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5.


PRIMARY SURVEY:

PR:108 BPM

BP:130/90 MM/HG

RR:22CPM

TEMP: 103F.

SPO2:98% AT RA

GRBS:113MG/DL

CHEIF COMPLAINTS:

A 52 year old male Patient has complaints of generalised weaknesss since 1 week.

h/o loss of speech and deviation of mouth since 3 days

HOPI: PATIENT WAS BROUGHT TO CASUALITY WITH COMPLAINTS OF GENERALIZED

WEAKNESS OF BOTH UPPER AND LOWER LIMBS SINCE 1 WEEK, COMPLAINTS OF UNABLE

TO SPEAK SINCE 3 DAYS , COMPLAINTS OF DEVIATION OF MOUTH TO RIGHT SIDE SINCE 3

DAYS , COMPLAINTS OF FEVER SINCE 1 DAY.

NO HISTORY OF SEIZURES,HEADACHE, GIDDINESS,SHORTNESS OF

BREATH,FEVER,RASHES,PAIN ABDOMEN AND BURNING MICTURATION.

SECONDARY SURVEY:

GENERAL:PATIENT IS DROWSY, NON COHERENT , NOT ORIENTED TO TIME, PLACE AND

PERSON

HEAD: ATRAUMATIC, NORMOCEPHALIC ,GCS: E2V2M4[8/15] EYES: ATRAUMATIC, NO DISCHARGE, B/L PUPILS EQUAL REACTING TO LIGHT,RT EYE CATARACT. EARS:ATRAUMATIC, NO DISCHARGE. NOSE:ATRAUMATIC, NO DISCHARGE. NECK:NO NECK SWELLINGS,NO JVP DISTENSION,B/L CAROTIDS FELT, NO STRIDOR CHEST: B/L CHEST RISE EQUAL. HEART: S1S2 HEARD, NO MURMURS. LUNGS: BAE+ No added breath sounds. ABDOMEN: SOFT,NON TENDER,NO DISTENSION,BOWEL SOUNDS PRESENT PAST MEDICAL HISTORY: nil significant PAST SURGICAL HISTORY : no past surgical history NO SIGNIFICANT FAMILY HISTORY NO KNOWN DRUG OR FOOD ALLERGIES NO KNOWN COMORBIDITIES.

Investigation MRI BRAIN PLAIN AND CONTRAST: Multiple ring enhancing lesions in pons mid brain bilateral straito capsular regions,left frontal lobe and right cerebellar hemisphere with extensive edema in the above areas. F/S/O Neurotoxoplasmosis/Neurotuberculosis DD-cryptococcal meningitis CSF ANALSYSIS: CSF CULTURE:zn stain-no acid fast bacilli seen. gram stain:few disintegrated pus cells,occasional gram positive cocci in pairs seen. CSF CYTOLOGY:few lymophocytes and few monocytes are seen.

Diagnosis ? NEUROTOXOPLASMOSIS. ? NEUROTUBERCULOSIS.

Treatment Given(Enter only Generic Name) 1)INJ NEOMOL 1GM IV/TID 2)INJ PANTAPRAZOLE 4OMG IV/STAT 3).INJ.ONDENSETRON 4MG IV/OD 4)OPTINEURON 4AMP IN 500ML NS IV/OD 5)TAB ECOSPORIN 75MG/RT/OD 6)TAB ROSUVASTATIN 40MG/RT/OD

7)INJ CLEXANE 60MG/SC/OD

8)INJ MANNITOL 100 /IV/TID

9)INJ LEVETIRACETAM 500MG /IV/BD

10)INJ THIAMINE 200MG /IV IN 500ML/NS/OD

11)TAB FOLIC ACID 5MG/RT/OD

1)TAB DOLUTGRAVIR 5OMG/OD+TAB LAMIVUDINE 300MG+TENOFOVIR 300MG

2)TAB SULFADIAZINE 1GM/RT/6TH HOURLY

3)TAB PYRIMETHAMINE 50MG/RT/6TH HOURLY

4)TAB LEUCOVORIN 15MG/RT/6TH HOURLY

Advice at Discharge

1)TAB DOLUTEGRAVIR 5OMG/OD+TAB LAMIVUDINE 300MG+TENOFOVIR 300MG OD FOR 1

MONTH

2)TAB SULFADIAZINE 1GM/RT/6TH HOURLY FOR 1 MONTH

3)TAB PYRIMETHAMINE 50MG/RT/6TH HOURLY FOR 1 MONTH

4)TAB LEUCOVORIN 15MG/RT/6TH HOURLY FOR 1 MONTH

5]TAB.PANTAPRAZOLE 40MG RT/OD FOR 1 MONTH

6]TAB. MVT RT/OD

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