33 years old female with weakness in the left upper limb

A 33 years old female came to the GM OPD with chief complaints of 

 - Deviation of mouth to right side

 - Weakness of Left Upper Limb on 31/12/2021 at 8:14 am.

History of present illness: She was apparently asymptomatic 4 days ago. Then as she was coming out of her washroom she was unable to use her left upper limb followed by which she developed deviation of mouth to the right side. It was associated with drooling of saliva from the right angle of mouth. She also developed parasthesia over face and left upper limb.Her  symptoms are improving gradually. She was initially aphasic but now she is able to speak. She also c/o fine tremors in right hand fingers since morning (on 31/12/21).

She was admitted in KIMS, Narketpally 1 month back for Acute GE with polyarthralgia with hypoproliferative marrow.

- No c/o headache.

- No c/o nausea.

- No c/o fever.

- No c/o vomitings.

Link to the blog when she was admitted for the first time is given as follows-

https://medcases1.blogspot.com/2021/12/a-case-of-30-year-old-female.html

Past history: She is a k/c/o SLE on medication since 2 months.

Not a k/c/o DM, HTN, TB, BA, Epilepsy, CAD.

Family h/o: K/C/O DM and HTN In mother.

Personal h/o: 

Diet -mixed 

Appetite - decreased since 2 months 

Bowel habits - regular 

Bladder habits - regular

Sleep - adequate 

No addictions 

Obstetric history :

Age of marriage - 18

P2L2 

General examination: Patient is conscious, coherent,cooperative ,thin built and poorly nourished. 

Deviation of mouth to right side.

Nasolabial fold on left side absent

Frowning present.

Mild pallor present.

No icterus, cyanosis, clubbing, lymphadenopathy, Edema.

Vitals: 

Pulse rate - 80 bpm 

Temperature- 98.2  degree Fahrenheit 

RR - 15 cpm 

BP - 100/80 mmHg 

Systemic examination : 

CVS : S1 S2 + , no added murmurs 

RS :BAE + ,NVBS heard 

P/A :soft , non tender 

        No organomegaly 

        No distension 

        Bowel sounds heard

CNS:

GCS- E4V5M6

EOM- Full

Pupils- B/L dilated, reacting to light 

Tone-               Rt.                          Lt.

          UL         N                            N

          LL          N                            N

Power-

          UL         5/5                          4/5

          LL          5/5                         5/5

Reflexes-

          B-            +                           +

          T-            +                            +

          S-            +                            +

          K-           +                            +

          A-           +                            +

          P-       Flexor                    Flexor

Hand grip        100%                      30%

Provisional diagnosis-

CVA WITH LEFT UPPER LIMB MONOPARESIS WIYH ACUTE INFARCT IN THE RIGHT PARIETAL LOBE.

SECONDARY TO SLE VASCULITIS.

WITH K/C/O SLE

With K/C/O RUPTURED SEBACEOUS CYST.

Investigations:

On 01/01/2022

Treatment:

1. TAB. ECOSPIRIN 150 mg PO/OD/HS

2. TAB. CLOPIDOGREL 75 mg PO/OD

3. TAB. ATORVASTATIN 40 mg PO/OD/HS

4. INJ. DEXAMETHASONE 8 mg I.V./OD

5. INJ. PANTOP 40 mg IV/OD

6. TAB. HCQ 200 m PO/OD

7. BP/PR/TEMPERATURE MONITORING HOURLY

8. GRBS MONITORING 6th hourly

9. PHYSIOTHERAPY OF LEFT UPPER LIMB