60/M with ?CVA

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Interns:

Dr Archana

Dr Jeeharika

Dr Sreeja

Dr Harsha

Dr Kalyan

Dr Raveen PGY1

Dr Aashitha PGY2

Dr Aravind PGY3

Dr Vamshi PGY3

Dr Hareen SR

Dr Praveen Naik Ass Prof

DR. RAKESH BISWAS HOD

Here is a case i have seen:

Admission under unit 3 on 03/03/2021

60/M with C/O : inability to speak since evening (around 6pm.)

Deviation of angle of mouth to left side since evening (around 6pm)

Patient was apparently alright till evening, suddenly he was unable to speak (?slurring) with deviation of angle of mouth to left side. 

No h/o weakness of upper and lower limbs.

No h/o fall / LOC.

No h/o involuntary movements.

No h/o nausea/ vomiting/ fever 

Past history: 

No h/o DM /HTN /TB /Asthma /Epilepsy /thyroid abnormalities /CAD

h/o appendicecty in the past (30years back)

Personal history : 

Diet - mixed

Appetite - normal 

Sleep - adequate 

Bowel and bladder movements - regular 

Takes alcohol occasionally 

Not a smoker

Family history :

No significant family history 

Drug and allergic history :

No known drug and allergic history 

On examination : 

Patient is conscious, coherent and cooperative 

Moderately build and nourished 

Deviation of angle of mouth to left side.

No pallor/icterus/cyanosis/clubbing/generalised lymphadenopathy/ pedal Edema 

Vitals : 

BP: 110/70mmhg

PR: 98bpm

RR: 18cpm

SPO2: 98% at RA

Afebrile to touch

Systemic examination: 

CVS: s1,s2 heard, no murmurs 

RS: BAE present, no added sounds 

P/A: soft, non - tender 

CNS: 

Patient is oriented to time, place, person, and self 

Speech is slurred 

Increased tone in right upper limb

Power : 

              Right.              Left 

       UL.   3/5.              4/5

       LL.   4/5.               4/5

Reflexes 

                             Right.                     Left

Biceps.               3+                              3+

Triceps.              3+                              3+

Supinator.          0.                                0

Knee.                  2+                              2+

Ankle.                 3+                              3+

Plantar.           Withdrawal.        Withdrawal

Hb: 12.2 g/dl

Diagnosis : 

 Acute ischemic stroke - acute infarct in left frontal and parietal lobes and left insular cortex