65 year old male with a known case of left hemiparesis ( 2 episodes) with visual hallucinations and urinary incontinence

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Case presentation:

A 65 year old male Pt with k/c/o Lt sided hemiparesis of 2 attacks presented with C/O some one going to hit him (according to Pt) and seeing familiar faces (even though no one is there) and increased appetite and urinary incontinence since 2 months

Patient presented with chief compliants of some one going to hit him and seeing familiar faces since 2 days . Sudden onset associated with ringing sensation in ears and hearing voices from surroundings.

Urinary incontinence since 2 months Pt feels bladder fullness but he can’t hold the stream.

H/o first CVA attack  5yrs back for which he went to hospital and managed conservatively and used antiplatelets for few weeks.

Then he developed second episode 6 months back for which he used herbal medication for 3 months. 

c/o generalised weakness with loss of appetite since 3 months 

Decreased interest in doing work , frequent irritability and anger outburst over wife

Patient seeing sparkling items ! Seeing familiar faces group of people briefly for 15 to 20 mins and later they disappear, occassionally he will try to communicate with them but get no response from them since 3 days 

H/0 discord with son regarding his health condition 2 months back since then patient felt he is dependent on family members , unable to hold household work due to illness so he felt depressed and feels to die than being burden to family 

Hypertensive episode 4 days back 

Pt unable to speak and move durring that episode took treatment at local hospital and discharged after 2 days as patient felt better 

H/o episode of seeing people , talking to self , wanderings outside with sleeplessness 3 days back

Past h/o:

History of similar episodes in past 

K/c/o DM since 6 yrs and on OHA

K/c/o HTN since 6 yrs and on Atenolol 50mg 

N/k/c/o asthma 

PERSONAL HISTORY:

Mixed diet

Appetite decreased

Sleep inadequate

Bowel movements regular 

Alcoholic abstinence 2 years 

O/E 

Patient is conscious , coherent, co operative

Afebrile

Bp 130/80 mmhg

Pr 90bpm

No Pallor 

No icterus

No cyanosis -

No clubbing -

No edema 

CVS - No scars 

            Apex beat @ 5th ICS medial to mid clavicular line

            S1 & S2 heard 

P/A - soft & nontender

CNS - Higher mental functions normal

            No sensory and motor defects

            All cranial nerves intact

             No signs of cerebellum dysfunction.

RS -  shape of chest - barrel 

           BAE+

          

INVESTIGATIONS 

CBP

CUE

Chest x ray 

Ecg 

Treatment given 

1) TAB PAN 40 MG PO OD 

2) TAB MVT PO OD 

3) TAB ECOSPRIN 75 MG OD 

4) TAB ATORVOSTATIN 20MG OD 

5) BP MONITORING 8TH HOURLY 

6) TAB ATEN 50 MG OD 

7) TAB GLIMIPERIDE - MV3  2MG / 500/ 0.3

8) GRBS 6TH HOURLY PRE MEAL 

Diagnosis 

K/c/o Lt sided hemiparesis with ? Delusion of Persecution under evaluation.K/c/o of DM , HTN

Day 2 

Investigations 

RFT