65 year old male with tremors and urinary incontinence

65 year old male with tremors and urinary incontinence

A 65 year old male patient came to casuality with the Chief complaints of:

-Tremors since 5 years
-Giddiness since 2 months
-Uncontrolled urination since 2 months
- Slurring of speech since 3 months

History of presenting illness:

Patient was apparently asymptomatic 5 years ago then he developed tremors in upper limbs which was insidious in onset and gradually progressive and involved lower limbs,

3 months back his speech got slurred, drooling of saliva started,

since 2 months patient was unable to control micturition and he started to felt giddiness and falls suddenly while walking and he is complaining of constipation since 2 months

No H/O Fever, Vomitings, burning micturition,chills, SOB

Past history:

He is a K/C/O Parkinson's disease and he is using Syndopa 125 mg and trihexiphenidyl 2mg since 3 years

No history of similar complaints in the past

N/K/C/O DM,Htn,Tb,Asthma, epilepsy,CAD,

Thyroid disorders

Family history:

Not Significant

Personal History:

Diet - mixed

Appetite - normal

sleep - adequate

Bowel and Bladder movements- irregular, constipation and urinary incontinence is seen

Addictions - no

No known allergies

Drug history : 

No significant drug history

General examination:

Patient is conscious ,coherent ,cooperative and was well oriented to time ,place and person at the time of examination

He is examined in a well lit room, with consent taken.

He is moderately built and moderatly nourished.

Pallor - absent

Icterus - absent

Cyanosis - absent 

Clubbing - absent

lymphadenopathy - absent

Pedal edema - absent

Vitals : on the day of admission (12/11/2022)

Temperature - afebrile

Pulse rate - 82 bpm

Respiratory rate - 16 cpm

Blood pressure - 120/80 mmHg

SpO2 - 99% on Room air

GRBS - 127 mg/dl

Postural hypotension not present:

- Supine BP - 120/70mmHg & On Standing 120/80mmHg

Systemic examination:

CVS : S1 and S2 heart sounds heard 

NO murmurs and thrills

RESPIRATORY SYSTEM : Bilateral air entry present position of trachea - central 

 Vesicular breathsounds heard

CNS : mask like expression less face is seen

Festinant gait present

Able to do finger nose test,knee heal test,no dysdiadokokinesia,

Not able to walk in a straight line

ABDOMEN :

Soft On deep palpation -non TENDER no palpable masses

Bowel sounds heard 

NO organomegaly

Investigations:

On 12/11/2022:


On 13/11/2022:

HEMOGRAM:

SERUM CREATININE:

SERUM ELECTROLYTES:
SERUM CALCIUM:

COMPLETE URINE EXAMINATION:

BLOOD SUGAR-RANDOM:


BLOOD UREA:

LIVER FUNCTION TEST:

Anti HCV Antibodies-RAPID:
HBsAg-RAPID:

HIV1/2 RAPID :

X-ray :



Ultrasound Report:


ECG Report:


On 14/11/2022:


Diagnosis:

Parkinson's disease

Treatment:

1)Tab.Syndopa 125 mg PO/TD

2)Tab.Trihexyphenidyl 2 mg PO/BD

3)Inj. Optineuron 1amp in 500ml NS IV/OD


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