1701006017 CASE PRESENTATION
LONG CASE
A 53 year old female came with
altered sensorium ,difficulty in walking ,loss of speech ,weakness of right upper limb and right lower limb.
HOPI :
Patient was A known Case of Diabetes Since 11 Years and Hypertensive since 1 Year.
She developed Giddiness which later Resolved on the Next Day.
RMP was called on and He prescribed Cinarizine and He also found that her BP was around 280 mmHg and gave Anti Hypertensive Drug(Telmisartan).
On the next Day While she was going to washroom was unable to lift her leg and she was dragging her leg which was noticed by daughters so was brought to our Hospital .On her Way to Hospital She Couldn’t recognise her Daughters.
On Examination She Had Altered Sensorium ,Difficulty in Speaking,Weakness in right Upper Limb And Lower Limb.
Daily Routine : She used To wake up At
5: 30 am and would complete her Daily House Old Activities.
Negative History : No History of Headache,Fever,Vomiting , seizures,
Chest Pain,Palpitations and Shortness of Breadth.
Treatment History : For Diabetes - Dapaglifozin 10mg Metformin 500mg
For Hypertension :
Telma 40mg
Cilindipine 10mg
Metoprolol 50mg
Personal History:
Diet Mixed
Appetite Normal,
Bowel And Bladder Regular.
Sleep Adequate
No Allergies And Addictions.
Attained Menopause at -48 yrs
Family History not Significant
General Examination:
Patient is Conscious, but not Cooperative and is oriented to Place and Person.
Moderately Built and Nourished.
Pallor :Absent
Icterus: Absent
Clubbing: Absent
Cyanosis :Absent
Lymphadenopathy :Absent
Edema:Absent
Vitals :
Temperature - 100.8F⁰
Pulse- 90 bpm
B.P -180/80mmHg
SpO2 -94%.
SYSTEMIC EXAMINATION :
CVS : S1 S2 heard, no murmurs
RS : Bilateral air entry present, normal vesicular breath sounds, no added sounds
GIT : Soft, non-tender, no organomegaly
CNS :
Dominance - Right handed
Higher mental functions
• conscious
• oriented to person and place
• memory - able to recognize their family members
• Speech - Broca's aphasia ( only comprehension, no fluency, no repitition)
Cranial nerve examination
• 1 - couldn't be elicited
• 2- Direct and indirect light reflex present
• 3,4,6 - no ptosis Or nystagmus
• 5- corneal reflex present ( slightly delayed on right side, normal on left side)
• 7- no deviation of mouth, no loss of nasolabial folds, forehead wrinkling present
• 8- able to hear
• 9,10- position of uvula couldn't be visualized
• 11- sternocleidomastoid contraction present
• 12- no tongue deviation
Motor system
Attitude - right lower limb externally rotated
Tone - Hypotonia on right side(both UL,LL)
Normal tone on left side(UL,LL)
Bulk - Rt. Lt.
Arm 26cm. 26cm
Forearm 19cm 19cm
Thigh 42 cm. 42cm
Leg 28cm. 28cm
Power
Right. Left
UL 0/5 4/5
LL. 0/5 4/5
Reflexes Right Left
Biceps 1+ 2+
Triceps 1+ 2+
Knee jerk 0 2+
Ankle jerk 0 1+
Supinator 2+ 2+
Babinski Extensor Flexion
Corneal reflex present on both sides
Light reflex present on both sides
(Direct and indirect)
Biceps Reflex(Right)
Biceps reflex (left)
Tricepsreflex(left)
Triceps reflex (right)
Knee jerk reflex(right)
Knee Reflex(left)
Assessment of tone
Left lower limb
Ankle jerk reflex (left)
Ankle jerk reflex(right)
Right supinator
Babinskis positive (rt side)
Babinski (left side)
Sensory system : responding to pain
Cerebellar signs : couldn't be elicited
Diagnostic tests:
MRI
T2 weighted image
FLAIR
ADC
DWI
COLOUR DOPPLER
ECG
Medication
IV FLUIDS-NS @ 75 ml / hr
-RT. 100ml MILK WITH PROTEIN POWDER 8th hrly
100ml water Every 2nd hrly
-ING.CITICHOLINE800mg /IV/IN 100 ml NS/BD
-ING.PIRACETAM 800mgIV/IN 100ml NS/TID
-ING.PAN40mg/PO/OD
-TAB. ECOSPIRIN 150mg /PO/HS
-TAB.ATORVAS40mg/PO/OD
-TAB.AMLONG 5mg /PO/OD
-ING .HUMAN ACTRAPID INSULIN ACC. TO GRBS CHECK
-TAB . DOLO 650mg SOS if temp>100F
-B.P. MONITORING 4th hrly
Diagnosis-Acute ischemic stroke with right hemiplegia
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SHORT CASE
A 56 year old male, daily wage labourer came with c/o
Pain abdomen since 20 days
Multiple masses per abdomen since 1 week
Fever (high grade) associated with chills and rigorous since 1 week.
History of presenting illness :
Patient was apparently asymptomatic 5 months back, then he developed dry cough which was sudden in onset, gradually progressive. Later he had fever - high grade, associated with chills and rigor.
He went to the hospital for the above complaints - fever was relieved with medications no replased after stopping the medicines.
Patient observed loss of weight and loss of appetite and 2 months later on advice of a govt doctor he got tested for Kochs and HIV - report was positive and was started on ART and ATT.
He now came with c/o abdominal discomfort, pain in periumbilical region a/w multiple masses felt over abdomen with fever, chills and rigor.
No h/o burning micturition
No c/o cough or SOB.
Vitals :
Temp - Afebrile
PR - 88 bpm
BP - 110/80 mm Hg
RR - 18 cpm
GRBS : 106 mg/dl
General examination :
Patient is conscious, coherent and cooperative
No pallor, Icterus, Cyanosis, Clubbing
Lymphadenopathy + (Multiple palpable lymphnodes in neck and per abdomen)
Systemic examination :
CVS : S1 S2 +
CNS : NAD
RS : BAE +, Clear
P/A : soft, Non tender. Multiple lymphnodes palpable
X RAY
ECG
COLOUR DOPPLER
CUE
BLOOD SUGAR
Treatment :
T DOLO 650mg PO/TID
T MVT PO/OD
Inj NEOMOL 1g IV/SOS
Surgery referral :
Provisional diagnosis :
Fever with generalised lymphadenopathy
?TB ?LYMPHOMA with RVD
TAR DOLO 650 MO PO TID 2 TAI DOLUTEGRAVIR
LAMIVUDINE
TENOFOVIR
DISOPROXIL FUMERATE
50MG-300M 300MG POVOD 37AB
RIFAMPICIN-150MG
,ISONIAZID -75MG
PYRAZINAMIDE -40MG
ETHAMBUTOL-250MG
TAB SEPTRAN-DS
NEOMOL-1GM I/V(SOS)
PAN OMG IV OD
ZOFER 4MG IV SOS
8TAB MVT PO OD
SYRUP ARISTOZYME PO 10ML TID
Advice at Discharge
1.TAB DOLO 650 MG PO TID FOR SDAYS
2 TAB DOLUTEGRAVIR LAMIVUDINE.TENOFOVIR DISOPROXIL FUMERATE 50MG+300MG-300MG/PO/OD
3TAB
RIFAMPICIN ISONIAZD PYRAZINAMIDE ETHAMBUTOLITOMG 75MG, 400MG 2 4 TAB SEPTRAN-DS 800/160MG POBOX
STAR PAN 40MG POD
6 TAB MVT PO OD FOR DAYS
7 SYRUP ARISTOZYME PO 10ML TID
Follow Up
REVIEW IN GENERAL MEDICINE OPD AFTER 15 DAYS
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