A 21 year old patient suddenly had vomiting on 19/05/2020 at 1 pm and became unconscious. He then admitted to hospital at around 2 pm, was still unconscious and presented with frothing from mouth , uprolling of eyes. MRI done which was normal . He attain consciousness at 10 pm on the same day but was unable to speak and had no movement on the right half of his body . Next day in the morning he started normal walking and all movements were normal but was unable to speak .In between he experienced sudden headache around 3-4 times nd showed temperature spikes of 102°F twice and was relieved by paracetamol . Condition remains same for the day and night but on the next day ie on 21/05/2020, in the morning , hemiparesis started in right half of the body, more in the lower limb as compared to upper limb.
On examination, loss of pain, temperature, superficial touch and crude touch seen in right lower limb.
No past history of any illness.
Vitals are stable .
Pulse : ranging in between 70-90 beats per minute
Temp : ranging in between 98-99°F
Bp : ranging in between 124/80 mm of hg to 110-70 mm of hg
Spo2 : 98% without O2 support
Second time MRI done on 21/05 is still normal .
Cbc , Lft , Rft normal
IgM for S.typhi positive
Treatment given -
Inj. Augmentin 1.2 gm 12 hourly
Inj . Pantop 40 mg 12 hourly
Inj. Emset 8 hourly
Inj. Eptoin 100 ml 8 hourly
Inj. Mannitol intermittently
What is the provisional diagnosis and further needfull investigations and treatment if any.