case 10- 60 YEAR OLD MALE WITH CVA

 DR.NAVYA(INTERN)

DR.CHETANA(INTERN)

DR.ABDUL RAHEEM (INTERN)

DR.ASHFAQ(INTERN)

DR.SRAVYA(INTERN)

DR.GNANADA(INTERN)

DR.CHARAN(PG1)

DR.VAMSI(PG1)

DR.SUSMITHA(PG2)

DR.ADITHYA (PG3)

DR.PRANEETH(PG3) 

DR.PRAVEEN NAIK (ASS.PROF)

DR.RAKESH BISWAS(HOD)


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:

 A 60 year old male who is a band drummer presented with c/o right sided weakness since 6 days 

H/o seizures -6days back 

Pt was apparently asymptomatic 7 years back later he developed fever and incidentally diagnosed with HTN and on irregular medication since then .

6 years back he had giddiness  for which he was told that he had uncontrolled hypertension which is even not relieved with medication and developed B/L MR palsy , following which he developed seizures , deviation of angle of mouth to RT  then he was diagnosed with ischemic stroke involving posterior cerebral artery with 3 rd nerve palsy

Since he is walking with support .

H/o seizure episode 5months associated with tonic movements of all four limbs and loss of consciousness for 5mins.No post ictal confusion

Since 3 months he even not walking with support.

Rt upper limb and lower limb weakness since 20 days back , he developed generalised weakness since 10 days  and then 6 days back he developed seizures at early morning associated with tongue bite , frothing , loss of consciousness for 30 min , with altered behaviour for 1 day then he brought to opd today 

H/O past illness

K/c/o CVA, 6yrs back

HTN Since 7yrs on omlesartan 40 mg

Not k/c/o DM,TB, ASTHMA

He is a non vegetarian with regular bowel and bladder movements 

H/o regular alcohol intake since 40 yrs/180ml per day

H/o smoking since40yrs 3beedi per day

O/E:

Pt is  drowsy, moderately built and nourished

Vitals:

Temp: afebrile

PR: 79bpm

RR:17/min

BP:150/80mm hg

No signs of pallor,icterus,cyanosis,clubbing,koilonychia,

No generalised pedal edema,lymphadenopathy     

HMF: 

Level of consciousness: Drowsy

Speech: slurred

Cranial nerves:

RT EYE: gaze : outwards and downwards

LEFT EYE : Central

3 Rd nerve palsy

Motor system:

  TONE            RIGHT.                    LEFT

   UL _.         hypertonic               Normal     


  LL _.          hypertonic.               Normal


POWER

     UL.                  2/5.                     Normal


      LL.                  2/5.                    Normal

REFLEXES

  

Biceps.                3+.                       2+


Triceps.               2+.                       2+

 

Knee.                absent.                absent


Ankle.               absent.                absent


Plantar.            Extensor.            Extensor


Investigations:

Heamogram:

Hb:13.0gm/dl

TLC:4,800 cells/cumm

Lymphocytes:14 percent





Blood urea:28mg/dl

Serum creatinine:0.9 mg/dl




















TREATMENT:  
TAB.CLINIDIPINE  10 MG PO OD.    
TAB.ECOSPRINE AV 75/10 MG PO OD
INJ.OPTINEURON ONE AMPOULE IN 100 ML NS IV OD
STRICT I/O CHARTING
BP/PR/SPO2 MONITORING.

DAY 2: CHANGED DIPINE 10 MG QID



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