cortical sinus thrombosis

MEDICINE CASE DISCUSSION

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9th August, 2021

CASE SCENARIO

A 35 yr old female banker came to the casualty with complaints of fever since 4 days.

Headache since 2 days. 

Nausea since 1 day. 

Involuntary movements of right upper limb and lower limb since 2 hours. 

HISTORY OF PRESENT ILLNESS 

Patient was apparently alright 4 days ago then she had fever which was low grade, intermittent, relieves with medication, not associated with chills and rigors. 

2 days ago she developed headache which was dull aching. 

Today morning patient had weakness of Right UL and LL for which she took treatment at a local hospital. She left for work. After 1 hour while doing her bank work she suddenly had stiffness of her right upper limb and stiffness of neck and right side.

 Later she developed involuntary movements of right UL and right LL. 

Every episode lasts for 5 minutes. 

No loss of consciousness. No involuntary micturition and defecation. No up rolling of eye ball. 

On presentation to casuality she had 1 episode of involuntary movements of Right UL and LL. 

HISTORY OF PAST ILLNESS:

No h/o diabetes, HTN, trauma, pregnancy, Asthma, TB and epilepsy 

PERSONAL HISTORY 

Appetite- decreased

Sleep- reduced

Bowel and bladder movements- normal and regular 

Addictions- none 

FAMILY HISTORY

Not significant

GENERAL EXAMINATION 

Patient is conscious, coherent, co-operative. 

Pallor+

No icterus, clubbing, lymphadenopathy, edema, pallor, cyanosis, kolionychia

VITALS 

Temperature- Afebrile

Pulse rate- 74 bpm

BP-120/80 mmHg 

SPO2 at room air- 99% at RA

GRBS- 119 mg%

SYSTEMIC EXAMINATION

CVS :

 S1S2 HEARD 

no thrills no murmurs

RS: B/L AE +  

ABDOMEN:

Soft

Non distended

Diffuse tenderness absent 

Guarding and rigidity absent

CNS

                     Right    Left 

Tone    UL  normal  normal 

             LL  normal  normal

Power  UL    3/5          5/5

             LL     5/5         5/5

Reflexes

              B-       +             +

              T-        +             +

              S-        +             + 

              K-        +             +

              A-        +             +

              P-    flexed    flexed

INVESTIGATIONS:

1. EEG

2. Hemogram 

3. LFT

4. RFT

5. RBS

DIAGNOSIS: Cortical sinus thrombosis 

TREATMENT:

Day one:

Inj. LEVIPIL 1gm/IV/BD 

Inj. OPTINEURON 1 amp in 100ml NS/IV/OD

Inj. LORAZEPAM 2cc/IV/SOS

Tab. PCM 650 mg PO/TID

Inj. ZOFER IV/SOS

Inj. MANNITOL 100ml IV/TID

Temp charting 4th hrly

Day Two:

9th August, 2021 at 5:00pm there was an episode of GCTS

Inj. CLEXANE 40 mg x S/C stat given

COURSE IN THE HOSPITAL: 

35 yr old female came to the casuality with c/o involuntary movements of right upper limb and lower limb since 2 hours. Additionally patient had h/o fever, headache and nausea. The patient was treated conservatively. On day two there was an episode of GCTS and Inj. CLEXANE 40 mg x S/C stat given. The patient wished to be shifted to another hospital and was discharged at request.