a weird case we saw yesterday

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medicinewise

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sorry if im using the thread wrongly.

yesterday we were doing our neurology rotations ,by the way im a 4th, anyway we came across a very interesting case :

it was a female patient ,39 years of age , who was doing well until 2012 when she started to feel pain in her head ,now what is really interesting is that her mental condition started to deteriorate rapidly after so , she had hirsutism she couldn't control her urination or bowel , she couldn't even speak ,i remember she had injuries on her hands and her lips looked like they were bitten , also she had gazy eyes ,she kept moving in the bed continuously ,and she really had low mental capabilities , she couldn't talk and didn't understand ,but when our senior did a general cranial nerve examination ,she did respond when he told her to look to the right and left ,she used to be smart -that's what her father said- no one in her family had similar symptoms.

im sorry if i'm making it vague , but what i'm interested in knowing is that how can someone suddenly develop this kind of mental deterioration :s

on the DDx list we had :

1) huntington disease.
2) creutzfeld jacobs disease.

thank you very much and sorry if i didnt provide enough info as my main concern is knowing how can someone develop such mental symptoms.

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There are many conditions that can cause altered mental status and sensorium in addition to involuntary movements in a woman of child-bearing age. Your differential diagnosis is surprisingly short. I'm not entirely sure what your question is. Typically we use medical terminology when describing cases, not terms like "gazy eyes" which have absolutely no shared meaning. I've never even heard that term before.

Overall your question reminds me most of the scene on 30 Rock when Steve Buscemi is pretending to be a high school student. Are you actually a medical student, or are you asking for medical advice? The only thing that gives me pause is that you use the abbreviation "DDx". But typically medical students would classify a condition in which an individual could not speak or understand verbal content as "aphasia".

Other than that, George Huntington was a person and his name is capitalized. And Creutzfeldt was a person with a T at the end of his name. And Jakob was a person who didn't have a C in his name, or an S.

And I don't like to do this, but commas come before a space, not after.

Overall your post leaves me concerned that you are asking for us to develop a differential diagnosis for a family member with the symptoms you have mentioned. Please clarify if this is, in fact, the case, as if that were the case it would be a violation of our Terms of Service.
 
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hello there
first thanks for replying ,sorry if my post wasnt perfectly typed , yes i am a medical student ,if you want a proof i will be more than happy to provide :) , actually we started our rotations very recently ,and by that we just moved from basic science years (3 years) into the clinical years (3 years , again thanks for pointing out the defects in my post since i usually write notes instead of neat posts, i should have read more about the neurological pathologies before posting - i admit this-

anyway no it is not a family member of mine, and we only had the chance to interview her family for like 10 min, so i just typed what the family told us and what i managed to observe.

and now if you could be more helpful and share your ideas on what could this case be, i will try my best and obtain more info about it.

and again im really thankful for your advices, i would have investigated it more if i didnt have to prepare for usmle :)
 
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and again im just interested in knowing how can a very healthy person suddenly deteriorate mentally, i wish i could have filmed her so you can actually see the signs as i am unable to represent them correctly, but this would violate her privacy.
 
there are so many differentials for this presentation. Something specific that could be seen in a young female- assuming the first line of testing is negative, could be limbic encephalitis.
 
there are so many differentials for this presentation. Something specific that could be seen in a young female- assuming the first line of testing is negative, could be limbic encephalitis.
this is a really interesting suggestion, next week im going to check with the resident dr there and ask him if he could explain more about her condition, im pretty sure by now they have figured out what was the cause of her symptoms as they also said she was admitted due to seizures.

thank you very much ^^
 
This doesn't seem like a post from a medical student... what are "gazy eyes"? "pain in her head"? meaning headache, but what kind i.e. band-like, unilateral, retroorbital, etc. very poor description.

"couldn't control her urination"
there are various types of incontinence, very unclear whether this is related to any neuro condition

"she kept moving in the bed continuously"
what

"she really had low mental capabilities"
this has no meaning
 
"couldn't control her urination"
there are various types of incontinence, very unclear whether this is related to any neuro condition

Given your avatar, I'm resisting the urge to make a "Fuller, go easy on the Pepsi!" joke. Especially at this time of year.
 
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and now if you could be more helpful and share your ideas on what could this case be, i will try my best and obtain more info about it.

and again im really thankful for your advices, i would have investigated it more if i didnt have to prepare for usmle :)

Is it really hard to use capital letters, speak in complete logical sentences that contain a segmented thought, and build them into paragraphs? I really tried to get through it, but failed. I did catch one thing: you need to really do some deep prep for the USMLE.
 
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i dont know why are you guys making such a fuss, anyway as i stated before these were my notes of that case, would also like to add she was already diagnosed with HD 3 months ago and was only admitted due to seizures ,i should have asked for her files earlier, the family thought it was unnecessary to talk about her past history.
"she really had low mental capabilities"
this has no meaning
her words were incomprehensible.
she couldn't identify her father nor her sister.
and unable to take good care of her self (bath,use bathroom, eat).

"couldn't control her urination"
there are various types of incontinence, very unclear whether this is related to any neuro condition

this is just funny :D if her incontinence was due to something else im pretty sure her urine culture,imaging would have shown some abnormalities.
could have been psychological though.
what are "gazy eyes"? "pain in her head"?

that's what her father said actually, i tried to quote exactly what he said because he talks arabic , if the headache was anything else i would have explained more but he just described it as "a very generalised headache"


"she kept moving in the bed continuously"
what
this would be explained as chorea

Is it really hard to use capital letters, speak in complete logical sentences that contain a segmented thought, and build them into paragraphs? I really tried to get through it, but failed. I did catch one thing: you need to really do some deep prep for the USMLE.
should i really argue with you too ?!
 
Well, if she was diagnosed with Huntington's Disease, then she probably has Huntington's Disease. You can read about the varied psychiatric and motor presentations of HD in most any neurology textbook. We do not need to recapitulate a synopsis here. And in the future, as a bit of advice, you should write in such a way as you help those donating their time to giving you an answer. Things like poor punctuation, capitalization, and imprecise application of terminology all point to an overall lack of attention and/or awareness, and these issues make professional physicians less likely to give you the answers you want.
 
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Well, if she was diagnosed with Huntington's Disease, then she probably has Huntington's Disease. You can read about the varied psychiatric and motor presentations of HD in most any neurology textbook. We do not need to recapitulate a synopsis here. And in the future, as a bit of advice, you should write in such a way as you help those donating their time to giving you an answer. Things like poor punctuation, capitalization, and imprecise application of terminology all point to an overall lack of attention and/or awareness, and these issues make professional physicians less likely to give you the answers you want.
you are right, sorry for not making my previous post neat, i will work on it in the upcoming future, again thank you all very much and hope the best to all of you :D
 
should i really argue with you too ?!

Let me assure you that you're not capable of arguing with me, so put your mind at ease on that score. You should certainly reflect, however, and consider that writing is the way you make your mind and thoughts known. We know the tree mostly by the fruit. If the writing is garbage, and yours is, then I usually safely assume the mind is in exact proportion to it. I also believe that it is a sign of respect to carefully formulate clear and coherent sentences, I take anything less as a sign of disrespect. Throwing garbage at me will not make me admire you, want to teach you or mentor you. Finally, writing things down in the way I've described helps you learn.
 
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Let me assure you that you're not capable of arguing with me, so put your mind at ease on that score. You should certainly reflect, however, and consider that writing is the way you make your mind and thoughts known. We know the tree mostly by the fruit. If the writing is garbage, and yours is, then I usually safely assume the mind is in exact proportion to it. I also believe that it is a sign of respect to carefully formulate clear and coherent sentences, I take anything less as a sign of disrespect. Throwing garbage at me will not make me admire you, want to teach you or mentor you. Finally, writing things down in the way I've described helps you learn.
you know that you are not adding anything new or useful, right?
perhaps if you read any of the above posts you would have realised that :)
 
You can lead a horse to water...

I think this thread has likely run its course. If anyone has something else to add, please let it be of a medical nature or else let it lie fallow. I'm fairly sure this serve and volley is not going to benefit anyone at this point.
 
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