Anastasia Zherlitsyna — timeline

LLC CAPITAL

License of the Ministry

of Health of Ukraine

AG No. 599781

dated January 17, 2012

MEDICAL DOCUMENTATION

Institution code for the All-Ukrainian Classifier of Enterprises and Organizations: 32381903

Universal clinic "Oberig"

3 Zoolohichna Street, Kyiv, 03057, Ukraine

(044) 521-30-03
emergency aid 3003
5213003@oberig.ua

www.oberig.ua

ADVISORY OPINION OF THE HEAD OF THE STROKE CENTER, CANDIDATE OF MEDICAL SCIENCES, ASSOCIATE PROFESSOR, HONORED PHYSICIAN OF UKRAINE Y.V. FLOMIN

Patient: Zherlitsyna Anastasia Stanislavivna, 46 years old

Stationary card No. 00054

Date: 16.01.2023

13:00 The patient was examined in the ward of the Hospital for adult patients at the request of the attending physician.

COMPLAINTS: At the time of inspection, she did not express any complaints.

DISEASE HISTORY: Since the summer of 2022, the patient has been treated for uterine cancer at the "Innovation" clinic. After a course of chemotherapy at the beginning of January 2023, treatment with the drug Votrient was started. Through a short period of time after starting to take the drug Votrient, the patient began to suffer from headache pain, which increased in a horizontal position, increased every day and eventually became permanent. To reduce the headache, the patient took various pain relievers and pressure medications, which provided temporary relief. The patient remembers what she did on January 12, 2023, but has a very bad memory of the events of January 13, 2023. According to the records in the medical record, the patient was found unconscious at home on January 13, 2023 around 4 pm with traces of foam at the mouth and was taken to the Oberig clinic by the emergency medical care team, but the patient practically does not remember these events. On the morning of January 14, 2023, she regained consciousness and again remembers subsequent events. During her stay in the hospital, the headache did not bother her, but there were difficulties with orientation in space (she could not find the light switch). Sleep and appetite were normal.

LIFE ANAMNESIS: She suffered from iron deficiency anemia, took iron preparations. She was sick with hepatitis A many years ago. Was operated on for appendicitis in childhood. Smokes 2-3 cigarettes a day. Has high blood pressure, heart disease, diabetes, tuberculosis, alcohol abuse. She denies drug allergies. She did not take any medication, except for Votrient, on a regular basis.

Right-handed. Higher technical education. Does not work. She lives with her mother, who also suffered from uterine cancer.

PHYSICAL EXAMINATION: BP 112/83 mmHg. pulse 58 per minute, the respiratory rate 12 per minute, body temperature is normal.

Sufficient nutrition. The skin is of normal color. There are no significant peripheral tumors.

NEUROLOGICAL STATUS: Clear consciousness, speech is definitely not impaired, memory and attention are reduced, visual fields are narrowed to the right, eyeball movements are preserved, there is no nystagmus, facial expressions are symmetrical, articulation is preserved, the tongue is in the midline, active movements and limb tone are not disturbed, the strength of the muscles of the limbs is sufficient, the tendon reflexes of the hands are animated, D=S, of the legs are low, D=S, pain and tactile sensitivity are preserved, the gait is slightly ataxic.

CONCLUSION: Given the close temporal relationship between neurological disorders and the start of Votrient treatment and the possibility of such side effects as headache, increased blood pressure, convulsions and posterior reversible encephalopathy syndrome listed in the instructions for this drug, the most likely cause of the patient's disorders is PRES as a side effect of Votrient treatment. Differential diagnosis should be carried out with other subacute leukoencephalopathies, in particular of an autoimmune and toxic nature, and the reversible cerebral vasoconstriction syndrome (RCVS).

RECOMMENDED: 1. Refuse treatment with Vontrient.

2. Consider the possibility of pulse therapy with methylprednisolone (500 mg IV once a day in the morning N3) with correction of possible hypertension, hypoglycemia or electrolyte disturbances.

3. Repeated MRI of the brain with MRA of extracranial and intracranial arteries one week after the first examination (January 20, 2023).

4. Chemotherapy consultation regarding further treatment.

5. Complete cessation of smoking.

Doctor: Y.V.Flomin ___________________