shirish_sss
Forum Senior
Topics: 32
Posts: 134
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HI GUYS....
THIS QUESTION IS ABOUT A PATIENT WHOM I ENCOUNTERED DURING MY INTERNAL MEDICINE RESIDENCY BEFORE 2 YEARS IN INDIA.....
A REAL WORLD QUESTION (SOME OF OUR MEMBERS MAY BE INTERESTED TO HAVE A LOOK AT IT).....
HERE IT GOES...........
A 34 YEARS OLD PATIENT CAME TO THE EMERGENCY DEPARTMENT OF NEW CIVIL HOSPITAL, AHMEDABAD, INDIA (IT'S ASIA'S LARGEST TERTIARY CARE HOSPITAL...VOW...) WITH CHIEF COMPLAINS OF...
1) WEAKNESS OF THE LEFT LOWER LIMB SINCE LAST 10 HOURS WHICH HAS BEEN SLOWLY PROGRESSIVE AND ALSO DEVELOPING IN UPPER LIMB
2) SENSORY DISTURBANCES IN THE LEFT SIDE OF BODY
3) HEADACHE SINCE LAST 12 HOURS
ON EXAMINATION-----
PATIENT HAD BLACK MARKS ON BOTH LOWER LIMBS AND HISTORY SUGGESTS THEM TO BE RELATED TO REPEATED THROMBOSIS OF THE LOWER LIMB VEINS.
PHYSICAL EXAMINATION IS OTHERWISE NORMAL.
NEUROLOGICAL EXAMINATION......
POWER IN LEFT LOWER LIMB---3
LEFT UPPER LIMB ---------------3+
POWER IN RIGHT SIDE OF BODY---4
REFLEXES---EXAGGERATED IN LEFT SIDE...
NO CRANIAL NERVE WEAKNESS ....
CT-SCAN BRAIN EXAMINATION ON THE DAY OF ADMISSION WAS NORMAL.....
PT. BECAME DROWSY 6 HOURS AFTER ADMISSION AND ON THE NEXT DAY DEEPLY COMATOSE.
FAMILY HISTORY REVEALED THAT HIS FATHER DIED AT AGE 48 YEARS FROM PULMONARY THROMBOSIS..
HIS PATERNAL AUNT WAS TWICE ADMITTED IN HOSPITAL FOR ACUTE EPISODES OF CHEST PAIN AND DYSPNOEA (LATER DIAGNOSED AS PULMONARY EMBOLISM).
OUR PATIENT DID NOT HAVE ANY HISTORY OF --DIABETES, HYPERTENSION, DRUG HISTORY.
HE DID NOT TAKE ANY TREATMENT FOR PREVIOUS EPISODES OF LOWER LIMB VEIN THROMBOSIS--WHICH HIS WIFE SAY'S RESOLVED SPONTANEOUSLY.....
MRI-BRAIN CONTRAST STUDY WITH GADOAMINE DYE OF THE COMATOSE PATIENT ON THE NEXT DAY OF HIS ADMISSION WOULD MOST LIKELY REVEAL WHICH OF THE FOLLOWING ?
1) RIGHT MIDDLE CEREBRAL ARTERY THROMBOSIS
2) RUPTURED VASCULAR MALFORMATION IN BRAIN
3) SUPERIOR SAGGITAL VENOUS SINUS THROMBOSIS
4) HEMORRHAGIC INFARCT OF THE RIGHT FRONTO-PARIETAL LOBE
5) SPACE OCCUPYING LESION IN THE RIGHT FRONTO-PARIETAL LOBE
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| Delusional
Forum Elite
Topics: 41
Posts: 226
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Superior sagittal vepus sinus thrombosis...
Patient has typical risk of venous thrombosis and in addition to that the sudden headache with the rapid deterioration to coma makes it the likeliest possibility.
MCA thrombosis....wouldn't be so aggressive in presentaion and rapid ensuing coma is rare
The rest of thye possibilities are all too noncharacterisitic.....
One question thought what is Gadoamine.... :? :?
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| shirish_sss
Forum Senior
Topics: 32
Posts: 134
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HI DEL.......
YOU R ALWAYS RIGHT..... :lol: :lol:
THIS PATIENT HAD WHAT IS CALLED HEREDITARY THROMBOSIS SYNDROMES
IT IS INHERITED AS AUTOSOMAL DOMINANT DISEASE.....
MOST COMMON TYPE--- FACTOR V LEIDEN
OTHERS--- ANTITHROMBIN III DEFICIENCY, PROTEIN C AND S DEFICIENCY.
GADOAMINE IS A DYE USED FOR CONTRAST MRI-BRAIN STUDY.....
IT DIFFERENTIATS WELL VASCULARISED BRAIN STRUCTURES FROM POORLY VASCULARISED ONES.....
THAT WAS CORRECT ANSWER DEL...........
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| shirish_sss
Forum Senior
Topics: 32
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THE PATIENT WAS IN COMA FOR ABOUT 2 MONTHS.......
AFTER WHICH HE ULTIMATELY DIED..........OF INFECTIONS AND DIC.....
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| Delusional
Forum Elite
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Thanx.... 
Is it Gadolinium ..u mean .... :?
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| shirish_sss
Forum Senior
Topics: 32
Posts: 134
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YES DEL...
DIFFERENT NAMES FOR THE SAME THING.........
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| Delusional
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Thanx
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good question
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