case 21 - 65 M with altered sensorium and right sided weakness.

 Patient came with c/o altered sensorium since 5 hours around 6:34 PM on 2/12/2020.

patient was apparently alright before 5 hours later he had sweating, went into altered sensorium ,brought to hospital,
GRBS found to be 26 mg/dl. After giving 2 [100 ML] 25 D he regained consciousness aw¹+ee+¹ started talking after 3 hours .
Patient is k/c/o Recurrent CVA
1st episode = 6 years back , had deviation of mouth ,recovered with in 2 months after using allopathic medications
2nd episode = 1 year back left sided hemiparesis with deviation of mouth, used herbal medications
3rd episode = 2 months back had left sided hemiparesis with visual hallucinations
4 th episode = 1 month back had right sided hemiparesis
K/c/o DM 2 and HTN since 15 years and on medications 
Patient had bed sores since 20 days
K/c/o TB ,used ATT for 6 months, 4years back
patient has no history of fever,cough,cold
,vomitings,loose stools ,chest pain, palpitations, pedal edema.
H/O alcoholic since 40 years( saara)
 H/O Smoking since 40 years (2 chutte per day) and stopped both 2 years back.
Diet :mixed
Sleep :adequate
Bowel and bladder :regular
Micturition :normal
General examination: no pallor,icterus,cyanosis,clubbing,lymphadenopathy,no edema
Sytemic examination:
Cvs:s1s2 heard
No murmurs
Respiratory system:
Bilateral air entry present
Per abdomen:
Scaphoid abdomen,no tenderness,no mass
Liver and spleen not palpable
Cns:
Patient conscious, speech normal ,no neck stiffness, no Kerning's sign,Glasgow scale 15/15
Right. Left
Tone : UL. Hypertonia. N
LL. Hypertonia N
Power:UL. 3/5 3/5
LL 3/5. 3/5
Reflexes :
Biceps. + +
Triceps. + +
Supinator. - +
Knee. _ +
Ankle. - +
Plantar extensor flexor
Sensory system:        right         Left
                 
                Fine touch    +         +
               Vibration      +             +
            Position sense +         +
           Crude touch      +         +
       pain and temperature +      +

Rhomberg's - absent

Cerebellum: 
Nystagmus -ve
Pendular knee jerk -ve
Rebound phenomenon -ve
Dysdiadochokinesia -ve
Finger nose incoordination-ve
Finger finger incoordination-ve


Cranial nerve examination:
  I : intact
II : visual acuity 6/6
      Colour vision normal
III,IV,VI : normal pupil size
                No nystagmus,ptosis,eyemovements normal
V: Sensory - normal
    Motor - normal
Corneal & conjunctival reflexes - normal

Vll: No Deviation of angle of mouth towards right, Able to close eyes.
frowning present on both sides of forehead 

VIII : normal.
IX,X: Uvula- visualised,gag reflex + 
XI: normal
XII: tongue- tone normal,no deviation

ANS:regular bladder movements (incontinance +). No sweating and palpitations.

 Meninges: no signs of meningeal irritation(fever, headache, neck stiffness, nausea and vomitings)

Provisional Diagnosis : Hypoglycemia? Iatrogenic
Recurrent CVA with right sided Hemiparesis .









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