SLIDE 3 3
Zuckerberg San Francisco General
Presentation Title 9
Patient MJ
- On initial evaluation in the UCSF Neuro-Immunology Clinic,
she reported progression in her symptoms, as well as new episodes of nausea and vomiting.
- She was admitted to the hospital from clinic for further
management.
Zuckerberg San Francisco General
Presentation Title 10
Patient MJ – Admission Examination
- GENERAL: well appearing, comfortable, neck supple
- NEURO:
- MS: Awake, alert, not clearly hard of hearing but had difficulty
comprehending what was being said, able to name “pen”, ”thumb” and ”glasses” but not “knuckles”; followed 1-step commands inconsistently and was unable to perform digit span or calculations
- CN: able to count fingers and detect movement bilaterally, blink to
threat was intact bilaterally, pupils were equal and briskly reactive to light with no rAPD, fundoscopic exam was normal bilaterally, extraocular movements were full, facial sensation and strength were intact, able to hear finger rub bilaterally (L<R)
- Motor, sensory, reflex, coordination and gait exam were
unremarkable
Zuckerberg San Francisco General
Presentation Title 11
Patient MJ – Inpatient Evaluation
Zuckerberg San Francisco General
Presentation Title 12
Patient MJ – Inpatient Evaluation
protein 24 mg/dL, glucose 67 mg/dL
- IgG index 0.6
- No unique oligoclonal bands
- Negative:
- HSV PCR
- VZV PCR, IgG & IgM
- CMV PCR
- WNV IgM/IgG
- AFB & fungal culture
- VDRL
- Cytology & flow cytometry
- Universal microbial DNA screen
- Serum – all negative
- Aquaporin-4-Ab
- HIV
- Treponema
- Coccidiodes
- Brucella
- Bartonella
- Leptospira
- ANA, dsDNA, ANCA,
C3/C4, beta-2- glycoprotein, lupus anticoagulant screen
