Intriguing headache

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Information about Intriguing headache

Published on February 6, 2014

Author: GghNeurology


PowerPoint Presentation:  A CASE OF CHRONIC HEADACHE WHICH MISLED ME PowerPoint Presentation: A 45 yr old female by name Vijay lakshmi came with the chief complaints of Headache & Blurring of vision for past 5 years Double vision on looking to left for past 2 months PowerPoint Presentation: Head ache-5 yrs Insidious in onset , gradually progressive & continuous in the left fronto- parieto -occipital area. More after awakening from sleep associated with projectile vomiting and photophobia Pain & Neck stiffness. PowerPoint Presentation: Blurring of vision for past 5 years , insidious in onset , gradually progressive, painless, involving both the eyes , initially in the left eye then in the right eye after an interval of 3 months. She could not discriminate even the colors Diplopia on looking to left PowerPoint Presentation: Hearing loss in left ear-1yr Gradual onset, progressive in nature Unable to hear low intensity sounds No discharge from the ear No tinnitus or vertigo PowerPoint Presentation: There was no fever No altered sensorium / behavior No focal motor/sensory deficit No cerebellar ataxia No dementia No h/o trauma PowerPoint Presentation: Past history: no h/o similar complaints in the past. Family history: nil Personal history: known diabetic-5yrs on medication GENERAL CONDITION:  GENERAL CONDITION Moderately built and moderately nourished anemia - Cyanosis- Icterus- Clubbing- Lymphadenopathy- Pedal edema- Skin manifestations- VITAL DATA :  VITAL DATA Pulse rate: 80/min BP: 130/80 mm of Hg Temp : normal RR : 20/min PowerPoint Presentation: Lungs :clear CVS:S1,S2+ P/A:soft,no organomegaly . SYSTEMIC EXAMINATION Examination of nervous system: Examination of nervous system Higher mental functions are normal Loss of abduction of left eye, Visual acuity 6/60 in both eyes Left ear – Rinnes test is positive & webers lateralized to right ear Pupillary reflexes are normal Fundus examination- Bilateral papilledema Motor system examination : Motor system examination Bulk of the muscles –normal Tone and power in all the limbs -normal Superficial and deep tendon reflexes -normal PowerPoint Presentation: No involuntary movements No cerebellar signs Sensory system -normal Gait -normal PowerPoint Presentation: MENINGEAL SIGNS: Neck rigidity present Kernigs sign positive PowerPoint Presentation: A 48 year old diabetic presented with chronic progressive raised intracranial pressure with diplopia , impending visual loss, left sensory neural deafness with intact HMF, motor/ sensory system, cerebellum & autonomic functions . INVESTIGATIONS:  INVESTIGATIONS PowerPoint Presentation:  COMPLETE BLOOD PICTURE - NORMAL RENAL PARAMETERS -NORMAL CHEST X-RAY- NORMAL 2D ECHO- NORMAL STUDY CT BRAIN:  CT BRAIN HYPODENSITY NOTED{4mm thickness} on the left cerebral convexity ,with peripheral enhancement HYPERDENSITY along the left tentorial leaf PowerPoint Presentation: Admitted and subjected to surgery on 21/4/2012 Discharged on 30/4/2012 Biopsy report: :  Biopsy report: Dense fibro collagenous tissue Showed no specific infective or neoplastic pathology PowerPoint Presentation: In spite of surgery her symptoms didn’t subside and she went back to neurosurgeon on 9/5/2012 MRI BRAIN was done on 10/5/2012 CT BRAIN on 06-06-2012:  CT BRAIN on 06-06-2012 PowerPoint Presentation: She was admitted in GGH on 7/6/2012 As there was no relief Lumbar puncture was done on 16/6/2012 in spite of papilloedema , midline shift & mass effect. CSF ANALYSIS: CSF ANALYSIS Color : colorless Total count:10cells Protein:117mg/dl Glucose:160mg/dl Chlorides:126.7m mol/l Pandys :positive ADA:1.0u/l Cryptococcal antigen : positive TREATMENT :  TREATMENT IV AMPHOTERCIN B & FLUCONAZOLE FOR 2 WEEKS INSULIN FOR GLYCEMIC CONTROL DISCHARGED AFTER 2 WEEKS. CAME FOR FOLLOW UP ONCE, AFTER 1 MONTH. LOST FOLLOW UP . FINAL DIAGNOSIS : FINAL DIAGNOSIS CRYPTOCOCCAL MENINGITIS (LEPTO & PACHY MENINGITIS). CRYPTOCOCCAL MENINGITIS :  CRYPTOCOCCAL MENINGITIS Cryptococcal meningitis is a fungal infection of the tissues covering the brain and spinal cord ( meninges ). CAUSES: CAUSES Cryptococcal meningitis is caused by the fungus Cryptococcus neoformans . This fungus is found in soil around the world. Cryptococcal meningitis most often affects people with a weakened immune system. Risk factors include: AIDS Recent organ transplant Cirrhosis Diabetes Leukemia Lymphoma Sarcoidosis SYMPTOMS:  SYMPTOMS Unlike bacterial meningitis, this form of meningitis comes on more slowly, over a few days to a few weeks. Symptoms may include: Fever Headache Nausea and vomiting Mental status change Hallucinations Stiff neck Sensitivity to light (photophobia)

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