NEUROLOGY POSTINGS(KHL)

 DAY- 1:

1) GBS with respiratory failure given 5 days IVIG and monitored for single breath count . as the patient has fall of saturations emergency tracheostomy done( day 6) . But patient had complication of right lung collapse .. tracheostomy tube connected to CPAP for 2 day with maintaining saturations of 95 % .. after 2 days trial of T piece done and patient able to maintain saturations with no respiratory distress. Bed sore( grade1) , oral and tracheostomy care taken

2) 55/M with right upper limb and lower limb waekness with Global aphasia underwent thrombolysis with teleplase

Intra arterial thrombolysis 4.5 hrs 

Intra venous thrombolysis 6 hrs 

Surgical thrombectomy 24 hrs 

Alteplase 0.9 mg/kg -10% direct IV and remaining in Ns over 1 hour 

Teleplase : 0.2 mg /kg iv over 1min

Contraindications for thrombolysis 

1) high bp more than or equal to 200/100 

2) high sugars more than 400 mg/dl 

3) Bleeding disorders 

4 ) liver disease 

5) large infarct more than 1/3 rd of brain 

NIH criteria to acsess the neurological condition and whether to iniatiate thrombolysis or not 

NIH less than 5 and more than 25 - No thrombolysis

3) RTA : pt irritable GCS 8/15 

 Check Pupils ,GCS hrly ( fall of GCS by 2 and anisocoria - indiactes deterioration )

Check Power and tone -12 th hrly 

Haemogram 12 th hrly for 24 hrs 

Develops AKI within 6 hrs if severe muscular injury occurs 

Oesophageal temperature at 30 cms ( continous temperature  monitoring) -RTA is a catabolic state

Head to toe examination 

Mostly prefer oro- pharangeal tube 

DAY 2:

1) 45/M with h/of headache thrombing type intermittently lasted for 1 year .. as her husband is also Doctor by profession on his force she underwent CT brain diagnosed as meningioma ... Took consultation from neurosurgeon in 2015 as she had sudden loss of consciousness advised for surgery and underwent surgery in 2015. After that she had 2 episodes of GTCS type of seizures for 3 years and then frequency decreased to one for year .. patient was on antiepileptics 500 mg Po/tid since then .. on routine checkup her hba1c 8 and started her on Metformin -SR 500 mg Po/od .. after starting her on OHA her hba1c 5.. now presented to our hospital with complaints of aura .. on presentation to casualty she had focal seizure f/by GTCS with post ictal confusion lasted for ( with no focal neurological deficit) and planning for CT contrast 

2) 34/M with sudden onset of right upper limb and lower limb weakness with broca's aphasia with h/of chronic smoking and alcohol intake since 15 years with echogenic thrombus in left ICA causing 75% occlusion with CNS : patient - conscious and cooperative with decreased tone on right upper and lower limb with 1/5 power on right upper limb and lower limb with 2+ reflexes and right plantar upgoing and left - flexion.. 

3) 45/M with sudden onset of weakness of right upper limb and lower limb with deviation of mouth to left side since morning (7 am) .. lorry driver by occupation had h/of CVA in 2016 which he recovered within 20 days used medication for 6 months and discontinued but patient didn't stop taking alochol and smoking cigarettes.. now presented with acute ischemia with provisional diagnosis as AIS ( infarct in CG and coronoa radiatia) . On examination dysarthia + , tone decreased in right upper and lower limb, power 3/5 in right upper and lower limb .reflexes 2+ , with plantars upgoing on right and flexion on left.. planning for CT brain, 2D echo and carotid Doppler 

Day 3 

1) clonus 

2) TB meningitis 

Day 4 

Day 5  Presentation on CIDP


Day 6 AIDP

Day 7  Attended the mortality meet 


Day 8 Foot drop 

Day 9 Seizures 

Night duty 

Day 10 Parkinson's disease

Day 11 Reemergent tremors 

Day 12 occular movements (saccades)

Day 13 peripheral neuropathy

Day 14 vascuilitis

Day 15 PRESS

Day 16 Meningioma- presented as seizures

Day 17 Ataxia

Day 18 ICP waves - normal and abnormal wave forms ,medically and surgerical approach

Day 19 - Presentation on  Dermatome ( bedside)

Day 20 - chorea and other involuntary movements 

Day 21- Clinical presentation :upper limb : examination (bed side)

Day 22 -Clinical presentation : Lower limb : examination (bed side)

Day 23- seizures  and mirror seizure

Day 24- Discussion on Meningitis and dengue encephalitis 

Day 25 - Discussion on stroke in young 

Day 26 - 65/M with MLF lesion

Day 27 - Aphasia

Day 28- Presented a case of 50/M with brainstem bleed

Day 29 -Presented a case of  48/F with cauda equina syndrome 

Day 30- Difference between cauda equina syndrome and conus medullaris 

Day 31 - Discussion on Anatomy of spinal cord











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