Clinical History: 38 years old female who’s illness began at 31 June, 2005 with left lower extremity’s asthenia, feeling of weight and hardly revealed shuffle. During clinical investigation at 2 July, 2005 asthenia of left upper extremity was revealed. Muscular tonus and force of left extremities were decreased. Reflexes were spastic, but pathologic reflexes were not caused. Sensibility was kept. Signs of hypoxia were revealed at eye ground. During last two days increasing of body temperature (38°C) without any catarrhal signs is observed. Paresis had been strengthened: upper extremity obtained classical appearance – rotated forearm, prolapsed hand, lower extremity is rotated inside, shuffled of leg became obvious. Extension of fingers is observed too. Active movements are limited. Force is decreased. Muscular tonus is increased. Reflexes – high with spastic appearance and extended zones. Axils reflex – polykinetic. Pathologic reflexes are not caused.   

Laboratory

Cerebrovascular Triplexsonography:

	Right			Left
	PSP (cm/sec)	EDV (cm/sec)		PSP (cm/sec)	EDV (cm/sec)
DICA	74	28	DICA	81	28
MICA	72	27	MICA	70	26
PICA	50	15	PICA	54	17
ECA	100	9	ECA	94	10
DCCA	95	19	DCCA	88	20
PCCA	136	18	PCCA	136	18
VERT	54	12	VERT	57	13
SUB	-	-	SUB	-	-
OPTH	39	7	OPTH	38	5

Comment: Symmetrical streams in both eye-socket arteries. Cephalic and vertebral arteries’ route – normal, streams – symmetrical. Blood flow – normal. Hemodynamic changes are not observed.

 

Peripheral Blood Counts:

Erythrocytes – 4.0

Hemoglobin – 72 g/L

Color index – 0.2

Leukocytes – 5.6

Eosinophiles – 1.0%

Stab neutrophils – 2.0%

Mature neutrophils – 57.0%

Lymphocytes – 38.0%

Monocytes – 2.0%

Erythrocyte Sedimentation Rate – 12 mm per hour

 

Coagulogram:

Coagulation Time - 5¢35¢¢

Recalcification Time - 190¢¢

Prothrombin Index – 90.0%

Formation of Fibrin Clot - 3¢35¢¢

Concentration of Fibrinogen – 425 mg%

Fibrinolysis – 14.0%

Thrombotest – V stage

Fibrinogen – negative

 

Magnetic-Resonance Tomography Investigation:

Magnetic investigation of brain nervous tissue by T1se-T2tse-flair regimes in sagital, coronoral and axial projections with intravenous contrasting was performed. Infiltrated area at right side in area of brain trunk and thalamus was revealed. Periventricular leukoencephalopathy. 

 

Treatment:

4 - 9 July, 2005:

1) Intravenous transfusions – Ringer, Mexidol, Gliatilin, Vit. C

2) Cavinton Forte per orally 3 times per day

10 July, 2005 till today:

1) Injections - Mexidol, Actovegin 40, Vit. E

2) Lucetam, Valium Roche, Cavinton  Forte, Cardioaspirin (150 mg per day)  - per orally

 

Comments:  Please, write Your opinion and the suggestions about this case and its treatment strategy to Eka Kldiashvili, Ph.D. kldiashvili@georgia.telepathology.org, Georgian Telemedicine Union (Association), Tbilisi, Georgia.