80 yr male

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 80 yrs old Male came to casualty with 

C/O loss of consciousness (for half an hour)

C/O involuntary bowel and bladder incontinence and slurred speech since 4am today(19/12/21)



HOPI



Patient was apparently asymptomatic till 4:00am today got up from bed and walked to washroom ,while walking near the door at 4:00am,patient slipped and fell on the ground-sustained injury to back and head.

He had loss of consciousness for half an hour and then regained.Conscious spontaneous with no involuntary movements,froth from mouth.

H/O involuntary micturition and defecation present 

H/O slurred speech present after fall

On presentation patient is conscious,confused,slurred speech present.



Past history 



N/K/C/O HTN,DM,TB,epilepsy,CVA,CAD



Personal history 

Diet -mixed

Appetite-normal

Bowel movements-irregular 



He is a toddy drinker and smokes chutta 



Family history 

Not significant 



General examination 

Pt is conscious 

Vitals

Temp-Afebrile 

Bp-120/60mmHg

PR-90bpm

Spo2-99% on RA



Systemic examination 



CVS-S1,S2 +

RS- BAE+,NVBS

P/A-soft,non tender

CNS-

He is conscious and confused 

Speech is slurred 



Motor examination

Tone -increased on rt side

Reflexes-

          Rt. Lt 



       B. 2+. +

       T. 2+. +

       S. 2+. +

       K. 3+. +

       A. 3+. +

Planters-B/L mute



Sensory examination 

Flexion movement to pain



Provisional diagnosis 

Acute ischemic stroke (Lacunar infarct) 

Frontal occipito-temporal lobe 

DENOVO HTN, DM II

H/O Chronic smoker and alcoholic

GRADE 2

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