Paresthesia/Numbness multiple area of body

60 year old male with paresthesia and numbness almost multiple areas of the body along with a history of DM, HTN Chief Complaints 60 year old male presented to OPD with complaints of tinnitus both ear, accompanied with numbness over right half of face with lips too and occasional lacrimation from right eye. He also compalints of paresthesia over left thigh and left leg esp. upon getting up from chair and walking. He also complaints of constipation and instability upon walking which I could attribute to Pregabalin History He is a known case of Hypertension and T2DM He has had an attack of stroke in the past too Vitals BP 130/90 SPO2 - 99 PR - 60/min ECG - WNL Management He is currently on - 1) Tab Glimestar M1 BD 2) Tab Carbamazepine 100mg OD 3) Tab Pregabalin 75 mg HS 4)Tab Palminges once daily 5) Tab Nebilong AM once daily Kindly comment what all changes needs to be instituted in the current regimen of treatment? In my opinion, I would like to add him on Gingko Biloba + Piracetam combination for his tinnitus. Secondly, I would like to add him on Telmisartan plus Amlodipine combination for blood pressure instead of Nebilong AM. Kindly give your valuable opinion on this case

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As his pulse is 60 per minute- it is a better idea to stop nebivolol - a beta blocker and stop Nebilong - AM and replace by an ARB and calcium channel blocker ( Telmisartan 40 mg + Cilnidipine 10 mg ) as his B.P is also borderline high ( 130 / 90 ) . It is better to investigate for bilateral tinnitus, and facial numbness with MRI scan of brain to rule out 1. A CP angle tumour 2.Alzheimer 's disease 3.Any recent cerebral stroke or paraventricular hyperintensities

All reports are normal. Firstly do MRI Brain for any type of infarct or ischemic changes, then consider Bells palsy in knowledge. For tinnitus, Ginko biloba with piracetam needed. For HTN give Telmisartan with Cilnidipine

Adv MRI Brain with contrast Might be CP angle lesion ..Vestibular schwannoma or Meningioma

GERIATRIC CASE..WITH.. ? UNCONTROLLED DM.. HT.. AND.. IT'S ASSOCIATED COMPLICATIONS.. NEED'S CLINICOPATHOLOGICAL EVALUATION WITH EXPERTS OPINION TO CONCLUDE DIAGNOSIS AND TREATMENT..

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