A 70 year old patient with c/o of Altered sensorium since 3 days

Patient was apparently asymptomatic till afternoon (21jan2021) then she developed altered sensorium ,after she had her afternoon lunch and took a nap and when she woke up her daughter in law noticed abnormal behaviour (not recognizing her, murmuring).H/o fever 4days back which was sudden in onset gradually progressive & not present throughout the day and also subsided on taking medication.H/O neck pain and shoulder pain for which she was taken to the near RMP for which she was given NSAIDS.No H/o of chest pain, palpitations, burning micturition,SOB,pedal edema.Not a K/C/O of DM and HTN K/C/O alcoholism (occasionally) 50ml .

O/E pt was c/c/c.

Pallor -

Icters-

Cyanosis-

Clubbing-

Edema-

Dehydration+

Dry tongue+

Vitals BP 130/80mm Hg

Temperature 99.6°F

PR 86bpm

CVS-S1 S2 heard

RS - BAE +,NVBS

P/A soft and non tender,no organomegaly, passage of stools +.

CNS examination  LT             RT

Tone                         N              N

Power                      5/5           5/5

DTR

Biceps                    ++             ++

Triceps                  ++            ++

Knee                     ++            ++

Ankle                    ++            ++

Plantar                         Flexor

 Investigations