1. 2-2-2012

2. Name-F O A Age -50 Male Admission date-7-1-2012

3.  A known RVD on HAART  On the continuation phase of antikochs Presented with hx of 1. neck pains 6/12 2. Shoulder pains4/12 3. Bilateral lower limb weakness 4. Upper limb weakness

4.  Neck pain - dull continuous ache worse at night  Fever,night sweats  weakness –progressive in nature from the foot cranially  1/12 ago  Unable to move the lower limbs completely  Stool and urine incontinent

5.  Medical assistance at a private facility  Cervical spine x ray-C6-c7 collapse  Cxr-pleural effusion Started on atikochs12/10/2011  Nerve conduction studies- central weakness With no evidence of GBS  MRI-C6,C7 destruction  CT scan brain - normal  Referred to KNH

6.  Admitted before?when  Muscle tear-rt leg  No BT  No known allergies

7.  Married  2 children  A meter connector with NWC  Smoked 1984-1987  Occasssionally –alcohol  No hx of chronic illnesses

8.  Rest of the systems -Non revealing

9.  Sick looking on a stretcher and on a hard cervical collar  No pallor  Nojaundice  No ln

10.  Cervical examination 1.Inspection on a collar No obvious scars,blisters discoloration or skin lessions 2.Bony and soft tissue palpation -There was no regional lymph node enlargement -Thyroid was essentially normal -motion palpation-not performed was on a collar then

11.  activeRotatory cervical compression test  Shoulder depression  Cervical hyperextension compression test All elicited tenderness Cervical percussion,auscultation Not done -collar

12. lulrullllrll motor3500 Sensory- pain+ +00 Fine touch++oo propriorecep tion ++o0 Deep reflexes ++o0

13.  Sensory level-L4  Anal wink-not clear  Anal tone- reduced  bulbocavenous reflex-non reactive

14.  GCS15/15  PBERL  Cranial nerves-ok

15.  Vesicular breath sounds  No rhonchi  No crepitation

16.  Essentially normal

17.  DRE – Anal tone- reduced prostate not enlarged Median sulcus felt Smooth Not adherent to the rectum

18.  C6,c7 collapse with cord compression In a pt who is on mx for potts disease and rvd Ddx-metastatic lession to the cervical spine - granulomatous spine lession - com -primary malignancy-?chordoma

19.  Hgm+esr  U/e/cs  Lfts  Biopsy- C6,C7 corpectomy -strut bone graft -anterior cervical plating