80 YEAR OLD MALE WITH ALTERED SENSORIUM

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80 year old male farmer by occupation residing in miryalguda came with chief complaints of

- altered sensorium since afternoon

- aphasia, right upper limb weakness since 5 'o clock in the evening 

HISTORY OF PRESENT ILLNESS :

Patient was apparently asymptomatic till 12:30pm today. After 12:30pm, patient first complained of weakness followed by inability to walk and then slowly the weakness started worsening and by 5:00pm in the evening, the patient could not speak and could not move his right upper limb and from 6:00pm, the patient had c/o incontinence of urine

PAST HISTORY : 

Not a k/c/o hypertension, diabetes, asthma, epilepsy, TB, thyroid

PERSONAL HISTORY :

Diet - mixed

Sleep - adequate

Appetite - normal

Alcoholic - abstinence from alcohol since 4years

GENERAL EXAMINATION :

Patient is drowsy

No pallor, icterus, cyanosis, lymphadenopathy 

BP - 140/70 mm Hg

PR - 101 bpm

RR - 17 cpm

Spo2 - 94% on RA

GRBS - 133 mg/dl

Systemic examination :

CVS - S1 S2 +

RS - BAE+

P/A - soft, nontender

CNS - 

Patient is drowsy

Spontaneous movements of left upper and lower limbs

Right upper limb - no movements 

Right lower limb - decreased movements 

Tone - 

. Left upper and lower limbs : normal

. Right upper limb : hypotonia

. Right lower limb : hypertonia

Reflexes - Right Left

. Biceps : 2+ 2+

. Triceps : 2+ 2+

. Supinator : 2+ 2+

. Knee : absent absent

. Ankle : absent absent

. Plantar : mute mute

INVESTIGATIONS : 

SEROLOGY - NEGATIVE

DIAGNOSIS : 

- MULTIPLE INFARCTS IN LEFT MCA, ACA 

- AF WITH FVR

- CARDIOEMBOLIC STROKE

TREATMENT :

1. TAB ECOSPORIN 150MG OD R/T

2. TAB CLOPITAB 75MG R/T OD

3. TAB ATOCOR 40MG R/T OD

4. INJ AMIODARONE 150MG STAT F/B

300MG (2AMP) IN 50ML NS @ 8ML/HR FOR 6HRS F/B

600MG (4AMP) IN 50ML NS @ 2.8ML/HR FOR 18HRS

5. IVF : NS, RL, DNS @ 75ML/HR

6. RT FLUID 200ML MILK WITH PROTEIN POWDER, 50ML FREE WATER 1ST HRLY

7. I/O CHARTING, MONTIOR VITALS, GRBS MONITORING 6TH HRLY

8. INJ CEFTRIAXONE 1GM IV/BD

9. TAB PAN 40MG OD

10. NEB IPRAVENT 8TH HRLY, BUDECORT 12TH HRLY