Concluded Case

Septic Embolism infarts and abscess with Meningitis

Acute onset of rt hemiparesis with left sided UMN facial weakness and with alteration in sensorium , developed in a 67 yr old female,on 14th March with bilateral knee replacement on 13th march at neighbouring state. Chief Complaints She had undergone bilateral knee replacement on 13th March in a private hospital in the neighbouring state.On 14th March she developed rt sided weakness .After 2-4 hrs left facial weakness with alteration in sensorium and difficulty to communicate.MRI was done and then transfered to our hospital.Denied having any fever, and the ref letter also noted afebrile.After surgery she she was well till the next day 12 noon.. History Known diabetic and hypertensive, both under control. Known case of osteoarthritis both knees. Vitals Temporal.8 f,BP 250/ 80 mmhg,HR 70/ mt Physical Examination Unresponsive to calls. GCS E3V2M3.Optic fundi- normal. Deep painful stimulation moving the left side. DTRS elicitable , plantars bilaterally extensor . Investigations WBC 20,200/ cumm,poly 90 % Hb 9.3 / dl.ESR 115/ hr,CRP 87.Electrolyltes ,blood biochemistry, LFT,RFT were Normal .Screening for infectious virology were normal.RtPCR for Covid - ve.MRI brain - report for discussion.Blood culture - ve for organism. Anerobic bliid culture no growth after 5 days Diagnosis Alteration in sensorium with bilateral pyramidal signs on the 2nd pidt op day.Final diagnosis is very clear in the MRI brain ( for discussion ). Management Started on appropriate drugs as per the MRI findings.well stabilised, pt is improving.

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Thanks Curofy and others for the answeres. * Sub acute infarction with hemorrhagic transformation in the left frontotrmoporal and Rt parieto occipital region with associated adjacent subcortical and deep white matter edema and mass effect in the form of effacement of left sylvian fissure.Another tiny area of T2/ FLAIR hyperintensity & diffusion restriction in the left pisyetomedial temporal lobe. **Conglomerate peripherally enhancing lesion with saggy wall and surrounding moderate edemain the rt frontalparasagittal cortex .Few ting foci of enhancement seen in the Rt cerebellum. Smooth bilateral convexial Leptomeningeal enhancement. Imp: Septic embolic infarctions and brain abscess with meningitis . Started antibiotics,ceftriaxone,vancomycin ,Metronidazole with steroid with nannitiol

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Thanks Curofy and others for the answeres. * Sub acute infarction with hemorrhagic transformation in the left frontotrmoporal and Rt parieto occipital region with associated adjacent subcortical and deep white matter edema and mass effect in the form of effacement of left sylvian fissure.Another tiny area of T2/ FLAIR hyperintensity & diffusion restriction in the left pisyetomedial temporal lobe. **Conglomerate peripherally enhancing lesion with saggy wall and surrounding moderate edemain the rt frontalparasagittal cortex .Few ting foci of enhancement seen in the Rt cerebellum. Smooth bilateral convexial Leptomeningeal enhancement. Imp: Septic embolic infarctions and brain abscess with meningitis . Started antibiotics,ceftriaxone,vancomycin ,Metronidazole with steroid with nannitiol

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