Tuesday, November 25, 2008

Discoid lupus

A young lady in station 5 in MRCP or short case in medical students with these skin lesions on the face can only be discoid lupus. As have been mentioned before, discoid lupus is one of the criteria for the diagnosis of SLE. There is atrophy with scarring and hyperpigmented lesions on the face. Do not forget to look at the hair and you will notice scarring alopecia.
I saw this young lady in the combine clinic.

Saturday, November 8, 2008

Non medical Books

Well, these would be useful for medical students. If you are interested, pls drop me an email at thienthienlim@gmail.com. I hope I don't need them anymore !

These books are simple to read.

Thursday, November 6, 2008

Wallenberg syndrome

video video

A common case but may be underdiagnosed. I was informed by my fellow colleague regarding this interesting case. This patient is a 67 years old Indian man who is a known case of hypertension and diabetes mellitus for the past 10 years. He presented with difficulty in swallowing for the past 2 days associated with unsteady gait.
From the video, you will notice the following :
1) Patient is on a ryles tube and there is hoarseness of voice
2) R Horner's syndrome (miosis and ptosis seen)
3) Lack of movement of the R soft palate causing uvula pulled to the L
4) Reduced pin prick of the R face (inconsistent when I tested for this)
5) Bilateral cerebellar signs
6) Reduced pin prick L half of the body

This patient has R posterior inferior cerebellar infarct (PICA) also known as Wallenberg syndrome. This common stroke is caused by infarction of a wedge of lateral medull lying posterior to the inferior olivary nucleus. Let me try to explain the signs -
1) Nucleus ambiguus and fibers of IXth and Xth CN
2) Descending synpathetic tract
3) Nucleus ambiguus and fibers of IXth and Xth CN
4) Descending tract and nucleus of the V nerve
5) R cerebellar - ?restiform body, cerebellar hemisphere, olivocerebellar fibres, spinocerebellar tract, L cerebellar - patient also had an old infarct at the L cerebellar hemisphere(encephalomalacia from the CT scan)
6) Spinothalamic tract

Thanks to my radiologist, we will proceed for a CT angiogram soon.