Case of a 36 year old male with paraplegia

June 12, 2023

Case of a 36 year old male with paraplegia

This is the case of a 36-year-old gentleman, a resident of West Bengal, who sells fish for a living. The patient presented to the hospital yesterday with chief complaints of

Paraplegia since 4 months
Bladder incontinence since 4 months

History Of Presentig Illness

The patient was apparently asymptomatic 4 months ago

On 7th March 2023, the patient met with a Road Traffic Accident. Wherein he fell from the bike under the effect of alcohol and sustained injuries in his spinal cord. On MRI of the Spine, hyperintensity was seen in the cervical spinal cord at levels C3-C4 and C4 to C5.

- MRI of SPINE on the day of the accident

The patient described an inability of any motor activity in all 4 limbs -(Quadriplegia), nerve conduction velocity studies suggested an axonopathic neuropathy in both upper and lower limbs.

The patient experienced urinary retention and Foley's catheterisation was done, which still persists.

On the day of the accident, the patient was unable to speak and hear, which resolved in a day.

One and a half Months later, the patient gradually regained sensory and Motor activity in his upper limbs bilaterally. The regaining of motor activity in his upper limbs first began in his shoulders, then progressed to his digits. There still is muscle weakness in all 4 of his limbs.

The patient is unable to extend his digits entirely and describes a stiffness and tingling sensation from the past 1 month. This stiffness is relieved by forceful stretching of his fingers.

Since 1 month, the patient has regained sensations in his lower limbs and explains that he is unable to feel painful stimuli, but can feel pressure and touch, which was confirmed in the examination subsequently.

The patient also complains of pain in his lower back which is relieved on rest and aggravated on walking with support. the pain is of dull character and because of this, the patient flexes his lower limbs while lying down, as this position provides him relief.

Since 1 month, the patient is also complaining of the fullness of his abdomen describing an uncomfortable sensation with the stiffness of his neck muscles.

At present, the patient is unable to initiate micturition and is unable to completely evacuate urine even though the patient feels the fullness of his bladder and passing of urine.

The patient also complains of constipation and describes that his last bowel movements were 3 days ago. The stool is hard and passing stool is painful. The patient is unable to evacuate the bowel without a laxative.

Past History

The patient is not a known case of DM, TB, Hypertension, Epilepsy.

No previsous surgeries

Family History

Insignificant

Personal History

Diet: Mixed

Appetite: Normal

Bladder Movements: inability to initiate micturition and complete evacuation of urine. The fullness of the bladder is felt . Foley's catheterization is done.

Bowel Movents: COnstipation. requires a laxative to evacuate the bladder. The last stool passed : 3 days ago.

Addictions: Alcoholic, consumes 125 ml of Alcohol on the days he gets the money. Has been consuming alcohol for 5 years.

Sleep: Reduced quality and quantity of sleep. Before the accident, the patient used to sleep for 8 hours, now, there is the presence of disturbed sleep.

Prior investigations

MRI SPINE