Aye Chan Moe Thant, a medical graduate from Myanmar, joins the discussion to present a challenging case of a 51-year-old woman with behavioral changes, headaches, and blurry vision. They delve into diagnosing complex neuroimmune disorders and explore potential diagnoses like hydrocephalus and encephalitis. The conversation highlights the role of environmental factors and intra-cranial pressure symptoms, emphasizing the importance of thorough clinical evaluations and imaging. Aye's commitment to health equity adds a powerful dimension to the medical intricacies discussed.
The importance of a comprehensive evaluation of differential diagnoses, particularly in neurological cases, is critical for tailored patient management.
Understanding the time course of symptoms helps narrow down potential neurological conditions, enhancing diagnostic accuracy in complex presentations.
The case underscores the value of diagnostic imaging and interdisciplinary collaboration in establishing a definitive diagnosis and effective treatment plan.
Deep dives
Introduction to the Case
A case involving a 51-year-old woman presenting with behavioral changes is introduced, focusing on the clinical reasoning process of the medical team. The discussion emphasizes the importance of considering various differential diagnoses related to altered mental status, particularly in neurological contexts. Factors like time course and localization play crucial roles in narrowing down potential conditions. Notably, a meticulous evaluation of potential emergencies, such as encephalitis or mass lesions affecting the frontal lobe, is highlighted as the team begins to formulate a clinical approach.
Differential Diagnosis
The concept of ‘rounding to the nearest diagnosis’ becomes a focal point, underscoring the necessity of broadening differential diagnoses even when faced with unfamiliar clinical presentations. The team discusses key schemas and mnemonics, particularly the MIST mnemonic, as tools to categorize the patient’s symptoms. Potential causes for the patient’s behavioral change include metabolic disturbances, ongoing infections, or neoplasms compressing frontal lobe structures. The importance of considering the time course of symptoms in guiding diagnosis is emphasized.
Case History and Symptoms
The clinical history reveals a multifaceted symptomatology, including episodes of confusion, changes in appetite, and headaches, alongside a notable decline in everyday activities. This collection of symptoms raises concerns about the presence of elevated intracranial pressure or possible seizure activities. The patient’s exposure to toxins from her work at a petrol station also generates hypotheses regarding possible underlying systemic or malignancy-related issues. The discourse encourages a careful collection of family history and social factors, all instrumental in piecing together the puzzle of her declining health.
Imaging and Clinical Findings
A comprehensive physical examination yields normal findings aside from the presence of bilateral papilledema, indicating elevated intracranial pressure. This prompts further consideration of potential underlying conditions affecting the brain's structure, such as infections or malignancies. The mention of neurocysticercosis arises as the team discusses the implications of the patient’s clinical presentation alongside laboratory results indicating anemia. The discussion stresses the relationship between imaging findings and patient presentation, reinforcing the role of diagnostic imaging in uncovering the etiology behind the patient's condition.
Final Diagnosis and Management
The imaging results ultimately reveal the presence of neurocysticercosis, which explains many of the patient’s episodic neurological symptoms. Upon diagnosis, an effective management plan involves the use of antiparasitic therapy combined with corticosteroids to address the inflammatory response. The case illustrates the necessity of a collaborative approach in patient management, highlighting the interconnection between clinical examination, radiological findings, and treatment strategies. Additionally, it emphasizes the unpredictable nature of seizures and the variability in clinical presentations seen in neurocysticercosis.
We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Aye presents a case of behavior change, headaches, and blurry vision to Vale.
Aye graduated from University of Medicine, Mandalay, Myanmar, and has been working with her mentor neurologist, one of only three neurologists covering the Upper Myanmar region of 23 million population. Through her experiences witnessing the challenges faced by patients in underserved areas and hearing their stories, Aye is dedicated to advancing health equity, global health initiatives, and various aspects of neurology, both in clinical practice and medical education. She is going to apply for a neurology residency program this year. Outside of work, she spends time playing piano, jogging along trails, and listening to music.
Valeria Roldan (@valeroldan23)
Valeria Roldan was born and raised in Lima, Peru. She recently graduated medical school at Universidad Peruana Cayetano Heredia and is excited to pursue a career in Neurology. She is passionate about LGBTQ+ health, particularly advocating for trans rights, as well as medical education. She would describe herself as an optimist and outside of medicine you probably will find her running or talking about pop culture over a glass of wine.
