Thread by @nirmalregency

We were consulted for a 2nd opinion.
30F. D1. Deep dog bite L cheek while tending fields. Multiple others bitten. Dog was killed the same day by villagers. #NeuroTwitter #MedTwitter #IDtwitter #NeuroRad #Neurology

D2. Visited PHC.
Prescribed PVRV (Abhayrab) D2, D5, D8, D13. NO RIG given.

D16. Fever, uncontrolled vomiting.
D20: admitted. Rx as sepsis.
D22 discharged. No hydro/aerophobia.
D23. Drowsy/unresponsive/taking orally food/water. Readmitted.
NB: Aerophobia is seen in ~50%, Hydrophobia in 10-15%

D23. CEMR done👇 DWI/ADC/GRE/T1+C unremarkable. Became dull, mouth frothing. Ventilated. Virus migrate retrogradely @ up to 250 mm/d through axoplasm > DRG of cord > diencephalon, hippocampus, brainstem. T2/Flair 👇

D24: CSF
~60,000 die per yr, probably more, as many cases go unreported. RIG is usually not prescribed as often it should be. Once you see a rabies patient you will never miss on the RIG.

When I was doing my residency, at LKO railway station I was bitten in my ankle by a huge sewer rat. I washed it thoroughly. I taxied back to the hospital & got both RIG & ARV knowing fully well that rats are not carriers. THAT should be the PANIC when deeply bitten by Dogs.

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@ABStewardess @drtimothyli @BJegorovic @PrathitKulkarni @LyellJ @a_charidimou @Jagan1234 @Narenmbbs @hyderabaddoctor @LD_McCullough @theneurolander @JayKinariwala @Divyani_Garg @DrTusharNeuro @sudhir_kothari @aksbnc @piandro3142 @drpradeepck @DrLKrishnamurt1 @jackie_palace @Vishy89 @abgohel @Tracey1milligan @_aiswarya_raj_ @drvenkimdrd @rkchoi @bobvarkey @caseyalbin @SunilAShethMD @EricGoldsteinMD @drSurjthVattoth
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@ABStewardess @drtimothyli @BJegorovic @PrathitKulkarni @LyellJ @a_charidimou @Jagan1234 @Narenmbbs @hyderabaddoctor @LD_McCullough @theneurolander @JayKinariwala @Divyani_Garg @DrTusharNeuro @sudhir_kothari @aksbnc @piandro3142 @drpradeepck @DrLKrishnamurt1 @jackie_palace @Vishy89 @abgohel @Tracey1milligan @_aiswarya_raj_ @drvenkimdrd @rkchoi @bobvarkey @caseyalbin @SunilAShethMD @EricGoldsteinMD @drSurjthVattoth @EMiddlebrooksMD @LorenzoPinelli @theneuroradguy @drbejoy2002 @drharunyildiz @frankgaillard @PeterGKranz @samrad77 @daniel_gewolb @sarbesh1984 @DrArpitaSahu @BrentWeinberg @drforamgala @NeuroradRogers @VMSilvera @nihaal08 @drmankad @draash @JordiRoldanB A comprehensive recent review on Rabies.
tandfonline.com/doi/full/10.10…

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