LONG CASE 1

66 yr old right-handed male patient was complaining of weakness of the left side of his body for last
15 days. At the onset when he was about to go to bathroom at about 5 a.m. he suddenly felt weak
and could not move his left side. The episode was sudden in onset and the evolution of paralysis was
completed within 6 hours. The patient complained of headache and vertigo at the beginning of the
attack but neither he lost consciousness nor there was any difficulty in speech though there was
some behavioural abnormalities present at that moment. He was immediately hospitalised. The
patient also said that the weakness was marked in the left upper limb in comparison to left lower
limb. There was no loss of bladder and bowel control. He had no H/O vomiting, convulsions, double
vision, nasal regurgitation or nasal intonation; but he complained of deviation of face to the right
side during eating, speaking or attempted smiling. he is gradually improving in the hospital. There
Was no H/o fever, head injury, palpitation, chest pain, breathlessness, previous neurodeficit of this
type which recovered completely no H/O diabetes mellitus; a non-smoker by habit

On examination pulse : 95bpm regular in rhythm normal volume . BP 160/90mmhg, rt arm

measured in supine position in rt arm

O/E-

HMF- global aphasia

CRANIAL NERVES

Extraocular movements- normal

deviation of angle of mouth to right side

uvula- central, gag reflex +

MOTOR RUL RLL LUL LLL

TONE NORMAL NORMAL INCREASED INCREASED

POWER 5 5 2 3

REFLEX 2+ 2+ 3+ 3+

INVOLUNTARY MOVEMENTS- NONE

PLANTAR- R-FLEXOR, LEFT-EXTENSOR

RUL RLL LUL LLL

SENSORY NORMAL NORMAL IMPAIRED IMPAIRED

CEREBELLAR SIGNS- NORMAL

SKULL AND SPINE- NORMAL

No signs of meningeal irritation

Other systems- normal