A 74 year old female presented with weakness
Patient was apparently asymptomatic 10 years ago then she had met with RTA and had history of left forearm fracture , from then onwards she had ℅ weakness of left upper limb
Head injury unknown
Then 10 days back she had H/o fall while going to washroom,unconsciously
℅ weakness of right upper limb and lower limb and deviation of mouth to left side
She also had ℅ seizures at time of fall
She also had similar episodes 7-8 times since then
No ℅ head ache,nausea,vomiting
She is able to recognise faces
Decreased appetite,significant weight loss present
No ℅ fever ,cold,cough
Speech slurred
No h/o Htn,dm,epilepsy,asthma,tb,cva,cad
GCS-15/15
Tobacco chewer since 50 years
Alcoholic occasional since 50 years
General Examintaion:
Temperature:afebrile
Pr:92bpm
Bp:120/80mm hg
SpO2:98 at room air
Rr:18cpm
Cvs:s1s2 heard
Rs:bae+,nvbs
Per abdomen :soft ,non tender
Cns:alert,
Speech slurred
Reflexes:
Biceps triceps supinator knee ankle
Right. ++. ++. ++. ++. +
Left. +. +. +. +. +
Finger nose in coordination -no
Knee heel in coordination-no
INVESTIGATIONS:
Treatment:
Day 0:
TAB ECOSPRIN 75 mg po\od
TAB ATORVAS 20 mg po/hs
INJ OPTINEURON 1 amp in 100 ml NS IV BD
TAB MVT
physiotherapy of right upper limb and lower limb
Bp,Pr,spO2,RR CHARTING 6th hourly
Physiotherapy of all four limbs
Syp lactulose 10 ml /po /bd
Day 1:
TAB ECOSPRIN 75 mg po\od
TAB ATORVAS 20 mg po/hs
INJ OPTINEURON 1 amp in 100 ml NS IV BD
TAB MVT po od
physiotherapy of right upper limb and lower limb
Bp,Pr,spO2,RR CHARTING 6th hourly
Physiotherapy of all four limbs
Syp lactulose 10 ml /po /bd
Day 2:
TAB ECOSPRIN 75 mg po\od
TAB ATORVAS 20 mg po/hs
INJ OPTINEURON 1 amp in 100 ml NS IV BD
TAB MVT PO OD
physiotherapy of right upper limb and lower limb
Bp,Pr,spO2,RR CHARTING 6th hourly
Physiotherapy of all four limbs
Syp lactulose 10 ml /po /bd
Day 3:
TAB ECOSPRIN 75 mg po\od
TAB ATORVAS 20 mg po/hs
INJ OPTINEURON 1 amp in 100 ml NS IV BD
TAB MVT PO OD
physiotherapy of right upper limb and lower limb
Bp,Pr,spO2,RR CHARTING 6th hourly
Physiotherapy of all four limbs
Syp lactulose 10 ml /po /bd
Day 4:
Tab ECOSPRIN 75 mg/po/od
Tab ATORVAS 20 mg po /hs
Tab MVT PO/od
Physiotherapy of right upper limb and lower limb
Tab Pan 40 mg od
Tab LEVITRACETAM 500 mg po bd
ATT STARTED
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