22/F WITH RIGHT HEMIPARESIS

Unit 3 admission: 
Interns:
Dr Archana
Dr Sreeja
Dr Jeeharika
Dr Harsha 
Dr Kalyan 

Dr Raveen PGY1
Dr vaishnavi PGY2
Dr Aravind PGY3
Dr Vamshi PGY3
Dr Hareen SR
Dr Praveen Naik - Ass. prof
Dr. Rakesh Biswas - HOD 

22/F
C/o :  inability to lift the right upper limb and lower limb since yesterday night.
Deviation of mouth to the left side.
HOPI:
Patient was apparently asymptomatic yesterday night.
her mother noticed she was unable to lift her right hand  and right leg since yesterday night. Deviation of mouth to the left side since yesterday night.
History of delayed development of milestones. 
Completed nine months of gestation it was a normal delivery, walking was attained at the age of five years, cooing sounds were at the age of 5 - 6 years.she didn’t attend school until 17 years of age .she attended Anganwadi centre  for three years (started at 17years age)and later stopped.
History of fall , that is,slippage on the floor two months back.there was a left femur neck fracture seen on the x-ray. treatment was delayed  for two months, They came to kamineni 4 days back, as she was complaining of pain in the left leg, were adviced for a surgery, but they didn’t get it done.
Past history:
No h/o DM, HTN, TB, Epilepsy, asthma, thyroid abnormalities, CAD 

Personal history: 
Diet-mixed
Appetite - normal
Sleep- normal 
Regular bowel and bladder movements 

No known drug / allergic history.

No significant family history 

On examination: 
Patient was conscious/coherent /co-operative 
Thin built and moderately nourished 
No pallor/icterus/clubbing/cyanosis/generalised lymphadenopathy/pedal Edema 
BP: 110/70mmhg
PR: 88bpm
RR: 20cpm
SPO2: 99% at RA
Afebrile to touch
GRBS - 109mg/dl

Systemic examination: 
CVS: s1,s2 heard, no murmurs 
RS: BAE present, no added sounds 
P/A: soft, non - tender 
CNS: conscious 
Deviation of angle of mouth to left side 

Power : 
              Right.              Left 
       UL.   3/5.              4/5
       LL.   3/5.               4/5
Reflexes 
                             Right.                     Left
Biceps.               2+                              +
Triceps.                0                                 +
Supinator.          0.                                0
Knee.                  2+                              +
Ankle.                 0                              0
Plantar:Extension of great toe .        Flexion
 

Investigations:

Diagnosis : 
ACUTE INFARCT IN LEFT FRONTAL LOBE ACA/MCA BORDER ZONE
K/C/O DOWNS SYNDROME.

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