Clinical Logs

Parvathalu Chief Complaints: c/o of slurring of speech and deviation of mouth to the right side since yesterday morning. HOPI:  Patient was apparently asymptomatic 10 years back after which he had a history of a thorn prick to the left middle finger which formed a swelling filled with pus. - Patient was diagnosed to have diabetes mellitus, after which his left middle finger was amputated. Since then, the patient is on regular diabetic medication. -H/O of burning sensation and tingling in both lower limbs since 1 year - Patient is having slurring of speech and deviation of mouth to the right side since yesterday morning - No H/O weakness of limbs, seizures, trauma, headache/nausea, or fever. Past history: -K/C/O DM type 2 since the last 10 years (on regular medication, Glimi M1) Personal History: Diet: Mixed Appetite: Normal Bowel and Bladder Movements: Normal Smoking: Regular smoker since 40 years - 40 pack years Alcohol: Regular Drinker since 35 years.  GENERAL EXAMINATION: Pt is C/C1

BIKSHAMAIAH CHIEF COMPLAINTS: PATIENT WAS BROUGHT TO CASUALITY WITH COMPLAINTS OF DIFFICULTY IN SWALLOWING AND DROOLING OF SALIVA SINCE YESTERDAY EVENING. HISTORY OF PRESENT ILLNESS: PATIENT WAS APPARENTLY NORMAL 2-3 YEARS BACK , HE THEN DEVELPOED WEAKNESS OF LEFT UPPER LIMB INSIDIOUS IN ONSET AND GRADULLAY PROGRESSIVE OVER 2-3 DAYS.INITIALLY HAD FEVER WHICH WAS FOLLOWED BY WEAKNESS AND APHASIA.APHASIA AND WEAKNESS THEN IMPROVED OVER 2MONTHS WITH SLURRING OF SPEECH ,CONTINUED MEDICATION. 2MONTHS BACK PATIENT HAD FEVER FOLLOWED BY WEAKNESS OF RIGHT UPPER LIMB AND APHASIA. RIGHT UPPER LIMB WEAKNESS IMPROVED BUT APHASIA IS STILL PRESENT. PATIENT SUDDENLY DEVELOPED DROOLING OF SALIVA SINCE YESTERDAY NIGHT AND WITH DIFFICULTY IN SWALLOWING ORALLY. NO H/O LOSS OF CONSIOUSNESS,SHORTNESS OF BREATH,CHEST PAIN. PAST HISTORY: K/C/O HYPERTENSION SINCE 10YERAS USING UNKOWN MEDICATION T.TELMA 40MG OD K/C/O SEIZURES SINCE 10YERAS USING T.EPOTIN 100MG BD LAST EPISODE 45DAYS BACK. K/C/O CVA SINCE 3YEAR

SK MAHBUBI  CHIEF COMPLAINTS: C/O WEAKNESS OF RIGHT LOWER SINCE YESTERDAY AND VOMITINGS 2 EPISODES HOPI: PT WAS APPARENTLY ASYMPTOMATIC 1 DAY BACK THEN DEVELOPED WEAKNESS OF RIGHT LOWER LIMB SUDDEN IN ONSET GRADUALLY PROGRESSIVE VOMITINGS 2 EPISODES WITH FOOD AS CONTENT NON PROJECTILE, NON BILIOUS, NOT ASSOCIATED WITH DEVIATION OF MOUTH , DROOLING OF SALIVA NO LOSS OF WRINKLES ON FOREHEAD , NO DIFFICULTY IN COMBING OF HAIR, MIXING FOOD, NO H/O INVOLUNTARY MICTURITION , NO H/O FALL OR TRAUMA NO H/O INVOLUNTARY MOVEMENTS , HEADACHE NO LOSS OF CONSCIOUSNESS, SLURRING OF SPEECH PAST HISTORY: K/C/O HTN SINCE 5 YEARS NOT USING MEDICATION N/K/C/O DM2, CVA, CAD, ASTHMA, THYROID DISORDERS , SEIZURE EPISODES PERSONAL HISTORY: DIET: MIXED  SLEEP: ADEQUATE BOWEL AND BLADDER MOVEMENTS: NORMAL ALCOHOL: NO SMOKING: NO GENERAL EXAMINATION: AFEBRILE. PR: 103 BPM BP: 240/120 MMHG. RR: 18 CPM SPO2: 98% GRBS: 138 MG/DL SYSTEMIC EXAMINATION: CVS:S1, S2 + RS:B/L AE+, NVBS. P/A:SOFT, NON TENDER. CNS: PUPILS

SOKKAM CHIEF COMPLAINTS: PATIENT WAS BROUGHT WITH COMPLAINTS OF FEVER SINCE 3 DAYS AND WEAKNESS OF RIGHT UPPER LIMB AND LOWER LIMB SINCE 31/08/23 AFTERNOON 3PM. HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO.HE THEN DEVELOPED FEVER OF HIGH GRADE WITH CHILLS AND RIGOR ,RELIEVED WITH MEDICATION.NO DIURNAL OR SEASONAL VARIATION.HE THEN DEVELOPED WEAKNESS AND UNABLE TO MOVE RIGHT UPPER LIMB AND LOWER LIMB SINCE 6 HOURS SUDDEN ONSET,WHILE TAKING BATH,N/H/O FALL,H/O ?LOSS OF CONSCIOUSNESS FOR 5 MINUTES N/H/O INVOLUNTARY MOVEMENTS IN BILATERAL UPPER AND LOWER LIMB,UPROLLING OF EYEBALL,TONGUE BITE N/H/O BLURRING OF VISION DEVIATION OF ANGLE OF MOUTH TO HIS LEFT SIDE SLURRING OF SPEECH PRESENT LAST BINGE OF ALCOHOL 2 DAYS AGO PAST HISTORY: N/H/O COUGH,BURNING MICTURITION,SOB,PALPITATIONS,PEDAL EDEMA N/K/C/O HTN/DM/CAD N/H/O VOMITINGS,LOOSE STOOLS,PAIN ABDOMEN PERSONAL HISTORY: DIET: MIXED  SLEEP: ADEQUATE BOWEL AND BLADDER MOVEMENTS: NORMAL ALCOHOL: REGULAR DRINKER SINCE 25 YEARS AROUND 9

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, COOPER

N. RAVI CHIEF COMPLAINTS: A 48 YEAR OLD MALE CAME TO CASUALITY WITH COMPLAINTS OF DIFFICULTY IN SWALLOWING INCREASED FREQUENCY OF URINE UNILATERAL WEAKNESS OF LEFT SIDE UPPER AND LOWER LIMBS SINCE 1 WEEK HISTORY OF PRESENTING ILLNESS: PATIENT WAS APPARENTLY ALRIGHT 1 WEEK BACK AND THEN HE DEVELOPED DIFFICULTY IN SWALLOWING SINCE 1 WEEK ;SOLIDS GREATER THAN LIQUIDS INCREASED FREQUENCY OF URINE SINCE 1 WEEK ;SENSES ABSENT;FOUL SMELLING . NO H/O FEVER,COLD,COUGH. NO H/O BURNING MICTURITION.NO H/O CHEST PAIN ,PALPITATIONS,SWEATING,SOB PAST HISTORY: K/C/O CVA IN 2019 -TAB.CARDIOSTATIN -10 GOLD K/C/O EPILEPSY IN 2019 -TAB.LEVITERACETAM 500 MG PO /OD K/C/O DM TYPE 2 SINCE 12 YEARS ON INJ MIXTARD AND TABLET TENEGLIPTIN 20 MG PO/OD PERSONAL HISTORY: DIET: MIXED  SLEEP: ADEQUATE BOWEL MOVEMENTS: NORMAL BLADDER MOVEMENTS: INCREASED FREQUENCY OF MICTURITION SINCE 1 WEEK ALCOHOL: REGULAR DRINKER SINCE 20 YEARS. STOPPED 6 YEARS AGO. SMOKING: NO GENERAL EXAMINATION: ON EXAMINATION PT IS C/C/C NO PALL

This is a case of a 60 year old female with Ballismus Chief complaints: The patient was brought by her attendings to casualty with history of involuntary movements of both upper and lower limbs and head since 4 days.  History of presenting illness: Patient was apparently asymptomatic 6 days back. Then she had severe dragging pain in both upper and lower limbs. She was taken to the local hospital and was found to have high blood sugars (600 mg/dl). She was admitted for 2 days and treated with insulin injections.  The day after the discharge, she suddenly had involuntary movements of all four limbs and head. No aggravating and relieving factors No h/o aura, post ictal confusion, amnesia, loss of bladder control, uprolling of eyes No complaints of fever, cold, cough, vomiting, loose stools, SOB, chest pain, facial puffiness, decreased urine output, orthopnea, PND No h/o trauma, fever, vomiting, diarrhea Past history: K/c/o type 2 DM since 10 days Not a known case of HTN, TB, asthma, epile