All Journals from Satyen Shukla
A sixty-six year old lady was admitted after describing two ‘vacant’ episodes with collapse. She had also complained of chronic fronto-occipital headache and more than 10kg weight loss over the preceding three month period. She denied any gastrointestinal, respiratory or cardiac symptoms. She was a non-smoker and did not drink alcohol regularly. She had a past history of hypertension and hypothyroidism for which she was taking ramipril and thyroxine. On examination she appeared cachexic, but no other abnormality was detected.
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The MRI images (see page 27) show lobulated meningeal thickening along the medial aspect of the right middle cranial fossa extending into sylvian fissure, suprasellar cistern, interpenduncular cistern and roof of 4th ventricle which enhanced on postcontrast images. These appearances are diagnostic of metastatic leptomeningeal carcinomatosis.
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A 60 year old female was admitted with jaundice, malaise & loss of appetite. Two weeks before admission she had complained of diarrhoea with abdominal pain. There was no previous history of jaundice, blood transfusion or foreign travel. She denied pruritus, and stools were of normal colour, although her urine was dark. She was non-smoker & did not drink alcohol regularly. She was known to have ischaemic heart disease & hypercholestolaemia and had been taking ramipril 5mg , clopidogrel 75mg, simvastatin 20mg & omeprazole 20mg daily for the previous two years.
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