A*******s
发帖数: 9638 | 1 A 49 yrs old male presented with loss of taste and smell. It happened
about 3-6 months ago and he could not specify which function he has lost
first. He denies any other symptoms.
PMH/SH/FMH/ROS are all unremarkable.
PEs are normal except ageusia and anosmia.
His MRI of Brain is normal.
ENT consult is pending.
What does he mostly like have? |
s**********t
发帖数: 217 | 2 Have seen one with CNS sarcoidosis. It is unlikely in this case with normal
MRI. Need to rule out ENT tumor. Or just as simple as sinusitis, DM or
hypothyroidism. |
A*******s
发帖数: 9638 | 3 Good try.
Sinusitis rarely causes ageusia.
normal
【在 s**********t 的大作中提到】
: Have seen one with CNS sarcoidosis. It is unlikely in this case with normal
: MRI. Need to rule out ENT tumor. Or just as simple as sinusitis, DM or
: hypothyroidism.
|
s**********t
发帖数: 217 | |
A*******s
发帖数: 9638 | 5 Nope
【在 s**********t 的大作中提到】
: wegener
|
b******a
发帖数: 704 | 6 "PMH/SH/FMH/ROS are all unremarkable.
PEs are normal except ageusia and anosmia.
His MRI of Brain is normal. "
Normal PE & history ruled out inflammation in sinus nasal & oral cavity/nasal
polyps, surgery or trauma, drug induced toxicity, Alzhermer dz, Pakingson's
dz.
Normal MRI may rule out brain tumor, MS, brain injury.
Patient has both ageusia and anosmia ruled out thalamus defect?
He is too young for a normal aging.
How about endocrine diseases such as diabetes (should have other sympteoms),
hypothyroidism? Need check blood tests.
Or poor dental hygiene induced dental diseases? |
A*******s
发帖数: 9638 | 7 Nice analysis.
His blood work was also normal.
nasal
s
【在 b******a 的大作中提到】
: "PMH/SH/FMH/ROS are all unremarkable.
: PEs are normal except ageusia and anosmia.
: His MRI of Brain is normal. "
: Normal PE & history ruled out inflammation in sinus nasal & oral cavity/nasal
: polyps, surgery or trauma, drug induced toxicity, Alzhermer dz, Pakingson's
: dz.
: Normal MRI may rule out brain tumor, MS, brain injury.
: Patient has both ageusia and anosmia ruled out thalamus defect?
: He is too young for a normal aging.
: How about endocrine diseases such as diabetes (should have other sympteoms),
|
b******a
发帖数: 704 | 8 Psychological disorder: stress induced ?
Anything helpful from ENT consult?
Otherwise, idiopathic, hehe. |
A*******s
发帖数: 9638 | 9 Imagine if you tell him his problems are psychological or idiopathic, what
response would you get most likely? :)
ENT could not find anything wrong but comfirmed his problems. Of course they
are subjective.
【在 b******a 的大作中提到】
: Psychological disorder: stress induced ?
: Anything helpful from ENT consult?
: Otherwise, idiopathic, hehe.
|
a**e
发帖数: 5094 | 10 medication list?
【在 A*******s 的大作中提到】
: A 49 yrs old male presented with loss of taste and smell. It happened
: about 3-6 months ago and he could not specify which function he has lost
: first. He denies any other symptoms.
: PMH/SH/FMH/ROS are all unremarkable.
: PEs are normal except ageusia and anosmia.
: His MRI of Brain is normal.
: ENT consult is pending.
: What does he mostly like have?
|
|
|
A*******s
发帖数: 9638 | 11 None.
【在 a**e 的大作中提到】
: medication list?
|
D*********t
发帖数: 140 | |
A*******s
发帖数: 9638 | 13 Polyps cause neither anosmia nor aguesia
【在 D*********t 的大作中提到】
: nasal polyps?
|
y******a
发帖数: 590 | 14 any dry eyes or dry mouth? how is his fasting glucose level? |
A*******s
发帖数: 9638 | 15 Didn't ask, but he did not complain either. His non-fasting CMP was also
normal.
He did not have any signs of joint pain, skin rash, allergies or anemia.
【在 y******a 的大作中提到】
: any dry eyes or dry mouth? how is his fasting glucose level?
|
y******a
发帖数: 590 | 16 I just saw a patient with sensorimotor polyneuropathy with negative SSA/SSB,
biopsy confirmed sjogren. |
A*******s
发帖数: 9638 | 17 Which tissue got biopsy?
SSB,
【在 y******a 的大作中提到】
: I just saw a patient with sensorimotor polyneuropathy with negative SSA/SSB,
: biopsy confirmed sjogren.
|
y******a
发帖数: 590 | 18 sorry my laptop just got infected with " privacy protection" a rogueware.
headache.
it was salivory gland bx. I will post the story later.
【在 A*******s 的大作中提到】
: Which tissue got biopsy?
:
: SSB,
|
A*******s
发帖数: 9638 | 19 Sound like a great case. Does the patient suffer from ageusia? I would
doubt the patient has anosmia though.
Polyneuropathy may affect multiple nerves, but rarely has cranial nerve
involvement, especially so selective.
You are on right track, it is a nerve system problem. Have you thought about
CNS instead of PNS?
【在 y******a 的大作中提到】
: sorry my laptop just got infected with " privacy protection" a rogueware.
: headache.
: it was salivory gland bx. I will post the story later.
|
y******a
发帖数: 590 | 20 Viral infection related neuropathy?
My pt has cranial nerve involvement, her sensory loss started from her face.
I didn't ask her about ageusia or anosmia. She complained about dry mouth
, however she also has sensory loss inside her mouth, so it was ambiguous.
我以后用中文写这个case，省得惹麻烦。 |
A*******s
发帖数: 9638 | 21 You may alter the race and story. Chinese writing is also a good way to go.
This patient is likely developping neurodegenrative diseases, like Parkinson
's or alzheimer's disease. Someone mentioned this but did not stick to it.
These non-motor symptoms can occur several years or even a decade prior to
motor symptoms in Parkinson's disease.
A disease modifying therapy can be introduced in this case.
face.
mouth
【在 y******a 的大作中提到】
: Viral infection related neuropathy?
: My pt has cranial nerve involvement, her sensory loss started from her face.
: I didn't ask her about ageusia or anosmia. She complained about dry mouth
: , however she also has sensory loss inside her mouth, so it was ambiguous.
: 我以后用中文写这个case，省得惹麻烦。
|
b******a
发帖数: 704 | 22 只有书面知识， 没有经验，以及动态的考虑，所以才不能stick to the possible
right Dx.
很好的学习案例。 非常感谢。
有没有半个包子的精神奖励的?
Parkinson
【在 A*******s 的大作中提到】
: You may alter the race and story. Chinese writing is also a good way to go.
: This patient is likely developping neurodegenrative diseases, like Parkinson
: 's or alzheimer's disease. Someone mentioned this but did not stick to it.
: These non-motor symptoms can occur several years or even a decade prior to
: motor symptoms in Parkinson's disease.
: A disease modifying therapy can be introduced in this case.
:
: face.
: mouth
|
