Case of the day

MIDDLE CEREBRAL ARTERY INFARCTION IN TUBERCULOUS VASCULITIS.

14yrs/M boy presented to ED in unconscious and gasping state with H/o High grade fever, Headache,one episode of fits right side of the body and unconsciousness.He has prior H/o Intermittent fever, Episodes of fits and difficulty in speech for last one month. Neurologically he was comatose with decerebrate movements of left upper limb to pain. GCS -E1M2V1,Pupils -B/l Semidilated non reactive to light. Tendon reflexes were brisk bilaterally Plantars B/l Downgoing. CSF analysis were done outside S/o TBM Lymphocytic pleocytosis with increased protein with increased ADA. Chief Complaints Headache,Fever,Fits,Right sided weakness History Headache,Fever Vitals BP -90/60,Pulse - 42,Spo2 -82% Physical Examination GCS -E1M2V1,Pupils -B/l Semidilated non reactive to light. Tendon reflexes were brisk bilaterally Plantars B/l Downgoing. Investigations CSF ANALYSIS -Lymphocytic pleocytosis with increased protein with increased ADA. Management MANAGEMENT PLAN?

4 Likes

LikeAnswersShare

One must rule out the possibility of aneurysmal (? Mycotic) bleed with vasospastic complications

T B encephalitis with fresh infarction. How about status of pulmonary T B or involving other otgans

What ever the treatment it remains grave to gaurded prognosis If proven TB the CT is showing already established infarcts probably secondary to artritis and basal Exudates Ventilation, Dexona, Anti Coagulants, ATT and other supportive medications Over all poor prognosis @Prashant Vedwan

Thank you doctor
0

Keep on ventilator a/c requirements. Iv fluids, antibiotics if indicated, anti-epileptic, LMWH/Aspirin and inotrops a/c to indication. Start Dexona and anti tubercular drug a/c RNTCP guidelines.

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you doctor
0

Thanks Dr.Arif Mirza

TB encephalitis... Management according to WHO Protocols .

Diseases Related to Discussion

Cases that would interest you