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Case Presentation: Sunday, 29 May
Case Presentation: Sunday, 29 May
Dr.Ghaffari
Dr.Ghanbari
Sunday,29 May
Dr.Chraghi
1
CASE NUMBER:1
ID
2
CC & PI
CC
Headache+Weakness of Limbs
Pl
A 37 years-old woman with thunderclap headache from two
days before the visit and hemiparesis of the left limbs and
hemifacial paresis of the right and numbness of the left half of
the face one day after headache
3
No blurred vision
Diplopia
Seizures
Swallowing disorder
Speech disorder
Oral and genital aphtuos
Fever and chills
Recent vaccination
Lermit sign
Weight lost
Vasculitis symptoms
Histor y of similar attacks
Hormonal medication
4
PMH, DH & HH
PMH
Hypothyroididism
PID
Gilbert
DH
Levotyroxin50 daily
HH
Negative
5
PHYSICAL EXAM & CRANIAL NERVES
Physical Exam
The patient is awake and alert orient to the place, time and
person.
Vital Sign: Normal
Neck stifness :Negative
Pupils:mid-sized and reactive to light
Marcusgan, ptosis, nystagmus, gaze, anhydrosis: Negative
Carnial nerves:
3,4,6:nl
5:left sensory impaired
7:right hemifacial paresis
9,10,11:nl
6
REFLEXES
Reflexis:
DTR:3+
Babinski:up
Hof fman:neg
Clonus:neg
Sensory level:nl
Propriocepion;nl
7
SYNDROME DIAGNOSTIS
Syndrome diagnosis
Acute flaccid left hemiparesis plus
Thunderclap headache
8
WHITE MATTER LESION DIFFRENTIAL DIAGNOSIS,
NUTRRITIONAL AND METABOLIC & INFECTIOUS
9
THUNDERCLAP HEADACHE DDX
10
THINGS DONE FOR THE PATIENT
Labtest:
Cbc,bs,vasculopathy,hypercouagulopathy,MOG ab, NMO ab
Csf analysis ocb, lGg Index
Cxr
Brain an cervical MRI + -gad
Consulting:
1-Infectious
2-Gynecology
3-Neurointervention
11