28/M with inability to walk,weakness of left UL,LL
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PATIENT CAME WITH C/O LEFT UPPER LIMB, LOWER LIMB WEAKNESS SINCE 2 DAYS.
SLURRING OF SPEECH SINCE 1 DAY.
HOPI:-
PATINET WAS APPARENTLY ASYMPTOMATIC 2 DAYS BACK THEN, WHILE DRIVING CAR HE HAD SUDDEN ONSET WEAKNESS OF LEFT UPPER AND LOWER LIMBS WITH SLURRING OF SPEECH.
NO H/O INVOLUNTARY MOVEMENTS OF UL & LL, INVOLUNTARY MICTURITION, DEFECATION.NO H/O LOSS OF CONSCIOUSNESS.
8 YEARS BACK,PATIENT HAD 3 EPISODES OF GTCS FOR WHICH HE WAS ADMITTED IN GANDHI HOSPITAL AND WAS DIAGNOSED AS CSVT ( THROMBUS IN TRANSVERSE AND SIGMOID SINUS ) AND WAS KEPT ON WARFARIN WHICH HE USED FOR 1 MONTH AND DISCONTINUED.ALL THESE YEARS,HE DID NOT HAVE ANY SIMILAR COMPLAINTS.
PAST HISOTRY:-
NOT A K/C/O DM, HTN,TB,ASTHMA
GENERAL EXAMINATION :
PATIENT IS C/C
NO PALLOR,ICTERUS,CLUBBING,CYANOSIS,LYMPHADENOPATHY,PEDAL EDEMA
VITALS : TEMP - AFEBRILE,BP - 140/90 MMHG,PR - 86 BPM,SPO2-99% @ RA
SYSTEMIC EXAMINATION :
CVS : S1S2 HEARD,NO MURMURS
RS : BAE + , NVBS +
P/A : SOFT,NON TENDER
CNS : LEFT RIGHT
TONE
UL N N
LL N N
POWER
UL 5/5 4/5
LL 5/5 4/5
REFLEXES
BICEPS + +
TRICEPS + +
SUPINATOR + +
KNEE + +
ANKLE + +
PLANTAR + +
PROVISIONAL DIAGNOSIS :
ACUTE CVA WITH LEFT HEMIPARESIS (ACUTE INFARCT IN RIGHT THALAMUS) WITH K/C/O CSVT (THROMBUS IN TRANSVERSE AND SIGMOID SINUS) WITH HYPERHOMOCYSTEINEMIA ( HOMOCYSTEINE > 65 MMOL/L ON 17-01-2021 )
MRI BRAIN PLAIN WITH MR VENOGRAM AND MRI ANGIOGRAM
IMPRESSION :
1.SUB ACUTE INFARCTS IN THE RIGHT THALAMUS,RIGHT CEREBELLAR HEMISPHERE AND RIGHT SUPERIOR CEREBELLAR PEDUNCLE WITH HEMORRHAGIC TRANSFORMATION IN RIGHT SUPERIOR CEREBELLAR INFARCT - LIKELY EMBOLIC INFARCTS
2.LOSS OF NORMAL FLOW VOID SIGNAL IN LEFT TRANSVERSE SINUS AND PROXIMAL PART OF LEFT SIGMOID SINUS WITH FEW SURROUNDING COLLATERALS - S/O CHRONIC THROMBUS.
3.NORMAL MR ANGIOGRAM STUDY
CAROTID ARTERY DOPPLER :
NO ABNORMALITY DETECTED
2D ECHO :
EF - 60 %
NO MR/AR/TR
NO RWMA,NO AS/MS
GOOD LV SYSTOLIC FUNCTION
NO DIASTOLIC DYSFUNCTION,NO PAH/PE
FASTING LIPID PROFILE :
CHOLESTEROL : 139
TGL : 100
HDL : 39
LDL : 92
VCDL : 20
PLAN :
1.TAB ECOSPIRIN 150 MG PO/OD
2.TAB CLOPIDOGREL 75MG PO/OD
3.INJ.OPTINEURON 1 AMP IN 100ML NS IV/OD
4.TAB ATORVAS 80MG PO/OD
5.PHYSIOTHERAPY OF LEFT UPPER AND LOWER LIMBS
