Regaining The Strength

Elderly man bounces back to normalcy after experiencing
weakness on the right side with slurring of voice

THE CASE

A 62-year old male hypertensive since 5 years was brought to Nanavati with mild right sided weakness and slurring of speech for 12 hours and focal convulsion of right side just before he was brought to the emergency department. He was an ex-smoker, with no other signifi cant co-morbidities. His vitals were also stable and the blood pressure was 150/90. His right sided power was 2/5 and he had right UMN facial palsy. On further examination, no other neurological and systemic abnormality was found. His CBC, LFT, renal function and lipid profi le were normal.

Basis the fi ndings, the stroke protocol was activated. His MRI revealed a space occupying lesion in left parietal lobe. The lesion showed restricted diffusion with peripheral enhancement and perilesional oedema. MR Spectroscopy revealed, presence of lipid lactate peak and diffusion tensor imaging showing displaced tracts.

THE PROCEDURE

Based on MRI fi nding the differentials were an abscess, neoplasm/ metastasis. The patient had progressed to power 0/5 by the time he was wheeled in to the OT within 36 hours of hospitalisation. Left parietal craniotomy with intra opt USG Sonography guided aspiration and excision of the mass was done. The necrotic aspirated material was sent for pathological and microbiological investigations. The histopath revealed the presence of sulphur granules and VITEK based culture revealed presence of Actinomyces israelii.

THE RESULT

The patient was treated with IV Ceftriaxone 1gm twice a day for 6 weeks. He was also given antiepileptic medications. He showed a remarkable recovery over a period of next few months. His power improved to 5/5 in right lower limb and 4/5 in right upper limb when he was last seen after 6 months of surgery.

Dr. Harshad Limaye

Sr. Consultant
Internal Medicine
Nanavati Super Speciality
Hospital, Mumbai

Dr. Pradyumna J. Oak

Sr. Consultant
Interventional Neurologist
Nanavati Super Speciality
Hospital, Mumbai