A 40 year old male patient with complaint of weakness in right upper limb

This is an e-LOG depicting patient's de-identified data centered approach for learning medicine. This log has been created after taking consent from patient and his family. Here we discuss about patient's problems with a series of inputs with an aim to solve them.
CHEIF COMPLAINT :
 45 yr old male came to the casuality with the cheif complaint of weakness of right upper and lower limbs and slight deviation of mouth towards left in the morning
HISTORY OF PRESENT ILLNESS:
A 45 yr old male patient , construction worker by 
Occupation was apparently asymptomatic 2 days back and then developed 2 to 3 episodes of vomitings , food particles as contents and non blood stained .and then again asymptomatic till yesterday morning and then developed weakness of right upper and lower limb and mild deviation of mouth towards left .
patients also experienced headache , blurring of vision and giddiness.
---> patient normally wakes up at 6 am and
HISTORY OF PAST ILLNESS:
History of trauma 1month back and injury to upper right limb which resulted in pain and swelling and relieved on medication.
No history of diabetes ,hypertension ,asthma ,TB,epilepsy.
 PERSONAL HISTORY:
- Marital status : married 
-Diet:- mixed
-Appetite- normal appetite 
-Bowel and bladder movements - Regular
-Micturition : normal
-Sleep :- irregular
-Addictions:-patient has a habit of chewing gutka  and discontinued since 4 yrs
-Smoking - daily(2 packs a day)
-Alcohol : daily
-Drug addiction:- no
-Allergies :- no history of allergies.
FAMILY HISTORY :
no relevant family history
GENERAL EXAMINATION:
Patient was conscious non coherent and coperative moderately fit, moderately nourished and examined ina well lit room.

No Pallor, 
No Icterus,
No Cyanosis,
No Clubbing,
No oedema (pedal)
No Lymphadenopathy
VITALS :
Temp :- 98 ‘F
PR:- 89 bpm
BP: 120/90 mmHg
SpO2: 98% 
RR:- 20 cpm
SYSTEMIC EXAMINATION :
CVS : 
no thrills no murmurs
S1 and S2 are positive
RESPIRATORY SYSTEM :
vesicular breath sounds 
No dyspnea
No wheeze 
Central position of trachea
ABDOMEN :
Shape : scaphoid
No tenderness
Liver ,spleen -not palpable
CNS : 
Conscious
Speech : incoherent
Neck stiffness : no
PROVISIONAL DIAGNOSIS: 
Acute ischemic stroke involving left temporal, frontal and parietal lobe.
Investigations:
Hb : 16.6
Tlc: 9,900
Rbc: 5.59
PT count : 2.04
CUE :
Colour pale yellow
Appearance : clear
Pus cells : 3- 4
Epithelial  cells : 2-4
---:creatine : 0.9
Urea :23
Blood group: A positive
LFT :
Total bilirubin :1.32
Alt:12
Ast: 18
Alp:178
Total proteins:6.3
Serology:
Hbs ag : negative 
HIV 1&2 : negative
Anti Hcv ab's : negative 
---:Na+ :140
K+ : 3.9
Cl-  100
ECG :
Ultrasound 


TREATMENT :

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