Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

West syndrome case presentation

1,986 views

Published on

case presentation

Published in: Education, Health & Medicine
  • Be the first to comment

West syndrome case presentation

  1. 1. Welcome to Clinical Meeting Presented by DR. Amlendra K. Yadav DR. Chandra Shekhar Bhagat Resident (phase-A)
  2. 2. Particulars of the Patient  Name : Ahona  Age : 3 month  Sex : Female  Address : Narayangonj  Religion : Islam  Date of Admission : 05/01/2014  Date of Exammination : 06/01/2014
  3. 3. Chief Complaints • Seizure for 2 months
  4. 4. History of Present illness According to the statement of informant mother , her child was reasonably well two month back then she developed seizure. The seizure was sudden, brief contraction of neck and extremities. It occurred in cluster (3 – 4) episodes per day and lasts for (3 - 5) minutes and during awakening. There is no history of passing urine or defecation during the episode of seizure.There was no postictical phemenon .Mother also complainted that her child had no interest to surroundings . There was no history of fever, vomitting, respiratory problem, loss of consciousness or trauma.
  5. 5. For above mentioned complaints she visited general pediatrician and was treated with anti epileptic drugs for 4 weeks but the seizure didn’t improve .Then they brought the child to BSMMU for better evaluation and management.
  6. 6. Birth History Antenatal : There was no history of fever, rashes,abortion or sibs death. Natal : Delivered by LUCS due to oligohydriamnios at term . Postnatal: Baby cried immediately after birth. Immunization History Immunization as per EPI schedule started. Feeding History The child is on Exclusive breast feeding.
  7. 7. Milestones of Development Gross motor :- no neck control Fine motor :- palmar grasp present Language :- cooing Social :- smile present
  8. 8. Consanguinity No H/O consanguinity. Family History She is the only issue of her parents. Other family member are healthy.
  9. 9. History of Past Illness Nothing significant. Drug History Phenobarbitone for 2 weeks. Sodium Valproate for 2 weeks.
  10. 10. Socio-Economical History Belongs to poor socio-economical status family , stays in pakka house , drink tubwell water . DRUG REACTION HISTORY No past drug reaction history present .
  11. 11. Physical Examination General Appearance : alert, playfull  Pallor  Edema  Jaundice  Cyanosis Absent  Clubbing  Koilonychia  Dehydration  Neck vein : Not engorged
  12. 12.  Lymph Node :- Not enlarged  Skin survey : – BCG mark present.  Signs of meningeal irritation : – Absent  Bony tenderness : – Absent  Fontanelle : - open but not bulged
  13. 13. Vital Signs Temperature – 98o F HR – 120 beats /min BP – 70/40 mm Hg RR – 40 breaths /min ANTHROPOMETRY: Weight - 5.5 kg, ( lies on 50th percentile) Length - 62cm, ( lies on 25th percentile) OFC - 38cm ( lies on 10th percentile )
  14. 14. Nervous system • Patient is playfull • Cranial nerve - Intact as per I exammined • Motor :- Bulk of muscle – normal Tone - normal Jerk – Normal • Sensory - normal • Plantar – b/l extensor type • Primitive reflex – normal
  15. 15. Inspection • Shape of the chest : normal • R/R : 38 breaths/min • Visible vein & Pulsation : absent • Scar mark : absent Palpation • Trachea : centrally placed • Apex beat : left 5th ICS, medial to midclavicular line Respiratory System:
  16. 16. Percussion note • Resonant all over the lung fields Auscultation • Breath sound : vesicular • Added sound : absent
  17. 17. Inspection:  No visible pulsation Palpation: • Apex beat : left 5th ICS, • Thrill : absent • P2 :Not palpable • Lt. parasternal heave : absent Auscultation: • 1st & 2nd heart sounds audible in all 4 areas • Murmur : absent Cardiovascular system examination
  18. 18. Mouth & Oral cavity: Tongue : Normal Gum : Normal Buccal mucosa, tonsils & fauces : Normal Alimentary system examination
  19. 19. Abdomen Inspection: Umbilicus centrally placed & inverted Engorged vein/visible peristalsis – absent Palpation: Soft, non tender, non-distended Liver just palpable . Spleen not palpable Percussion: Upper border of liver dullness : Rt. 5th ICS Shifting dullness: Absent Auscultation: Bowel sound : Present Bruit (Hepatic / Renal) : Absent
  20. 20. Salient Features Ahona 3 months old female child only issue of non-consanguinous parent came from narayangonj, was admitted with a complain of seizure for 2 month. The seizure was sudden , brief contraction of neck and extremities.It occurred in cluster (3 – 4) episodes per day and lasts for 3 -5 min and during awakening. There is no history of passing urine or defecation during the episode of seizure . There was no post ictical phemenon . Mother also complainted that her child was not responsive to surrounding . She was treated with anti-epileptic drugs for 4 weeks but the condition didn’t improve. The child was delivered by LUCS , there is no H/O perinatal Asphyxia.
  21. 21. On examination Ahona was alert ,playful , BP – 70/40 mm of hg , RR – 40/min , HR – 120 beats/min, temperature – normal, BCG mark present, fontanels – open but not bulged, signs of meningeal irritation - absent ,lymph node – not enlarged , cranial nerve – intact , bulk- normal , tone – normal , jerks – Normal, plantar – b/l extension , lungs – B/L clear, P/A-Liver just palpable . Other systemic exammination reveals normal findings.
  22. 22. Provisional Diagnosis ???
  23. 23. Provisional Diagnosis West-Syndrome
  24. 24. Differnential diagnosis  1) Early Myoclonic infantile encephalopathy  2) Early infantile epileptic syndrome
  25. 25. Differential diagnosis D/D Point in favor Point against West Syndrome Seizure in cluster during awakening Developmental delay Severe myoclonic epilepsy in infancy Age less than 2 month Seizure in cluster myoclonic jerks Early infantile epileptic syndrome Age less than 2 month Seizure in cluster Tonic spasm
  26. 26. INVESTIGATION AND MANAGEMENT
  27. 27. E.E.G - 17/12/2013 Normal Findings
  28. 28. TORCH screening CMV IgG - Positive CMV DNA - Positive USG of Brain :- Normal Study.
  29. 29. Inv./Date 06/01/2014 15/01/2014 C.B.C Hb% 9.2 g/dl 9.4 g/dl ESR 05 mm in 1st hr T.C 17,000/cumm. 10,000/cumm. D.C N=13% L= 80% N= 10% L= 86% Platelet count 3,00,000 SGPT 23 u/l Sr.Creatinine 0.3 mg/dl Eye Evaluation chorioretinitis Hearing Test Normal
  30. 30. Final Diagnosis: West syndrome with CMV positive
  31. 31. Follow-up on 16/01/2014  Subjective :- No new complain  Objective :- G/C – alert, playful, afebrile respiratory rate – 38/min heart rate – 110/min temperature – 98o F Blood pressure – 80/40mmhg Asessment – Improving Plan – stop inj. Gancyclovir
  32. 32. Rx after admission  Counseling  Breast feeding Inj Gancyclovir-6mg/kg/dose- 12 hourly Tab.Vigabatrin-100 mg/kg/day Syp.Cefixime- 8 mg/kg/day Developmental therapy
  33. 33. Follow-up PLAN  Weekly CBC examination  Repeat EEG before discharge  CT scan of brain
  34. 34. Thank You..

×