My experiences with general cellular and neural cellular pathology in a case based blended learning ecosystem's CBBLE "

 

As keen learner, i want to share some insights of me and my medicine journey, theres a patient , who came to medicine department with a bruise that doesn't heal , her bt ct was prolonged and her platelet count is 6000,  i was  stunned by seeing her counts, and she was admitted,immediate platelet transfusion was planned, and she had idiopathic thrombocytopenic purpura, tried steroids got pedal edema and many more side effects, she used to do weekly hemogram counts are maintained at 60,000, one fine day , she started have nleeding,menorrhagia,melena,her platelet counts fallen rapidly,SHE is on azathioprine,eletrombopag, iv ig  and high dose steroid injections to get the platelet count higher, no use ,she suffered from side effects, there comess the RITUXIMAB, the wonder drug, after she tried it, her platelet count, drastically improved without any relapse. I observed a complete medical case and monitored the entire treatment process until the patient was cured. I learned a lot in her journey . Subsequently, inmy postings  I took a case of hemiplegia ,which i have to present in front of 200 people, I thought to address questions of my patient problems in an hour, the presentation is deviated I cannot get the solutions to my patients issues However,  In response to my dissatisfaction, I created a blog post as per my curriculum  to address the issues I had encountered.https://alavaramyatulasitejasri11.blogspot.com/2021/11/hemiplegia.html This action resulted in a slight improvement of the situation. During my surgical rotations, I encountered a patient who exhibited persistent, involuntary movements of the head. The patient and their carers recognised me from a previous encounter, during which I conducted a thorough clinical examination that included assessments of cerebellar function. Despite my limited experience as a third-year medical student, I was able to perform the examination without causing any harm to the patient. As a tip, conducting a non-invasive examination can help to establish a positive rapport with patients and encourage them to return for follow-up care.http://87tharunkumar.blogspot.com/2023/05/22y-f-with-pcod-and-bronchial-asthma.html

 ANOTHER CASE ,The occurrence of reversible paraparesis following a spinal cord stroke is a case that raises questions. Is this phenomenon truly feasible? ,https://alavaramyatulasitejasri11.blogspot.com/2022/06/45-year-old-female-with-reversible.html I have also seen a case of  Recurrent Reversible Constructional Apraxia, which has led me to explore the field of Transference of neurons . https://alavaramyatulasitejasri11.blogspot.com/2023/01/a-60-year-old-female-with-difficulty-in.html .Neuronal injury doesn't always follow neurodegeneration . I have seen many cases in daily opd cases ,with burning paresthesias in diabetic neuropathy,sensory dysesthesia in vitamin b12 deficesncies , neck pain with cervical radiculopathy., lumbar spondylosis , median nerve compression,some of the form of nerve injuries ,now I want to share a case where the nerve injury happened in a brain due to impaired blood supply, which lead to degeneration which is progressive and formed as a encephalomalacia.

A 50 year old male diabeticand hypertensive came with complaints of left upper limb and lowerlimb weakness  with GCS E4v3M5 , on further history , patient has same complaints in the past , which is sudden in onset one left side without any altered sensorium , he became normal within 1 day and able to walk with stick within 15 days , persisted some mild motor deficits . after 2 years ,no behavioural changes, one fine morning he got a weakness in left side with altered consciousness  , he cant able to walk or talk , but can open eyes on examination, hypertonia of left upper limb and lower limb, hyper reflexia and with no power of left upperlimb and lower limb,meningeal signs are present, during the course of hospital he was into septic encephalopathy and respiratory failure and finally he is improving.

INVESTIGATIONS  revealed in MRI acute right infarct in superior parietal lobe,superior frontal gyrus, centrum semiovale ,periventricular white matter.

Encephalomalacia with gliotic changes in left frontal lobe .

.http://tejasridevaruppala36.blogspot.com/2023/05/acute-cerebrovascular-accidentleft.html

CASE DISCUSSION

what's the reason for his tachypnea , he is maintaining at room air?

How sepsis causes acute lung injury?

Persistent vegetative state characteristics?

Encephalomalacia,  does his clinical features correlate with the mri findings?

wheres the septic foci , what's the cause of his septic encephalopathy?

Why recurrent attack caused altered sensorium? 

Thank you.