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 patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome




60yr old , daily wage labourer by occupation presented to casualty with inability to move his right upper and lower limb with deviation of mouth to left side , with slurring of speech.


History of present illness 

He was apparently asymptomatic since 4-5 days ago and then on afternoon 3-4 pm , he experienced sudden onset of deviation of mouth to left side with slurring of speech

Next day mrng following his daily routine around 7:30am , after having cup of tea he suddenly fell from chair and was unable to lift his right upper and lower limbs.

PAST HISTORY:

No significant family history
No significant drug history.

Not a k/c/o diabetes mellitus, hypertension, asthma, TB, epilepsy .

PERSONAL HISTORY:
Diet:Mixed
Appetite:Normal
Bowel and Bladder moments: normal 










General Examination 

No pallor,icterus,cyanosis, clubbing,lymphadenopathy edema

VITALS:
BP: 140/90MMHG
PR:74BPM
RR:18CPM
TEMP: 98.7F
SPO2:94% 

CVS: S1S2+,No Murmurs
RS: NVBS+ , decreased breath sounds in left ISA.
PER ABDOMEN:
 soft non tender
CNS: 
consciousness+
Speech: slurred.
No signs of meningeal irritation.
Deviation of mouth to left side.
Power:.  R.        L
     UL.    0/5.     5/5
     LL.     0/5.     5/5
TONE.    R.                   L
    UL.    Decreased.   Normal
    LL.    Decreased.   Normal
REFLEXES:.     R.         L
  BICEPS.      2+.        2+
  TRICEPS.    1+.       2+
  SUPINATOR 1+.      1+
  KNEE.          3+.        2+
  ANKLE.        -.            -
CEREBRAL SIGNS:
NO FINGER NOSE COORDINATION.

NO KNEE HEEL IN COORDINATION.
Investigations
HB:15.6 GM/DL
RBC:4.8
WBC:7,300


Provisional Diagnosis 
Right sided Hemiplegia secondary to Acute ischemic stroke

Treatment 
1.IVF @50ml/hr
2.Inj Pantop 40mg/IV/OD 
3.T.Ecospirin 75 mg/po/OD
4.T.Clopidogrel75mg/po/OD
5.T.Arribas 40 mg/po/OD
6.Physiotherapy of right UL,LL





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