BLURRING OF VISION! A MYSTERY TO SOLVE!
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Patient was apparently asymptomatic 6 years back the complaints of intermittent headache and blurring of vision.
Patient complaints of giddiness since 3 days and blurring of vision since yesterday morning.
Patient was apparently asymptommatic 3 days back then he developed giddiness which was sudden in onset, non rotational. He was normal after the 1st episode then again developed giddiness since yesterday morning.
He also complaints of headache associated with blurring of vision Vomitings which was non bilious and contains food particles.
H/o generalised weakness since 3 days.
He is k/c/o Hypertension since 6 years and is on T.CLINIDIPINE 10MG AND T.TELMA 40MG
He is an alcoholic
O/E - pt is conscious,coherent
Vitals:
Temp: 103.4 F
PR: 117bpm
BP: 150/90mm hg
RR:30cpm
Spo2:97% at room air
CNS:
1st time:
He complained of headche 6 years back for which he went to government hospital in narketpally and was diagnosed as hypertension.
Then later he developes intermittent headache with blurring of vision which subsided on taking antihypertensive medication. The frequency of episodes were every 3-4 days/week
On friday i.e on 1st october he came to opd with same complaints and given treatment( sublingual) On sunday i e 3rd october he came with complaints of acute retention of urine and relieved after foley' s catheterisation.
Patient complaints of giddiness since 3 days and blurring of vision since yesterday morning.
Patient was apparently asymptommatic 3 days back then he developed giddiness which was sudden in onset, non rotational. He was normal after the 1st episode then again developed giddiness since yesterday morning.
He also complaints of headache associated with blurring of vision Vomitings which was non bilious and contains food particles.
H/o generalised weakness since 3 days.
He is k/c/o Hypertension since 6 years and is on T.CLINIDIPINE 10MG AND T.TELMA 40MG
He is an alcoholic
O/E - pt is conscious,coherent
Vitals:
Temp: 103.4 F
PR: 117bpm
BP: 150/90mm hg
RR:30cpm
Spo2:97% at room air
CNS:
Higher mental functions: Intact
CRANIAL NERVES-
Optic nerve-
Sensory system- sensitive to pain and touch.
Motor system
Right Left
Power- UL 5/5 5/5
LL 5/5 5/5
Tone- UL Normal Normal
LL Normal Normal
Reflexes-
Biceps +++ +++
Triceps +++ +++
Supinator + +
Knee +++ +++
Ankl +++ +++
Plantar Flexion Flexion
response withdrawal response
Gait- Ataxic
Cerebellar system - intact
CVS:S1S2+
RS: BAE+,NVBS
P/A: SOFT, NONTENDER.
Provisional diagnosis:
GIDDINESS UNDER EVALUATION SECONDARY TO ? HYPERTENSION? WITH U/L OPTIC DISC EDEMA WITH PYEREXIA UNDER EVALUATION WITH K/C/O HYPERTENSION.
Treatment:
INJ. MANNITOL 100ml IV/ TID
INJ. ZOFER 4MG IV/ BD
INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD
INJ. CIGXANE 60MG SC/OD
INJ. NEOMOL 100ML IV/ SOS
TAB. VERTIN 16 MG PO/ BD
Motor system
Right Left
Power- UL 5/5 5/5
LL 5/5 5/5
Tone- UL Normal Normal
LL Normal Normal
Reflexes-
Biceps +++ +++
Triceps +++ +++
Supinator + +
Knee +++ +++
Ankl +++ +++
Plantar Flexion Flexion
response withdrawal response
Gait- Ataxic
Cerebellar system - intact
CVS:S1S2+
RS: BAE+,NVBS
P/A: SOFT, NONTENDER.
Provisional diagnosis:
GIDDINESS UNDER EVALUATION SECONDARY TO ? HYPERTENSION? WITH U/L OPTIC DISC EDEMA WITH PYEREXIA UNDER EVALUATION WITH K/C/O HYPERTENSION.
Treatment:
INJ. MANNITOL 100ml IV/ TID
INJ. ZOFER 4MG IV/ BD
INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD
INJ. CIGXANE 60MG SC/OD
INJ. NEOMOL 100ML IV/ SOS
TAB. VERTIN 16 MG PO/ BD
TAB. PCM 650 MG PO/ TID
Strict temperature monitoring 4th hourly
Strict BP monitoring 2nd hourly
DAY -1
38 yr / M
S :fever,headache decreased
Blurring of vision present
O :
Pt is c/c/c
Temperature : 98.6 F
BP : 130/100mm Hg
PR : 113bpm , regular
CVS : S1 S2 +, no murmur
RS : NVBS +
P/A : soft, non tender
A :
GIDDINESS UNDER EVALUATION SECONDARY TO BENIGN INTRACRANIAL HYPERTENSION? WITH U/L OPTIC DISC OEDEMA WITH K/C/O HYPERTENSION WITH AKI WITH PYREXIA UNDER EVALUATION
Plan of care:-
INJ. MANNITOL 100ml IV/ QID
INJ. ZOFER 4MG IV/ BD
INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD
INJ. NEOMOL 1g 100ML IV/ SOS
TAB. VERTIN 16 MG PO/ BD
TAB. PCM 650 MG PO/ BD
TAB.METXL 50MG PO/OD
TAB.CINOD 10MG PO/OD
Strict temperature monitoring 4th hourly
Strict BP monitoring 2nd hourly
Strict temperature monitoring 4th hourly
Strict BP monitoring 2nd hourly
SOAP NOTES
38 yr / M
S :fever,headache decreased
Blurring of vision present
O :
Pt is c/c/c
Temperature : 98.6 F
BP : 130/100mm Hg
PR : 113bpm , regular
CVS : S1 S2 +, no murmur
RS : NVBS +
P/A : soft, non tender
A :
GIDDINESS UNDER EVALUATION SECONDARY TO BENIGN INTRACRANIAL HYPERTENSION? WITH U/L OPTIC DISC OEDEMA WITH K/C/O HYPERTENSION WITH AKI WITH PYREXIA UNDER EVALUATION
Plan of care:-
INJ. MANNITOL 100ml IV/ QID
INJ. ZOFER 4MG IV/ BD
INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD
INJ. NEOMOL 1g 100ML IV/ SOS
TAB. VERTIN 16 MG PO/ BD
TAB. PCM 650 MG PO/ BD
TAB.METXL 50MG PO/OD
TAB.CINOD 10MG PO/OD
Strict temperature monitoring 4th hourly
Strict BP monitoring 2nd hourly
DAY -2
38 yr / M
S :headache decreased
Blurring of vision present
No fever spikes
O :
Pt is c/c/c
Temperature : 98.6 F
BP : 140/100mm Hg
PR : 113bpm , regular
CVS : S1 S2 +, no murmur
RS : NVBS +
P/A : soft, non tender
A :
LEFT OPTIC DISC EDEMA SECONDARY TO OPTIC NEURITIS? WITH ACUTE RETENTION OF URINE SECONDARY TO UMN BLADDER? WITH SECONDARY TO NEUROMYELITIS OPTICA WITH K/C/O HYPERTENSION WITH AKI
Plan of care:-
INJ. MANNITOL 100ml IV/ QID
INJ. ZOFER 4MG IV/SOS
INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD
INJ. METHYL PREDNISOLONE 1G IN 100ML NS IV OVER 30 MIN
INJ. PAN 40MG IV OD
INJ. NEOMOL 1G 100ML IV/ SOS
TAB. PCM 650 MG PO/SOS
TAB.METXL 50MG PO/OD
TAB.CINOD 10MG PO/OD
TAB. NICARDIA 20MG PO/ SOS
Strict temperature monitoring 4th hourly
Strict BP monitoring 4th hourly
38 yr / M
S :headache decreased
Blurring of vision present
No fever spikes
O :
Pt is c/c/c
Temperature : 98.6 F
BP : 140/100mm Hg
PR : 113bpm , regular
CVS : S1 S2 +, no murmur
RS : NVBS +
P/A : soft, non tender
A :
LEFT OPTIC DISC EDEMA SECONDARY TO OPTIC NEURITIS? WITH ACUTE RETENTION OF URINE SECONDARY TO UMN BLADDER? WITH SECONDARY TO NEUROMYELITIS OPTICA WITH K/C/O HYPERTENSION WITH AKI
Plan of care:-
INJ. MANNITOL 100ml IV/ QID
INJ. ZOFER 4MG IV/SOS
INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD
INJ. METHYL PREDNISOLONE 1G IN 100ML NS IV OVER 30 MIN
INJ. PAN 40MG IV OD
INJ. NEOMOL 1G 100ML IV/ SOS
TAB. PCM 650 MG PO/SOS
TAB.METXL 50MG PO/OD
TAB.CINOD 10MG PO/OD
TAB. NICARDIA 20MG PO/ SOS
Strict temperature monitoring 4th hourly
Strict BP monitoring 4th hourly
DAY -4
38 yr / M
S :-
Blurring of vision present
No fever spikes
O :
Pt is c/c/c
Temperature : 98.6 F
BP : 140/100mm Hg
PR : 101bpm , regular
CVS : S1 S2 +, no murmurs
RS : NVBS +
P/A : soft, non tender
A :
LEFT OPTIC DISC EDEMA SECONDARY TO OPTIC NEURITIS?WITH SECONDARY TO NEUROMYELITIS OPTICA? WITH K/C/O HYPERTENSION WITH AKI
Plan of care:-
INJ. ZOFER 4MG IV/SOS
INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD
INJ. METHYL PREDNISOLONE 1G IN 100ML NS IV OVER 30 MIN
INJ. PAN 40MG IV OD
INJ. NEOMOL 1G 100ML IV/ SOS
TAB. PCM 650 MG PO/SOS
TAB.METXL 50MG PO/OD
TAB.CINOD 10MG PO/OD
TAB. NICARDIA 20MG PO/ SOS
Strict temperature monitoring 4th hourly
Strict BP monitoring 4th hourly
AMC Case
Unit 2
DAY -5
38 yr / M
S :-
Blurring of vision improved
No fever spikes
O :
Pt is c/c/c
Temperature : 98.6 F
BP : 140/100mm Hg
PR : 88 bpm , regular
CVS : S1 S2 +, no murmurs
RS : NVBS +
P/A : soft, non tender
A :
TRANSVERSE MYELITIS (D8-D12) WITH LEFT EYE OPTIC NEURITIS WITH SECONDARY TO NEUROMYELITIS OPTICA?
? ANTI MOG ANTIBODY DISEASE WITH K/C/O HYPERTENSION WITH AKI
Plan of care:-
INJ. ZOFER 4MG IV/SOS
INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD
INJ. METHYL PREDNISOLONE 1G IN 100ML NS IV OVER 30 MIN
INJ. PAN 40MG IV OD
INJ. NEOMOL 1G 100ML IV/ SOS
TAB. PCM 650 MG PO/SOS
TAB.METXL 50MG PO/BD
TAB.CINOD 10MG PO/OD
Strict temperature monitoring 4th hourly
Strict BP monitoring 4th hourly
AMC Case
Unit 2
DAY -6
38 yr / M
S :-
Blurring of vision improved
O :
Pt is c/c/c
Temperature : 98.6 F
BP : 140/100mm Hg
PR : 87 bpm , regular
CVS : S1 S2 +, no murmurs
RS : NVBS +
P/A : soft, non tender
A :
TRANSVERSE MYELITIS (D8-D12) WITH LEFT EYE OPTIC NEURITIS WITH SECONDARY TO NEUROMYELITIS OPTICA?
? ANTI MOG ANTIBODY DISEASE WITH K/C/O HYPERTENSION WITH AKI
Plan of care:-
INJ. ZOFER 4MG IV/SOS
INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD
INJ. METHYL PREDNISOLONE 1G IN 100ML NS IV OVER 30 MIN
INJ. PAN 40MG IV OD
INJ. NEOMOL 1G 100ML IV/ SOS
TAB. PCM 650 MG PO/SOS
TAB.METXL 50MG PO/BD
TAB.CINOD 10MG PO/BD
Strict temperature monitoring 4th hourly
Strict BP monitoring 4th hourly
AMC
Unit 2
DAY -7
38 yr / M
S :-
Blurring of vision reduced
O :
Pt is c/c/c
Temperature : 98.6 F
BP : 140/100mm Hg
PR : 87 bpm , regular
CVS : S1 S2 +, no murmurs
RS : NVBS +
P/A : soft, non tender
A :
TRANSVERSE MYELITIS (D8-D12) WITH LEFT EYE OPTIC NEURITIS WITH SECONDARY TO NEUROMYELITIS OPTICA?
? ANTI MOG ANTIBODY DISEASE WITH K/C/O HYPERTENSION WITH AKI
Plan of care:-
TAB. METHYL PREDNISOLONE 60MG PO/OD
TAB.PAN 40MG PO OD
TAB. TELMA 40MG PI/ OD
TAB. PCM 650 MG PO/SOS
TAB.METXL 50MG PO/BD
TAB.CINOD 10MG PO/BD
Strict BP monitoring 4th hourly
Ward Case
Unit 2
DAY -8
38 yr / M
S :-
Blurring of vision reduced
O :
Pt is c/c/c
Temperature : 98.6 F
BP : 150/110mm Hg
PR : 82 bpm , regular
CVS : S1 S2 +, no murmurs
RS : NVBS +
P/A : soft, non tender
A :
TRANSVERSE MYELITIS (D8-D12) WITH LEFT EYE OPTIC NEURITIS WITH SECONDARY TO NEUROMYELITIS OPTICA?
? ANTI MOG ANTIBODY DISEASE WITH K/C/O HYPERTENSION WITH AKI
Plan of care:-
TAB. WYSOLONE 60MG PO OD
TAB. TELMA 40MG PO OD
TAB. PAN 40MG PO OD
TAB. PCM 650 MG PO/SOS
TAB.METXL 50MG PO/BD
TAB.CINOD 10MG PO/BD TAB. ZINCOVIT PO OD
Strict BP monitoring 4th hourly
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