53 year old female came with Dizziness

 Chief complaints: altered sensorium,difficulty in walking ,loss of speech,weakness of right upper limb and right lower limb

HOP1: Patient is diabetic since 11 years and hypertensive since 1 year 

During recent regular health checkup Blood Glucose level was 350 mmol/L and blood pressure was 280mm Hg. Later that day she developed giddiness and was unable to walk properly so was brought to the hospital.

Negative History : No History of Headache,Fever,Vomiting ,Chest Pain,Palpitations and Shortness of Breath.

Past history: 

She was diagnosed with diabetes 11 years ago when she went to a doctor in her locality due to frequent urination. High Bp was noticed during regular blood glucose level checkup. 

On medication(diabetic and anti hypertensive drugs)

Treatment History : For Diabetes -Dapaglifozin 10mg                            

 -Metformin 500mg

For Hypertension :

Telma 40mg 

Cilindipine 10mg

Metoprolol 50mg

Personal History: Vegetarian

Appetite Normal

Bowel And Bladder-Regular 

 Sleep Adequate 

No Allergies And Addictions.

Attained Menopause 4 years ago

Family History not Significant 

General Examination: 

Patient is Conscious, but not Cooperative 

Moderately Built and Nourished.

Pallor Absent

Icterus Absent

Clubbing Absent

Cyanosis Absent

Lymphadenopathy Absent

Edema Absent

Vitals : 

Temperature - 100.8

Pulse 90 bpm

B.P 180/80mmHg

SpO2 94%.

SYSTEMIC EXAMINATION : 

CVS : S1 S2 heard, no murmurs

RS : Bilateral air entry present, normal vesicular breath sounds, no added sounds

GIT : Soft, non-tender, no 

CNS :

Dominance - Right handed

Higher mental functions

 • conscious

 • memory - able to recognize their family members

 • Speech - Broca's aphasia (only comprehension, no fluency, no repitition) 

Motor system:

Attitude - right lower limb externally 

Tone : Hypotonia on right side 

           Normal tone on left side

Power: Right upper limb- 0/5

             Right lower limb- 0/5

             Left upper limb-  3/5

             Left lower limb-   3/5

Sensory system : responding to pain

Cerebellar signs : couldn't be elicited

Lab diagnosis:

Treatment:- 

-IV FLUIDS-NS @ 75 ml / hr

-RT. 100ml MILK  WITH PROTEIN POWDER 8th hrly

 100ml water Every 2nd hrly

-ING.CITICHOLINE800mg /IV/IN 100 ml NS/BD

-ING.PIRACETAM 800mgIV/IN 100ml NS/TID

-ING.PAN40mg/PO/OD

-TAB. ECOSPIRIN 150mg /PO/HS

-TAB.ATORVAS40mg/PO/OD

-TAB.AMLONG 5mg /PO/OD

-ING .HUMAN ACTRAPID INSULIN ACC. TO GRBS CHECK

-TAB . DOLO 650mg SOS if temp>100F

-B.P. MONITORING 4th hrly