60/f difficulty in speech

 NAGENDRAMMA

CHIEF COMPLAINTS : 

PATIENT CAME WITH CHIEF COMPLAINTS OF LOSS OF SPEECH SINCE

3 DAYS.

HISTORY OF PRESENTING ILLNESS : 

PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS

THEN SHE DEVELOPED LOSS OF SPEECH AND DIFFICULTY IN SWALLOWING , WHILE

OBEYING COMMANDS. PATIENT HAD SIMILAR COMPLAINTS IN PAST 2 MONTHS AGO WITH

RIGHT UPPER LIMB PLEGIA WITH SWALLOWING DIFFICULTY AND LOSS OF SPEECH FOR

WHICH SHE WAS TAKEN TO LOCAL HOSPITAL AND WAS DIAGNOSED AS ISCHEMIC CVA

(CHRONIC INFARCTION IN RIGHT HIGH FRONTOTEMPORAL REGION).

NO C/O FEVER, VOMITIMG, HEADACHE, LOOSE STOOLS, BURNING MICTURITION.

NO C/O CHEST PAIN,PALPITATIONS,SOB.

PAST HISTORY:

K/C/O HYPERTENSION SINCE 4YEARS (ON TAB TELMA 40 MG PO/OD).

NOT A K/C/O DM,CAD,CVA,EPILEPSY,TB,ASTHMA.

PERSONAL HISTORY:

DIET: MIXED 

SLEEP: ADEQUATE

BOWEL AND BLADDER MOVEMENTS: NORMAL

ALCOHOL: NO

SMOKING: REGULAR SMOKER SINCE 35 YEARS AROUND 1 CHUTTA PACKET/DAY. LAST SMOKE WAS 1 WEEK AGO

GENERAL EXAMINATION:

THE PATIENT IS CONSCIOUS, COHERENT, COOPERATIVE, WELL ORIENTED TO TIME, PLACE

AND PERSON, MODERATELY BUILT AND NOURISHED.

VITALS:

BP: 110/70 MMHG

PR: 115 BPM

RR: 16 CPM

GRBS:113 MG/DL

TEMP: 98.4 F

CVS: S1, S2 HEARD, NO MURMURS

RS: BAE +, NVBS, NO ADDED SOUNDS

P/A: SOFT, NON TENDER

CNS:

CRANIAL NERVE : 9TH AND 10TH NERVES INVOLVED

MOTOR SYSTEM:

TONE-RIGHT(UL-INCREASED,LL-INCREASED)

LEFT(UL-NORMAL,LL-NORMAL)

POWER-RIGHT(UL-2/5,LL-4/5)

LEFT(UL-4+/5,LL-4+/5)

REFLEXES: B T S K A P

RIGHT +++ +++ +++ +++ +++ E

LEFT ++ ++ ++ ++ + f

COURSE IN THE HOSPITAL :

60 YRS FEMALE WAS ADMITTED WITH ABOVE MENTIONED COMPLAINTS. NECESSARY

EXAMINATIONS AND INVESTIGATIONS WERW DONE AND DIAGNOSED AS RECURRENT

ISCHEMIC CVA (ACUTE INFARCT IN LEFT PARIETAL LOBE AND RIGHT PARIETAL LOBE) WITH

RIGHT HEMIPARESIS ?BROCA'S APHAISA(HYPERTENSION SINCE 4 YRS).THE PATIENT WAS

CONSERVATIVELY MANAGED. THE SYMPTOMS SUBSIDED. PATIENT IS HEMODYNAMICALLY

STABLE AND PLANNED FOR DISCHARGE.

Diagnosis

RECURRENT ISCHEMIC CVA (ACUTE INFARCT IN LEFT PARIETAL LOBE AND RIGHT

PARIETAL LOBE) WITH RIGHT HEMIPARESIS ?BROCA'S APHAISA.

(HYPERTENSION SINCE 4 YRS)

Investigation

MRI DONE ON 13/08/23

IMPRESSION:

-ACUTE INFARCT IN LEFT PARIETAL LOBE.

-ACUTE INFARCT IN RIGHT PARIETAL LOBE ADJACENT TO THE MARGINS OF OLD INFARCT.

-FEW ACUTE LACUNAR INFARCTS IN RIGHT PARIETAL LOBE.

-OLD INFARCTS IN B/L FRONTAL LOBES, RIGHT PARIETO OCCIPITAL LOBE , LEFT OCCIPITAL

LOBE, LEFT PERIVENTRICULAR, LEFT STRIATO CAPSULAR REGION AND RIGHT SIDE OF

PONS.

CHEST X RAY - NORMAL

ECG -NORMAL SINUS RHYTHM

LFT: 13/8/23

TB: 0.87 MG/DL

DB: 0.19 MG/DL

SGOT: 16 IUL

SPGT: 12 IUL

ALP: 245 IUL

TP; 6.7 GM/DL

ALBUMIN: 3.45 GM/DL

A/G RATIO: 1.06

BLOOD GROUP: O +VE

CUE: ALBUMIN: TRACE

SUGARS: NIL

PUS CELLS: 3-4 CELLS

EPITHELIAL CELLS: 2-3 CELLS

RFT:13/8/23

UREA: 54 MG/DL

CREATININE: 1.4 MG/DL

URIC ACID: 7.3 MG/DL

CALCIUM: 10.0 MG/DL

PHOSPHOROUS: 5.7 MG/DL

SODIUM: 139 MEQL

POTASSIUM: 5.2 MEQL

CHLORIDE: 102 MEQL

HEMOGRAM: 13/8/23

HB: 10.9 GM/DL

TLC: 10,800 CELLS CUMM

PCV: 33.7 VOL %

RBC COUNT: 3.94 MILLIONS/CUMM

PLT: 3.36 LAKHS/CUMM

14/8/23

PT - 15SEC

INR - 1.11

APTT - 33SEC

TOTAL CHOLESTEROL - 135 MG/DL

TRIGLYCERIDES - 231 MG/DL

HDL - 31.3 MG/DL

LDL - 78.4 MG/DL

VLDL - 46.2 MG/DL

Treatment Given(Enter only Generic Name)

1.RT FEEDS (100ML WATER 2ND HRLY AND 200ML MILK 4TH HRLY)

2.TAB ECOSPRIN GOLD (75/75/20)

3.TAB TELMA 40 MG RT/OD

4.REGULAR ORAL SUCTIONING 6TH HRLY

5.MONITOR VITALS 4TH HRLY AND INFORM SOS

Advice at Discharge

1.RT FEEDS (100ML WATER 2ND HRLY AND 200ML MILK 4TH HRLY)

2.TAB ECOSPRIN GOLD (75/75/20)

3.TAB TELMA 40 MG RT/OD

4.REGULAR ORAL SUCTIONING 6TH HRLY