A 28 year old woman with pain and weakness in the right upper and lower limbs

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This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through a series of inputs from the available global online community of experts intending to solve those patients' clinical problems with collective current best evidence-based inputs

A 28 year old married woman, farmer by occupation, resident of kunjbihar came to medicine OPD with chief complaints of
Pain and weakness in upper and lower limbs since 8 years
History of Present Illness-
The patient was apparently asymptomatic 8 years ago, then had a sprain with sharp pain in the right hip region while drawing water from well. It was sudden in onset and dragging type of pain. Radiating towards  lower back and slowly spread to right upper limb amd lower limb. Pain aggravated on movement i.e., after work in the nights and relieved on medication, massage and rest. 
In the last 3 years, weakness has increased and she was not able to perform normal household works.
She went to an orthopedicean 3 years ago, pain was relieved on medication, so she discontinued taking medicine, which brought back the pain. Later, she was asked for investigation like blood and x ray. The doctor saw the result and asked her to consult a neurologist, which they didn't consult.
She then came to KIMS 1 year later.
No h/o fever, headache, vomiting, constipation, loose stools, burning micturition
Past History- n/k/c/o HTN, DM, Asthma, CAD, Epilepsy, Thyroid disorders 
Family History- no significant history 
Personal History-
Married
Diet mixed
Appetite normal
Sleep adequate 
Bowel and bladder movements regular
Addiction- tobacco chewing 3-4times/day since 4 years
Allergy- she had rashes all over her upper limbs after consuming egg 1 year ago
General Examination 
Physical Examination 
The patient was conscious, coherent and cooperative 
Well oriented with time, place, person
Moderately built and nourished
No pallor
No icterus
No cyanosis
No Clubbing of fingers
No lymphadenopathy 
No pedal edema
Vitals-
Pulse- 74bpm
BP- 120/90 mm Hg
Respiratory rate- 20 times /min
Temp- Afebrile


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