2. By: Dr. Aqeela Rasheed PGR Medical Unit-IV

3. Patient Profile Patient XYZ Age/sex 23 years/female D.O.A 5.10.2012 M.O.A. Emergency

4. Presenting Complaint

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

6. History (contd…)

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

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

10. 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

11. EXAMINATION

12. 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

13. CNS Examination

14. 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

15. Ear Examination

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

18. INVESTIGATIONS

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

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

21. USG Abdomen Pelvis Normal scan CXR Normal

22. CT Scan Brain (Plain)

25. Magnetic Resonance Venography

26. C T Scan Mastoid Rt. Lt.

27. Final Diagnosis

28. Management

31. Course Of Disease DayFeverFitsGCSPapilledemaWeaknessTLC Lt. ArmLt.Leg 1100°FFreq.5/15Present__28,000 299°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

34. 62% 17 % 18% 41-45% 12% 11% Venous Sinus Thrombosis on MRV

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

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

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

38. Clinical Features Isolated intracranial hypertension syndrome Focal syndrome Encephalopathy

39. Dense Triangle Sign

40. Cord Sign

41. Empty Delta Sign

42. Venous Hemorrhage

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

44. THANKSTHANKS