CASE PRESENTATION

Dr.Ghaffari
Dr.Ghanbari
Sunday,29 May
Dr.Chraghi
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CASE NUMBER:1
ID

 A 37 years old female

Housewife
Right Handed
From Tehran

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 CC & PI

 CC
Headache+Weakness of Limbs
 Pl
A 37 years-old woman with thunderclap headache from two
days before the visit and hemiparesis of the left limbs and
hemifacial paresis of the right and numbness of the left half of
the face one day after headache

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 No blurred vision
 Diplopia
 Seizures
 Swallowing disorder
 Speech disorder
 Oral and genital aphtuos
 Fever and chills
 Recent vaccination
 Lermit sign
 Weight lost
 Vasculitis symptoms
 Histor y of similar attacks
 Hormonal medication

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 PMH, DH & HH

 PMH
Hypothyroididism
PID
Gilbert

 DH
Levotyroxin50 daily

 HH
Negative

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 PHYSICAL EXAM & CRANIAL NERVES

 Physical Exam
The patient is awake and alert orient to the place, time and
person.
Vital Sign: Normal
Neck stifness :Negative
Pupils:mid-sized and reactive to light
Marcusgan, ptosis, nystagmus, gaze, anhydrosis: Negative
 Carnial nerves:
3,4,6:nl
5:left sensory impaired
7:right hemifacial paresis
9,10,11:nl

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 REFLEXES

 Reflexis:
DTR:3+
Babinski:up
Hof fman:neg
Clonus:neg
Sensory level:nl
Propriocepion;nl

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 SYNDROME DIAGNOSTIS

 Syndrome diagnosis
Acute flaccid left hemiparesis plus
Thunderclap headache

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 WHITE MATTER LESION DIFFRENTIAL DIAGNOSIS,
NUTRRITIONAL AND METABOLIC & INFECTIOUS

 White matter lesion dif frential diagnosis

Demeyelling diseases
Ms
Nmo
 Nutrritional and metabolic
Vit b 1 2
Wernicke
Odms
Mithocondrial
 Infectious
Hiv
Cmv
Hsv
Tb
Syphilis
Htlv

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 THUNDERCLAP HEADACHE DDX

 Thunderclap headache ddx

SAH
CV T
Dissection
RCVS
Pituitary apoplexy
Temporal artheritis
Meningits
Ischemic

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 THINGS DONE FOR THE PATIENT

 Labtest:
Cbc,bs,vasculopathy,hypercouagulopathy,MOG ab, NMO ab
Csf analysis ocb, lGg Index
Cxr
Brain an cervical MRI + -gad
 Consulting:
1-Infectious
2-Gynecology
3-Neurointervention

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