sᴘᴏᴛ ᴅɪᴀɢɴᴏsɪs

2021-12-14 00:25:27 Open / Comment

2021-12-13 00:28:40 Open / Comment

2021-12-13 00:20:47 Open / Comment

2021-12-12 22:12:47 #Vitamin_B12_deficency:
Follwing features suggestive of Vit B12 deficiency :

1- Symptoms of Anemia.

2- CBC: MCV> 100fL, hypersegmented neutrophil.

3- Neurological symptoms : weakness and Ataxia

4- Romberg test postive: patient is asked to stand stright and close the eyes if patient looses balance when he closes the eyes romberg test is said to be positive and hence sensory Ataxia ( loss of balance following loss of visual cues)
#Explanation:
Patients with Impaired Proprioception (sense of position and awareness of how body parts are oriented in space is known as propreception) use their vision heavily to move around and when visual cues are masked as in this test patient loose balance (sensory Ataxia).

5- Elevated serum methylmalnoic acid ( MMA)

#Source of image:
UWORLD Open / Comment

2021-12-12 01:27:02 #Answer :
1- Sensory Ataxia
2- occasional pain
3- urinary incontinence (neurogenic)
4- Irregular pubil (#Argyll_robertson pupil) : miotic, irregular and responsive to accommodation but not to light.

#Spot_diagnosis :
TAPES DORSALIS ( tertiary syphilis)
Neurodegenerative disease caused by an infection (treponema pallidium), affect the dorsal clomn ( epicritic sensations) and dorsal root ganglia ( pain and areflexia), history of past exposure to syphilis is usually present ( homosexuals and multiple partners are at risk I.e. An STD ).

#Treatment:
Intravenous Penicillin for 10-14 day.

Vitamin B12 deficiency :
1- posterior clomn degeneration : sensory Ataxia
2- lateral clomn degeneration : weakness and motor Ataxia

1+2 = subacute combined cord degeneration.

Vitamin B1 deficiency :
- wernickle /Korsakkof : Occulomotor dysfunction with normal pupils

#Source :
Uworld Open / Comment

2021-12-12 01:07:39 Open / Comment

2021-12-12 01:07:39 Open / Comment

2021-12-11 19:18:51 Open / Comment

2021-12-11 00:43:13 #Wernickle_Encephalopathy:

Neurological symptoms duo to vitamin B1(TᕼIᗩᗰIᑎE ) deficiency :

1- Encephalopathy : confusion
2- Occulomotor dysfunction : nystagmus & abducent palsy
3 - Ataxia: clumsiness and wide based gait.

#Causes :
1- Malnutrition : eating disorder (anorexia nervosa), protien energy malnutrition
2 - Chronic alcoholism
3- Hypermesis gravidarum

#Management :
No glucose containing fluid is given to a patient you suspect to have "wernickle encephalopathy" ( administration of glucose in such conditions will further deplete body store of Vitamin B1 as its used robustly in glucose metabolism and therefore wernickle encephalopathy increases as in this patient).

Thiamine infusion then glucose.


#Reference :
Goldman-Cecil medicine 25th ed.
USMLE neurology.

http://static.us.elsevierhealth.com/goldman_cecilmedicine25e_9781455750177/9781455750177_0094 Open / Comment

2021-12-11 00:28:25 Open / Comment