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:


Day 1 chest xray
Day 3 chest x ray
















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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