Help Me With My Case... Plizz
Mr. XXX, 54 years old Malay man and self employed. Know to have hypertension and ischemic heart disease since last year, admitted complaining of right-sided weakness one day prior to admission. He also complaint of headache and numbness, difficulty to swallow and aphasia. Past history indicate he had also experience left sided weakness last year which subside after had traditional medication. He was on Perindopril, Carvidelol and Lovastatin and he was not compliant to the medication. No family history of similar illness, no history of smoking and alcohol consumption.
Physical examination reveal blood pressure was high with 190 / 122, pulse rate 98 beats per minutes, and respiratory rate 36 breath per minute. Cranial nerves examination reveal facial (VII) cranial nerve lower motor neuron lesion , which is loss of nasolabial fold and wrinkle on right side, vagus (X) cranial nerves weakness with no gag reflex and Hypoglossal (XII) cranial nerves abnormalities with the tongue deviated to the right. Other neurological examination shows reduced tone of right upper and lower limb, power grade 0/5 of right upper and lower limb, and negative Babinski sign.
On investigation the Electrocardiography shows an ST elevation on V2 – V3, lipid profile with abnormal result of cholesterol, triglycerides, HDL and LDL level, Urea and electrolyte investigation shows raised in chloride level, and Computed Tomography of brain shows hypo dense on the thalamic area.
So What Do You Think The Diagnosis Is? and why ?
<< Home