8/12 hx of change in personality involuntary shakes and change in sleep pattern

1. ME AND MY SHAKES
Dr opeoluwa folorunsho
A/E chesterfield royal Hospital
derbyshire

2. CASE
64
GC
8/12
Feeling unwell

3. CASE
Complaints have gotten worse in the past few weeks
Not sleeping well
Both day and night
Generalized joint pains
Both large and small joints
Having intemittent shakes

4. CASE
Family reports:
periods where they find it difficult to understand him
Starring and feeling lost
Sometimes he appears stiff and unresponsive
These episodes last seconds to minutes and he’s then back
to his baseline

5. CASE
No headache
No numbness
No focal weakness
No urinary/feacal incontinence
No visual disturbances

6. CASE
Seen his GP on 3 occasions in the past 8/12
Started on amitryptiline
Didn’t feel any better
And the medication made his shakes “worse”

7. CASE
Subsequently referred to the neurologist
Saw neurologist a 4/7 prior to a/e visit
In patient’s words “ I went there for help..but he only
reduced my amitryptilline dose and asked me to go back to
my gp”

8. CASE
Neurologist ordered folate and vitamin B 12
 creatinine kinase
 thyroid function levels
 open appointment if necessary…..

9. PROBLEM SOLVED ?

10. PMH
Anxiety
TIA 2010
Encephalitis 8/12 ago

11. CASE
Labs normal
Examinations unremarkable

12. DIFFERENTIALS
??
???
OGK !!!

13. DISCUSSION
Post-encephalitic syndrome
Discussed with consultant
Start low dose diazepam
Letter back to neurologist

14. DISCUSSION
ICD – 10 describes the condition as a syndrome
which includes residual behavioral change that follows
recovery from viral or bacterial encephalitis
 Kluver-Bucy syndrome (herpetic encephalitis)
Non specific

15. DISCUSSION
Symptoms varies post encephalitis
No or minimal after effects
Fatigue

16. DISCUSSION
Chronic pain
Involuntary movements
Alteration in the sleep cycle
Repiratory symptoms
Parkinsonian festures
depression

17. DISCUSSION
behavioral and/or personality changes - such as mood
swings, bouts of frustration, anger and anxiety.
 Sexuality changes
emotional placidity
hyperorality (sticking inappropriate items in the mouth)
hypermetamorphosis (compulsive fascination with nearby
objects)
hypersexuality.

18. DISCUSSION
Epilepsy, persistent anomia, aphasia,
motor deficit, and a chronic amnestic state
similar to Korsakoff’s psychosis.

19. DIFFERENTIAL
The syndrome of prolonged and persistent
fatigue, myalgia, nervousness, concentration
impairment, and postexertional malaise
(postviral chronic fatigue syndrome)

20. REFERENCES
 Ravi V, Desai A, Shankar SK, et al. Japanese encephalitis. In: Davis
LE, Kennedy PGE, eds. Infectious diseases of the nervous system. Oxford:
Butterworth-Heinemann, 2000: 231–58.
 The Encephalitis society( The after effects and social
consequences on encephalitis)
 A Chaudhuri, P G E Kennedy Diagnosis and treatment of viral
encephalitis Postgrad Med J 2002;78:575–583

21. THANK YOU