23 year old male with complaints of lower limb weakness
After going through the patient details as given by our Intern Mam through the following link..
https://vaish7.blogspot.com/2020/05/medicine.html?m=1
My analysis of the patient is as follows :
CHIEF COMPLAINTS :-
1)weakness of bilateral lower limbs and complaints of tingling and numbness.
2)vomitings 5days back 3-4 episodes non projectile non bilious food particles is content.
3)when he got up for urination,suddenly he had a fall and got up with the help.
4)gluteal abscess since 5months ( operated 5 months back )
5)scrotal abscess since 20 days (incision and drainage 10 days back) These two abscess are cold abcess
1.ANATOMICAL LOCATION OF THE PROBLEM
FROM THE above investigations and reports the anatomical location of present paraparesis problem lies in the anterior right and left cerebral hemispheres, midline of falx cerebri and pyramidal tracts .
2.Possible etiology of WEAKNESS
As the MRI suggests of disseminated tuberculosis and ring enhancing lesions in the brain.
The possible etiology might be spread of this mycobacterium from lumbosacral abcess to the blood vessels and from the blood vessels it reaches the circle of Willis in brain and further into anterior communicating artery occlusion
And further causing infarcts in pyramidal tracts causing Paraparesis.
3.POSSIBLE INVESTIGATIONS
as we are suspecting mycobacterium from MRI investigations we need to further confirm the organism
Best step is to isolate the organism
1-sputum microscopy
2-monteaux test
3-cbnaat
4-Bronchoscopy followed by bronchoalveolar lavage study
5-Culture of abcess fluid
Hence from the above investigations we can be able to confirm which type of mycobacterium it is and further treatment option is done.
4-Provisional Diagnosis from the case.
Paraparesis with L4,L5infective spondylodiscitis with left psoas abscess with ring enhancing lesions in right and left cerebral hemispheres with healing ulcer in right gluteal region secondary to drained gluteal abscess with pyocele left side operated ( 10 days back)
5- Therapeutic modality
1)T.ATT 3 tabs/day fdc
2)T.Benadon 40mg/od
3)T.pregabalin 75mg/po/h/s
4)OINT.MEGAHEAL FOR LOCAL APPLICATION
5)SITZ BATH WITH BETADINE TID
6)FREQUENT CHANGE OF POSITION
https://vaish7.blogspot.com/2020/05/medicine.html?m=1
My analysis of the patient is as follows :
CHIEF COMPLAINTS :-
1)weakness of bilateral lower limbs and complaints of tingling and numbness.
2)vomitings 5days back 3-4 episodes non projectile non bilious food particles is content.
3)when he got up for urination,suddenly he had a fall and got up with the help.
4)gluteal abscess since 5months ( operated 5 months back )
5)scrotal abscess since 20 days (incision and drainage 10 days back) These two abscess are cold abcess
1.ANATOMICAL LOCATION OF THE PROBLEM
FROM THE above investigations and reports the anatomical location of present paraparesis problem lies in the anterior right and left cerebral hemispheres, midline of falx cerebri and pyramidal tracts .
2.Possible etiology of WEAKNESS
As the MRI suggests of disseminated tuberculosis and ring enhancing lesions in the brain.
The possible etiology might be spread of this mycobacterium from lumbosacral abcess to the blood vessels and from the blood vessels it reaches the circle of Willis in brain and further into anterior communicating artery occlusion
And further causing infarcts in pyramidal tracts causing Paraparesis.
3.POSSIBLE INVESTIGATIONS
as we are suspecting mycobacterium from MRI investigations we need to further confirm the organism
Best step is to isolate the organism
1-sputum microscopy
2-monteaux test
3-cbnaat
4-Bronchoscopy followed by bronchoalveolar lavage study
5-Culture of abcess fluid
Hence from the above investigations we can be able to confirm which type of mycobacterium it is and further treatment option is done.
4-Provisional Diagnosis from the case.
Paraparesis with L4,L5infective spondylodiscitis with left psoas abscess with ring enhancing lesions in right and left cerebral hemispheres with healing ulcer in right gluteal region secondary to drained gluteal abscess with pyocele left side operated ( 10 days back)
5- Therapeutic modality
1)T.ATT 3 tabs/day fdc
2)T.Benadon 40mg/od
3)T.pregabalin 75mg/po/h/s
4)OINT.MEGAHEAL FOR LOCAL APPLICATION
5)SITZ BATH WITH BETADINE TID
6)FREQUENT CHANGE OF POSITION
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