An Interesting case....
A 43 year old female came to the OPD, she was unable to walk.
there was h/o tremors and involuntary movements in hands and feet since 15years.
there is associated speech difficulty since 10 yrs.
h/o swaying while walking.
tremors occur during work but are absent during rest.
no significant past history or family history.
pt. is conscious and coherent
all cranial nerves appear to function normally.
on motor system examination :
tone of upper limbs muscles are decreased on both rt and lt sides
rt beating nystagmus is present
Dysdiadochokinesia is present
ataxic gait is seen
scanning speech +
tandem walking negative
The patient is currently being monitored and a provisional diagnosis has been kept.
Can you guys find out the diagnoasis ?
Hb : 11gm%
TC - 6100 cells
DC - p68 L26 E4 M2
PCV - 35%
platelets - 1.4 lakhs
HIV, HbsAg - NR
urine albumin urine sugar - nil
s. copper - 34 mcg/dl (decreased)
urea - 42 mg/dl
ALP - 175 u/l
SGOT - 25 u/l
SGPT - 12 U/L
creatinine - 0.9 mg/dl
MRI brain impression:
ill defined , non enhancing, non restricting, T2 and FLAIR hyperintensity.
hypointense on T1 WI involving B/L thalami, midbrain.
mild diffuse cerebellar atrophy
diffuse cerebral atrophy with small ischemic changes
Provisional R/x :
T. Promethazine 25mg
T. Haloperidol 0.5 mg BD
T. Pantop 40mg OD
PS : I'll update the case again. So stay tuned.....