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 Loss of movement in fingers and legs


From: "S" 
To: arabneurosurgery@yahoo.com 
Subject: Loss of movement in fingers and legs

Date of Birth :30/07/1975 
Age: 25 Y 3m oD 
This is 25 years old Arf from OCR was transferred to AfH ICU form sultan Qaboos Hospital, Salalah with history Of alleged involved in an RTA driver of one of the vechile which overturned .Was initially taken to UAG Hospital, salalah. There no history of loss of consciousness, vomiting or bleeding ENT or fits. On arrival in UAG casualty pationt was conscious, alert, coherent . Quadriplegic with movements in the upper limbs of power grade II on the left side and grade III on the right side and 0 power on the lower limbs. Pationt was stabilised in casualty and transferred to sultan Qaboos University Hospital , salalah where he was admitted in the ICU and put on skull traction . CT scan done showed fracture padical C2 and body vertebral arch and facet joint C6 with quadriparasis at C6 level. He was also put in hard collar and was given injection solu-Medrole and antibiotics . In the ICU , pationt developed respiratory distress so he was antiverted and ventilated catheterized .
On Arrived in ICU, AFH pationt was in cervically coller and skull traction intubatedand on ventilatory support . there were movements in both upper limbs right more than the left.
Afebrile , pulse was 72 /min, Bp was 110/70. there were abrasions on both hands.systemic examination , RS/CVS/pA- clinically ned. CNS patient intubated and ventilated only moving the upper limbs more on the right sid. No movements on the lower limbs . Reflexes both biceps were normal , triceps were decreased ,supinator were normal. Knee, ankle and plantars were lost on 
vertebral large and facet c6 with dislocation of c5/ c6
In AFH, patient underwent anterior discectomy C5/C6 with bone grafting and plating for fracture dislocation C5/C6 under CA. post operatively patient was running temperature. Sputum culture showed staphylococcus so he was put on Augmention and cefuroxime . His urine culture showed pseudomonas for which he was treated with Gentamicin and Augmentin. As he was still not responding to these Antibiotics he was referred to the physicians to rule out the course of p. Various blood test like malaria parasites, brucella, widal-negative so avague lung scan was done which showed high probability of pulmonary embolism right lung . So he was put on Fragmin and later converted to warfarin and regular INR were done . His neurological status were the same. His temperature settled, mobilized on a wheel chair and discharged.He was reviewed in fracture clinic two and half months post trauma. He was advised to continue physiotherapy in MAM Hospital but patient preferred to continue his physiotherapy in Ibri Hospital which is close to his home.
He is on regular warfarin with a control of INR. He will be reviewed again in fracture clinic.
N.B. Now he can moves his U.L.s above his head but he can not differntiate between hot or cold water on his legs. He also can catch a glass of water but no movement in his fingers






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