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The MRI as per the report short white matter lesions, which is suggestive of a demyelinating disease. I would require some additional details inorder to give you a more solid opinion.
1. For how long he is having the symptoms ? How did it progress ?
2. Is there any weakness of legs or arms ? Any trembling ? any memory loss ? any tightness of body ?
3. Any other symptoms as a matter of fact ( A good medical history is very important in Neurological cases )
4. If possible please share the scanned MRI report + 1 or 2 cuts of the film.
5. Was a CSF study done ?
Patient replied :
Whilst I requested for the information, he was transferred to a better hospital in Calcutta, India for treatment. His condition did not improve and doctors there have diagnosed him with Encephalitis. He will have another MRI done today.
1. It has started 2 days before I posted the query to you. First diagnosis was sodium and potassium shortage that has caused brain functions to not work properly! Then, they found there was something in the throat for which they inserted a pipe to check it. Since, then breathing suffered and he went to ventilation. He was brought to Calcutta and the doctors found that the pipe poked the throat and caused a lump there which they removed. Breathing came down to normal since then but he was still in ventilation. Then came complications like high creatinine levels, not responding to people, senselessness and finally yesterday a senior doc diagnosed him with encephalitis.
2. I think encephalitis answers all your questions in point 2. Yes, yes, yes and no.
3. There isn't anything else that I am aware of. Sorry.
4. I have requested for it but his state was serious that his relatives could not send the report photographed/scanned to me. Tomorrow there is another MRI report coming out so I will ask for it.
Further questions: I am assuming right from Day 1, encephalitis virus had set in. Taking into consideration that it is almost 2 weeks now and finally the right diagnosis has taken place, we are afraid the patient may have suffered brain damage. Do you think there is a treatment to encephalitis and a possibility that the risk of brain damage is low even now? I guess an MRI report can show it better but please provide me your knowledge about this disease till I send you the latest reports.
Thank you for the update. Well, my opinion here will be based on very limited information, so please take that into consideration. Always follow your Doctors recommendations.
It seems a immediate diagnosis was not possible in the patient's case. This can occur in Neurological scenarios. In these condition Doctors would presumptively treat all the possible conditions (for example antibiotics, antiviral, anti seizure medications). I am pretty sure that he has got treatment in those lines.
The current diagnosis of encephalitis , I feel will not alter the course of the treatment or prognosis. I am sure this was under consideration. From what your have mentioned - ventilatory support, high creatine levels, neurological deterioration are not good signs. He does have good amount of mortality risk. You need not in lines of brain damage as encephalitis is an infection if he recovers well, his neurological function can be still good (90% or so).
Supportive care is very important - Ventilatory, Nursing, Critical care . I hope he is under good care and wishing all the best.
Hope this helps
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