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.
Following is my analysis of this patient's problem:
1)Migraine attacks associated with AURA.
2)Swelling of face and abdomen
3)Sleeplessness
4) Oliguria
The reasons causing the above problems:
1) Migraine associated with aura:
Patient gives history of frequent headaches since she was 2 years old which increased in severity with advancing age. By age 34, episodes and severity of headaches increased and aura intensified.
Investigations:
•EEG
•MRI
•Eye examination
•Head CT scan
Treatment:
•triptans
•dihydroergotamines
2) Swelling of face and abdomen:
The patient is diagnosed with hemolytic anemia, due to G6PD deficiency. She might have developed swelling and fatigue due to oxidative stress G6PD catalyzed the rate limiting step in PENTOSE PHOSPHATE PATHWAY.
Investigations:
•HEMOGRAM-ANEMIA
•AST AND ALT- increased
•CXR-left atrial enlargement
•G6PD enzyme levels
•Urine analysis
Treatment:
•CIMETIDINE was given to reduce swelling but caused profuse sweating
•Oxygen therapy
3) Sleeplessness:
Patient complains of sleep disturbances since 1 year of age. She sleeps only for about 2-3 hours a day with no REM sleep at all.
The cause might be G6PD deficiency (leads to impaired production of glycine) or AMPD1 deficiency.
Investigations:
•Physical exam
•Sleep habits
•Sleep study
•EEG
Treatment:
•L-serine
4) Oliguria:
Patient complains of decreased urinary output and dark colored urine.
This might possibly be due to G6PD deficiency which leads to reduced production of NADPH and increased loss of ions.
Investigations:
•Urinary output
•CUE
•Blood test
Treatment:
•Increased fluid intake
•Diuretics
OTHER MAJOR PROBLEMS:
•Patient was diagnosed with Polycystic Ovarian Disease at age 21
•Cervical degeneration and scoliosis
•Increased tolerance to pain - WNK 1 Mutation
•Vision loss and failed LASIK surgery
•Diagnosed with Bipolar disorder, depression and anxiety at age 15
•Von Willebrand Disease due to mutation of VWF gene.
•Excessive hair loss
•Recently diagnosed with Behçet's disease which is a vascular disease causing oral and genital ulcers.
