58y male with AIS (Left front parietal insular cortex)

 SOKKAM


CHIEF COMPLAINTS:

PATIENT WAS BROUGHT WITH COMPLAINTS OF FEVER SINCE 3 DAYS AND WEAKNESS OF

RIGHT UPPER LIMB AND LOWER LIMB SINCE 31/08/23 AFTERNOON 3PM.


HOPI:

PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO.HE THEN DEVELOPED

FEVER OF HIGH GRADE WITH CHILLS AND RIGOR ,RELIEVED WITH MEDICATION.NO

DIURNAL OR SEASONAL VARIATION.HE THEN DEVELOPED WEAKNESS AND UNABLE TO

MOVE RIGHT UPPER LIMB AND LOWER LIMB SINCE 6 HOURS SUDDEN ONSET,WHILE

TAKING BATH,N/H/O FALL,H/O ?LOSS OF CONSCIOUSNESS FOR 5 MINUTES

N/H/O INVOLUNTARY MOVEMENTS IN BILATERAL UPPER AND LOWER LIMB,UPROLLING OF

EYEBALL,TONGUE BITE

N/H/O BLURRING OF VISION

DEVIATION OF ANGLE OF MOUTH TO HIS LEFT SIDE

SLURRING OF SPEECH PRESENT

LAST BINGE OF ALCOHOL 2 DAYS AGO


PAST HISTORY:

N/H/O COUGH,BURNING MICTURITION,SOB,PALPITATIONS,PEDAL EDEMA

N/K/C/O HTN/DM/CAD

N/H/O VOMITINGS,LOOSE STOOLS,PAIN ABDOMEN



PERSONAL HISTORY:

DIET: MIXED 

SLEEP: ADEQUATE

BOWEL AND BLADDER MOVEMENTS: NORMAL

ALCOHOL: REGULAR DRINKER SINCE 25 YEARS AROUND 90ML/DAY. LAST BINGE OF ALCOHOL 2 DAYS AGO

SMOKING: NO




ON EXAMINATION:

PATIENT IS DROWSY BUT AROUSABLE ORIENTED TO PLACE AND PERSON

TEMP-99.3F

PR-70BPM

BP-180/100 MM HG

RR-16 CPM

SPO2-96%AT RA

GRBS-98 MG/DL

RS-WHEEZE ABSENT

CNS- GCS-E4V4M6

PUPILS- B/L NSRL

Investigation

31-08-23

BLOOD UREA-65 mg/dl

SODIUM-142 mEq/L

POTASSIUM-4.3 mEq/L

CHLORIDE-102mEq/L

CALCIUM IONIZED-1.11 mmol/L

HEMOGLOBIN-12.2 gm/dl

TOTAL COUNT-7400

NEUTROPHILS-90%

LYMPHOCYTES-10%

EOSINOPHILS-00

MONOCYTES-00

PCV-39.9

MCV-77.5

MCH-23.7

MCHC-30.6

TOTAL BILURUBIN-1.12 mg/dl

DIRECT BILURUBIN-0.20 mg/dl

SGOT-31 IU/L

SGPT-13 IU/L

ALKALINE PHOSPHATASE-137 IU/L

TOTAL PROTEINS-7 gm/L

ALBUMIN-3.8 gm/L

SERUM CREATININE-1.3 mg/dl

01/09/23

TROPONIN-I - 2.9 pg/ml

02/09/23

BLOOD UREA-57mg/dl

SERUM CREATININE-1.2 mg/dl

2D ECHONO

MR/AR/TR

NO RWMA. NO AS/MS SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION

DIASTOLIC DYSFUNCTION PRESENT

NO PAH/PE

USG ABDOMENMINIMAL

ASCITES

MRI BRAIN PLAINACUTE

INFARCT IN LEFT FRONTAL LOBE AND LEFT INSULAR CORTEX

FEW SMALL ACUTE INFARCTS IN LEFT FRONTAL AND LEFT PARIETAL LOBE

LOSS OF FLOW VOID OF LEFT ICA SUGGESTIVE OF COMPLETE LEFT ICA OCCLUSION


Diagnosis

ACUTE CVA SECONDARY TO ACUTE INFARCT IN LEFT FRONTAL LOBE AND INSULAR

CORTEX,LEFT PARIETAL LOBE WITH ?ALCOHOL WITHDRAWL WITH RIGHT LMN FACIAL

PALSY WITH COPD WITH LOSS OF FLOW VOID IN LEFT ICA S/O COMPLETE LEFT ICA

OCCLUSION


Treatment Given(Enter only Generic Name)

1. RYLES FEED

WATER-100ML 2ND HRLY

MILK-200ML 4TH HRLY

2. IV FLUIDS NS AT 50ML/HR

3. INJ.THIAMINE 200MG IN 100ML NS IV/TID

4.TAB.ECOSPORIN 75MG + CLOPIDOGREL 75MG + ATORVASTATIN 20MG/R

5.PHYSIOTHERAPY OF RIGHT UPPER AND LOWER LIMB


Advice at Discharge

REFER TO HIGHER CENTRE:

PATIENT HAS BEEN REFERRED TO HIGHER CENTRE FOR VASCULAR SURGEON

INTERVENTION IN VIEW OF MRI FINDINGS

ACUTE INFARCT IN LEFT FRONTAL LOBE AND LEFT INSULAR CORTEX

FEW SMALL ACUTE INFARCTS IN LEFT FRONTAL AND LEFT PARIETAL LOBE

LOSS OF FLOW VOID OF LEFT ICA SUGGESTIVE OF COMPLETE LEFT ICA OCCLUSION

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