3. Subjecti
ve
evidence
Chief complaints:
c/o right upper limb heaviness
(feeling weak) F/B blurring of
vision and left sided headache
since morning around 6:30 am
lasted for half hour then
spontaneously recovered.
H/O Presenting Illness:
patient last seen normal around
4:30 am and doing his routine
works in early morning after
which he developed upper limb
heaviness f/b blurring of vision
and spontaneously recovered
around 6:30 am . H/O persistent
headache+
4. N/H/O vomiting,, slurring of speech, LOC,
giddiness, seizure, fever, numbness, weakness of
other limbs, Abnormal gait,drooling saliva.
N/H/O chest pain, palpitation, syncope, shortness
of breath, urinary and bowel disturbances.
N/H/O similar complaints in past.
Past history:
No comorbidities
5. Allergic History:
No allergic history known
Social History & personal history:
Diet – mixed
sleep- regular
Alcoholic(occasional) & smoker 3 cigars/day (3
pack years)
6. Objective evidence
Vital signs:
BP- 140/80 MMHG
TEMP: 97.2 F
HR- 94/MIN
SPO2 – 98 % RA
RR- 14/MIN
CBG – 112 MG/DL
All peripheral pulses are regular
NO EVIDENCE OF
PALLOR,CYNOSIS,ICTERUS,CLUBBING,LYMPHADENOPATHY,EDEMA.
7. Higher mental functions
Appearance and behaviour – oriented to
time,person & place
Conscious – Gcs 15/15 ,B/L pupil 2 mm RTL
Memory & attention – normal.
Speech & language- able to tell one full sentence,
difficulty in reading and writing
8. Cranial nerve –visual field intact
Ext.ocular eye movements no restriction
Corneal reflex – patient blink his eyes
Taste intact,loss of nasolabial right side
mouth deviation left side
Gag reflex present
Motor System – Bulk, tone UL/LL normal
Both upper & lower limb right power 5/5
Sensory system : preserved
Finger Nose Test, Rapid alternating movements, Heel-knee-shin
– normal
No Nystagmus.
Reflexes: superficial and deep tendon reflexes – 2+
Plantar reflexes- extensors
9. CVS- S1 S2 heard
RS- B/L Air Entry+
P/A – Soft, Non tender
13. Radiographic data
MRI BRAIN:
Acute non hemorrhagic infarcts involving left thalamus, left medial
and posterior occipital regions and cerebellar vermis- likely PCA
territory
Echo:
No RWMA
Normal lv systolic & diastolic function
Trivial MR & TR/No PAH
No Evidence of Clot or vegetation.
USG Carotid Doppler:
Increased intima media thickness in Left carotid
No E/O hemodynamically significant stenosis in both carotid system.
16. PATHOPHYSIOLOGY OF STROKE
Abrupt onset of focal neurological deficit that is
attributable for a focal vascular cause
TIA:
A transient ischemic attack (TIA), also sometimes referred to as a “mini-stroke,”
starts like a stroke but only lasts from several minutes up to 24 hours.
