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: 23.01.2023

15:00 The patient was re-examined in the hospital ward for adult patients at the request of the attending physician.

COMPLAINTS: She complained of bad sleep at night (it is sometimes difficult to fall asleep, she often wakes up).

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 a headache, 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, use the restroom).Sleep and appetite were normal. During the past week, the patient's well-being has improved: her unsteadiness when walking has significantly decreased, the orientation in space has improved, and the need for external assistance has disappeared. Repeat MRI of the brain with MRA of the vessels of the head and neck (January 20, 2023): MR image of diffuse focal changes in the cortico-subcortical substance of both hemispheres of the brain, with a predominance of changes in both occipital lobes, with the appearance in the dynamics of foci of cytotoxic edema of the cortex of both parietal lobes, intracerebral hemorrhage of the left occipital lobe and signs of cerebral vasculopathy with multifocal stenotic segments of vasoconstriction. The described changes, taking into account the acute clinical course, are typical and characteristic of posterior reversible encephalopathy syndrome (PRES), with intracerebral hemorrhage and cerebral vasculopathy.

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: The most likely cause of the patient's disorders is posterior reversible encephalopathy syndrome (PRES) as a side effect of Votrient treatment.

RECOMMENDED: 1. Stop taking Vontrient.

2. Complete cessation of smoking.

3. Add to treatment Aspirin cardio 100 mg 1 time a day - for a long time, as well as Ketilept 25 mg 1 time a day at night - 1 week.

4. Increase motor activity (at least 3-4 thousand steps per day).

5. Observation by an oncologist, to consider the issue of long-term drug prevention of venous thrombosis and thromboembolism.

Doctor: Y.V.Flomin ___________________