65M with Recurrent CVA with visual hallucinations and k/c/o pulmonary Koch’s
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 recovered spontaneously.
Patient complains of generalised weakness with loss of appetite since 3 months associated with decreased interest in doing work, frequently irritability and anger outburst over wife. Patient seeing sparklings, Seeing familiar faces group of people briefly for 15 to 20 mins and later they disappear, occassionally he will try to communicate with them but get no response from them since 3 days
H/0 discord with son regarding his health condition 2 months back since then patient felt he is dependent on family members , unable to hold household work due to illness so he felt depressed and feels to die than being burden to family.
Hypertensive episode 4 days back
Pt unable to speak and move durring that episode took treatment at local hospital and discharged after 2 days as patient felt better
Hypoglycaemic episodes 3 days back where GRBS was dropped to 50mg%.
H/o episode of seeing people , talking to self , wanderings outside with sleeplessness 3 days back
History of similar episodes in past
K/c/o DM since 6 yrs and on OHA
K/c/o HTN since 6 yrs and on Atenolol 50mg
N/k/c/o asthma
PERSONAL HISTORY:
Mixed diet
Appetite decreased
Sleep inadequate
Bowel movements regular
Alcoholic abstinence 2 years
O/E
Patient is conscious , coherent, co operative
Afebrile
Bp 130/80 mmhg
Pr 90bpm
No Pallor
No icterus
No cyanosis
No clubbing
No edema
CVS - No scars
Apex beat @ 5th ICS medial to mid clavicular line
S1 & S2 heard
P/A - soft & nontender
CNS :
RS - shape of chest - obese
BAE+
INVESTIGATIONS:
TREATMENT GIVEN :
TAB. ECOSPRIN 75MG OD
TAB. CLOPITAB 75MG OD
TAB. ATORVAS 40MG HS OD
TAB. TELMA 40MG OD
TAB. PAN 40MG OD
TAB. LORA 2MG SOS
TAB. NEXITOFORTE PO HS (Escitalopram 10mg + Lonazepam 0.5mg)
TAB. NITROFURONTOIN 100MG BD
INJ HAI SC TID According to Sliding Scale
TAB. BPLEX FORTE PO OD
DIAGNOSIS:
RECURRENT CVA WITH ACUTE INFARCT IN FRONTAL LOBE & GENU OF CORPUS CALLOSUM WITH K/C/O HTN & DM WITH MODERATE DEPRESSION WITH ?DIABETIC NEPHROPATHY WITH OLD PULMONARY KOCHS.
Home death after 1-1/2 month
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