80year male patient with vomitings and giddiness

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80 YRS MALE WITH COMPLAINTS OF VOMITINGS  AND GIDDINESS.

80 years male who is a farmer by occupation came to casuality with chief complaints of vomiting 2 episodes since morning and giddiness since morning.

History of Presenting illness:

Patient was asymptomatic until Today morning, Then he woke up and ate food and after 2 1/2 hours, he went to his work in field, while working in the field he had sudden onset of giddiness followed by vomitings-2 episodes - bilious,non projectile type not associated with pain abdomen, fever, loose stools.

- Vomitings followed by giddiness (self reeling type) since morning - sudden onset aggravated with movements or sitting up, swaying while walking present, associated with headache holocranial type, associated with nausea and vomitings.

- No history of loss of consciousness, seizures, diplopia, blackouts, chest pain, constipation, sweating and palpitations, earache, aural fullness or discharge, tinnitus.

- No history of trauma to head.

- No complaints of weakness, tingling or numbness of limbs, difficulty in chewing, swallowing, deviation of mouth.

- No bowel and bladder incontinence.

PAST HISTORY:

- Known case of  Hypertension since 4 years - on treatment TAB. ATENOLOL 50 mg

- Not a Known case of  diabetes mellitus/TB/Epilepsy/Asthma/CAD/CVA

PERSONAL HISTORY:

Diet- mixed

Sleep- adequate

Appetite- normal

Bowel and bladder movements- regular

No known allergies

- ALCOHOLIC SINCE 40 YEARS- 3 times/week 90 ml

- SMOKER SINCE 40 YEARS- 1 packet/day

FAMILY HISTORY: Not Significant

GENERAL EXAMINATION:

-Patient was examined after taking informed consent in a well lit room.

-Patient is Conscious, coherent and cooperative.

-No pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy, edema.

VITALS:

Temperature - Afebrile

PR- 68 bpm

RR- 14 cpm

BP- 120/70 mmHg

SpO2- 99% at RA

GRBS- 132 mg/dL

SYSTEMIC EXAMINATION:

CVS- S1S2 heard, no murmurs

RS- BAE+, NVBS+

P/A- Soft, Non-tender

CNS:

Patient is oriented to time,place,person

Memory : recent, remote intact

Speech: Normal

Cranial nerves: Intact

Motor system: 

Power-5/5 in both upper and lower limbs

Tone- Normal in bilateral upper and lower limbs

Sensory system: crude ,pain, temperature, fine touch, joint position, proprioception are normal in all dermatomes

GCS: 15/15

Reflexes :

Biceps, Triceps, Supinator, Knee and ankle reflexes were absent

Plantars: mute

Cerebellum:

Finger nose incoordination - Yes

Knee heel incoordination - Yes

No dysdidokinesia.

Nystagmus+ in both horizontal and vertical gaze.

PROVISIONAL DIAGNOSIS :

Giddiness under evaluation secondary to ?PCA Stroke with Hypertension

     ?BPPV

INVESTIGATIONS:

Hemogram on 6/01/2022:

Hemogram on 7/01/2022:

CUE:

PT,APTT,INR:

ECG on 7/01/2022:

ECG on 8/01/2022:

USG ABDOMEN:

MRI BRAIN:

ENT REFERRAL:

TREATMENT:

1) INJ. THIAMINE 1 amp in 100 ml NS IV/TID

2) INJ. OPTINEURON 1 amp in 100 ml NS Slow IV/OD

3) INJ. PANTOP 40 mg IV/BD

4) INJ. ZOFER 4 mg IV/TID

5) TAB. PROMETHAZINE 25 mg PO/TID