65 year old male with diffuse involuntary movements of left lower limb

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A 65 year old male came to casuality with 

C/o diffuse involuntary movements of left lower limb since 2 years

C/o difficulty in swallowing ( solids > liquids) since 20 days

HOPI

 

Patient was apparently asymptomatic 2 years back , later developed involuntary movements of left upper limb and lower limb since 2 years.

Movements are present at rest , and decreased on doing work and later they got admitted and started in TAB.SYNDOPA PLUS ( initially 2 tabs twice daily) , movements subsided for 4 hours after taking medication and again started after 4 hours of medication and after 2 months used 3 tabs per day and also started on herbal medication for 3 months, for which movements subsided completely and recurred after stopping herbal medication . Now, since 4 months using tablet four times per day and only resting tremors are present 

PAST HISTORY

Not a K/C/O HTN,DM,ASTHMA

O/E: 

CVS: S1S2 heard 

RS: BAE+

P/A :soft and non tender 

CNS: 

Speech : delayed 

Tone        UL                  LL

RT           increased     increased 

LT            increased     increased 

power     

Rt            4/5                 4/5

Lt             4/5                 4/5

Reflexes 

                  Biceps   triceps   supinator

RIGHT       ++           ++          ++

LEFT          +++        ++           ++

                 Knee         ankle

Right           ++             +

 Left            ++             +

Vitals: 

temp: afebrile

Bp :100/60 mmhg

Pr: 99 bpm

Rr: 17cpm

Grbs: 126 mg/dl

Provisional diagnosis:

 ? Parkinson's  disease(lt>rt) 

Treatment: 

1) TAB.SYNDOPA PLUS 110 MG/PO/QID 

2)TAB.PAN 40 MG/PO/OD

3)INJ.OPTINEURON 1 AMP IN 100ML NS/IV/OD

SOAP NOTES DAY 1 

S: involuntary movements of left lower limb since 2 years 

Difficulty in swallowing (more to solids)  since 20 days 

O: 

Pt is c/c/c 

Oriented to time/place/person 

No pallor/icterus/cyanosis/lymphadenopathy/edema 

BP: 110/80 mmhg 

PR: 80bpm 

RR: 18cpm 

CVS: S1S2 +, no murmurs 

P/A: soft and non tender

CNS: 

Speech : delayed 

Tone        UL                  LL

RT           increased     increased 

LT            increased     increased 

power     

Rt            4/5                 4/5

Lt             4/5                 4/5

Reflexes 

                  Biceps   triceps   supinator

RIGHT       ++           ++          ++

LEFT          +++        ++           ++

                 Knee         ankle

Right           ++             +

 Left            ++             +

A: ? PARKINSON’S DISEASE 

P: 

1. TAB. SYNDOPA PLUS 100mg/25mg/PO/QID

2. TAB. PAN 40mg/PO/OD 

3. INJ. OPTINEURON 1 AMP in 100ml NS/IV/OD 

4. BP/PR/TEMP 4th hourly 

5. GRBS 12th hourly