59M AIS (Lt.Basal Ganglion & Caudate Nucleus ; DM

 Case History and Clinical Findings

A 59YRS OLD MALE CAME WITH COMPLAINTS OF RIGHT UPPER AND LOWER LIMB SINCE 1 DAY i.e ON 18/2/23 AT AROUND 1 AM

HOPI:

PATIENT WAS APPARENTLY ASYMPTOMATIC TILL 1 AM OF 18/2/23 WHILE WATCHING TV HE DEVELOPED WEAKNESS OF RIGHT UPPER AND LOWER LIMB AND HAD HISTORY OF FALL OF REMOTE FROM HIS HAND WITH DEVIATION OF MOUTH RIGHT SIDE AND SLURRING OF SPEECH 2-3 SEC AND RECOVERED AFTER MASSAGE OFRIGHT UPPER AND LOWER LIMB THEN AFTER 15MINS SIMILAR EPISODES OCCURED AGAIN HE WAS SHIFTED TO NEAR BY HOSPITAL WHERE THEY SUGGESTED CT SCAN

THE PATIENT WAS SHIFTED TO OUR HOSPITAL BY HIS ATTENDER

NO H/O LOC,VOMITINGS

NO H/O FEVER,NO INVOLOUNTARY MICTURITION

NO UP ROLLING OF EYES PRESENT, NO TONGUE BITE , NO INVOLUNTARY MOVEMENTS OF LIMBS

NO HEADACHE, NO FROTHING THROUGH MOUTH

WEAKNESS NOT PROGRESSED

NO FRESH EPISODES TILL NOW

PAST HISTORY:

NO SIMILAR EPISODES IN THE PAST

K/C/O DIABETES MELLITUS II ON SINCE 4 MONTHS ON TAB.METFORMIN 500MG +GLIMIPRIDE 80MG

HTN DIAGNOSED YESTERDAY DURING THE EPISODE

PERSONAL HISTORY:

APPETITE:NORMAL

BOWEL REGULAR

MICTURITION :NORMAL

KNOWN ALLERGIES- NO

HABITS: OCCASIONALLY ALCOHOL

FAMILY H/O: INSIGNIFICANT

GENERAL EXAMINATION

PT IS C/C/C WELL ORIENTED TO TIME, PLACE, PERSON

PR 86BPM

BP 150/90MMHG

RR 14CPM

SPO2 98% AT ROOM AIR

NO PALLOR, NO ICTERUS, NO CYANOSIS, NO CLUBBING, NO LYMPHADENOPATHY, NO EDEMA


SYSTEMIC EXAMNATION:-

CNS

MOTOR RIGHT LEFT

POWER UPPERLIMB - 0/5 5/5 LOWERLIMB 0/5 5/5

TONE UPPERLIMB - NORMAL INCREASED

LOWERLIMB NORMAL NORMAL

REFLEXES B T S K A P

RIGHT - - - - - WITHDRAWL

LEFT +++ - - - - WITHDRAWL

CVS: S1S2 HEARD, NO CARDIAC MURMERS

RS: BAE+ NVBS HEARD

P/A:

SHAPE: OBESE ABDOMINAL WALL

SWEELING OVER UMBILICAL AREA SEEN

NO TENDERNESS

NO PALPABLE MASS

HERNIAL ORIFIES NORMAL

FREE FLUID NO


COURSE IN THE HOSPITAL :

PATIENT PRESENTED WITH ABOVE COMPLAINTS AND ADMINISTERED ANTI-PLATELET DRUGS, HIS ANTI DIABETIC DRUGS WERR CONTINUED

DERMATOLOGY REFERRAL I/V/O C/O ITCHING OVER THE BACK,THORAX,THIGHS SINCE 7 DAYS

O/E:MULTIPLE HYPERPIGMENTED SCALY WELL DEFINED PLAQUES NOTED OVER LEFT UPPRR BACK LRFY LOWER BACK AND MEDIAL SIDE OF THIGH

DIAGNOSIS:TINEA CORPORIS ET CRURIS

TREATRMENT:

TAB.TAB.TERBINAFINE 250MG OD AFTER FOOD X 2WEEKS

OPHTHALMOLOGY REFERRAL I/V/O RAISED ICT FEATURES

IMPRESSION:NO FEATURES OF RAISED ICT IN BOTH EYES ON FUNDUS EXAMINATION.


Provisional Diagnosis:-

ACUTE ISCHEMIC STROKE WITH ACUTE INFRACT IN LEFT BASAL GANGLION AND LEFT CAUDATE NUCLEUS K/C/O DIABETES MELLITUS SINCE 4 MONTHS.OM TAB.GLIMIPERIDE AND TAB.METFORMIN.


Investigation:-

USG ON 20/2/23

IMPRESSION: NO SONOLOGICAL ABNORMALITY

HEMOGRAM:

HB:16.0 GM/DL

TLC:9900

PLC:2.97

PCV:48

RBC:5.84

FBS:172MG/DL

HBA1C:7%

MRI REPORTING: ON 19/2/23

ACUTE INFRACT IN LEFT CORONA RADIATA AND LEFT BASAL GANGLIA


2D ECHO ON 20/02/2023:-

EJECTION FRACTION: 66%

TRIVIAL TR/AR NO MR

NO RWMA. NO AS/MS,

GOOD LV SYSTOLIC FUNCTION

DIASTOLIC DYSFUNCTION

NO PAH/PE


Treatment Given:-

TAB ECOSPRIN-AV 75/10MG/PO/H/S

TAB.METFORMIN 500MG +GLIMIPRIDE 80MG PO/OD

TAB CLOPIDOGREL 75MG/PO/OD

PHYSIOTHERAPY OF RIGHT UPPER AND LOWERLIMB

Advice at Discharge

TAB ECOSPRIN-AV 75/10MG/PO/H/S

TAB.METFORMIN 500MG +GLIMIPRIDE 80MG PO/OD

TAB CLOPIDOGREL 75MG/PO/OD

TAB.TERBINAFINE250 MG PO/OD AFTER FOOD X 2 WEEKS

T.TECZINE 10MG PO /SOS OD

LUCICONAZOLE 1% CREAM L/A BD 2 WEEKS

PHYSIOTHERAPY OF RIGHT UPPER AND LOWER LIMB


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