A 43 year old female presented with weakness of upper limb and lower limb.
Chief complaints : weakness of upper limb and lower limb. History of present illness : Patient was apparently asymptomatic 1 year back the developed joint pains and stiffness in the upper limb in the fingers. Then she developed flexion deformity in the metacarpals. Past history : No similar complaints in the past. Not known case of diabetes, hypertension, Asthma, TB, thyroid. Personal history : Diet:mixed Appetite: Normal Sleep : adequate Bowel and bladder : regular Addictions: none Family history : No similar complaints in the family General physical examination : Patient is conscious, coherent and Cooperative, thin built and nourished. Pallor : absent Icterus: absent Cyanosis: absent Clubbing : absent Lymphadenopathy : absent Edema: absent Systemic examination: CVS : S1 S2 heard RESPIRATORY SYSTEM: Normal vesicular breath sounds heard. CNS: No focal neurological deficits Abdomen: Soft , non tender. Investigat