A 60yr old male with CVA

 60 year old male came with cheif complaints of both upper limb and lower limb weakness since 3days

HOPI:

Pt was apparently asymptomatic one and half year back , developed vomitings 3_4 episodes associated with giddiness and weakness ,then he was diagnosed with hypertension.

After 6months he developed a wound with delayed healing then he was diagnosed with DM_2 

5days back he suddenly developed left sided weakness after he had his lunch associated with deviation of mouth towards rt side and slurring of speech

K/c/o of HTN since 11/2 year on atenolol 50mg OD

k/c/o of DM since 1 year on metformin 500mg OD

He is an occasional toddy intaker 

H/o smoking :1 chutta/day

O/E

 Temperature: afebrile

 PR:55bpm

RR: 14cpm

BP: 140/90mm hg

spo2_99 

GRBS_ 171MG percent

No signs of pallor, icterus, cyanosis, clubbing, koilonychia.

CVS: S1S2 HEARD

RS: BAE PRESENT,

P/A:Soft ,non tender,Bowel  sounds present.

CNS:

HMF: normal

speech: slurred

No signs of meningeal irritation.

Tone:              Right.              left

  UL.               Normal.      decreased(hypo)

  LL.                Normal.       deceased  

power:

 

UL.                   5/5.              0/5

LL.                    5/5.              4/5

REFLEXES:

Biceps:.            2+.               3+

Triceps :.           2+.               3+

supinator :.       2+.                2+

knee:.                  +.                3 +

ankle:.             flexor.          extensor

Investigations

Treatment:

1.TAB.ECOSPRIN AV 75/20 PO OD X___X_____1

2.TAB.TELMESARTAN 40MG OD 1____X______X

3.INJ.THIAMINE 1 AMPOULE IN 100 ML IV OD

4.INJ.OPTINEURON 1 AMPOULE IN 100ML NS IV OD

5.TAB.METFORMIN 500 MG PO BD 1____X_____1

6.BP/TEMPERATURE/PR /GRBS MONITORING 4TH HOURLY