A 65 year old Male ?seizures with post-Ictal confusion , ? Seizures secondary to OLD CVA [infarct] , ?Acute infarct
March 13 , 2022
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New admission
ICU Bed no: 4
A 65 year old male was brought to casualty with
C/O Loss of speech since 8 am (13/3/2022)
C/O unresponsiveness since 8 am (13/2/2022)
C/O inability to move his LEFT LOWER LIMB AND LEFT UPPER LIMB as explained by the attender when he asked the patient to lift his hands and legs.
C/O deviation of angle of mouth towards one side.
HOPI: On the morning of 13/2/2022 patient completed his routines all by himself (too cautious about his sugar levels, does everything on time , as explained by the attender ) and suddenly developed weakness in the LEFT LOWER LIMB and LEFT UPPER LIMB and deviation of angle of mouth towards the RIGHT side, panicking patient attender (son) immediately shifted the patient on to the bed and tried to interact, but the patient was unresponsive, and did not respond to any of the attendee’s commands , so he brought him here to this hospital.
Patient attendee’s give a history of similar complaints in the past , { H/O CVA in July 2021 } almost an year ago , H/O similar episode LEFT UL AND LL weakness and deviation of mouth towards Right and loss of speech, for which he was hospitalised and treated for 10days.
He is a K/C/O
Hypertension since 2years on unknown medication.
Diabetes MELLITUS since 3years on Glimi M2 OD
Patient was advised to take LEVIPIL 500 mg OD , after being treated and discharged in the month of July , 2021 after having similar episode! He continued using levipil 500 OD for 5 months, and then since the last 2 months patient altered the dosage of the medication (levipil 500) by taking one tablet a day , alternatively{not daily} .
GENERAL PHYSICAL EXAMINATION
Fixed neck deformity since 10 years.( That’s why MRI couldn’t be done)
O/E
Vitals:
PR: 122/min
RR: 21 cpm
BP: 150/70
SPO2: 85% @ R.A
GRBS: 287mg/dl
SYSTEMIC EXAMINATION:
CNS:
Patient is conscious!
Comprehension+ (present)
No speech
Pupils - B/L NSRL
NOT OBEYING ORAL COMMANDS
TONGUE BITE+ (present)
Deviation of mouth towards RIGHT+
POWER R L
UL: Not elicit-able. Not elicit-able
LL: Not elicit-able. Not elicit-able
TONE NORMAL INCREASED
REFLEXES
BICEPS : 2+ 2+
TRICEPS : 2+ 2+
SUPINATOR : — —
KNEE : 2+ 2+
ANKLE : 1+ 1+
*** After 1 hour patient started to speak and move all his 4 limbs.
CVS : S1 S2 +
RS: BAE + , NVBS+
PA: soft , non tender , distended (mildly)
TREATMENT:
1) Inj. LEVIPIL 500 mg IV in 100 ml NS
2) Inj. PAN 40 mg IV OD
3) Inj. ZOFER 4mg IV TID
4) Inj. ECOSPRIN 150mg RT H/S
5) Inj. CLOPITAB 75 mg RT H/S
6) Inj. OPTINEURON 1amp+100ml NS IV OD. X—1–X
7) GRBS charting 6th hourly
8) RT Feeds 2nd hrly 300ml Milk + water 100ml
9) Inj. HUMAN ACTRAPID according to GRBS
10) TAB. Atorvas 20mg RT H/S
11) O2 inhalation if spo2 < 94%
12) syrup. Cremaffin 10ml RT stat.
INVESTIGATIONS:
CBP: Hb: 13.2 mg /dl
Total count : 9,900
platelets:1.90 lakhs
peripheral smear
NORMOCYTICNORMOCHROMIC
RBS : 236mg/dl
RFT: urea: 24
Creatinine : 1.4
Electrolytes : Na: 136 , k: 4.0, cl: 98
LFT: T.B : 1.24
D.B : 0.3
AST: 30
ALT: 18
ALP: 180
TP : 6.4
ALB : 4.4
PROVISIONAL DIAGNOSIS: LEFT HEMIPARESIS SECONDARY TO ?OLD CVA (INFARCT)/ TODD’s PALSY ,K/C/O epilepsy ( on irregular medication) HYPERTENSION+, DIABETES MELLITUS+
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