1701006129 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.
.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, 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 on both sides ( direct and indirect)
• 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)
Sensory system : responding to pain
Cerebellar signs : couldn't be elicited
Diagnostic tests:
MRI
USG:
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
--------------------------------------------------------
SHORT CASE
A 22yr old male pt. painter by occupation resident of nalgonda came with
Cheif complaints:
Pain abdomen since 4 days.
HOPI:
Pt. Has started consuming alcohol 4 yrs back due to peer pressure , intially taking one peg per day which has increased to 90ml morning and evening i. e twice daily. He has stopped consuming alcohol 3 months back as advised by the doctor.
Pt. Has history of smoking since 2 yrs . He has been smoking beedies 5 per day till date.
Pt was apparently asymptomatic 3 months back then he developed abdominal pain which was dragging in character for which he was admitted in near by hospital in nalgonda . He was diagnosed with acute pancreatitis and was treated inadequately and was advised to stop consumption of alcohol.
Since then pt has stopped consuming alcohol and has been experiencing alcohol withdrawal symptoms like getting angry , agitation , irritability , craving to consume alcohol, tremors . Pt had consumed alcohol 4 days back due to family problems.
In veiw of this symptoms pt.has been brought to psychiatry OPD for deaddiction. He was referred to medicine OPD in veiw of pain abdomen.
Pain was , insidious in onset , started after consuming of alcohol in epigastrium and left hypochondrium which was relieved on bending forward and lying down , aggrevated on eating food and standing straight.
No h/o fever , nausea , vomiting.
Past history:
H/o similar complaint in past 3 months back.
No other co morbid conditions
No h/o previous medical surgical history.
Family history :
Not significant
Personal history
Diet : mixed
Appetite : normal
Bowel bladder: regular
Sleep: inadequate
General examination:
Pt was concious coherent and cooperative
Thin built and moderately nourished
Pallor - present
No icterus,cyanosis , clubbing,lymphadenopathy, edema
Vitals at the Time of admission
Temperature- afebrile
Pulse rate-94bpm
Blood pressure-120/80mmHg
Respiratory rate- 16cpm
Systemic examination:
Abdominal examination:
Inspection:
Shape of the abdomen- flat
Umbilicus is central
No visible scars,pulsations, peristalsis, engorged veins
Palpation:
All the inspectory findings are confirmed.
Tenderness present over the epigastrium region
No organomegaly
Percussion
No free fluid
Ascultation:
Bowel sounds heard
Other systems:
Respiratory:
b/l air entry present , no added breath sound
CVS :
S1 S2 heard , no added murmurs
CNS :
Higher function intact
No motory and sensory deficit.
Cranial nerves normal .
Investigations
Complete blood picture
Complete urine examination
RFT
USG abdomen
Serum amylase
Serum lipase
Diagnosis:
Pseudocyst of pancreas secondary to unresolved acute pancreatitis.
Treatment:
Nil per oral
IV fluids Ringer lactate ,Normal saline 100 ml per hour
Inj. Tramadol100mg in 100ml NS IV BD
Inj.pantop 40 mg IV OD
Inj. Optineurin 1 ampoule in 100ml NS IV OD
Psychiatry medication
Tab . Lorazepam 2mg BD
Tab . Benzothiamine100mg OD
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