85 yrs old female came to casuality with complaints of weakness of right upper and lower limbs and deviation of mouth to left side and right hemineglect

 

 GENERAL MEDICINE CASE




"This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome

85 yrs old female came to casuality with complaints of weakness of right upper limb and lower limb and deviation of mouth to left side and right hemineglect

Patient was apparently asymptomatic 2 days back and developed sudden onset of weakness of right upper limb and lower limb since yesterday afternoon with deviation of mouth to the left side since yesterday afternoon with right hemineglect+.

No history of seizures ,loss of consciousness and GCS on admission is E4V2M6(11/15).

Past history:-

Patient is k/c/o Hypertension  and on tab telma 40mg.

General examination:-

No pallor, icterus, cyanosis,clubbing lymphadenopathy, edem

Patient is Afebrile

PR - 89 bpm

RR - 22 cpm.

BP - 180/90 mmHg.




SYSTEMIC EXAMINATION:

CVS - S1, S2 heard , No murmurs

RS - BAE +, NVBS +

P/A - Soft, Non tender

CNS -           ?

RIGHT          LEFT    

Power- UL-   1/5                 5/5

              LL-   1/5                  5/5.

Tone-.    UL-  Decreased     Normal

                LL- Decreased     Normal


Reflexes  RIGHT     LEFT          

Biceps          2+          3+

Triceps        2+          3+

Supinator    2+          3+

Knee             2+          3+

Ankle            1+          1+

Plantar    extension  Flexion.

Investigations:-




Serology- negative

RBS-146mg/dl.

X-ray


ECG:-


2d echo:-


USG:-


Provisional diagnosis:-

CVA with right sided hemiplegia with acute infract in left capsuloganglionic region( involving MCA territory)  with right UMN facial palsy.


Treatment:-

Inj mannitol 100ml IV TID.

RT feeds - 200ml milk every 2nd hourly.

                   100ml water every hourly.

Tab ecospirin 150mg/RT/OD.

Tab clopidogrel 75mg/RT/OD .

Tab atorvas 40mg/RT/OD/h/s.

Inj pan 40 mg IV OD

Physiotherapy of right upper limb, right lower limb.

BP monitoring 2nd hourly

GRBS monitoring












Comments

Post a Comment

Popular posts from this blog

75 yrs old female patient came with complaints of chest pain associated with shortness of breath and pedal edema

Image
 GENERAL MEDICINE CASE "This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome. 75 yrs old female patient came with complaints of chest pain associated with shortness of breath and pedal edema Patient was apparently asymptomatic 4 days back and then developed chest pain which is diffuse,non radiating associated with shortness of breath( grade2-3) associated with wheeze and complaints ofpedal edema which is bilateral and pitting type. No H/o Abdominal distension and no H/o decreased urine output. Past history:- not a known case of
Read more

54 yrs old male patient with acute kidney injury secondary to left lower limb cellulitis

Image
54 years old male patient came with chief complaints of shortness of breath and left lower limb swelling since 5 days . H/o present illness:- Patient was apparently asymptomatic 5 days back and then he had a injury to his left leg followed by itching of leg and developed left lower limb swelling associated with shortness of breath ( grade II- III) according to NYHA  classification. No history of chest pain/palpitations. No history of chronic cough/hemoptysis In 2016 patient went to hospital  due to pedal edema where patient had? Ischemic encephalopathy followed by 4 sessions of dialysis was done and discharged not as any medications after that. Past history:- Patient is not a k/c/o Dm, asthma, epilepsy hypertension. Personal history: Diet-mixed  Appetite-decreased Bowel and bladder movements-regular Daily alcohol consumer 5 years back,stopped 5 years back and recently he had 100 ml of alcohol General examination: Patient is conscious, coherent, cooperative . Pallor + No icterus,cyanosi
Read more