45yr old female with fever and neck pain

A 45 year old female patient resident of nakrekal agriculture worker  by occupation presented with

CHIEF COMPLAINTS :- fever since 2days ,

 generalised body pains since 2 days, 

head ache and neck pain since 1 day and 

2 episodes of vomitings 


HISTORY OF PRESENTING ILLNESS:-patient was apparently asymtomatic since 2days then she developed high grade fever which is  continous and not associated with chill , rigor and any kind of rash and does not relieved on medication.

Then she was taken to a local doctor  where she was given the medication for fever and body aches (medication unknown) then she had an episode of projectile vomiting non bilious .

Then she developed generalised body pains and nek pain by which she could not sleep .

 The next day she was taken to a bigger hopital where she was admitted and then had an episode of vomting after drinking water which is projectile and the contents are water .All the routine investigations are done to find the cause but the investigations did not reveal any cause so she was referred to our hospital for further management

                      

PAST HISTORY: 

No h/o HTN,DM,asthma,thyroid disturbances,epilepsy,CAD,CKD


PERSONAL HISTORY: 


diet-mixed

Appetite-normal

Bowel and bladder-regular

Sleep-adequate 

Addictions- occasionally toddy and paan .


Extended personal history :- 

She is an agricultural worker who is economically poor . She has bluring of vision since 1 year and started spects intermittently .

When the patient works in hot sun she has vomitings and get dehyrated and used to go to  local doctor for treatment .she intermittent low grade fever attack from past 1year which resolved on medication.

On the day of the complaints she was asymptomatic on the day and normally went to work in fields and ate lunch in lunch break and when she went to work she developed fever and generalised body pains



FAMILY HISTORY: not significant 


TREATMENT HISTORY:- no relevant history 

ALLERGIC HISTORY:- no allergies for any kind of drugs and food items

GENERAL EXAMINATION: 


Pt was semi  conscious, c, cooperative and well oriented to time place and person.


Moderately built 


Pallor  +


Icterus  -

Cyanosis  -

Clubbing  -

Lymphadenopathy  -

Pedal edema   - 


VITALS:

BP :- 150/80 mmHg

PR:- 80 bpm

RR:- 20cpm

Spo2 :- 96 on RA






SYSTEMIC EXAMINATION:




CNS :HIGHER MENTAL FUNCTIONS:


speech : normal


Behavior : normal 


Memory : Intact.


Intelligence : Normal


Lobar Functions : Normal.


No hallucinations or delusions.


CRANIAL NERVE EXAMINATION:




1st   : Normal

2nd  :visual field is normal 

colour vision normal

  fundal glow present.


3rd,4th,6th  :  pupillary reflexes 

 EOM full range of movements   gaze evoked Nystagmus present.


5th             :  sensory intact  motor intact


7th             :  normal


8th             :  No abnormality noted.


9th,10th     : palatal movements present and equal.


11th,12th   : normal.

SUPERFICIAL REFLEXES:




   CORNEAL                                    present                                            present       




   CONJUNCTIVAL                         present                                            present


ABDOMINAL                                                             present



   PLANTAR                                     withdrawal                                      withdrawal



SIGNS OF MENINGEAL IRRITATION:

KERNIG TEST :- POSITIVE 

BRUDZINSKI SIGN :- POSITIVE 


INVESTIGATIONS :- 
















DIAGNOSIS:- 

VIRAL ENCEPHALITIS.


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