ALTERED SENSORIUM SECONDARY TO RECURRENT HYPOGLYCEMIA (RESOLVED) WITH VIRAL MENINGO ENCEPHALITIS (RESOLVED) WITH K/C/O DM-2 WITH CHOLILITHIASIS WITH LEFT CORTICAL CYST

 A 70yr old female with involuntary movements in upper and lower limb


MEDICINE E LOG BOOK

“This is an online e log book to discuss our patient’s de- identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patient’s clinical problems with collective current best evidence based inputs. This e-log book reflects my patient centered online portfolio and your valuable inputs on the comments is welcome.”

CHIEF COMPLAINT

Patient came to casualtiy with altered sensorium with involuntary movement in Right upper limb since 12:00 am, c/o loss of speech and no  movement  in left upper limb and lower limb after 12:00 am pt had h/o 3 episodes of involuntary micturition since  5 days , c/o one episode of fever  2 days back which was relieved on medication . On the way to the hospital PT grbs was found to be 15 mg/dl and a 25 d was connected after which the grbs was 131 mg /dl 

HISTORY OF PRESENTING ILLNESS

Pt was apparently asymptomatic 2days ago then she developed b/l involuntary movements in upper and lower limb,  loss of speech and recognition of people. Associated with drooling of frothy saliva from mouth,up rolling of eyes, biting of tongue.  No h/o fever,nausea, vomiting, headache, blurring of vision, diarrhoea, constipation 

PAST HISTORY

K/c/o DM since 2 yrs and on medication metformin 500 mg and pt medication was changed by local practioner to glimi m 1 8 days back from the presentation to the casualtiy.

Not a k/c/o epilepsy, asthma, HTN, tuberculosis

No H/o previous surgeries


PERSONAL HISTORY

Diet: mixed

appetite: normal.

sleep: adequate, 

b&b movt: regular

addiction: tobacco  chewing 


FAMILY HISTORY  no significant family hisory

General examination

Pt is drowsy 

No pallor, icterus, cyanosis, clubbing generalized lymphadenopathy and oedema.






Vitals

Bp 150/100 mmhg

Pulse 97 bpm

RR 20 cpm

Temperature 98.6

Spo2 97

Grbs 81 mg/dl



SYSTEMIC EXAMINATION 

CNS 

                         Upper limb                               lower limb

                       Rt                    left               Rt            left

Tone     normal       normal      increased increased

Power           3/5                   3/5             3/5              3/5

Reflexes         right                left

Biceps              ++                   ++

Triceps            ++                   ++

Supinator       ++                   ++

Knee                ++                   ++

Ankle   

Plantar         flexon       mild extension 

https://youtube.com/shorts/-7N-84kWxAI?feature=share.

CVS S1,S2 +,no added murmurs

R/S NVBS heard

P/A soft and non tender


Provisional diagnosis:

ALTERED SENSORIUM SECONDARY TO RECURRENT HYPOGLYCEMIA (RESOLVED) WITH VIRAL MENINGO ENCEPHALITIS (RESOLVED) WITH K/C/O DM-2 WITH CHOLILITHIASIS WITH LEFT  CORTICAL CYST


TREATMENT 

1) LEVIPIL 500 MG IN 100 ML NS/IV BD
  1------X--------1
8AM.            8PM
2) INJ. OPTINEURON.1AMP IN 100ML/NS/IV/OD OVER 30 MINTS
----------1--------------
3) INJ.HAI S/C ,ACC to GRBS 
4) GRBS MONITORING 70 PROFILE
 


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