Ciencias de la Salud
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Item “Dificultades en el diagnóstico de mielitis transversa”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-04-01) Marín Tabares, Adriana Paola; Dr. Lana Saavedra, Héctor EnriqueThe present clinical case corresponds to a 53 years old male patient whit personal clinical pathologic antecedents of pain and paresthesia of the lower members, he has an surgical treatment antecedents of left saphenectomy during two times. Left inguinal hernioplasty from one year ago. He is attended because he presents a picture of progressive and generalized asthenia of three years of evolution, that seven hours previous to the entrance, he is exasperated provoking difficulty of moving, accompanied of sporadic paresthesia of the lower members. At the moment in the physical exam, he presents TA: 110/60, FC: 61 LPM, FR: 18RPM, SAT O2: 97% AA, T: 36.70C, WEIGTH 68Kg HEIGTH 165 cm, IMC 25 m/kg, the patient is awake, conscious, febrile, hydrated, algid, normocefalic head, without apparent pathology, eyes pupils of 2mm. isochoric, norm reactive to the light and to the accommodation, normal hearing, permeable nostrils, humid oral mucous, normal oropharynx, not painful to the palpation and movement, OA thyroid, preserved thorax expansibility, lungs with vesicular whisper kept without over added noise, heart with cardiac rhythmic noise, without blowing, soft abdomen, depressible, non-painful to the palpation, hrydroaerial noises present, scar of an hernioplasty in the left region, painful lumbar region to the digital pressure at the level of L1-L2, lower members with decreased strength 1/5, tone preserved, tactile sensibility abolished ( sensitive levels until hips region T12-L1, reflexes osteotendinous Rotuliano and Aquileo (hiperreflexia), Babinski negative, Lasegue negative, Neurological exam: Patient orientated in time, space and person, Glasgow 15/15 higher mental functions preserved, cranial pairs preserved. Motor exam: The patient remains in dorsal decubitus, it is not possible to value the progress, the sensibility of higher members preserved, the lower members abolished. Complementary exams: Thyroid profile, Prostatic and Lipidic : Normal Reactive Protein C: negative, Procalcitonin: 0.08, Hematic Biometry: Normal, Antibodies: Normal, Anticardiolipin: 3.9, Anticardiolipin 1GM: 1, Cardiolipin Beta2: 1.6, Antinuclear Antibodies: 0.04, Glucose: 97.70, Urea in serum: 62.4, Creatinine: 0.9, Na 139, K 4.2, Speed of erythrocyte sedimentation: 3, Latex: Negative, VDRL: Not reactive, Cytomegalovirus IGG: > 500.00, IGM: 0.252, Hepatitis C: 0.067, Herpes I-IGG: 44.42, Folic Acid 11.42, Albumin: 3.9 The patient enters to the service of neurology with the diagnostic of paraplegia in study; is not possible to establish a clear diagnostic based on the clinical history data. He stays in observation with therapy for the pain, complex B and physiotherapy. Complementary exams are taken with the purpose of establishing the etiology. After the corresponding exams, the results are within the normal parameters; during the hospitalization he presents favorable clinical evolution and progressive increase in the motor activity of the lower members, showing muscular strength of 3/5 and evident sensibility until S2 and S3. He can stay standing on foot and starts his ambulation; for that reason it is considered as a clinical picture of Transverse Myelitis and it is decided his exit from the hospital with the corresponding pursuit from the part of physiatrist. Until now he has reached a high progress in his motor activity, allowing him walking in short steps without help, but he continues receiving physiotherapy.Item Carcinomatosis Meníngea secundaria A Tumor primario del Sistema Nervioso Central (Snc)(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-06-01) Buenaño Solís, María del Carmen; Lana Saavedra, Héctor Enrique Dr.Analysis of the clinical case of a female patient of 23 years with a history of brain tumor and incomplete removal thereof (Lymphoma Diffuse small and medium B cells) approximately 1 month and a half ago, appendectomy about 15 days ago. Who goes for about 8 days ago presents headache of moderate intensity, compression type, and abdominal pain holocraneana intensive, crampy, diffuse, accompanied by nausea, vomiting arriving on several occasions, asthenia and myalgia. The T / A 90/60 mmHg physical examination, FC 80 lpm, FR 20 rpm, T ° 37.7, awake, álgica, feverish, pale-oriented; Head scar + - 15 cm length in right frontotemporal region, ptosis left, mydriatic pupils + - 7 mm, anicteric sclera, pale conjunctive; neck, painful on palpation and movement in posterior region, marked rigidity, Brudzinski sign (+); soft, depressible painful mesogastrio, ureteral point and rights + middle and lower abdomen, slightly decreased RHA. Upper and lower members have pain on movement and tenderness, decreased tone, strength 4/5 not present edemas pulses, capillary refill <2 sec. neurological exam-oriented patient, Glasgow 15/15; higher mental functions preserved. Cranial nerve: N. Optical (II), alteration of bilateral visual acuity: oculomotor (III) Motor, left ptosis, bilateral mydriasis; Pathetic and Abducens (VI) preserved. Exam Engine: patient who remains in the supine position, can not assess progress. preserved superficial and deep sensitivity. Complementary tests: Leukocyte 8.61 x 103, 80.2% segmented, Mon 3.1, Lyn 16.3, Eos 0.3, 6.6 Urea, BUN 3 63 Glucose, Creatinine 0.69, PCR 69.3; CSF study: xanthochromic, slightly cloudy, 0xmm3 cells, glucose 1.0, 2908.1 proteins, LDH 283u / l, negative for malignancy cytology; Eco Abdominal: ileus, pyelonephritis investigate; TAC is requested thoraco abdominal and pelvic contrastadada reference to the third level. Treatment: Dexamethasone 8 mg IV c / 8h, Omeprazole 40 mg IV QD, Tramadol 200 mg IV in 24 h, Ondansetron 8 mg IV c/8 h. In HEEE, enter the service of Hematology diagnosed with lymphoma B cell diffuse small and medium post tumor resection and right frontoparietal Urinary Tract Infection; here is not performing Chemotherapy is achieved and reference is made to SOLCA Quito where state of the patient by two sessions of radiotherapy is done and maintained with palliative care until his death.