LONG CASE HOMEWORK

1.
In this patient we found FOCAL TO BILATERAL TONIC CLONIC WITH IMPAIRED
AWARENESS
2.

3. Phenytoin maintenance dose for this patient

Tablet
 100 mg PO TID
 Maintenance: 300-400 mg/day; increase to 600 mg/day if necessary
 May adjust dose no sooner than 7-10 day intervals when indicated

4. CNS Lupus
-Nervous system manifestations are present in up to 70% of patients with
SLE.
-There are 19 definitions which are components of NPSLE. The earlier classifications only
recognized 2 clinical entities – seizures and psychoses.
NPSLE component entities
-Epileptic attacks
-Headaches and migraines
-Cereberovascular diseases
-Demyelinating syndromes
-Aseptic meningitis
-Chorea
-myelopathy

Other differential diagnoses?

Infections and metabolic diseases not found in this patient

5. Methylprednisolone is a corticosteroid medicine that prevents the release of substances in the

body that cause inflammation

Methylprednisolone is used to treat many different inflammatory conditions such as arthritis,

lupus, psoriasis, ulcerative colitis, allergic disorders, gland (endocrine) disorders, and conditions
that affect the skin, eyes, lungs, stomach, nervous system, or blood cells

Common methylprednisolone side effects may include:

 fluid retention (swelling in your hands or ankles);

 dizziness, spinning sensation;
 changes in your menstrual periods;
 headache;
 mild muscle pain or weakness; or
 stomach discomfort, bloating.
 Why do was Methylprednisolone given in this patient?

According to a research:

Three patients had organic brain syndrome with psychosis, 3 had seizures, 1 stroke, 1
cerebral vasculitis, 1 optic neuritis, and 1 transverse myelitis. In 3 of these cases, nervous
system involvement was the initial presentation of SLE. Five patients had 2 or more NP
manifestations. Most of them were accompanied by general SLE activity. Anticardiolipin
antibodies were positive in 3 patients and none was anticoagulated. All patients improved, 6
patients had a complete recovery and 1 patient recovered with minor neurological deficit. All
but one improved significantly within the first week of combined IVMP and IVCy. The mean
time of follow-up was 37 months (range 8-55). IVCy was well tolerated with minimal side
effects.

With a conclusion that Early aggressive treatment with combined IVMP and IVCy followed
by monthly IVCy may be an effective therapy for severe NPSLE in children.

6. The Most Common Causes of Teenage Stroke

Teenagers who experience stroke often have one or more of these underlying medical problems
that can predispose to blood clots and stroke.

 Sickle cell anemia is a hereditary blood condition that causes blood clots due to a
process called 'sickling,' or a characteristic change in the shape of red blood cells in
response to physical stresses such as infection. These blood clots can form anywhere in
the body, and if the blood clots form in the brain or travel to the brain, they cause a
stroke.
 Inborn blood vessel abnormalities such as brain aneurysms or arteriovenous
malformations may clot, causing an ischemic stroke, but are more likely to burst, causing
a hemorrhagic stroke.
 Heart disease or heart malformations can result in an irregular heartbeat, heart
function problems or heart attacks, all of which can lead to stroke. Inborn heart disease is
generally diagnosed at a very early age, but teenagers need to have regular health check
ups to detect and manage these types of problems.
 Hypertension is not very common in teenagers, and it is usually a sign of a medical
illness such as a hormonal imbalance. Untreated hypertension can disrupt blood vessels
and may cause heart disease or strokes.

 Infections, especially severe infections, can disrupt the body's immune system and blood
cells to such an extent that increased blood clotting, resulting in a stroke, may occur. The
best way to protect against serious infections is to stay up to date on immunizations.
 Migraines rarely have anything to do with strokes. But teens who suffer from migraines
experience a slightly higher rate of stroke, and should have a thorough medical evaluation
to determine whether the migraines are truly just benign migraines or whether they are, in
actuality, TIAs.
  Cancer increases the formation of blood clots due to changes in the body’s physiology
and also as a consequence of some anti-cancer therapies.
 High cholesterol is relatively uncommon in teens, but there are some inborn metabolic
disorders that can cause elevated blood cholesterol levels, which can in turn lead to heart
disease or cerebrovascular disease, increasing the chances of a stroke.
 Hormone therapy, steroid use, birth control pills and pregnancy all change the
body’s hormones, blood vessel physiology and blood clotting functions, increasing the
risk of stroke.

 Head trauma, concussions or other severe trauma trigger a disruption in the body,
which can cause either ischemic or hemorrhagic strokes in young people.
 Drugs can cause strokes at any age. The use of cigarettes, energy drinks, caffeine pills or
illegal recreational drugs are all huge risk factors for stroke.

In this patient, stroke is not the primary diagnosis due to the aforementioned factors are not
present in this patient