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/
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/
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/
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/
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+. http://doctors.hopkinsmedicine.org/
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/
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.
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/
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 albmin 3+. Steroids were slowly tapered off. Sugar levels came down. BP was fluctuating. http://doctors.hopkinsmedicine.org/
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.
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.
Index eevntYoung Stroke Hypertension 6 months Oedema, Proteinuria 1 year Deep Vein Thrombosis 2 years http://doctors.hopkinsmedicine.org/
Stage is open for discussionhttp://doctors.hopkinsmedicine.org/