Neurology 2B

CASE 2B:

Link to the patient details:

https://kausalyavarma.blogspot.com/2021/05/a-52-year-old-male-with-cerebellar.html?m=1

QUESTIONS:

1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?

Answer:

History:- Patient has giddiness 7 days back and associated with 1 episode of vomiting on the same day.

•Patient was asymptomatic for 3 days, after which he consumed a small amount of alcohol He then developed giddiness, that was sudden in onset, continuous and gradually progressive.

•This was associated with Bilateral Hearing loss, aural fullness and presence of tinnitus.

•He has associated vomiting- 2-3 episodes per day, non projectile, non bilious containing food particles.

•Patient has H/o postural instability

2) What are mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological interventions used for this patient?

Answer:

1)Tab Veratin 8 mg PO TID

   Mechanism of action:  Betahistine is one of the few drugs known which is said to improve the microcirculation of the inner ear. It works as a histamine analogue through 2 modes of action(1) agonist of H1 receptors and (2) antagonist of H3 receptors. It has a weak effect on H1 receptors but strong effect on H3 receptors.

2)Inj Zofer 4 mg IV/TID

   Mechanism of action: Zofer Tablet works by inhibiting the action of a chemical substance named serotonin, which is responsible for inducing nausea and vomiting. Ondansetron binds to a receptor known as 5-HT₃, thus inhibits the binding of serotonin to it and prevents vomiting and nausea.

3)Tab Ecosprin 75 mg PO/OD

   Mechanism of action: Ecosprin is an antiplatelet medicine. It works by inhibiting the action of an enzyme, which makes platelets aggregate together to form a blood clot.

4)Tab Atorvostatin 40 mg PO/HS

   Mechanism of action: Atorvastatin competitively inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase. By preventing the conversion of HMG-CoA to mevalonate, statin medications decrease cholesterol production in the liver.

5)BP monitoring- 4rth hourly

6)Tab Clopidogrel 75 mg PO/OD

    Mechanism of action: The active metabolite of clopidogrelselectively inhibits the binding of adenosine diphosphate (ADP) to its platelet P2Y12 receptor and the subsequent ADP- mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation. This action is irreversible.

7)Inj Thiamine 1 AMP in 100 ml NSPO/BD

    Mechanism of action: Thiamine combines with adenosine triphosphate (ATP) in the liver, kidneys, and leukocytes to produce thiaminediphosphate. Thiamine diphosphate acts as a coenzyme in carbohydrate metabolism, in transketolation reactions, and in the utilization of hexose in the hexose-monophosphate shunt.

8)Tab MVT PO/OD