60 year old Male with sudden onset deviation of angle of mouth to left


This is an online Elog book to discuss our patient deidentified health data shared after taking his/ her guardians signed informed consent.

Here we discuss our individual patient problems through series of inputs from available Global online community of experts with an aim to solve the patients  clinical problem with current best evidence based input.

This Elog also reflects my patient centered online learning portfolio.
I have been given this case to solve in an attempt to understand the topic of “patient clinical data analysis” to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with a diagnosis and treatment plan.
A 60 Year old male daily labourer by occupation resident of suryapet presented with chief complaints of
Deviation of angle of mouth to left since 2 days
Slurring of speech since 2 days
Weakness in right upper and lower limb since 1 day

History of present illness
Patient was apparently asymptomatic  2 days back  whhen he developed Deviation of angle of mouth to left  sudden in onset associated with Slurring of speech around 3 to 4 pm while having food.
He had difficulty in chewing the food
No difficulty in closing  his eyes
Patient  had slurring of speech which was sudden in onset
 He is able to understand the commands and could speak and tepeat the words but fluency is reduced.
Next day morning around 8 am he experienced sudden Weakness in right upper and lower limbs and  he fell down from the chair.
There was no associated injuries
Weakness is equal in both the limbs
He had Difficulty  in holding the objects and 
Difficulty in walking ,rolling over and squatting.
Patient  had a past history of seizures episode lasted for some time  1 year ago
No history of double vision
No  history of headache, Nausea ,vomiting 
No history of trauma
No history of loss of consciousness 
No history of any involuntary movements 
No loss of bladder or bowel control
No history of loss of sensation ,tingling or numbness

His daily routine includes
Waking up around 7 30 am has his  cup of tea rice as breakfast goes to work and around 1 pm has his lunch 
Comes back home and has his dinner around 8 pm
And daily he drinks about 90 ml alcohol before sleep 

  Past history 
No history of similar complaints in the past
No history of Hypertension Diabetes Bronchial Asthama Tuberculosis .
No h/ o transient ischaemic attacks
 No history of surgeries in the past


 Personal history 
He has normal appetite
Takes mixed diet 
Not adequate sleep due to Weakness in his right upper and lower limb
Bowel and bladder movements are regular 
He is a smoker and consumes alcohol  (1 pack per day
  Family history 
No history of similar complaints in the family

CNS   EXAMINATION
Conscious non coherent slurring of speech and oriented to time place and person
Power in right upper and lower limb 0/5
Left upper and lower limb 5/5
 Tone reduced in right upper and lower limb
Reflexes:

Biceps:   Right 2+ Left 2+
Triceps:Right 1+  Left2+
Supinator:Right 1+Left 1+
Knee:Right 3+ Left3+
Ankle:Right 1+ Left2+
Babinski sign positive 



 



CVS EXAMINATION:
Cardiac sounds S1 S2 heard
No murmers  heard 

 RESPIRATORY SYSTEM 
Normal vesicular breath sounds heard
Trachea: central
No wheeze
 
ABDOMEN EXAMINATION:
Shape of abdomen: scaphoid
No tenderness 
No palpable mass
Liver not palpable


Right biceps jerk
https://youtu.be/LsGFA-IUG-0

Triceps jerk

https://youtu.be/A7XelrvkLME

   Right knee jerk

https://youtu.be/dxc7zo4X1t0


Left knee jerk

https://youtu.be/xBSEfTYNO_M

Left Ankle jerk
https://youtu.be/QbPcDVTOcg4

Babinski sign

https://youtu.be/GkzjdpXXsP0

 Deviation of angle of mouth

https://youtube.com/shorts/qnA6O19qdlY?feature=share
INVESTIGATIONS 

MRI
 

Provisional diagnosis 
Right sided hemiplegia secondary to stroke.




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