A CASE OF ACUTE CEREBROVASCULAR ACCIDENT PRESENTED IN SUMMER 2023

 NOTE:


The following E-log aims at discussing our patient de-identified health data shared after taking the guardian's signed consent.

Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve the patients clinical problem with current best evidence based input.

This E-log also reflects my patient's centered online learning portfolio.

 A 50 years male presented in the casualty with complaints of weakness in left upper and lower limb.

CHIEF COMPLAINT

Weakness in left upper and lower limb since morning 

HISTORY OF PRESENTING ILLNESS

Patient was apparently asymptomatic till same day morning. After sleep he was not able to get up from the bed due to weakness in left upper and lower limb which was sudden in onset and gradually progressive. 

No h/o loss of consciousness, drooling of saliva, difficulty in eating and talking 

HISTORY OF PAST ILLNESS 

K/c/o CVA 3 years back(resolved) 

K/c/o HTN since 2years

K/c/o DM since 2 years

n/K/c/o TB, Epilepsy, asthma 

DRUG HISTORY

T.metformin 500mg + glimperide 1mg Po/od (mrng)

T.metformin 500mg +po/of

T.Amlong 2.5mg po/od

PERSONAL HISTORY

Diet- mixed

Appetite - normal

Sleep -normal

Bowel and bladder -regular

Addictions-

-He is chronic alcoholic since 30 years, stopped 2 years after right hemiplegia.

-he chews tobacco since 10 years .

FAMILY HISTORY:

No similar complaints in the family.

GENERAL EXAMINATION:- 

GCS -E4V4M5


-B/L pupils-NSRL


Pallor - absent

Icterus - absent

Cyanosis - absent

Clubbing - absent

Lymphadenopathy - absent

Oedema - absent 

Vitals :- 

Temp - 97.2F

BP - 110/70 mm Hg

Pulse rate - 72 bpm

Respiratory rate - 14 cycles per minute 


SYSTEMIC EXAMINATION:

 CNS EXAMINATION :-

Motor system

Power:-


Rt UL - 3/5 Lt UL-0/5


Rt LL - 3/5 Lt LL-0/5


Tone:-


Rt UL - Hyper


Lt LL-Hypo


Rt LL-Hyper


Lt LL- Hypo




Reflexes: 


                   Right Left


Biceps: ++ +++


Triceps: ++ +++


Supinator: +++ ++


Knee: +++ ++


Ankle: + +



Plantar: flexor. Extensor


Involuntary movements - absent


Fasciculations - absent




Sensory system - 


-Pain, temperature, crude touch, pressure sensations,Fine touch, vibration, proprioception -normal


Cerebellum - 


Finger nose test , dysdiadochokinesia, Rhomberg test could not elicited.




Autonomic nervous system - normal

• Meningeal sign  

Neck stiffeness -present 

Brudzinski sign -present

Kernigs sign -present.

ABDOMEN EXAMINATION:


Inspection -


Umbilicus - inverted


All quadrants moving equally with respiration


No scars, sinuses and engorged veins , visible


 pulsations.


CVS EXAMINATION 


S1S2 heard,no murmurs.


Respiratory system examination


Bilateral air entry present.

Diagnosis-


Left hemiplegia sec to Acute infarct in right superior parietal lobule;Superior frontal gyrus 








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