55 YEAR OLD MALE WITH GIDDINESS AND LETHARGY

Arushi Kumari 
Roll no. 151

55 year old male painter by occupation came to casualty with cheif complaints of 
1.Giddiness since 2 days
2.lethargy since 1 day
- Patient was apparently alright 2 days back then at 9:00 am he had sudden episode of giddiness while urinating in the bathroom where he fell down on his knees, no LOC,No involuntary movements of UL/LL.

- He was taken to outside hospital found out to be having BP-250/120mm of hgand so  antihypertensives were given.

- 1 day back patient was brought  here with lethargy,  decreased responsiveness for further evaluation.
- On presentation to casualty , he had 
 BP: 180/120mm hg f/b 170/100 f/b 160/100 and 150/80 mm hg.

Past history:
K/C/O HTN since 2 years and on irregular medication,Not a K/C/O DM, Bronchial asthma,CAD.

Family History
No family history of HTN, DM, bronchial asthma, epilepsy.

General examination:- 
- Patient is conscious,coherent, cooperative,oriented to time,place and person.
- No signs pallor,icterus,cyanosis,lymphadenopathy&pedal edema .

Vitals:
Temp:- 98.3 F
BP:- 180/120 mmhg
RR:- 20 cpm
PR:- 72 bpm
Systemic examination:-
CVS- S1, S2 heard,
RS:BAE present
CNS: 
          TONE      UL     LL
          Right   Normal Normal
          Left     Normal Normal

          POWER    UL    LL
           Right       4/5   4/5
           Left          4/5   4/5
           
        REFLEXES RIGHT LEFT
              B              +         + 
              T              +         +
              S             +          +
              K             +          +
              A             +          +
              P           Flexion Flexion
Gait: 
Investigations:
                             ECG 


USG abdomen: Impression-No sonological abnormality detected.

MRI BRAIN(PROVISIONAL):
Impression:
1.Acute infarct in putamen,globus pallidus on RT side which shows blooming on SWI-Likely Hemorrhagic transformation
2.Old infarct in left side of pons
3.B/L periventricular hyperintensities on T2/FLAIR-S/O small vessel ischaemic changes.

Diagnosis:CVA with Acute infarct in putamen,globus pallidus on RT side 
With Hemorrhagic transformation Hypertensive urgency with
 K/C/O HTN since 2 years.

Treatment:

1.BP MONITORING HOURLY
2.STRICT I/O CHARTING
3.TAB.TELMA-H PO OD

 Day 1:
S- C/O Giddiness reduced compared to yesterday
 C/O Generalized weakness
O-O/E: Pt-C/C/C
Temp:Afebrile
PR:84bpm
BP:160/100 mm of hg
RR:18cpm
CVS:S1,S2 heard,no murmurs
RS:BAE+,NVBS heard
P/A:Soft,non tender
CNS: 
E4V5M6

          TONE   UL           LL
          Right   Normal    Normal
          Left     Normal    Normal

          POWER   UL         LL
           Right.    4/5       4/5
           Left        4/5      4/5
           
        REFLEXES RIGHT  LEFT
              B.             +          + 
              T              +          +
              S              +          +
              K              +         +
              A              +         +
              P          Flexion    Flexion
              
A:  CVA with Acute infarct in                          putamen,globus pallidus on RT side 
with Hemorrhagic transformation Hypertensive urgency with
 K/C/O HTN since 2 years

P:
1.BP MONITORING HOURLY
2.STRICT I/O CHARTING
3.TAB.TELMA-H PO OD


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