R.sriharsha ;reg no:1701006146




CASE:

CHIEF COMPLAINTS:
A 64yr old male
Patient came to casuality with chief complaints of 
- unable to talk since 4 days
- hiccups since 7 days
- bowel and bladder incontinence, loss of appetite since 3 days 
- loose stools 5 days back relieved on medication 
- fever 4 days back 

HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic 7 days back , he then developed hiccups , loss of speech

- 5 days back he developed diarrhoea 5 episodes/ day , for one day which was relieved on medication 

-loss of appetite since 3 days , since one day he is unable to talk
 
- No H/O SOB , cough , palpitations
- No H/O loss of consciousness , giddiness , involuntary passage of urine and stools .

PAST HISTORY:

h/o panic attack one month back secondary to family issues 

- K/C/O DM2 since 2 yrs , on medication , 
-tab Metformin OD , tab Glimiperide OD

- Not a K/C/O HTN, TB, Asthma, epilepsy, CAD, CVD

PERSONAL HISTORY:

Appetite - lost

Diet - Mixed 

Sleep - adequate

Bowel and bladder movements - incontinence 

Addictions: Occasional alcoholic ( during functions ) , tobacco chewing occasionally 

Allergies : No allergies  

FAMILY HISTORY: Not significant

GENERAL EXAMINATION:

Patient is conscious ,incoherent , uncooperative
 Moderately Built and Moderately Nourished .

Pallor : present 
Icterus : absent 
Cyanosis: absent 
Clubbing : absent 
Lymphadenopathy : absent 
Edema : absent








 vitals :- 

Temp: Afebrile 
BP : 100 / 50 mmHg 
PR : 120 bpm 
RR : 16 cpm 
SPO2 : 98 % at RA
GRBS : 193 mg/dl 



SYSTEMIC EXAMINATION :

CNS examination :-
State of consciousness : conscious 
Speech : incoherent 
Kernigs sign :- positive

Sensory system :- 

Pain - Normal 
Touch- fine touch - normal
      crude touch - normal
Temp - normal
Vibration - normal
Joint position - normal

Cranial nerves : intact


CNS :-
                    Right. Left
Tone :- UL N. N
               LL. N. N

Power :- UL. 5/5. 5/5       
               LL 5/5 5/5 

Reflexes :-
Biceps + +
Tricep s + +
Supinator + +
Knee + +
Ankle. ++
Flexor. Plantar. Plantar 

Finger nose in coordination - no 
Heel knee in coordination - no

CVS : S1 S2 + ,no murmurs ,no thrills 

Respiratory System : decreased air entry on left side . Diffuse crepts on left side. Position of trachea - central.

Per abdominal examination:- 

Soft , non tender , no signs of organomegaly 

Investigations:- 
ECG 


CHEST XRAY PA VIEW:



USG abdomen : 



MRI BRAIN :


Hemogram


RBS:


LFT :


Serum creatinine :



Serum electrolytes : 



provisional diagnosis:- 

CVA: cerebro vascular accident , meningitis

Management:-
Initial management:
*Assess ABCs
*Secure airway
*Monitor oxygenation
*Provide ventilatory support if required

1) IVF 0.9 %NS IV @ 50 ml / hr 
2) Inj , 1 amp Optineuron in 500 ml NS IV /OD 
3) tab Ecosprin AV 75/10 RT / OD / HS
4) GRBS monitoring 6 th hrly 
5) Inj Thiamine 200 mg IV/BD in 100 ml NS 


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