ACUTE CVA SECONDARY TO ACUTE INFARCT IN LEFT FRONTAL LOBE AND INSULAR CORTEX WIRH LMN FACIAL PALSY

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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 90ML/DAY. LAST BINGE OF ALCOHOL 2 DAYS AGO
SMOKING: NO



ON EXAMINATION:
PATIENT IS DROWSY BUT AROUSABLE ORIENTED TO PLACE AND PERSON
TEMP-99.3F
PR-70BPM
BP-180/100 MM HG
RR-16 CPM
SPO2-96%AT RA
GRBS-98 MG/DL
RS-WHEEZE ABSENT
CNS- GCS-E4V4M6
PUPILS- B/L NSRL
Investigation
31-08-23
BLOOD UREA-65 mg/dl
SODIUM-142 mEq/L
POTASSIUM-4.3 mEq/L
CHLORIDE-102mEq/L
CALCIUM IONIZED-1.11 mmol/L
HEMOGLOBIN-12.2 gm/dl
TOTAL COUNT-7400
NEUTROPHILS-90%
LYMPHOCYTES-10%
EOSINOPHILS-00
MONOCYTES-00
PCV-39.9
MCV-77.5
MCH-23.7
MCHC-30.6
TOTAL BILURUBIN-1.12 mg/dl
DIRECT BILURUBIN-0.20 mg/dl
SGOT-31 IU/L
SGPT-13 IU/L
ALKALINE PHOSPHATASE-137 IU/L
TOTAL PROTEINS-7 gm/L
ALBUMIN-3.8 gm/L
SERUM CREATININE-1.3 mg/dl
01/09/23
TROPONIN-I - 2.9 pg/ml
02/09/23
BLOOD UREA-57mg/dl
SERUM CREATININE-1.2 mg/dl
2D ECHONO
MR/AR/TR
NO RWMA. NO AS/MS SCLEROTIC AV
GOOD LV SYSTOLIC FUNCTION
DIASTOLIC DYSFUNCTION PRESENT
NO PAH/PE
USG ABDOMENMINIMAL
ASCITES
MRI BRAIN PLAINACUTE
INFARCT IN LEFT FRONTAL LOBE AND LEFT INSULAR CORTEX
FEW SMALL ACUTE INFARCTS IN LEFT FRONTAL AND LEFT PARIETAL LOBE
LOSS OF FLOW VOID OF LEFT ICA SUGGESTIVE OF COMPLETE LEFT ICA OCCLUSION

Diagnosis
ACUTE CVA SECONDARY TO ACUTE INFARCT IN LEFT FRONTAL LOBE AND INSULAR
CORTEX,LEFT PARIETAL LOBE WITH ?ALCOHOL WITHDRAWL WITH RIGHT LMN FACIAL
PALSY WITH COPD WITH LOSS OF FLOW VOID IN LEFT ICA S/O COMPLETE LEFT ICA
OCCLUSION

Treatment Given(Enter only Generic Name)
1. RYLES FEED
WATER-100ML 2ND HRLY
MILK-200ML 4TH HRLY
2. IV FLUIDS NS AT 50ML/HR
3. INJ.THIAMINE 200MG IN 100ML NS IV/TID
4.TAB.ECOSPORIN 75MG + CLOPIDOGREL 75MG + ATORVASTATIN 20MG/R
5.PHYSIOTHERAPY OF RIGHT UPPER AND LOWER LIMB

Advice at Discharge
REFER TO HIGHER CENTRE:
PATIENT HAS BEEN REFERRED TO HIGHER CENTRE FOR VASCULAR SURGEON
INTERVENTION IN VIEW OF MRI FINDINGS
ACUTE INFARCT IN LEFT FRONTAL LOBE AND LEFT INSULAR CORTEX
FEW SMALL ACUTE INFARCTS IN LEFT FRONTAL AND LEFT PARIETAL LOBE
LOSS OF FLOW VOID OF LEFT ICA SUGGESTIVE OF COMPLETE LEFT ICA OCCLUSION

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