62 years old female with paralysis of upper limb and lower limb

62 years old female with paralysis of upper limb and lower limb

Nov-7th 2022

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Chief Complaint:

Left upper and lower limb paralysis since one day

History of presenting illness

Patient was asymptomatic 1 week ago (till last sunday)and going to her work till sunday,and stopped working since sunday as she developed tingling of left upper limb and lower limbs and when she was about to wakeup in the early morning (4:00 am)for washroom,she was unable to get up from the bed and noticed weakness of left sided upper and lower limbs associated with tingling sensation,the very next day local RMP doctor noticed high recordings of BP and gave her anti hypertensives and advised her to higher centre and she came to OPD yesterday with complaints of unable to move  left upper and lower limbs

No c/o fever,vomitings,loose stools,giddiness 

No c/o slurring of speech,and no drooling of saliva.

No c/o chestpain,palpitations,syncopal attacks.

Past history:

Not a known case of HTN,DM,TB,ASTHMA,CAD,EPILEPSY .

Personal history:

Diet - mixed

Appetite - normal

sleep - adequate

Bowel and Bladder movements -regular

No known allergies

Addictions:Tobacco smoker since 40years

Alcoholic since 40years,(90ml)once in every 10days

Family History:

Not Significant

Drug history :

No significant drug history

General examination :

Patient is conscious ,coherent,cooperative and was well oriented to time ,place and person at the time of examination

She is moderately built and well nourished.

Pallor - absent

Icterus - absent

Cyanosis - absent 

Clubbing - absent

lymphadenopathy - absent

Pedal edema - absent

Vitals at admission:

Bp:130/80mmHg

PR:88bpm

Cvs:s1 and S2 heard,No murmurs

RS: NVBS,BAE PRESENT

Abdomen:SOFT,NON TENDER

CNS Examination

Higher mental functions:

Oriented to time,place,person

Memory :  Immediate,recent, remote intact

Speech: Normal

No delusions or hallucination

Cranial nerves: 

1- not tested

2- Pupillary reflex present

3,4,6- No restriction of movement of eye

5-normal( muscles of mastication+sensations of face)

7-Normal, wrinking of forehead seen, able to blow up cheeks

8- Normal hearing

Motor examination:

Tone - Decreased in left upper and lower limb

Power-.                     Right    Left

             Upper limb   4/5       2/5

              Lower limb   4/5      3/5

Reflexes :

Biceps: Right++

               Left: absent

Triceps: Right++

               Left: absent

Supinator: Right++

               Left: absent

Knee: Right: ++

           Left: Absent

Ankle: Right: ++

             Left: Absent

Plantar: Right : Flexion of great toe

               Left: Extension

Cerebellum examination:

Able to do finger nose test.

Not able to do  dysdiadokinesia 

Gait: did not walk due to weakness

Investigations:

Hemogram

Lipid profile

Liver function tests

Random blood sugar 

Blood urea

Serum creatinine 

Serum Electrolytes 

X ray 

ECG

Color doppler 2d Echo

Diagnosis

Acute Ischemic Stroke - Acute infarct in right occipital lobe,right posteriotemporal lobe and right thalamus- PCA territory

Treatment:

T.Ecospirin 150mg po od

T.clopitab 75 mg po od

T.atorvas 20 mg po od

T.pregaba M 75mg po od 

Vitals monitoring 4th hrly