Neuromuscular complications of Cancer and Cancer Chemotherapy доклад по теме Здоровье и Медицина

Вашему вниманию предлагается доклад и презентация по теме Neuromuscular complications of Cancer and Cancer Chemotherapy. Данны материал, представленный на 13 страницах, поможет подготовится к уроку Здоровье и Медицина. Он будет полезен как ученикам и студентам, так и преподавателям школ и вузов. Вы можете ознакомиться и скачать этот и любой другой доклад у нас на сайте. Все материалы абсолютно бесплатны и доступны. Ссылку на скачивание Вы можете найти вконце страницы. Если материал Вам понравились – поделитесь им с друзьями с помощью социальных кнопок и добавьте сайт в закладки в своем браузере.
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Case
69 yr old female
Known non small cell cancer of lung
Post 4th cycle of chemotherapy
Cisplatin
Vinotubuline
Ongoing radiotherapy
Admitted to Oncology ward
Complaints:
Worsening pins and needles both legs
Vibrations through arms and legs
Shooting pains both legs
Dropping things held in hands
Worsening gait/ stiff legs/ unsteadiness
Decreased awareness of bladder fullness
Case 69 yr old female Known non small cell cancer of lung Post 4th cycle of chemotherapy Cisplatin Vinotubuline Ongoing radiotherapy Admitted to Oncology ward Complaints: Worsening pins and needles both legs Vibrations through arms and legs Shooting pains both legs Dropping things held in hands Worsening gait/ stiff legs/ unsteadiness Decreased awareness of bladder fullness
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Symptoms started after 3rd cycle of chemotherapy
Worsened abruptly after 4th cycle
Constipation and incontinence of feces
Decreased urinary stream
On amitriptyline
Symptoms started after 3rd cycle of chemotherapy Worsened abruptly after 4th cycle Constipation and incontinence of feces Decreased urinary stream On amitriptyline
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O/E:
Motor system:
Feet in dropped posture while sitting
Pseudoathetosis upper limbs worst on right
grade 4+/5 in all four limbs and preserved reflexes and down going plantars
Ataxic on finger nose
Sensory:
Decreased pin prick, light touch glove and stocking distribution up to groins bilaterally in lower limbs and upto mid arm bilaterally in upper limbs
Decreased proprioception toes/ ankles/ fingers/ wrists bilaterally
Decreased vibration sensation toe/ankle bilaterally
Rombergs positive
Gait 
Ataxic with broad base
O/E: Motor system: Feet in dropped posture while sitting Pseudoathetosis upper limbs worst on right grade 4+/5 in all four limbs and preserved reflexes and down going plantars Ataxic on finger nose Sensory: Decreased pin prick, light touch glove and stocking distribution up to groins bilaterally in lower limbs and upto mid arm bilaterally in upper limbs Decreased proprioception toes/ ankles/ fingers/ wrists bilaterally Decreased vibration sensation toe/ankle bilaterally Rombergs positive Gait Ataxic with broad base
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Mobility:
Transfer with light assistance and 4WW
Gait: 
Difficulty holding 4 WW
Ataxic Gait
Light assist to close standby
Mobility: Transfer with light assistance and 4WW Gait: Difficulty holding 4 WW Ataxic Gait Light assist to close standby
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Labs:
Folate and Vit B12 normal
TFT Normal
Antibodies:
ANA negative
Antineuronal Ab negative
Anti Purkunje Cell Ab Negative
Anti Hu/ Yu negative
CSF: 
Proteins 0.48	Gluc	3.3
RBCs 150	PMN 	2
Cytology:?
Labs: Folate and Vit B12 normal TFT Normal Antibodies: ANA negative Antineuronal Ab negative Anti Purkunje Cell Ab Negative Anti Hu/ Yu negative CSF: Proteins 0.48 Gluc 3.3 RBCs 150 PMN 2 Cytology:?
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Severe sensory neuropathy consistent with Cisplatin induced neuropathy
Severe sensory neuropathy consistent with Cisplatin induced neuropathy
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Oncology Review
Odd presentation of Cisplatin induced neuropathy
Progressively worsened for more than 2 weeks post chemotherapy
Low cumulative dose of 249 mg/m2
Other possibilities:
Paraneoplastic peripheral neuropathy
Autoimmune neuropathy
Oncology Review Odd presentation of Cisplatin induced neuropathy Progressively worsened for more than 2 weeks post chemotherapy Low cumulative dose of 249 mg/m2 Other possibilities: Paraneoplastic peripheral neuropathy Autoimmune neuropathy
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Neurology Review
Dorsal root ganglionitis consistent with paraneoplastic neuropathy
Should improve with treatment of cancer
Other Differentials:
Paraproteinemia
Sjogren’s Syndrome
Recommendations:
Check EPG/ Syphilis
VDRL 1:16 false positive
EPG reported as normal
IVIG 0.4 g/kg for five days
Neurology Review Dorsal root ganglionitis consistent with paraneoplastic neuropathy Should improve with treatment of cancer Other Differentials: Paraproteinemia Sjogren’s Syndrome Recommendations: Check EPG/ Syphilis VDRL 1:16 false positive EPG reported as normal IVIG 0.4 g/kg for five days
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TREATMENT
Indwelling catheter
Decreased amitriptyline dose
Fluids
IVIG
TREATMENT Indwelling catheter Decreased amitriptyline dose Fluids IVIG
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PROGRESS
Developed AF rate controlled with metoprolol
Muscle spasms improved with diazepam
Continue to worsen functionally
Transferred to rehabilitation C
2 controlled falls
Diazepam tapered
Gabapentin commenced
Mobility improved with physiotherapy to independent on frame
Bowel and bladder continent
PROGRESS Developed AF rate controlled with metoprolol Muscle spasms improved with diazepam Continue to worsen functionally Transferred to rehabilitation C 2 controlled falls Diazepam tapered Gabapentin commenced Mobility improved with physiotherapy to independent on frame Bowel and bladder continent
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DISCHARGE PLAN
Respite pending home modifications
Driving license suspended
Taxi vouchers
DVA personal alarm
Small aids
Home modification
DISCHARGE PLAN Respite pending home modifications Driving license suspended Taxi vouchers DVA personal alarm Small aids Home modification
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NEUROMUSCULAR
COMPLICATIONS OF
CANCER
NEUROMUSCULAR COMPLICATIONS OF CANCER
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