a 38 year old Male patient came to psychiatry opd with wife and brother ( informants - reliable and adequate) with complaints of giddiness, headache, tingling sensation and numbness in bilateral limbs with coarse tremors, disturbances in gait ( wide base gait with stamping of the feets) , visual disturbances ( both short and distant vision with blurring) wife reports low mood, decreased interaction and irritability. forementioned complaints present for past 5-6 months. The patient is a also a known alcoholic with consumption from last 5-6 years. Has h/o consumption of both English and country liquor ( desi, hath bhatti) ranging from two and half to three quarters with h/o binge drinking for 6 month. There have short intervals of abstinence with patient having tremors and headache. however the patient has been abstinent for past 4-5 months owing to above mentioned complaints that were gradually progressive. The patient has H/o head trauma 6 months backs falling roadside with H/o severe bleeding, patient was intoxicated then no Loss of consciousness, ENT bleed, seizures. the patient's major complaint is visual and gait disturbances with coarse tremors. with mood disturbances and irritability. provisional diagnosis with Differentials investigations treatment.

(Edited)

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Consider wernickes /korsakoffs and Withdrawal Do a b12 assesment Treat with thiamine.....apart from others

Thank you sir
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Rare disorder but could be one of the possibilities- marchiafava bignami syndrome.

Plz explain sir!
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CT is showing significant ventriculomegaly ... Please get fundoscopy, visual acuity and perimetry... Need to rule out organic causes along with psychiatric evaluation

Need to rule out hydrocephalus... Potentially treatable with CSF diversion
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D.d. Wernicke's vs hepatic. Also peripheral neuropathy. Before lab do a thorough neuro examination. W/f nystagmus. Lft S.electro. cbc with platelets. Other lab investigation can be done later if they come derranged. Mx requires thiamine 100 mg im with mvi. Benzodiazepines. If affordable go for neuroimaging.

Thank you sir
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Ventricular dilatation is commonly found in ch alcoholism. Give him 100 mg thiamine n mvi esp b12. That should suffice. But do keep the differential in mind

This looks like organic cause, sir. I feel there's nothing much to do for Psychiatric management except giving thiamine supplements.
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In alcoholism cerebral atrophy is more common than ventriculomegaly.. In scan there's no brain atrophy.. Sulci and gyri are not well seen suggestive of raised ICP...

True that sir!
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Ct scan showing hydrocephalous Shunt needed

@Dr. Manik Prabhu the sulci and gyri appear effaced

That's what I said sir...
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Chronic subdural hematoma. Get ct brain done

Consensus is do an imaging - CT brain or MRI (To rule out organicity like SDH or Marchiafava)

Have added CT scan brain - images sir Juss now got it done
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