PBL :MEDICINE

PRESENTED BY:-
SUNIL PANDEY
KAMAL P. SAUD
INDRA K. GURUNG
ANANDA JHA
 Question:-
A young lady who delivered 7 days back by
LSCS presented with fever, seizures followed
by right sided hemiplegia.

1) What are the possibilities?....4 marks

2) How will you investigate your case?..4 marks
3) How will you treat cortical vein
thrombosis?...4 marks
INTERPRETATION OF THE CASE
Hemiplegia results from an upper motor neuron
lesion above the midcervical spinal cord; most such
lesions are above the foramen magnum.

The presence of seizure points the lesion being in the

cerebral hemisphere : right sided hemiplegia so left
sided lesion.

Since there are no other sensory symptoms , visual

and speech symptoms : lesion must be involving
majority of motor cortex of left hemisphere.

Presence of fever points etiology to be of infective

origin.
POSSIBLE CAUSES

Puerperal sepsis meningitis brain

abscess
Post partum cortical venous thrombosis
Post partum ischaemic stroke
Post partum eclampsia
DIAGNOSIS:GOOD HISTORY AND EXAMINATION

1) PUERPERAL SEPSIS
History of::::: prolonged labor / prolonged
rupture of membrane/ any chronic diseases
/ multiple vaginal examination during labor.
O/E ::::: increased pulse rate and
temperature/ copious and offensive lochial
discharge
2) CORTICAL VEIN THROMBOSIS
History of ::::: severe blood loss/ anemia /
prolonged labor/ history suggestive of
infection/ headache/ blurring of vision
O/E :::: anemia/ dehydration/
DIAGNOSIS
3. Post partum ischaemic stroke
History of :::: hypertension/ diabetes/ heart
diseases / anemia/ headache/ blurring of vision
Family history of coagulopathy
History of smoking and alcohol consumption
O/E :::::
4. Post partum eclampsia
History of ::::: edema/ hypertension/ proteinuria/
fits
O/E::::: abnormal wt. gain, edema, rise of BP
INVESTIGATIONS

1. Puerperal sepsis
- High vaginal and endocervical swab
- Clean catch mid stream urine
- Blood: TLC, DLC, Hb, Platelet
- Thick blood film for malarial parasite
- Blood culture
- Pelvic ultra sound
INVESTIGATIONS

2. Cortical veinous thrombosis

- CT scan: Delta sign
- MRI: T1 hyper intense, T2 hypo intense
- PT, BT, aPTT
3. Post partum Ischaemic stroke
- CT / MRI scan: Localize the lesion,
differentiate ischemic and hemorrhagic type,
- ECG/ Echocardiogram: For cardiac source of
emboli
- Blood cholesterol/ glucose
INVESTIGATIONS

4. Eclampsia
- Urine: Hyaline cast, epithelial cells, red cells,
protein
- Opthalmoscopy: Retinal edema,
constrictions of arterioles
- Blood: Serum urea, creatinine, platelets
- Liver function tests
TREATMENT OF CVT

1. General treatment
- Monitor vitals
- Fluids and electrolyte balance
- Nursing care
- Care of bowel and bladder
- Glucose and saline infusion: To maintain
hydration
- Blood transfusion: For anemia
TREATMENT OF CVT
2. Specific treatment
- Heparin inj. started as soon as possible,
changed to oral anticoagulants (warfarin)
after 5-7 days
- Anti epileptic drugs: Phenytoinfor fits
- Certain medicines (steroids, mannitol) are
given to reduce the brain swelling
THANK YOU