A 65 yr old male came to opd with

HOPI

He is a 60 yr old who was a toddy tree climber for 30 yrs.later on continued as daily wage labourer along with his wife.he stopped working since 4 yrs.
His daily activities inude waking up at 8/9 in the morning, attending nature call, rice for breakfast going back to sleep around 9/9:30 AM, waking up again around 3/4 PM having lunch, going back to sleep around 8PM, having dinner or indulging in alcohol weekly once with his relatives who visits their house.
On Friday .He had tingling sensation throughout the body starting from lower limbs denies H/O fall/trauma around in the evening as it was not subsiding went to local doctor and was given medication, not subsided.
On Saturday morning, in his daily activity .He couldn't get up after going loo.He had to take support of the walls & slowly moved to door, opened the latch and had a fall,with no apparent injuries. He was taken to nakrekal for further management & was not subsided. By evening he was back to his home and had a H/O fall as he was trying to walk with the stick.
On Sunday morning,he was taken to nalgonda and then he visits a neurologist (Hyderabad) .After using that medication he had nausea, denies vomiting and was taken back home.He had progressive weakness as he was unable to sit, unable to roll over bed (or) get up from bed, he could not abduct his arm over the head, hand grip reduced till tuesday and came to our hospital on Wednesday. 
Personal history:
Appetite-normal
Bowel- not passing stools since 4 days( per rectal examination done- sphincter tone- normal
Micturition- normal
Takes alcohol occasionally
Stopped smoking two years ago
No significant family history
General examination:
No palor, cyanosis, icterus, clubbing
Temp-98. 1f
Pr-86bpm
Bp-140/90mmHg
Spo2-96% at RA
CVS-S1S2+
RS-BAE+
Abdomen-Soft, non tender, bowel sounds heard
CNS- HMF : intact
Orientation to time,place ,person +
Power: R.      L
         UL. 4/5. 4/5
         LL  2/5.    2/5
Tone:R.       L
        UL  N.       N
          LL. Decreased. Decreased
Reflexes
B: -
T: -
S: -
K: -
A: -
P: -
Provisional Diagnosis : Quadriparesis under evaluation

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A 65 yr old male came to opd with HOPI He is a 60 yr old who was a toddy tree climber for 30 yrs.later on continued as daily wage labourer along with his wife.he stopped working since 4 yrs. His daily activities inude waking up at 8/9 in the morning, attending nature call, rice for breakfast going back to sleep around 9/9:30 AM, waking up again around 3/4 PM having lunch, going back to sleep around 8PM, having dinner or indulging in alcohol weekly once with his relatives who visits their house. On Friday .He had tingling sensation throughout the body starting from lower limbs denies H/O fall/trauma around in the evening as it was not subsiding went to local doctor and was given medication, not subsided. On Saturday morning, in his daily activity .He couldn't get up after going loo.He had to take support of the walls & slowly moved to door, opened the latch and had a fall,with no apparent injuries. He was taken to nakrekal for further management & was not subsided. By evenin
Read more