A 40 year old female came with the complaints of sudden onset of giddiness- 2 episodes on friday evening with no loss of consciousness and fits

HOPI-

The patient was apparently asymptomatic  8hrs    ago

H/o weakness of left upper limb,lower limb, deviation of mouth to right since 8 hrs with slurred speech

No h/o any tingling,numbness,headache

No h/o fever

C/o dragging of left leg while walking since 5 hrs

PAST HISTORY-

Not a k/c/o DM,HTN,CAD,epilepsy

PERSONAL HISTORY-

Sleep-adequate

Appetite-normal

Diet-mixed

Bowel and bladder - regular

Addictions-

Consumes 1 bottle of toddy daily

Tobacco chewer since 20 years

FAMILY HISTORY-

No significant family history

GENERAL EXAMINATION-

The patient is conscious,coherent and cooperative

No pallor,icterus,cyanosis,clubbing,lymphadenopathy and pedal edema

VITALS-

PR-95

BP-140/90 mmHg

Spo2-100%

GRBS- 78 mg%

SYSTEMIC EXAMINATION-

CVS- 

S1,S2 heard

No thrills ,murmurs

RESPIRATORY SYSTEM-

BAE+

NVBS heard

ABDOMEN-

shape- normal

No tenderness,palpable mass

Liver and spleen not palpable

CNS-

The patient is conscious

Speech- normal

No signs of meningeal irritation

Cranial nerves- deviation of mouth to right



Power-        R             L

UL             5/5            4/5

LL             5/5            4/5

Tone         Normal    Normal

REFLEXES-    

                     R               L

Biceps         2+              3+

Triceps        2+             3+

Supinator    2+             3+

Knee          3+              3+

Ankle         1+             2+

Plantar- extensor

Finger-nose-in coordination- no

Knee-heel-in coordination-no

PROVISIONAL DIAGNOSIS-

?Acute CVA- acute infarct involving right lentiform nucleus

Small  vessel ischemic  Changes

INVESTIGATIONS-










Course in the hospital:
Patient was admitted with left upper and lower limb weakness and deviation of mouth to right,non diabetic,non hypertensive,chronic tobacco chewer and toddy drinker.on examination left side power was 4/5 and reflexes exxagerated on left upper and lower limbs with extensor plantar.MRI brain was done which showed acute infarct in right lentiform nucleus.2d echo was normal,carotid artery doppler was normal.Patient was started on prophylactic antiplatelets and is being discharged with following advice 

Advice at discharge

Tab ecospirin 150mg OD
Tab Clopitab 75mg OD
Tab atorvas 40mg night 8pm







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