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Re: What is the diagnosis? From: Eberhard Lisse (el@ac.lisse.na) Thu Oct 24 00:17:32 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Re: Should I do an abdominal cerclage?" Previous message: Ivan Lee: "Re: What is the diagnosis?" In reply to: Eberhard Lisse: "What is the diagnosis?" Next in thread: DoctorJoe@aol.com: "Re: What is the diagnosis?" LP showed no bacteria, no white cells 3 red cells (I haven't done an LP for 5 years, so I needed two attempts, my SMO (Resident) found several excuses not to do it herself :-)-O) Protein was elevated, glucose low. Indian Ink negative. Direct Microscopy to come today. HIV was reactive and has been sent for confirmation. I feel this is Tuberculous Meningitis or HIV encephalitis. I have put her on full TB Rx and of course we added Potassium to her drip :-)-O, but this I don't thinks has much to do with it. I have also put he ron some steroids. The nearest CT is 750 km away by road transport (remember, I work in rural Africa :-)-O). If she doesn't improve I might send her for imaging after all. But, what do we do about the pregnancy? I'll keep you informed. greetings, el -- Dr. Eberhard W. Lisse \ * / Obstetrician & Gynaecologist (Saar) <el@lisse.NA> el108 / | Oshakati State Hospital Private Bag X5501 \ / Telephone: +264 81 124 6733 (cell) Oshakati, Namibia ;____/ Managing Member, NA-NiC (cc) Please send DNS/NA-NiC related e-mail to dns-admin@na-nic.com.na only In message <20021023193318.5E27D6350C@ac.lisse.na>, Eberhard Lisse writes: > Hi, > > Day before yesterday a 26 year old lady was brought in by her family > at 34 weeks of pregancy according to the dates in the patient based > maternity passport with the complaints of talking inappropriately, if > at all, confusion, throwing things, and aundressing herself in public > for two days. > > In the passport we noted 4 visits to ANC, nil of note. Furthermore she > had been admitted at a hospital down the road with experienced O&G two > weeks ago for a fever, with Malaria smear being negative. The > discharge note showed no diagnosis being made. > > On admission her GCS was 8/15, without localizing signs. Temperature > was 38.8 C, she was not anemic, chest was clear. Fundal height was > 32-34 weeks, vertex, loose, FH 132, FM present. > > FBC showed WCC of 6.7, Hb of 9.5 rest nil of note > ESR 123 > LFT nil of note > U&E: Potassium 2.4, rest nil of note. > Uric Acid: normal. > Fasting glucose 5.4, random glucose 7.6 > > Two Malaria Smears within 6 hours of each other were negative. > > Blood Cultures were done, results not back. > > Empirically put on Pen/Genta ivi. > > In the ward the level of consciousness fluctuated (GCS 8-11/15) as did > the temperature between 36 and 40. She removed her drips and catheter > and had to be restained. > > Ultrasound showed a single vital vertex at 32+3/40. > > Chest X-Ray (supine) with cover nil of note. > > So, what's the diagnosis and what further investigations did we do if > any? > > Treatment? > > What are we going to do about the pregnancy? > > el > -- > Dr. Eberhard W. Lisse \ * / Obstetrician & Gynaecologist (Saar) > <el@lisse.NA> el108 / |Consultant Obstetrician & Gynaecologist > Private Bag X5501 \ / Oshakati State Hospital > Oshakati, Namibia ;____/ Telephone: +264 81 124 6733 (cell) > Partner: Namibian Network Information Center, the ccTLD Domain Manager > Please send DNS/NA-NiC related e-mail to dns-admin@na-nic.com.na only > Next message: DoctorJoe@aol.com: "Re: Should I do an abdominal cerclage?" Previous message: Ivan Lee: "Re: What is the diagnosis?" In reply to: Eberhard Lisse: "What is the diagnosis?" Next in thread: DoctorJoe@aol.com: "Re: What is the diagnosis?"

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