55F involuntary movements of UL&LL
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Afeefa farzana
Roll no:03
Intern
This is case of 55 year old lady resident of nakrekal came with chief complaints of fever and involuntary movements of both left upper and lower limbs
Sequence of events
Before the event
She is a farmer by occupation they have their own farm [lemon farm].she is an active person wakes up at 5:00AM freshen up drinks tea and does household chores prepares food for the family and goes to work by 8:00AM.Usually drinks jowar java in the morning and eats rice in lunch and dinner.she comes back from work by 5:00PM freshen up prepares dinner and then sleeps by 9:00PM. Usually she takes pain killers because of body pains after work
She was diagnosed with diabetes 15 Years back
She was sitting in the chair and then suddenly she fell down had loss of consciousness and involuntarymovenentsof both upper and lower limbs, frothingfrom mouth,uprolling of eyeballs immediately she was rushed to hospital and was diagnosed with diabetes mellitus
1 year back she went for general check up and was diagnosed with hypertension but stopped medications 4 months back as she had constipation she believed that it was due to tablets and stopped using them
The day prior to the event
As usual she woke up done with household chores went for work but she was unable to work as she had dragging type of pain in the neck [naralu gunjutunnai] she came back home and took rest
The day of event
She woke up and was unable to see it was sudden ,painless loss of vision but tried to get up from bed but she felt weakness in left upper and lower limb buy managed to go to kitchen to make tea but couldn't then she was taken to local hospital where she had 1 episode of involuntary movements of both upper and lower limbs with 1 minute of loss of consciousness, frothing and deviation of mouth .On Sunday she had 3-4 similar episodes. On monday she was taken to Government hospital where she had 7-8 similar episodes CT scan was done which showed sub acute infarct in right posterior parietal lobe and right frontal lobe
On Tuesday she had similar 2 episodes and was brought to casualty in altered sensorium
PAST HISTORY
k/c/o DM since 15 years
K/c/o HTN since 1 year but stopped using medications 4 months back
N/k/c/o TB,epilepsy ,CAD, asthma,CVA
FAMILY HISTORY
not significant
TREATMENT HISTORY
Uses pain killers very often
GENERAL EXAMINATION
Patient is in altered sensorium
Well build and nourished
VITALS
Pallor : absent
Icterus: absent
SYSTEM EXAMINATION:
Abdominal examination
Soft, non-tender
RESPIRATORY EXAMINATION
trachea central,
normal respiratory movements,
normal vesicular breath sounds.
CARDIOVASCULAR SYSTEM
S1 ,S2 heard ,no murmurs
26.5.2023
Ward : ICU
Unit : 2
DOA : 23/05/23
S
-Stools passed
O:
No pallor ,icterus , clubbing,cyanosis,lymphadenopathy
Vitals :
BP- 140/80mm Hg
PR -90bpm
RR-24cpm
Spo2- 99%
GRBS - 190mg/dl at 8AM
Temperature -98 F
Cvs: s1,s2 heard ,no Murmurs
Rs: BAE present,NVBS
P/A: soft,non tender
CNS:
Reflexes:
R L
B + 2 +2
T + 2 +
S +2 -
K. +.2 +
A + 2 +
P extensor. Extensor
Tone:
Rt Lt
UL. Hyper hypo
Hyper hypo
Power:
Rt. Lt
UL. 4/5. 0/5
L L 4/5. 0/5
A:
Altered sensorium secondary to pyogenic meningitis left hemiparesis secondary to MCA stroke with seizures ?GTCS,focal seizures
ophthalmoplegia secondary to affected right frontal eyefield
K/c/o DM2 since 10 years
K/c/o HTN since 1 year. With renal AKI(resolving)
P:
1.i.v. Fluids NS @75 ml/hr
2.inj.monocef 2gm IV/BD
3.inj.dexamethasone 6mg iv/TID
4.inj levipil 1gm iv/BD
5.inj.thiamine 200 mg IV/TID
6.inj.sodium valproate 1000 mg iv/BD
7.INJ.HAI acc to GRBS after informing
8.GRBS 7 point profile
9.tab ecosprin gold 75/75/10
10.monior vitals BP,PR,RR,Temp,Spo2 every hourly
27.5.2023
Ward : ICU
Unit : 2
DOA : 23/05/23
S
Stools passed
O:
No pallor ,icterus , clubbing,cyanosis,lymphadenopathy
Vitals :
BP- 120/90mm Hg
PR -78bpm
RR-18cpm
Spo2- 99%
GRBS - 231mg/dl at 8AM
Temperature -98.5F
CVS: S1, S2 heard. no Murmurs
RS: BAE present,NVBS
P/A: soft, non tender
CNS:
Reflexes:
R L
B +2 +2
T +2 +1
S +1 +1
K +2 +1
A +2 +1
P Extensor Extensor
Tone:
Rt Lt
UL Hyper hypo
LL Hyper hypo
Power:
Rt Lt
UL 4/5 0/5
LL 4/5 0/5
A:
Altered sensorium (resolved)
left hemiparesis secondary to acute infarct in right MCA territory mainly right fronto-parietal and parieto-temporal region with hemorrhagic transformation.
Left ophthalmoplegia secondary to RFEF
K/c/o DM2 since 10 years
K/c/o HTN since 1 year with renal AKI(resolved)
P:
1. IVF NS @75 ml/hr
2. Inj. Monocef 2gm IV/BD
3. Inj. Dexamethasone 6mg iv/TID
4. Inj. Levipil 1gm iv/BD
5. Inj. Thiamine 200 mg IV/TID
6. Inj. Sodium valproate 1000 mg iv/BD
7. Inj. Thiamine 200mg IV/TID
8. Inj. HAI s/c acc to GRBS after informing
9. Tab. Ecosprin GOLD (75/75/10)
10. Physiotherapy of Left UL&LL
11. Monior vitals BP,PR,RR,Temp,Spo2 every hourly
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