65 yr old male farmer by occupation came with
chief complaints of
Loss of memory since 1 yr
Rt sides upper and lower limb weakness since 1 yr
Burning sensation of both feet since 1 yr
HOPI
The patient was apparently asymptomatic 1 yr ago then he developed sudden onset seizures for which he has admitted in the hospital at 10pm. He was unconscious up to 12 hours. after gaining consciousness he happened to observe that the entire right half of the body was feeling weak. His right lower limb was involved more than his right upper limb due to which he was unable to walk.
He also developed deviation of mouth to the left side.
he also had an attack of headache, vertigo, and projectile vomiting.
No h/o trauma to the head, double vision, or nasal regurgitation.
pt has also developed loss of memory for 1 year which was insidious in onset and gradually progressive the pt was unable to recall the things he has done this morning.
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 DM, 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
- He know about hospitalization
- did not give history properly
- No able memorize numbers orderly
- able to say phalam , Samayam , cinema
- Able to 10 names of vegetables, animals in one minute
- Motor luria test - done
- proverbs - able to say
- 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
Gait
Provisional diagnosis -
Dementia under evaluation ? Vascular with right sided hemiplegia ?
Investigations -
Chest X ray PA view
ECG
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