Doctor, What Else Can You Do For My Wife?

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Day 10Patient Reviewed Again• Fever persisted up to 39.5 o C• BP 131-192/66-111 (fluctuating)• P 85-137 (tachycardiac)• Diaphoresis, SaO2 95-97% room air• GCS 13/15 (E4V4M5), mutism• Marked rigidity of 4 limbs (lead pipe) with increasedflexor tone & tremulous limbs• Jerks not increased, plantar downgoing• No clonus / myoclonus• Cardiovascular, chest, abdominal examination:unremarkable
1Discussion:<strong>What</strong> are the DifferentialDiagnoses in this Patient?• Primary Brain Disorders– CNS Infection (meningitis, encephalitis, brainabscess)Negative CSF results– Stroke– Tumor– TraumaNo focal neurologyNormal neuroimagingNormal neuroimagingNo fall / head injuryNormal neuroimaging– Non-Convulsive Status EpilepticusNormal EEG
Page 1 and 2: Doctor,What else can You do for My
Page 3 and 4: Madam Tang• Past Medical History:
Page 5 and 6: Day 1Transfer from Psychiatric Unit
Page 7 and 8: Day 1Special Observation Ward• Af
Page 9 and 10: Day 2Transfer to Cohort Ward• Tra
Page 12 and 13: Discussion:What are the Differentia
Page 14 and 15: Day 1-2Investigations• Complete B
Page 16 and 17: Day 2ECG
Page 18 and 19: Day 2Chest X-Ray
Page 20 and 21: Day 2CT Brain (Plain) Report• No
Page 22 and 23: Day 1-4Temperature ChartD1 D2 D3 D4
Page 24 and 25: Summary / Problemsat this Juncture1
Page 26 and 27: Day 5Lumbar Puncture• Lumbar Punc
Page 28 and 29: Day 1-9Temperature ChartD1 D2 D3 D4
Page 30 and 31: Day 8Septic Workup• Sputum cultur
Page 32 and 33: Day 8Advice fromInfectious Disease
Page 34 and 35: Day 11-15Temperature ChartD11 D12 D
Page 38 and 39: 23Discussion:What are the Different
Page 40 and 41: Discussion:What else Can We Do?•
Page 42 and 43: Discussion:NMS: Clinical Features
Page 44 and 45: Day 10The Clinical Picture is Compa
Page 46 and 47: Day 5-8Blood Pressure/Pulse ChartHy
Page 48 and 49: Discussion:Is Elevated Creatine Kin
Page 50 and 51: Day 1-10Temperature ChartD1 D2 D3 D
Page 52 and 53: Discussion:What else Can We Do?Can
Page 54 and 55: Day 10Drug Record in Our PatientFlu
Page 56 and 57: Discussion:Why is so Important to D
Page 58 and 59: Conclusion:Most Likely Diagnosis in
Page 60 and 61: Discussion:NMS: Epidemiology• Inc
Page 62 and 63: Discussion:Why does this Patient be
Page 64 and 65: Discussion:What is So Special in Ou
Page 66 and 67: Discussion:NMS in Elderlyhttp://hk.
Page 68 and 69: Discussion:NMS in Elderly• Increa
Page 70 and 71: Discussion:Why does our Patient wit
Page 72 and 73: Discussion:Treatment of NMS• Mild
Page 74 and 75: Discussion:Treatment of NMS:Dantrol
Page 76 and 77: Day 11-22Temperature ChartD11 D12 D
Page 78 and 79: Day 12-24Progress• Physiotherapy:
Page 80 and 81: Day 35Progress inConvalescent Hospi
Page 82 and 83: Day 103Discharge• Upon Discharge-
Page 84 and 85: Discussion:SUMMARYWhat Have I Learn
Page 86 and 87:
Discussion:What Have I Learned from
Page 88 and 89:
After Discharge• Followed Up in M
Page 90 and 91:
Discussion:Anti-Psychotics in Elder
Page 92 and 93:
Discussion:NMS after Anti-Psychotic
Page 94 and 95:
Discussion:Age-Related Physiologica
Page 96 and 97:
Discussion:NMS in ElderlyNeurolepti
Page 98 and 99:
Day 2Abdominal X-Ray
Page 100 and 101:
Discussion:What are the Differentia
Page 102 and 103:
Day 5Lumbar Puncture• Lumbar Punc
Page 104 and 105:
Typical vs. Atypical Anti-Psychotic
Page 106 and 107:
Discussion:Risk Factors of NMS• D
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Doctor, What Else Can You Do For My Wife?

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