case 1

I've been given this case to solve in an attempt to understand the topic of " Patient clinical data analysis " to develop my competency in reading and comprehending clinical data including history , clinical findings , investigations and come up with a diagnosis and a treatment plan .


Following is my analysis of this patients's problem:

The problems in order of priority I found are 
 
1) Frequent falls to left 

2)Swelling of face and abdomen 

3) sleep disturbances

4) Migraine with aura

5) Oligouria 

6) Fatigue

7)Rashes

Frequent falls to left  
- The patient complains of frequent falls to left . Left foot starts giving out and left hand also.
-Left hand began going numb and left face felt like someone was pouring ice water over my cheek. Awoke one night to feeling like I was falling and spinning
unbearable feeling of spinning when I turned left.
-loss of function of left side intermittently dropping things and severe cramping only in left arm.
Reason
-AMPD1 deficiency 
-Hemiplegic migrane
-Brain infection,tumors
Investigations
lab investigation: CBP , Neurological examinations , immune related diseases

Swelling of face and abdomen
- Diagoned with G6PD Deficiency 
- Swelling of face maybe due to renal failure 
-Increased salt intake
Investigations 
CBP , G6PD Enzyme levels , urine analysis ,PBS

Sleep disturbances
- G6PD Deficiency causes impairment in serotonin levels 
Investigations 
EEG , Sleep habits , physical study , any stress 
Treatment
L-serine

Migrane with aura
- Had headache since 2yrs , increased at the time of menarche at age 14yrs , very severe at age 15yrs. Age 34 increased with aura
-Aura (intensified to the point of not just colors obscuring vision, but full getting out of vision. This happened on and off. About a month later after my first spinning event- had the worst headache ever and lost vision- began stuttering. Lost vision duration can’t remember, less than 2 hours- that’s how long I get my vision loss from migraine with aura but that’s colorful and sparkly.
Investigations
Head CT , MRI , Ophthalmology examination.
Treatment
Triptans , Anti emetics , Dihydroergotiamines

Oligouria
G6PD Deficiency - Oxidative stress causing kidney damage 
Investigations
CUE , USG

Fatigue
G6PD Deficiency - Decreased production of ATP .
Aggravated on stress and exertion 
Treatment
Ribose

DIAGNOSED - BEHCETS SYNDROME


Treatment options 
L-serine 
Ribose
Vitamin B complex 
Antioxidant vitamins 
Cimetidine 
Iron folate supplements



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