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.