A 60 YEAR OLD MALE WITH CVA
DR.NAVYA(INTERN)
DR.CHETANA(INTERN)
DR.ABDUL RAHEEM (INTERN)
DR.ASHFAQ(INTERN)
DR.SRAVYA(INTERN)
DR.GNANADA(INTERN)
DR.CHARAN(PG1)
DR.VAMSI(PG1)
DR.SUSMITHA(PG2)
DR.ADITHYA (PG3)
DR.PRANEETH(PG3)
DR.PRAVEEN NAIK (ASS.PROF)
DR.RAKESH BISWAS(HOD)
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A 60 year old male who is a band drummer presented with c/o right sided weakness since 6 days
H/o seizures -6days back
Pt was apparently asymptomatic 7 years back later he developed fever and incidentally diagnosed with HTN and on irregular medication since then .
6 years back he had giddiness for which he was told that he had uncontrolled hypertension which is even not relieved with medication and developed B/L MR palsy , following which he developed seizures , deviation of angle of mouth to RT then he was diagnosed with ischemic stroke involving posterior cerebral artery with 3 rd nerve palsy
Since he is walking with support .
H/o seizure episode 5months associated with tonic movements of all four limbs and loss of consciousness for 5mins.No post ictal confusion
Since 3 months he even not walking with support.
Rt upper limb and lower limb weakness since 20 days back , he developed generalised weakness since 10 days and then 6 days back he developed seizures at early morning associated with tongue bite , frothing , loss of consciousness for 30 min , with altered behaviour for 1 day then he brought to opd today
H/O past illness
K/c/o CVA, 6yrs back
HTN Since 7yrs on omlesartan 40 mg
Not k/c/o DM,TB, ASTHMA
He is a non vegetarian with regular bowel and bladder movements
H/o regular alcohol intake since 40 yrs/180ml per day
H/o smoking since40yrs 3beedi per day
O/E:
Pt is drowsy, moderately built and nourished
Vitals:
Temp: afebrile
PR: 79bpm
RR:17/min
BP:150/80mm hg
No signs of pallor,icterus,cyanosis,clubbing,koilonychia,
No generalised pedal edema,lymphadenopathy
HMF:
Level of consciousness: Drowsy
Speech: slurred
Cranial nerves:
RT EYE: gaze : outwards and downwards
LEFT EYE : Central
3 Rd nerve palsy
Motor system:
TONE RIGHT. LEFT
UL _. hypertonic Normal
LL _. hypertonic. Normal
POWER
UL. 2/5. Normal
LL. 2/5. Normal
REFLEXES
Biceps. 3+. 2+
Triceps. 2+. 2+
Knee. absent. absent
Ankle. absent. absent
Plantar. Extensor. Extensor
Investigations:
Heamogram:
Hb:13.0gm/dl
TLC:4,800 cells/cumm
Lymphocytes:14 percent
Blood urea:28mg/dl
Serum creatinine:0.9 mg/dl
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