60 year old male with loss of consciousness

 A 60 years old male patient came to casuality with loss of consciousness at 2 Am 

HOPI : 


Patient was apparently alright and asymptomatic 12 days and then he experienced slip and fall on 15/4/24 and was taken to government hospital there he was diagnosed as intertrochanteric hip fracture and then shifted to ot there they have undergone surgery .

On 17/4/24 patient developed altered sensorium and is so irritable and for further four days he is under observation of doctors and the concerned doctors did not inform the accurate cause to the patient attenders and then he was discharged 

After discharge patient was at home with same irritable condition and altered sensorium for four days and again on 24/4/24 he suddenly developed SOB and then the patient attenders  admitted him to hospital there he had undergone CT brain suggested age related changes and for SOB they followed conservative treatment and altered sensorium is present

And on Saturday at 2 Am patient loss consciousness so they shifted to our causality around 5pm 


History of past illness

N/k/c/o HTN , DMII , TB , Epilepsy , Asthma , CAD

Personal history : 

Occupation :

Patient is married

Patient takes mixed diet 

Bowel and bladder movements regular

Micturition normal

No known allergies

Regular consumption of alcohol and tobacco since 30 years 1 Beedi pack / day last consumption of alcohol was on 14/4/24

No drug use

Family history : normal 






General examination : 

Bp: 110/60mm/Hg

Spo2: 98% 

GRBS : 116mg/dl

RR: 20cpm

PR: 116bpm

Pallor , icterus , cyanosis , clubbing , lymphadenopathy , pedal edema absent 

SYSTEMIC EXAMINATION : 

CVS : S1 & S 2 heard , no murmurs , no thrills 

Respiratory system : Dyspnea present 

Wheeze absent 

Position of trachea central 

Vesicular breath sounds 

P/A : On inspection : shape of abdomen : scaphoid 

No tenderness or palapable mass

Hernial orifices normal 

Bowel sounds present 

No free fluid , bruits 

Liver , spleen not palpable 

Genitals, speculum examination normal

CNS EXAMINATION : Higher mental functions ; unconscious 

Speech no response 

Signs of meningeal irritation : 

Neck stiffness : no

Kernigs sign : no

On admission 

Glasgow coma  scale E1 V1 M2

Reflexes : Right left 

Biceps 2+

Triceps -

Supinator -

Knee - 

Ankle -

Plantar - flexor ( b/l)

Provisional diagnosis : Altered sensorium secondary to  delirium ? metabolic encephalopathy( hypoxia)

Investigations : 







D- dimer - 930 ug / ml




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