60 year old male with acute ischaemic stroke
60 year old male,farmer by occupation came with complaints of:
Provisional diagnosis:
- Irrelevant talk since 10 days.
- Altered sensorium since 10 days.
History of present illness:
Patient was apparently asymptomatic 10 days back then he developed altered sensorium and irrelevant talk.
No H/O limb weakness, seizures, headache, fever,vomitings/loose stools.
Patient was apparently normal and went to work on 12/12/21 and slept at night.On 13/12/21 after waking up the patient was walking aimlessly at home and was talking irrelevantly.
He was taken to outside hospital 2 days later and was diagnosed with acute infarct in right frontotemporoparietal region,was admitted and treated for the same.
C/O hallucinations present after admitting in the hospital.
Past history:
H/O PTCA (2° to CAD) in 2016.
H/O giddiness 2 years ago diagnosed with CVA(left cerebellar infarct)-not on any medication.
Denovo HTN.
Personal history:
Diet-mixed
Appetite-normal
Sleep-adequate
Bowel and bladder movements-regular
Daily alcohol consumer-90-180ml
Daily cigarette smoker-1 pack/day
General examination:
No pallor,icterus,cyanosis,clubbing,
lymphadenopathy,edema.
Vitals on admission:
Temperature-98 F
PR-93 bpm
RR-18 cpm
BP-190/110 mmhg
SpO2-98% @RA
GRBS-88 mg%
Systemic examination:
CVS-S1,S2 heard
RS-BAE present, NVBS heard
P/A-soft,non-tender
CNS
GCS-E4V3M6
Not obeying commands
Irrelevant speech
Increased tone in all 4 limbs
Motor system-moving all 4 limbs
Reflexes: Right left
Biceps 3+ 2+
Triceps 3+ 2+
Supinator 3+ 2+
Knee 3+ 3+
Ankle 2+ 2+
Plantar mute flexor
Investigations:
Acute infarct in right frontotemporoparietal region.Denovo HTN.
S/P PTCA.
?Alcohol withdrawal delirium.
Treatment:
Tab.Ecospirin 150mg RT OD
Tab.Clobitab 75mg RT OD
Tab.Atorvas 40mg RT H/S
Tab.Telma 40mg RT OD
Tab.Met-xl 25mg RT OD
Tab.Librium 25mg RT BD
RT feeds 2nd hrly 100ml milk+water
Tab.Nicardia 10mg RT stat
Inj.Thiamine 100mg in 100ml NS IV BD
GRBS monitoring 12th hrly
BP/PR monitoring 2nd hrly
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