RIGHT FOCAL SEIZURE POST SEIZURE TODD'S PARESIS UPPER RESPIRATORY TRACT INFECTION (RESOLVED) AKI ON CKD ANEMIA SECONDARY TO CKS HYPERTENSIVE SINCE 1 YEAR
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A 58 YEAR OLD FEMALE CAME TO THE OPD WITH THE COMPLAINTS OF FALLS SINCE 6 DAYS, COUGH SINCE 6 DAYS, SHORTNESS OF BREATH SINCE 5 DAYS, INVOLUNTARY MOVEMENTS OF RIGHT UPPER LIMB SINCE 3 DAYS AND WEAKNESS SINCE RIGHT UPPER LIMB AND LOWER LIMB SINCE 2 HOURS.THE PATIENT WAS EVALUATED CLINICALLY AND DIAGNOSED AS A CASE OF RIGHT FOCAL SEIZURE POST SEIZURE WITH TODD'S PARESIS WITH UPPER RESPIRATORY TRACT INFECTION (RESOLVED). THE PT WAS STARTED ON CONSERVATIVE MANAGEMENT( INJ PIPTAZ 2.25 GM IV QID, INJ. LASIX 40 MG IV BD, TAB AZITHROMYCIN 500 MG PO OD, TAB CLINOD 10 MG PO BD, SYP GRILLINCTUS 10 ML PO TID, T PROPRANOLOL 20 MG PO HS, MUCAINE GEL 10 ML PO TID)
GENERAL EXAMINATION-
THE PATIENT IS CONSCIOUS, COHERENT, COOPERATIVE
MODERATELY BUILT AND NOURISHED
SIGNS OF PALLOR,
NO ICTERUS ,CYANOSIS, CLULBBING, EDEMA
VITALS:
TEMP: AFEBRILE
PR: 87 BPM
RR: 26 CPM
BP: 170/90 MM HG
SPO2: 99% @ RA
GRBS: 155 MG/DL
CVS: S1, S2 HEARD, NO MURMURS
RS: BAE+, NVBS
TRACHEA: CENTRAL
NO DYSPNOEA AND WHEEZE
NO RHONCHI
ABDOMEN: TENDER, SOFT, DISTENDED, UMBLICAL HERNIA PRESENT
LIVER AND SPLEEN NOT PALPABLE
BOWEL SOUNDS NOT HEARD
CNS:
LEVEL OF CONSCIOUSNESS: DROWSY, NOT ORIENTED TO TIME, PLACE, PERSON
NECK STIFFNESS ABSENT
KERNINGS SIGN ABSENT
GCS: 15/15 E4V5M6
POWER
UL
R - 3/5 L - 4/5
LL
R - 4/5 L-4/5
REFLEXES
R L
B 3+ 3+
T 3+ 3+
S 2+ 2+
K 3+ 3+
A 2+ 2+
PLANTAR - LEFT - EXTENSOR; RIGHT - FLEXOR
GAIT - ANTALGIC GAIT
NEUROLOGY REFERAL DONE I/V/O FOCAL SEIZURES
INJ SODIUM BICARBONATE 150 MG IN 100 ML NS IV STAT
IV FLUIDS 2 U NS @ 75 ML / HOUR
INJ LASIX 40 MG 1V BD (IF SBP >= 110 MMHG)
OPHTHALMOLOGIY REFERAL DONE I/V/O HYPERTENSIVE RETINOPATHY
IMPRESSION - NO HYPERTENSIVE RETINOPATHY CHANGES NOTED
INVESTIGATION:
USG
RAISED ECHOGENICITY OF B/L KIDNEYS
REVIEW USG I/V/O RAISED SER CREATININE
B/L RAISED ECHOGENICITY OF KIDNEYS
2D ECHO
MODERATE AR, MILD TR, TRIVIAL MR
NO RWMA, NO AS/MS
SCLEROTIC AV
GOOD LV SYSTOLIC FUNCTION
DIASTOLIC DYSFUNCTION
NO PAH/PE
SPUTUM C/S - NORMAL FLORA GROWN
BLOOD C/S - NO GROWTH AFTER 24 HRS OF ANAEROBIC INCUBATION
URINE C/S - POLYMICROBIAL FLORA GROWN
ECG - NORMAL SINUS RHYTHM
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DIAGNOSIS:
RIGHT FOCAL SEIZURE
POST SEIZURE TODD'S PARESIS
UPPER RESPIRATORY TRACT INFECTION (RESOLVED)
AKI ON CKD
ANEMIA SECONDARY TO CKS
HYPERTENSIVE SINCE 1 YEAR
ADVICE AT DISCHARGE:
SYP GRILLINCTUS 15 ML PO TID
TAB PROPRANOLOL 20 MG PO HS
MUCINAIR GEL
TAB NODOSIS PO OD
TAB OROFER PO OD
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