A 42yr old female with FEVER AND LEFT HEMIPARESIS

 24December 2021

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This Elog book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment .

Patient and his/her attenders have been informed and their consent has been taken.


SNEHA JAJU

Roll no 148

Discussion video part 1

Discussion video part 2

A 42yr old female came to opd with C/o giddiness and unable to get up on her own. 

C/o fever.



HOPI

Patient was apparently asymmtomatic 5 days back then in morning she was unable to stand on her own without support and swaing to right side on standing.

C/O giddiness

C/O fever night before she got this symptoms a/ w chills and body pain.

No c/o weakness of limbs,seizures,headache,sensory symptoms 

No c/o burning micturition,cough,SOB,vomiting,loose stools 

No H/o head trauma.

PAST HISTORY

K/c/o DM since 10yrs (diagnosed when pregnant had giddiness and went for checkup) 

K/c/o hypothyroidism.

FAMILY HISTORY

No significant family history.

PERSONAL HISTORY

Diet - Mixed

Appetite - Normal

Sleep - Adequate

Bowel and bladder movements - Regular

No addictions.

TREATMENT HISTORY

T.Glucoryl 1mg BD 

T.Thyronorm 25mg OD 

GENERAL EXAMINATION

Patient was conscious. Oriented to person and not to place and time.

Pallor - Mild

Icterus -  Absent

Cyanosis - Absent

Clubbing - Absent

Lymphadenopathy - Absent

Pedal Odema - Absent

Temp: 101°F 

PR: 98 bpm 

BP: 120/80 mmhg 

RR: 18/min 

SPo2: 98%

SYSTEMIC EXAMINATION 

Day 1 

CVS - S1 S2 + 

RS - BAE + 

P/A - soft, non tender 

CNS - 

HMF - intact 

delay in obeying commands 

Cranial nerves - intact 

Power RT LT 

      UL 5/5 5/5

      LL 5/5 5/5

Tone normal normal 

Reflexes RT LT 

    Biceps 2+ 2+

   Triceps 1+ 1+

Supinator 1+ 1+

      Knee - -

      Ankle - -

    Plantar flexor extensor 

Cerebellar- swaing to Rt side on walking Rombergs - Pt unable to stand 

No nystagmus 

Day 2 

 She had fever spikes and vomitings 3episodes in morning

CNS - GCS : E4V3M6

Pupils - b/l reacting to light

Corneal conjuctival- present b/l

Dolls eye- present

Tone-  Rt.   Lt

Ul.      N   Dec

LL.     N   Dec

Power-  Rt. Lt

UL. 3/5. 3/5

LL. 3/5 2/5

Reflexes Rt. Lt

Biceps.      -   -

Triceps.     -  -

Supinator  -   -

Knee           -   -

Ankle         -  -

Plantar Extensor extensor

Thrombophlebitis + at lt hand region

Day 3 

 Fever spikes +, vomitings subsided, myalgia +

CNS -  GCS : E4V4M6

Pupils - b/l reacting to light

Corneal conjunctival- present b/l

Dolls eye- present

Neck stiffness +

Tone-  Rt. Lt

Ul        N Dec

LL.      N Dec

Power  Rt. Lt

UL. 3/5. 1/5

LL. 3/5 2/5

Reflexes    Rt. Lt

Biceps - -

Triceps - -

Supinator - -

Knee- - -

Ankle. - -

Plantar Extensor extensor

Thrombophlebitis + at lt hand region

Day 4

Fever spikes +, headache+, severe myalgia

CNS -  GCS : E4V4M6

Pupils - b/l reacting to light

Corneal conjuctival- present b/l

Dolls eye- present

Neck stiffness +

Tone-

             Rt.                 Lt

Ul.          N                Dec

LL.          N.              Dec

Power

             Rt.                 Lt

UL.        3/5.              1/5

LL.         3/5               1/5

Reflexes

            Rt.           Lt

Biceps    -           -

Triceps   -            -

Supinator -           -

Knee-       -           -

Ankle.       -           -

Plantar    Extensor extensor

Thrombophlebitis + at lt hand region(resolved)


INVESTIGATIONS

Hb- 7.4 TLC- 6,400 PLT- 2.1 

Smear- microcytic hypochromic anaemia Sr.Creat- 1.1 

Serum electrolytes : 

Na -144 

K - 3.9 

Cl -103 

CUE: 

Alb ++ 

Sugar nil































DIAGNOSIS

ACUTE INFRACT IN RT MEDIAL TEMPORAL POSTERIOR ASPECT OF LENTIFORM NUCLEI with AREAS OF HEMORRHAGIC TRANSFORMATION +

??BRAIN ABSCESS

?? ENCEPHALITIS/CEREBRITIS

ANAEMIA (MICROCYTIC HYPOCHROMIC).


TREATMENT

Day 1

Inj.Mannitol 100ml IV TID

Inj.Pantop 40mg IV OD

Inj.Human Actrapid acc to grbs

Inj.Neomol 1gm IV SOS if temp >101 F

Tab.DOLO 650mg PO TID

IVF NS,RL @75ml/hr

T.Thyronorm 25mg PO OD

Temp/BP/PR monitoring 4th hrly

Grbs monitoring 6th hrly

Day 2

Rt feeds 100ml milk + protein 

50ml free water. 4th hrly

Inj monocef 1gm iv bd. D2

Inj optineuron 1amp in 100ml NS iv od

Tab atorvas 20mg rt hs

Tab dolo 650mg rt sos

Inj HAI SC tid after informing grbs 

Bp / PR / TEMP charting 4th hrly

Day 3

Rt feeds 100ml milk + protein 

50ml free water. 4th hrly

Inj monocef 2gm iv bd. D2

Inj metrogyl 500mg iv tid d1

Inj optineuron 1amp in 100ml NS iv od

Tab atorvas 20mg rt hs

Tab dolo 650mg rt sos

Inj hai SC tid after informing grbs 

Bp / PR / TEMP charting 4th hrly

Day 4

Rt feeds 100ml milk + protein 

50ml free water. 4th hrly

Inj meropenem 1gm iv tid. D1

Inj metrogyl 500mg iv tid d2

Tab amlong 5mg rt od

Inj optineuron 1amp in 100ml NS iv od

Tab atorvas 20mg rt hs

Tab dolo 650mg rt sos

Inj hai SC tid after informing grbs 

Bp / PR / TEMP charting 4th hrly


DISCUSSION






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