45 Y/O male with complaints of breathlessness, weakness of Right UL and LL

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I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

Case 

This is a case of a 45 year old Male admitted in the ward, with a complaints of 

• Breathlessness on & off since 20 days
• Weakness of Right upper and lower limbs since 3 hrs
• Unable to speak since 1 hr

History Of Presenting illness:

Patient was apparently asymptomatic 10 years back and devloped weakness of RT. upper and lower limb for which they visited KIMS nkp and was managed conservatively and was diagnosed with DM (type -2) and has been on OHAs since then.

Now since 20 days pt. Is having breathlessness which is intermittent for which he want to local hospital diagnosed with consolidation of Right middle lobe . He tested CB-NAAT -ve, and managed conservatively.

On 14th December, at around 9 pm Pt. Started developing weakness of Rt. UL and LL and was unable to speak since 1 year. 

No h/o headache , seizure........

Pt. Mention that he did not take his Diabetes medicine yesterday .

History of Past illness:

K/c/o D.M. type 2 since  10 years ( on Tab. Glimy M2)

Not a k/c/o HTN, asthma, CAD, T.B. ...

Personal history-

Occupation:- Farmer(tractor drivers)

Married

Diet- mixed

Apetite- Normal

Seep- adequate

Bowel  and bladder movements:- regular 

Addictions:- Alcohol occasionally

                       No other addictions

Family history

No Similar Complaints in the family 

Allergic history

No known allergies

General examination

Pallor : no

Icterus: No

Cyanosis :no

Clubbing of fingers/toes : No

Lymphadenopathy : No 

Edema of feet : No

Malnutrition : No

Temp. : 98.6 F

P.R. : 112 bpm

R.R. : 16 cpm

B.P. : 100/80 mmhg.

SYSTEMIC EXAMINATION

CVS 

Cardiac sounds      :- S1 & S2 - Present

Cardiac murmurs   :- NO 

RESP. SYSTEM

Dyspnoea  :Yes

Wheeze    : No

Position of Trachea : Central

Breadth Sounds : Vesicular

ABDOMEN

Shape of abdomen : Scaphoid

Tenderness : NO

Palpable Mass : NO

Bruit:- No

Liver : Not Palpable

Bowel sounds: Yes

C.N.S

Level of consciousness : Consciousness: Conscious / Alert 

Speech : Slurred

Signs of Meningeal irritation a)Neck stuffiness: NO b)Kernig's sign: NO

        R ight.                          Left.

 Tone.  

                          UL.                Normal.                     Normal.   

                          LL.                 Normal.                     Normal

Power 

                           UL.                    1/5                              5/5

                            LL.                    1/5                             5/5

Reflexes.     

                          Biceps:.               1+.                              2+

                          Triceps.               1+.                              2+

                           Supinator.          -.                                 1+

                            Knee.                   1+.                              2+

                             Ankle.                  -.                                 1+

INVESTIGATIONS:

Provisional Diagnosis:- 

Right Hemiplegia. 2° to ? Acute ischemic stroke? 

With Right middle lobe of lung consolidation, 2° pneumonia?