75 yr old male farmer by occupation presented with altered sensorium to casuality around 4:30 hrs 

As the clinical examination was done which showed hypoglycemia(around 22 mg/dl) was corrected with 3. 25 D and was soon regaining consciousness.
Patients earliest recall of events started 20 days back while on his usual work in his field. Later in the afternoon after his lunch resumed the work harvesting the crop developed weakness inthe left arm and leg fell on the ground on further probing he said he was conscious all the time his daughter in law quickly called her husband and was taken to their home. Later in the evening, he received medication from a local doctor his weakness progressively increasing for 3 days He had slipage in the washroom. He was given herbal medication with an alternative day infections (unknown) for 6 days. At around 2:00pm on the day of presentation while he was sleeping developed profuse sweating he went for a nature call using support and was feeling giddiness,headache and fell unconscious and he was presented to casuality in altered sensorium

He often drinks alcohol and enjoys smoking tobacco since 25 years of 90ml whisky /day and 1 pack every 2 days respectively.

General examination:
 pallor +
icterus -
cyanosis -
clubbing -
edema -
lymphadenopathy -
Malnutrition +

Temp 98
BP 140/80mm hg
PR 71bpm
spO2 97
grbs 22mg/dl

Sys E:
CVS S1S2 +
RS clear
Abdomen non tender
CNS
Level of consciousness - stuporous
Speech normal
Power Rt. Lt.
   UL. +4/5 3/5
  LL. -4/5. 3/5
Reflexes. Rt. Lt.
Biceps     3+ 3+
Triceps    3+ 3+
Supinator 3+  3+
Knee.        3+ 3+
Ankle.      3+. 3+

Plantars extensor on L side 
                Withdrawal on R side
CXR:
2decho:

Treatment:
Day 1:
T.Ecospirin -AV (150/20mg) PO HS
T.Clopidogrel 75 mg PO /HS
Inj.Thiamine 1 ampoule in 100ml NS /IV/TID
Inj.Optineuron 1ampoule in 100 ml NS/IV/OD
25% dextrose /IV if GRBS <75mg/dl

Day 2:
T.Ecospirin -AV (150/20mg) PO HS
T.Clopidogrel 75 mg PO /HS
Inj.Thiamine 1 ampoule in 100ml NS /IV/TID
Inj.Optineuron 1ampoule in 100 ml NS/IV/OD
25% dextrose /IV if GRBS <75mg/dl
Day 3:
IVF 1DNS@75ml/hr
T.Ecospirin -AV (150/20mg) PO HS
Inj.Thiamine 1 ampoule in 100ml NS /IV/TID
Inj.Optineuron 1ampoule in 100 ml NS/IV/OD
25% dextrose /IV if GRBS <75mg/dl
Day 4:
T.Ecospirin -AV (150/20mg) PO HS
T.Clopidogrel 75 mg PO /HS
Inj.Thiamine 1 ampoule in 100ml NS /IV/TID
Inj.Optineuron 1ampoule in 100 ml NS/IV/OD
Syrup POTLHLOR 15ml PO TID 1glass glass of water

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