65 M with Lower limb Weakness

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Currently in ward, yesterdays admission 
A 65 year old man, working as a maestri at Nakrekal presented yesterday to our OPD with the complaints of 
Neck pain since 15 days
Bilateral lower limb weakness since 15 days 
Unable to hold objects with bilateral hands since 12 days
Numbness in all the four limbs (UL>LL)

A 65 year old man, works as a maestri by occupation and is a father to 5 children gives a history of left femur fracture for which he used splint and other ayurvedic medications.

6 months back he started to experience giddiness after which he was diagnosed to be a diabetic after he was taken to a local hospital and he was initially started on Tab Metformin 500mg OD, he was later started on Tab Glimi M1 OD a month later.

Since the past 6 months the patients grandson tells us that he has been developing itchy, hyperpigmented lesions on and off after consuming chicken, or fish. 20 days back after consuming fish he developed scaly itchy hyperpigmented lesions over his lower abdomen and thighs.

Around 25-30days back the patient received his first covid vaccination - Covaxine first dose.
15 days later he experienced neck pain along with low grade fever. The next day morning he found it hard to get up from bed and then he noticed that he was unable to move his lower limbs. 
He was also unable to hold objects with his bilateral hands. However he is able to raise his arms. 
He subsequently started to experience numbness in all his lower limbs, upper limbs > lower limbs. 
He however gives no complaints regarding bowel and bladder movements, 
He also gives no history of trauma 
On examination: 
Obese patient with Pallor +
PR - 85bpm
Bp - 110/79mmhg
Spo2 - 98%
RR - 18 cpm
Afebrile
CNS:

HMF - Intact 
Tone :
Increased in bilateral lower limbs 
Power      Right       Left 
  UL            4/5          4/5
LL                2/5         2/5











Reflexes     Right       Left
B                   3+            3+
T                   3+            3+
S                   3+            3+
K                   3+             -
A                    +               +
P           Withdrawal    Flexion 

Abdominal reflex + 

Sensory system:
Proprioception Intact
Fine touch, crude touch - Intact 
Temperature - Intact
Vibration- Intact

On palpation of the spine - cervical region tenderness +

Cranial nerves - Normal
No meningeal signs 

Cvs - S1,S2 +
Lungs - BAE+
Clear
 
Per Abdomen - 
Non tender
Soft
Bowel sounds +


Provisional diagnosis -
? Cervical myelopathy
Known case of Type 2 DM since 6 months


Xray Cervical spine - AP, Lateral view

Showing reduced disc space
OPLL - ? Nalgonda Fluorosis

We got his MRI cervical spine with whole spine screening done 


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