A 55 year old male with slurred speech and drolling of saliva

 A 35 year old male resident of nalgonda and mechanic by occupation presented with chief complaints of slurred speech, drolling of saliva and difficulty in swallowing since today morning .

HOPI:The patient was apparently asymptomatic 10 hrs back .Then he developed sudden onset of slurring of speech and dysphagia since 10 hrs .There is also drolling of saliva since 10 hrs .

No history of loss of consciousness 

No history of involuntary movements 

No history of visual disturbances

No history of fever ,vomiting 

No history of trauma 

Past History: a)2 years ago he presented with complaints of constipation and fever which was more at night and was diagnosed with hepatic encephalopathy secondary to ALD




b) 1 year ago he presented with weakness in left lower limb and upper limb and deviation of mouth towards right side. And was diagnosed with acute ischemic CVA with left hemiperisis.




He is a known case of Hypertension since 3 years and is on Tab.Telmisartan 

No history of Diabetes Mellitus 

No history of Epilepsy 

No history of TB

No history of Asthama 

No history of blood transfusions 

No history of any previous surgery 

Personal History: 

Diet : Mixed 

Appetite : Normal 

Sleep: Adequate 

Bowel and Bladder: Normal 

Addictions : He is  a chronic alcohol addict consuming 90ml 3 times a day

He also used to smoke 8 packets a day ,but now he stopped smoking 

No allergies .

General Examination:

Examination was done after taking the consent of the patients attended in a well ventilated room

He is conscious, non coherent 

Cooperative 

Moderately built and nourished 

Well oriented to time place and person 

No Pallor, 

No icterus 

No cyanosis 

No clubbing of fingers

No pedal edema

No lymphadenopathy

Vitals : 

Temperature: febrile 

Pluse rate: 64bpm with normal volume and normal rhythm

BP: 130/80mmhg

Respiratory Rate: 18cpm

Spo2: 97% 

Systemic Examination:

CNS : 

HIGHER MENTAL FUNCTIONS 

Patient is conscious 

Well oriented to place time and person 

Unable to speak

No dementia 

No signs of meningeal irritation 

Cranial nerves. Intact 

Sensory system: couldn't elicit 

Motor system : 

                                  Left                    Right 

1)  Tone 

Upper limb             Not present     Normal 

Lower Limb          Not present      Normal 


2 Reflxes     

Biceps                   Not present       Present 

Triceps                 Not present        Present 

Brachioradialis  Not present        Present 

Knee                     Not present       Present 

Ankel                   Not present        Present 

Babinski sign   Not present          Present 


Cerebellum signs : Coudnt elicit 

CVS : S1 AND S2 heard without murmurs 

Respiratory System : Trachea central position

                                    Breath sounds  heard with granting 

Abdomen: Soft non tender 

                  Bowel sounds present 

Investigation 










 


 










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