CASE REPORT
A 16 years old girl presented to the outpatient department at a regional
referral hospital with involuntary movements of limbs, both upper and
lower for past 2 weeks duration. Left sided extremities were more
affected than her right side. The symptoms had affected her daily
activities and because of which she was unable to continue her school.
Parents don’t recall any febrile illness or any major trauma in the
recent past. There was history of joints pain or swelling, rashes or
chest pain. There was no history of drug intake, over the counter
medications or herbal medications. There were no similar problems in the
past or any family history of similar problem.
On examination, she was alert, well oriented in time, place and person.
GCS E4V5M6, pulse = 82/min, regular in rhythm, normal character and
volume, BP = 108/61 mmHg in right arm. There was no pallor, icterus,
cyanosis, clubbing, oedema, skin rash or lymphadenopathy.
Nervous system: Higher mental function was intact, no cranial nerve
deficit. Her speech was slow, reduced verbal fluency. There was jerky
involuntary movement of her left sided extremities with writhing
movements of her fingers. The muscle tone, deep tendon reflexes and
muscle power were all symmetrical and normal. There was no cerebellar
signs. Gait was unsteady with an episodic jerky movements of limbs.
Cardiovascular system: No chest wall deformities, first and second heart
sounds were heard normal with no murmurs or rub. Respiratory system:
bilateral vesicular breaths. Abdomen: Soft with no palpable liver or
spleen.