This is a CT scan of a 67 year old who is oriented but has been extremely sleepy and drowsy (sleeps almost 23 hrs a day). He is also dizzy and walks unsteadily. No certain gait, just needs someone to fully support him while walking. Neurological examination shows no significant findings.
This is the CT scan done 3 days after the onset of his condition. Is a cerebral ischemic event responsible, or should we look for another cause?
https://www.mediafire.com/?5tffxo3gt5566ye
Dear Dr. Alia,
This a typical case of "Sheikh's Syndrome". See the London Conference presentation of mine.
I am Prof. Dr. Shahid H. Sheikh, Sr. Research Scientist of NIDS Treatment & Research Center, Lahore Pakistan. Call me on my personal phone: 92300-481-6677
https://fbcdn-video-m-a.akamaihd.net/hvideo-ak-xfl1/v/t42.1790-2/11955130_870267759726607_1688029755_n.mp4?efg=eyJybHIiOjMwMCwicmxhIjoyNzMyfQ%3D%3D&rl=300&vabr=127&oh=90ead762a03839549f170528f6eaebca&oe=55EFFCE9&__gda__=1441791707_efb9d395e2567b5a8f9f709909f4237e
Then Run the following Blood Tests.
1. HSV TyPe I IgG & IgM
2. HSV- Type II IgG & IgM
3. CMV IgG & IgM.
4. Lipids Profile
5. CBC
Then Call me.
Best Regards.
Dr. Sheikh
It looks like there an area of ischemia on the left side, and the MCA of the same side appears too well defined, which may be a sign of ischemia.
Dear colleague, as far as I know an ischemic lesion could produce such a sleepy state if it is localized in the medial thalamus, mostly bilaterally. In the CT scan showed I'm not able to find any lesion so, since the scan has been performed 3 days after the onset of the symptoms, it doesn't seem to be an ischemic lesion. I think it's worthy to look for another cause and to perform MRI, if it is possible, and a spinal tap. With best reguards, Fabio M. Corsi
Hypodense areas in both cerebellar hemispheres, with one-side pedunculus involvement, could be the cause of vertigo and gait ataxia, and somnolence - the result of reticular formation irritation
There appear to be multifocal hypodensities in the cerebellum and possible lesions in the diencephalon. I favor an ischemic process involving the vertebro-basilar system (posterior circulation), which would be consistent with the acute onset and the symptoms of unsteadiness and somnolence. Similar somnolence -but typically associated with impaired orientation and memory - is characteristic of the "top of the basilar" syndrome. An MRI with diffusion-weighted images would help diagnostically.
A spinal tab was performed. It was clear.
The patient was found hyponatrimic. His Na was 110mEq/L. He was admitted immediately to the ICU. His Na has been titrated and now it is at 133mEq/L. It is suspected to be a viral or bacterial encephalitis. ADH levels were high (SIADH), and it is suspected to be caused by the infection. Because the patient was already given Cefurexime, there were no bacteria in the CSF. CSF came clear. However the patient is kept on 4 antibiotics in the ICU. His fever has subsided. Right now the patient is improving and there's no neurological deficit. However his speech is somewhat sluggish and heavy (He has hypothyroidism, and he has stopped talking Levothyroxine (125mg) a day before this CT was taken, and 2 days after, that is a total of 4 days).
He has been fully oriented for the past 2 days, however today he experienced some moments of confusion. But motor function is intact.
Right now, doctors are waiting for blood culture results to rule out septicemia.
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