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 abdomen: soft, non tender, bowel sounds heard
CNS : GCS: E4V5M6
Higher mental functions-
Slurring of speech+
Oriented to time,place, person
Cranial nerves-
Unable to raise his right eyebrow
Rightside forehead wrinkling absent
Deviation of mouth to left side
Gag reflex absent
Other cranial nerves-Intact
Reflexes couldn't be elicited
Power. Rt Lt
UL 4/5. 5/5
LL 4/5. 5/5
Investigations
Chest X ray A/P view
Ecg
Hemogram
Hb:15.1gm/dl
Tlc:10900 cells/cumm
Plt:2.4 lakhs/cumm
Rbc:5.29 million/cumm
Neutrophils:83%
Lymphocytes:13%
RFT
Urea :23 mg/dl
Creatinine:1.1 mg/dl
Uric acid :4.3 mg/do
Ca:9.9mg/do
Ph:2.8mg/do
Na:142meq/L
K:3.9meq/L
Cl:103meq/L
LFT
TB:1.30mg/dl
DB:0.30 mg/dl
AST:27 IU/L
ALT:25 IU/L
ALP:234 IU/L
TP:6gm/dl
Albumin :3.4 gm/dl
A/G:1.32
Usg abdomen
MDCT Scan brain plain
Ryles tube aspirate
