An Interesting case....
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S M Ahmed
An Interesting case....
A 43 year old female came to the OPD, she was unable to walk.
there was h/o tremors and involuntary movements in hands and feet since 15years.
there is associated speech difficulty since 10 yrs.
h/o swaying while walking.
tremors occur during work but are absent during rest.
no significant past history or family history.
o/e :
pt. is conscious and coherent
all cranial nerves appear to function normally.

on motor system examination :
tone of upper limbs muscles are decreased on both rt and lt sides

rt beating nystagmus is present
Dysdiadochokinesia is present
ataxic gait is seen
scanning speech +
tandem walking negative
rhombergs +

The patient is currently being monitored and a provisional diagnosis has been kept.
Can you guys find out the diagnoasis ?

I/x :
Hb : 11gm%
TC - 6100 cells
DC - p68 L26 E4 M2
PCV - 35%
platelets - 1.4 lakhs

HIV, HbsAg - NR
urine albumin urine sugar - nil
s. copper - 34 mcg/dl (decreased)
urea - 42 mg/dl
ALP - 175 u/l
SGOT - 25 u/l
SGPT - 12 U/L
creatinine - 0.9 mg/dl

MRI brain impression:
ill defined , non enhancing, non restricting, T2 and FLAIR hyperintensity.
hypointense on T1 WI involving B/L thalami, midbrain.
mild diffuse cerebellar atrophy
diffuse cerebral atrophy with small ischemic changes

Provisional R/x :
T. Promethazine 25mg
T. Haloperidol 0.5 mg BD
T. Pantop 40mg OD


PS : I'll update the case again. So stay tuned.....
S M A●●●d and 18 others like this
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N●●●●l J●●●●h
N●●●●l J●●●●h General Medicine
Could you keep updating here in the comments section?
May 7, 2017Like
S M A●●●d
S M A●●●d General Medicine
Will try to do that
May 7, 2017Like
S M A●●●d
S M A●●●d General Medicine
The patient had a scheduled check up at the College of Neurology and the report is pending evaluation. I' ll update about the report .
May 7, 2017Like1