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Long case on hypoparathyroidism bya dr.hasan al banna
1. A 14-YEAR- OLD BOY PRESENTED
WITH ABNORMAL MOVEMENT
DR.HASAN AL BANNA
PHASE- A STUDENT
CRITICAL CARE MEDICINE
MEDICINE UNIT 4
DHAKA MEDICAL COLLEGE
2. Md. Ryhan Kabir, 14 years old, madrasa student, hailing
from Sokhipur, Tangail, was admitted in this hospital on
03/04/2018 at 12:00 pm with the complaint of :
- Repeated abnormal movement hands & feet for 4
months
3. History of Present Illness
According to mother’s statement, patient was resonably
well about 4 months back. Then suddenly developed
vacant stare with stiffening of whole body, spontaneous
repeated spasm of fingers, wrists, ankles, neck and
backwards bending of trunk with harsh sound production.
It occurs 2-3 times in a day both in day & night, lasts for 1-2
minutes, accompanied by tingling and numbness in hands
4. and feet, mild headache, bodyache, feverish feeling,
occasional drowsiness and lethargy in the absence of
tongue bite, bowel and bladder incontinence or loss of
consciousness and got spontaneous recovery. For the last
3 days the duration and frequency of attack was
increased. He had similar type of several episodes in his
first 2 years of life in an irregular interval and got
5. improvement without treatment and remain
asymptomatic for the last 12 years. He gave no history of
jaundice, blood transfusion, bony deformity, early morning
headache or vomiting, visual disturbance, palpitation, neck
surgery or taking any diuretics. He is non-diabetic non
hypertensive and his bowel-bladder habit is normal.
6. He had a history of fall from tree and head injury 7 years back,
treated by local physician at home and recovered. He has no
previous history of thyroid surgery. At the age of 7 months, had an
episode of generalized swelling of the body with complete recovery
withouttreatment.
History of Past Illness
7. Treatment History
He took following drugs for last 1 month irregularly and
have some improvement-
Sodium valproate
lamotrigine
Oral calcium
Antibiotic
8. Personal and Socioeconomic history
Non-smoker, non-alcoholic, belongs to low socioeconomic
condition, lives in a tin-shed house, drink arsenic free tube-
well water.
9. Family History
He is the second issue of his non-consanguineous
parents. All siblings are in good health. There is no such
type of illness in his family.
11. Delivered at home through spontaneous NVD. Have no
history of delayed or obstructed labour. His milestone of
development was normal according to age.
Birth & Development History
17. Neurological Examination
• Higher psychic function and speech -Normal
• Cranial nerves with fundoscopy -Normal
• Motor function -Intact
• Sensory function -Intact
• Cerebellar function -Intact
• Signs of meningeal irritation -Absent
• Gait -Normal
19. Musculoskeletal System
•Bones : No bony deformity seen
•Muscles : No muscle wasting
•Joints: bilateral-
Flexion of metacarpophalageal joints of fingers
Extension of interphalageal joints
Adduction of thumb
Pedal spasm
•Spine :Normal
20. Alimentary System
Oral cavity:
Tongue, teeth, gum and buccal mucosa appears normal
Abdomen proper:
• Size and shape of abdomen is normal
• Umbilicus is centrally placed, inverted
• No visible veins or skin changes
• Liver, Spleen, Kidney not palpable
• No abdominal lymphadenopathy
• Percussion note of abdomen –Tympanitic& no signs of
ascitis
• Bowel sound Present
23. Salient Features
Md. Ryhan Kabir, a 14-year-old student, normotensive,
non-diabetic presented with suddenly developed vacant
stare with stiffening of whole body, repeated carpo-pedal
spasm and stridor for 4 months. It was episodic, occurs
2-3 times in a day both in rest and activities, lasts for 1-2
minutes, accompanied by tingling and numbness in hands
and feet, headache, bodyache, drowsiness without
24. association of tongue bite, bowel and bladder
incontinence or loss of consciousness. It resolved
spontaneously but for the last 3 days the duration and
frequency of attack was increased. He had similar type
of several episodes in his first 2 years of life in an
irregular interval and got improvement without
treatment and remain asymptomatic for the last 12
25. years. He was treated by anti-convulsents and oral
calcium for last 1 month irregularly and got some
improvement. He gave no history of jaundice, blood
transfusion, bony deformity, early morning headache or
vomiting, visual disturbance, palpitation, neck surgery or
taking any diuretics. He is normotensive, non-diabetic and
his bowel-bladder habit is normal. There is no history of
26. consanguity of marriage and such type illness in his family.
His birth and milestone of development was uneventful.
On examination, he was ill looking, mildly
anaemic, his pulse 84 beats/min, regular, BP-100/60mmHg
with no postural drop, Temp-98°F, Resp. rate was 18
breaths/min, trousseau’s sign and chvostek’s sign were
present. All other examination shows no abnormalities.
41. CT scan of Head shows hyperdense lesions involving the putamen, globus
pellidus, internal capsule, caudate neucleus, thalamus and centrum semiovale
42.
43. MRI of Brain shows bilateral hyperintense lesions involving the basal ganglia
47. • Childhood convulsion with a long asymptomatic
interval and re-symptomatic for last 4 months
• History of head injury in the interval period
• Treated as Epilepsy/?Wilson’s disease with little
improvement
Problem List
48. • S.Ca2+ decreased
• PO4
3- increased
• PTH & Vit-D hormone lower normal
• 24hs Urinary Ca2+ decreased
• 24h Urinary Cu = normal
• S.Ceruloplasmin
• Basal ganglia calcification in CT scan
• Bilateral parathyroid cyst in USG