case x - 62F with left hemiparesis



62 F brought to casuality with complaints of sudden onset Left upper and lower limb Weakness since 3 days. Burning and tingling sensation of lower limbs. Difficulty in getting up from bed. bowel and bladder incontinence. No sleep since yesterday.

Patient was apparently asymptomatic 3days back then she Developed sudden onset weakness of both left upper limb and lower limb associated with difficulty in getting up from bed.then she told she could feel the sence of fullness of bowel and bladder but can not control till the attenders lift her to cammod.. 

No H/o altered sensorium
No seizures
No loss of consciousness
No Headache and neck pain

Not a known diabetic, hypertensive, CKD, asthmatic, epileptic

On examination : 
Patient conscious, oriented
Bp 130/80mmhg
Pr 88bpm
Spo2 98% on RA
GRBS 319mg/dl

attitude of the left limb externally rotated to left. Deformed Rt ankle.

deformed and swollen joints .


CVS : S1, S1 Heard. No murmurs

2D echo : 





No RWMA
Global hypokinesia 
Moderate AR, TR with PAH


RS : Bilateral Air entry present. B/L IAA crepts present.


Per abdomen : soft and non tender

CNS : 
Patient is conscious, oriented to time,place , person, cooperative.

HMF- normal

Cranialnerves : intact

Motor examination:


                                 Rt.        Lt.

1.Tone

Upper limbs. Normal     hypotonia

Lower limbs. Normal.    Hypotonia

2.power

Upper limbs. 4-/5.   0/5

Lowerlimbs. 4-/5.    0/5

Hand grip. 100%. 0%

3. Reflexes 

                                          Rt. Lt.

 1.Corneal Present. Present

 2. Conjunctival Present. Present

 3. Pharyngeal Present. Present

 4 Palatal. Present. Present 

  

  6. Biceps.            1 +  0 
 7. triceps               1 +   0
  8.supinator            1 +  0
  9. Knee.                  1 +   0
10. Ankle                  1+   0
11 . plantar.      Ext.       Ext

 Cerebellar examination : Normal

Sensory examination:Normal

Autonomic nervous system-Normal

 Spine examination: No tenderness.

Meningeal signs:

Neck rigidity,Kernigs and brudzinski signs -. Negative







Investigations : 

                                      CBP


CUE


RFT


                                    LFT



Treatment

Inj. Optineuron. 1amp OD
IVF 2 units NS , 1 unit RL OD
Tab Ecosprin 150mg po OD
Tab Clopitab 75 mg po OD
Tab Atocor 40mg po OD

Comments

Post a Comment

Popular posts from this blog

DISSERTATION 2020-2022.

Image
DISSERTATION  Dr. Saicharan Kulkarni pgy1 ( 2020 ) TITLE OF THE TOPIC :   CLINICO-RADIOLOGICAL PROFILE, RISK FACTORS AND OUTCOMES IN PATIENTS WITH MOTOR WEAKNESS BRIEF RESUME OF THE INTENDED WORK Problem Representation  1)The repercussions of paralysis/weakness are enormous, both personally to the individual and to their family; and have huge economic costs to society. Paralysis takes many forms with multiple disorders causing paralysis, and multiple body systems often affected. (1,)   2) Motor learning is considered crucial for rehabilitation in general. In stroke, motor learning does not refer to the acquisition of new skills, but to the re-learning process of a previously acquired movement pattern .(2)   3) 3.  Though both clinical evaluation and MRI are complimentary in detection and precise localization of the level of lesion in patients with cervical myelopathy, there is paucity of data comparing segment specific clinical features with the MRI abnormalities in cervical myelopath
Read more

65M with Recurrent CVA with visual hallucinations and k/c/o pulmonary Koch’s

Image
 A 65-year-old male patient with known case of recurrent CVA presented with complaints of seen the faces, increased appetite and urinary incontinence since 2 months Visual Hallucinations are sudden in onset associated with the ringing sensation in ears and hearing voices from surroundings Patient was apparently a symptomatic six years back then he developed generalised weakness and giddiness for which he went to local doctor and diagnosed with diabetes and on OHA, then few months later he diagnosed with hypertension and on atenolol 50mg since 3yrs History of first CVA attack 5 years back for which she went to hospital and managed conservatively and on dual antiplatelet TS for few weeks. Then 4 years back he developed low-grade fever associated with productive cough and generalised weakness. For which he was diagnosed with pulmonary tuberculosis and on ATT for 6 months. Then he developed second attack of CVA 8 months back for which he took some herbal medication for 3 months and recover
Read more

case 19 - 58 year old male with right sided hemiplegia,acute hemorrhagic stroke ,hypertensive bleed in left frontoparietal lobe with midline shift to left

Image
    This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. Here is a case i have seen: 58 year old male,daily labourer by occupation came with  c/o inability to move right upper and lower limb since yesterday evening  Aphasia since yesterday evening  Deviation of mouth to left side  Altered sensorium + History of present illness: Patient was apparently asymptomatic till yesterday evening and was brought home by outside people around 6pm where there was a sudden history of fall with inability to lift right upper and lower li
Read more