A 55 year male with unable to speak

 A 55 year old male patient resident of suryapet and laborer by occupation presented with chief complaints of unable to move his right hand and right leg and unable to speak since 3 days. 

HOPI: The patient was apparently asymptomatic 3 days back.On 7th morning, suddenly  he developed weakness in right upper and lower limb ,and was unable to speak. 

No history of fever or vomiting 

No history of loss of consciousness 

No history of involuntary movements 

No history of visual disturbances 

No history of burning micturition 

No history of constipation 


Past History : 2 years ago he had weakness in the right upper limb for which they visited the local hospital in suryapet ,and the condition was cured after taking medications .

He is a known case of Hypertension since 2 years .

No history of Diabetes 

No history of TB

No history of Epilepsy 

No history of Blood transfusions 

Surgical history : 6 months ago he was operated for hydrocele. 


Personal History: 

Appetite : Normal 

Diet : Mixed 

Sleep: Adequate 

Bowel and Bladder : Regular 

Addictions : 

He consumes 3 -4 units of whisky on a daily basis ,and also smokes  2 to 3 cigarettes a day .

No allergies .


General Examination: 

Examination was done after taking the consent of the patient in a well ventilated room .

The patient is conscious and coherent 

Well oriented to place time and person

Moderately built and nourished 

No Pallor

No icterus 

No cyanosis 

No clubbing of fingers 

No pedal edema 

No lymphadenopathy 

Vitals 

Temperature: Febrile 

Pulse: 80bpm with normal rhythm and volume 

BP : 120/80 mm hg

Respiratory Rate : 20cpm

Spo2 : 97% on RA


Systemic Examination: 

CNS : 

HIGHER MENTAL FUNCTIONS : 

SPEECH : Slurred 

Conscious and coherent 

No loss of memory

No loss of consciousness 

No signs of meningeal irritation 


Cranial nerves : All 12 Cranial nerves are intact 

Motor system: 

Tone  of muscle : 

                                            Right             left 

Upper limbs   :                negative         Normal

Lower Limbs :                Negative        Normal 


Power of muscle       

Biceps     :                          0                     5

Triceps:                              0                      5

Wrist :                                0                     5

Hip :                                    0                     5

Knee:                                  0                      5

Ankle:                                0                       5

Reflexes : 

               Biceps reflex:    1                      2

              Triceps reflex :  1                       2

             Supinator reflex: 1                      2

             Knee reflex         :  1                      2

             Ankle reflex :         1                      2

            Babinski sign :       down going    up going 


Sensory system :   coudnt elicit as the patient was not Cooperative 


Cerebellum signs are normal 


CVS : 

S1 and S2 heard without murmurs 

Respiratory System : 

Bilateral air entry 

Trachea in central position 

Crepitus heard 


Investigations : 

On 7/6/23










On 8th 9th and 10th June 2023





















Provisional Diagnosis : Recurrent stroke with right hemiperisis 

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