53 Year Old Female

 53 year old female came with chief complaint of altered sensorium ,difficulty in walking ,loss of speech ,weakness of right upper limb and right lower limb.

HOPI :
Daily Routine : She used To wake up At
 5: 30 am and would complete her Daily House Old Activities.
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 and Lower Limb.

Negative History : No History of Seizures Headache,Fever,Vomiting ,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 Years

Family History not Significant 

General Examination: 
Patient is Conscious, but not Cooperative 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 - 100.8
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 ( slightly delayed on right side, normal on left side) 

    • 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    20cm 19cm

Thigh         42 cm. 44cm

Leg             28cm. 28cm



POWER 

.                     Right.                  Left
Biceps               1+.                   2+
Triceps.       .     1+.                   2+
Supinator.          2+.     
Ankle.                 Zero.              1+
Knee.                   Zero.             2+

Babinski. Extensor on right side

Sensory system : responding to pain

Cerebellar signs : couldn't be elicited

Diagnostic tests:

MRI


COLOUR DOPPLER
ECG

X RAY

TEMPERATURE


Medication








                        








Diagnosis-Acute ischemic stroke with right                         sided hemiplegia
TREATMENT:
IV FLUIDS-NS @ 75 ml / hr

 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

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