55 yr old with sluring of speech
1801006059- Long Case
PER ABDOMEN
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CASE-
A 55 year old male with chief complaints of
- deviation of mouth to left side since 2 days and
- slurring of speech since 2 days
History of presenting illness:
Patient was apparently asymptomatic 2 days ago.
He then developed slurring of speech which was sudden in onset . He also developed B/L blurring of vision which was sudden in onset and which lasted for an hour . On the same day his wife noticed deviation of mouth to left side and was taken to local doctor for which he was given ORS but the symptoms had not subsided.
The next day his wife took him to another doctor for which he was given ORS again.
On 13/03/2023 he came to the our hospital.
At the time of presentation
- slurring of speech had decreased
-slight deviation of mouth was present
No weakness of upper and lower limb
No h/o loss of consciousness
No drooping of eyelids
No drooling of saliva
No difficulty in swallowing
Daily routine:
Patient is a farmer by occupation resident of yadgirigutta.
Patient wakes up at 5am in the morning and does his daily work and prays for an hour.
He has rice for breakfast by 8 am.
He goes to the fields along with his wife on scooty by 9am.
He has his lunch by 1pm.
In the evening they return from work at 6pm.
He goes for bath and has his tea.
He has rice for dinner at 8pm and prays for an hour.
He goes at bed at 10pm.
Past history:
No history of similar complaints in the past.
Patient is a known case of Hypertension since 1 year and does not take his medication regularly.
History of tuberculosis 21 years ago and was on medication.
Personal history:
Diet: mixed
Apetite: normal
Sleep: disturbed
Bowel and bladder: regular
Addictions: drank sara when he was 23 years old and stopped when he was 30 years.
Family History-
Father is a known case of Diabetes Hypertension and Tuberculosis and he passed away due to COVID.
Mother passed away due to breast cancer
Both the sons of the patient were also affected with tuberculosis at the same time
Both his sisters are known case of diabetes and Hypertension
Brother , sister in law,and both their children were affected with tuberculosis.
Brother had history of stroke 3 years back.
General examination:
Patient is conscious,coherant,cooperative,moderately built and moderately nourished.
Pallor:absent
Icterus:absent
Cyanosis:absent
Clubbing: absent
Lymphadenopathy:absent
Pedal edema:absenti
Vitals:
Temperature: afebrile
Pulse: 60 beats per minute
Blood pressure: 130/80 mmHg
Respiratory rate: 18 cycles per minute
Systemic examination:
CNS:
conscious,coherent and cooperative
memory- able to recognize his family members
Speech - comprehension present, no fluency, repetition present
Cranial nerve examination
I- Olfactory nerve- sense of smell present
II- Optic nerve- direct and indirect light reflex present
III- Oculomotor nerve, IV- Trochlear and VI- Abducens- no diplopia, nystagmus or ptosis
V- Trigeminal nerve- Masseter, temporalis and pterygoid muscles are normal. Corneal reflex is present.
VII- Facial nerve- face is symmetrical, forehead wrinkling present , nasolabial folds prominent on both sides.
VIII- Vestibulocochlear nerve- decreased hearing of the left ear ( rinne’s negative for 256 Hz and 512 Hz) and normal hearing of the right ear
IX- Glossopharyngeal nerve- palatal movements present and equal
X- Vagus- palatal movements present and equal
XI- Accessory nerve- sternocleidomastoid contraction present
XII- Hypoglossal nerve- deviation of tongue to right side and no fasciculations present
Sensory system examination:
Right Left
crude touch present present
fine touch Present present
pain Present Present
vibration Present Present
temperature Present Present
stereognosis Present Present
2 pt discrimination Present Present
graphaesthesia Present Present Motory examination-
Rt. Lt.
BULK: U/L- arm 28cm 29cm
-forearm 20 cm 22cm
L/L- thigh 49cm 49cm
- leg 33cm 31cm
TONE : U/L Norrmal normal
L/L Normal normal
Right Left POWER:
U/L- Arm 5/5 5/5
Forearm 5/5 5/5
L/L Hip 5/5 5/5
- knee 5/5 5/5
- ankle 5/5 5/5
REFLEXES-
Right Left Biceps ++ ++
Triceps ++ ++
Knee ++ +++
Ankle + +
Plantar Flexion Flexion
Gait.- Normal
Videos
CVS: Inspection
Chest wall is bilaterally symmetrical.
No precordial bulge is seen
Palpation
JVP- Normal
Apex beat -felt in the left 5th intercoastal space in the mid clavicular line
Auscaltation-
S1&S2 are heard,no murmur found.
RESPIRATORY SYSTEM
Position of trachea- central
Bilateral air entry, normal vesicular breath sounds are heard.
No added sounds
On inspection:
Abdominal distention - absent
All quadrants are moving equally with respiration
Umbilicus - central and inverted
No scars,dilated veins, prominent Venous pulsations and visible peristalsis.
On palpation::- No Local rise in temperature and no - No guarding, rigidity
INVESTIGATIONS-
Complete blood picture
Haemoglobin:11.7
Peripheral smear: normocytic normochromic anemia
Red blood cells:3.86u
Pcv:34.6
Platelet count:2.10
Total leucocyte count:5,100
Fasting blood sugar : 92 mg/dl
Serum creatinine :1.3 mg/dl
Blood urea 38 mg/dl
CUE:
Colour : pale yellow
Appearance : clear
Reaction :acidic
Albumin:nil
Sugar: nil
Bile salts and bile pigments : nil
RBC : nil
Crystals :nil
Casts : nil
pus cells:2-3
epithelial cells-2-3
Serum electrolytes
Sodium: 145 mEq/L
Potassium:4.2mEq/L
Chloride:104
Calcium ionized:1.11 mmol/L
ECG:
MRI :
2D ECHO:
https://youtube.com/shorts/J_NReYstBi8?feature=share
Treatment:
INJ. OPTINEURON 1 AMP IN 500ML
IV FLUIDSNS IV OD
TAB. CLOPITAB 75 MG PO/OD
TAB. ECOSPRIN AV 75/10 PO
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