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 Image
D2. Visited PHC.
Prescribed PVRV (Abhayrab) D2, D5, D8, D13. NO RIG given. Image
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% Image
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 👇 ImageImage
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. Image
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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More from @nirmalregency

Apr 2
Learning through mistakes.
(1/11) 38F. 90kg. No PMH. Fever x 3-4D ☞ body pains.
D6: frequent seizures. Multiple ASMs.
D7: CT head + CSF WNL.
D11: MR brain WNL (not shown).
D13: Repeat CSF WNL.
D16: Repeat MR Brain👇 faint b/l medial temporal hyperintensities.
Acyclovir ✅
(2/11) D19: shifted here.
Seizures ++, mostly over face w/ partial preserved consciousness.
Intubated. 4 ASMs ☞ Ketamine bolus ☞ infusion.
D19: IVIG + IV MPS also started.
Repeat CSF: routine normal. CSF BioFire -ve, including HSV. Acyclovir stopped.
(3/11) CSF autoimmune encephalitis panel -ve👇Serum paraneoplastic antibody panel -ve 👇
Read 16 tweets
Dec 11, 2022
Like to present a case seen in 2017. We were not aware of the entity then. 17F, 15D vomiting, headache. No deficit. Evaluated at institute. Extensive blood/CSF/tropical diseases workup -ve. CSF: P81, G57, cell 30 (all L). IVMPS x 5gm. Discharged with Dx of ADEM. 1st CEMR. (1/8)
8D later readmitted there w/ headache x 3D w/ mild rt ptosis. Again IVMPS x 3gm. Better. Again recurrence of headaches. Both times followup oral steroids not given. Came to us.
2nd CEMR. Similar findings. Slight increase in lesion burden. (2/8)
MR looked odd. We had never seen before. Googled. This paper surfaced. (3/8) pubmed.ncbi.nlm.nih.gov/20639547/
Read 11 tweets
Dec 9, 2022
2nd case of this season. Found in bathroom in unconscious/confusional state. Small bathroom. To start w/ dizzy/headaches & attempt to open door but can’t. Inappropriate ventilation. Prolonged bathroom utilisation. Gas geyser fitted inside.
Same story every year this time around.
Mostly wrongly diagnosed as seizure episode. My 1st case a decade ago & was pointed out by a GP: GAS GEYSER SYNDROME. Mostly the pt is found naked, females & Sikhs more likely because of long hair wash. Takes more time than usual seizure; prolonged confusional state. #MedTwitter
Read 4 tweets

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