Interesting consult...

[OldPsychDoc]

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That is a very House-like case 🙂

This was fun. Do more!

Doc Samson IS "House".

 

[Poety2]

I'd like HIV, EEG, and lumbar puncture results please - I'm writing this before getting to the end so bear with me if I'm goig to hit the answer

 

[Poety2]

OK, so first off, you guys rock. If the med students (and some of the residents) I get to deal with every day were 1/2 as enthusiastic as you guys about cases like this, my job would be much easier.

Second, I'm off to Tucson for the APM meeting tomorrow (anyone else going, BTW?), and don't want to leave you all hanging for 5 days until I get back, so here's the gist:

I, also, got hung up on the methadone as an etiology. That one article in the literature (that turned out to be about rhesus monkeys drinking methadone all day long) was something of a red herring.

Next (with the MRI in hand) I went to the heavy metals, with no joy (kinda cool though how this discussion followed my work-up).

As always, "never worry alone" so got some supervision... after digging through his files, the boss pulled out an article on Acquired Non-Wilsonian Hepatocerebral Degeneration. Essentially portosystemic shunting due to hepatic failure leads to exposure of the basal ganglia to all kinds of schmutz (manganese is thought to be a leading contributor), but serum levels of the heavy metals remain wnl. Clinically, it's a dead ringer for Wilson's disease, and has classic MRI findings IDENTICAL to the ones seen in this patient (seriously the scan in the article looked like it was lifted out of his chart). It resolves with liver transplant, which is what this pt is waiting for.

I LOVE my job.

Now, go forth and read.

dammit - theres the answer

 

[sdn1977]

Doc Samson IS "House".

👍 but without the Vicodin addiction!😀

 

[OldPsychDoc]

👍 but without the Vicodin addiction!😀

I presume you have the pharmacy records to back up that assertion...😉

 

[medstudent99]

OK Doc

Could this be confused with any other movement disorder such as Parkinson's?

If the patient past any possible withdrawal phase?

Other meds can cause TD such as Reglan.

yes that's true! lol and it's not a well known fact either. you are generous with the wisdom. more than i. lol

 

[medstudent99]

OK, so first off, you guys rock. If the med students (and some of the residents) I get to deal with every day were 1/2 as enthusiastic as you guys about cases like this, my job would be much easier.

Second, I'm off to Tucson for the APM meeting tomorrow (anyone else going, BTW?), and don't want to leave you all hanging for 5 days until I get back, so here's the gist:

I, also, got hung up on the methadone as an etiology. That one article in the literature (that turned out to be about rhesus monkeys drinking methadone all day long) was something of a red herring.

Next (with the MRI in hand) I went to the heavy metals, with no joy (kinda cool though how this discussion followed my work-up).

As always, "never worry alone" so got some supervision... after digging through his files, the boss pulled out an article on Acquired Non-Wilsonian Hepatocerebral Degeneration. Essentially portosystemic shunting due to hepatic failure leads to exposure of the basal ganglia to all kinds of schmutz (manganese is thought to be a leading contributor), but serum levels of the heavy metals remain wnl. Clinically, it's a dead ringer for Wilson's disease, and has classic MRI findings IDENTICAL to the ones seen in this patient (seriously the scan in the article looked like it was lifted out of his chart). It resolves with liver transplant, which is what this pt is waiting for.

I LOVE my job.

Now, go forth and read.

cool case. i was going to say something ******ed like hepatic encephalopathy or some kind of weird hep c induced i dunno encephalitis of some sort LOL cool case

 

[medstudent99]

One last question...did you get a fasting schmutz level?

LOL!!!!!!!!!!!!!!!!!!!!!!!!!!!!

 

[J1515]

Not to hijack this thread, but psychologists feel they should have prescribing capabilites and essentially have the same "power" as a psychiatrist. You show me one psychologist that could come up with the differential diagnosis that you guys all have and then I'll agree they should be on equal footing.