This condition started after the severe head injury 3

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This condition started after the severe head injury 3 years ago, has cyclic course and precipitated with stress, weather changes and heavy physical work. Hearing and vision deteriorate progressively. His vital parameters: BP – 135/86 mm Hg, pulse – 76 beats/sec., breath rate – 17/sec. During neurological examination next signs were revealed – slightly 28
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decreased convergence, mildly non-symmetric mimic muscles, positive right-sided Strumpell’s sign, swaying during Romberg’s test, intention tremor during finger-to-nose test, intensive perspiration. Blood assay – normal. CSF assay – normal. Fundoscopy – incipient optic atrophy. What is your diagnosis? Describe algorithm of diagnosis and treatment. Diagnosis: arachnoiditis Algorithm of diagnosis: echoencephalography, CT(hypertension syndrome, atrophy of cortex, widening of subarachnoid space, increased size of ventricles) Treatment: Intracranial HTN – diuretics + corticosteroids (acetazolamine) Epileptic activity – anticonvulsive drugs (carbamazepine, valproic a.) Presence of adhesions, scars – enzyme drugs – lidase(?), iodine drugs Chronic HTN with cortical atrophy – stimulation of brain metabolism – piracetam Decreased hearing, vision – control of peripheral cranial neuropathy – cholinesterase inhibitors 5 Patient, female, in age of 39 years, was admitted to the hospital in state of coma with body temperature 40,0 C and motor focal and sometimes secondarily generalized seizures. This condition developed rapidly within 2 days and was preceded by confusion, fatigue and non-specific skin lesions. Her vital parameters: BP – 129/70 mm Hg, pulse – 92 beats/sec., breath rate – 17/sec. During neurological examination next signs were revealed – mild rigidity of neck, positive Kernig’s and Brudzinski’s sings, non-symmetric tendon reflexes, left-sided central hemiparesis. Blood assay – increased level of white blood cells (15000/mm 3 ), ESR – 33 mm. CSF assay – increased pressure during puncture, cell count 390/nm 3 , mostly lymphocytes (70%), slightly elevated level of protein, level of glucose is 3,1 mmol/l. Fundoscopy – non-specific changes. EEG – diffuse slowing and focal changes over the right temporal area. MRI – high-signal intensity in the right frontal cortex and right temporal lobe. What is your diagnosis? Describe algorithm of diagnosis and treatment. Diagnosis: HSV encephalitis Algorithm of diagnosis: PCR test of CSF Treatment: To decrease edema of the brain – diuretics + corticosteroids (furosemide + mannitol + prednisolone) Antiherpetic drugs I.V. – acyclovir, valacyclovir, gancyclovir Antiepileptic drugs (valproic acid) TOPIC “NON-EPILEPTIC PAROXYSMAL CONDITIONS + HEAD INJURY” TEST QUESTIONS 1 Affection of what neural structure is associated with development of panic attack?
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  • Winter '18
  • Jane doe
  • Neurology, Seizure, Seizure types

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