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
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