Sunday, October 20, 2024
Bobble head doll clinical complexity outcomes project
Introduction: During the seventeenth century, figurines of Buddha and other religious figures called "temple nodders" were produced in Asia.[3] The earliest known Western reference to a bobblehead is thought to be in Nikolai Gogol's 1842 short story "The Overcoat," in which the main character's neck was described as being "like the necks of plaster cats that wag their heads.
Thanjavur dolls are a type of Indian bobblehead doll known as "Thanjavur Thalayatti Bommai" in the Tamil language, meaning "Tanjore Head-Shaking Doll." They are a native art form in the Thanjavur region of Tamil Nadu.
CC licence: https://commons.m.wikimedia.org/wiki/File:A_Tanjore_doll.jpg#mw-jump-to-license
Project thoughts beginning from our first tryst with the patient seen in 2004 in Vydehi medical college, Bangalore although at that time we didn't even realise what his symptoms were and he googled us ten years later to show us again in another city where we documented our first observation of this syn in a reflective note as fished out from that time in an email sent on 2013 below:
Date: Thu, 10 Jan 2013, 12:35
Subject: re: Bobble head Doll history
To
To
I met this 39 year old man yesterday after a gap of 7 years since our first meeting in Bangalore. At the time i had simply taken his history and prescribed some non specific medications based on his history without actually witnessing the movements (which at the time was reported to be of a momentary duration). The physician-placebo effect had probably brought him back to me in Bhopal after he managed to locate me through an internet search and sent me an email.
His symptoms had gradually progressed in duration and frequency such that i could easily witness it for myself now. It was a stereotypical head movement that appeared to say no-no.He also had a badly impaired tandem walk among other positive findings. His head movements appeared to increase while lying down and this made us have to resort to a good dose of IV diazepam to sedate him during the cranial MRI (attached).
Copying this also to our neurosurgeon so that it helps to evaluate him soon by the next working day.
There is not much evidence on how to go about the further management of such patients other than convincing reports of improvement following endoscopic third ventriculostomy in different case series. http://www.ncbi.nlm.nih.gov/
The other unique feature of our patient was the manifestation of this syndrome in adult life. The oldest patient (among the 57 patients reported till date) is 13 years http://www.neuroscience.org.
Also why were his symptoms increasing with lying supine? Is it because the normal third ventricular pressure increases during supine? http://www.ncbi.nlm.nih.gov/
best,
Subsequently again lost him to follow up for nearly another 7 years before he again got in touch through Facebook and our students in Hyderabad prepared the case reports below through telephonic data capture:
case report link from a student's online learning portfolio linked below:
Hand written case report from another student's online learning portfolio:
https://drsaranyaroshni.
CBBLE and PaJR conversations also at the description box in the YouTube link above.
Got the content below from his PaJR description box possibly added in June 2023 during first encounter:
Sequence of events:
1993: He was born by NVD and cry after birth (+)with no H/o birth insult
He is the youngest in the family with four sisters elder than him who are apparently healthy
2015- For the first time patient noticed involuntary movements of head and neck as insisted by his friends which were mild,he visited a hospital in Karimnagar where he was prescribed Tab Clonazepam 0.25 mg +propranolol 20 mg and? one more medication at night (which he was even using now)
2016- He was married to a woman with some? spine deformity and had a kid in 2017, born by LSCS and no H/o birth insult and he is healthy now
2017-He consulted a Neurologist in Hyderabad and used medication for 6 months, but symptoms did not subside and stopped the medication
2018-By this time his involuntary movements of head increased and he visited a hospital in Nalgonda where he was prescribed with some medication which he almost 3-4 months, but symptoms did not subside
2019-2020: His symptoms gradually increased despite using different medications
2021: He Visited our hospital with pain abdomen and was diagnosed with liver abscess and the abscess was drained and he was relieved
2022: There if further increase in head and neck movements associated with tremulous speech and movements of left upper limb and after 6 months he developed similar complaints in the right upper limb.
No involuntary movements of lower limbs till now
2023: He consulted a physician in February where he used Vit B12 and thiamine along with some other medication after which he felt his symptoms decreased a bit
Initially he felt the symptoms relieved on taking alcohol but gradually didn’t find any difference on consumption of alcohol
These abnormal movements are absent during rest or sleep
No H/o Loss of consciousness
No H/o seizure activity
No H/o giddiness, falls
Last alcohol intake was 15 days back(90ml whiskey)
Consumes around 90ml/day since 12 years
O/E:
Pt is conscious, coherent and cooperative
Pt maintained eye contact through out the examination
HMF
EMR summary of second patient from June 2023:
Age/Gender: 27 Years/Male
Address:
Discharge Type: Relieved
Admission Date: 06/05/2023 11:18 AM
Diagnosis
TREMOR PLUS SYNDROME SPASTIC CEREBELLAR ATAXIA? GENETIC CAUSE? OTHER CAUSES
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