1701006049 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

Upper limb tone

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

ECG

X RAY

TEMPERATURE

Medication

TREATMENT:

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

40 old female came to OPD with chief complaints of :

Abdominal Distension since 1 year
Facial puffiness since 1 year
Itching all over the body since 1 year and developed multiple plaques on abdomen and Lower limbs

Sob since 5 days

pedal edema since 5 days pitting type

H/O PRESENT ILLNESS

Patient was apparently asymptomatic 1 year back then she developed abdominal distension, facial puffiness,itching all over the body and 5 days ago she developed pedal edema and SOB grade 3.

she had an episode of vomiting two days back which contained food particles. It was relieved on medication.

PAST HISTORY

she developed B/L Knee pain - since 3years, onset - insidious, gradually progressing, type- pricking, more at the night, aggravated on walking, relieved on sitting n sleeping, no radiation and is under medication( demisone 0.5 mg and acelogic SR)

She developed abdominal distension and facial puffiness one year back.

She also developed itching and skin lesions and was diagnosed as tinea and was given medications.

Not a K/C/O DM/HTN/ asthma / Ischemic heart disease / epilepsy / TB

FAMILY HISTORY

NO SIGNIFICANT FAMILY HISTORY

PERSONAL HISTORY:

OCCUPATION Daily wage worker , stopped going to work since 3 months
DIET MIXED
APPETITE decreased
SLEEP NORMAL
BOWEL AND BLADDER HABITS : decreased urine output
ADDICTIONS: NO

MENSTRUAL HISTORY:

Menarche -13 years

Regular monthly cycles

No of pads per day -2

No clots

Menopause -35 years

GENERAL EXAMINATION :

Patient is concious coherent and coperative, well oriented to time palce and person.

VITALS

BP 110/80

PR 90bpm

TEMP 98.5degrees F

SPO2 98 @ RA

GRBS 106

No Pallor , ICTERUS , CYANOSIS, CLUBBING , LYMPHADENOPATHY ,

SYSTEMIC EXAMINATION

CVS EXAMINATION

Inspection-

The chest wall is bilaterally symmetrical

No raised JVP.

Palpation-

Apical impulse is felt in the left 5th intercostal space, medial to the midclavicular line

• No parasternal heave felt.

Percussion- no pericardial effusion

Auscultation-

S1 and S2 heard, no added thrills and murmurs are heard

P/A-

Inspection:

Abdomen is distended

Umbilicus is inverted

Movements :- gentle rise in abdominal wall in inspiration and fall during expiration.

No visible gastric peristalsis

palpation : SOFT, NON TENDER, NO ORGANOMEGALY

RS - BAE + , normal vesicular breath sounds