Opsoclonus Syndrome: A Case Study

I did talk with him about my concern regarding the lesions that are close to the eye and I felt it was very important that he be seen by ophthalmology and this was arranged for him today. He will keep that appointment this afternoon over at Eyesight. I talked about antiviral therapy as he is within a couple days of the onset. He was written for Valtrex 1000 mg three times daily for seven days. In addition, prednisone 10 mg tablets, 40 mg for two days, then 20 mg for two days, then 10 mg for two days. I reviewed the case with Brett Rankin, MD, as I was concerned with the lesions in the ear and my concerns regarding the possibility of this leading to a Ramsay Hunt syndrome. Currently as his hearing is unchanged and there is no facial paralysis issues, I am hoping that will not be worry with the steroids and the antiviral therapy starting. Dr. Rankin talked about doing a hearing evaluation to ensure there is no asymmetry between his two ears, even though the patient perceived that his hearing was okay and that will be arranged for him. He knows he will be contacted by Dr. Rankin's office for that. He knows to contact me if his symptoms worsen in any way. We did talk about the potential complications and he is aware of what to be looking for. A viral culture was performed to confirm the diagnoses, but he understands that may take time to return the results to us. He will monitor symptoms in the

Renal History: The patient learned that he had kidney disease a few years ago. He had a biopsy in October 2012 that showed IgA nephropathy per TGH records. He started dialysis in 2013. Initially, he started peritoneal dialysis for seven months. He had a lot of side effects

Review of the medical record indicates that he had a MVA in 1977 with C4-5 injury that resulted in him been a Quadriplegic. Due to his bedbound and immobility status he has had multiple pressure ulcers over the years that have resulted in hospital admission and rehab stays. Other medical history include, HTN, hyperlipidemia, Sacral pressure ulcer, Right hip pressure ulcer, Constipation, depression. Bilateral arm contractures, bladder cancer, prostate cancer, urostomy and colostomy, aspiration pneumonia, neuropathy and MRSA.

Final diagnoses: (1) Epistaxis secondary to Coumadin, (2) recurrent cancer of vestibule of the mouth, (3) atrial fibrillation, (4) transfusion nonautologous plasma through peripheral vein.

CASE STUDY PROGRESS: The client has now received 3 cycles of combination chemotherapy for her breast cancer. Her last treatment with doxorubicin, cyclophosphamide, and 5-fluorouracil was approximately 12 days ago. She came to the emergency room with a 2-day history of fever, chills, and shortness of breath. On arrival, she is disoriented and agitated. Vital signs are 86/43, 119, 28, 39.8° C, SaO2 85% on room air. Laboratory data include WBC 1.2 thou/cmm, Hct 24.9%, Hgb 8.7 g/dl, platelets 125 thou/cmm. Differential WBC count shows 37% granulocytes, 60% lymphocytes, 3% monocytes. Chem 14 is within normal limits, with the exception of BUN 28 mg/dl, creatinine 1.6 mg/dl, and lactic acid 2.4 mg/dl. Chest x-ray demonstrates diffuse infiltrates in the left lower lung.

On 4 June 2018 at around 2pm, I visited Mr. Mueller at his home located on Fort Drum, NY. Mr. Mueller is awake, alert, and oriented to person and location. When evaluating his hearing, Mr. Mueller is able to repeat whispered words appropriately. Evaluation of breathing pattern while watching his nostrils reveals unlabored breathing with no nasal flaring. Lymph nodes post-auricular, submandibular, and supraclavicular are not swollen and Mr. Mueller does not report pain during palpation of lymph nodes. Assessment of eyes reveals bilateral quick reacting pupils to light. Extraocular movement test is normal; Mr. Mueller is able to follow the pen with his gaze. Lung sounds are clear bilateral, breathing pattern

At today's visit he is awake, alert and oriented. He complains of generalized pain. He states “I have pain all over today, my head, my back, my feet" I have not felt good for the last few days”. He rates his pain as 6/10 in severity; he describes his pain as shooting pain in different places. His pain does

DATA: Today’s group has been facilitated by Kirsten again, and includes relapse, what it is, and how each client can prevent it. Being that relapse is a process, it is an ongoing situation that can be interrupted, rather than a static event that is over and cannot be changed. It involves the individual reverting to old attitudes, beliefs, values, and risk behaviors. These are part of a progressive pattern, and will worsen until the process is interrupted or changed. Relapse is not a sign of failure, and, at times, may be part of the recovery process. There are times when individuals are more vulnerable to relapse, specifically, when they are too hungry, angry, lonely, or tired (HALT), and need to be aware of this vulnerability, and take

Also, if caught early enough, the less likely there will be residual brain damage and memory impairment. Treatment for WKS is immediate administration of thiamine. Thiamine doses differ from patient to patient depending on severity of the WKS. Oral thiamine supplements are not effective in severe cases because of the liver damage and disrupted thiamine metabolism. It usually is administered intramuscularly. Taking the thiamine may not completely reverse all damage, but can prevent the progression of the disease. Also, a few lifestyle changes should be made, including a complete diet and refraining from heavy

DMTs reduce the relapse rate but some also reduce brain atrophy and slow disease progression. Medications such as one of the injectable INFs or glatiramer acetate are first line recommendations due to their long history of safety and efficacy. However, in the last ten years the options for treatment have grown substantially with the introduction of DMTs with better dosing schedules and administration routes. There are now three oral medications that all have different mechanisms of action: fingolimod, dimethyl fumarate and teriflunomide. They are all now used as first line treatments or to replace INFs or glatiramer acetate in patients who have developed neutralizing antibodies that have reduced the effects of those medications. Several second line treatments have been developed to treat patients who either did not respond to first line treatments or have progressive types of MS. They include an immunosuppressant chemotherapy agent (mitoxantrone) and two monoclonal antibody medications (alemtuzumab and natalizumab). These medications are available by infusion only and have much riskier side effects including the development of other auto-immune disorders and progressive multifocal leukoencephalopathy (which can be fatal). DMTs are approved for patients with relapsing forms of MS, but patients with non-remissive courses have fewer treatment options. For example,

The patient appeared to be alert, very engaging during the counseling session, and No evidence of SI/HI. The patient does his treatment plan goals in every counseling session and his coping mechanism.

4- Was the transplant given for recurrent PB or one time occurrence with other signs of failed Fontan.

noted. He will follow up in 3 months when further injections are needed. He is to

However, the results of many clinical trials promulgate its inefficacy and unreliability, with high relapse rates and a dependence on therapist competence.13

Addiction is a “chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.” The initial decision to take drugs is voluntary for most individuals, but frequent drug use can lead to brain alterations that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain alterations can be persistent, which is why drug addiction is considered a "relapsing" disease. People in recovery from drug use disorders are at increased threat for returning to drug use even after years of not taking the drug. It's common for an individual to relapse, but relapse doesn't mean that treatment doesn’t work. As with other chronic health conditions, treatment should be constant and should be adjusted based on how the patient answers. Treatment plans need to be reviewed often and modified to fit the patient’s changing desires.