"42 YEAR OLD FEMALE WITH MULTIPLE HEALTH EVENTS"

I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan. 

You can find the entire real patient clinical problem in this link here..https://classworkdecjan.blogspot.com/2019/05/42-f-with-severe-regular-edema-with_17.html?m=1

Following is my analysis of this patient's problem:

The problems in order of priority I found are 

1) Migraine

2) Swelling

3) left side weakness

4) Sleep deprivation

5) Exercise induced fatigue

 ELABORATION OF COMPLAINTS:

1) MIGRAINE WITH AURA:

•     She had sudden ,recurrent ,progressive and severe migraine attacks since 2 years of age.
• It was unilateral and mostly on the left side.
• Aura description - It always starts as a small Flicker in the upper left and then eventually becomes a crescent that covers the entire center of my vision. Lots of rainbow colors and movement. 
• CAUSES : It may be due to hormonal problems as her attacks were severe during her menses period and while she was taking OCP's  and even later she was diagnosed with PCOS. She was even diagnosed with G6PD deficiency(it causes headache).
• INVESTIGATIONS:

        Fundus Examination

        CSF Examination

        CT and MRI of brain

        EEG for detecting seizures.

        X-RAY OF Paranasal sinuses

• TREATMENT : Triptans,anti epileptics, avoid stress

2)SWELLING : 

• Aggrevating factors : emotional stress, smoke , eating wrong food .
• Causes: 

      G6PD :It causes hemolytic anemia.

        Hemolytic anaemia could have led to right heart failure thus                      leading to pulmonary hypertension causing shortness of breath.
        Emotional stress and eating fava beans may have led to edema.                because she has G6PD Deficiency.
        This anaemia could be responsible for kidney infections as G6PD is            required for producing NADPH which in turn is needed by the                  kidneys for their functioning. In G6PD deficiency, she could have            had low NAPDH levels and thus kidney infections.

        Symtoms suggestive of hemolysis are coke colored                                  urine,diarrhoea,vomiting,swelling and acute kidney injury

• INVESTIGATIONS:

        HAEMOGRAM for anemia  

             CBP

             CHEST X-RAY(PNEUMONIA)

              ECG

         LIVER ENZYMES ELEVATED

• TREATMENT: 

           Avoid stress
          Do not consume fava beans, sulpha drugs, antimalarials
          APPLE HAS ANTIOXIDANT PROPERTIES.

3) LEFT SIDE WEAKNESS:

• Numbness in left side of face, loss of function on left side of the body.
• Had this type of weakness at the time of migraine attack.
•   CAUSE: 

         Hemiplegic migraine causes intense and throbbing pain, nausea,               and sensitivity to light and sound. It also causes temporary                     weakness, numbness and tingling, and paralysis on one side of               the body. These symptoms start before the headache.                           “Hemiplegia” means paralysis.

         IT AFFECTS A SMALL NUMBER OF PEOPLE WHO GET MIGRAINE                 WITH AURA.

• INVESTIGATIONS:

         CT SCAN

         MRI 

         ELECTROENCEPHALOGRAM

         ECHOCARDIOGRAM.

        THESE SCANS ARE DONE TO DIFFERENTIATE whether it is due to               hemiplegic migraine or or due to TIA.

• TREATMENT:

    NSAIDs, antiemetics, and sometimes narcotic analgesics are used for symptomatic relief of hemiplegic migraine. Intranasal ketamine has been shown to shorten the duration of aura symptoms in patients with hemiplegic migraine.

4)SLEEP DEPRIVATION:

• She had sleep deprivation since her birth.
• she could sleep only for 2-3 hours a day.
• Causes:

          G6PD Deficiency impaired the glycolysis so glycine is not formed               well . Glycine is also an inhibitory neurotransmitter.
          AMPD1 Deficiency can cause sleep disturbances because                            Adenosine is an inhibitory neurotransmitter so it should help in                sleep.

• INVESTIGATIONS: Poly somnography ,CT and MRI OF BRAIN.    
• TREATMENT:

         L seine.

5)EXERCISE INDUCED FATIGUE:

•  CAUSES:

           AMPD1 deficiency - lack of ATP hence the person gets easily                     tired.

• Treatment: Ribose- it provides ATP.

6)INCREASED PAIN TOLERANCE:

• CAUSE : Her genetic analysis showed WNK1 gene mutation.her increased pain tolerance may be related to this gene mutation.
• TREATMENT: There is no such treatment for it.She just has to be carefull.

7)OTHER CLINICAL PROBLEMS:

• Recurrent infections,shortness of breath,mood changes due to G6PD deficiency. 
• Attention defict hyperactivity disorder due to ANKK1 deficiency.
•  Intolerance to food may be due to G6PD deficiency .
• instability during walking may be due to G6PD deficiency.

MY advice to her is avoid alcohol, smoke ,too much exercise,and to take her drugs in time and factors which increase oxidative stress.