50Y/F PRESENTED WITH SLURRING OF SPEECH.

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Chief complaint;

50 year old female presented with the  of slurring of speech since 3 months

History of present illness

Patient was apparently asymptomatic 3 months ago ,then she developed slurring of speech which was preceded by history of head trauma (fall onto door) For 2 days she complained of slurring of speech which improved gradually 

History of weakness and tingling of all4 limbs, delayed response to normal stimuli, decreased memory and episodes of giddiness  one month ago

22 days ago @ 3:30 am attenders had noticed staring eye movements which lasted for 15 mins, which was  loss of consciousness, uprolling of eyes, stiffness of all 4 limbs frothing at mouth , post ictal confusion lasted for 30 mins

6 days ago attenders  had noticed staring eye movements which lasted for 10 mins which was  loss of consciousness , stiffness of all 4 limbs, involuntary micturition ,clenching of teeth  post ictal confusion lasted for 20 mins 

Past history;

Not a known case  of DM HTN TB asthma thyroid disorders 

From 22 days she was complaining of slurring of speech

No history of vomitings ,loose stools , fever,  and pain abdomen 

History of electric shock 6 years ago

History of burning micturition cold and cough 6  years

Personal history;

Married

Diet mixed

Apatite_ lost. takes food when the family member provided

Micturation is normal

No known allergies

Habits .no addictions

MENSTRUAL HISTORY;

Menopause 4years ago

Family history;

No relavent history is found

General examination;

Patient is conscious,coherent,cooperative

-No icterus

-pallor present

-No lymphadenopathy

-No cyanosis

-No clubbing of fingers

No oedema

EXAMINATION 

BP:140/100mm hg

PR:90bpm

RR:16/min

Temp : Afebrile 

CNS:

Pupils- left- normal in size reactive to light

             right-NSRL

Higher mental functions

- Conscious +

- Memory - Intact

- Speech - slurred

Cranial nerve examination 

          • 1 - olfactory sense - normal

          • 2- visual acuity present,

          • 3,4,6 - no ptosis Or nystagmus

          • 5- corneal reflex present 

           • 7- no deviation of mouth, no loss of nasolabial     folds, forehead wrinkling present

          • 8- Normal hearing

          • 9,10- position of uvula is central ,Gag reflex-   present

          • 11- sternocleidomastoid contraction present

          • 12- no deviation of tongue

 Motor system 

Reflexes 

                          Right        Left            

Biceps                3+            3+     

Triceps               3+            3+     

 Knee.                 3+.           3+

Ankle.                 2+             2+

Plantars-       Extension     Extension 

Power.           Lt.        Rt

Upper limb -4/5.       4/5

Lower limb  -4/5       4/5                                  

               

TONE.                    Lt.        Rt

 Upper limbs           N        N                

 Lower limbs           N         N               

No Involuntary movements

 SENSORY SYSTEM

I – SPINOTHALAMIC       R     L

1. Crude touch                 N     N 

2. Pain.                              N.    N

3. Temperature.               N.     N

II – POSTERIOR COLUMN

1. Fine touch.                    N.    N

2. Vibration.                      N.     N

3. Position sense.             N.     N

III – CORTICAL

1. Two point 

    discrimination.               N.    N

2. Tactile localisation.       N.    N

CEREBELLAR Tests

Finger Nose test - normal

Heel Knee test - normal

CVS; S1S2 +,No murmurs 

RS :Bilateral air entry present 

       Normal vesicular breath sounds heard

Provisional diagnosis 

ACUTE CVA (ACUTE INFARCT IN RIGHT PARIETAL REGION) WITH SEIZURES (GENERALIZED TONIC SEIZURES)

Investigations 

           

2D ECHO ON 16/01/2023

CAROTID DOPPLER

final diagnosis

ACUTE ISCHEMIC INFARCT VASCULAR DEMNTIA

ACUTE CVA ACUTE INFARCT IN RIGHT PARIETAL REGION WITH SEIZURES (GENERALIZED TONIC SEIZURES) 20 DAYS AGO

WITH IRON DEFICIENCY ANEMIA

treatment.

1) INJ . LEVIPIL 500 mgIV/BD

    

3) Tab. ECOSPRIN 75 mg 

      

4) Tab. ATORVAS 40mg 

     

5) TAB. OROFER- XT 

6) INJ . PANTOP 40 MG