By: Dr. Aqeela Rasheed PGR Medical Unit-IV

Patient Profile Patient XYZ Age/sex 23 years/female D.O.A M.O.A. Emergency

Presenting Complaint

History Of Present Illness Normal delivery ( ♂ ) - 8 days back at local hospital in Okara Baby - healthy & delivery - uneventful Discharged on the same day

History (contd…)

Systemic Inquiry H/o Rt. ear discharge - 1 year No other significant history Past History Not significant Allergic History No known drug allergies

Family History No significant family history Treatment History Not significant Socioeconomic History Poor socioeconomic status

Personal History House wife Normal sleep and bowel habits Non-smoker, non addict Gynecological History Married for 3 years P2 A0 Both children are alive and healthy

EXAMINATION

General Physical Examination A woman of average physique lying in bed, unconscious, with an I.V. line secured, NGT & Foley`s are in situ: BP: 130/70 mmHg Pulse: 105/min Temperature: 100°F R/R: 18/min

CNS Examination

RightLeft BulkNN Tone U/L L/L NNNN Power U/L L/L Could not be assessed Reflexes Ankle Knee Supinator Triceps Biceps PlantarsDown goingNon specific CNS Examination

Ear Examination

Differential Diagnosis Meningo-encephalitis Brain abscess Cerebral malaria Cerebral venous thrombosis SAH Ecclampsia Puerperal sepsis

INVESTIGATIONS

Investigations InvestigationPatients Value Hemoglobin11.5 g/dl TLC28,ooo/cmm Platelets352,000/cmm LFTsNormal Urea34 mg/dl Creatinineo.6 mg/dl

InvestigationPatients Value Na137 mg/dl K3.8 mg/dl ESR20 ANA-ve Pt13 aPTT33 Investigations

USG Abdomen Pelvis Normal scan CXR Normal

CT Scan Brain (Plain)

Magnetic Resonance Venography

C T Scan Mastoid Rt. Lt.

Final Diagnosis

Management

Course Of Disease DayFeverFitsGCSPapilledemaWeaknessTLC Lt. ArmLt.Leg 1100°FFreq.5/15Present__28, °FFreq.5/15Present__23,300 3Afebrile_15/15Present2/54/510,000 4Afebrile_15/15Absent2/54/57,700 5Afebrile_15/15Absent3/54/56,700 6Afebrile_15/15Absent3/55/55,300

62% 17 % 18% 41-45% 12% 11% Venous Sinus Thrombosis on MRV

Epidemiology Female to male ratio 3:1 Common in neonates and children Overall incidence <1/100,000 annually

Pathogenesis Cerebral parenchymal lesions or dysfunction Decreased CSF absorption and raised intra cranial pressure

Etiology Prothrombotic conditions, genetic or acquired Oral contraceptives Pregnancy and the puerperium Head and Neck Infection Malignancy Head injury & mechanical precipitants

Clinical Features Isolated intracranial hypertension syndrome Focal syndrome Encephalopathy

Dense Triangle Sign

Cord Sign

Empty Delta Sign

Venous Hemorrhage

Take Home Message Uncommon but serious neurologic disorder. Imaging plays a primary role in diagnosis. Potentially reversible.

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