case

Hello everyone I'm a medical intern.This blog is to share my experiences and cases I came across during this period

This is an online E log book to post and discuss our patient's de-identified health data posted after taking informed consent where we discuss patient-centered clinical problems through series of discussions among the community of experts without letting the patient move to distant places to different doctors with an aim to solve their clinical problems with the collective best evidence input from them. This online platform also reflects my patient-centered learning portfolio.

This is a case of 33 year old male with csvt

A 33 year old male lorry driver by occupation the patient hailing from pochampalli came with the chief complaint of headache unilateral left-sided since four days frontotemporal region radiating to occipital region no diurnal variation associated with nausea blurring of vision diplopia no photophobia vomiting phonophobia

Diplopia since 2 days binocular vertical gaze evoked

No loss of consciousness no trauma no aggravating or relieving factors

No history of involuntary movements No involuntary movements weakness of limbs slurring of speech fever cough chest pain palpitations shortness of breath loose stools sweating

No bowel and bladder incontinence no ptosis no pain in the eye movements no loss of smell decreased visual acuity no facial asymmetry no drooling of saliva and tinnitus giddiness dysarthria no motor weakness no tremors no sensory impairment

Past history

Not a known case of diabetes mellitus hypertension no similar complaints in the past no CVA no CAD no TB epilepsy

Personal history

he is a non-vegetarian chronic alcoholic 90 ML of whiskey per day since eight years stopped four days ago and he is a non-smoker non-gutka chewer

General examination

Patient is conscious coherent cooperated well built and well nourished

No pallor no icterus no cyanosis no clubbing no lymphadenopathy no Edema

PR: 94bpm

BP: 130/80

CVS S1 S2 heard no murmurs

P/A of non-tender

CNS higher motor function intact

Cranial nerve is normal

Bulk normal (both sides both limbs)

Tone normal (both side both limbs)

REFLEXES Right Left

Biceps - -

Triceps - -

Supinator - -

Knee - -

Ankle - -

Plantar Flexor Flexor

Superficial reflex- abd +

Cremaster +

Sensory

pain + +

touch + +

vibration + +

temperature + +

joint + +

Cerebellum - normal

Deltoid. 5/5. 5/5

Biceps. 5/5. 5/5

Triceps. 5/5. 5/5

Brachioradialis. 5/5. 5/5

Serratus anterior 5/5. 5/5

Pectoralis Major 5/5. 5/5

Supraspinatus. 5/5. 5/5

Infraspinatus. 5/5. 5/5

Latissimus dorsi 5/5. 5/5

ECR 5/5 5/5

ECU 5/5 5/5

FCR 5/5 5/5

FCU 5/5 5/5

EPB 5/5 5/5

EPL 5/5 5/5

FDP 5/5 5/5

Iliopsoas 5/5 5/5

Adductor femoris 5/5 5/5

Gluteus medius 5/5 5/5

Gluteus maximus 5/5 5/5

Hamstrings 5/5 5/5

Quadriceps 5/5 5/5

Tibialis anterior 5/5 5/5

Tibialis posterior 5/5 5/5

Gastronemius 5/5 5/5

EDL 5/5 5/5

FDL 5/5 5/5

EHL 5/5 5/5

EDB 5/5 5/5

Investigations

APTT-29s

INR- 1

RBS- 94

PT- 14s

Urea- 18

Creat- 0.8

UA- 10.0

K+ 4.0

TB- 1.10

Direct bilirubin- 0.30

AST 24

ALT 32

ALP 202

TP 6.9

ALBUMIN 3.4

A/G 1.21

HEMOGRAM

Hb: 16.9%

TLC 7700

Neutro- 60

Lympho-30

Eosino-04

Mono- 06

Baso- 00

RBC- 5.06

Plt- 2.58

MRI

Supratentorial region large ill defined t2 hypointense

T1 hyper intense areas showing Patchy peripheral diffusion restriction And complete blooming on SWI Measuring approximately 4×2.7cm Seen in the left posterior and temporal lobe With mild to moderate Peri lesional Edema

Loss of flow void in transverse and sigmoid sinuses Blooming on SWI—-s/o thrombosis

Mild effacement of left cerebral cortical Sulci Likely mild cerebral oedema

Diagnosis consideration: Venus haemorrhage due to thrombosis of left transverse and sigmoid sinuses

Provisional diagnosis

Thrombosis of left transverse and sigmoid sinus

Treatment

1.inj.clexane 60mg SC BD

2. Injection pan 40 MG/IV/OD

3.PCM tablet 650 MG/TID

4.monitor BP PR RR

5.Tepid sponging

6. Head end elevation