4. History of Present Illness
The condition started 3 days ago with gradual onset of weakness of
both lower limbs that was bilateral in lower limb more than upper li
mb, proximal more than distal, symmetrical.
The patient sought medical advice, receive treatment in the form of
analgesic antipyretics, IV fluids. No improvement was noticed, neurol
ogic consultation was done, advised NCV studies that was done and
reveled sensomotor nerve affection of lower limbs suggesting GBS f
or clinical correlation for which he was admitted to ZUH for further
5. History of Present Illness
After admission ABG was withdrawn and reveled hypokalemia that w
as corrected with IV potassium infusion. The next morning the patei
nt was well and good. Weakness improved, he was able to walk on
6. History of Present Illness (cont.)
No involuntary movement.
No symptoms suggest sensory affection.
No symptoms suggest cranial nerve affection.
No symptoms suggest increased intracranial tension.
No symptoms suggest speech affection.
No symptoms suggest sphincteric or sexual affection.
No symptoms suggest other system affection.
9. General Examination
Patient is consciuos, GCS
•Eye movement: Eye to pain→ 4
•Speech: inappropriate words → 5
•Motor response: move to localize → 6
oBlood Pressure: 130/80
oPulse: 100, regular, equal on both sided, of average volume
oRespiratory rate: 14
10. General Examination (cont.)
Appearance: looks healthy
Complexion: no pallor, no cyanosis, no jaundice, no pigmentation
Decubitus: lies flat on bed
Facial Expression: no characteristic facies
Head & Neck examination:
•Eyes: no pallor, no cyanosis, no jaundice, normal eye brows and lashes
•Lips: no pallor, no cyanosis, no signs of vitamins deficiency
•Parotid: not enlarged
•LN and thyroid: not palpable
•Neck veins: pulsating, no congested.
11. General Examination (cont.)
• Upper limbs: no clubbing, no pigmentations, no pallor, normal muscl
es and nerves.
• Lower limbs: bilateral lower limb edema up to knees, no pigmentatio
Back: no pigmentation, no swelling, no spine deformities.
13. Examination (cont.)
Neurological examination (cont.)
•Power: 5/5 bilaterally
•No wasting, no deformity, no hypertrophy, no trophic changes, no invol
Plantar response: equivocal.
Cerebellar: no abnormality
Gait: normal gait.
14. Examination (cont.)
Inspection/Palpation: no precordial bulge, no pulsation, apex is normaly locat
ed in 5th space MCL, regular rate 100/min, no dullness outside the apex, no th
rill, no palpable sounds
Percussion: normal percussion notes
Auscultation: normal heart sounds, no additional sound, no murmur
Inspection/Palpation: symmetrical chest, no bulge, no retraction, no visible v
eins, no pulsation, no deformity, normal TVF bilaterally.
Percussion: resonant except bare area of the heart.
Auscultation: normal vesicular breathing, no additional sounds (no crackles,
no rhonchi, bronchophony or aegophony.
15. Examination (cont.)
Inspection: normal, normal hair distribution, no pigmentation, no hernial orific
es, as regard genitalia; no deformity, mild scrotal swelling
Palpation: no rigidity, no tenderness, no organomegaly, no plapable paraaortic
LN, no pulsation
Percussion: no shifting dullness, no organomegaly with percussion
Auscultation: normal intestinal sound, no bruit or venous hum.