A 14 year old male child , was brought to the emergency department with chief complaint of fever with headache for the past 4 days, high grade continuous fever, relieved on taking medication, gets back fever on stopping medication, no diurnal variation, associated with headache, no blurring of vision, no complaints of vomiting, no neck stiffness, no signs of meningeal irritation, h/o seizure present, 1 episode, generalised..,generalised lymphadenopathy present, b/l cervical and b/l inguinal, left foot drop, right has involuntary movements, known smoker and betel nut chewer.,cvs normal, p/a normal, cns sensory system intact, motor left ankle 2/5 , plantar b/l flexor, pupils normal..need help in approaching this case..

A 14 year old male child , was brought to the emergency department with chief complaint of fever with headache for the past 4 days, high grade continuous fever, relieved on taking medication, gets back fever on stopping medication, no diurnal variation, associated with headache, no blurring of vision, no complaints of vomiting, no neck stiffness, no signs of meningeal irritation, h/o seizure present, 1 episode, generalised..,generalised lymphadenopathy present, b/l cervical and b/l inguinal, left foot drop, right has involuntary movements, known smoker and betel nut chewer.,cvs normal, p/a normal, cns sensory system intact, motor left ankle 2/5 , plantar b/l flexor, pupils normal..need help in approaching this case..

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Ask for any iv drug abuse history As at 14 years of age if he is smoker, high likely hood for other drug addiction also. Various I v drug or even some time can have lymphadenopathy, fever and withdrawal seizure 2nd possibly of infection Tubercular, lymphadenopathy, TBM can have arachnoiditis and tuberculoma presented with seizure, fever, foot drop 3rd Infectious mononucleosis, all synonyms can be explained 4th leukemia, lymphoma and other malignancy Get detail history related with addiction, type of addiction, route of administration, with his friends if possible. Other constitution symptoms like wt loss, history related with sexual abuse Even on of d/d can be HIV related condition can explain all his synonyms..

He has cannabis addiction,hiv ruled out sir,thank you for the valuable opinion..
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D/d- meningitis /Dengue fever /viral fever/ sepsis /Ricketssial /Brucellosis/Infectious mononucleosis/,CNS malignancy. Management- send baseline labs( Haemogram, crp , blood culture , serum electrolyte , sgpt , ionic calcium, lactates , CSF , BSL). Start anticonvulsant & supportive measures. Monitoring - consciousness level ,pupil , reflexes, urine output , BP & vitals. On the basis initial labs start antibiotics. Neurologist opinion sos EEG & MRI brain. Look for foci of infection & treat the cause.

Generalised lymphadenopathy and dengue maam?
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First R/O Infectious Disease like Dengue,Rickettsial,//ALL,, 1Episode of Seizure,Rt.involuntary movement,Left foot drop—-> Ped.neurologist opinion,/??MRI Brain

Tq.dr.pooja.L.
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You will have to explain all findings with one clinical diagnosis.So first possibility should be TBM.Get CSF done alongwith MRI brain.Get all routine and related tests to rule out TBM.Meanwhile start with broad-spectrum antibiotic cover and neuroprotectives and symptomatic treatment.

Csf acellular, ADA negative sir..
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It looks like Meningism.as there is lymhphadenopathy .Seizures & neurodeficit strong possibility of tuberculous etiology is there .pl go for X RAY CHEST .usg abdomen and pelvis. Usg of lympnodes Pl get the opinion of Neurologist Csf study &,MRI brain should clear the picture

Csf analysis came normal sir...
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It could be, viral encephalitis.. But unilater CNS involvement mostly s/o focal lesion in brain.. MRI is very useful. Start higher antibiotic and acyclovir. Continuous monitor vitals and sign for meningitis. Rule out TBM. ?? Neurocysticercosis or Tuberculoma?

Csf analysis is normal sir
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NEED'S.. ROUTINE INVESTIGATIONS.. NERVE SYSTEMS. STUDY.. MRI STUDY.. NEUROLOGISTS OPINION..

Sir wanted approach clinically ...
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May be dengue fever with neurological complication since pt is 14 yrs , also rule out vasculitis and mass lesion in spine ,do MRI spine ,ANA ,ESR ,lymph node biopsy

Infectious mononucleosis TB are DDS

P U O WITH HISTORY' OF SEIZURES POSSIBLE C N S INVOLVEMENT M R I BRAINE NEUROLOGICAL CONSULTATATION

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