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Case information
Patients, female, 20 years old, complained to the hospital for "obvious muscle spasm appears in both upper limbs".
The current medical history: Patients have no obvious causes before January without obvious causes of double limb muscle spasm, unconscious lost, not accompanied by foaming and urine incontinence, and continue to continueThe role of about 5 minutes is relieved by itself.Patients can recall what happened at the time.
Consident in the local hospital considers "special comprehensive epilepsy (IgES)".Give oral antiepile epilepsy: Ramanzine 50mg, once a day, no the above symptoms occur after discharge, and are considered to be well controlled by the symptoms.Two weeks ago, the above -mentioned symptoms of discomfort occurred again, and they were diagnosed in our hospital.
Examination: The patient is 165cm tall, weighs 55kg, and has no skeletal or dental deformed.There is no rash in the skin, and there is no obvious abnormalities in the cardiac examination.
Improve the relevant inspection, electrolyte prompt Severe calciummia 0.7 mmol/L (normal range 2.25-2.62mmol/L), hypertension 2.4 2.4Mmol/L (normal range 1.1-1.8mmol/L).The remaining tests were obviously abnormal.
diagnosis and treatment passes:
Obvious hand-foot convulsions appeared during the consultation, considering the patient decreases calcium, and then walks CHVOSTTEK Examination and TrousSeau Examination . The results show positive. Due to the severe pain in the patient, no images were taken.
Symptoms after intravenous calcium are significantly improved.Since then, the CT CT examination has been improved, which shows the permeable intracranial calcification (see Figure 1).
Figure 1 Ctarios CT image
According to patients and family members, "seizures"When she appeared weakness and spasm, numbness around the mouth, and difficulty in speaking (larynx spasm), she was completely awake at the time of the attack and could vividly recall the details of the time.Her family did not notice the tangylla movement, and she did not have any drowsiness or bite her tongue.Overall, These features are inconsistent with epilepsy .
Further improve the relevant examination, showing that the whole parameter of the thyroid gonadotropin (iPTH) decreases: 0.58pmol/L, (normal range 1.58-6.03pmol/L), 24-hour urine calcium decreased decreased.: 0.2 mmol/24h (normal range 2.5-7.5 mmol/24h).
Seeing this, do you know the diagnosis of the patient?How should I treat it next?
References:
[1] khor zx, pua qy, TAI YT. Primary Hypoparathyhroidism: HyPocalCAEMIA MISDIASED As EpilePsy. BMJ CASE Rep. 2023 Oct 4; 16 (10): E257005. : Endocrine Channel in the medical community
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