65 yr old male farmer by occupation came with 

 chief complaints of 

Decreased memory since 1 yr 

Rt sides upper and lower limb weakness since 1 yr 

Burning sensation of both feet since 1 yr 

Sob since 1 yr 

Hopi 

Patient was apparently asymptomatic 1 yr ago then he developed sudden weakness of right UL and LL with seizure activity with unrolling of eyeballs , deviation of mouth to right side with involuntary micturition and defaecation and loss of consciousness for 1 day . 

No h/o trauma to head 

No h/o seizure activity again till now 

Past illness 

K/c/o cva 1 yr ago 

K/c/o HTN since 10 yrs ( on atenolol 50 mg and amlodipine 5 mg OD since 1 yr ) 

Not a k/c/o Dmt 2 , cad , asthma , thyroid disorders , tb .

Personal h/o 

Appetite- normal

Diet - mixed

Bowel and bladder - regular

Any known Allergies- absent

Addictions-  consumption of alcohol ( 90 ml / day , 2 pack bidis / DM day since 40 years . 


Family h/o - not significant


On general examination - 

patient is conscious,coherent and cooperative 

Well oriented to time , place and person. 

There is no pallor, icterus, cyanosis, clubbing, lymphadenopathy and bilateral pedal edema .  
















Vitals- 

Temp - 99.2F

PR- 80 bpm

Bp- 150/70 mmhg

RR -20 cpm

Grbs - 118 mg/ dl 

Systemic examination -

Cvs- S1 S2 present , no murmurs . 

RS - BAE present, NVBS

P/A- soft, non tender and no organomegaly 

CNS :  

Higher mental functions  

MMSE score - 16 

Conscious , oriented to person , place and time .

Speech : normal 

Memory: loss of recent memory 

No Visual hallucinations

No delusions 

No emotional lability. 

CRANIAL NERVE EXAMINATION:


1st   : Normal


2nd  :  visual acuity is normal


                  

3rd,4th,6th  :  normal 

                        

5th             :  sensory intact


                      motor intact


7th             :  normal


8th             :  No abnormality noted.


9th,10th     : palatal movements present and equal. 


11 th : intact 

12 th : normal 


Motar examination 

                      Cns         R.              L

Tone                 UL               N                N

                          LL   hyper.     Hyper

 Power               UL 4/5.       4/5

                           LL   4/5.      4/5

Reflexes 

     B                             -.            -

     T.                            -              -

     S.                             -.            -

     K.                             -.             -

     A.                            -.             -

      P.                           Extensor flexor


Lobar function tests 

Frontal 

  1. He know about hospitalization
  2. did not give history  properly 
  3. No able memorize numbers orderly
  4. able to say phalam , Samayam , cinema 
  5. Able to 10 names of vegetables, animals in one minute  
  6. Motor luria test - done
  7. proverbs - able to say 
  8. Luria graphic test - able to draw triangle and square 

Orbital and  basal 


Go and no go test 


 1. Direction - 2 errors 

2. color -able to say 


Parietal lobe


Ideational apraxia - able to perform folding of paper as shown . 

Right  left orientation- present 


Temporal lobe


Recent memory - absent 

Remote Memory - present but not able to recall some events 

Immediate memory present 

Delusion and hallucinations - absent 


Occipital lobe 

 

Prosopagnosia - present 

Visual memory 



SENSORY EXAMINATION:  

SPINOTHALAMIC SENSATION:

                              R                          L 

Crude touch : Normal                 Normal 


pain : Normal                              Normal 


temperature : Normal                 Normal 


DORSAL COLUMN SENSATION:

                                    R                         L 

Fine touch :         normal                    Normal 


Vibration sense : normal                    Normal 


Proprioception : normal                   Normal



CORTICAL SENSATION:

                                               R                   L 

Two point discrimination : normal           Normal 


Tactile localisation :  normal                   Normal 


CEREBELLAR EXAMINATION:

 Slight tremors are present  

Nystagmus -absent 


Finger nose test 

https://youtube.com/shorts/04rTbYonUk4?feature=share


Gait  

https://youtube.com/shorts/aU_A1mkIV2M?feature=share



Provisional diagnosis -

Dementia under evaluation ? Vascular with right sided hemiplegia ? 

Investigations -  

Chest X ray PA view 


ECG 


 









12/04/23
Pt is c/c/c 
BP - 160/90
PR - 78 bpm
RR - 18 cpm 
Temp - 98.4 F 
SPO2 - 100%@ RA 
Rx
Salt restricted diet 
Tab. Novartis 10 mg /po/od 
Tab. ECOSPRIN AV 75/10 po/od 
Tab . NEUROBION  PORTE po/od 

13/04/23 
Pt is c/c/c 
BP - 150/70 
PR - 80 bpm 
RR - 18 cpm 
Temp - 97.2F 
SPO 2 - 100@RA
CVS -S1,S2 + , no murmurs
RS - BAE+, NVBS 
P/A - soft , non tender 
Cns    
     R.              L
Tone  ul N.               N
           LL hyper.      Hyper
 Power ul. 4/5.       4/5
              LL.  4/5.      4/5
     B              -.            -
     T.             -              -
     S.              -.            -
     K.             -.             -
     A.            -.             -
      P.          flexor   extension 

Rx -  
salt restricted diet 
T. ATENOLOL 50 mg and AMOLODIPINE 5 mg po/ od T. ECOSPRIN AV 75/10 po/ od 
T. NEUROBION FORTE po/od . 


      

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