70 MALE , CHRONIC ALCOHOLIC WITH RECUURENT CVA

 LAKYA


Case History and Clinical Findings

C/O SLURRING OF SPEECH SINCE 10 DAYS

DIMINISION OF VISION VISION SINCE 10 DAYS


HOPI:

PT WAS APPARENTLY ASYMPTOMATIC 10 DAYS BACK THEN HE DEVELOPED SUDDEN

ONSET OF SLURRING OF SPEECH,

NO H/O DEVIATION OF MOUTH

H/O DIMINISION OF VISION , SUDDEN IN ONSET

NO H/O WEAKNESS OF LIMBS, INVOLUNTARY MOVEMENTS

H/O 1 EPISODE OF GIDDINESS 10 DAYS BACK AFTER WHICH THESE SYMPTOMS STARTED.

NO H/O LOC, BITING OF TONGUE, INVOLUNTARY PASSAGE OF STOOLS, URINE

NO H/O NAUSEA, VOMITING, HEADACHE.


PAST HISTORY:

K/C/O CVA 6 YEARS BACK, USED MEDICATION FOR 2 MONTHS(ECOSPRIN AV)

N/K/C/O HTN DM CAD SEIZURES THYROID DISORDERS.

SURGERIES- NEPHROLITHIASIS 20 YEARS BACK


ON EXAMINATION:

PATIENT IS CONSCIOUS COHERENT AND COOPERATIVE

CLUBBING +

NO PALLOR, CYANOSIS, ICTERUS, LYMPHADENOPATHY, PEDAL EDEMA

TEMP 100.8F

PR 90BPM

RR 18CPM

SPO2 96%

BP 110/70MM HG



CNS-

GCS:E4V4M6

HMF -COULDNT BE ELICITED

SPEECH -


PUPILS: ANISOCORIA

RT LT

POWER : UL 5/5 5/5

LL 5/5 5/5

TONE: UL N N

LL: N N

REFLEXES: B 3+ 2+

T 2+ 2+

S 2+ 2+

K 3+ 2+

A - -

PL: MUTE EXT

CEREBELLAR SIGNS:

FINGERNOSE IN-COORDINATION ,KNEE- HEEL IN- COORDINATION - COULD NOT BE

ELICITED


CRANIAL NERVES-

PUPILARY REFLEX +

CORNEAL,CONJUNCTIVAL REFLEX IS PRESENT





CVS S1S2+

PA SOFT

RESP BAE+



Investigation

LIVER FUNCTION TEST (LFT) 02-04-2024 05:55:PM

Total Bilurubin 0.48 mg/dl 1-0 mg/dl

Direct Bilurubin 0.18 mg/dl 0.2-0.0 mg/dl

SGOT(AST) 70 IU/L 35-0 IU/L

SGPT(ALT) 68 IU/L 45-0 IU/L

ALKALINE PHOSPHATASE 151 IU/L 119-56 IU/L

TOTAL PROTEINS 6.2 gm/dl 8.3-6.4 gm/dl

ALBUMIN 3.75 gm/dl 4.6-3.2 gm/dl

A/G RATIO 1.53

BGT- O POSITIVE

RBS- 101MG/DL

HBSAG- POSITIVE

HIV- NEGATIVE

HCV- NEGATIVE

HEMOGRAM 2/4/24:

HB- 11.6GM/DL

TLC- 3000

RBC- 3.50

PLT- 1.28

RFT 02-04-2024 05:55:PM

UREA 61 mg/dl 50-17 mg/dl

CREATININE 1.9 mg/dl 1.3-0.8 mg/dl

URIC ACID 4.6 mmol/L 7.2-3.5 mmol/L

CALCIUM 10.0 mg/dl 10.2-8.6 mg/dl

PHOSPHOROUS 4.7 mg/dl 4.5-2.5 mg/dl

SODIUM 137 mmol/L 145-136 mmol/L

POTASSIUM 4.6 mmol/L. 5.1-3.5 mmol/L.

CHLORIDE 104 mmol/L 98-107 mmol/L

RFT 03-04-2024 12:00:AM

UREA 59 mg/dl 50-17 mg/dl

CREATININE 1.7 mg/dl 1.3-0.8 mg/dl

URIC ACID 4.7 mmol/L 7.2-3.5 mmol/L

CALCIUM 10.0 mg/dl 10.2-8.6 mg/dl

PHOSPHOROUS 5.1 mg/dl 4.5-2.5 mg/dl

SODIUM 138 mmol/L 145-136 mmol/L

POTASSIUM 4.1 mmol/L. 5.1-3.5 mmol/L.

CHLORIDE 106 mmol/L 98-107 mmol/L

COMPLETE URINE EXAMINATION (CUE) 02-04-2024 05:55:PM

COLOUR Pale yellow

APPEARANCE Clear

REACTION Acidic

SP.GRAVITY 1.010

ALBUMIN ++

SUGAR Nil

BILE SALTS Nil

BILE PIGMENTS Nil

PUS CELLS 5-6

EPITHELIAL CELLS 1-2

RED BLOOD CELLS 10-12

CRYSTALS Nil

CASTS Nil

AMORPHOUS DEPOSITS Absent

OTHERS Nil

COMPLETE URINE EXAMINATION (CUE) 03-04-2024 12:00:AM

COLOUR Pale yellow

APPEARANCE Clear

REACTION Acidic

SP.GRAVITY 1.010

ALBUMIN ++

SUGAR Nil

BILE SALTS Nil

BILE PIGMENTS Nil

PUS CELLS 4-5

EPITHELIAL CELLS 3-4

RED BLOOD CELLS Nil

CRYSTALS Nil

CASTS Nil

AMORPHOUS DEPOSITS Absent

OTHERS Nil

COMPLETE URINE EXAMINATION (CUE) 03-04-2024 12:32:PM

COLOUR Pale yellow

APPEARANCE Clear

REACTION Acidic

SP.GRAVITY 1.010


LIPID PROFILE:

TOTAL CHOLESTEROL-177MG/DL

TRIGLYCERIDES- 117MG/DL

HDL- 44MG/DL

LDL- 97MG/DL

VLDL- 23MG/DL


USG ON 3/4/24

IMPRIGHT

GRADE II RPD CHANGES IN KIDNEY AND LEFT GRADE I RPD CHANGES IN KIDNEY

LEFT RENAL CALCULI

RIGHT RENAL CORTICAL CYST

BORDERLINE PROSTATOMEGALY.


2D ECHO ON 3/4/24:

TRIVIAL AR+/TR+, NO PAH, NO MR

GOOD LV SYSTOLIC FUNCTION

GRADE I DIASTOLIC DYSFUNCTION

NO PE CLOTS


MRI ON 2/04/24

ACUTE INFARCTS IN LEFT FRONTAL AND LEFT PARIETAL REGIONS-WATER SHED

TERRITORY INFARCTS

OLD INFARCTS WITH ENCEPHALOMALACIC CHANGES IN B/L FRONTAL LOBES AND LEFT

PARIETAL REGIONS

OLD INFARCTS IN SUPERIOR ASPECTS OF LEFT CEREBELLAR HEMISPHERE



Treatment Given(Enter only Generic Name):


IV FLUIDS NS AND RINGER LACTATE 75ML/HR

INJ NEOMOL 1GM IV/SOS(IF TEMP >101.1F)

TAB ECOSPRIN AV 75MG/20MG PO/HS

TAB DOLO 650MG PO/TID

TAB PAN 40MG PO/OD/BBF

Advice at Discharge

TAB ECOSPRIN AV 75/20MG PO/HS

TAB DOLO 650MG PO/TID

TAB PAN 40MG PO/OD/BBF


FINAL DIAGNOSIS-

ACUTE ISCHEMIC STROKE(RECURRENT STROKE) WITH INFARCTS AT LEFT FRONTOPARIETAL LOBE

WITH WERNICKES APHASIA


 


LEARNING POINTS-

70 MALE , CHRONIC ALCOHOLIC WITH RECUURENT CVA 

INITIAL DIFFERENTIALS MADE US LOCALISE TO OCCIPITAL LOBE

WITH DETAILED FURTHUR EXAMINATION AND SUPPORTED BY RADIOLOGICAL INPUTS MADE US DIAGNOSE THE CASE TO HAVE CORTICAL INFARCTS @ FRONTL PARIETAL

WITH BACKGROUND HISTORY OF CVA PATIENT WAS  NOT ON ANTIPLATELET MEDICATION WITH CONTINUED ALCOHOL CONSUMPTION (COULD BE A CAUSE FOR RECURRENCE ) 

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