Chief complaints:-

Patient c/o weakness of right UL and LL for 7 days.

History of presenting illness

Patient apparently alright 7 days back, when she started having weakness of right UL and LL, insidious onset, gradually
progressive, that was noticed by the care takers as there was change in gait and was unable to lift water glass with right hand.

h/o difficulty in walking present,

no h/o bowel and bladder complaints,

no h/o difficulty in rolling over the bed, lifting head ,

no h/o cranial nerve involvement,

Past History

Not a known case of diabetes and HTN

no h/o bronchial asthma, TB

Personal History

diet-mixed

appetite-normal,

sleep- disturbed

bowel and bladder –regular

Family history:

Not significant

GENERAL EXAMINATION:-

Moderately built and nourished.

T- normal

BP- 120/80 mm HG

RR- 19/min

Pulse- 84/min

GCS- E4V5M6
Pupils- both 3mm equally reactive to light

Cranial nerve examination

CN 1:Intact

CN 2:

Visual acuity: RE 6/6 LE 6/6

Visual fields: Normal

Color vision: Normal

Fundus: Grade 1 papilledema noted on the right side?

CN 3,4,6 EOM Normal

CN 5- V1 V2 V3 Normal

Sensory: Normal

Motor : Normal

Corneal reflex-

Eye Direct Consensual

present present
Right eye

present present
Left eye

Jaw jerk- Present

CN 7- Normal

CN 8-

Test Right Left

Rinne AC > BC AC > BC

Weber not lateralised not lateralised

CN 9,10:
Uvula – Midline
Palatal movement- Normal

Gag Reflex- Normal

CN11: Normal

CN12:

Tongue - Bulk - Normal

Deviation - No
POWER:-

tone and bulk-normal

RIGHT LEFT

Shoulder Flexion 5/5 5/5

Extension 5/5 5/5

Adduction 5/5 5/5

Abduction 5/5 5/5

Elbow Flexion 5/5 5/5

Extension 5/5 5/5

Wrist Flexion 5/5 5/5

Extension 5/5 5/5

Hand grip 100% 100%

Hip Flexion 5/5 5/5

Extension 5/5 5/5

Adduction 5/5 5/5

Abduction 4+/5 5/5

Knee Flexion 4+/5 5/5

Extension 4+/5 5/5

Ankle Dorsiflexion 4+/5 5/5

Plantar Flexion 4+/5 5/5

EHL 4+/5 5/5

Reflexes :
Superficial- present
Abdominal reflexes- present
Plantars-
 Deep Tendon Reflexes : B T S K A

Right - 2+ 2+ 2+ 2+ 2+
Left- 2+ 2+ 2+ 2+ 2+

Sensory system:-

Touch – intact
Rhomberg’s sign- negative
2 point discrimination test- intact
Vibration sense- intact
Joint position sense-

Cerebellar signs:-
Dysdiadochokinesia- absent
Finger-nose test- intact
Finger-nose-finger test- intact
Knee-heel-shin test- intact
Pendular knee jerk- absent
Rebound phenomenon- absent

Other system examination:-

Cardio-vascular system- S1,S2+

Respiratory system- NVBS+, BE+
Per abdomen- soft

CT ; ? Pontine /midbrain glioma with Hydrocephalus

DIAGNOSIS- ? Pontine /midbrain glioma with

obstructive Hydrocephalus

Case discussed with Dr. Ramesh Chandra (HOD

neurosurgery):-

Advice:- VP Shuntinng