Her vital parameters bp 11770 mm hg pulse 88 beatssec

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Her vital parameters: BP – 117/70 mm Hg, pulse – 88 beats/sec., breath rate – 16/sec. During neurological examination next signs were revealed – mild rigidity of neck, slightly positive Kernig’s and Brudzinski’s sings, hyperesthesia, moderately depressed tendon reflexes, sometimes positive left-sided Babinski’s sign, unilateral ophtalmoplegia, mildly non-symmetric mimic muscles, slightly decreased gag reflex. Blood assay – slightly increased level of white blood cells (10000/mm 3 ), ESR – 29 mm. CSF assay – increased pressure during puncture, mildly yellowish color, slightly cloudy fluid, cell count 450/nm 3 , mixed pleocytosis (lymphocytes/neutrophils – 60%/40%), slightly elevated level of protein, decreased level of glucose down to 1,9 mmol/l. Fundoscopy – moderate papilledema. What is your diagnosis? Describe algorithm of treatment. Diagnosis: tuberculous meningitis Algorithm of treatment: we need to use 4 tuberostatic drugs for at least 18 months Isoniazid, rifampicine, etambutol, pyrazinamide Because isoniazid may cause very toxic polyneuropathy we need to prescribe high doses of vit. B6 3 Patient, female, in age of 58 years, is admitted to the hospital with complaints of muscular stiffness, tremor, gait disorders, slow motions, difficulties during vision, periodic short- lasting paroxysms of eyes-rolling. This condition has been existing and slowly-progressing for almost 15 years and started after acute state, accompanied with dissomnia, high body temperature (up to 40,1 C) and strabismus combined with double vision. Her vital parameters: BP – 110/65 mm Hg, pulse – 74 beats/sec., breath rate – 13/sec. During neurological examination next signs were revealed – rigidity of limbs’ muscles, cogwheel phenomenon, shuffling gait, resting tremor, torpid tendon and periosteal reflexes, bilateral palsy of accommodation and convergence. Blood assay – normal. CSF assay – non- specific. Fundoscopy – non-specific. What is your diagnosis? What brain structures are affected in this disease? Describe approaches to treatment. Diagnosis: Lethargic encephalitis – chronic stage Affected structures: midbrain (oculomotor, trochlear nn.) and basal ganglia (paleostriatum) Treatment: there’s no cure to this disease because we don’t know the causative agent. Treatment is purely supportive and involves management of parkinsonism symptoms: Dopamine precursors - levodopa & carbidopa Physical therapy and exercise. Physical activity may help improve physical and mental well- being, balance, flexibility and strength. 4 Patient, male, in age of 26 years, was admitted to the hospital with severe headaches and intensive vomiting, mild vertigo, decreased vision and hearing, tinnitus and periodic short- lasting paroxysms of fear and consciousness loss with subsequent generalized clonic jerks.
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  • Winter '18
  • Jane doe
  • Neurology, Seizure, Seizure types

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