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[ami.t]

Hallo,

Meine Schwester in Indien hat sich vor kurzem merkwürdige erkrankt. Die Krankheit haben die Ärzte noch nicht feststellen (diagnosieren) können. Ich würde sehr dankbar, wenn mir jemand dabei helfen könnte. Im Folgenden ist die Kurzfassung dieses Falles:

Patient Name- Prachi Jain, 23 Yrs. Female

History- C/O: Ammenorrohea-4 Month

Pain Left Lower limb& foot- 15 days- Burning pain with pins & needle sensation in lower leg & sole (esp. along the lateral border of left foot) and numbness in Right thumb & index finger, Left thumb & little finger.

Diplopia & Blurring of Vision- 3 days-Sudden onset (15/8/04)

No History of altered sensorium, vomiting, headache, seizure, Ataxia, Fever, weakness, rashes
No Past History of Diabetes, Migraine, Hypertension, Seizure
Admitted in Saroj Hospital & Heart Institute on 18/8/04, Discharge on 22/8/04
Again admitted on 23/8/04 for MTP, discharge on 24/8/04

Family history - Not Significant

Examination- Vital Stable, BP- Normal, Conscious, Oriented

Right 3 rd N. Palsy(eye outward & upward) with Papillary involvement (Dilated & Fixed), Minimal Ptosis

Other cranial N. - Normal

Tone- Normal, Power- Normal in all limbs

DTR- Brisk Bilaterally (Knee & Ankle) Planter- Extensor B/L

No Cerebellar sign

Hyperasthesia along the lateral border of left foot

R/S, CVS, P/A- NAD

Fundus- Normal

Investigations- Counts- N, ESR- 56, LFT- N., RFT-N

18/8/04- MRI Brain Contrast- Normal Study

20/8/04- MRI Whole Spine- Normal Study

20/8/04- MRI Venogram- Normal Study

18/8/04-V.E. P. - B/L delayed

21/8/04-CSF Oligoclonal Band- Negative

21/8/04- CSF R/M- NAD, Protein-40 mg%

21/8/04-CSF PCR TB - Negative
21/8/04- CSF India ink preparation- Negative

15/9/04 Nerve conduction velocity of lower limbs- Normal study

15/9/04 Serum Lactate level- 18mg% ( 3-12 mg%)

Vasculitis Profile-21/8/04-

ANA- Negative

Anti Phospholipid antibody, IgM- Negative

Anti- ds DNA antibody (double strand)- Negative

ANCA-MPO/C-ANCA (ELISHA)- Negative

Anti Cardiolipin antibody, IgM- Negative

Thyroid Profile - Normal

Orthopedic Opinion- Normal



Treatment- Methyl predinisolone 1 gms IV OD for 5 days

·On wysolone (Predenisolone) 20 mg BD

· Oxytol (Oxcarbemazepine) 150 mg BD- now increase to 300 mg BD

· Pantodac (Omeprazole) OD

·Cap Ubi Q 100mg OD

·Rivotril 0.25mg ½ HS

Progress- No Deterioration

Pain in foot now decrease, Vision improve

Diplopia subside then again reappear, squint persist (outward & upward), Pupil dilated & fixed

Numbness in fingers & thumb decrease

Diagnosis- Initially was Demylinating disorder- Ruled out

Then the possibility of Vasculitis- still is a possibility

Thrombo-embolism- Ruled out

Mononeuritis multiplexa & Mitocondrial Cytopathy now is a possibility


vielen Dank im voraus.

Mit freundlichen Grüssen

Amit Goyal