70 yr old female came wid c/o severe headache ,abnormal talk ,tingling sensations all over the body n insomnia.no h/o any addiction .ct brain s/o gliosis got better wid serenace , trifluperazine n b12.discontinued all drugs n now again presented wid slurred speech n fissured tongue n abnornal behaviour.kindly suggest the diagnosis for discoloured fissured tongue.



Headache with abnormal behaviour with cyanosis is suggestive of co2 narcosis. Do ABG and X-ray chest. Tongue looks large ... Exclude hypothyroidism by sTSH. Surely do CBC it will further help. Patient is not drowsy so excludes SOL feature.

alright sir

its korsakoffs psycosis with dry berri berri....mostly thiamine ( vit b1 efficiency) all picture is simple and clear. mental confusion is due to Warnock koraffkos psychosis which was cured early due to seranace. glossitis is commen in b1 defficiency. peripheral neuropathy is nothing but dry berri berri. temporary paralysis like slurred speech again due to b1. plz let me know if I'm correct. give her large dose of thiamine . life long.

after 3 months of bcomplex i had ruled dat out as a possibility but would lik to consider it again sir

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1.It could be normal tongue and may be present for long 2 Typical colour of the tongue (Purple ) is seen in Riboflavin (B2) deficiency. 3 Poor oral hygiene is another factor

agreeable sir

No treatment is required for The tongue as it is normal.Treat the other symptoms accordingly

initially i thought the same sir but her slurring got worsen which wasnt explained by her ct scan brain findings

hypovitaminosis ?need investigation & psychiatric advice


Agree with Dr Ravindra Kumar Das.

vit B12 deficiency


although it seems to be hypovitaminosis but doctor Dushyant the general appearance of the patient is putting in some doubt. I request you to kindly get Hcv and whatever will be the result please post here. thanks

hcv is negative sir

i agree with dr yog raj but still get a cat scan done for brain features looks more like in iron and b complex deficiency cases important to know about Socio economic status and dietery schedule

pt comes from a poor socio economic status n has a poor dietary intake

asgandh50gm+brahmi50gm+shatavari 50gm +badam pdr50gm mix all.take 1spoon twice daily with Milk. smriti sagar ras2tab+mahavatvidhvansan ras 2tb twice. mahanarayan tailam massage on scalp

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