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.

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

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

Image
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
Read more