PBL GROUP 3 CASE 4 by Ain Solehah https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn en-us 2024-11-16 11:29:15 UTC 2024-11-18 04:49:53 UTC hello@padlet.com TRIGGER 1 https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221243317 2024-11-18 02:55:50 UTC https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221243317 TRIGGER 1 https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221243832

  • 27-year-old Caucasian female

  • painful monocular vision loss

  • last two days - acute ( allergic , trauma )

    • ]]>     2024-11-18 02:56:03 UTC https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221243832     TRIGGER 1 https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221244292 A 27-year-old Caucasian female

    painful monocular vision loss

    last two days



    FURTHER QUESTIONING

    • SITE - exact location? ( right or left )

    • ONSET - first notice vision loss

    • CHARACTERISTIC -stabbing pain

    • RADIATES - to anywhere

    • ASSOCIATED SYMPTOMS - any other symptom ,diabetic? , HTN , retinal detachment ( orang rabun tinggi can lead to vision loss)

    • SEVERITY - 1 to 10

    • PMH - medication?

    • FAMILY HISTORY - genetic ? , multiple sclerosis ( autoimmune ds where immune system attack myelin sheath , Caucasian ) , ada family yang rabun ?

    • SOCIAL HISTORY - alcohol consumption , occupation

    • TRAVEL HISTORY - ( infection , dengue , gum bleeding )


      DIFFERENTIAL DIAGNOSIS

    • infection

    • trauma

    • cataract

    • multiple sclerosis

    • sinusitis

    • glaucoma

    • rabun

    • Diabetic neuropathy

    • medication

    • optic neuritis



    ]]>     2024-11-18 02:56:15 UTC https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221244292     TRIGGER 2 https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221325198

  • paraesthesia - pin and needle

    • ]]>     2024-11-18 03:39:06 UTC https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221325198     TRIGGER 2 https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221329072

  • Initially she developed discomfort in the left eye which

  • became worse with

    • eye movements, followed by

    progressive blurring of left eye vision; in particular,

    • coloured objects appeared pale or washed out compared with

    their appearance through her right e

    ye. There were no right eyesymptoms.

    • Past medical history

    There was no previous ocular history. While giving a detailed history, she

    recalled fleeting episodes of limb paraesthesia several times in the past

    year lasting minutes, with no other history of transient neurological

    symptoms. Past history of asthma but took no regular medications.

    • Medication history

    The patient was not on prescription or OTC medication.

    No history of head/eye trauma or surgical procedures

    • Family history

    She had a cousin with multiple sclerosis (MS) and she was very

    concerned about her own risk of developing the condition.

    • Social history

    There was no history of alcohol abuse or illicit drug use

    ]]>     2024-11-18 03:41:29 UTC https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221329072     TRIGGER 2 https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221338546

  • Initially she developed discomfort in the left eye which - effect optic nerve before optic chiasm

  • became worse with

    • eye movements, followed by

    progressive blurring of left eye vision; in particular,

    • coloured objects appeared pale or washed out compared with

    their appearance through her right e

    ye. There were no right eyesymptoms.

    • Past medical history

    • There was no previous ocular history. - first time

    • While giving a detailed history, she

    recalled fleeting episodes of limb

    paraesthesia several times in the past

    year lasting minutes, with no other

    history of transient neurological -

    history of nerve

    • Past history of asthma but took no regular medications.

    • Medication history .The patient was not on prescription or OTC medication - might get Multiple sclerosis

    • No history of head/eye trauma or surgical procedures

    • Family history

    She had a cousin with multiple sclerosis (MS) and she was very

    concerned about her own risk of developing the condition.

    • Social history

    There was no history of alcohol abuse or illicit drug use


    • DIFFERENTIAL DIAGNOSIS

    • infection

    • trauma

    • cataract

    • multiple sclerosis

    • sinusitis

    • glaucoma

    • rabun

    • Diabetic neuropathy

    • medication

    • optic neuritis


    • FURTHER INVESTIGATION

    • BReHeT ( BP , respiratory rate , HR , temperature )

    • Temperature high , WBC high , ESR ( inflammation )

    • pain , heat , redness , loss of fx , swelling ( sign of acute inflammation )

    • Eye movement test ( ishihara test )

    • Visual acuity test ( snellen test )

    • RAPD

    • Weber test ( to check for photophobia and neck stiffness )




    ]]>     2024-11-18 03:48:19 UTC https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221338546     TRIGGER 3 https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221356865

  • left eye red desaturation - nampak merah pudar


    • ]]>     2024-11-18 03:59:56 UTC https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221356865     TRIGGER 3 https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221365824

  • Vital signs were normal - no fever, no hypertension, no hypotension

  • Visual acuity was 20/20 on the right eye and 20/40 on the left.

    • nearsightedness (myopia) on the left eye

  • Visual fields were full to confrontation

    • normal peripheral vision and central vision

  • left eye red desaturation and abnormal colour vision on Ishihara plate testing

    • abnormal colour vision - cone photoreceptor damage

  • left relative afferent pupillary defect was noted

    • optic nerve damage

  • On ophthalmoscopy, the cornea, anterior chamber, lens and vitreous humour appeared normal in both eyes, as did both optic discs. There were no haemorrhages or other abnormal retinal findings

  • Eye movements were normal, but she found looking to the extremes of gaze painful in the left eye

  • No other abnormal neurological findings were detected.

  • The remainder of the cranial nerve examination was normal. Strength, coordination, and sensation were normal, as was a gait examination.

    • cerebellum normal, other nerve normal

  • systemic examination was unremarkable


    • ]]>     2024-11-18 04:08:02 UTC https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221365824     TRIGGER 3 https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221423184

  • DIFFERENTIAL DIAGNOSIS

  • infection

  • trauma

  • cataract

  • multiple sclerosis

  • sinusitis

  • glaucoma

  • rabun

  • Diabetic neuropathy

  • medication

    • optic neuritis

    MOST LIKELY: optic neuritis secondary to multiple sclerosis

    triad:

    • cranial nerve signs - nystagmus

    • motor and sensory impairment - paresthesia

    • unilateral visual impairment

    • DR haplotype at 6 chromosome

    • environmental factor: away from equator, low vit D, low sunlight exposure

    • BBB dysfx - cover rosak

      1. central nervous system - UMN sxs

      2. disseminating in time - on off

      3. disseminating in place - cerebellum, cerebrum, brainstem, spine (tempat lain lain)


      Further ix

    • FBC - normal, MCH, MCV, MCHC, hematocrit, platelet, WBC

    • MRI of brain - white matter plaque

    • Serology test - Ig G level increase

    • CSF

    • OPTICAL COHERENCE TOMOGRAPHY

    • CRP

    • BLOOD GLUCOSE


    ]]>     2024-11-18 04:49:52 UTC https://padlet.com/nurainsolehah16/l9vk5jmopr5pdimn/wish/3221423184