BENIGN HEREDITARY CHOREA
BENIGN HEREDITARY CHOREA ACUTE PHARYNGITISULCERS SECONDARY TO ? FOLLICULITIS, TRAUMA WITHECZEMA ADJUSTMENT DISORDER
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Unit 1 Admission
ICU bed no 6
A 23yr old female came with chief complaints of involuntary movements of both upper limbs and Lower limbs since 5yrs of age
HOPI
Patient was apparently asymptomatic before 5years of age.Then she developed involuntary movements of upper limbs and lower limbs for which she was prescribed with some medications which she has used for 2yrs.There was no control of seizures.
5yrs back she was taken to Supraja hospt in nagole where she was prescribed with some medications.She used those medications for 1month.She used to develop suicidal tendency upon using those medication.
1month back she was taken to an ayurvedic practitioner for same problem.Used ayurvedic medication
Since 1month she developed increased involuntary movements of whole body
Involuntary movements are present mostly during sleep last for 1-5min
Sometimes she develop involuntary movements when she stands up from prolonged sitting position
She has H/O consumption of amniotic fluid in intrauterine life
She also have a h/o delayed milestone
Past history
N/K/C/O DM,HTN,TB,BA
Personal history
Diet - mixed
Appetite
Sleep -inadequate
General examination:
Patient is conscious , coherent, co-operative .
Pallor +ve , no icterus, cyanosis , clubbing , koilonychia , lymphadenopathy,edema
Vitals
Temp - Afebrile
BP -120/70 mm Hg
PR - 84bpm
RR -14cpm
SpO2 - 99%@ RA
Systemic examination
CVS -S1 S2 +ve , No murmurs
RS - BAE+ , NVBS+
P/A - soft , non tender , BS+ve
CNS - NAD
Provisional diagnosis :
? Chorea
Investigations
Day1
S-c/o throat pain
1 fever spike yesterday
O- pt had 16 episodes of choreiform movements yesterday night ,each lasting less than a minute
Pt - conscious, coherent
Afebrile
Pr 100 /min
Bp 120/70 mmhg
Rr cpm
Spo2 98 % on room air
Cvs- s1s2+
Rs- b/l air entry +
Ophthalmology referral taken - no KF rings
Dvl opinion in v/o itchy lesions over gluten region and both lower limbs
Ent opinion in v/o throat pain and pain during swallowing- mild congestion in posterior pharyngitis wall and anterior pillars
Psychiatry referral - adjustment disorder due to physical illness
?dissociative motor disorder
A- ? Benign hereditary chorea
Acute pharyngitis
Ulcers secondary to ? Folliculitis, trauma with
Eczema
Adjustment disorder
P- To start on tab tetrabenazine 12.5 mg po bd
Tab Augmentin 625mg po bd
Tab levocitrezine 10mg po od
Salt water gargles
Momate f cream for local application bd
Mupirocin gel for local application bd
Day2
S- c/o Disturbed sleep
throat pain decreased
No fever spikes
O- pt had 14 episodes of choreiform movements yesterday night ,each lasting less than a minute
Pt - conscious, coherent
Afebrile
Pr 86 /min
Bp 120/70 mmhg
Rr 16cpm
Spo2 98 % on room air
Cvs- s1s2+
Rs- b/l air entry +
Ophthalmology referral taken - no KF rings
Dvl opinion in v/o itchy lesions over gluten region and both lower limbs
Ent opinion in v/o throat pain and pain during swallowing- mild congestion in posterior pharyngitis wall and anterior pillars
Psychiatry referral - adjustment disorder due to physical illness
?dissociative motor disorder
A- ? Benign hereditary chorea
Acute pharyngitis
Ulcers secondary to ? Folliculitis, trauma with
Eczema
Adjustment disorder
P-
Tab Augmentin 625mg po bd
Tab levocitrezine 10mg po od
Salt water gargles
Momate f cream for local application bd
Mupirocin gel for local application bd
Day4
S- c/o Disturbed sleep
throat pain decreased
No fever spikes
O- pt had 25 episodes of choreiform movements yesterday night ,each lasting less than a minute
Pt - conscious, coherent
Afebrile
Pr 84 /min
Bp 120/70 mmhg
Rr 16cpm
Spo2 98 % on room air
Cvs- s1s2+
Rs- b/l air entry +
Ophthalmology referral taken - no KF rings
Dvl opinion in v/o itchy lesions over gluten region and both lower limbs
Ent opinion in v/o throat pain and pain during swallowing- mild congestion in posterior pharyngitis wall and anterior pillars
Psychiatry referral - adjustment disorder due to physical illness
?dissociative motor disorder
A- ? Benign hereditary chorea
Acute pharyngitis
Ulcers secondary to ? Folliculitis, trauma with
Eczema
Adjustment disorder
P-
Tab Augmentin 625mg po bd
Tab levocitrezine 10mg po od
Salt water gargles
Momate f cream for local application bd
Mupirocin gel for local application bd
To collect sample for 24hr urinary copper from today mrng.
Day 5
S- c/o Disturbed sleep
throat pain decreased
No fever spikes
O- pt had 28episodes of choreiform movements yesterday night ,each lasting less than a minute. Frequency and intensity of episode has increased
Pt - conscious, coherent
Afebrile
Pr 84 /min
Bp 120/70 mmhg
Rr 16cpm
Spo2 98 % on room air
Cvs- s1s2+
Rs- b/l air entry +
Ophthalmology referral taken - no KF rings
Dvl opinion in v/o itchy lesions over gluten region and both lower limbs
Ent opinion in v/o throat pain and pain during swallowing- mild congestion in posterior pharyngitis wall and anterior pillars
Psychiatry referral - adjustment disorder due to physical illness
?dissociative motor disorder
A- ? Benign hereditary chorea
Acute pharyngitis
Ulcers secondary to ? Folliculitis, trauma with
Eczema
Adjustment disorder
Iron deficiency anemia sec to ? Nutritional
P-
Tab Augmentin 625mg po bd
Tab levocitrezine 10mg po od
Salt water gargles
Momate f cream for local application bd
Mupirocin gel for local application bd
To send samples for serum copper , cerruloplasmin and 24hr urinary copper excretion today and discharge her
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