CSVT in a nulliparous female with ?clinical picture of PCOS

 38 YR OLD FEMALE CAME WITH THE 

C/O SEIZURES SINCE 4 DAYS .

HOPI

Patient was apparantly asymptomatic 20 days back then she had fever , headache , cough , cold for which she had taken treatment from the local hospital , from then she had on and off fever with generalized wekness and 4 days back she had slurring of speech for which she went to a local hospial and there she had episode of seizure involving right upper limb and deviation of mouth , associates with tongue bite ,episode lasted for 5 min . No H/o loss of consciousness , involuntary micturition , involuntary defecation . Again 6 more episodes of right upper limb unilateral focal seizures on the next 3 days that is 2 episode each night .from there she was referred to our hospital for further treatment .


PAST HISTORY 

K/C/O poliomyelitis since 3 years of age (5 -10 days post vaccination)

Not a k/c/o DM , HTN , CAD , ASTHMA , TB .

Underwent surgery for removal of ? Lipoma  8 years ago .


PERSONAL HISTORY 

Married 

Occupation :Tailor ( sweing with hand )

Diet : mixed

Appetite : decreased

Bowel and bladder : Regular 

No addictions .

No known allergies .


FAMILY HISTORY 

No K/C/O HTN , DM, ASTHMA , THYROID , TB , EPILEPSY in the family .


MENSTRUAL HISTORY 

- Age of menarche : 12 years 

- Regular cycles , 4-5 days bleeding for every 30 days .

No pain and No clots 

No c/o heavy menstrual bleeding .


MARITAL HISTORY

Age at time of marriage - 28 years 

Age of her husband at time of marrige - 32 years .

Non consaguinous marriage.

Marital life - 9 years .

Both patient and her husband used  some herbal medications for a week for infertility two years after marriage and later they did not 

Use any medications for infertility.

Patient husband is k/c/o diabetic since last 1 year and not on any medication .


 DAILY ROUTINE

She was homemaker and wakes up daily at 6 am in the morning followed by daily chores and eats breakfast (rice with curry) and then countinues her daily household work and takes lunch around 2-3 pm. Later she finishes the works which were pending in the morning and then have her dinner around 7:30 pm and sleeps aorund 8:30 - 9 :00 pm.


GENERAL EXAMINATION 

Patient is conscious , cooperative 

No Pallor, icterus ,cyanosis, clubbing , lymphadenopathy , edema.

VITALS 

TEMP : 98.6

BP : 120/ 80 mmhg

PR : 92/ min

RR : 20/ min 

Spo2 : 98% on RA


SYSTEMIC EXAMINATION 

CVS : S1, S2 + 

RS : BAE + , NVBS 

P/A : SOFT , NON TENDER 

CNS : 

PATIENT IS CONSCIOUS , 

SPEECH : SLURRED 

SENSORY SYSTEM : INTACT 

FACIAL DEVIATION TOWARDS LEFT SIDE.

MOTOR SYSTEM :  

                               R                         L 

TONE      UL   Hypotonic   Normal/hypotonic

                  LL      Hypotonic       Hypotonic 

       

POWER     UL       1/5                  3/5 

                   LL       1/5                  3/5

  

REFLEXES

 

         B      T      S      K        A         P


R      1+     1+     -       -          -         Extensor


L       1+    1+   1+     -          -         Extensor


PROVISNAL DIAGNOSIS 

Seizures secondary to hemorrhagic infarct - left parietal lobe .

? CSVT 

RIGHT HEMIPARESIS WITH BROCA'S APHASIA














INVESTIGATIONS 


30/10/21

Serology - Negative 

























4/11/21

PT -16 SEC.

INR- 1.1

APTT- 32 SEC

FINAL DIAGNOSIS

Right hemiparesis with brocas aphasia secondary to acute to subacute thrombus in anterior saggital sinus .


TREATMENT GIVEN 

- HEAD END ELEVATION

-IVF - NS , RL @ 75 ML / HR

- INJ. LEVIPIL 500MG IV BD IN 100ML NS

- INJ . MANNITOL 100ML IV TID

- INJ. LORAZ 2CC IV SOS 

- TAB. DOLO 650 MG PO SOS 

- TAB. PAN 40 MG PO OD

- SYP. AMBROXOL 10ML TID

- OINT. THROBOPHOBE FOR L/A

- INJ. CLEXANE 60MG SC OD 



SOAP NOTES

Day2 

ICU BED 4

38 yr old female


S : NO FREASH COMPLAINTS 


O :

SYSTEMIC EXAMINATION 

CVS : S1, S2 + 

RS : BAE + , NVBS 

P/A : SOFT , NON TENDER 

CNS : 

PATIENT IS CONSCIOUS 

SPEECH : SLURRED 

SENSORY SYSTEM : INTACT 

FACIAL DEVIATION TOWARDS LEFT SIDE.

MOTOR SYSTEM :  

                               R                         L 


TONE      UL   Hypotonic   Normal/hypotonic


                  LL      Hypotonic       Hypotonic       


POWER     UL       1/5                  3/5 


                   LL       1/5                  3/5

REFLEXES

         B      T      S      K        A         P

R      1+     1+     -       -          -         Extensor

L       1+    1+   1+     -          -         Extensor


A : 

Seizures secondary to hemorrhagic infarct - left parietal lobe .

? CSVT 

RIGHT HEMIPARESIS WITH BROCA'S APHASIA


P: 

HEAD END ELEVATION

-IVF - NS , RL @ 75 ML / HR

- INJ. LEVIPIL 500MG IV BD IN 100ML NS

- INJ . MANNITOL 100ML IV TID

- INJ. LORAZ 2CC IV SOS 

- TAB. DOLO 650 MG PO SOS 

- TAB. PAN 40 MG PO OD

- SYP. AMBROXOL 10ML TID

- OINT. THROBOPHOBE FOR L/A

- INJ. CLEXANE 60MG SC OD



SOAP NOTES

Day 3

 ICU BED 4

38 yr old female


S : COMPLAINTS OF PAIN AND SWELLING OF RIGHT UPPER LIMB


O :

SYSTEMIC EXAMINATION 

CVS : S1, S2 + 

RS : BAE + , NVBS 

P/A : SOFT , NON TENDER 

CNS : 

PATIENT IS CONSCIOUS 

SPEECH : MONOSYLLABLES +

SENSORY SYSTEM : INTACT 

FACIAL DEVIATION TOWARDS LEFT SIDE.

MOTOR SYSTEM :  

                               R                         L 


TONE      UL   Hypotonic   Normal/hypotonic


                  LL      Hypotonic       Hypotonic       


POWER     UL       1/5                  3/5 


                   LL       1/5                  3/5

REFLEXES

         B      T      S      K        A         P

R      1+     1+     -       -          -         Extensor

L       1+    1+   1+     -          -         Extensor


A : 

Seizures secondary to hemorrhagic infarct - left parietal lobe .

? CSVT 

RIGHT HEMIPARESIS WITH BROCA'S APHASIA


P: 

HEAD END ELEVATION

-IVF - NS , RL @ 75 ML / HR

- TAB. LEVIPIL 500MG IV BD IN 100ML NS

- INJ . MANNITOL 100ML IV TID

- INJ. LORAZ 2CC IV SOS 

- TAB. DOLO 650 MG PO SOS 

- TAB. PAN 40 MG PO OD

- SYP. AMBROXOL 10ML TID

- OINT. THROBOPHOBE FOR L/A

- INJ. CLEXANE 60MG SC OD


SOAP NOTES 

Day 4

AMC BED 3

38 yr old female


S : NO FREASH COMPLAINTS 


O :

SYSTEMIC EXAMINATION 

CVS : S1, S2 + 

RS : BAE + , NVBS 

P/A : SOFT , NON TENDER 

CNS : 

PATIENT IS CONSCIOUS 

SPEECH : SLURRED 

SENSORY SYSTEM : INTACT 

FACIAL DEVIATION TOWARDS LEFT SIDE.

MOTOR SYSTEM :  

                               R                         L 


TONE      UL   Hypotonic   Normal/hypotonic


                  LL      Hypotonic       Hypotonic       


POWER     UL       1/5                  3/5 


                   LL       1/5                  3/5

REFLEXES

         B      T      S      K        A         P

R      1+     1+     -       -          -         Extensor

L       1+    1+   1+     -          -         Extensor


A : 

Seizures secondary to hemorrhagic infarct - left parietal lobe .

? CSVT 

RIGHT HEMIPARESIS WITH BROCA'S APHASIA


P: 

HEAD END ELEVATION

-IVF - NS , RL @ 75 ML / HR

- TAB. LEVIPIL 500MG IV BD IN 100ML NS

- INJ . MANNITOL 100ML IV TID

- INJ. LORAZ 2CC IV SOS 

- TAB. DOLO 650 MG PO SOS 

- TAB. PAN 40 MG PO OD

- SYP. AMBROXOL 10ML TID

- OINT. THROBOPHOBE FOR L/A

- INJ. CLEXANE 60MG SC OD



SOAP NOTES

Day 5

AMC BED 3

38 yr old female


S : NO FREASH COMPLAINTS 


O :

SYSTEMIC EXAMINATION 

CVS : S1, S2 + 

RS : BAE + , NVBS 

P/A : SOFT , NON TENDER 

CNS : 

PATIENT IS CONSCIOUS 

SPEECH : SLURRED 

SENSORY SYSTEM : INTACT 

FACIAL DEVIATION TOWARDS LEFT SIDE.

MOTOR SYSTEM :  

                               R                         L 


TONE      UL   Hypotonic   Normal/hypotonic


                  LL      Hypotonic       Hypotonic       


POWER     UL       1/5                  3/5 


                   LL       1/5                  3/5

REFLEXES

         B      T      S      K        A         P

R      1+     1+     -       -          -         Extensor

L       1+    1+   1+     -          -         Extensor


A : 

Seizures secondary to hemorrhagic infarct - left parietal lobe .

? CSVT 

RIGHT HEMIPARESIS WITH BROCA'S APHASIA


P: 

HEAD END ELEVATION

-IVF - NS , RL @ 75 ML / HR

- TAB. LEVIPIL 500MG IV BD IN 100ML NS

- INJ . MANNITOL 100ML IV TID

- INJ. LORAZ 2CC IV SOS 

- TAB. DOLO 650 MG PO SOS 

- TAB. PAN 40 MG PO OD

- SYP. AMBROXOL 10ML TID

- OINT. THROBOPHOBE FOR L/A

- INJ. CLEXANE 60MG SC OD


SOAP NOTES 

Ward patient

38 yr old female


S : NO FREASH COMPLAINTS 


O :

SYSTEMIC EXAMINATION 

CVS : S1, S2 + 

RS : BAE + , NVBS 

P/A : SOFT , NON TENDER 

CNS : 

PATIENT IS CONSCIOUS 

SPEECH : SLURRED 

SENSORY SYSTEM : INTACT 

FACIAL DEVIATION TOWARDS LEFT SIDE.

MOTOR SYSTEM :  

                               R                         L 


TONE      UL   Hypotonic   Normal/hypotonic


                  LL      Hypotonic       Hypotonic       


POWER     UL       0/5                  3/5 


                   LL       0/5                  3/5

REFLEXES

         B      T      S      K        A         P

R      1+     1+     -       -          -         Extensor

L       1+    1+   1+     -          -         Extensor


A : 

Seizures secondary to hemorrhagic infarct - left parietal lobe .

? CSVT 

RIGHT HEMIPARESIS WITH BROCA'S APHASIA


P: 

HEAD END ELEVATION

-IVF - NS , RL @ 75 ML / HR

- TAB. LEVIPIL 500MG IV BD IN 100ML NS

- INJ. LORAZ 2CC IV SOS 

- TAB. DOLO 650 MG PO SOS 

- TAB. PAN 40 MG PO OD

- SYP. AMBROXOL 10ML TID

- OINT. THROBOPHOBE FOR L/A

- INJ. CLEXANE 60MG SC OD

- TAB. ACITRAM 2MG PO OD 


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