This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input

40yr old male came to opd with complaints of Giddiness, slurring of speech , parasthesia and weakness of left upper and lower limb , difficulty in swallowing, Diplopia (Binocular) , hyperacusis left aural fullness since 1week 
HOPI 
Pt was apparently asymptomatic 1week back , then he had sudden onset of weakness of left lower and upper limb associated with slurring of speech and giddiness at around 2pm 1week back 
Pt had history of polio since childhood ,6 months of age 
He used to walk on B/L upper limb since childhood 
Weakness- sudden onset of left lower and upper limb , unable to roll on bed, unable to walk on upper limb associated with parasthesia of left half of the body 
Able to lift the hand above shoulder 
Giddiness ( self reeling ) - increasing with sitting , not associated with nausea, vomitings , headache 
No bowel and bladder incontinence
No loss of consciousness, seizures , palpitations, sweating , sob
In village health checkup he was diagnosed to have hypertension and was put on Telma 40mg 

PERSONAL HISTORY 
Diet - mixed 
Appetite - Normal 
Bowel and bladder- regular 
No allergies 
Alcohol- since 20yrs 2-3 times / week 
90ml/day 
 
FAMILY HISTORY - not significant 

GENERAL EXAMINATION 
Pt is c/c/c 
No pallor , icterus, cyanosis, clubbing, lymphadenopathy, koilonychia , oedema 

VITALS 
   Temp- Afebrile 
    PR- 88bpm
    RR - 12cpm 
    Bp- 140/8mmhg 
    Spo2 - 99%RA 
    Grbs- 128 mg% 

SYSTEMIC EXAMINATION 
 CVS- s1s2 + 
 RS- BAE+ , NVBS heard 
 P/A - soft , no tender 
 CNS 
  CNS- oriented to time,place,person
memory : recent, remote intact
speech: slurred,
 dysarthria.
 cranial nerves:

6 - Rt lateral rectus palsy 

8- left side air conduction more than bone conduction ( Rinne’s)
Weber’s- patient cannot confirm the lateralisation 
9-deviation of uvula to right side 
Rest of the cranial nerves are normal 
*motor*:
*tone* :-b/l UL-normal
b/l LL-flaccid
*power* 4/5 in left upperlimb ,5/5 in right upper limb
2/5 in left lower limb, 2/5 in right lower limb 
reflexes :biceps:b/l: +
triceps +, supinator+, knee -, plantars: b/l mute


sensory: crude ,pain,temp, fine touch, joint position, proprioception are normal in all dermatomes

cerebellum- 
finger nose- normal
Finger finger test normal
No Nystagmus,

Gait:cannot be elicited

Provisional diagnosis:
Left CVA- Left hemiparesis secondary to acute infarct in ? Right pons with hypertension 

Rx:
1. RT feeds 100ml milk 2nd hrly ; 50ml water hrly
2.Inj pantop 40mg IV/od 
3. Tab ecospirin 150 mg        
Rt/0d  
4. Tab Atorvas 40mg Rt/od  
5. Physiotherapy of left upper and lower limbs 
6. Inj . Zofer 4mg lv/sos

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This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.   A 42 year old female came to the OPD with C/o    - pitting type of pedal edema since 11months    - facial puffiness since 11 months    - decreased urine output since 11months   - Shortness of breath (SOB)
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