65 yr female with head ache and and involuntary movements of limbs

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65 year old female who is an agricultural labourer by occupation came with the C/O involuntary movements, giddiness and memory loss since 4 month s

History of present illness:

Patient was apparently asymptomatic 4 months back 

 she had H/O Fever -  associated with generalised weakness which lasted for 3 days for which she visited the hospital, fever evaluation was done (dengue ,MP, Widal Negative) and

 she was prescribed antipyretics for 5 days and the fever subsided within 3 days after medication

After 1 week of fever history, she had right leg  pain with tingling sensation of right upper limb and lower limb (upper limb more than lower limb)- associated with sudden outstretching movements of right upper limb associated with tapping of right 

These involuntary movements were episodic with a frequency of 1 episode per hour, with each episode lasting for 1-2 secs.

Movements were present at rest.

These movements were associated with giddiness.

The movements disappeared on sleeping.

Patient went to the orthopedician for her right leg pain and X-Ray was done which was found to be NORMAL after which she was referred to a neurologist where CT Brain was done which showed OLD CALCIFIED GRANULOMA

The neurologist had started her on:

Tab. Valpraote 300 mg BD

Tab. Gabapin 100 mg OD

Tab. Vitamin D3 PO/OD for 10 days

Tab. Zapiz 0.5 mg PO/HS.

 the frequency of involuntary movements had decreased.

History of past illness:

Patient had a H/O head injury 20 yrs back,where she was hit with a wooden log on her head as well  fall due to giddiness and she sustained an injury to her head 

over the left parietal region and a bleeding happened  for which she visited a local rmp doctor -- suturing was done and patient was put on antibiotic.

Because of disturbed sleep, she visited a doctor n was referred to psychiatrist and she was started on Tab. Escitalopram and clonazepam.

Personal History-

Diet: mixed

Reduced appetite.

Sleep: decreased since 10 days

Bowel and bladder habits: regular

History of tobacco chewing.

Family History:

No significant history.

General Examination:

Patient is Conscious, coherent, cooperative

Mild pallor +

No icterus/ cyanosis/ clubbing/koilonychia/ lymphadenopathy/ edema

Dry scaly skin

Pallor+

Vitals at admission:

Temp.- Afebrile

BP- 130/80

PR- 69 bpm

RR- 17 cpm

SpO2- 99% 

Systemic Examination:

CVS- S1S2 heard, no murmurs

P/A- Soft, Non-tender

CNS-

Pt. is C/C/C

Oriented to time, place, person

Speech: Normal

Motor system: Normal

Sensory system: Normal

Clinical report s/investigation s

Ultra sound report:

Gall bladder- distended.

Right n left kidney: decrease in size and increase in echo.

U.bladder distended- minimally.

PROVISIONAL DIAGNOSIS:

hemiballismus with dementia under evaluation

ONGOING TREATMENT:

1. Tab. Queitapine 25 mg PO/OD

2. Tab. Valproate 300 mg PO/OD

3. Tab. VERTIN 16 mg PO/OD

4. Tab. Esihans Plus(Escitalopram(10 mg) and Clonazepam(0.5 mg)) for 15 days