Saturday, October 20, 2012

Tumefactive MS (multiple sclerosis)

In our hospital we deal with a lot of WEIRD/uncommon diseases. One of the weird ones I've encountered is tumefactive MS. I hadn't ever heard of this and I had to do some research on this. I also spoke with one of our neurologists. Especially considering my aunt has MS and when they started treatment for my patient, it was completely different than the normal.

I'll give you some background cuz how this pt came to us is unusual.... the pt is a new mom, still a teenager (therefore should have gone to paediatrics, but didn't) and when she was brought to the hospital it was because her family thought she had post partum depression (PPD).... she was sleeping like 20 hrs a day and had stopped taking care of herself and her baby. The crazy thing is that she had been like this for 2+ WEEKS before they brought her to the hospital!!! Her BF admitted that he had been oblivious to what was going on with her and the only reason they brought her to the hospital was because she had gone crazy on her BF's head when he tried to push her into having a shower.

Now, I will at least give the physician's at our hospital a kudos because when they received her, they gave her a head CT - but after they put her on a form 1 (involuntary psych hold for 72 hrs for assessment) and gave her the diagnosis of "psychosis" - which even after a definitive diagnosis still follows her throughout her stay at the hospital, and IMO is ridiculous!

When they did the CT scan they found FIVE lesions on her brain - HOLY CRAZY BAT MAN!!! Because of this all he brain was swollen and put all together caused a massive decrease in her LOC and mental capabilities.

When she came to our unit, I asked her our person, place, and time questions but made it more personal, this is how it went...

me: "can you tell me what month we're in..."
her: "it's June"
my thoughts - ok we're only off by 4 months LOL
me: "ok, what day is it..."
her: "the 27th"
my thoughts - yep we sure are off like 3 weeks!
me: "well then, what year are we in..."
her: "1994"
me.... trying VERY hard not to giggle at her.... we're only off like 18 yrs....

I looked at her mom and said, "isn't that her birthday?" Ya sure is....

When I asked her about what gender her baby was, she told me that she had had a boy

that's when I knew she was in deep trouble because there isn't ANY mother that would screw up the gender of their child unless there's something major going on!

When they started treatment for her, they started her on solu medrol (aka prednisone - aka steroid)but no meds that decrease the demyelinization that occurs with MS... that's when I asked the neurologist why they did this....

I guess the difference between regular MS and this kind is that it's a fast acting MS and causes lesions to occur in the brain and therefore the solumedrol will decrease this.... the freakiness of this condition is that it attacks fast and mimics a lot of other neuro conditions and is often mis diagnosed as a brain tumor which is dealt with differently and could lead to the patient's demise.

Even 4 days on a high level of this steroid there wasn't much change in her neurological status until they doubled the dose... now she's a spit fire and soon will need to have rehab to try to gain what this condition has robbed her of. Patient's like these make me wish that I could follow them along because it's soooo interesting.

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