65 year old man with slurring of speech Deviation of mouth And inability to move left upper limb
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Chief complaint:
A 65 year old man came to OPD with the chief complaint of
slurring of speech
Deviation of mouth
And inability to move left arm( upper limb)
since 1 day
Motions since 7 months
History of present illness:
Patient was apparently asymptomatic 1 day back,then he developed
slurring of speech
Deviation of mouth
And weakness & inability to move left arm/ upper limb
pt was apparently asymptomatic 6 months back. Then he had 6/0 Loose stools 6-7 Episodes daily.
yellow colour
No pain Abdomen, No mucus and blood in stool
, H/o Fever 2 Episodes in the past 6 months not relieved by taking medication
No h/0 Nausea, vomitings.
H/o decreased appelite ":"6 months
Patient bought to the OPD with c/o slurring of speech, deviation of mouth to Right side. weakness of
left upper limb since yesterday morning.
pt was normal when he woke up and he suddenly developed weakness of left UL and, slurring of Speech & deviation of mouth to right side.
No h/0 cold, cough, Seizure, Headache) Blurring of Vision, Diplopia:
Clo/Pedal edema Sina 1 day Pitting type Upto ankle,
decreased urine output since 3 days.
No Burning micturition. NO SOB.
History of past illness:
No similar history
Known case of hypertension since 7yrs
Past history of hernia( hernioplasty) 18 years ago
History of falling on bathroom room leading to trauma on head
Not a known case of diabetes mellitus, epilepsy, tb
Personal history:
Daily routine: Pt wakes up at 7-8 am the rest up and eat at 11am-12pm and again rest or sits and have dinner and again rest
Diet: mixed
Appetite:normal
Bowel movements: abnormal since 7 months
Bladder movement micturition decreased since 3 days
Addictions: beedi
Stopped 1 month ago
Family history:
No similar or relevant past family history
GENERAL EXAMINATION:
Patient is conscious, coherent, cooperative, well oriented to time, place and person at the time of joining
-No pallor
-No icterus
-No lymphadenopathy
-No cyanosis
-No clubbing of fingers
- edema of feet- present upto ankle
-No malnutrition
-No dehydration
Vitals
Blood Pressure 140/80mmhg
Temperature-afebrile
Pulse rate - 88 bpm
Resp rate - 18 cpm
GRBS -94
Spo2 - 100%
SYSTEMIC EXAMINATION
▪️CVS
-no thrills
-no cardiac murmurs
S1&S2 sounds are heard
▪️RESPIRATORY SYSTEM
Bilateral air way entry present
No added sounds
ABDOMEN
Soft non tender
No organomegaly
▪️CNS
Wating and thinning of muscles is seen
*Higher mental function
Speech disturbances ,
Emotional disturbances( getting irritated easily)
CRANIAL NERVES:. R. L
I olfactory nerve
sense of smell. Normal Normal
II optic
Visual Acuity N. N
field of vision vision
Colous vision
Fundus
III & IVoculomotor nerve & trochlear
ExtraOcular Musles N. N
VI abducens nerve
Accomodation. Normal Normal
Ptosis. —. —(absent)
(Dropping of eye)
Nystagmus. —. —
V trigeminal
Sensory. Normal
Motor normal
Reflex Corneal. Normal Normal
Conjunctival. Normal Normal
Jaw jerk. N
VII facial nerve
motor normal in
Orbicularis oris.
baccinator.
Sensory - taste Ant 2/3rd.. of tounge
Reflex Corneal. N N
Conjunctival. N N
Secreto motor:
Moist eyes & tongue N N Buccal Mucosa N N
IX & X. (GLOSSOPHARYNGEL& (VAGUS)
Gag reflex
XII Hypoglossal Nerve
: Tone. N. Left ULhypotonia
Tongue profusion -no deviation
MOTOR SYSTEM:
BULK. Decreased in ul and LL
Inspection
Palpation
TONE UL. N Left hypotonia
LL. N N
POWER
•Wrist 0/5
R. L
UL. 4/5. 3/5
LL 4/5. 4/5
Reflexes
A superficial.
corneal. Normal Normal Conjunctival. Normal Normal
Palatal. Normal Normal
Sensory SYSTEM
Test
I-SPINOTHALAMIC Right Left
1. Crude touch. Normal Normal
2. Pain. Normal Normal
3. Temperature. Normal Normal
II POSTERIOR COLUMN
1.fine Touch. Normal Normal
2. Position sense. Normal Normal
III CORTICcal
1. Two point discrimination.NormalNormal
2. Hypotonia. Left ul +
Provisional diagnosis
Hypertension
CeebralVascular Accident hyperacute infarcts in temporal lobe
Investigation
MRI brain
Ultrasound
