35 Female with diminision of vision in Right eye and Headache

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CHEIF COMPLAINTS AND HOPI:

35 year old female came with cheif complaints of

-Diminision of vision of right eye since morning 3am

-Headache since 2 days

Patient was apparently asymptomatic 2 days back then started developing diffuse headache sudden in onset,gradually progressive associated with neckpain 

No H/O nausea and vomiting,photophobia,phonophobia

Then since morning 3am had sudden painless loss of vision

No H/O ocular trauma or head trauma

No H/O giddiness,LOC,weakness of both UL and LL

No H/O fever,cough,cold,chestpain,palpitations,orthopnea,PND

PAST HISTORY:

H/O some insect bite 2 months back and took herbal medication

N/k/c/o DM,HTN,Epilepsy 

K/c/o hypothyroidism since 5 years  and on tab.thyronorm 100 mcg.

GENERAL EXAMINATION:

Patient is conscious coherent and cooperative 

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

Vitals : 

BP- 140/90mmhg

PR -90bpm

RR-18cpm

Spo2 99% at room air 

Temperature -98.2F

Cvs: s1,s2 heard ,no Murmurs,jvp not raised 

Rs: BAE,no added sounds ,NVBS, 

P/A: soft, non tender,bowel sounds can be heard 

CNS:

Pt is conscious

Speech is normal

GCS: E4,V5,M6

TONE:   RT.              LT

        UL NORMAL.     NORMAL

        LL NORMAL        NORMAL

POWER:

        UL  4/5.          4/5   

        LL  4/5.          4/5

REFLEXES:

        B:   3+         3+

        T:   2+         2+

        S:   1+         1+

        K:   3+        3+

        A:   2+        2+

        P:   Flexors

INVESTIGATIONS:

05/05/2023:

06/05/23:

CLINICAL IMAGES:

OPHTHALMOLOGY REFERRAL:

PROVISIONAL DIAGNOSIS:

?CRVO

TREATMENT:

T.Dolo 650mg PO TID

Inj.Zofer 4mg IV BD

Inj.Ultracet 1 amp in 100ml NS IV SOS

Inj.Optineuron 1 amp in 1 NS IV OD