Concluded Case

25yrs old female Post 25yrs old female Post LSCS a month back presented 3 week history of headache, Vomittings and fever on n off with Right eye ptosis.Severe headache relief by mannitol.Typhoid positive,Hb -9.6,TLC-5700,Neutrophils -78,ESR-60,Viral profile - Normal O/e - Conscious,alert,Moving all four limbs,Meningeal sign negative,Right ptosis with restricted movement,pupils B/l partially Dilated fixed(due to fundus)S/o 3rd nerve palsy,Left eye normal.CSF done,Today morning suddenly patient had respiratory arrest and condition deteriorated, intubated and put on ventilator support as per standardised protocol.O/e - Pupils - Partially dilated fixed due to fundus examination,GCS - E1V1M1,BP - 80/60 on inotropes support,PR - 110/mt.Urgent CT head was performed.Prognosis explained to attendants by neurologist and Neurosurgeon. PLEASE GIVE UR EXPERT ADVICE ON THIS CASE. @Dr. Manorama Rajan mam,@Dr. Saumya Mittal sir,@Dr. Anand Kumar sir,@Dr. Yashesh Dalal sir,@Dr. Parveen Yograj sir,@Dr. Hardik Ahuja sir

3 Likes

LikeAnswersShare
Concluded answer

Young lady presented with 3 weeks history of head ache,vomiting ,intermittent fever with intact sensorium and rt 3rd nerve palsy. There is no signs of encephalone involvement like seizures,alteration of sensorium or focal deficits to suggest any form of encephalitis.Normal WBC counts with elevated ESR low Hb with 16cells in the 1st CSF with Rt 3rd nerve palsy all indicative of subacute meningitis.No mention about the optic fundi in the notes. MRI no contrast film posted to check for any meningeal enhancement which is very crucial in this case.3rd nerve palsy with the back ground history of fever ,head ache with vomiting of weeks duration is in favour of TBM.2nd CSF showed increase in cells with elevated protein is more for TBM.3rd nerve involvement is related to basal lesion. Sudden deterioration probably due to arteritis basilar artery due to part of underlying pathology. MRV FINDINGS LOOK LIKE NONSPECIFIC/ UNRELATED WITH THE PRESENT PROBLEM. My impression is TBM,basat adhesion resulting on 3rd nerve palsy,sudden deterioration due to arteritis of basilar artery.

All Answers

Considering the elevated C.SF protein - 210- a strong possibility of viral meningitis is there. The condition may be aggravated with hypo plastic left transverse and left sigmoid sinuses which has caused cerebral venous sinus thrombosis. As patient is already having lowered immunity after LSCS and typhoid fever- viral meningitis can occur. In medical science- some times exact diagnosis cannot be made - only a provisional diagnosis can be assumed. CT scan is indicative of white cerebellum sign - indicative of ischaemic- hypoxic brain injury with extensive cerebral oedema - A sign of poor prognosis

Thank you doctor
0

View 2 other replies

Young lady presented with 3 weeks history of head ache,vomiting ,intermittent fever with intact sensorium and rt 3rd nerve palsy. There is no signs of encephalone involvement like seizures,alteration of sensorium or focal deficits to suggest any form of encephalitis.Normal WBC counts with elevated ESR low Hb with 16cells in the 1st CSF with Rt 3rd nerve palsy all indicative of subacute meningitis.No mention about the optic fundi in the notes. MRI no contrast film posted to check for any meningeal enhancement which is very crucial in this case.3rd nerve palsy with the back ground history of fever ,head ache with vomiting of weeks duration is in favour of TBM.2nd CSF showed increase in cells with elevated protein is more for TBM.3rd nerve involvement is related to basal lesion. Sudden deterioration probably due to arteritis basilar artery due to part of underlying pathology. MRV FINDINGS LOOK LIKE NONSPECIFIC/ UNRELATED WITH THE PRESENT PROBLEM. My impression is TBM,basat adhesion resulting on 3rd nerve palsy,sudden deterioration due to arteritis of basilar artery.

Valuable opinion
0

CSF shows Elevated CSF Protein.... Post LSCS pt is having headache...a feature of Cortical Venous Thrombosis.... Typhoid positivity is not clinically important... Typhoid induced Encephalopathy is very rare.. MR venography is grossly normal.. HSV or Other Viral Encephalitis can be an imp differential.... Send CSF PCR for same n include Zoster

Thank you doctor
0

Raised i/c pressure with csf elevated csf protein a viral menengitis there therd nerve with pupillary sluggish and ptosis and LSCS associated with hypoxic brain injury with cereberal oedema . Need active advice of neuro physician and respiratory therapist, may initiate i/v methyl predenisolone to control intracranial pressure and help survival

Thank you doctor
0

There are 2 body fluid reports...??? Which of these belongs to this pt ?? If both are From same pt than mentioned date please.. Clinical features suggestive of chronic meningitis with raised icp Blood reports again favouring chronic illness with normal tlc and high esr.. Is raised icp if csf done without precautions brain stem may herniate and leads to sudden cardiorespiratory arrest.. probable reason in this pt.. Later on ct showing loss of grey-white different s/o significant hypoxia and poor prognosis

Sir,Both reports are of d same patient First one - 6/9/19 Second one - 13/9/19
0

View 1 other reply

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you doctor
0

Csf suggestive of either viral or tubercular meningo encephalitis.. This patient already had signs of increased icp like headaches vomiting.. Still icp worsened and had respiratory distress likely because of coning.

Thank you doctor
0

Pt has got raised ICT & ? Basal meningitis , possibly TBM

Thank you doctor
0

Cavernous Sinus Thrombosis

Thank you doctor
0

Cases that would interest you