A 65 year old male came to opd with complaints of weakness

A 65 year old male came to opd with complaints of weakness  since yesterday

He was apparently asymptomatic 1 week ago which subsided on its own and then he started having neck pain since 6 days which increased in intensity since 4 days.

He had 1 episode of vomiting last night,non bilious and non projectile following which he started having  headache and giddiness after which he had loss of speech

No H/o DM, HTN, TB,CVA,CAD,Asthma

Personal history:

Appetite: normal

Diet:mixed

Bowel and bladder movements-regular

Addictions:

Alcoholic since 6 years,takes alcohol weekly once or twice, consuming around 250 ml

Smoking daily since 6 years,he smokes 12 beedis per day and stopped smoking after he had fever

Family history:

No family h/o DM, HTN, TB, CVA, CAD,Asthma

On examination, patient is conscious, coherent and cooperative

No pallor, icterus, cyanosis, clubbing, lymphadenopathy,edema

Vitals:

Temp-98.3 degrees F

PR-60 bpm

RR-22 cpm

BP-170/90 mm Hg

Spo2-100%

CVS- S1S2+

RS- BAE+;NVBS+

P/A-soft,non tender

CNS-He is drowsy with slurred speech 

No signs of meningeal irritation

Tone increased in right and left upper limbs

INVESTIGATIONS:

On day of admission (26/10/2021)

RFT:

Na-133

K-3.4

Cl-107

Urea-33

Creat-0.9

LFT:

TB-0.86

DB-0.20

AST-18

ALT-20

ALP-180

TP-5.9

ALB-3.5

A/G-1.5

HEMOGRAM:

HB-12.5

TLC-12,500

PTC-2.36

NORMOCYTIC, NORMOCHROMIC

RBS-119

TREATMENT:

1)IVF NS @50 ML/HR

2)INJ.OPTINEURON 1 AMP IN 100 ML NS OVER 30 MIN

3)INJ.PAN 40 MG IV/OD

4)RT FEEDS WITH 100 ML MILK,100 ML WATER,2ND HOURLY

5) STRICT I/O CHARTING

6)BP,PR MONITORING 4TH HOURLY