TUBERCULOMA
-
Upload
ranjit-panicker -
Category
Documents
-
view
172 -
download
4
Transcript of TUBERCULOMA
CASE OF FOCAL CASE OF FOCAL SEIZURESSEIZURES
PRESENTED BY: MAJ ARVIND KUMARPRESENTED BY: MAJ ARVIND KUMAR
DISCUSSED BY: WG CDR K S DISCUSSED BY: WG CDR K S MULTANI MULTANI
Case detailsCase details
11 yr old male child11 yr old male child Product of non consanguinous Product of non consanguinous
marriagemarriage Informant- fatherInformant- father Resident of BHIWANI(HARYANA)Resident of BHIWANI(HARYANA) Reliability -goodReliability -good
Presenting complaintsPresenting complaints
One episode of loss of consciousness One episode of loss of consciousness with generalized seizures - 24 hrs with generalized seizures - 24 hrs beforebefore
Weakness of left upper limb x 24 hrsWeakness of left upper limb x 24 hrs Headache ×24 hrsHeadache ×24 hrs
HISTORY OF PRESENT HISTORY OF PRESENT ILLNESSILLNESS
Apparently well child till one day backApparently well child till one day back while playing carrom ,he developed while playing carrom ,he developed
pain and numbness in left upper limb. pain and numbness in left upper limb. Soon he developed generalized Soon he developed generalized
seizuresseizures Associated with loss of consciousnessAssociated with loss of consciousness Deviation of angle of mouth Deviation of angle of mouth Up rolling of eye ballsUp rolling of eye balls Lasted for 03 minutesLasted for 03 minutes
HOPI contd…HOPI contd… H/O WEAKNESS UPPER LEFT LIMBH/O WEAKNESS UPPER LEFT LIMB
Acute onset,involving elbow ,wrist and finger gripsAcute onset,involving elbow ,wrist and finger grips NonProgressive NonProgressive
HEADACHEHEADACHE B/L FRONTAL REGIONB/L FRONTAL REGION MILD MILD CONTINOUSCONTINOUS
NEGATIVE HISTORYNEGATIVE HISTORY
No H/o ofNo H/o of NO BOWL/BLADDER INCOTINENCENO BOWL/BLADDER INCOTINENCE NO POOLING OF NO POOLING OF
SALIVA,DYSPHAGIA,NASAL SALIVA,DYSPHAGIA,NASAL REGURGITATIONREGURGITATION
FLUSHING/SWEATING/GIDDINESSFLUSHING/SWEATING/GIDDINESS FEVERFEVER COUGHCOUGH CHEST PAIN OR PALPITATIONCHEST PAIN OR PALPITATION VOMITING/DIARRHEAVOMITING/DIARRHEA
PAST HISTORYPAST HISTORY
No past h/o seizuresNo past h/o seizures No other significant historyNo other significant history
FAMILY HISTORYFAMILY HISTORY
Nonconsaguinous Nonconsaguinous marriagemarriage
No h/o No h/o seizures,neurologiseizures,neurological disorderscal disorders
Mother has Mother has completed ATT completed ATT course 07 yrs back course 07 yrs back for pulmonary T B .for pulmonary T B .
13yrs 13yrs 11yrs11yrs
IMMUNISATION HISTORYIMMUNISATION HISTORY
As per UIPAs per UIP No optional vaccinesNo optional vaccines BCG scar mark presentBCG scar mark present
DEVELOPMENTAL DEVELOPMENTAL HISTORYHISTORY
Studying in 7th class Studying in 7th class Good scholastic performance Good scholastic performance
SOCIAL HISTORYSOCIAL HISTORY
4 family members4 family members Nuclear middle classNuclear middle class 2 rooms + kitchen2 rooms + kitchen Ventilation adequateVentilation adequate
Summary after history Summary after history
11 yr old male child apparently well 11 yr old male child apparently well 1 days back, presented with h/o one 1 days back, presented with h/o one episode of generalized seizures of 3 episode of generalized seizures of 3 minutes duration followed by minutes duration followed by weakness and numbness in upper weakness and numbness in upper left limb and frontal headache with left limb and frontal headache with family h/o pulmonary tuberculosis in family h/o pulmonary tuberculosis in mother 07 yrs back,had completed mother 07 yrs back,had completed ATT course ATT course
General examinationGeneral examination Child is conscious ,oriented to time, Child is conscious ,oriented to time,
place ,sitting on bed comfortably place ,sitting on bed comfortably AfebrileAfebrile Pulse- 88/min,all peripheral pulses well Pulse- 88/min,all peripheral pulses well
felt,sinus arythmiafelt,sinus arythmia R/R- 20/minR/R- 20/min BP- 110/68mm Hg RASBP- 110/68mm Hg RAS CFT < 2 secCFT < 2 sec No pallor /icterus /cyanosis/ No pallor /icterus /cyanosis/
clubbing/lymphadenopathy/ pedal oedemaclubbing/lymphadenopathy/ pedal oedema No neurocutaneous markersNo neurocutaneous markers
AnthropometryAnthropometry
Weight- 35kg (25-50Weight- 35kg (25-50thth p ) p ) Height- 146.7 cm (50-75Height- 146.7 cm (50-75thth p) p) Nutritional status WNLNutritional status WNL
CNSCNS
HMF normalHMF normal Speech normalSpeech normal Cranial nerves normalCranial nerves normal
Fundoscopy normalFundoscopy normal
CNS contd…CNS contd…
MOTOR SYSTEMMOTOR SYSTEM Bulk normalBulk normal ToneTone
Power Power
UL UL NN
LLLL NN
PowePower r
Rt Rt LtLt
ULUL 5/55/5 4/54/5
LLLL 5/55/5 5/55/5
CNS contd…CNS contd…
Reflexes Reflexes
reflexreflex bicepbicep triceptricep supintsupintrr
kneeknee ankleankle plantplantarar
RTRT ++++ ++ ++ ++++ ++ flexorflexor
LTLT ++ ++ ++ ++++ ++ flexorflexor
Superficial reflexes intactSuperficial reflexes intact No sensory lossNo sensory loss Gait normalGait normal Skull/spine normalSkull/spine normal
Resp Resp B/L equal air entryB/L equal air entry vesicular breath soundsvesicular breath sounds
CVS –SI S2 normal,no murmurCVS –SI S2 normal,no murmur Abdomen – Abdomen –
Soft ,no organomegalySoft ,no organomegaly B/S +B/S +
SUMMARYSUMMARY
11 yr old male child apparently well 11 yr old male child apparently well 1 days back, presented with h/o one 1 days back, presented with h/o one episode of generalized episode of generalized seizures ,presently having some seizures ,presently having some weakness in left upper limb and weakness in left upper limb and frontal headachefrontal headache
INVESTIGATIONSINVESTIGATIONS Hb-12.3gm%Hb-12.3gm% TLC-9500TLC-9500 DLC-P53 L41DLC-P53 L41 Platelets- 2.6 lacsPlatelets- 2.6 lacs PBS for MP- NegPBS for MP- Neg ICT for MP –VEICT for MP –VE BUN-10BUN-10 Creatinine- 0.8Creatinine- 0.8
INVESTIGATIONINVESTIGATION
Na 140Na 140 K 4.2K 4.2 Cl 101Cl 101 Ca 3.6 repeat 4.4Ca 3.6 repeat 4.4 Urine normalUrine normal LFT normalLFT normal CPK 14 U/LCPK 14 U/L Montoux test negativeMontoux test negative
CXR normalCXR normal ECG normalECG normal USG abdomen normalUSG abdomen normal MRI Brain showed –ring enhancing MRI Brain showed –ring enhancing
lesions in posterior parietal lobe Rt lesions in posterior parietal lobe Rt side with perilesional side with perilesional edema,suggestive of tuberculoma.edema,suggestive of tuberculoma.
DIAGNOSISDIAGNOSIS
Functional -MonoparesisFunctional -Monoparesis
Anatomical - UMN typeAnatomical - UMN type
Etiological -TUBERCULOMAEtiological -TUBERCULOMA
FINAL DIAGNOSISFINAL DIAGNOSIS
TUBERCULOMA IN RT PARIETAL TUBERCULOMA IN RT PARIETAL LOBE LOBE
MANAGEMENTMANAGEMENT
DefinitiveDefinitive ATTATT
SupportiveSupportive STEROIDSSTEROIDS ANTI EPILEPTICANTI EPILEPTIC Watch out for SEIZURESWatch out for SEIZURES
COURSE IN HOSPCOURSE IN HOSP
Child was seizures free Child was seizures free Showed improvement in power in Showed improvement in power in
left upper limbleft upper limb Got relief from headacheGot relief from headache Tolerating ATT wellTolerating ATT well
THANK YOUTHANK YOU