Scribd Logo
Upload

Welcome to Scribd!

  • 65 views

    Y2020 PBL Case Neurology System 150622

    Uploaded by

    Trâm SV. Lê Thị Mỹ
    - A 32-year-old female kindergarten teacher presented with a 2-week history of continuous holocranial headache of increasing severity, as well as recent heavy menstrual bleeding and anemia. - On examination, she was found to have papilledema but no other neurological deficits. Blood tests showed iron deficiency anemia. - A lumbar puncture revealed clear CSF with elevated white blood cells and slightly elevated protein. Brain MRI was ordered to investigate further.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Y2020 PBL Case Neurology System 150622

    Uploaded by

    Trâm SV. Lê Thị Mỹ
    65 views15 pages
    - A 32-year-old female kindergarten teacher presented with a 2-week history of continuous holocranial headache of increasing severity, as well as recent heavy menstrual bleeding and anemia. - On examination, she was found to have papilledema but no other neurological deficits. Blood tests showed iron deficiency anemia. - A lumbar puncture revealed clear CSF with elevated white blood cells and slightly elevated protein. Brain MRI was ordered to investigate further.

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    - A 32-year-old female kindergarten teacher presented with a 2-week history of continuous holocranial headache of increasing severity, as well as recent heavy menstrual bleeding and anemia. - On examination, she was found to have papilledema but no other neurological deficits. Blood tests showed iron deficiency anemia. - A lumbar puncture revealed clear CSF with elevated white blood cells and slightly elevated protein. Brain MRI was ordered to investigate further.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    65 views15 pages

    Y2020 PBL Case Neurology System 150622

    Uploaded by

    Trâm SV. Lê Thị Mỹ
    - A 32-year-old female kindergarten teacher presented with a 2-week history of continuous holocranial headache of increasing severity, as well as recent heavy menstrual bleeding and anemia. - On examination, she was found to have papilledema but no other neurological deficits. Blood tests showed iron deficiency anemia. - A lumbar puncture revealed clear CSF with elevated white blood cells and slightly elevated protein. Brain MRI was ordered to investigate further.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 15

    PBL Y2020

    Administration

    • Patient’s full name: Tran T. Bich L., female, 32-year-old


    • Address: Chau Doc – An Giang province
    • Occupation: kindergarten teacher (at a local school)
    • Reason of admission: headache
    History of present illness
    • Two weeks history of a continuous headache.
    History of present illness
    • Holocranial headache was the sole complaint for the past 2 weeks.
    • The patient presented with a gradual onset of headache, from VAS score of 2/10 to
    VAS score of round 6-8/10 at admission.
    • She had sporadic menorrhagia with recent heavy menstrual bleeding during her
    last cycle (3 weeks ago) 
    • The patient’s hematology tests were consistent with iron deficiency anemia. She
    was subsequently transfused with 3 units of packed red blood cells and discharged
    after 2 days when hemoglobin returned to 11.2g/dL.
    • However, she returned to the hospital one day later due to a worsening headache
    and vomiting.
    • In the course of the disease, the patient had no fever, no aura, no blurring vision,
    no convulsion.
    Past history

    Individual:
    ???

    Family:
    ???
    Past history

    Individual:
    • There are no history of cardiovascular disease, coagulopathy, no prior
    history of migraines, chronic/recurrent headaches or recent head trauma.
    • Daily using oral contraceptives.

    Family: no disease-related records


    Clinical examination???
    Clinical examination

    • Her vital signs showed a temperature of 37.0°C, blood pressure of 130/80 


    mmHg, pulse 85 bpm and oxygen saturation of 97% on air.
    • She was conscious and oriented.
    • Her neck was soft. Neurologic examination presented intact reflexes,
    motor and sensory functions, no evidence of cranial nerve involvement but
    the ophthalmoscopy found papilledema.
    • On full examination no other external signs of disease.
    Solutions

    • Diagnostic hypothesis ?
    • Differential Diagnosis ?
    • Investigations ?
    Investigations

    • Blood counting
    • Na+, K+, Cl- , AST, ALT, uremia, Creatinemia
    • ECG, Chest X-ray, abdominal echography
    • Fundoscopy
    • Brain CT-scan/MRI
    • (Cerebrospinal fluid microscopy ???)
    Relevant blood test results
    • Glycemia 105 mg/dL
    • WBC 6,73 K/uL, N 78,0%, Lympho 7,1%, Mono 8,2%, Eos 0,6%
    Hgb 11,9 g/dL, Hct 35,7%, MCV 83,7fL, MCH 28pg, MCHC 33,9 g/dL.
    PLT 220 K/uL
    • Na+ 128 mmol/l, K+ 3,22 mmol/l
    • Creatinemia 55 µmol/l, Uremia 4,8 mmol/L
    • AST/ALT 22/23 UI/L
    CSF results

    • CSF appearance clear


    • CFS microscopy: WCC: 78/mm3 (N 16%; M 84%, E 0%)
    • CFS protein 5,1 g/L; CFS glucose 3,8 mmol/L (glycemia 6,7);
    Lactate 2,9 mmol/L
    • CFS culture: no bacterial growth
    • India ink stain: no detect
    • Acid-fast bacillus stain: negative
    Diagnosis?

    You might also like