83 yr old male with left sided upper and lower limb weakness and right side deviation of mouth

A 83 yr old male patient came with the chief complaint of left lower limb weakness since yesterday morning 
Complaint of left upper limb weakness since25 days
Complaint ofright side deviation of mouth since yesterday morning 
HOPI: patient was apparently asymptomatic 25days agothen he had left upper limb weakness which was sudden in onset gradually progressive(from distal to proximal for which he used herbal medication
No c/o headache, vomiting , blurring of vision ,diplopia
H/o left upper limb weakness 5 yrs ago for which he used herbal medication 
H/o of RTA 4yrs ago rt upper limb and left shoulder fracture 
H/o pulmonary TB 3 yrs ago on ATT for 6 months 
Not a k/c/o HTN,DM,CAD, epilepsy
 GENERAL EXAMINATION:-

Patient is conscious , coherent & co-operative
Well built and nourished.
No signs of pallor, icterus, clubbing, cyanosis, pedal edema and lymphadenopathy.




Vitals @ admission 
Temp - 99.2F
RR -18CPM
PR - 68BPM
BP - 100/60mmHg
Spo2 - 98% RA

SYSTEMIC EXAMINATION:-
Respiratory system:-
Bilateral air entry present 
NVBS heard
Cardiovascular system:-
S1, S2 heard

CNS-
Level of consciousness:Conscious
Speech:slurred 
Cranial nerves:7th cranial nerve involved
Tone:    Rt.      Lt 
         UL. N     Decreased 
          LL.  N.    Decreased
 Power.   Rt.      Lt        
                 5/5.   0/5
                 5/5    3/5
Superficial- Corneal conjuctival and plantar reflexes present on both sides 
Deep - 
                   Rt.           Lt
Biceps       2+.          - 
Triceps      1+.          -
Knee          2+.            2+
Ankle          -              -
Plantar reflex:rt nd lt both extensors


Sensory Examination -
Fine touch vibration and joint sense 
is intact on both sides.
Pain and temperature intact on both sides 
Cerbellar functions - Normal
No signs of meningeal irritation.
Investigations:
Hb:15.3
Tc:7500
Plt count:2.34 lakhs/cumm

Lft:
TB:0.48
DB:0.23
SGOT:12
SGPT:18
Alkaline phosphate:261
Total proteins:7.6 gm/dl
Albumin:4.05



Rft:
Urea:29
Creatinine:1.5
Uric acid :3.3

RBS:203
       
                                ECG


                        MRI
. Multiple small acute infarcts in right cerebral hemisphere,predominantly in frontal and parietal lobes




Provisional diagnosis :
Acute ischemic stroke 
?TIA
Treatment :
1.Tab.ECOSPRIN 75 mg PO/HS
2.Tab MvT PO/BD
Monitor vitals.inform SOS





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