text
stringlengths 0
4.02k
|
|---|
then DDI. He developed chronic diarrhea and was switched to D4T in 1/95. However, he developed severe neuropathy and this was stopped 4/95. The diarrhea recured. He has Acyclovir resistant genital herpes and generalized psoriasis. He most recent CD4 count (within 1 month of admission) was 20. |
FHX: |
HTN and multiple malignancies of unknown type. |
SHX: |
Homosexual, in monogamous relationship with an HIV infected partner for the past 3 years. |
EXAM: |
7/14/95 (by Internal Medicine): BP134/80, HR118, RR16 on vent, 38.2C, Intubated. |
MS: Somnolent, but opened eyes to loud voices and would follow most commands. |
CN: Pupils 2.5/3.0 and "equally reactive to light." Mild horizontal nystagmus on rightward gaze. EOM were otherwise intact. |
MOTOR: Moved 4 extremities well. |
Sensory/Coord/Gait/Station/Reflexes: not done. |
Gen EXAM: Penil ulcerations. |
EXAM: |
7/17/96 (by Neurology): BP144/73, HR59, RR20, 36.0, extubated. |
MS: Alert and mildly lethargic. Oriented to name only. Thought he was a local hospital and that it was 1/17/1994. Did not understand he had a brain lesion. |
CN: Pupils 6/5.5 decreasing to 4/4 on exposure to light. EOM were full and smooth. No RAPD or light-near dissociation. papilledema (OU). Right lower facial weakness and intact facial sensation to PP testing. Gag-shrug and corneal responses were intact, bilaterally. Tongue midline. |
MOTOR: Grade 5- strength on the right side. |
Sensory: no loss of sensation on PP/VIB/PROP testing. |
Coord: reduced speed and accuracy on right FNF and right HKS movements. |
Station: RUE pronator drift. |
Gait: not done. |
Reflexes: 2+/2 throughout. Babinski sign present on right and absent on left. |
Gen Exam: unremarkable except for the genital lesion noted by Internal medicine. |
COURSE: |
The outside MRI was reviewed and was notable for the left frontal/parietal mass lesion with surround edema. The mass inhomogenously enhanced with gadolinium contrast. |
The findings were consistent most with lymphoma, though toxoplasmosis could not be excluded. He refused brain biopsy and was started on empiric treatment for toxoplasmosis. This consisted of Pyrimethamine 75mg qd and Sulfadiazine 2 g bid. He later became DNR and was transferred at his and his partner's request Back to a local hospital. |
He never returned for follow-up. |
CC: |
Sudden onset blindness. |
HX: |
This 58 y/o RHF was in her usual healthy state, until 4:00PM |
1/8/93, when she suddenly became blind. Tongue numbness and slurred speech occurred simultaneously with the loss of vision. The vision transiently improved to "severe blurring" enroute to a local ER |
but worsened again once there. While being evaluated she became unresponsive, even to deep noxious stimuli. She was transferred to UIHC for further evaluation. Upon arrival at UIHC her signs and symptoms were present but markedly improved. |
PMH: |
1) Hysterectomy many years previous. 2) Herniorrhaphy in past. 3) DJD |
relieved with NSAIDs. |
FHX/SHX: |
Married x 27yrs. Husband denied Tobacco/ETOH/illicit drug use for her. |
Unremarkable FHx. |
MEDS: |
none. |
EXAM: |
Vitals: 36.9C. HR 93. BP 151/93. RR 22. 98% O2Sat. |
MS: somnolent, but arousable to verbal stimulation. minimal speech. followed simple commands on occasion. |
CN: Blinked to threat from all directions. EOM appeared full, Pupils 2/2 decreasing to 1/1. +/+Corneas. Winced to PP in all areas of Face. +/+Gag. Tongue midline. Oculocephalic reflex intact. |
Motor: UE 4/5 proximally. Full strength in all other areas. Normal tone and muscle bulk. |
Sensory: Withdrew to PP in all extremities. |
Gait: ND. |
Reflexes: 2+/2+ throughout UE |
3/3 patella, 2/2 ankles, Plantar responses were flexor bilaterally. |