Thursday, October 28, 2010
Thursday, October 21, 2010
Unusual recovery in an unusual situation in unusual social circumstances
Mrs UR 30 yrs F
A 30 years female patient operated for Mitral Valve Replacement surgery by Dr H. S. Pannu ,admitted with large right FPT subdural haematoma with deteriorating level of sensorium. On examination, her coagulation profile was deranged with platelets decreased to alarming level (10000/mm3). She was operated for SDH by me and my team explaining all the risks to attendants. Patient had multiple platelet transfusion along with ventilation ± tracheostomy. Had waxing and waning response. Later patient resumed to recovery. She improved in all her parameters and sensorium. Hemiparesis also improved. She is able to walk without support. Her chronic renal failure also improved possibly due to improved cardiac output due to MVR surgery. Managing this patient was a real team approach experience in view of multisystem failure (MVR Surgery, Chronic Renal failure, pulmonary embolism, thrombocytopenia, deranged coagulation parameters, with intracranial bleed etc.) which was further accentuated due to a highly fragile balance to be maintained between hypo & hypercoagulable State. MVR needs Acitrom which was relatively contraindicated due to Neurosurgery but after all, its God’s domain we are just the means to do it. PLUS over all & above it was her family ,especially her mother in law , her handicapped husband , who supported her in all her bad times with their efforts, money & their continuous prayers . in todays era when a girl child is not always welcome , unrelented support for a daughter in law shown by her family is really appreciable. Hats off to all her family members .
Wednesday, October 20, 2010
Thursday, April 8, 2010
MIRACULOUS RECOVERY IN A LIFE THREATENING CONDITION -- GOD,S GREATNESS
Mentioned here is a case of mrs g. k. 32 years female who presented tous at ivy hospital mohali emergency with pulseless bpless condition with gasping respiration . she was immediately resuscitated & put on ventilation .as per attendants she was perfectly o.k. about 4 hrs back when she complained of severe pain in upper part of back of chest & lower part of neck with excessive sweating. For first 24 hours after resuscitation she was really a diagnostic dilemma as almost all investigative reports were normal . her cardiac work up including mr angio of chest revealed no evidence of any dissection of aorta .. to our surprise her mri cervicodorsal spine revealed evidence of holocervical ( c2 to d2 ) acute cervical myelitis .patient was managed with all treatable measures viz. i/v methylprednisolone, methycobal ,inotropes , plasmapharesis, ventilation etc.. her sensorium improved but she remained quadriplegic. No respiratory drive was seen. Repeat mri revealed mild resolution of myelitis features but small syrinx was formed at about c4 to c6 levels . she continued on ventilation after tracheostomy for 4 months , showed very slow but gradual recovery.
She is still in hospital on path of recovery . she is off ventilator , off oxygen with reasonable power in her upper & lower limbs . we hope to see her walking in near future , all due to GOD,S GREATNESS.
As we all know that acute transverse myelitis is a rare disease with a very high mortality & morbidity.
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