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Disclaimer Note: Any resemblance of the person with the same psychological sufferings is purely COINCIDENTAL and we, the staff of the Dept of Psychiatry and the RLJ Hospital do not intend to cause any hurt/pains to the sentiments of the people. Any resemblance to someone, if any, is purely coincidental and the following examples are intended purely for patients to seek help for their psychological sufferings AND PROMOTE MENTAL HEALTH!

Case 1 - HASHIMOTO ENCEPHALOPATHY -AN AUTOIMMUNE NEUROENDOCRINE DISORDER

HASHIMOTO’S ENCEPHALOPATHY (HE) is a rare steroid responsive neuroendocrine disorder. It occurs with a male to female ratio 1:5.It occurs as a result of toxic effect of increased thyrotropin-releasing hormone on the central nervous system leading to autoimmune vasculitis and disruption of the cerebral microvasculature.
A 26-year-old female was presented with c/o altered sensorium and decreased appetite. Patient is a k/c/o hypothyroidism since 2 years currently not on any medications. Patient intubated i/v/o of low GCS (gcs e3v2m1). On examination pupils were equal and reactive, plantars were flexor, other systemic examinations were within normal limits. Laboratory findings revealed TSH: 54.7UI/ML, T3:0.38ng/ml, T4:4.42 microg/dl; TPO ANTIBODIES: >1300;MRI BRAIN was within normal limits. HASHIMOTO’S ENCEPHALOPATHY (HE) diagnosis was made based on elevated TPO, normal neuroimaging. Patient was treated with steroids and thyroxine supplements. Patient condition gradually improved and she attained euthyroid state.

Case 2 - A RARE CASE OF THYROID MYOPATHY PRESENTED WITH TYPE 2 RESPIRATORY FAILURE

A 35-year-old female k/c/o thyroid disorder since 5years presented with shortness of breath since 5 days. On presentation patient was tachypneic, with 35% room air saturation, ABG – respiratory acidosis, emergency intubation was done and patient was stabilized. Further detailed history revealed h/o proximal muscles weakness since 1 month. Examination revealed exaggerated reflexes. Echo showed global hypokinesia of LV with rEF-30%. TSH value found to be 150 IU/L. CPK was elevated, 1156U/L. Patient was diagnosed of thyroid myopathy with cardiomyopathy with respiratory failure. Patient was started on Tab thyroxine100mcg. Patient was followed up for next 2months with a successful recovery.

Case 3 - HYPOXIC ISCHAEMIC ENCEPHALOPATHY SECONDARY TO ELECTROCUTION

32-year-old female patient with no non-comorbidities came with altered sensorium (reduced responsiveness) to emergency medicine department. Patient was in ventricular fibrillation, after cardioversion and three cycles of CPCR. Patient was revived. Detailed history and examination revealed patient was electrocuted and sustained a cardiac arrest. MRI Brain was done following which patient was later diagnosed with hypoxic ischemic encephalopathy with an added complication of seizures. Patient was treated with injection levetiracetam, injection dexamethasone and injection magnesium sulphate. Patient made a dramatic recovery with no focal neurological deficits and was discharged.

Case 4 - INTERESTING CASE OF PHEOCHROMOCYTOMA

A pheochromocytoma is a rare tumour that grows in an adrenal gland. A 40 year old female who is known case of hypertension came with complaints of headache, vomiting , pain abdomen ,excessive sweating and palpitation . Systemic examination shows heaving apical impulse. ECG showed left ventricular hypertrophy and 2d echo showed concentric LVH .CT brain and USG ,renal artery Doppler were done which were normal. Then MRI abdomen was done which revealed left adrenal gland pheochromocytoma. Laboratory findings showed urine free metanephrines to be 85.2 pg/ml. USG neck was done to rule out MEN syndrome which was normal. Patient was started on prazosin and left adrenalectomy was done by surgeons following which patient improved clinically and became symptom free following which she was discharged.