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EVALUAREA LOMBALGIEI LA UN PACIENT CU RETARD MENTAL USOR

EVALUAREA LOMBALGIEI LA UN PACIENT CU RETARD MENTAL USOR. Vizitiu Alina ̶ m edic rezident Medicina Interna – Spitalul Universitar Bucuresti. C.G, sex M, 34 ani. Anamneza dificila Pacient partial cooperant si fara documente medicale durere acuta in lomba dreapta – fara iradiere ,

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EVALUAREA LOMBALGIEI LA UN PACIENT CU RETARD MENTAL USOR

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  1. EVALUAREA LOMBALGIEI LA UN PACIENT CU RETARD MENTAL USOR Vizitiu Alina ̶ medic rezident Medicina Interna – Spitalul Universitar Bucuresti

  2. C.G, sex M, 34 ani • Anamneza dificila • Pacient partial cooperantsi fara documente medicale • durere acuta in lomba dreapta – fara iradiere, • Greata • Crize convulsive de la 15 ani • Carbamazepina 1cp/zi – intrerupt de ~ 2-3 sapt MI: APP:

  3. Clinic: • afebril; • agitatie psiho-motorie, incoerent si bradilalic; • microadenoamefaciale; • ficat cu MI la 1 cm sub RC, margine rotunjita, consistenta ferma, nedureros la palpare; • RD palpabil, usor sesibil la palpare; • Giordano (+) pe dr; • TA= 110/60 mmHg, AV= 80 bpm, regulat.

  4. Supozitii de diagnostic: • Litiazarenaladreapta • Rinichi polichistic • Formatiunetumoralarenala dreapta • Discopatielombara • Litiaza biliara

  5. Laborator: • HLG • Biochimie in limite normale • SU • Urocultura → negativa

  6. Paraclinic: • EKG • Rg C-P faramodificari

  7. Eco - abdominala Formatiunehiperecogenaseg VI (ᴓ = 50 mm) multiple formatiunineomogene (ᴓ < 54/45 mm)

  8. MarkerihepaticiMarkeritumorali • Ag-HBs →negativ • Ac-HCV →negativ • CEA • AFP in limitenormale

  9. Consult psihiatric • Retard mental usor (IQ= 60)

  10. Eco abdominal – reevaluare: • LSH= 67mm, LDH= 135 mm, formatiunehiperecogena , ᴓ= 54/35 mm (posibilhemangiom) • RS: 89/45mm, cu stergereadiferentierii c-m • RD: 83/48mm, ecostructuradezorganizata

  11. CT- cerbral: • nodulicalcificatisubependimarila nivelul ventriculilor laterali • CT-abdominal: • hepatomegalie(ᴓ cranio-caudal al LDH=19,6 cm), strneomogenaprinprezenta a 4 angiomiolipoame (ᴓ = 1-5 cm) • nefromegaliebilaterala, strcompletdezorganizataprinprezenta a multipeangiomiolipoame (ᴓ= 6 – 8 cm) • fereastra de os – modificariosteocondensante/sclerotice: corpivertebrali L2, L5, oaselorbazinului, viscerosineurocraniului.

  12. SCLEROZA TUBEROASA

  13. Sclerozatuberoasa (B. Bourneville) • Afectiunegenetica cu transmitereautozomaldominanta – gr sdrneuro-cutanate • Tumoribenigne - hamartoame (SNC, tegumente,ochi, inima, rinichi, plamani, intestin,oase,dinti) • Prevalenta -1 caz la 14500 nou-nascuti • Manifestari clinice: leziunicutanate (98%): angiofibroamefaciale, placard frontal, macule hipomelanice, fibroameunghiale(t. Koenen), peteshagreen tulburarineuro-psihice (80%): convulsii, deficit intelectual, tulburari de comportament, autism tumoriviscerale : nodulicalcificatisubependimari(95%), tuberculicorticali(10%), chisturi (20-30%)/angiomiolipoamebilat (60-80%)/carcinomrenale, rabdomiomul cardiac(50-70%), agiomiolipoameretiniene/nv. Optic(50%), leziunischeletice, digestive, hepatice

  14. Dg cert: 2 criteriimajore/ 1 major si 2 minore; Dg probabil: 1major si 1 minor; Dg posibil: 1 major/ >2 minore

  15. Diagnostic pozitiv • Anamneza • Clinic • Imagistic SCLEROZA TUBEROASA

  16. Evolutiesitratament: • Tratamentantispastic, analgezicsianticonvulsivant • Evolutiefavorabila • Rec: - ecocardiografie, FO - terapielasserleziunilecutanate - reevaluare la 3-6 luni

  17. Particularitateacazului • Varstadiagnosticarii ; • Boalapauci-simptomatica; • Neintegrarea intr-un context clinic comun al crizelor convulsive, retardului mental si leziunilor cutanate – triada clasica

  18. Vamultumesc!

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