Rare Cases Diagnosed

  Writers cramp

A 20 year engineering student from the faculty of Engineering & Technology presented to us with complaint of inability to write due to pain & abnormal turning in of fingers while holding the pen. This reduced his speed of writing during exams. A condition called “Writers Cramp” was suspected & neurology reference was done which confirmed the diagnosis. Writers Cramp is a task specific dystonia characterized by cramps & spasms of the hand & forearm while performing certain task like writing or playing piano. It interferes with the patients ability to write. Treatment is unrewarding& patients are advised to use the other hand requiring normal dexterity. Appropriate counseling was given to the student. The student has trained himself in using his left hand during writing & is leading a normal life.

A Case Of Primary Hypoparathyroidism

A 26 year old female, wife of a university staff member presented to us with a complaint of muscular cramps mainly involving hands with sustained stiffness and spasm of fingers of both hands. She also complained of perioral tingling and numbness sensation as well as abdominal pain. Classic physical signs like Chvostek and Trousseau sign were elicited. Her serum calcium levels was 5.8 mg only. Diagnosis of Hypocalcemia was made and she was given intravenous Calcium after which she recovered. She had such episodes recurrently and hence serum Parathyroid levels were done which were well below normal i.e. 7.2 pg /ml only against normal range of 12 to 65 pg /ml. She was referred to Endocrinologist for further treatment. She is on high dose calcium supplements as well as twice weekly Vitamin D capsules. Patient has responded to this treatment. Her recurrent episodes of Tetany and abdominal pains have decreased.

Parathyroid is a hormone which maintains Serum Calcium levels. Decrease in these hormones can lead to low calcium levels which can prove fatal. Teriperatide 3 is a recombinant preparation of human PTH 1-34. It is effective in treating hypothyroidism but very high cost and need for frequent injection limits its use.

A Case Of Young Hypertensive.

A 20 year old student presented to us with complaint of recurrent episodes of severe headaches and giddiness. Her blood pressure was 180/110 mmHg which is very high. She was thoroughly investigated to find her cause. Her renal profile including USG kidneys and renal artery Doppler study was normal. Her serum Cortisol level was also normal. As she was obese, a condition called as Insulin resistance Syndrome was suspected and fasting Serum Insulin levels were done which was found to be very high. Her calculated Homa index was very high. This is mostly genetically acquired condition for which there is no specific treatment. She is now on antihypertensive medication and is advised diet control and exercise as well as Tab Metformin all of which are  known to increase insulin sensitivity.