A 38yr old Man with Slurred Speech and weakness in limbs

 This is 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 patients clinical problems with collective current best evidence based inputs .This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome.


Dr. Sarbesh Mishra

Roll no.: 142


A 38 year old male, resident of Yelareddygudem has come with c/o :

Slurring of speech since 2hrs

Difficulty in swallowing since 2hrs


HOPI:

Patient was apparently asymptomatic 2hrs ago then while drinking tea,Patient observed sudden inability to swallow tea,and difficulty in speech(slurring) and deviation of angle of mouth.Episode lasted for 5min and subsided.After 30min Patient experienced another similar episode which lasted for 2-3mins.

N/h/o loss of consciousness, involuntary movements,involuntary defecation and micturition.

Past History 

K/c/o type 2 DM, since 5 years not on medication 

K/c/o hypertension since 1 year using medication regularly 

Circumcision done 8 years ago 

Past History of tonsillectomy during childhood 

N/k/c/o asthma,TB, epilepsy,  thyroid disorders 

Personal history:

Diet: mixed 

Appetite-Normal 

Bowel and bladder: Regular 

Sleep - Adequate 

H/o Smoking since 20 years daily 2- 3 cigarettes 

Alcohol consumption weekly twice 180 ml 


Daily routine:

He used to work as ward boy in ESI hospital.He used wake up early in the morning @6 am and do all the daily activities and send his children to school and go to work around 8am and have lunch and return to home by 8 pm and have dinner around 10 pm and sleep by 11 pm and 2 years ago he stopped working as the contract was expired and from then he stays at home.


GENERAL EXAMINATION:

Pt is c/c/c 

No pallor, icterus cyanosis, Clubbing, lymphadenopathy ,oedema .

VITALS :

Temp: 98.4 F 

Pulse: 84bpm

RR:16cpm

BP:130/90 mmHg 


SYSTEMIC EXAMINATION :


CVS -s1 s2 heard,no murmurs


RS-bae+, nvbs heard


P/A-soft,non tender,no organomegaly




CNS 

On examination

                                 R. L

TONE

UPPER LIMB.        N. N

LOWER LIMB.      N. N


POWER 

UPPER LIMB.        5/5. 5/5

LOWER LIMB.      2/5. 2/5


REFLEXES 

     Rt. Lt

B +++ +++

T ++   ++

S. +    +

K. -    -

A. -     -

P. Flexion Flexion


The patient asked us to discharge him , and he with his attender would go to some Hyderabad hospital 


PROVISIONAL DIAGNOSIS:

?Acute ischemic stroke

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