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 








Comments

Post a Comment

Popular posts from this blog

A CASE WITH PAINFUL SKIN LESIONS PRESENTED IN SUMMER 2023

Image
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. I have been given this case to solve in an attempt to understand the topic of "Patient Clinical Data Analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and providing treatment best to our skills and wisdom.  A 35 years old female , daily wage worker  by occupation came presented with chief complaints of painful skin lesions on B/L upper and lower limbs since 2 months, fever and burning micturition since 4days.  Date of admission: 12/09/23 CHIEF C
Read more

BIOPSYCHOSOCIAL HISTORY OF 25/F PRESENTED WITH FEVER AND MULTIPLE SKIN LESIONS

BIOPSYCHOSOCIAL HISTORY OF A 25 F PRESENTED WITH FEVER AND MULTIPLE SKIN LESIONS OVER BOTH LEGS  WITH  SUSPECTED  SYSTEMIC LUPUS ERYTHEMATOSUS Case blog link : https://asjad24.blogspot.com/2023/10/a-case-of-sle-presented-in-october-2023.html PSYCHOLOGICAL HISTORY : Before Disease : Patient was brought up in a rural background with her father working as a stone cutter. Due to financial constraints and social backwardness she couldn't even attain the primary education. Although her family had financial crisis, there was no stress in the family.  She got married at an early age of 17 years(2015) and two children at 20(2018) and 23(2021) respectively which overburdened her shoulder with responsibilities at an early age. After that she started working as a daily wage worker with her husband.  During her second pregnancy she got rashes over her both the cheeks but she wasn't  worried about that and after labour she didn't even pay heed to it. She had cheerful marital life.  No h/
Read more

General Medicine OSCE questions towards optimising clinical complexities.

 OSCE QUESTIONS: Case-  A 35 years old female , daily wage worker  by occupation came presented with chief complaints of painful skin lesions on B/L upper and lower limbs since 2 months, fever and burning micturition since 4days https://asjad24.blogspot.com/2023/09/note-following-e-log-aims-at-discussing.html BASED ON HISTORY AND BIOPSYCHOSOCIAL PROFILE  1)What factor suddenly triggered her skin lesions? 2)How long it took for her pain to progress in to severe deformity? 3)What investigations/diagnosis made her to take medication for RA? 4)What factors led her to stop medications for RA? 5) How did she manage to work even with severe deformities? BASED ON EXAMINATION  1)Why is she severely cachexic even after proper diet? 2)Is the violaceous hue around the margin of ulcer insinuate something? 3) What is the reason for her continous hypotension? 4)What is the reason for her severe anemia? BASED ON DIAGNOSIS AND MANAGEMENT  1) Why it can't be Raynaud's disease? 2)Why she was not
Read more