A 85 year old female with weakness of right upper and lower lim and deviation of head to left side since 2 days(26/01/22)

A 85 old female,resident of mothkur,came to casuality with cheif complaints of weakness of right upper and lower limb and deviation of head to left side since 1 day

Right hand

         

                                 Right leg

                                       

         

                                 

HOPI:

Patient was apparently asymptomatic 1 day back and then she developed sudden onset of  weakness of right upper and lower limb and deviation of head to left side.No history of seizures,loss of consciousness and her GCS on admission is E4V2M6(11/15)

PAST HISTORY:

She is a known case of HYPERTENSION and on TAB.TELMA-40mg.No similar complaints in the past.

GENERAL EXAMINATION:

Patient was conscious but not coherent and cooperative and not well oriented to time,place,person.She is moderately built and nourished.

No signs of pallor,icterus,clubbing,cynosis, generalized lymphedenopathy,edema.

Her vitals are:

TEMPERATURE:98.3F(Afebrile)

PULSE RATE:112 bpm

RESPIRATORY RATE:24 cycles per min

BP:140/90mm Hg

SYSTEMIC EXAMINATION:

CVS:S1,S2 heard,no murmurs

RS:NVBS heard,BAE(bilateral air entry) present

PER ABDOMEN:soft and tender

CNS EXAMINATION:

POWER:      RIGHT          LEFT

UL.               1/5               5/5

LL.                1/5              5/5

TONE:

UL.               Increased.     Normal

LL.                Increased      Normal

REFLEXES:

BICEPS:.         2+                 3+

TRICEPS:.       2+                 3+

SUPINATOR:. 2+                  3+

KNEE:.             2+                  3+

ANKLE:.           1+                 1+

PLANTOR:.      Extension     Flexion

INVESTIGATIONS:

USG:

PROVISIONAL DIAGNOSIS:

CVA(Cerebral vascular accident),with right sided hemiplegia with acute infarct in left capsuloganglionic region(involving middle cerebral artery territory) with right UMN Facial palsy.

TREATMENT:

inj.mannitol 100ml iv TID

Ryles tube:200ml milk every second hourly,100ml water every hourly.

BP monitoring 2nd hourly.