sᴘᴏᴛ ᴅɪᴀɢɴᴏsɪs

2021-12-17 02:24:07 55 yrs old women admitted to your clinic C/O of increasing headache for 1 month and Rt arm and leg weakness for the last 3 days, patient deny any Hx of trauma Hx otherwie unremarkable #OEx Bp: 135/89, right side hemiparesis and papiloedema #investigation Non contrast CT
Showed will circumscribed calcified mass in the left frontal lobe.

#Source:
UWORLD Open / Comment

2021-12-15 23:44:50 Open / Comment

2021-12-15 23:20:20 Open / Comment

2021-12-15 22:24:38 #Neurolyptic_malignant_syndrome (NMS) :
Usual Hx is that of a patient who recently received antipsycotic medication or known psychotic patient on antipsycotic drugs (#Dopamine_antagonis) who develope terad of:

1- Confusion (change in MS)
2- Hyperthermia (fever)
3- Muscle rigidity (all limbs are resistant to passive movement).
4- Autonomic instability : labile blood pressure and heart rate.

#DDx :
- CNS infection : worth to note patient with NMS has elevated total white blood cells.

- Drug Parkinsonism : tremors are prominent.

- Tetanus.
- Serotonin syndrome (SS) : remarkably similar to NMS lab tests are used to distinguish between them :
1- Elevated LFT
2- Elevated creatine kinase
3- #Leuckocytosis
Are seen in #NMS

#Management :
Supportive : ICU admission, hydration and vital signs monitoring, give muscle relaxants (e.g. #Dantrolene)
Stop offending medication

Further reading :
https://pubmed.ncbi.nlm.nih.gov/22563571/ SS vs NMS Open / Comment

2021-12-15 00:56:27 Open / Comment

2021-12-15 00:53:20 76 yrs old male presented to The ED with 2 hour onset double vision and difficulty rising his right eyebrow, Hx is significant for Hypertension and diabetes mellitus patients deny any headach, slurring of speech or any other Neurological deficits o/Ex right ptosis, when eyebrow lifted eye ball in down out position and unable to adduct or move upward, pupilary light response is intact #Investigation RBG : 238, H1Ac : 11 the likely cause of this patient condition : Open / Comment

2021-12-15 00:41:56 Open / Comment

2021-12-14 14:15:32 #Hypertension & hemorrhagic stroke(CVA) :

#Pathogenesis:
Weakening of blood vessele from the Shear and tear effect of chronic high blood pressure lead to development of microaneurysms known as (#charcot_bouchard_aneurysm ) theses microaneurysms are susabtiple to rupture and therefore hemorrhagic sttoke(CVA).

#Notes:
Sudden headach + loss of consciousness suspect hemorrhagic CVA do urgent CT.
Commonest site of hemorrhagic CVA is basal ganglia (especially #Putamen).

#Source:
Images from
https://www.sciencedirect.com/topics/medicine-and-dentistry/charcot-bouchard-aneurysm

Further on hemorrhagic strokes:

https://t.me/spotdiagnosis/173 lobar hemorrhagic stroke case.

https://t.me/spotdiagnosis/648
https://t.me/spotdiagnosis/649
https://t.me/spotdiagnosis/650 Open / Comment

2021-12-14 13:50:55 #Lacunar_stroke:

#Etymology:
from Latin lacūna a defect, hole or gap.

#Pathogenesis : lipohyalinosis a small cerebral vascular disease involving commonly deep penetrating arteries (e.g. Leniculostriae artery)
Shear and tear injury to blood vessels cause :
1- hyaline deposition.
2- fibrinoid necrosis.
3- atheroma formation.
Leading to narrowing of the leumen and small infarction (lacunar)

#Risk_factors:
1- Hypertension: commonly cause ischemic stroke rather than hemorrhagic.
2 - Diabetes mellitus
3-Hyperlipidemia.

#Clinical:
5 clinical syndromes :
1- Pure motor hemiparesis (the #commonest).
2-Pure sensory stroke
3-Sensimotor stroke
5- Ataxic hemiparesis.
5- Dysarthria-clummsy hand.

#Notes:
Lacunar stroke greatest risk factor is HTN.
Lacunar stroke is part of ischemic CVA.
Hypertension also predisposes to hemorrhagic CVA although less common than ischemic CVA.

#Reference :
Uworld neurology block.
https://emedicine.medscape.com/article/1163029-overview Open / Comment

2021-12-14 00:34:27 Open / Comment