulty in swallowing more to liquids and also his voice was changed .
• No sphenteric disturbance .
• No double vision .
• No numbness or tingling sensation .
• Condition associated with neck & backache .
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SYSTEMIC REVIEW
GIT
GUS
CVS no symptoms related to
MSS all these systems
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PAST MEDICAL HISTORY
- PH of hospitalization 1 month ago because of upper respiratory infection .
- No PH of similar condition .
- Not known to be diabetic ,hypertensive or having any chronic illness .
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SOCIAL HISTORY
• Single , basic study up to class 4 , then went to khalwa . .
• Live with family .
• Worked in farming. no health insurance .
• Not alcoholic , smoker or snuffer .
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DRUG HISTORY
• Not known to be allergic to Penicillin or other drugs .
• Not on long term medication .
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FAMILY HISTORY
• No F/H of DM ,HTN or BA .
• No F/H of similar condition .
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SUMMARY
• 17 yrs man with a preceding URTI presented with ascending weakness and difficulty in swallowing and change in voice for 2 weeks prior to admission .
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ONEXAMINATION
• Looks unwell, not pale , jaundiced or cyanosed , conscious and oriented to time , place and person .
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• PR 88 b / m regular , normal volume , synchronous , no radiofemoral delay , peripheral pulses intact .
• BP 110 / 70 JVP not raised
• S1 ,S2 normal No added sounds or murmurs .
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• CHEST
Normal vesicular breathing .
No added sounds .
• ABDOMEN
No area of tenderness
No palpable organs
MSS
No skin lesion or joints abnormality detected .
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• CNS
Conscious ,oriented to time place & person ; intact memory , normal speech content with nasal tone
Cranial nerves
Bilateral 7th CN LMN weakness .
Bilateral 9 & 10 th CN weakness .
All other were normal
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• No neck stiffness .
• Weakness in neck flexion .
• Back examination normal .
• Upper limb Rt Lt
Tone decreased decreased
Power shoulder G3 G3
hand G4 G4Reflex absent absent
Sensation intact intact
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• Lower limb Rt Lt
Tone decreased decreased
Power hip&knee G3 G3
foot G4 G4Reflex absent absent
Sensation intact intact
Plantar response equivocal equivocal
Gait walking with support
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CBC value
Hb 14.4 g/dl
T WBC 25700( NEUT 83) %
HCT 46
MCV 90 fl
MCH 28 pg
MCHC 32 g/dl
Platelet 242000
ESR 55
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• Urinalysis
Protein +
Pus cells 3 - 5 RBC 0 - 1
BF for malaria -ve
RFT
B. urea 54 mg/dL
S. creatinine 0.8 mg/dL
S. Na 135 mmol/L S. k 3.9 mmol/L
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Barium swallow
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CT NASOPHARYNX
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CT BRAIN
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Nerve conduction study
• NCS revealed electrophysiological consistent with demyelination distal motor neuropathy .
• The associated clinical presentation intermingled with these finding might suggest AIDP .
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ACUTE IMFAMATORY DEMYELINATING POLY
NEUROPATHY
( AIDP )
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COURSE IN HOSPITAL
After hospital admission Pt developed fever which most probably due chest infection resulting from his bulbar weakness and barium aspirated during imaging .
Still in hospital , his condition is static no affection to respiratory muscles & no deterioration in power of other muscles groups .
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Message to take home
• Drs’ ignorance to give their pts enough time while they are telling their diagnosis, still going on that pt pay its cost ,risk and complication .
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