50 year old female with loss of speech and weakness in left arm and lower limb

50 years old female a diabetic and hypertensive since past 12 years and is on tab Glimipride 2mg and metformin 500 mg twice daily and tablet telmisartan 40mg + cilindipine 10mg + hydrochlorthiazide 6.25 mg once daily presented to our casuality with Complaints of loss of speech since yesterday morning and according to the attenders patient has hearing difficulty also since many years ( they could not recollect the exact time)
Patient was apparently asymptomatic till morning .
she went to a diagnostic center in the morning to give her fasting blood sample after which she came home, and had a nap after she woke up she was unable to talk, she went to shower after that , attenders have observed she couldn’t drape her saree and had weakness in right upper limb and lower limb with deviation of mouth to left . 
She was taken to a near by consultant where her BP was 190/90 mmhg and GRB 370 mg/dL
They have given medication for her hypertension , and advised for MRI Brain and was referred to our hospital.
At the time of presentation her BP was 130/90 mmHg with a pulse rate of 98 beats per min and her blood sugars were 294 mg/dL
On examination she was conscious and cooperative 
She is able to walk without support ( she is  dragging her right leg she is not able to lift it completely above the ground) , deep tendon reflexes are absent on right side and both the plantars were up going 
She was not able to hold anything with her right hand and left hand grip is 90% 
There is hypotonia on right side and left it’s normal 
No cerebellar signs 
She was able to comprehend but not able to talk 
Deviation of mouth to left side nasolabial fold is reduced on right side and on asking her to frown forehead folds were present on both sides 
INVESTIGATIONS:
Diagnosis - motor aphasia secondary to acute infarct in left frontal lobe involving the broccas area ( occlusion of proximal superiors segment of MCA) Left UMN facial palsy
TREATMENT:DAY1:
1.INJECTION OPTINEURON 1 AMPULE IN 100 ML NS IV OD
2.INJECTION HAI SUBCUTANEOUS ACCORDING TO SLIDING SCALE
3.TABLET CLOPIDOGREL 150 MG PERORAL OD
4.TAB ECOSPRIN 150 MG P/O OD
5.TAB ATORVAS 40 MG P/O OD
6.TAB MANNITOL 20 GM IV TID
7.TAB TELMA 40 MG P/O OD
8.BP MONITORING 2ND HOURLY
9.GRBS MONITORING
BEFORE BREAKFAST
2 HOURS AFTER BREAKFAST
BEFORE LUNCH
2 HOURS AFTER LUNCH
BEFORE DINNER
2 HOURS AFTER DINNER
AT 2AM.
DAY 2:.INJECTION OPTINEURON 1 AMPULE IN 100 ML NS IV OD
2.INJECTION HAI SUBCUTANEOUS ACCORDING TO SLIDING SCALE
3.TABLET CLOPIDOGREL 150 MG PERORAL OD
4.TAB ECOSPRIN 150 MG P/O OD
5.TAB ATORVAS 40 MG P/O OD
6.TAB MANNITOL 20 GM IV TID
7.TAB TELMA 40 MG P/O OD
8.BP MONITORING 2ND HOURLY
9.GRBS MONITORING
BEFORE BREAKFAST
2 HOURS AFTER BREAKFAST
BEFORE LUNCH
2 HOURS AFTER LUNCH
BEFORE DINNER
2 HOURS AFTER DINNER
AT 2AM.

Comments

Post a Comment

Popular posts from this blog

70/M WITH FEVER SINCE 4DAYS AND DRY COUGH SINCE 4DAYS

Image
Unit 3 admission: Interns- Jeeharika Archana Harsha Kalyan Sreeja Dr.Raveen PG1 Dr.vaishnavi PG2 Dr.Vamshi PG3 Dr.Aravind PG3 Dr.Hareen SR Dr.Praveen Naik Ass.Prof 70year old male presently staying at home,r/o pochampally,was apparently alright 8days ago,then patient son met with an accident (sustained multiple fractures). patient is in grief about it and used to visit his son 3days ago,patient had an episode of syncope lasting for 2-3mins .Later he woke up and did his daily routine activity(like cooking ).Patient lives with his wife who is also not well.since next day ,patient was in altered state ,having irrelevant talk ,associated with involuntary passage of urine.H/O pricking movements present. Patient is able to walk on his own till yesterday.No H/O seizures ,ENT bleed ,head trauma ,No h/o weakness . Since morning patient is unable to walk on his own ,associated with stiffness of limbs (b/l UL and LL).patient is in altered state.Not oriented to time,place and person. C/o fever sin
Read more

60 year old male with complaints of dyspnea on exertion and pedal edema since 1.5 years

Image
  60 year man presented with complaints of  Dyspnea at rest since 15 days Bilateral pedal edema since 10 days upto knees Facial puffiness since 1 week Patient works as a tailor at a local village. He has been consuming Zarda since the last 20years he stopped ten years back and alcohol intake since 20 years stopped in 2003  and resumed in 2011. He was diagnosed on routine investigations to be a diabetic and was using medication on and off and is a known case of hypertension since 10 years and was on irregular medication and has been using regularly for the past 4 to 5 years.  He has been experiencing Dyspneic and palpitations since the last 10 years.   Patient noticed bilateral pedal edema extending up to ankle pitting type, 2 years back. For which he paid a visit to our hospital and was told that he had kidney failure and was started on maintainence oral medications.  He also complains of tingling sensation upto the ankles since 1 year. Slippage of footwear since 1 year He one day de
Read more

BIMONTHLY ASSESSMENT FOR FEBRUARY

Image
General Medicine BIMONTHLY ASSESSMENT FOR FEBRUARY. February 20, 2021 February 19, 2021   "This is my submission for the Bimonthly internal assessment for the month of February ." Most of the information here have been collected from different reference sites, links to which have been mentioned.The points copy pasted have been put in quotes. The questions to the cases being discussed are from the link below: https://medicinedepartment.blogspot.com/2021/02/medicine-paper-for-february-2021.html?m=0 1.) 50 year man, he presented with the complaints of Frequently walking into objects along with frequent falls since 1.5 years Drooping of eyelids since 1.5 years Involuntary movements of hands since 1.5 years  Talking to self since 1.5 years  More here: https://archanareddy07.blogspot.com/2021/02/50m-with-parkinsonism.html?m=1 Case presentation  links:  https://youtu.be/kMrD662wRIQ a). What is the problem representation of this patient and what is the anatomical localization for his
Read more