Skip to main content

40 Year Old Lady with History of Past Head Injury Presenting With Recent Voice Change

Disclaimer:-

This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here August 2017 after collecting informed patient consent (form downloadable Click Here)

 A 40-year-old lady presented with the history of significant head injury 5 years back where she was comatose  for 12 days and regained consciousness with left sided weakness from which she recovered and started doing normal household work. From last 2 months attendants started noticing that her voice was changing, slurring gradualy and they also told that she was coughing each time she tried to drink water or milk. She was feeling a sense of imbalance. 

On examination, respiratory rate was 27 per minute, regular, no pallor, cyanosis, clubbing. Her higher mental function was normal . She has had dysarthria? scanning speech, and swaying to right side, however it is not clear if it was due to her weakness. All cranial nerves normal except 10 and 11 (palatal palsy) with absent Gag reflex and Uvula was central in position.

Her muscle tone is normal with no atrophy, power grade 4 in all muscle groups in right upper limb and lower limb (?residual). Sensory system is normal. Coordination ?? impaired on right side (cannot be commented due to weakness). All superficial reflexes intact but all deep reflexes are exaggerated bilaterally. On respiratory examination, she has right sided chest crackles. Her CVS examination is apparently normal. 

Videos are attached below:


Comments

Popular posts from this blog

Consent Forms

Hindi BMJ Consent form   Bengali BMJ Consent form English BMJ Consent form   Telegu BMJ Consent Form Telegu BMJ Consent Form   UDHC Consent Form                

57 Year Old female with goiter and thyrotoxicosis

This 57 year olf lafy presented with neck swelling, anxiety and tremor. Her medical information is attached below: We need to take a decision on this lady. To operate or not to operate. Now that our clinical suspicions of thyroticosis have been proved and malignancy not proved (not disproved either) what would be the next best step? Medical management for her thyrotoxicosis or still get an excision biopsy with sub total thyroidectomy (and subtotal thyroidectomy other than disproving malignancy will also become treatment for her hyperthyroidism). So which one should we prefer (if the family has no reservations from their side)?

60 year old woman with hypothyroidism and SIADH

This patient is a 60 year old woman with recent vomiting, coma (sodium 107) and clinical features of dull apathy, skin coarsening, bradycardia, areflexia strongly suggesting hypothyroidism. Serum osmolality and urine sodium are suggesting SIADH. Thyroid profile: Our patient's current dose of sodium is 10ml per hour and she is having mild hypotension at times and in her blood sugar recordings hypoglycemia (attached below) was noted. In brain imaging, empty Sella is noted (attached below).  Most of the data we have till now is suggesting hypopituitarism Online Discussion: