42 year old female with multiple health events since birth

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CASE:

The present complains of this patient are as follows

She gives a history of frequent falls on her left side with giving away of foot and hand.

There is also history of left sided jaw pain radiating all over the face.

History of intensified aura and increased headache 1 month after the incident of left sided spinning event which increased to such an extent that it caused her to vision loss for 2hours or so and also gives complains of on and off stuttering and inability to walk and memory loss.

Her weight fluctuates because of swelling which occurs when she is in stress , exercise or eats something wrong.

The priority of her complains according to my analysis should be

1. Her cognitive functions(since its patient's own request)

2. To focus on why she has somemuch of salt cravings just to make her feel better(because increase intake of salt can lead to further complications)

3. Her left sided symptoms and her headaches which are present since the age of 2

The 1st question that arises in my mind is why is her left sided only getting affected?

Is it because she has a lesion on her right side of the hemisphere? If so, what kind of lesion it is. For that we have to do an imaging study (CT AND MRI)

Since she is not hypertensive yet that means she having hypertensive CVA can be ruled out for the cause of her symptoms?

Or can it be because she has  AMPD1 gene mutation resulting in decrease AMPD enzyme because of which her muscle power and tone is decreased?

She also is at risk of vitamin B12 deficiency and increase levels of homocysteine in blood due to mutated MTHFR gene. So is it possible that ischemia and stroke resulting in those symptoms? For that vitamin B12 in serum and homocysteine levels should be checked and peripheral smear.

Her cognitive functions impairment may be because of a consequence of left sided symptoms or neurological impairment due to decrease myelin synthesis and increase degeneration due to vitamin B12 deficiency?

 Loss of muscle function and neurological impairment due to accumulation of methylmalonic acid in blood can also be one of the reasons.

Her headache and aura have been progreesive since birth....why is she having those? Can  it be because of raised intracranial tension? For that we have to do CSF analysis and rule out.

One of the most important symptoms is her swelling in face, abdomen.

We is she swelling after exercise or stress or after eating wrong food. In my view because she is G6PD deficient patient, her oxidative stress is causing cytotoxic edema resulting in swelling.

Another question that arises is why is she having salt cravings to make her feel better?

Since she has G6PD enzyme deficiency, exceesive hemolysis resulting in increase bilirubin and urobilin levels. 

Urobilin causes kidney damage and hence the ions are not reabsorbed and so to keep her hydrated and to maintain her ionic balance body is trying to take salt? 

 She is been diagnosed with Bechet's where the autoimmune inflammation in the blood

 vessels is responsible for formation of clots and ischemic disease which may explain the left sided symptoms.