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.

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