70 year old female with complaints of slurring of speech

 

M. Sri Nithya

Roll. No-86

Unit-2


70 year old female was brought to the casualty with complaints of slurring of speech in morning for 15 minutes at 8am following which patient returned to normal 

No loc, seizure like activity, drooling of saliva,deviation of mouth ,no weakness of limbs,
No H/O Fever; Headache; Giddiness
No H/O Chest pain; orthopnea; sweating, palpitations;, PND.
No H/O Burning Micturition
No H/O loose stools; Nausea, Vomiting
Was treated by local practioner with unknown medications
Patient continued her daily routine cooking,eating
At around 7pm patient developed similar episode lasting for 15 minutes
Was taken to Mothkur for treatment and was given clopidogrel a ,neurobion 
( no investigations were done)
On the way back to the home , patient developed deviation of mouth ,uprolling of eyeballs, dif haficulty in moving lower limbs with decreased responsiveness
Brought to our hospital for further management 

Daily wage labourer ( agriculture)
Stopped working 20years back 
Walking with support from past 3years due to worsening knee pains

2y back- neck pain, giddiness --> diagnosed as hypertension started on medication telma 40

1year increased giddiness diagnosed as cervical spondylosis and prescribed C collar

3-4 months back patient c/o increased giddiness imaging done showing no abnormality 
( no trauma/ recurrent falls)

Past history
K/C/O Hypertension since 10 years (on Telmisaratan 40Mg PO/OD)

Menopause attained 30 years ago.

OBSTERIC HISTORY
   Age of marriage: 13
   Age at first child birth: 14
   Para: 5
   No. of living children: 5

At presentation 
Patient 
Drowsy but arousable 
Concious and cooperative 
Gcs- E2V2M5
Pupils -bilateral Normal size ,reacting to light 
Vitals - 
Bp -110/70 mmHg
Pr- 95bpm regular
Rr- 18cpm
Sat - 100 on RA
Temp - 97F

Moderately built, well nourished
CARDIO VASCULAR SYSTEM
 S1S2 +
RESPIRATORY SYSTEM:
BAE present
Position of Trachea – Central
ABDOMEN
    Shape of abdomen – Obese
    Bowel sounds – Yes
CNS
Hmf - couldn't be assessed 
Gait- couldn't be assessed 
Motor- 
Tone- 
        Rt.     Lt. 
UL  inc.     Inc. 
LL.  Inc.     N

Reflexes- 
        B.     T.    S.     K.    A.   Pl
Rt. +++   ++   ++    ++   ++   Extension 
Lt.  ++   +++  ++    ++   ++  ex-> mute

Response to pain + in left upper limb and lower limb 














Meningeal signs-absent
Carotid bruit  absent

Cvs-s1,s2+, no added murmurs
Rs- bae+,nvbs present

Provisional diagnosis 
Acute stroke ? MCA. ? PCA

MRI done showing acute infarcts in occipital lobes

Fever chart
Chest Xray AP view
ECG

Investigations
Rbs 173
Blood urea 33
Hba1c 6.8
Tb 0.80
Db 0.20
Alkaline phosphatase 250
Albumin 3.1
Serum creat 0.8
Hb 13.1
Fbs 148

Treatment
RT feeds 200ml milk every 4th hourly
100ml water every hourly
IV fluids NS at 500ml/hr
Tab ecospirin AV 75/10mg po od 
Strict input output charting 

16/02/23
ICU-BED NO.2
UNIT 2
73-year-old female came to the casualty with 
c/o slurring of speech since 1 day 

S
One fever spike since yesterday at 9pm 101F
Stools passed 

O
On examination
Patient is concious but drowsy
Temp: afebrile
Bp 140/80mmhg
PR- 102bpm
Grbs 162mg/dl
15/2/23
8 am 170
2pm 147
8pm 147
Spo2- 95%
Input 2400
Output 1700
CARDIO VASCULAR SYSTEM 
 Cardiac Sounds S1S2 +
RESPIRATORY SYSTEM
BAE present, NVBS present 
Per abdomen:
Soft,non tender
Tone: normal in all 4 limbs 

Investigations
Hb 12.7
TLC 10800
PLT 2.43
A

Acute CVA secondary to acute infarct in ?right parietal lobe, B/l cerebellar hemisphere,B/L temporal lobe ,B/L thalamus, pons, midbrain with diffuse cerebral atrophy
k/c/ HTN since 10 years
Denovo DM

Treatment
RT feeds 200ml milk every 4th hourly
100ml water every hourly
IV fluids NS at 500ml/hr
Tab ecospirin 150 mg po od
Tab.clopitab 75 mg po/qid
Tab.Atorvac 40 mg po/hs
Monitor vitals every 2 nd hourly
Grbs charting every 6 th hourly 
Strict input output charting

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