55 year old male with Cerebrovascular accident

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 55 year old male a goat Heder from Gouraram came to the department on 23/ 12 / 2022 with chief complaints of weakness in left upper arm associated with sudden involuntary moments. 

HOPI- Patient was asymptomatic 10 days back. On 17/ 12/ 22 he developed sudden involuntary moments on the left upper limb associated with weakness and loss of speech. The patient was taken to a hospital in nalgonda where he was admitted and the following tests were done- 
-MRI brain
-CBP
-Echocardiogram 
- Lipid profile 
- CT cerebral angiogram 
- ECG
-LFT
- CT neck angiogram 
-Renal function test 
The following medication was prescribed- 
- Metformin hydrochloride sustained release tablets ip - 500mg
- Atorvastatin tablets ip- 40mg
- pantopazole gastroresistant - 40mg and domperidone prolonged release 30mg gelatin capsule.
- clopidogrel - 75mg and aspirin - 150mg capsules 
- Cefixime and Lactic acid bascillus dispersable tablets 
- Telmisartan tablets - 40mg 
- soluble insulin injection 40 IU/ ml 
- cerebroprotein hydrolase injection 
- lignocain hydrochloride gel. 
The patient was discharged from the hospital on Thursday morning( he had gained his speech by then but had a slurred speech) after which he had administered these medications once which was followed by an episode of vomiting the next day.The patient could walk only with a support.  On Friday night ( 23/ 12/ 2022) the patient developed sudden involuntary moments in his left upper arm for 2 min after which he was brought to the casuality that night and was admitted. On Sunday night he had an episode of vomiting after eating dosa for dinner. Today ( 26/12/ 2022) he complained of burning micturition and slight blood in urine. 

Past history -  He was diagnosed with diabetes 5 years back and stopped having medications 1 year back . He also had a head injury with a transformer and followed by stampede by his goats while he was trying to protect them. After this he has developed a severe contimuous headache on his left temporal region.He was diagnosed with Hypertension last week when he was admitted in nalgonda.

Personal history-
 -Adequate sleep 
- Increased appetite after stoppage of medicines but his appetite decreased since 1 week 
- Mixed diet 
- bladder and Bowel moments normal 
- no addictions 
Family history - none 
Drug history - none 

Investigations - 
- done in hospital in nalgonda 














Investigations done here - 








Diagnosis - Reccurrent Cerebrovascular accident 

Follow up - 
27/12/2022
The patient continued to have headache. Last night ( 26/ 12/ 2022) he had vomited after eating an idli for dinner. 
The burning micturition has reduced compared to yesterday. And had no blood in urine now. Today he has pain on his left arm.
The urinary catheter has been removed. 
The patient had adequate sleep last night. He still has slurred speech today. 

28/12/2022
The patient continued to have headache. 
The burning micturition has increased  compared to yesterday. And there is decreased urine output.No hematurea. He continued to have pain in his left arm. He had adequate sleep last night. He still has slurred speech today. 

The patient got discharged on 28/12/2022.











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