24 M with Primary progressive Multiple sclerosis

FINAL DIAGNOSIS
1. Primary progressive Multiple sclerosis

CHIEF COMPLAINTS & HISTORY OF PRESENT ILLNESS
Tremulousness since 4 years
Swaying while walking since 1 year
Slurring of speech since 6 months
Patient was a/a normal 4 years back, started with Tremulousness of left hand during his routine activities. 20 days 
later started in Right hand. 1 year later Patient noticed Swaying while walking towards left side with imbalance 
during walking. Imbalance present whenever he closes eyes like during washing his face. Patient went elsewhere 
with these complaints along with B/L knee pains was treated for 3 months.
Patient noticed complete resolution of symptoms within 10 days. Patient was symptom free for 3 months and then 
Patient noticed recurrence of symptoms 10 days later. Then Patient had Slurring of speech since 6 months and 
buckling of knees when he does namaz. Paroxysmal vertigo since 1 year

PAST MEDICAL HISTORY
Not a K/C/O Hypertension, T2DM, Cardiac disease, COPD, Bronchial asthma, or Tuberculosis.
No H/O Cerebrovascular accident or Epilepsy
No H/O recurrent infection and unexplained fever
No H/O thyroid disorder

SYSTEMIC EXAMINATION
Patient conscious, oriented and Obeys commands
HMF- Normal
CN- Normal
Pupils- B/L NSRL
EOM- Full
                           
Power                 Rt.           Lt.
             UL -       5/5         5/5
             LL -        4/5         4/5
DTR-2+
Sensory- Normal
FNF- Impaired
No bulbar symptoms
No sensory symptoms
Rhomberg's sign- Positive
Tandem walking impaired
No autonomic symptoms
No bowel and bladder dysfunction
RELEVANT INVESTIGATION RESULTS

CONTRAST MRI OF BRAIN DONE ON 16/07/2024 IMPRESSION:
25-year-old male, K/c/o Multiple Sclerosis, Contrast MRI brain with whole spine
screening demonstrates:
* Features in keeping with Multiple sclerosis Stable Disease.
As compared to previous imaging done on 20.02.2024, no significant interval changes.
COURSE IN HOSPITAL
Young male known case of MS, presented with progressive worsening of imbalance while walking , slurred speech. 
On examination ataxia+, FNF - impaired. Patient was given inj. Methylprednisolone 1 g iv for 3 days. Functional 
rating scales EDSS-3 ,  FIM -120, barthel index - 90. Patient will be reviewed with functional rating scales once in 3 
months, Repeat MRI after 6 months.
Treatment given:
1. INJ. SOLUMEDROL 1G in 250ml NS IV over 4 hrs 1-0-0
2. INJ. PAN 40MG IV 1-0-0
3. TAB. DYFIRA 240MG 1-0-1
4. TAB. NOVOSTEM XT 1-0-0
5. REFRESH EYE DROPS 2 DROPS EACH EYE SOS
CONDITION AT THE TIME OF DISCHARGE
SATISFACTORY 

ADVICE AT DISCHARGE
1. Tab. DYFIRA 240 mg 1-0-1 to continue
2. Tab. Novostem XT 1-0-0 to continue

Comments

Post a Comment

Popular posts from this blog

24yr male with Transverse Myelitis - Case presentation

Image
Chief complaints:- A 24yr male who is a agricultural labourer came with complaints of Weakness of All limbs ( LL > UL ) , Urinary retention since 3 days. HOPI :- Patient is apparently asymptomatic 3 days back when he woke up at early morning 6am noticed weakness & Numbness in all limbs ( Lower limbs > upper limbs) due to which he is unable to roll or sit or get down the bed by himself so called his father for help. With 2 people support he's able to walk for few metres .He also notice weakness in upper limbs however he is able to do his activities with mild difficult.H/o Lower abdominal fullness and difficulty in passing urine. Pt is able to perceive sensation of bladder stones but unable to pass urine for which he visited a local hospital and got catheterised following which urine drained. H/o fever 2 weeks back , moderate grade lasted for 2days subsided by taking OTC Medication. H/o Tight band like sensation above the level of nipples. H/o constipation from 2days howeve...
Read more

Post partum Hypernatremic Osmotic demyelination, Stress Cardiomyopathiy

Image
A patient by name ******,23 F, G1P1L1 delivered a female baby by vacuum assisted NVD on 10/7/2024 at private hospital, 20 minutes post delivery she had an Seizure ( GTCS type ) episode managed conservatively, Over next 2 hrs she had two more seizure episodes for which she is referred to Tertiary hospital for further management, There She had one more seizure episode & was unresponsive I/v/o low GCS patient is Intubated and Connected to MV. Patient is evaluated with CT brain which showed ill defined hypodensities along cortical & subcortical white matter of Right parietal lobe a possibility of PRESS to be considered. So Patient is referred to Our Hospital, Neurology Dept for Further management. On arrival her GCS is E1VtM3, PR- 110bpm, BP- 120/80mmhg , Evaluation with MRI brain showed bilateral medial temporal lobe & insular cortex & Thalamic hyperintesnities a possibility of Atypical PRESS or Viral meningitis is considered & Treated accordingly. Her 2decho showed Gl...
Read more