55/F with Left hemiparesis

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio.



Case history:

A 55/F came with complaints of fever and involuntary movements of both upper and lower limbs since 5 days. 
1 episode of involuntary movements in both upper and lower limbs with 1 min of LOC with frothing and deviation of mouth on 1st day and she got admitted in hospital (outside). She then was taken to another hospital (government)after 3 days as the symptoms didn't subside. There CT Scan was done yesterday, showing Sub acute infarct in right posterior parietal lobe and right frontal lobe. And was referred to another hospital. She was brought here in altered sensorium and a history of 7-8 episodes yesterday, 2 episodes since morning. No frothing and deviation of mouth, loss of consciousness and involuntary micturition/defecation. 
C/o weakness in both upper and lower left limbs since 2 days. 

K/c/o HTN since 1year. On T. Telma H 40mg 
K/C/O DM-II since 15 years. On T. Glimipiride and metformin 500mg. 
K/C/O epilepsy 15 years back. 
Not a K/C/O CVA, CAD, TB, Asthma.

Vitals:
Pt is c/c/c
BP: 130/90 mm Hg
PR: 100bpm
RR: 20cpm
Temp: 98.7 F
CVS: S1, S2 heard. No murmurs.
RS: BAE+, NVBS heard.
P/A : soft, NT, no organomegaly. 
CNS:

Tone :        R            L 
UL           hyper      hypo
LL            hyper      hypo

Power:
UL              4/5        0/5
LL              3/5         0/5

Reflexes:         R          L
Biceps             -           -
Triceps            -           -
Supinator        -           -
Knee                -           -
Ankle               -           -
Plantar            -           -







On 23/5/23

Chest Xray: 


RBS - 193 mg/dl 
Hemogram:


Blood urea - 31 --> 51(25/5) --> 37(26/5)
Sr. Creatinine - 1.4 --> 1.1(25/5) --> 0.8(26/5) 
Sr. Electrolytes:
Na - 139 --> 141(25/5)--> 141(26/5)
K - 3.5--> 4.1(25/5) --> 3.9(26/5)
Cl - 104--> 104(25/5)--> 104(26/5)

On 24/5/23

FBS: 233mg/dl
CSF analysis:
Sugar- 128
Protein - 26
Chloride - 118
ADA - 10
HbA1c - 7.2 

On 25/5/23 

Hemogram

MRI Brain: 
Acute infarct in right MCA territory mainly right fronto-parietal and parieto-temporal region with hemorrhagic transformation. 

On 26/5/23

Hemogram:

On 27/5/23

Hemogram:

Ophthalmology opinion was taken i/v/o any retinopathic changes. No features of raised ICT, diabetic and hypertensive retinopathic changes were seen. 






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