Howdy friends, and welcome back to Diagnose This, the game where we ask you to use your noggin to nut out some tricky medical questions and revise those core concepts that we all love so much.
Last week we showed gave you a patient with a number of worrying symptoms and a rather abnormal FBC and peripheral blood smear. The condition that would cause such findings is Vitamin B12 deficiency due to destruction of the parietal cells in the stomach, with the megaloblastic anaemia referred to as pernicious anaemia in this case. This destruction of parietal cells reduces the concentration of intrinsic factor, a factor essential for the proper absorption of B12 in the small bowel. The results shown in both the table and in the blood film are all classic signs of Vitamin B12 deficiency. Other conditions besides the destruction of parietal cells in the stomach include general malabsorption, metformin use, and Coeliacs disease (although the latter is due to ileal damage rather than a lack of intrinsic factor), among many other causes. Treatment includes supplementation of the lack of B12 through either injections or through pill form, although the oral route requires rather large doses to overcome the lack of intrinsic factor/ileal damage.
So hopefully that was as much fun for you as it was for us to research and write up! Now on to the next case:
A 71 year old woman presents to the clinic with dysphagia, vertigo, left sided ptosis, and meiosis in the same eye. On examination she also appears to have an ataxic gait to the left side, impaired temperature and pain on the left side of the face, and the right side of the upper and lower limbs.
What is your provisional diagnosis, and which artery is most commonly occluded to cause this array of symptoms? Finally, what is one symptom of this condition that is incredibly difficult to cure and can last for a few weeks?
Find out next week on Diagnose This, found exclusively on bloodbonesandbodies!
This is the first drawings of Raymond Damadian’s invention, called the “Apparatus and method for detecting cancer in tissue,” circa 1972!
“Damadian invention”. Licensed under Public Domain via Commons – https://commons.wikimedia.org/wiki/File:Damadian_invention.jpg#/media/File:Damadian_invention.jpg