psmr A case of 65 yr old came with the chief of Vomitings since 5 days Altered sensorium since 4 days. Patient was apparently asymptomatic 7 months back when he suddenly developed pain in the low back and loin region for which he went to hospital and was diagnosed with Ckd .. but was only on maintainance medication since 7 months and SINCE 1 month patient had history of intermittent head ache , FEVER intermittent, which was low grade , no evening rise of temperature ,not associated with chills rigors . Headache was not associated with blurring of vision and diplopia .No history of ,giddiness ,photophobia and phono phobia . Pt even has history of ? CAD , was on medication since 6 months . Since 10 days patient had h/o loss of appetite and generalised weakness. H/o vomittings since 5 days , 5-6 episodes/day, non bilious,non- blood stained, not associated with pain abdomen, loose stools, immediately after food intake. So patient got admitted in local hospital on 13/06/20 where h