Create a ppt with the details below Slide 1 Right Leg Cellulitis in a Patient with Progressive Neurodegenerative Disorder with Supranuclear Vertical Gaze Palsy, Facial Dystonia and Distal Motor Neuropathy Presenter Department of General Medicine Institution --- Slide 2 Objectives Present the current illness Discuss chronic neurological disease Correlate investigations Discuss differential diagnosis Review probable inherited neurodegenerative syndrome Learning points --- Slide 3 Patient Profile Name : Balamurugan Age : 38 years Sex : Male Occupation Address Date of admission --- Slide 4 Chief Complaints Swelling of right leg × 2 years Pain over right leg × 2 years Difficulty walking Bilateral hand deformity since childhood Abnormal facial movements Myoclonus --- Slide 5 History of Present Illness Present in chronological order Recurrent swelling over right foot Redness Pain Gradually progressed to mid-calf No trauma Previous similar admission 2 years ago Treated conservatively Current episode worsening --- Slide 6 Neurological History Developmental delay Delayed milestones Intellectual disability Tremulous speech since childhood Tremors Progressive weakness Frequent falls Distal wasting Facial dystonia Vertical gaze palsy Seizures since age 2 years Progressive gait difficulty --- Slide 7 Past History Previous admission GPMCH Similar cellulitis Bilateral claw hand Myoclonus Subclinical hypothyroidism (<3 months) No diabetes No hypertension No CKD No tuberculosis --- Slide 8 Personal History Appetite Sleep Bowel normal Bladder normal Non-smoker Non-alcoholic --- Slide 9 Family History Very important Consanguineous parents Female sibling died of hepatic illness No similar neurological illness in family Include pedigree diagram. --- Slide 10 Birth History LSCS baby Birth asphyxia Delayed developmental milestones --- Slide 11 General Examination BP 120/80 PR 88/min SpO₂ 98% Afebrile Conscious Oriented --- Slide 12 Local Examination Right Leg Diffuse swelling Redness Tenderness Warmth Extends up to mid calf Clinical photograph if available. --- Slide 13 Systemic Examination CVS S1 S2+ RS BAE+ PA Soft CNS NFND except chronic neurological deficits --- Slide 14 Detailed Neurological Examination Higher functions Speech Mental status Cranial nerves Motor Sensory Reflexes Coordination Gait --- Slide 15 Cranial Nerve Findings Vertical gaze palsy Horizontal gaze involvement Slow saccades Absent OKN Facial dystonia Dysarthria Illustration of supranuclear gaze palsy. --- Slide 16 Motor Examination Upper limbs Distal weakness Lower limbs Distal weakness Muscle wasting Claw hand Flat feet Hypotonia distally Spasticity proximally --- Slide 17 Reflexes Upper limb 2+ Lower limb Sluggish Absent ankle jerks Plantar equivocal --- Slide 18 Cerebellar Signs Gait ataxia Dysmetria Tremor Slow coordination --- Slide 19 Current Diagnosis Right Leg Cellulitis with Progressive Neurodegenerative Disorder --- Slide 20 Investigations During Current Admission CBC ESR CRP LFT RFT Blood culture Ultrasound leg Venous Doppler X-ray (Add current investigations) --- Slide 21 Previous Investigations (2006) MRI Brain Normal Copper studies Normal Bone marrow Normal No KF ring EEG EMG NCS IQ 46 --- Slide 22 Previous Investigations (2011) EEG Right frontal sharp waves MRI Posterior signal changes Normal copper CK Normal Ammonia elevated --- Slide 23 MRI Brain (JK Neurology) Insert MRI images Highlight Cerebellar atrophy Pontine atrophy Medullary atrophy Vermian atrophy --- Slide 24 MRI Findings Severe cerebellar shrinkage ↓ Pontine atrophy ↓ Olivary degeneration ↓ Mild cerebral atrophy --- Slide 25 Nerve Conduction Studies Normal sensory Reduced CMAP Motor axonal neuropathy Neurogenic EMG --- Slide 26 Laboratory Summary Copper normal KF ring absent Bone marrow normal No acanthocytes No storage cells Normal liver Normal renal --- Slide 27 Differential Diagnosis Wilson disease Neurodegeneration with Brain Iron Accumulation Niemann Pick Disease Type C GM2 Gangliosidosis Spinocerebellar Ataxia Juvenile Parkinsonism Mitochondrial disease Hereditary Spastic Paraplegia PLA2G6 ATP13A2 Kufor-Rakeb syndrome --- Slide 28 Why Wilson Disease is Unlikely Copper normal KF ring absent MRI not suggestive Liver normal Bone marrow normal --- Slide 29 Why NPC is Possible Vertical gaze palsy Ataxia Dystonia Cognitive impairment Consanguinity Progressive disease Sibling death --- Slide 30 Why PLA2G6 / Kufor-Rakeb Syndrome Possible Juxtapose clinical features --- Slide 31 Genetic Evaluation Needed Whole Exome Sequencing NPC1 NPC2 ATP13A2 PLA2G6 SPG genes SETX SACS --- Slide 32 Current Management IV antibiotics Analgesics Elevation Neurology review Physiotherapy Pressure care Thyroxine --- Slide 33 Long-term Management Genetic counselling Rehabilitation Speech therapy Occupational therapy Orthosis Seizure control Movement disorder clinic --- Slide 34 Final Diagnosis Right lower limb cellulitis in a patient with Progressive inherited neurodegenerative disorder characterized by Vertical supranuclear gaze palsy Facial dystonia Bilateral claw hands Distal motor neuropathy Cerebellar atrophy Cognitive impairment Seizure disorder Most likely an autosomal recessive neurodegenerative disorder, with Niemann–Pick disease type C, PLA2G6-associated neurodegeneration, or ATP13A2-related Kufor-Rakeb syndrome among the leading considerations pending genetic confirmation. --- Slide 35 Learning Points Cellulitis may occur due to chronic immobility and deformity. Vertical gaze palsy is a key localizing neurological sign. Consanguinity strongly suggests an inherited autosomal recessive disorder. Normal copper studies and absence of Kayser–Fleischer rings make Wilson disease unlikely. Progressive cerebellar atrophy with dystonia and distal motor neuropathy warrants comprehensive genetic testing. --- Slide 36 References Harrison's Principles of Internal Medicine, 22nd Edition Adams and Victor's Principles of Neurology Bradley's Neurology in Clinical Practice Movement Disorders Society Guidelines GeneReviews (NPC1, ATP13A2, PLA2G6) UpToDate (Inherited ataxias and dystonia syndromes) This would make a professional 35–40 slide postgraduate seminar/grand rounds presentation. If you want a presentation ready for direct use, I can also generate a fully formatted PowerPoint (.pptx) with tables, flowcharts, timelines, differential diagnosis algorithms, MRI illustration placeholders, animations, and speaker notes.