1. Echo-Conference R2 조경민

2. History 11584458 송 O 규 Chief Complaint Lt.side weakness O/S) Recent onset 3-4 days ago Present illness A 75 year old woman had taken medication for dysarthria at The KMC Oriental medicine OPD. But recently 3-4 days ago, She had Lt. side weakness. So, she was admitted to KMC Oriental medicine for further evaluation

3. Past Medical History HTN (-) / DM(-) / Hepatitis(-) / Pulmonary TB(-) HTN (-) / DM(-) / Hepatitis(-) / Pulmonary TB(-) Operation Hx. (-) Operation Hx. (-) Personal History Alcohol (-) Alcohol (-) Smoking (-) Smoking (-) Family History Unremarkable Unremarkable History

4. Review of System General Fatigue(+) Febrile sensation(-) Chill(-) Wt. gain (-) Skin Rash(-) Pigmentation(-) Itching(-) H&N Headache(-) Sore throat(-) Dysarthria (+) Respiratory Cough(-) Sputum(-) Hemoptysis(-) Cardiac Chest pain(-) Orthopnea(-) Dyspnea(-) Edema(-) exercise limits (-) Palpitation(-) exercise limits (-) Palpitation(-) G-I Postprandial abd. discomfort (-) Anorexia(-) Nausea(-) Vomiting(-) Abd. pain(-) Vomiting(-) Abd. pain(-) Renal Dysuria(-) Urgency(-) Frequency (-) Hematuria(-) Muscularskeletal pain(-) weakness(+) Nervous System Motor problem (+): gait disturbance

5. Physical Examination V/S 100/60mmHg – 92/min – 20/min - 36°C V/S 100/60mmHg – 92/min – 20/min - 36°C General Appearance General Appearance Alert mental status Alert mental status Chronic ill-looking appearance Chronic ill-looking appearance Head & Neck Head & Neck No cervical LN enlargement No cervical LN enlargement No neck vein engorgement No neck vein engorgement No thyroid enlargement No thyroid enlargement Eye & ENT Eye & ENT Isocoric pupil with PLR(++/++) Isocoric pupil with PLR(++/++) Pinkish conjunctiva with Clear sclera Pinkish conjunctiva with Clear sclera Body weight :62.2 Kg Height : 164 cm BMI:20.5 kg/m 2

6. Physical Examination Chest Chest Clear breathing sound without crackle or wheezing Clear breathing sound without crackle or wheezing Regular heart beat without murmur Regular heart beat without murmur Abdomen Abdomen Soft & flat abdomen Normoactive bowel sound Soft & flat abdomen Normoactive bowel sound Tenderness(-) Rebound tenderness(-) Tenderness(-) Rebound tenderness(-) Back & Ext. Back & Ext. CVA tenderness (-/-) Pretibial pitting edema(-/-) CVA tenderness (-/-) Pretibial pitting edema(-/-) Neurologic examination Neurologic examination Babinski (-/-) Ankle clonus (-/-) Babinski (-/-) Ankle clonus (-/-) Sensory Ⅴ Ⅴ motor Ⅴ I Ⅴ Sensory Ⅴ Ⅴ motor Ⅴ I Ⅴ Ⅴ Ⅴ Ⅴ I Ⅴ Ⅴ Ⅴ Ⅴ I Ⅴ

7. Initial Lab. Findings CBC/DC CBC/DC 5660/mm 3 –12.3g/dL – 34.9 % -237000 /mm 3 5660/mm 3 –12.3g/dL – 34.9 % -237000 /mm 3 (Seg. 59.8%) (Seg. 59.8%) Chemistry Chemistry Total Bilirubin 0.27mg/dL Total Bilirubin 0.27mg/dL Prot/ Alb 6.6 / 3.8g/dL Prot/ Alb 6.6 / 3.8g/dL AST/ALT 21/ 16 U/L AST/ALT 21/ 16 U/L ALP/ GTT 96/ 282 U/L ALP/ GTT 96/ 282 U/L BUN/ Cr 15/ 0.5 mg/dL BUN/ Cr 15/ 0.5 mg/dL Na/K/Cl 140/40/103 mg/dL Na/K/Cl 140/40/103 mg/dL Ca/ P /Uric acid 8.2/ 3.5/5.2mg/dL Ca/ P /Uric acid 8.2/ 3.5/5.2mg/dL

8. Chest X-ray (2009.01.30)

9. EKG (2009.01.30)

11. Brain MRI (2009.1.30) Subacute focal - Subacute focal - infarction infarction at the right BG at the right BG

12. Initial Assessments #1. Cerebral infarction #1. Cerebral infarction #2. Cardiomegaly d/t r/o CHF #2. Cardiomegaly d/t r/o CHF

13. Echocardiography (2009.01.30) Echocardiography 시행 이유 Echocardiography 시행 이유 : For further evaluation of causes of cerebral infarction, such as : For further evaluation of causes of cerebral infarction, such as intracardiac thrombus, ect. intracardiac thrombus, ect. Transthoracic echocardiography Transthoracic echocardiography

14. Final diagnosis #1. Severe AS with asymmetric LVH #1. Severe AS with asymmetric LVH #2. Cerebral infarction #2. Cerebral infarction