A CASE OF PROGRESSIVE GENERALISED WEAKNESS WITH WASTING

A CASE OF PROGRESSIVE GENERALISED WEAKNESS WITH WASTING

Case presentation - Department of General Medicine Presented by: Dr Priyabrata Sahu · Chairperson: HOD and Professor Dr Sarita

Three. HISTORY OF PRESENT ILLNESS

Patient was apparently alright two years back, when she developed weakness of the left lower limb, insidious in onset and gradually progressive. It manifested as tripping while walking with two episodes of fall, inability to grip the slippers and slippage of slippers while walking, of which she was aware. After fifteen days she was walking with the help of a stick.

After one month she developed weakness of the right lower limb, insidious in onset and gradually progressive, such that she had to walk holding on to walls and was unable to climb stairs or get up from a squatting position without help. Since three months she was moving in the sitting position by dragging her lower limbs, and since fifteen days she has been bed-ridden.

Simultaneously she had twitching movements in both upper and lower limbs.

She developed weakness of the left hand, such that she was unable to milk the cows; relatives noticed clawing of the left hand. Since one year she developed weakness of the right hand in the form of difficulty in mixing food and inability to open the cap of a bottle. Relatives noticed thinning of both lower limbs since six months.

Since one year she developed difficulty in speech, insidious in onset, with difficulty in initiating speech and straining while speaking; it progressed over six months such that relatives found her speech difficult to understand. Since one month she is unable to speak, though she understands words and responds to commands by gesturing. This is associated with inappropriate laughing and crying.

Since three months she has difficulty in swallowing, initially to solids and later to liquids, associated with drooling of saliva and not associated with nasal regurgitation.