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Medical case presentation-1        Dr Jishanth
 Mr A SHANMUGAM, 28 yr/M,     Unmarried, working in a shop,     admitted on 27-11-2007 with inability to      speak, mo...
 RBS 102 mg% BU 35 S Cr 1.2 Na+ 135 K+ 4 TC 11200 P82 L15 E3 CXR showed f/o LRTI ECG Normal CT Scan showed Left ...
http://doctors.hopkinsmedicine.org/
 Urine albumin+,   ANA negative, CRP negative   LFT normal   Total Cholesterol 255 mg%, TG 230,    HDL 49, LDL 123,  ...
 Patient was given anti-edema measures,      Aspirin, Atorvastatin and other      supportive therapies.     ECHO was nor...
End of Stage Ihttp://doctors.hopkinsmedicine.org/
 6 months later patient developed  hypertension, for which he was  started on Ramipril, BU 36, S Cr 1.28, Urine Alb 1+....
 One year after the stroke, patient developed facial puffiness and was evaluated for renal cause. BU 42, S Cr 1.8 Urine...
 FBS 90/ PPBS 118, Urine sugar-negative ANA neg, CRP neg HIV neg HBsAg neg, Anti HCV negative PT 11.7s(12s), aPTT 20s...
Medical second opinion Patient was given diuretics and  steroid. Elevated renal parameters  came down, BU 28, S Cr 1.1. ...
End of Stage IIhttp://doctors.hopkinsmedicine.org/
 After 3 months RBS 238, BU 32, S Cr  1.3, BP 110/90 mmHg, Serum total protein 5.8 g%, Alb 3.8,  Globulin 2g Urine alb...
 2 years after the initial stroke, patient  developed swelling of left lower limb  associated with pain, Doppler study s...
 At discharge 24 hr urine protein was  1.7g, BP 140/90 mmHg, Protein C 42.3(70-140), Protein S 54.9(60-150), Serum Ho...
Index eevntYoung Stroke  Hypertension                            6 months    Oedema, Proteinuria                    1 year...
Stage is open for discussionhttp://doctors.hopkinsmedicine.org/
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Medical diagnosis case 1

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A medical case presentation by a doctor

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Medical diagnosis case 1

  1. 1. Medical case presentation-1 Dr Jishanth
  2. 2.  Mr A SHANMUGAM, 28 yr/M,  Unmarried, working in a shop,  admitted on 27-11-2007 with inability to speak, motor weakness of R UL and LL, preceded by 2 days h/o fever to a private hospital.  No h/o HTN/DM/Epilepsy  No family history of similar illness.  O/E patient was conscious, co-operative, disoriented at time, BP-120/80 mm Hg, all peripheral vessels are palpable,  (R) Hemiparesis+, Plantar ↑on R, ↓on L.  Case reference by Online doctor consultationhttp://doctors.hopkinsmedicine.org/
  3. 3.  RBS 102 mg% BU 35 S Cr 1.2 Na+ 135 K+ 4 TC 11200 P82 L15 E3 CXR showed f/o LRTI ECG Normal CT Scan showed Left MCA territory acute infarct and a small infarct in right parietal region. http://doctors.hopkinsmedicine.org/
  4. 4. http://doctors.hopkinsmedicine.org/
  5. 5.  Urine albumin+,  ANA negative, CRP negative  LFT normal  Total Cholesterol 255 mg%, TG 230, HDL 49, LDL 123,  IgM/IgG ACL Ab negative,  RA factor negative.http://doctors.hopkinsmedicine.org/
  6. 6.  Patient was given anti-edema measures, Aspirin, Atorvastatin and other supportive therapies.  ECHO was normal,  Ultrasound abdomen showed mild splenomegaly, otherwise normal. RK 106/46mm, LK 111/43mm, Corticomedullary echo pattern normal.  HIV- negative.  Thrombophilia profile- normal  Patient improved, apparently normal, started walking, continued atorvastatin/aspirin.http://doctors.hopkinsmedicine.org/
  7. 7. End of Stage Ihttp://doctors.hopkinsmedicine.org/
  8. 8.  6 months later patient developed hypertension, for which he was started on Ramipril, BU 36, S Cr 1.28, Urine Alb 1+. http://doctors.hopkinsmedicine.org/
  9. 9.  One year after the stroke, patient developed facial puffiness and was evaluated for renal cause. BU 42, S Cr 1.8 Urine showed albumin 3+ 24 hr urine protein 5.5 g/day Ultrasonogram- normal sized kidneys Medical Renal disease+,Splenomegaly+ Dopplerstudy of renal arteries normal Serum Calcium- 8.1 mg% Serum Uric Acid 6.9 mg% http://doctors.hopkinsmedicine.org/
  10. 10.  FBS 90/ PPBS 118, Urine sugar-negative ANA neg, CRP neg HIV neg HBsAg neg, Anti HCV negative PT 11.7s(12s), aPTT 20s(30s) IgG/IgM ACL Ab negative CXR normal, ECG normal Peripheral smear study -normal. Patient underwent renal biopsy which showed segmental sclerosis with mesangial proliferation, focal tubular atrophy, and Immunofluroscence showed mesangial and peripheral deposits in IgA, http://doctors.hopkinsmedicine.org/ C3c and IgM with fibrinogen.
  11. 11. Medical second opinion Patient was given diuretics and steroid. Elevated renal parameters came down, BU 28, S Cr 1.1. Patient continued Ramipril, Atorvastatin, Aspirin. Patient was put on prednisolone.http://doctors.hopkinsmedicine.org/
  12. 12. End of Stage IIhttp://doctors.hopkinsmedicine.org/
  13. 13.  After 3 months RBS 238, BU 32, S Cr 1.3, BP 110/90 mmHg, Serum total protein 5.8 g%, Alb 3.8, Globulin 2g Urine albmin 3+. Steroids were slowly tapered off. Sugar levels came down. BP was fluctuating. http://doctors.hopkinsmedicine.org/
  14. 14.  2 years after the initial stroke, patient developed swelling of left lower limb associated with pain, Doppler study showed left popliteal vein thrombosis extending upto adductor canal, Blood Sugar 99, BU 28, S Cr 1.2 Na+ 138, K+ 3.9 CX- normal Urine albumin 2+ Cholesterol 182 S Total protein 5.9 g, Albumin 3.7, Glob 2.2. Patient again readmitted and continued Atorvastatin, Prednisolone, Ramipril, http://doctors.hopkinsmedicine.org/ +Acitrom 3 mg OD.
  15. 15.  At discharge 24 hr urine protein was 1.7g, BP 140/90 mmHg, Protein C 42.3(70-140), Protein S 54.9(60-150), Serum Homocysteine 16.50(5.9-16), Anti thrombin III level-normal. He was discharged with advice to continue aspirin, atorvastatin, ramipril, acitrom, and prednisolone. After 3 months 24 hr urine protein was 360 mg and steroid was slowly tapered. BU 27, S Cr 0.7, RBS 92 mg%. http://doctors.hopkinsmedicine.org/ Ultrasonogram-no splenomegaly.
  16. 16. Index eevntYoung Stroke Hypertension 6 months Oedema, Proteinuria 1 year Deep Vein Thrombosis 2 years http://doctors.hopkinsmedicine.org/
  17. 17. Stage is open for discussionhttp://doctors.hopkinsmedicine.org/

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