85 year old female with left sided weakness

August 04, 2020

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Case discussion:

4-8-2020

85 year old female presented to casualty with complaints of

-slurring of speech since yesterday evening around 6pm with deviation of mouth to right side

she was taken to local hospital with bp recording of 240/120 mmhg.some medication (unknown) was given where bp was lowered to 150/90 mmhg

she developed weakness of left upper limb and lower limb

Since 5yrs she used to have difficulty in walking.she uses walking aid(stick) since 4yrs.

frowning present,she was able to close eyes.

no history of involuntary movements, drooling of saliva,tongue bite,chest pain,SOB,pedal edema,fever,vomitings,loose stools,pain abdomen, micturition.

PAST HISTORY-

not a known case of HTN,DM,TB,CVA,CAD, epilepsy,

history of NSAID abuse since 4-5 years, 2/week-

For neck pain which might be due to cervical spondylosis.

PERSONAL HISTORY-

Her husband expired 10 years back (?COPD)

She is a daily wage labourer

diet-mixed

appetite-normal

bowel and bladder-regular

addictions-she consumes alcohol regularly

alcoholic since 40 yrs -180ml whisky/day

Betel leaf and betel nut chewing since 20 yrs

FAMILY HISTORY-

no similar complaints in the family

GENERAL EXAMINATION-

no signs of pallor,icterus, cyanosis, clubbing and lymphadenopathy.

*She is unable to turn her head towards left.

*Her gaze is towards right side.

VITALS-

pt is afebrile,

BP-180/90mmhg

PR-96bpm

RR-15cpm

spo2-98%in room air

GRBS-158mg/dl

CVS-S1S2 heard,no murmurs

RS-BAE present

ABDOMEN-soft,non tender

CNS-

Higher mental functions-

Pt is conscious, coherent,well oriented,speech-normal

Cranial nerves-

CN-7- she is able to tightly close her eyes, frowning is present,unable to clench the teeth completely,unable to inflate the cheeks.

Other CNs intact

motor system-. R. L.

power UL-. 4/5. 3/5.

LL-. 4/5. 3/5.

Tone-. UL-. increased decreased

LL-. normal increased

reflexes-. R. L.

biceps-. 1+. 1+.

triceps-. 3+. 3+.

supinator-. 1+. 1+.

knee. 2+. 2+

ankle-. 2+. 2+

plantar - bilateral extensor.

Sensory system-normal

Cerebellar functions-normal

INVESTIGATIONS-

APTT-31sec

PT-15sec

INR-1.11

CBP-

Hb-12.8gm/dl

TC-9000cells/cumm

N-73%

L-20%

E-03%

M-04%

Platelets-2.65lakhs/cumm

RBS-105Mg/dl

LFT-

Total bilirubin-0.75mg/dl

Direct bilirubin-0.26mg/dl

ALP-144 IU/L

SGOT-12IU/L

SGPT-10 IU/L

Total proteins-6.5gm/dl

Albumin-3.7gm/dl

A/G-1.38

RFT-

Urea-32mg/dl

Creatinine-1.0mg/dl

Uricacid-5.2mg/dl

Potassium-2.9mEq/l

Sodium-144mEq/l

Chlorine-103mEq/l

Phosphorus-3.6mg/dl

Calcium-10.1mg/dl

Troponin 1 -negative

Serum potassium-3.9mmol/l

ECG-

Ecg on day 2

MRI

Xray c spine

There is loss of lordosis of c spine might be due to flourosis/cervical spondylosis which is causing hypertonia on right side and hypotonia on left side.