Involuntary movements in UL and LL since 2 hours with deviation of mouth towards left

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C/oInvoluntary movements in UL and LL since 2 hours .

HOPI-

Patient came to causuality with complaints of INVOLUNTARY MOVEMENTS of UL and LL 3 episodes lasting for 5min each since 2 hrs which was sudden in onset associated with stiffening of LL and upward rooling of eyeball and drooling of saliva .and deviation of angle of mouth towards left side.

No h/o involuntary micturition or defecation

H/O POST ICTAL CONFUSION for 10 min

N/H/O cough,loose stools,giddiness

PAST HISTORY -

H/O HTN SINCE AND TYPE II DM since 15 yrs and on TAB DAPAGLIFLOZIN 10 MG

K/C/O CAD with HF with mid range EF

K/c/o cva with left hemiparesis since 10 years

No residual weakness

PERSONAL HISTORY :

Diet: mixed

Appetite: normal

Sleep: adequate

Bowel and bladder movements regular

No addictions

FAMILY HISTORY - 

No known affected relatives

GENERAL EXAMINATION:

Moderately built and nourished.

Pallor, Icterus,Cyanosis, clubbing, lymphadenopathy,  Pedal edema absent

Vitals-

Temp: Afebrile 

PR- 98bpm    

RR- 18/Min

BP- 120/80 mmHg

SYSTEMIC EXAMINATION

P/A - Shape of abdomen- flat. No scars. No organomegaly. Bowel sounds heard.

CVS- S1 S2 heard, no murmurs

apex beat shifted downwards laterally

RS- NVBS.

CNS- No focal neurological deficits

Tone-   RT.     LT

UL.       Normal.  increased

LL.        Normal.  Increases

POWER

UL.      5/5.   5/5

LL.        5/5.   5/5

Reflexes:          right left  

Biceps 2+ 2+

Triceps 2+ 2+

Supinator 1+ 2+

Knee 2+ 3+

Ankle  1+  1 +

Plantar present. Present

Provisional diagnosis- Left focal seizures secondary to acute cva with heart failure with mid range ejection fraction,known case of cva with left hemiparesis with type 2 dm

INVESTIGATIONS-

Treatment-

Inj levipil 1gm IV BD

INJ LORAZ 2 CC IV SOS

TAB DAPAGLIFLAZOLIN 10 MG PO OD

TAB METOSARTAN 50/40 PO OD

TAB ECOSPIRIN AV 75/20PO OD

TAB LASIX 40 MG PO/OD

INJ HAI S/C TID