80 FEMALE AIS WITH LEFT HWMIPLEGIA,? CADIO EMBOLIC STROKE, TYPE -1 RESPIRATORY FAILURE, ASPIRATION PNEMONIA, ATRIAL FIBRILLATION WITH FVR, PRE RENAL AKI, K/C/O.T2DM, HTN

PRESENTING COMPLAINTS 
80YRS FEMALE BROUGHT TO CASUALTY WITH H/O ALTERED SENSORIUM SINCE 2DAYS,
SLURRING OF SPEECH SINCE 2 DAYS
WEAKNESS OF LWFT UPPER AND LOWER LIMBS SINCE 2 DAYS 

HISTORY OF PRESENTING COMPLAINTS 
PATIENT WAS APPARENTLY ALRIGHT BEFORE 2 DAYS, SUDDENLY SHE HAD ALTERED SENSORIUM, PATIENT ATTENDERS BROUGHT HER TO NEAR BY HOSPITAL AND FOUND TO BE HYPOGLYCEMIC AND GOT TREATED, AND LATER FOUND TO BE HAVING WEAKNESS OF LEFT UPPER AND LOWER LIMBS AND SLURRING OF SPEECH
H/O. SHORTNESS OF BREATH GRADE-III PRESENT SINCE 3 MONTHS 
H/O B/L PEDAL EDEMA PRESENT SINCE 3 MONTHS 
NO H/O CHEST PAIN  OR CHEST TIGHTNESS 
NO H/O PALPITATIONS, PND, ORTHOPNOEA 
PAST HISTORY:
K/C/O. HYPERTENSION SINCE 4YRS, 
K/C/O. DIABETES MELLITUS SINCE 4 YRS
NO H/O. CAD /CVA 
NO H/O. TB/ ASTHMA / EPILEPSY 

TREATMENT HISTORY:
ON TAB. VILDAGLIPTIN+METFORMIN (50+500) ,TAB. TELMA. AM SINCE 4 YEARS

PERSONAL HISTORY: 
Diet - mixed 
Appetite - normal 
Bladder - decrease in urine output 
Bowel - constipation
Sleep - adequate 
Alcohol- No h/o alcohol intake 
No h/o.Smoking
No drug addictions 

FAMILY HISTORY:
No H/O HTN/DM/TB/ASTHMA/EPILEPSY/CAD/THYROID DISORDERS in the family.

PROVISIONAL DIAGNOSIS 
ACUTE ISCHAEMIC STROKE WITH LEFT HEMIPERASIS, K/C/O HTN, T2 DM 

GENERAL PHYSICAL EXAMINATION:
HEIGHT - 160 cms
WEIGHT - 65 kg
NO PALLOR 
NO ICTERUS 
NO CYNOSIS 
NO CLUBBING 
NO LYMPHEDNOPATHY 

DAY 1 ON EXAMINATION: 5/06/2025 at 11.50 AM
TEMP - 98. 3 f
PULSE - 102/min regular
HR - 110/min 
APEX PULSE DEFICIT - 6
BP - 130/80 mm of hg
RR - 20 / min
SPO2 - 98% on RA 
CVS -S1,S2 PRESENT, NO MURMURS 
RS - BAE -PRESENT , NVBS 
PA - SOFT , NON TENDER 
CNS -                 RT           LT
TONE  -       UL        N              N
                     LL         N              N
POWER-       UL        N              N
                      LL        N              N
REFLEXES-   B         +2             -
                       T          +              -
                        S          -              -
                        K          +              -
                        A          -              -
                         P         E              M
GRBS - 88 mg/dl 
INVESTIGATIONS ON 5/06/2025 
https://youtube.com/shorts/nZ0f2FSULWk?si=_uRusMI_yQ9udTKK

TREATMENT ON 5/6/25
1.IVF - NS, RL @50ml /hr
2.O2 SUPPLIMENTATION 4LT/hr
3.NEBS WITH SALBUTAMOL, BUDECORT 12th hrly
4.CAP. ECOSPRIN GOLD. RT. OD.
5.INJ. LASIX 40 MG. IV. STAT
6.INJ. KCL 3 amp IN 500ML NS OVER 5 hrs. STAT

DAY 2 ON EXAMINATION: 6/06/2025 at 8.00 AM
GCS - E4 V2 M5
TEMP - 98. 3 f
PULSE - 96 /min regular
HR - 104 /min 
APEX PULSE DEFICIT - 8
BP - 160/80 mm of hg
RR - 22 / min
SPO2 - 98% on RA 
CVS -S1,S2 PRESENT, NO MURMURS 
RS - BAE -PRESENT , NVBS 
PA - SOFT , NON TENDER 
CNS -                 RT           LT
TONE  -       UL        N              N
                     LL         N              N
POWER-       UL        N              N
                      LL        N              N
REFLEXES-   B         +2             -
                       T          +              -
                        S          -              -
                        K          +              -
                        A          -              -
                         P         E              M

PROVISIONAL DIAGNOSIS :
1. ACUTE ISCHAEMIC STROKE WITH LEFT HWMIPLEGIA 
2.ACUTE PULMONARY EDEMA 
3.? ASPIRATION PNEMONIA 
4. 

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