case 37 : A 60 YR OLD MALE WITH ?CARDIOEMBOLIC STROKE

 

A 60 YR OLD MALE WITH ?CARDIOEMBOLIC STROKE

May 28, 2022
thanks Dr. Jyothi (intern)
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
PATIENT CAME WITH COMPLAINTS OF LOSS OF VISION SINCE YESTERDAY AFTERNOON
COMPLAINTS DECREASED SPEECH SINCE YESTERDAY EVENING
AND DECREASED POWER IN RIGHT UPPER LIMG AND DEVIATION OF MOUTH TO LEFT SIDE SINCE TODAY MORNING
PATIENT WAS APPARENTLY ASYMPTOMATIC 1 WEEK BACK AND THEN DEVELOPED PAI  DIFFUSE IN NATURE FOR 1 WEEK AND SUBSIDED ON MEDICATION AND SINCE YESTERDAY AFTERNOON  DEVELOPED SUDDEN ONSET OF LOSS OF VISION AND AFTER 2 HRS DECREASED SPEECH SINCE FOR 2 HRS AND THEN COMPLETELY LOST SPEECH SINCE YESTERDAY NIGHT 10 :00 PM AND TODAG MPRNING AT 7 AM DEVELOPED WEAKNESS OF UPPERLIMB AND BROUGHT TO HOSPITAL AT 2 :00PM
NOT A K/C/O DM HTN ASTHMA TB.
 CHRONIC ALCOHOLIC AND CHRONIC SMOKER 1 BEEDI/DAY SINCE 40 YRS
GENERAL EXAMINATION 
PT WAS CONSCIOUS,COHERENT,NON COOPERATIVE
NO PALLOR CYANOSIS CLUBBING ,ICTERUS,LYMPHADENOPATHY AND EDEMA
TEMP 98.5F
PR 88 BPM
RR 16 CPM
SPO2.98 PERCENT
GRBS 106
BP 100/60 mmHg
CVS :S1S2+
RS: BAE+
P/A: SOFT NONTENDER
HMF
ALTERED SENSORIUM,MEMORY IMPAIRED
SPEECH APHASIC
TONE          RT             LT

UL               N                N
LL                 N               N
POWER
UL               2/5              4 /5
LL                 4/5              4/5

REFLEXES      RT             LT
BICEPS           ++              +
TRICEPS           ++              +
SUPINATOR       +                 +  
KNEE                 ++                  +
ANKLE                 +                  +
INVESTIGATIONS
CBP 
HB ;14.2
TLC; 13000
PLT ;2LAKHS
RBS: 112
BGT:.O +
BT :2 MIN 3O SEC
CT : 4 MIN 30SEC
Ecg on 29 /5/22
Chest x ray


Clinical images


LFT
RFT

Ecg on 28 /5/22
2D ECHO
EF 41 PERCENT
MILD AR +
MILD LV DYSFUNCTION
LAD AKINETIC, SCLEROTIC AV,DIASTOLIC DYSFUNCTION

PROVISIONAL DIAGNOSIS

?CARDIOEMBOLIC STROKE WITH ?ACUTE CORONARY SYNDROME WITH ISCHEMIC LBBB

TREATMENT
1)TAB CLOPITAB 325mg PO /STAT
2)TAB ECOSPIRIN 300 mg PO/STAT
3)TAB ATORVAS 80 mg PO/STAT
4)INJ OPTINEURON 1 AMP in100 ML NS/IV /OD

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