52/M c/o generalised weakness since 1 week

 19/09/2023

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Khushi Tulsyan, Intern

Roll no. 49

DOA - 15/09/2023

Location - EMD

A 52 yr male presented to casualty with c/o generalised weakness of both upper and lower limbs since 1 week

C/o unable to speak since 3 days and c/o deviation of mouth to right side since 3 days and c/o fever since 1 day

Past History-

N/k/c/o DM TB HTN Asthma Epilepsy CAD CVA

General Examination-

Pt is drowsy

E3V2M4 ( GCS - 9/15)

Temp - Fever spikes present 

Pr - 88 bpm

Bp - 120/70 mmhg

Rr - 22 cpm

Spo 2 - 96 RA

CVS - S1 S2 + no murmurs

RS - NVBS BAE +

P/A - Soft and NT

CNS - 

Power

UL Rt 3/5 Lt 2/5

LL Rt 3/5 Lt 2/5

Tone 

UL Rt 3/5 Lt 2/5

LL Rt 3/5 Lt 2/5

INVESTIGATIONS-

Serology -

HIV - Positive 

Blood for c/s -

No growth after 24 hrs of incubation

Sputum for AFB -

ZN stain - No AFB seen

Urine for culture and sensitivity-

No pus cells seen

No growth seen

Sputum for c/s-

Gram stain - Few pus cells ,no epithelial cells, few GNB seen

ZN stain - No AFB seen

MRI PLAIN-

E/o hyperintense signal on DWI/FLAIR / ADC noted on b/l corona radiata b/l genu of ant corpus collasum b/l thalamus b/l basal ganglia b/l midbrain pons and b/l cerebellar peduncles and b/l frontal regions 

Features suggestive of Subacute infracts

MRI CONTRAST-

Multiple ring enhancing lesions in pons midbrain b/l striatocapsular regions left frontal lobe and rt cerebellar hemisphere with extensive edema in the above areas 

f/s/o Neurotoxoplasmosis/Neurotuberculosis

PLAN OF TREATMENT-

Inj Neomol 1 gm IV/SOS (>100 F)

Inj Pantaprazole 40 mg IV/OD

Inj Optineuron 4 amp in 500 ml/NS/IV/OD

Inj Mannitol 100 ml/IV/TID

Inj Levetiracet 500 mg/IV/BD

Inj Thiamine 200 mg/IV IN 500 in NS /OD

Tab Folic Acid 5 mg/RT/OD 

Inj Clindamycin 600 mg/IV/QID