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A 18-year-old male presented with severe headache and neck pain for 3 days following an appendectomy. On examination, he had neck rigidity and papilledema. Imaging showed superior sagittal sinus thrombosis. He was diagnosed with superior sagittal sinus thrombosis and treated with anticoagulation therapy.
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1 15Academic Clinical Histo
The document contains a clinical history and physical notes for a 52-year-old male patient presenting with cerebral ischemia (ischemic stroke). Key details include:
- The patient experienced sudden severe headache, dizziness, and slurred speech. Exam found facial drooping and difficulties with coordination and swallowing.
- Medical history includes hypertension and hypercholesterolemia. Surgical history includes prior neck surgery.
- Diagnostic tests (CT scan, MRI) found an ischemic stroke in the middle cerebral artery, with signs of intravascular thrombus.
- Assessment identifies the leading diagnosis as cerebral ischemia. Differential diagnoses include hemorrhagic stroke, subdural hemorrhage, and
1 15Academic Clinical Histo
1
15
Academic Clinical History & Physical Notes for Cerebral Ischemia
Muhammad Aftkhar
Grand Canyon University
December 04th, 2020
Academic Clinical History & Physical Notes for Cerebral Ischemia
I am presenting the academic clinical history and physical notes for the patient of ischemic stroke. Ischemic stroke or cerebral ischemia occurs when one of the cerebral arteries is blocked by the clot leading to diminished blood supply and oxygen to brain cells resulting in damage or death of brain cells (Celik et al., 2020)
History and Physical Note
1.Chief complaint/reason for admission/visit/consult.
A 52 years old male patient came to the acute care hospital with the chief complaint of sudden severe headache, dizziness, and slurred speech.
HPI for the H&P or consult notes.
The patient felt a severe burning and shooting pain in the frontal region of the head while he was reading the newspaper in the morning. The patient said that he developed blurred vision during reading. The patient felt numbness when the pain started (Harriot et al., 2020). The patient said that the pain was not subsiding with the time as it persisted since its onset. The pain scale was nine by 10, started in the frontal region, and radiated towards the temporal region. The associated symptoms with pain are nausea, vomiting, aphasia, dysarthria, apraxia, and vertigo (De Cock, et al., 2020). The symptoms become aggravate in a standing position and become alleviating when he lay down on the bed with 3 pillows. The patient felt a significant change in body posture. He is positive for facial drooping while negative for fever and chills. He finds difficulty in sitting and maintaining coordination. The patient stated that he had a medical history of neck trauma in a road accident. He was hospitalized for 3 weeks after neck surgery.
2.Medical, surgical, family, social, and allergy history.
Medical history
The patient has hypertension and hypercholesterolemia (Haegens, et al., 2018).
Surgical history
The patient underwent neck surgery after neck trauma at the age of 42.
Family history
The patient’s mother is alive and diabetic. The father of the patient died due to a cardiac stroke. His sister is normal. One of the two brothers has hypertension, and the other is normal. Currently, the patient is living with his normal wife.
Social history
The patient has a long history of smoking and boozing, coupled with a sedentary lifestyle.
Allergy history
· Raw fruits and vegetables, Shellfish, Soy.
· Amoxicillin and aspirin.
3.Home medications, including dosages, route, frequency, and current medications, if a consultation note.
Antihypertensive drugs Edarbi & Hygroton.
40 mg oral Edarbi once a day, as the patient is on diuretics, Hygroton. Oral 50 mg Hygroton once in the morning.
Hypercholesterolemic drugs Lipitor
Oral tablet 40 mg once a day. He takes this tablet at night.
4.Review of systems with all body systems for H&P or consult notes. Review of systems i ...
1 15 Academic
1
15
Academic Clinical History & Physical Notes for Cerebral Ischemia
I am presenting the academic clinical history and physical notes for the patient of ischemic stroke. Ischemic stroke or cerebral ischemia occurs when one of the cerebral arteries is blocked by the clot leading to diminished blood supply and oxygen to brain cells resulting in damage or death of brain cells (Celik et al., 2020)
History and Physical Note
1.Chief complaint/reason for admission/visit/consult.
A 52 years old male patient came to the acute care hospital with the chief complaint of sudden severe headache, dizziness, and slurred speech.
HPI for the H&P or consult notes.
The patient felt a severe burning and shooting pain in the frontal region of the head while he was reading the newspaper in the morning. The patient said that he developed blurred vision during reading. The patient felt numbness when the pain started (Harriot et al., 2020). The patient said that the pain was not subsiding with the time as it persisted since its onset. The pain scale was nine by 10, started in the frontal region, and radiated towards the temporal region. The associated symptoms with pain are nausea, vomiting, aphasia, dysarthria, apraxia, and vertigo (De Cock, et al., 2020). The symptoms become aggravate in a standing position and become alleviating when he lay down on the bed with 3 pillows. The patient felt a significant change in body posture. He is positive for facial drooping while negative for fever and chills. He finds difficulty in sitting and maintaining coordination. The patient stated that he had a medical history of neck trauma in a road accident. He was hospitalized for 3 weeks after neck surgery.
2.Medical, surgical, family, social, and allergy history.
Medical history
The patient has hypertension and hypercholesterolemia (Haegens, et al., 2018).
Surgical history
The patient underwent neck surgery after neck trauma at the age of 42.
Family history
The patient’s mother is alive and diabetic. The father of the patient died due to a cardiac stroke. His sister is normal. One of the two brothers has hypertension, and the other is normal. Currently, the patient is living with his normal wife.
Social history
The patient has a long history of smoking and boozing, coupled with a sedentary lifestyle.
Allergy history
· Raw fruits and vegetables, Shellfish, Soy.
· Amoxicillin and aspirin.
3.Home medications, including dosages, route, frequency, and current medications, if a consultation note.
Antihypertensive drugs Edarbi & Hygroton.
40 mg oral Edarbi once a day, as the patient is on diuretics, Hygroton. Oral 50 mg Hygroton once in the morning.
Hypercholesterolemic drugs Lipitor
Oral tablet 40 mg once a day. He takes this tablet at night.
4.Review of systems with all body systems for H&P or consult notes. Review of systems is what the patient or family/friends tell you (by body system).
General appearance
The patient shows facial we ...
1 15 Academic
1
15
Academic Clinical History & Physical Notes for Cerebral Ischemia
I am presenting the academic clinical history and physical notes for the patient of ischemic stroke. Ischemic stroke or cerebral ischemia occurs when one of the cerebral arteries is blocked by the clot leading to diminished blood supply and oxygen to brain cells resulting in damage or death of brain cells (Celik et al., 2020)
History and Physical Note
1.Chief complaint/reason for admission/visit/consult.
A 52 years old male patient came to the acute care hospital with the chief complaint of sudden severe headache, dizziness, and slurred speech.
HPI for the H&P or consult notes.
The patient felt a severe burning and shooting pain in the frontal region of the head while he was reading the newspaper in the morning. The patient said that he developed blurred vision during reading. The patient felt numbness when the pain started (Harriot et al., 2020). The patient said that the pain was not subsiding with the time as it persisted since its onset. The pain scale was nine by 10, started in the frontal region, and radiated towards the temporal region. The associated symptoms with pain are nausea, vomiting, aphasia, dysarthria, apraxia, and vertigo (De Cock, et al., 2020). The symptoms become aggravate in a standing position and become alleviating when he lay down on the bed with 3 pillows. The patient felt a significant change in body posture. He is positive for facial drooping while negative for fever and chills. He finds difficulty in sitting and maintaining coordination. The patient stated that he had a medical history of neck trauma in a road accident. He was hospitalized for 3 weeks after neck surgery.
2.Medical, surgical, family, social, and allergy history.
Medical history
The patient has hypertension and hypercholesterolemia (Haegens, et al., 2018).
Surgical history
The patient underwent neck surgery after neck trauma at the age of 42.
Family history
The patient’s mother is alive and diabetic. The father of the patient died due to a cardiac stroke. His sister is normal. One of the two brothers has hypertension, and the other is normal. Currently, the patient is living with his normal wife.
Social history
The patient has a long history of smoking and boozing, coupled with a sedentary lifestyle.
Allergy history
· Raw fruits and vegetables, Shellfish, Soy.
· Amoxicillin and aspirin.
3.Home medications, including dosages, route, frequency, and current medications, if a consultation note.
Antihypertensive drugs Edarbi & Hygroton.
40 mg oral Edarbi once a day, as the patient is on diuretics, Hygroton. Oral 50 mg Hygroton once in the morning.
Hypercholesterolemic drugs Lipitor
Oral tablet 40 mg once a day. He takes this tablet at night.
4.Review of systems with all body systems for H&P or consult notes. Review of systems is what the patient or family/friends tell you (by body system).
General appearance
The patient shows facial we ...
Critical case study mariam fahad (1)
This document discusses intracranial hemorrhage, also known as bleeding within the skull or brain. It provides objectives to explain what intracranial hemorrhage is, discuss anatomy and physiology of the skull and brain, identify symptoms, diagnostic studies, drug treatment, and appropriate nursing interventions. It then outlines the case study of a 40-year-old male patient admitted with decreased consciousness found to have a large left parietal hematoma on CT scan. Relevant diagnostic test results are presented along with the patient's medications, nursing care plan, health teaching points, and references.
Presentation diag dilemma
Both cases describe patients presenting with severe unilateral orbital or supraorbital pain, conjunctival injection, tearing, nasal congestion, and mild ptosis. Initial diagnoses of migraine or meningitis were revised after symptoms failed to resolve with treatment. Diagnosis of cluster headache was made based on episodic attacks meeting diagnostic criteria of severe unilateral headache, autonomic symptoms and response to corticosteroids. Cluster headache is often misdiagnosed due to lack of awareness of its clinical features.
Vogt Koyanagi Harada Syndrome (VKH)
This document summarizes the case of a 38-year-old woman who presented with a 6-month history of headache and 3-month history of vision loss. Her examination revealed vitiligo, poliosis, hearing loss, and funduscopic findings of retinal detachment and sunset glow appearance, consistent with Vogt-Koyanagi-Harada syndrome. Investigations including MRI brain, audiometry, skin biopsy, and OCT confirmed the diagnosis of VKH. She was started on high-dose steroids and azathioprine for treatment.
Space-Occupying Bleeds: A Case Review
This is a review of a case of an infant admitted to pediatric ICU as a case of epidural hematoma after traumatic brain injury. A brief summary of the most important aspects. Part of the residency teaching program for pediatric residents at the pediatric and neonatology department at Istishari Arab Hospital, Ramallah, Palestine.
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1 15Academic Clinical Histo
The document contains a clinical history and physical notes for a 52-year-old male patient presenting with cerebral ischemia (ischemic stroke). Key details include:
- The patient experienced sudden severe headache, dizziness, and slurred speech. Exam found facial drooping and difficulties with coordination and swallowing.
- Medical history includes hypertension and hypercholesterolemia. Surgical history includes prior neck surgery.
- Diagnostic tests (CT scan, MRI) found an ischemic stroke in the middle cerebral artery, with signs of intravascular thrombus.
- Assessment identifies the leading diagnosis as cerebral ischemia. Differential diagnoses include hemorrhagic stroke, subdural hemorrhage, and
1 15Academic Clinical Histo
1
15
Academic Clinical History & Physical Notes for Cerebral Ischemia
Muhammad Aftkhar
Grand Canyon University
December 04th, 2020
Academic Clinical History & Physical Notes for Cerebral Ischemia
I am presenting the academic clinical history and physical notes for the patient of ischemic stroke. Ischemic stroke or cerebral ischemia occurs when one of the cerebral arteries is blocked by the clot leading to diminished blood supply and oxygen to brain cells resulting in damage or death of brain cells (Celik et al., 2020)
History and Physical Note
1.Chief complaint/reason for admission/visit/consult.
A 52 years old male patient came to the acute care hospital with the chief complaint of sudden severe headache, dizziness, and slurred speech.
HPI for the H&P or consult notes.
The patient felt a severe burning and shooting pain in the frontal region of the head while he was reading the newspaper in the morning. The patient said that he developed blurred vision during reading. The patient felt numbness when the pain started (Harriot et al., 2020). The patient said that the pain was not subsiding with the time as it persisted since its onset. The pain scale was nine by 10, started in the frontal region, and radiated towards the temporal region. The associated symptoms with pain are nausea, vomiting, aphasia, dysarthria, apraxia, and vertigo (De Cock, et al., 2020). The symptoms become aggravate in a standing position and become alleviating when he lay down on the bed with 3 pillows. The patient felt a significant change in body posture. He is positive for facial drooping while negative for fever and chills. He finds difficulty in sitting and maintaining coordination. The patient stated that he had a medical history of neck trauma in a road accident. He was hospitalized for 3 weeks after neck surgery.
2.Medical, surgical, family, social, and allergy history.
Medical history
The patient has hypertension and hypercholesterolemia (Haegens, et al., 2018).
Surgical history
The patient underwent neck surgery after neck trauma at the age of 42.
Family history
The patient’s mother is alive and diabetic. The father of the patient died due to a cardiac stroke. His sister is normal. One of the two brothers has hypertension, and the other is normal. Currently, the patient is living with his normal wife.
Social history
The patient has a long history of smoking and boozing, coupled with a sedentary lifestyle.
Allergy history
· Raw fruits and vegetables, Shellfish, Soy.
· Amoxicillin and aspirin.
3.Home medications, including dosages, route, frequency, and current medications, if a consultation note.
Antihypertensive drugs Edarbi & Hygroton.
40 mg oral Edarbi once a day, as the patient is on diuretics, Hygroton. Oral 50 mg Hygroton once in the morning.
Hypercholesterolemic drugs Lipitor
Oral tablet 40 mg once a day. He takes this tablet at night.
4.Review of systems with all body systems for H&P or consult notes. Review of systems i ...
1 15 Academic
1
15
Academic Clinical History & Physical Notes for Cerebral Ischemia
I am presenting the academic clinical history and physical notes for the patient of ischemic stroke. Ischemic stroke or cerebral ischemia occurs when one of the cerebral arteries is blocked by the clot leading to diminished blood supply and oxygen to brain cells resulting in damage or death of brain cells (Celik et al., 2020)
History and Physical Note
1.Chief complaint/reason for admission/visit/consult.
A 52 years old male patient came to the acute care hospital with the chief complaint of sudden severe headache, dizziness, and slurred speech.
HPI for the H&P or consult notes.
The patient felt a severe burning and shooting pain in the frontal region of the head while he was reading the newspaper in the morning. The patient said that he developed blurred vision during reading. The patient felt numbness when the pain started (Harriot et al., 2020). The patient said that the pain was not subsiding with the time as it persisted since its onset. The pain scale was nine by 10, started in the frontal region, and radiated towards the temporal region. The associated symptoms with pain are nausea, vomiting, aphasia, dysarthria, apraxia, and vertigo (De Cock, et al., 2020). The symptoms become aggravate in a standing position and become alleviating when he lay down on the bed with 3 pillows. The patient felt a significant change in body posture. He is positive for facial drooping while negative for fever and chills. He finds difficulty in sitting and maintaining coordination. The patient stated that he had a medical history of neck trauma in a road accident. He was hospitalized for 3 weeks after neck surgery.
2.Medical, surgical, family, social, and allergy history.
Medical history
The patient has hypertension and hypercholesterolemia (Haegens, et al., 2018).
Surgical history
The patient underwent neck surgery after neck trauma at the age of 42.
Family history
The patient’s mother is alive and diabetic. The father of the patient died due to a cardiac stroke. His sister is normal. One of the two brothers has hypertension, and the other is normal. Currently, the patient is living with his normal wife.
Social history
The patient has a long history of smoking and boozing, coupled with a sedentary lifestyle.
Allergy history
· Raw fruits and vegetables, Shellfish, Soy.
· Amoxicillin and aspirin.
3.Home medications, including dosages, route, frequency, and current medications, if a consultation note.
Antihypertensive drugs Edarbi & Hygroton.
40 mg oral Edarbi once a day, as the patient is on diuretics, Hygroton. Oral 50 mg Hygroton once in the morning.
Hypercholesterolemic drugs Lipitor
Oral tablet 40 mg once a day. He takes this tablet at night.
4.Review of systems with all body systems for H&P or consult notes. Review of systems is what the patient or family/friends tell you (by body system).
General appearance
The patient shows facial we ...
1 15 Academic
1
15
Academic Clinical History & Physical Notes for Cerebral Ischemia
I am presenting the academic clinical history and physical notes for the patient of ischemic stroke. Ischemic stroke or cerebral ischemia occurs when one of the cerebral arteries is blocked by the clot leading to diminished blood supply and oxygen to brain cells resulting in damage or death of brain cells (Celik et al., 2020)
History and Physical Note
1.Chief complaint/reason for admission/visit/consult.
A 52 years old male patient came to the acute care hospital with the chief complaint of sudden severe headache, dizziness, and slurred speech.
HPI for the H&P or consult notes.
The patient felt a severe burning and shooting pain in the frontal region of the head while he was reading the newspaper in the morning. The patient said that he developed blurred vision during reading. The patient felt numbness when the pain started (Harriot et al., 2020). The patient said that the pain was not subsiding with the time as it persisted since its onset. The pain scale was nine by 10, started in the frontal region, and radiated towards the temporal region. The associated symptoms with pain are nausea, vomiting, aphasia, dysarthria, apraxia, and vertigo (De Cock, et al., 2020). The symptoms become aggravate in a standing position and become alleviating when he lay down on the bed with 3 pillows. The patient felt a significant change in body posture. He is positive for facial drooping while negative for fever and chills. He finds difficulty in sitting and maintaining coordination. The patient stated that he had a medical history of neck trauma in a road accident. He was hospitalized for 3 weeks after neck surgery.
2.Medical, surgical, family, social, and allergy history.
Medical history
The patient has hypertension and hypercholesterolemia (Haegens, et al., 2018).
Surgical history
The patient underwent neck surgery after neck trauma at the age of 42.
Family history
The patient’s mother is alive and diabetic. The father of the patient died due to a cardiac stroke. His sister is normal. One of the two brothers has hypertension, and the other is normal. Currently, the patient is living with his normal wife.
Social history
The patient has a long history of smoking and boozing, coupled with a sedentary lifestyle.
Allergy history
· Raw fruits and vegetables, Shellfish, Soy.
· Amoxicillin and aspirin.
3.Home medications, including dosages, route, frequency, and current medications, if a consultation note.
Antihypertensive drugs Edarbi & Hygroton.
40 mg oral Edarbi once a day, as the patient is on diuretics, Hygroton. Oral 50 mg Hygroton once in the morning.
Hypercholesterolemic drugs Lipitor
Oral tablet 40 mg once a day. He takes this tablet at night.
4.Review of systems with all body systems for H&P or consult notes. Review of systems is what the patient or family/friends tell you (by body system).
General appearance
The patient shows facial we ...
Critical case study mariam fahad (1)
This document discusses intracranial hemorrhage, also known as bleeding within the skull or brain. It provides objectives to explain what intracranial hemorrhage is, discuss anatomy and physiology of the skull and brain, identify symptoms, diagnostic studies, drug treatment, and appropriate nursing interventions. It then outlines the case study of a 40-year-old male patient admitted with decreased consciousness found to have a large left parietal hematoma on CT scan. Relevant diagnostic test results are presented along with the patient's medications, nursing care plan, health teaching points, and references.
Presentation diag dilemma
Both cases describe patients presenting with severe unilateral orbital or supraorbital pain, conjunctival injection, tearing, nasal congestion, and mild ptosis. Initial diagnoses of migraine or meningitis were revised after symptoms failed to resolve with treatment. Diagnosis of cluster headache was made based on episodic attacks meeting diagnostic criteria of severe unilateral headache, autonomic symptoms and response to corticosteroids. Cluster headache is often misdiagnosed due to lack of awareness of its clinical features.
Vogt Koyanagi Harada Syndrome (VKH)
This document summarizes the case of a 38-year-old woman who presented with a 6-month history of headache and 3-month history of vision loss. Her examination revealed vitiligo, poliosis, hearing loss, and funduscopic findings of retinal detachment and sunset glow appearance, consistent with Vogt-Koyanagi-Harada syndrome. Investigations including MRI brain, audiometry, skin biopsy, and OCT confirmed the diagnosis of VKH. She was started on high-dose steroids and azathioprine for treatment.
Space-Occupying Bleeds: A Case Review
This is a review of a case of an infant admitted to pediatric ICU as a case of epidural hematoma after traumatic brain injury. A brief summary of the most important aspects. Part of the residency teaching program for pediatric residents at the pediatric and neonatology department at Istishari Arab Hospital, Ramallah, Palestine.
Our errors in diagnosing dizziness slides
This document summarizes a webinar on diagnosing dizziness presented by Best Doctors. It includes:
1) Four case studies on misdiagnoses of dizziness presented by Drs. Samuels, Calkins, Megerian, and Derebery focusing on conditions like pheochromocytoma, postural orthostatic tachycardia syndrome, endolymphatic sac tumor, and migraine-associated vertigo.
2) A discussion by Dr. Derebery of the differential diagnosis of dizziness and approaches to diagnosis based on temporal patterns and urgency.
3) Details on ACCME accreditation and speaker disclosures for continuing education credits.
Headache in children -indexforpaediatrics.com
Headache is one of the commonest neurological symptoms in children and young people who are
referred to doctors. Headache refers to pain involving the orbits, forehead, scalp and temples but not
the face or neck. The primary headache includes chronic or recurrent headache and migraine. The
prevalence of chronic or recurrent headaches in children occur in 60-69% by the age of 7-9 years
and 75% by the age of 15 years. The prevalence of migraine in children is up to 28% of older
teenagers. The most serious cause of the secondary headache is brain tumor and the prevalence of
brain tumours in children is 3 per 100,000 per annum.
https://indexforpaediatrics.com
A case of Arnold's Neuralgia
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Dr. Ahmed Tanjimul Islam.
MSc. (Leeds, England); MD (Neurology)
Rajshahi Medical College Hospital, Bangladesh.
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This case presentation describes a 16-year-old male student who presented with joint pain and swelling involving his left hip, right knee, and both ankles. His symptoms began 12 days prior and migrated between joints. Physical examination found mildly swollen joints with reduced movement due to pain. Investigations showed elevated inflammatory markers, a positive streptococcal antibody test, and ECG changes. He was diagnosed with acute rheumatic fever based on his migrating arthritis, lab results, and supporting investigations. He was treated with antibiotics, aspirin, steroids, and advised long-term antibiotic prophylaxis.
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This case presentation discusses a 59-year-old woman who was admitted with weakness and neurological symptoms. She had a history of pneumonia and was initially diagnosed with transverse myelitis. Her condition worsened, so further investigations were done. MRI showed lesions in the spinal cord and brainstem. Testing found elevated mycoplasma titers, leading to a diagnosis of acute disseminated encephalomyelitis (ADEM) secondary to Mycoplasma pneumoniae infection. She was treated with steroids, plasma exchange, and antibiotics, and showed gradual improvement in her neurological function.
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This document discusses giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) through 5 case studies. It presents on a 70-year-old male initially diagnosed with PMR based on shoulder and back pain, who later developed headaches and temporal artery tenderness and was diagnosed with GCA. Another case outlines an elderly male with headaches, jaw claudication and vision loss diagnosed with GCA. Less common presentations of GCA involving neurological symptoms are also reviewed. The pathophysiology of GCA is described as an inflammatory process involving dendritic cells, T-lymphocytes and giant cells affecting temporal and other cranial arteries. Complications can include blindness, stroke and aortic aneurysms
Cerebral venous sinus thrombosis
This document describes a case of cerebral venous thrombosis (CVT) in a 20-year-old female patient who presented with worsening headache, nausea, dizziness, and blurred vision. It provides details on her medical history, physical exam findings, lab and imaging results. CVT is an uncommon type of stroke more common in young individuals. Risk factors include genetic thrombophilias, acquired conditions like pregnancy/puerperium and cancer. Clinical symptoms vary depending on increased intracranial pressure or focal brain injury. Management involves anticoagulation to stop thrombotic process along with supportive care. Outcomes range from full recovery in 80% of patients to mortality in 6-20% depending on severity of presentation
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This document provides information on neurologic disorders and conducting a neurologic exam. It describes the anatomy and physiology of the brain and nervous system. It then presents two case studies of patients presenting with neurologic complaints. The first case involves a 66-year-old woman experiencing difficulty speaking, which upon assessment is determined to likely be an acute ischemic stroke. The second case involves a 68-year-old man who fell while walking and is complaining of a mild headache, with the differential diagnosis including intracranial hemorrhage or elevated intracranial pressure. The document stresses using the AMLS assessment pathway to evaluate patients with potential neurologic issues.
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This document summarizes key points about evaluating and managing headaches in the emergency department setting. It discusses distinguishing between primary and secondary headaches, red flags to identify high-risk causes, appropriate use of imaging like CT scans and lumbar punctures, specific conditions like subarachnoid hemorrhage and meningitis, and antibiotic treatment for meningitis. Case examples are also provided to demonstrate history taking, exam, differential diagnosis, and management of headache patients.
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Mrs. Neetu Devi, a 35-year-old woman, was admitted to GB Pant Hospital with symptoms of myasthenia gravis including double vision, weakness, difficulty swallowing, and shortness of breath. She underwent various tests which showed elevated acetylcholine receptor antibodies and slowing of reflexes. Her condition is being treated with IV infusions, medications like pyridostigmine and prednisone, and supportive care. Her condition is improving with treatment.
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This document discusses headaches in children. It notes that headaches are a common complaint, with migraines and viral infections being common causes. It outlines challenges in diagnosis due to limited verbal abilities in young children. The document discusses the International Classification of Headache Disorders and differentiating between primary and secondary headaches. It provides details on history taking, clinical examination, indications for MRI/MRV/CT, and management approaches including non-pharmacological therapies and pharmacological therapies like ibuprofen, sumatriptan, and various prophylactic medications.
TOLOSA HUNT SYNDROME
A 53-year-old female presented with a 4-month history of left periorbital headache and frontal parasthesia. Imaging showed a 1cm enhancing lesion in the cavernous sinus. She was initially treated for tuberculosis but did not improve. Further workup revealed positive Mantoux test but negative CSF studies. Her symptoms improved 90% with a short course of antibiotics and steroids. The differential diagnosis includes cavernous sinus syndrome such as Tolosa-Hunt syndrome, an idiopathic inflammatory condition. A repeat MRI after treatment showed reduction in the size of the lesion, consistent with inflammatory pseudotumor.
A Case of TOLOSA HUNT SYNDROME
A 53-year-old female presented with a 4-month history of left periorbital headache and frontal parasthesia. Imaging showed a 1cm enhancing lesion in the cavernous sinus. She was initially treated for tuberculosis but did not improve. Further workup revealed positive Mantoux test but negative CSF studies. Her symptoms improved 90% with a short course of antibiotics and steroids. The differential diagnosis includes cavernous sinus syndrome such as Tolosa-Hunt syndrome, an idiopathic inflammatory condition. A repeat MRI after treatment showed reduction in the size of the lesion, consistent with inflammatory pseudotumor.
Death by Neurological Criteria and Organ Donation: Bill Knight
Bill Knight explains the concept of death by neurological criteria and the complexities surrounding organ donation in such situations.
Bill discusses the process of dying, the definition of death, how to approach the neurologically dead patient and how to consider organ donation.
Death is a complex topic.
Due to advancements in medical technology and processes, the definition of death is a challenging one.
Bill talks at length about the definition of death by the neurological criteria. Dying is an active process, whereas death is an event.
The acceptance of death by the neurological criteria is often challenging as Bill will highlight. Bill talks about the care of the dying or dead patient.
There is a point at which care will transition from supporting the patient to supporting the organs. This is still good care.
There is an alignment of parallel intentions – first and foremost resuscitation of patients and then failing that, proceeding to considering and actioning organ donation. This is important due to the shortage of viable donor organ worldwide.
The donation process itself is complex. Bill provides his thoughts. He insists that an intensivist be involved as this has been shown to increase the number of viable and healthy organs made available.
The timing is also important. Available evidence does not support the need for immediate procurement after brain death. Taking time to optimise perfusion and allow recovery and cardiac function is appropriate and should be done.
Bill also discusses other treatment options at the time of death such as optimising endocrine function.
Finally, Bill will provide some practical considerations when communicating with the dead patient’s family. This involves being clear on your messaging. You are supporting organs, not life.
To reinforce this point, Bill suggests not examining or talking to the patient. He also recommends using all of the available hospital support services.
Similarly, it is best to not introduce the topic of organ donation to the family yourself as the treating clinician. Utilise the Organ Procurement Organisations (or similar services) and get them involved early to speak with the family.
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nasrin.pptx
- 1. A 18-year-old boy presenting with severe headache and neck pain Presented by: Dr. Nasrin Akter Intern Doctor Shaheed Syed Nazrul Islam Medical College Hospital
- 2. Name: Jahangir Age: 18 years Sex: Male Religion: Muslim Patient Profile
- 3. Marital Status: Unmarried Occupation: Medical Technologist Address: Katiarchar, Kishoreganj Date of Admission: 6-5-2023 Date of Examination: 8-5-2023
- 4. Chief Complaints • Severe Headache for 3 days • Neck Pain for 2 days
- 5. History of Present Illness According to the history of the patient he was apparently healthy 3 days back. Then he developed headache which was sudden, severe, diffuse, throbbing and diurnal in nature. Pain exaggerated in the morning especially soon after waking up but relieved at night. It was associated with photophobia and nausea. It was subsided by taking medication ( Paracetamol ) but reappeared after 2/3 hours. It was associated with neck pain.
- 6. Patient had no history of fever, limb weakness, blurring of vision, neurological deficit, vomiting or any head injury. He also gave no history of ear infection, eye infection or nose infection. With these complaints patient admitted to Male Medicine Ward of SSNIMCH for better management.
- 7. History of Past Illness Patient gave history of appendectomy four days back. He gave no history of Diabetes Mellitus, Hypertension, Tuberculosis and Cardiac Disease.
- 8. Family History His father is hypertensive and mother is a patient of bronchial asthma. Rest of the family members gave no significant medical history.
- 9. Personal History Patient is non smoker, non alcoholic and non beetle-nut chewer.
- 10. Immunization History All vaccinations were done as per EPI schedule. He is also vaccinated against COVID-19 and completed 3 doses.
- 11. Socio-Economic History Patient come from a middle-class family.
- 12. Occupational History He is a medical technologist.
- 13. Drug History After appendectomy patient took cefixime, metronidazole, omeprazole, Rolac and paracetamol.
- 14. General Examination Appearance : Ill looking Body built : Average Cooperation : Cooperative Decubitus : On choice Nutritional status : average Pulse : 82 beats/minute Blood pressure : 120/80 mm(Hg) Respiratory rate :16 breaths/min Temperature : 98F Anemia : Absent Jaundice : Absent
- 15. • Clubbing : Absent • Cyanosis : Absent • Oedema : Absent • Dehydration : Absent • Koilonychia : Absent • Leukonychia : Absent • Body hair : Normal • Bony tenderness : Absent • Neck Rigidity : Present • Lymph node : Not palpable • Neck vein : Not engorged • Thyroid gland : Not enlarged
- 16. Systemic Examination • Central nervous system : • Higher psychic function : Normal • Examination of cranial nerves : All are intact • Examination of sensory system : Intact • Examination of motor system : • #Muscle tone & power – Normal • #Reflexes : Normal • #Planter : Bilateral flexor • #Cerebellum (Gait) – Normal • #Fundoscopy : Bilateral Papilloedema
- 17. Cardiovascular system: S1 & S2 audible Respiratory system: Breath sound : Vesicular Added sound : Absent Alimentary system: No abnormality was detected
- 18. Salient Feature Mr. Jahangir 18 years old male, muslim, unmarried, medical technologist normotensive, non diabetic, no alcoholic, non smoker hailing from Katiarchar Kishoreganj got admitted to MMW at SSNIMCH with complaints severe headache for 3 days followed by appendectomy and associated neck pain for 2 days.He developed headache which was sudden, severe,diffuse, throbbing and diurnal in nature.
- 19. Pain exaggerated in the morning especially soon after waking up but relieved at night. It was associated with photophobia and nausea. It was subsided by taking medication (Paracetamol) but reappeared after 2/3 hours. It was associated with neck pain. Patient had no history of fever, limb weakness, blurring of vision, neurological deficit, vomiting or any head injury. He also gave no history of ear infection, eye infection or nose infection
- 20. Patient gave history of appendectomy four days back. He gave no history of Diabetes Mellitus, Hypertension, Tuberculosis and Cardiac Disease. On general examination he ill looking, non anaemic and non icteric. Neck rigidity was present and vitals were within normal limit. Nervous system examination revealed papilloedema was present. All other systemic examinations reveal normal findings.
- 22. Differential Diagnosis • Subarachnoid Hemorrhage • CVST • Meningitis • Idiopathic Intracranial Hypertension • Migraine • Intracranial Space Occupying Lesion
- 23. Investigation Profile Name of the Investigations/Results CBC • Hb% : 14 • ESR : 15 • Total count : 9400/cmm • Neutrophil : 67% • Total Platelet : 245000/cmm
- 24. • X – ray of Cervical Spine: Normal • CT scan of Brain: Hyper dense Dural venous sinuses • MRI of Brain: Unremarkable brain parenchyma • MRV of Brain: Suggestive Superior Sagittal Sinus Thrombosis
- 25. CT scan of brain
- 26. MRI&MRV of brain
- 27. CBC
- 28. Xray of cervical spine
- 29. Confirmatory Diagnosis Superior Sagittal Sinus Thrombosis
- 30. Treatment Anticoagulation: (Low molecular weight heparin) -Inj. Cardinex (60mg) BD for 7 days Followed by Warfarin or Rivaroxaban daily for 6 months General Management: Inj. Ceftriaxone 1gm 12 hourly Inj. Omeprazole 40mg 12 hourly Tab. Napa 500mg 8 hourly Tab. Flexilax 5mg 8 hourly Tab. Rivotril 0.5mg OD at bedtime
- 31. Thank You