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

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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