CVA LEFT HEMIPERESIS WITH SLURRING OF SPEECH RESOLVED SECONDARY TO ACTE INFARCT IN RIGHT PARIETAL LOBE AND SUBACUTE INFARCT AND LEFT CEREBELLUM ,MID BRAIN AND PONS SECONDARY TO CARDIO EMBOLIC STROKE WITH K/C/O HTN

Case History and Clinical Findings

A 70 year old male resident of Elugupalli came to casualty with complaints of:

History of Fall while bathing 3 days back

Difficulty in walking since 3 days

Slurred speech since 3 days

HOPI:

Pt was apparently asymptomatic 3 days back, then he had history of Fall while bathing on 12/10/22 at

evening 4pm he was taking bath by sitting on a rock, suddenly he felt giddiness and fell on the ground

on his legs with supporting his left hand to a bucket (no injury to head), and later patient was referred

to WellCare hospital at Khammam and later he came to our hospital due to economic issues

Difficulty in walking and slurred speech since 3 days(after fall)

Past history:

K/C/O HTN since 12 yrs

H/O epilepsy 1 episode 12 yrs back

N/K/C/O DM, TB, Asthma, thyroid

Personal history 

Patient is a retired constable and then worked as a farmer later stopped working from 10 yrs

he takes mixed diet. His appetite was normal.

Sleep is inadequate from 3 days. Bowel and bladder movements are regular.

Takes Regular Alcohol from 25 yrs: Daily 5-6 units brandy or takes 1-2 bottles toddy, last taken 4

days back

Beedi:1 packet/day from 50 yrs, last taken 4 days bacK

General examination:

No pallor,icterus ,cyanosis,clubbing ,generalized oedema

Vitals:

On admission

pt is conscious,not coherent and cooperative

Temp: 97F

PR: 82BPM

RR: 24Cycles per min

BP: 140/90 mmhg

Spo2: 95

GRBS: 133 mg/dl

GENERAL EXAMINATION:

CVS:S1S2+

RS:BAE+

P/A:SOFT,NT

CNS:

1. HIGHER MENTAL FUNCTIONS:

 Patient sitting on the bed and responding to oral commands and questions

 Speech-slurring->relevant

 Thought: Craving for nicotine

2.CRANIAL NERVES: INTACT

3.MOTOR

 Power NORMAL

 Tone NORMAL

Reflexes: RIGHT-LOST, LEFT-NORMAL EXAGGREATED ON BICEPS

4.SENSORY:N

 position sense 7/10 7/10

Romberg's: Positive

5.CEREBELLAR

 Titubation: -

 Trunkal ataxia/ Gait ataxia: +

 Nystagmus: -

 Rebound phenomenon:+

 Wide based gait: -

 Intentional Tremor: -

 Pendular Knee Jerk: -

 Tandem walking: +

 Coordination

 Finger nose test: absent

 Heel Knee: absent

 Dysdiadokokinesia: +

6.ANS: Normal

7.Meningial signs: NO

8.Spine, cranium, peripheral nerves: Normal

ON DISCHARGE

PT IS C/C/C

BP:110/80MMHG

PR:82BPM

SPO2:97 ON RA

TEMP:AFEBRILE

RR:22

CVS:S1S2+

RS:BAE+

P/A:SOFT,NON TENDER

CNS:

MSE:NORMAL,SPEECH SLIGHTLY SLURRY-RELAVANT

REFLEXES

BI: RT2+,LTRomberg's: Positive

5.CEREBELLAR

 Titubation: -

 Trunkal ataxia/ Gait ataxia: +

 Nystagmus: -

 Rebound phenomenon:+

 Wide based gait: -

 Intentional Tremor: -

 Pendular Knee Jerk: -

 Tandem walking: +

 Coordination

 Finger nose test: absent

 Heel Knee: absent

 Dysdiadokokinesia: +

6.ANS: Normal

7.Meningial signs: NO

8.Spine, cranium, peripheral nerves: Normal

ON DISCHARGE

PT IS C/C/C

BP:110/80MMHG

PR:82BPM

SPO2:97 ON RA

TEMP:AFEBRILE

RR:22

CVS:S1S2+

RS:BAE+

P/A:SOFT,NON TENDER

CNS:

MSE:NORMAL,SPEECH SLIGHTLY SLURRY-RELAVANT

REFLEXES

BI: RT2+,LT2+

TRI:RT2+, LT2+

SUP:RT+, LT-2+

TRI:RT2+, LT2+

SUP:RT+, LT-

K:RT-, LTA:RT-,

LTPLANTAR:

RT MUTE, LT MUTE

TONE:

RT-UL(N), LL(HYPER)

LT-UL(HYPER), LL(HYPO)


Treatment Given(Enter only Generic Name)

DAY-1

1.T. ESCOPSRIN AV 75mg PO/ODH/S

2.T. CLINIDIPINE 10mg PO/OD

3.T. UDILIV 300 mg PO/BD

4. T. LIBRIUM 10MG PO/BD

5.Inj.CEFTRIAXONE 2MG IV/BD

DAY-2:

1.T. ESCOPSRIN AV 75mg PO/ODH/S

2.T. CLINIDIPINE 10mg PO/OD

3.T. UDILIV 300 mg PO/BD

4. T. LIBRIUM 10MG PO/BD

5.Inj.CEFTRIAXONE 2MG IV/BD

DAY-3:

1.T. ESCOPSRIN AV 75mg PO/OD H/S

2.T. CLINIDIPINE 10mg PO/OD

3.T. UDILIV 300 mg PO/BD

4T. LIBRIUM 25MG PO/BD

5.Inj.CEFTRIAXONE 2MG IV/BD

6.T. BENFOTHIAMINE 100mg PO/BD

7.NICOTINE ZOLENGES 2mg BD

DAY-4

1.IV Fluids 1-DNS @30ml/hr

2.Inj.CEFTRIAXONE 2G IV/BD

3.6.INJ.THIAMINE 200mg IV/TID 4.T.ESCOPSRIN AV 75mg PO/OD H/S

5.T.CLINIDIPINE 10mg PO/OD

6.T. LIBRIUM 10mg PO/BD

7.T.UDILIV 300 mg PO/BD

8.T.LORAZEPAM 2mg PO/OD(x-x-1)

9.T.QUETIAPINE 12.5mg PO/OD(x-x-1)

10.NICOTINE ZOLENGES 2mg BD(1-x-1)

Day-5:

1.IV Fluids 1-DNS @30ml/hr

2.Inj.CEFTRIAXONE 2G IV/BD

3.INJ.THIAMINE 200mg IV/TID 4.T.ESCOPSRIN AV 75mg PO/OD H/S

5.T.CLINIDIPINE 10mg PO/OD

6.T. LIBRIUM 10mg PO/BD7

7.T.UDILIV 300 mg PO/BD

8.T.LORAZEPAM 2mg PO/OD(x-x-1)

9.T.QUETIAPINE 12.5mg PO/OD(x-x-1)

10.T.PCM 650mg PO/SOS

11.NICOTINE ZOLENGES 2mg SOS

DAY-6:

1.Inj.CEFTRIAXONE 2G IV/BD

2.INJ.THIAMINE 200mg IV/TID

3.T.ESCOPSRIN AV 75mg PO/OD H/S

4.T.AZITHROMYCIN 500MG PO OD

5.T.CLOPITAB 75MG PO/OD

6.T.CLINIDIPINE 10mg PO/OD

7.T. LIBRIUM 10mg PO/BD7

8.T.UDILIV 300 mg PO/BD

9.T.LORAZEPAM 2mg PO/OD(x-x-1)

10.T.QUETIAPINE 12.5mg PO/OD(x-x-1)

11.T.PCM 650mg PO/SOS

12.NICOTINE ZOLENGES 2mg SOS

13.NEBULISE WITH DUOLIN AND BUDECORT 6TH HRLY

DAY-7:

1.Inj.CEFTRIAXONE 2G IV/BD

2.INJ.THIAMINE 200mg IV/TID

3.T.ESCOPSRIN AV 75mg PO/OD H/S

4.T.AZITHROMYCIN 500MG PO OD

5.T.CLOPITAB 75MG PO/OD

6.T.CLINIDIPINE 10mg PO/OD

7.T. LIBRIUM 10mg PO/BD7

8.T.UDILIV 300 mg PO/BD

9.T.LORAZEPAM 2mg PO/OD(x-x-1)

10.T.QUETIAPINE 12.5mg PO/OD(x-x-1)

11.T.PCM 650mg PO/SOS

12.NICOTINE ZOLENGES 2mg SOS

13.NEBULISE WITH DUOLIN AND BUDECORT 6TH HRLY

14.T.PULMOCLEAR PO BD

17.SYP.ARISTOZYME 15ML PO TID

18.T.OROF XT PO OD

DAY-8

1.Inj.CEFTRIAXONE 2G IV/BD

2.INJ.THIAMINE 200mg IV/TID

3.T.ESCOPSRIN AV 75mg PO/OD H/S

4.T.AZITHROMYCIN 500MG PO OD

5.T.CLOPITAB 75MG PO/OD

6.T.CLINIDIPINE 10mg PO/OD

7.T. LIBRIUM 10mg PO/BD

8.T.UDILIV 300 mg PO/BD

9.T.LORAZEPAM 2mg PO/OD(x-x-1)

10.T.QUETIAPINE 12.5mg PO/OD(x-x-1)

11.T.PCM 650mg PO/SOS

12.NICOTINE ZOLENGES 2mg SOS

13.NEBULISE WITH DUOLIN AND BUDECORT 6TH HRLY

14.T.PULMOCLEAR PO BD

17.SYP.ARISTOZYME 15ML PO TID

18.T.OROF XT PO OD

DIAGNOSIS 

LEFT HEMIPERESIS WITH SLURRING OF SPEECH RESOLVED SECONDARY TO ACTE INFARCT IN RIGHT PARIETAL LOBE AND SUBACUTE INFARCT AND LEFT 

Advice at Discharge

1.T.ECOSPRIN AV 75mg PO/OD H/S

2.T.CLOPITAB 75MG PO/OD

3.T.CLINIDIPINE 10mg PO/OD

4.T.MVT PO/OD

5.T.PAN 40MG PO/OD

6.T.LORAZEPAM 2mg PO/OD(x-x-1)

7.LIBRIUM 10MG PO/OD

8.UDILIV 300MG PO/BD

9.T.THIAMINE 100MG PO/TID

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