Behaviors changes in 67 y/o Female
Chief Complaint A 67 y/o female presents with behavioral changes for 4-5 months. She said now a days mostly she stays quite with less involvement in day to day activities & she getting angry easily and also has mood swings. She also complain of difficulty in concentration on daily work. She is thin build and looks fine. History She was fine untill these complaints. No family history of any psychotic disease. vitals Vitals are wnl Investigations LDL-cholesterol - raised. vit B12 level - low Rest of the investigations are normal. MRI Brain shows hyperintensities in white matter Treatment What else do you suggest? and management options?
White matter hyperintensities are also referred to as Leukoaraiosis and are often found in CT or MRI’s of older patient, These intensities are a marker of small-vessel vascular disease, are indicative of cognitive and emotional dysfunction. Some potential neuropathological associations are: Demyelination and axonal loss Reduced glial density and atrophy Cortical thinning and cerebral atrophy Endothelial and immune activation Ischaemic damage Hypoxia and hypoperfusion Adv Carotid Doppler to look for atherosclerosis and plaque 2 D Echo to look for functioning of heart
* GERIATRIC SYNDROME ** SENILE DEGENERATION SECONDARY TO POST MENOPAUSAL SYNDROME AND ITD COMPLICATIONS. Tab ECOSPINE ALZIL 5MG OD FOR ATLEAST 6 . MONTH Tab encephalabol od for 6 month Reassurance and counciling required. Multivitamin and antioxidant orally.
W M. H s... ARE. FOUND. COMMONLY.,..ALBEIT. MILD ,. . ...IN. MIDDLE. ADULT. LIFE.. AND ... BOTH. PERIVENTRICULAR. AND DEEP. W. M. H s....ARE. OBSERVED. MORE. IN. FEMALES....AFTER. 60. YRS. OF. AGE. GROUP... THESE. ARE. GENERALLY... ASSOCIATED. WITH.. 1 .... .. PHYSICAL. DISABILITY THROUGH. REDUCED. SPEED...AND 2 .......SLOWED. INFORMATION. PROCESSING. SPEED... 3. ... MAYBE. ASSOCIATED. WITH ISCHEMIA.. 4. RISK. FACTORS..... ... HYPERTENSION ...DIABETES.. .. GENERALLY..... NOT. ASSOCIATED. WITH. OTHER. COGNITIVE. FUNCTIONS..... ...
Hyperintensities in white matter indicate demyelination and axonal loss.- which can result in cognitive symptoms. Ischaemia is one cause Treatment 1.Tab Ecosprin - AV75 / 10 O.D 2.Tab Alzil - M - ( memantine 5 mg + donezepil 5 mg ) O.D for at least 6 months will help 3.Multivitamins with Zinc
? GERIATRIC SYNDROME.. ? POST MENOPAUSAL SYNDROME.. WITH ASSOCIATED COMPLICATIONS. ? BRAIN ATROPHY..AND RELATED.. COMPLICATIONS..
Diffuse small vessel ischemia of brain . MRA can be suggested Involutional ( age related) psychosis, needs psychiatric evaluation. Can be onset of vascular dementia for Alzheimers
Must be evaluated by neurologist D/d Metabolic condition like vit b12 def, hypothyroidism, hyponatremia Degenerative disease like, AD, PSP, CBS, FTD Para neoplastic condition can also have these symptoms and mri finding Autoimmune conditions
autism 1) SHIRODHARA WITH BHRAMI OIL WHOLE BODY BALAASHWAGANDHA OIL MASSAGE 3)TAIL BASTI U CAN DECIDE ACCORDING TO THE SITUATION 4)ORALLY JATAMANSI+BHRAMI PREPARE SWEET KASHYAM AS YOUR Pt IS A CHILD U MAY HAVE TO CONTINUE THE TREATMENT FOR LONG TIME ACCORDING TO ME U CAN THINK OF AAKASH+ VAYU MAHABHUTA VRUDDHI AND THE LINE OF TREATMENT SHOULD BE TO INCREASE PRUTHVI + AAP MAHABHUTA
In this age groups we should throughly evaluate Reg Parkinson,Alzheimer's and any psychiatric illness will have such symptoms He needs Tab.ecosprin75 mg daily one And mood stabilizer s Vit d sachets weekly once for 8 weeks Tab.rosave 10 mg daily one night For 1 month
Most likely depression, so needs psychiatic consultation with Vitamin B12 and Rosuvastatine according to lipid profile.
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