47F with generalised weakness and pain in left upperlimb and shoulder.

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Bunni Sadhguna 

Roll no. 25

Pt came with chief complaints of generalised weakness and pain in left upperlimb and shoulder since 25 days.

HISTORY OF PRESENT ILLNESS:

patient was apparently asymptomatic 25 days back ,then she developed weakness, with dragging pain and tingling sensation in left upperlimb and shoulder,which was sudden in onset, gradually progressive and is associated with breathlessness Aggravating while working. 

PAST HISTORY:

K/c/o hypertension since 1 month,on medication ( telma 40 mg),thyroid since 10 yrs and asthma since 20 yrs.

H/O trauma in right lowerlimb 6 yrs back, followed by pain in right side of hip and leg,aggravating on working, which is not g radually progressive. 

Not a k/c/o DM,TB and epilepsy. 

FAMILY HISTORY: 

not significant 

PERSONAL HISTORY:

diet is mixed with normal appetite, inadequate sleep of 3hrs since 25 days,bowel and bladder movements are regular and not a significant history of addictions and allergies. 

GENERAL EXAMINATION:

patient was conscious, cooperative with slurred speech 

Well oriented to time ,place,and person,moderately built and well nourished

No Pallor 

No icterus 

No Clubbing of fingers 

No Lymphadenopathy 

No pedal edema 

VITALS EXAMINATION:

temperature: afebrile 

BP: 140/70 mm hg

PR: 82bpm

RR: 18 cpm

Diagnosis of  spinal stenosis 

The radiologic diagnosis of SS may be seen as an easy task at first sight. However, there are many confusing points. In particular, the main drawback is considered to be the lack of correlation between symptoms and degree of stenosis. Furthermore, the type of quantitative measurements, radiologic classification, and estimation of outcome are all matters to be addressed.

What is the best diagnostic test for the diagnosis of SS?

Which radiologic criteria (qualitative and quantitative) best describe SS?

Which radiologic criteria do we have to define instability in SS?

1.

In patients with history and physical examination findings consistent with SS, MRI is suggested as the most appropriate noninvasive test to confirm the presence of anatomic narrowing of the spinal canal or the presence of nerve root impingement (grade of recommendation B).

2.

In patients for whom MRI is either contraindicated or inconclusive, CT myelography and, if contraindicated, CT are suggested as the most appropriate tests to confirm the presence of anatomical narrowing of the spinal canal or nerve root impingement (grade of recommendation B).

3.

About imaging correlation with clinical findings there is insufficient evidence to make a recommendation for or against a correlation between clinical symptoms with the presence of anatomical narrowing of the spinal canal on MRI, CT myelography, or CT.2