70 years old male with left sided upper limb weakness since 2 days

A 70 years old male carpenter by occupation came to the casuality with the chief complaints of left sided upper limb weakness and slurred speech since 1 day.

History of present illness: Patient was apparently asymptomatic 2 days ago. Then while drinking water 2 days ago at around 2:00 pm, he was unable to hold the glass properly- suggestive of lack of grip in his left hand. This was sudden in onset.

Associated with Left upper limb weakness, non progressive.

No c/o seizures, giddiness.

No c/o headache.

No c/o fever, vomitings.

No c/o sensory symptoms.

Past h/o: He is a K/C/O HTN since 2 years on Tab. AMLONG 5 mg PO/OD.

Not a k/c/o DM, TB, Bronchial Asthma, epilepsy, CVA, CAD.

Family history: Not significant

Personal history: 

Diet- mixed

Appetite- normal

Sleep- Adequate

Bladder and bowel habits- regular

No addictions

No known drug allergies.

General Examination:

He is conscious, coherent, cooperative and well oriented to time, place and person.

He is moderately built and moderately nourished. 

Pallor- Absent

Icterus- Absent

Cyanosis - Absent

Clubbing- Absent

Lymphadenopathy- Absent

Edema- Absent

Vitals on admission-

Temperature - 98.6 F

PR- 90 bpm

BP- 140/90 mug Hg

RR- 18 cpm

SpO2- 98% on RA

GRBS- 110 mg/dl

Systemic examination-

CNS:

                         R.                             L

      Tone-    Normal                       Hypertonia

      Power-   UL-   5/5.                        4/5

                     LL-   5/5.                        5/5

      Reflexes-

            B-        2+.                            3+

            T-         2+.                            3+

            S-        2+.                             3+

            K-        2+.                            3+

            A-         -                               2+

       Plantar-   Flexor.                   Extensor

      

Hand grip-       100%.                        50%

                    DEVIATION OF MOUTH TO

                         RIGHT SIDE PRESENT.

CVS- S1, S2 sounds present, No murmurs

RS- BAE +, NVBS heard

P/A- soft, non tender, Bowel sounds +

Provisional diagnosis- ACUTE INFARCT IN RIGHT FRONTO- TEMPORO PARIETAL REGION

HTN+

Treatment received:

1) TAB. ECOSPIRIN 150 mg PO/STAT

     TAB. CLOPITAB 150 mg PO STAT

     TAB. ATORVAS 80 mg PO STAT

2) TAB. ECOSPIRIN 150 PO/OD

3) TAB. CLOPITAB 75 mg PO/OD

4) TAB. ATORVAS 40 mg Po/H/S

5) INJ. OPTINEURON 1 amp in 100 ml NS I.V./OD

6) BP/PR MONITORING 

7) GRBS 12th HOURLY.

8) TAB. PANTOP 40 mg PO/OD

Investigations-