N. Lavanya Internee 2019
A 75 year old female came with chief complaints of involuntary tonic movements of right upper limb with deviatioon of mouth to left side on 30/4/24
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Chief complaints :
Involuntary movements of Right upper limb and deviation of mouth to left since one day
History of presenting illness :
Patient was apparently asymptomatic until yesterday (30/4/24)
And Suddenly she developed involuntary tonic movements of right upper limb with deviation of mouth to left side
H/o tongue bite
H/0 post ictal confusion for about 5 min
H/o weakness of limbs after episode
No H/o frothing from mouth
No H/o fever
No H/o loose stools
No H/o nausea vomitings head ache
H/o of similar episodes on 30/4/24 evening 2 episodes
PAST HISTORY
Known case of hypertension since 5 years on amlodipine 10 mg
No history of diabetes mellitus, asthma, cardiovascular disease , epilepsy, tuberculosis
no history of blood transfusions.
Personal history
Married
Mixed diet
Sleep adequate
Bowel-Regular
Bladder-Irregular
No allergies known
Occasionally consumes toddy
Family history :
Not significant
General examination
The patient is conscious coherent cooperative
Well oriented to time place and space
Moderately built and nourished
Pallor present
No pedal Odema
No Clubbing
No icterus
No lymphadenopathy
Vitals on 30/4/24
Temp:99.1°F
PR: 90 non
Rr: 22/min
Bp:150/90 mm Hg.
Spo2: 95
GRBS:545mg
Vitals on 1/5/24
Temp:97.1°F
PR: 89 non
Rr: 22/min
Bp:110/80 mm Hg.
CNS examination
B/L pupils reacting to light mid dilated
Tone in all four limbs normal
Power - RT LT
U/L 5/5 5/5
L/L 5/5 5/5
REFLEXES- B T S K A P
Rt +++ +++ ++ ++ + +
Lt +++ +++ ++ ++ + +
CRANIAL NERVES EXAMINATION
OLFACTORY-INTACT
OPTIC NERVE-VISION NORMAL
(3,4 AND 6) NERVE-PUPILLARY LIGHT REFLEX PRESENT,
EXTRA OCCULAR MUSCKES INTACT
TRIGEMINAL NERVE : FACIAL SENSATION IS INTACT
FACIAL NERVE-FACIAL MUSCLES SENSATION INTACT
VESTIBULO COCHLEAR-HEARING AND BALANCE PRESENT
IX NERVE-TASTE SENSATION PRESENT
X NERVE-NO DIFFICULTY IN SWALLOWING
XI NERVE-SHRUGGING OF SHOULDERS IS PRESENT
XII NERVE-NO DEVIATION OF TONGUE
Cerebellar signs : No finger nose in coordination
No Kneel - Heel in coordination
CVS-S1,S2+ ,NO MURMURS
RESPIRATORY SYSTEM-BAE+,NVBS heard
Per Abdomen:
-Scapoid
-tenderness in epigastrium
-No palpable mass
-Spleen : not palpable
-liver : not palpable.
Investigations on 30/4/24
Investigations on 1/4/24
Provisional Diagnosis Hyperglycaemic seizures
Treatment
On 30/4/24
Inj levipil 1 gm iv /stat
F/b Inj levipil 500 mg iv /bd
Inj Hai sc 6u iv/stat
F/b Inj Hai sc /tid
Inj pan 40 mg po/od
Inj Zofer 4 mg po/bd
Tab amlodipine 10mg po/od
On 1/5/24
Inj levipil 500 mg iv BD
Inj Actrapid insulin s/c TID acc to grbs
Inj pan 40 mg iv od
Inj Zofer 4 mg iv
Tab amlodipine 10mg po/od
Vitals monitoring
Watch for seizures activity
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