Recurrent Ischemic CVA with Brocas Aphasia

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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, COOPERATIVE, WELL ORIENTED TO TIME, PLACE
AND PERSON, MODERATELY BUILT AND NOURISHED.
VITALS:
BP: 110/70 MMHG
PR: 115 BPM
RR: 16 CPM
GRBS:113 MG/DL
TEMP: 98.4 F
CVS: S1, S2 HEARD, NO MURMURS
RS: BAE +, NVBS, NO ADDED SOUNDS
P/A: SOFT, NON TENDER
CNS:
CRANIAL NERVE : 9TH AND 10TH NERVES INVOLVED
MOTOR SYSTEM:
TONE-RIGHT(UL-INCREASED,LL-INCREASED)
LEFT(UL-NORMAL,LL-NORMAL)
POWER-RIGHT(UL-2/5,LL-4/5)
LEFT(UL-4+/5,LL-4+/5)
REFLEXES: B T S K A P
RIGHT +++ +++ +++ +++ +++ E
LEFT ++ ++ ++ ++ + f

COURSE IN THE HOSPITAL :
60 YRS FEMALE WAS ADMITTED WITH ABOVE MENTIONED COMPLAINTS. NECESSARY
EXAMINATIONS AND INVESTIGATIONS WERW DONE AND DIAGNOSED AS RECURRENT
ISCHEMIC CVA (ACUTE INFARCT IN LEFT PARIETAL LOBE AND RIGHT PARIETAL LOBE) WITH
RIGHT HEMIPARESIS ?BROCA'S APHAISA(HYPERTENSION SINCE 4 YRS).THE PATIENT WAS
CONSERVATIVELY MANAGED. THE SYMPTOMS SUBSIDED. PATIENT IS HEMODYNAMICALLY
STABLE AND PLANNED FOR DISCHARGE.

Diagnosis
RECURRENT ISCHEMIC CVA (ACUTE INFARCT IN LEFT PARIETAL LOBE AND RIGHT
PARIETAL LOBE) WITH RIGHT HEMIPARESIS ?BROCA'S APHAISA.
(HYPERTENSION SINCE 4 YRS)

Investigation
MRI DONE ON 13/08/23
IMPRESSION:
-ACUTE INFARCT IN LEFT PARIETAL LOBE.
-ACUTE INFARCT IN RIGHT PARIETAL LOBE ADJACENT TO THE MARGINS OF OLD INFARCT.
-FEW ACUTE LACUNAR INFARCTS IN RIGHT PARIETAL LOBE.
-OLD INFARCTS IN B/L FRONTAL LOBES, RIGHT PARIETO OCCIPITAL LOBE , LEFT OCCIPITAL
LOBE, LEFT PERIVENTRICULAR, LEFT STRIATO CAPSULAR REGION AND RIGHT SIDE OF
PONS.
CHEST X RAY - NORMAL
ECG -NORMAL SINUS RHYTHM
LFT: 13/8/23
TB: 0.87 MG/DL
DB: 0.19 MG/DL
SGOT: 16 IUL
SPGT: 12 IUL
ALP: 245 IUL
TP; 6.7 GM/DL
ALBUMIN: 3.45 GM/DL
A/G RATIO: 1.06
BLOOD GROUP: O +VE
CUE: ALBUMIN: TRACE
SUGARS: NIL
PUS CELLS: 3-4 CELLS
EPITHELIAL CELLS: 2-3 CELLS
RFT:13/8/23
UREA: 54 MG/DL
CREATININE: 1.4 MG/DL
URIC ACID: 7.3 MG/DL
CALCIUM: 10.0 MG/DL
PHOSPHOROUS: 5.7 MG/DL
SODIUM: 139 MEQL
POTASSIUM: 5.2 MEQL
CHLORIDE: 102 MEQL
HEMOGRAM: 13/8/23
HB: 10.9 GM/DL
TLC: 10,800 CELLS CUMM
PCV: 33.7 VOL %
RBC COUNT: 3.94 MILLIONS/CUMM
PLT: 3.36 LAKHS/CUMM
14/8/23
PT - 15SEC
INR - 1.11
APTT - 33SEC
TOTAL CHOLESTEROL - 135 MG/DL
TRIGLYCERIDES - 231 MG/DL
HDL - 31.3 MG/DL
LDL - 78.4 MG/DL
VLDL - 46.2 MG/DL

Treatment Given(Enter only Generic Name)
1.RT FEEDS (100ML WATER 2ND HRLY AND 200ML MILK 4TH HRLY)
2.TAB ECOSPRIN GOLD (75/75/20)
3.TAB TELMA 40 MG RT/OD
4.REGULAR ORAL SUCTIONING 6TH HRLY
5.MONITOR VITALS 4TH HRLY AND INFORM SOS

Advice at Discharge
1.RT FEEDS (100ML WATER 2ND HRLY AND 200ML MILK 4TH HRLY)
2.TAB ECOSPRIN GOLD (75/75/20)
3.TAB TELMA 40 MG RT/OD
4.REGULAR ORAL SUCTIONING 6TH HRLY

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