AREA POSTREMA SYNDROME SECONDARY TO DEMYELINATION2) SERONEGATIVE PRIMARY CNS DEMYELINATION DISORDER:-

DIAGNOSIS-
1)  AREA POSTREMA SYNDROME SECONDARY TO DEMYELINATION
2) SERONEGATIVE PRIMARY CNS DEMYELINATION DISORDER

HOPI- C/o gait instability with swaying on b/l sides during walking, not worsening with closing eyes or on walking on smooth surfaces noted since 1 year progressive with time and duration . 2 month later patient developed intractable vomiting that is immediate post prandial vomiting a/w nasal regurgitation of solids and liquids since 1.5 month. Weakness of the left hemiface with inability to close left eyelid.
No risk factors 

O/E
Conscious, oriented obeying commands EOM- gaze evoked nystagmus
B/l primary posture normal
MMSE-30
Motor-
Power -5/5
Tone - normal
DTR- 3+
Plantar-b/l flexor
Sensory:
proprioception -normal
Vibration -normal
Pain, temperature, touch- normal
Meningeal signs- negative
Cerebellar signs:
B/l UL- dysmetria
       LL- incordination +
Cranial nerve-
Left LMN- Facial palsy
Gag reflex -hyporeflexia
Rest cranial nerves - normal
INVESTIGATIONS:
23/9/2024
CSF ANALYSIS - cell count -2, cell type- lymphocytes, LDH-13, protein - 38.3, glucose -75, chloride -134.4, ADA- 9.6.
CSF culture - no growth
Blood investigation:
PT TEST/ CONTROL -12.3/11.8, INR-1
ANA RAPID- Negative 

TREATMENT GIVEN:
Inj.MEPRESSO 500mg in 500 ml NS over 4 hrs X  4days ( 1 g was given on day 1)
Inj.PAN 40 mg iv 1-0-0
Inj.EMESET 4 mg iv 1-1-1
Tab.DOLO 650 mg SOS
Inj .LASIX 20 mg iv stat
Tab.AMIFRU p/o 1/2-0-0
Tab.PETRIL BETA 20mg 0-0-1

Course in the hospital: patient admitted with above complaints MRI was done outside s/o Hyperintensities in the area postrema region of brainstem. LP CSF analysis was done. Plan for pulse iv methylprednisolone therapy 1 g X 5 days. Patient had severe breathlessness after first dose hence dose was reduced to 500 mg for next 4 days . There was no SOB further, symptomatically good, improvement noted after 5 days of iv pulse therapy. Advice for follow up. Tab.OMNACORTIL 40 mg 1-0-0
Tab. PAN D 40 mg 0-0-1(b/f)
Tab. SHELCAL XT 1-0-0
Tab. AZORAN 50 mg 1/2 -0-0 for two weeks, followed by 1-0-0 to be continued till further advice.
Tab. OSTEOFOS 35 mg every Sunday on empty stomach with 250 ml of water in sitting position for 30 mins, *(do not* lie down immediately after taking tablet.)

Follow up after 1 month in neurology OPD.
On Monday/ Thursday/SOS.

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