Wednesday, May 30, 2007

Astrocytoma, hemiparesis and facial palsy

A girl of 6 yrs presented with hemiperesis of 1 month standing. On clinical evaluation She also had facial palsy of upper motor neurone type.
She had no fever, no cardiac problems, no hematologial abnormality.
Provisionally we diagnosed the case as Acute stroke syndrome.
Her routine examinations reveal no abnormality. But CT scan shows Astrocytoma of the the brain stem.


Monday, May 28, 2007

ASD with Mitral incompetence with heart failure

A boy of 7 years presented with dyspnoea, precordial bulging, hepatomegaly and leg oedema. Clinically he had pansystolic murmer over the left lower sternal border with loud second sound. Provisionally it was thought to be a case of VSD with heart failure.Xay showed cardiomegaly with pulmonary oedema. In ECG, there was right ventricular hypertrophy and right atrial hypertropy. In hospital, the patient had ungone a critical phase developing shock. When the shock was overcome, in Echo, the cardiologist commented ASD(secundum) with mild mitral incompetence and pulmonary hypertension.
But if we clinically corralate the case, it is better conform with ASD(primum) with Mitral incompetence with heart failure.

Saturday, May 26, 2007

Acute pancreatitis with persistent vomiting and hypocalcemia

A boy of 10 years presented with fever and abdominal pain for 15 days. Then he developed vomiting which was persistent in nature. On evaluating the patient, ultrasonography showed uniformly echogenic swollen pancreas suggestive of Panacreatitis. The patient serum amylase was found normal but urine amylase was highly elevated. The patient also had neutrophilic leucocytosis. At one stage, pt developed muscle spasm of the hands and neck. Serum calcium was found decreased.
The patient was a case of Acute Pancreatitis with persistent vomiting with hypocalcimia.
The patient was treated conservatively with nothing by mouth, infusion, parenteral antibiotic and calcium. The patient was improved and discharged .

Friday, May 25, 2007

Nonconvulsive status epilepticus

A boy of 6 years otherwise healthy developed sudden unconsciousness. He had a distant history of convulsive disorder at his earlier years for which he had taken anticonvulsant for one and half years. Than he discontinued the medicine for 3 years. Malaria, meningitis, metabolic derangement and intoxication were excluded.
The patient was levelled as 'Non convulsive Status Epilepticus'.


Thursday, May 24, 2007

Malaria with severe anaemia with haemoglobinuria

A boy of one and half years presented with fever of 5 days becoming pale rapidly and passing red colored urine coming from an endemic area.
The patient was found to be a case of Severe Malaria where anaemia developed due to rapid haemolysis of RBC and the urine become red due to presence of excess haemoglobin.
The patient was treated with Inj Quinine and responded well within days and then discharged.


Wednesday, May 23, 2007

Thalassemia with jaundice

At this momont, we have two patients of thalassemia with jaundice. Both are male, age 7 yrs, both are from poor socioeconomic class and both are thalassemia intermedia.
The first case has taken blood transfusion 1 year back, the second case was on hydroxyurea.
Both are HBsAg negative.
The first one develops jaundice due to acute hepatitis-nonB virus.In second the jaundice is induced by the hepatoxicity of the hydroxyurea.