sᴘᴏᴛ ᴅɪᴀɢɴᴏsɪs

2021-12-08 00:35:08 Open / Comment

2021-12-08 00:30:46 Open / Comment

2021-12-08 00:26:24 63 yrs old patient presented to the ER c/o severe left sided headach, halos around the light and Lacrimation for 2 hours
Hx significant for urinary incontinence and UTI medication wise patient on TMP/SMX & and Tolterodine

O/Ex : red eye, non reactive dilated pupil.
Investigation : ESR 35

Source of image:
The new England journal of medicine
https://www.nejm.org/doi/full/10.1056/NEJMicm1712742 Open / Comment

2021-12-06 22:34:57 Open / Comment

2021-12-06 22:23:05 #Central_Retinal_Artery_Occlusion ( CRAO) :

Opthamologic emergency in which Central retinal artery ( supply central retinal area) is occluded.

#Pathophysiology :
Central retinal artery is a branch of Opthalmic artery(OA) OA in turn is the first branch of the internal carotid artery which makes the eye susceptible to thromboembolic phenomenoa

#Causes:
1- Thromembolism : emboli detached from a carotid arthematous plaque #commonest.

2- Other : cardiac emboli ( atrial fibrillation, vegetation), giant cell arthritis (GCA) : vasculitis of the retinal artery occluding the vessel and threatening the vision #Symptoms of GCA:
Scalp tenderness.
temporal headache.
Jaw claudication: pain and tiredness of facial muscles upon chewing.
Middle age 50-60 onset.


#Clinical_picture: Sudden painless( except in GCA) profound loss of vision.
N.B
inflammation always painful
GCA=vasculitis =inflammation.

#Reference:
Bradley's Boweling-Kanski's clinical ophthalmology 8th ed /page 549-552. Open / Comment

2021-12-05 20:45:10 #Answer:
Multiple sclerosis (MS).

#Definition:
Relapse remitting autoimmune central demyelinating process common among young females with high prevelance among people living in areas where sun exposure is less (vitamin D deficiency thought to play a role).

#Symptom_signs:

Optic neuritis : painful eye movement, monoccular vision loss, paradoxical pupilary response to light (instead of contracting they dilate), weakness, sensory symptoms, bladder dysfunction and paraplegia( Transverse mylitis).
Uhthoff sign: eye symptoms get worse with hot paths
Lehermitt sign: flexion of the neck induce severe pain that descend down on the back.

#Clinical_Pattern:
1- Relapse remitting (hit and run) 60-80%
2- primary progressive (getting worse with every attack)
3-secondary progressive : get worse after few remittance.

#Invx: MRI /CSF oligoclonal IgG in 90%.

#Diagnosis:
Revised McDonald criteria 2017

#Treatment :
Supportive
Steroids, vitamin D.

#Reference :
Toronto notes 2020/neurology /page 799 Open / Comment

2021-12-05 14:17:41 #Answer:
Vitamin B12 deficiency.

#Evidence: from Hx fatigue, peripheral neuropathy of long duration (B12 deficiency to develop need long time) , Hx of multiple bowel surgeries (ileal resection, ileum is the site of vit B12 absorption).

From Investigation : macrocytic Anemia, build up of MMA : B12 is a Coenzyme needed to convert MMA to succinyl CoA.


Further reading :
https://www.researchgate.net/figure/B-12-dependent-enzymic-reactions_fig3_269469564 Open / Comment

2021-12-04 11:03:21 https://t.me/spotdiagnosis/606

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Thanx Open / Comment

2021-12-04 10:45:42 Open / Comment