A 70 yo Female with Neck Muscle Stiffness and Loss of Speech

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A 70 year old female came with complaints of neck muscle stiffness and unable to speak.

HISTORY OF PRESENT ILLNESS:
  • Patient was apparently asymptomatic 7 yrs back.
  • Then she developed pain in right shoulder for which she was managed conservatively.
  • 5 yrs ago, she developed weakness and giddiness and was diagnosed with HTN.
  • Since 5 yrs, she developed pain in both lower limbs.
PAST HISTORY:
  • k/c/o HTN
  • No history of DM.
  • No history of TB.
  • No history of Bronchial asthma.
PERSONAL HISTORY:
  • Diet: Mixed
  • Appetite: Decreased
  • Adequate sleep
  • Bowel & bladder movements: Normal and Regular
TREATMENT HISTORY:
1. TAB. ATENOLOL 25mg 
2. TELMA-40 
3. TAB. ACECLOPHENAC
4. TAB. PREDNISOLONE 5mg

GENERAL EXAMINATION:
  • Pt. is conscious
  • Pallor is seen
  • No icterus
  • No cyanosis
  • No clubbing
  • No lymphadenopathy
  • No pedal edema
                                                   

VITALS:
  • Temp: Afebrile
  • PR: 105 bpm
  • BP: 130/80 mmHg 
  • Respiratory rate: 22 cpm
                                                      


SYSTEMIC EXAMINATION:

CVS:
  • S1, S2 heard
  • No murmurs and thrills
                                                        

Respiratory system:
  • Normal vesicular breath sounds heard

Per Abdomen Examination:
  • Soft and non-tender
  • No mass
  • All quadrants moving equally with respiration
                                                     

CNS:
  • Conscious
  • Speech - Sluggish response
  • Signs of meningeal irritation absent
  • Cranial nerves intact
  • Motor system - Normal reflexes

PROVISIONAL DIAGNOSIS:
Hypocalcemic tetany

INVESTIGATIONS: 

1. Complete Blood Picture:


2. Blood Urea:

3. Serum Creatinine:


4. Serum Electrolytes:



TREATMENT:


1. Inj. OPTINEURON 1amp in 100ml NS IV/OD
2. TAB. HIFENAC-MR PO/BD
3. TAB. SHELCAL 500mg PO/OD








 







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