55F Pyogenic Meningitis; AIS ; DM

 Case History and Clinical Findings:-

CHIEF COMPLAINTS :-

FEVER AND INVOLUNTARY MOVEMENTS IN BOTH LEFT UPPERLIMB AND LOWER LIMB SINCE 2 DAYS ,2 DAYS BACK 1 EPISODE INVOLUNTARY MOVEMENT IN BOTH UPPER LIMB AND LOWER LIMB WITH DEVIATION OF MOUTH7 TO 8 EPISODES YESTERDAY2 EPISODES SINCE MORNING

 C/O WEAKNESS OF LEFT UPPERLIMB AND LEFT LOWER LIMB SINCE 2DAYS 

history of present illness:-

SHE WAS APPARENTLY ASYMPTOMATIC 15 YEARS BACK ,AFTER WHICH SHE SUDDENLY FELL DOWN AND HAD LOSS OF CONSCIOUSNESSAND INVOLUNTARY MOVEMENTS OF LEFT UPPER AND LOWER LIMBS,FROTHING ,UPROLLING OF EYEBALLS.PATIENT HAD PAINLESS SUDDEN LOSS OF VISION IN THE LEFT EYE ASSOCIATED WITH LEFT UPPER AND LOWER LIMB WEAKNESS.AFTER SOME TIME PATIENT HYAD 1 EPISODE OF INVOLUNTARY MOVEMENTS OF BOTH UPPER AND LOWER LIMBS ASSOCIATED WITH LOSS OF CONSCIOUSNESS FOR 1 MINUTE,FROTHING,DEVIATION OF MOUTH.ON SUNDAY SHE HAD SIMILAR 3-4 EPISODES OF SEIZURES, CT SCAN WAS DONE SHOWING SUBACUTE INFARCT IN RIGHT POSTERIOR PARIETAL LOBE AND RIGHT FRONTAL LOBE.NO H/O HEAD TRAUMANO H/O VOMITINGS

PAST HISTORY:- USED MEDICATION FOR 4 MONTHS FOR HYPERTENSION 1 YEAR BACK AND STOPPED

NOT A K/C/O ASTHMA, CVA,TB,THYROID DISORDER

K/C/O EPILEPSY 15YEARS

K/C/O DM II SINCE 15YEARS

COURSE IN THE HOSPITAL:- 55/F PRESENTED WITH ALTERED SENOSRIUM ON TUESDAYLUMBAR PUNCTURE WAS DONE ON THE DAY OF ADMISSION IN VIEW OF FURTHER EVALUATION AND WAS FOUND TO HAVE 9 CELLS CONTAINING 80% NEUTROPHILS AND 20% LYMPHOCYTES WITH SUGAR-128,PROTEIN-26,CHLORIDE-118 ,ADA-20 AND CSF CBNAAT WAS FOUND TO BE NEGITIVEOPHTHAL OPINION WAS TAKEN AND NO FEATURES OF RAISED ICT AND DIABETIC RETINOPATHY WERE NOTEDMRI BRAIN WAS DONE AND SHOWEDACUTE INFARCT IN RIGHT MCA MAINLY RIGHT FRONTO PARIETAL AND PARIETO TEMPORAL REGION WITH HEMORRHAGIC TRANSFORMATIONPATIENT WAS ADVISED FOR PHYSIOTHERAPY AND PATIENT WAS HEMODYNAMICALLY IMPROVED AND WAS DISCHARGED IN STABLE CONDITIONMRI VENOGRAM AND MRI ANGIOGRAM WERE DONE BOTH NORMAL.

VITALS:

TEMP: 98.6F

BP:110/90MMHG

RR: 20CPM

PR: 110 BPM

SPO2' 98% ON RA

SYSTEMIC EXAM:

CVS: S1S2+, NO MURMURS

RS: BAE +

P/A: SOFT, NON TENDER

CNS: RIGHT LEFT

TONE- UL HYPER HYPO LL HYPER HYPOPOWER- UL 4/5 0/5 LL 4/5 0/5B +2 +3T +1 -S +1 +1K +1 -A +1 +1P INCREASED INCREASED 

provisional Diagnosis:-

 ALTERED SENSORIUM SECONDARY TO? PYOGENIC MENINGITISLEFT HEMIPARESIS SECONDARY TO ACUTE INFARCT IN RIGHT MCA TERRITORY MAINLY RIGHT FRONTOPARIETAL AND PARIETOTEMPORAL REGION WITH HEMORRAGIC TRANSFORMATIONLEFT OPHTHALMOPLEGIA SECONDARY TO RFEFK/C/O HTN SINCE 1 YEARK/C/O DM2 SINCE 15 YEARS

Investigation:-

 HEMOGRAM :-23/05

HB 13.2

TLC 17800

PCV 42.7

RBC COUNT-5.27

PLATELET 3.1

025/05/24:-

HB:- 10.3

TLC 25000

PCV 31.2

RBC COUNT 3.94

PLATLET 1.96

26/05/24:-

HB :-9.9

TLC 18500

PCV 30.9

RBC COUNT 3.87

PLATELET 2.34

27/05/24:-

HB:- 10.7

TLC 12400

PCV 33.9

RBC COUNT 4.20

PLATLET 2.50

28/05/24:-

HB:- 11.5

TLC 14600

PCV 35.6

RBC COUNT 4.50

PLATLET 2.0

29/05/24:-

HB 10.8

TLC 12500

PCV 34.1

RBC COUNT 4.24

PLATELET 1.89

USG ABDOMEN:-

GRADE 1 FATTY LIVER2D ECHOTRIVIAL TR /AR /NO MRNO RWMA NO AS/MSGOOD LV SYSTOLIC FUNCTIONDIASTOLIC DYSFUNCTION NO PAH/PE  

Treatment Given:

IVF NS @75ML/HR

INJ MONOCEF 2GM IV /BD

INJ DEXAMETHASONE 6MG IV /TID

INJ LEVIPIL 1G IV/BD

INJ SODIUM VALPROATE 1000MG IV /BD

INJ THIAMINE 200MG IV/TID

INJ HAI S/CPHYSIOTHERAPY TO LEFT UPPERLIMB AND LOWER LIMB 

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