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34yr old man , as a working driver presented with difficulty in swallowing since 5am Weakness in Right UL and LL since 5am Deviation of mouth to left since 5 am Slurred speech since 6am . Pt developed sudden onset of difficulty in swallowing while he tried drinking water followed by he suddenly developed weakness of rt upper limb and rt lower limb . His attendant later observed deviation of mouth towards left side and slurring of speech. H/o 1episode of GTCS 3years back though wt on treatment. He has been an occasionally alcoholic since 20years . Not a k/c/o Htn ,Dm type2, Thyroid disorder, Asthama. No h/o any past surgeries. On examination: Patient was conscious coherent and cooperative. Vitals: Pulse : 108 bpm Respiratort rate: 18 cpm Temperature: 98.6 F Blood pressure: 170/100 mm hg Grbs-153 mg/dl Spo2: 98% at room air CVS: S1, S2 heard Respiratory system: Bilateral air entry present, normal vesicular breath sounds heard, no added sounds heard Per abd