case 5 : A 60 YEAR OLD MALE WITH CVA

 

A 60 YEAR OLD MALE WITH CVA

February 10, 2021

THANKS DR.NAVYA(INTERN)

DR.CHARAN(PG1)

DR.VAMSI(PG1)

DR.SUSMITHA(PG2)

DR.ADITHYA (PG3)

DR.PRANEETH(PG3) 

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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