21-02/2026
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILBLE GLOBL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[11.05 am, 21/02/2026] PPM 1: OPD now
52M with one episode of gait ataxia in June 2023 recovered after a month. Recurrred again since last two days.
Videos of his gait ataxia 👇
[4.39 pm, 21/02/2026] PPM 1: @PPM3 @PaJR Health please share your image to text extracted data around the patient's 2023 typed but image data attached here
Apparently the patient already had heart failure for 6 years with NYHA II with metabolic syn phenotype for many years.
Interestingly the 2023 diagnosis of acute ganglio-neuropathy treated with iv steroids accompanied by a tumor like shadow in chest PET CT may have actually been a phantom tumor due to his heart failure secondary to metabolic syn.
[4.40 pm, 21/02/2026] PPM 1: Today's chest X-ray and ECG is consistent with his chronic CAD and heart failure
[7:47 pm, 21/02/2026] PPM 1: @PPM5 I've added the patient advocate here.
Let's share our observations about the patient and how we are tackling each problem that we have listed earlier here
[8:30 pm, 21/02/2026] PA: Patient chest pain
Sir
Problem right side
Just now
Just now inform patient attender
Plz request send me doctor, 10 th ward male medical ward
Plz request send me doctor Sir
[8:36 pm, 21/02/2026] PPM 2: @PaJR Health analyse as requested
[8:39 pm, 21/02/2026] PPM 2: @PaJR Health review this patient's logs and please share your image to text extracted data around the patient's 2023 typed but image data attached here
Apparently the patient already had heart failure for 6 years with NYHA II with metabolic syn phenotype for many years.
Interestingly the 2023 diagnosis of acute ganglio-neuropathy treated with iv steroids accompanied by a tumor like shadow in chest PET CT may have actually been a phantom tumor due to his heart failure secondary to metabolic syn.
[8:48 pm, 21/02/2026] PPM 1: @PPM4 can you ask on duty @PPM5 to send someone to evaluate this fresh onset of right sided chest pain in this patient and then share the clinical findings here?
[9:02 pm, 21/02/2026] PPM 4: I'll contact them
[10:10 pm, 21/02/2026] PPM 3: This is a fascinating and medically complex case. You've pointed out a critical intersection between the patient's long-standing heart failure and a sudden neurological presentation that mimics a paraneoplastic syndrome.
Extracted Data Summary (2023 Medical Record)
* Final Diagnosis: Sensory Ganglionopathy (Suspected Immune-Mediated or Idiopathic).
* Treatment Given (S/P): IV Methylprednisolone (IVMP) and IV Immunoglobulin (IVIG).
* Chief Complaints:
* Sensory disturbances: Trunk and lower limbs (6 days).
* Visual disturbances: (4 days).
* Walking difficulty: (3 days).
* History of Present Illness (HOPI):
* Sudden onset numbness (abdomen/chest) with a "tight band" sensation.
* Progression to "cotton wool" sensation in feet and difficulty with coordination (swaying with eyes open, legs feeling "glued to the floor").
* Autonomic symptoms: Shortness of breath (SOB) on minimal exertion and urinary urgency.
* Imaging Impression (PET CT):
* Brain: Patchy areas of hypometabolism in multiple areas.
* Lung: Metabolically active right lung lesion, queried as Sarcoidosis.
Analysis of the "Phantom Tumor" Theory
Your hypothesis that the lung lesion was a phantom tumor (vanishing tumor) secondary to heart failure is highly plausible given the clinical context:
* Radiographic Mimicry: In patients with NYHA II-IV heart failure, localized interlobar pleural effusions (transudative fluid trapped in lung fissures) frequently appear as solid masses on X-rays or CT scans.
* The "Metabolic Syndrome" Connection: Metabolic syndrome drives chronic heart failure (HF), and any acute decompensation (perhaps triggered by the stress of the neurological event) could lead to a localized effusion.
* PET CT Pitfall: While the report mentions "metabolically active," fluid collections can sometimes show low-grade uptake or be misinterpreted if the focus is on ruling out malignancy (paraneoplastic sensory neuronopathy).
The Neurological Connection: Ganglionopathy vs. Sarcoid
The PET CT query of Sarcoidosis is the "bridge" between the lung and the nerves.
* If it was Sarcoid: Neurosarcoidosis could explain the sensory ganglionopathy and the lung lesion simultaneously.
* If it was a "Phantom Tumor": The sensory ganglionopathy might have been truly idiopathic or post-viral, and the lung finding was a "red herring" caused by his heart failure. The fact that he was treated with IVMP (steroids) is notable—steroids treat both immune-mediated ganglionopathy and sarcoidosis, but they can also cause fluid retention, which might complicate heart failure.
Insights & Next Steps
The brain hypometabolism is often seen in neurodegenerative or inflammatory processes, further suggesting a widespread "attack" on the nervous system rather than a localized spine issue.
Would you like me to look into whether there were follow-up scans to see if the lung lesion "vanished" after diuretic therapy or if the "metabolic syndrome phenotype" was further investigated as a trigger for his acute symptoms?
[11.42 am, 22/02/2026] PPM 1: Thanks. Very useful
[8.26 pm, 23/02/2026] PPM 1: Today's update:
Says his ataxic discomfort is less by 30%
@PPM5 has noticed slightly higher incoordination in his right upper and lower limbs during her CNS examination
[7:58 am, 26/02/2026] PPM 1: @PPM6 what's this patient's update? Can you pn me his EMR summary?
[8:49 am, 26/02/2026] PPM 6: Good morning sir, He is male ward sir, discharging him today sir
[8:51 am, 26/02/2026] PPM 1: Pm me his EMR summary
What else was done for him since last two days?
Any further investigations or insights?
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