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  • A Case of Dysphagia

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    Reen Mommed
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    This document presents the case of a 71-year-old male shopkeeper who presented with neck pain, difficulty opening his mouth, and difficulty swallowing for 4 days. On examination, he had trismus, dysarthria, spasms of the neck extensors, and involvement of the 9th and 10th cranial nerves. Testing and imaging showed normal results. He was diagnosed with cephalic tetanus based on his symptoms and examination. He was started on tetanus immunoglobulin, antibiotics, and muscle relaxants. His condition initially improved but he later required intubation and tracheostomy due to respiratory muscle involvement from the tetanus.

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    Clinical case discussion on a case of tetanus

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    A case of dysphagia

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    This document presents the case of a 71-year-old male shopkeeper who presented with neck pain, difficulty opening his mouth, and difficulty swallowing for 4 days. On examination, he had trismus, dysarthria, spasms of the neck extensors, and involvement of the 9th and 10th cranial nerves. Testing and imaging showed normal results. He was diagnosed with cephalic tetanus based on his symptoms and examination. He was started on tetanus immunoglobulin, antibiotics, and muscle relaxants. His condition initially improved but he later required intubation and tracheostomy due to respiratory muscle involvement from the tetanus.

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    9 views25 pages

    A Case of Dysphagia

    Uploaded by

    Reen Mommed
    This document presents the case of a 71-year-old male shopkeeper who presented with neck pain, difficulty opening his mouth, and difficulty swallowing for 4 days. On examination, he had trismus, dysarthria, spasms of the neck extensors, and involvement of the 9th and 10th cranial nerves. Testing and imaging showed normal results. He was diagnosed with cephalic tetanus based on his symptoms and examination. He was started on tetanus immunoglobulin, antibiotics, and muscle relaxants. His condition initially improved but he later required intubation and tracheostomy due to respiratory muscle involvement from the tetanus.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 25

    CASE

    PRESENTATION
    M1 UNIT
    BIODATA

     Kunhimon
     71/M
     Shop keeper

     DOA - 1/3/22
    PRESENTING COMPLAINTS

    Neck pain -4 days


    Difficulty in opening the mouth - 4 days
    Difficulty in swallowing - 4 days
    HISTORYOF PRESENT ILLNESS

     Patient presented with complaints of Neck pain and


    difficulty in opening the mouth for about 4 days
    duration. It was associated with difficulty in swallowing
    both solids and liquids.
     sudden in onset and gradually progressed.He finds
    difficulty in swallowing even saliva.
     It was also associated with disarticulation of speech and
    change in voice.
     No history of trauma, foreign body throat. No history of
    weakness of limbs , neck swelling .No history of angle of
    mouth deviation.
     No history of fever.
    Past history

     No history of diabetis mellitus , systemic hypertension ,


    TB , CLD or CKD
    Personal history

     Mixed diet
     Normal sleep and appetite
     Bowel and bladder habits normal
     Ex smoker
    Risus sardonicus
    ON EXAMINATION

     Patient conscious , oriented


     GCS- 15/15
     No pallor , icterus , clubbing or edema
     Bilateral inguinal lymphadenopathy present
     PR - 80 bts /mt
     BP- 120/70 mmHg
     RR- 18/ min
     SPO2-97 % in room air
     Afebrile
     CNS SYSTEM EXAMINATION

     HMF- Normal
     Dysarthria present

     Cranial nerve examination


     3,4,6- Extraocularmuscle movements- full in all
    directions
    5 th cranial nerve-

    Difficulty to open mouth

    Muscles of mastication -Normal

    Jaw jerk- Present

    Sensations -Normal
     9 and 10 th cranial nerve
     no nasal regurgitation
     palatal contour and position of uvula normal
     palatal movements b/l equal

     gag reflex present b/l


    11 th CN
    Neck movements restricted

    12 th CN
    Tongue - Normal
    No fasciculations
    SPATULA TEST
    CBC
    Hb 14.8
    TOTAL COUNT 21220
    NEUTROPHIL 92
    LYMPHOCYTE 5.5
    MONOCYTE 2.4
    HEMATOCRITE 46
    RBC 5.1
    PLATELET 3.3
    ESR 6
    SEROLOGY NON REACTIVE
    CRP 1.8
    RBS 125
    APTT 32
    PT 13.5
    INR 1
    CALCIUM 9
    MAGNESIUM 1.7
    SODIUM 137
    POTTASIUM 3.8
    UREA 45
    LFT
    TOTAL BILIRUBIN 1.3
    DIRECT BILIRUBIN 0.1
    INDIRECT BILIRUBIN 1.2
    SGOT 49
    SGPT 27
    ALKALINE PHOSPHATASE 75
    TOTAL PROTEIN 5.5
    SERUM ALBUMIN 3.2
    SERUM GLOBULIN 2.3
    A/G RATIO 1.4
     VLS- Normal
     MRI Brain- Normal
     CT neck- normal
     CECT neck- normal
     OGD scopy- normal
     DIAGNOSIS

     DYSPHAGIA + DYSARTHRIA + TRISMUS + SPASM OF NECK


    EXTENSORS 9th,10 th CRANIAL NERVE INVOLVEMENT

     CEPHALIC TETANUS
    1-INJ TETANUS IMMUNOGLOBULIN 5000 U IM STAT

    2-INJ CRYSTALLINE PENICILLIN 2 MILLION IU IV TID

    3-INJ METRONIDAZOLE 500 MG IV TID

    4-INJ DIAZEPAM 50 MG IN 500 ML NS OVER 24 HOURS


     Improving clinically

     Mouth opening increased from 2 finger to 3 finger

     Day 8: abdominal muscle guarding

     Day 9: shifted to micu in v/o of saturation fall


    intubated

     Tracheostomy done
     Now on muscle relaxants( vecuronium and diazepam)
    THANK YOU

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