77M WITH PARASTHESIA ALL OVER BODY

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A 77year old male came to the opd with chief complaints of pricking sensations all over the body since 1 year. 

COURSE OF EVENTS :

Patient is a farmer by occupation. He is uneducated and started working in the farms since his teenage. At the age of 25 years he got married(consanguineous marriage).After 2 years he lost his father due to? Seizure like activity.

 After 2-3 months suddenly he experienced unknown fear, palpitations, chest heaviness, tingling sensations. He experienced tingling sensations initially over the head later extending on to the face, trunk and his limbs. He reports that he ran away 2-3 times from his home and he was found and brought back by his mother . When enquired why he ran away from his home he said that due to unknown fear, anxiety and palpitations he didn't like to stay back at home.( He reported that he didn't have any problem with his mother and she took good care of him). 

He was not able to cope up from the death of his father. So his mother took him to many hospitals in warangal and hyderabad but it didn't help him. She took him to hospital in erragadda where he was treated for his symptoms. Patient was not compliant to medication. Later the patient used homeopathic medication but it also couldn't help him . He was later taken to some ayurvedic doctor and his symptoms subsided. During the start of his symptoms, his wife was taken away by her parents and she came back once he is completely alright. Initially he denied to accept his wife saying that the disease process might recur but he eventually accepted her. 

He started farming again and lived happily with her wife. Next year his first child was born. He became the sarpanch of his village the same year and continued in the same post for 20 years. He managed his farming simultaneously. 

8-9 years back he developed pain in the bilateral knee joints for which he was treated accordingly and the patient continued to use the treatment. 

6 years back the patient felt mass per rectum not associated with any pain, no h/o bleeding per rectum. 

He came to surgery opd in our hospital and was managed conservatively. 

Since 1 year the patient started experiencing pricking sensation initially over the head, later over face and entire body. There are no aggravating factors and slight relief on scratching. Patient reports that his sleep was inadequate due his symptoms but once slept he couldn't feel any pricking sensations. His appetite was normal. He didn't isolate himself from work or any social gatherings because of his symptoms. It didn't interfere with his daily activities. He is worried that his symptoms are reoccurring. 

Patient was taken to multiple hospitals and reported that many investigations were done and they all came out to be normal. 

He was diagnosed to have hypertension and started on tab. Telma 40 mg and he is using his medication regularly for the past 1 year. He is not going to work for the past 1 year due to his knee pains.

In one such hospital visit 5 months ago, he is diagnosed to have cyst in his kidney for which surgery was performed (no documentation available) .

General Examination-

Patient is C/C/C

Bp- 110/70mmHg

PR-72bpm

RR-16cpm 

Temperature-98.6’F

GRBS- 99mg/dl

Systemic Examination 

CVS- S1,S2 + no murmurs

RS- BLAE +, no added sounds 

P/A- soft , non tender 

CNS

 

Sensory Examination-

                              Right       Left

Spinothalmic

1. Crude touch-    +             +

2. Pain-                  +             +

3.Temperature-     +             +

Posterior Coloumn

1. Fine touch          +             +

2.Vibration 

 -olecranon 

process.                55            55

-styloid 

process                  75            65

-shaft of 

tibia                        85            55

-medial 

malleous                -                -

3. Joint Position- UL 8/10    LL 8/10

                               UL 8/10    LL 8/10

Cortical 

Graphaesthia-      +              +

Stereognosis-       +              +

Tactile locatlisation-+           +

  MOTOR EXAMINATION 

Tone  

UL-                        N             N

LL-                         N             N

Power 

UL-                      5/5        5/5

LL-                       5/5        5/5

Reflexs               

B                           +           +

T                           +            +

S                           -             -

K                          +            +

A                          -             -

Plantars      Flexion  Extension 

Nystagmus- absent 

Finger nose incordination- No

Knee heel test- able to do 

Rhomberg’s test- No swaying 

Dysdikokonesia- able to do 

Provisional Diagnosis-? Parasthesia under evaluation with k/c/o HTN since 1yr 

INVESTIGATIONS

Treatment- 

1. Tab.Gabapentin-M PO/OD

2. Tab.MVT PO/OD

3. Tab. Telma-40mg PO/OD

4. Montior Vitals 4th hrly.