Reversible Cerebral Vasoconstriction Syndrome In The Backdrop Of Cerebral Venous Thrombosis: A Post-Partum Catastrophe

Reversible cerebral vasoconstriction syndrome (RCVS) is an under-recognized condition characterized by the association of acute severe headaches, often of the thunderclap type, with or without additional neurological symptoms, and multifocal constriction of cerebral arteries, that resolve spontaneously within 1–3 months. Here, we report a rare case of post-partum stroke, where cerebral venous thrombosis was followed in quick succession by RCVS. A 24-year-old lady in her immediate post-partum period developed headache, seizure, and papilledema. After a subsequent episode of a severe headache, she had right hemiparesis and dysarthria. Computed tomography and magnetic resonance venography confirmed the presence of thrombosis. Afterward, she had another episode of a severe headache with altered sensorium. MR imaging of the brain revealed widespread infarct in bilateral medial frontal areas, and MR angiography was suggestive of segmental constriction of cerebral arteries bilaterally. The subsequent clinical course was uneventful with slow recovery. Repeat brain imaging, after 4 weeks, revealed near-total disappearance of diffusion restriction and subsidence of the beading pattern in the cerebral vasculature. This rare case depicts the co-occurrence of venous and arterial angiopathies in the setting of a post-partum headache with the stroke that led to a challenging clinical scenario

Multiple Cerebral Abscesses In Decompensated Cirrhosis Of Liver As A Mimicker Of Hepatic Encephalopathy: A Case Report

Cirrhosis of the liver is a state of immune dysregulation. It can give way to many infections. Brain abscess, though uncommonly reported in cirrhotic patients, deserves special attention as it presents a diagnostic and therapeutic challenge for physicians. We present here, the case of a 65-year-old diabetic and hypertensive female patient, with cirrhosis of the liver, who presented to us with fever and altered sensorium. She had mild neutrophilic leukocytosis and her serum ammonia level was slightly elevated. She was managed conservatively for hepatic encephalopathy precipitated by infection. No obvious source of infection was found on routine investigation and culture. Broad-spectrum intravenous antibiotic coverage was provided at the earliest, but the patient succumbed to multiorgan failure.

A rare cause of bleeding gastric ulcer: multiple myeloma.

The causes of GI bleed are many and varied with peptic ulcers accounting for about 50% cases. Multiple myeloma is the most common lymphoid neoplasm in older adults and accounts for approximately 10% of all hematologic malignancies. Extraosseous manifestations are said to be present in less than 5% of patients with Multiple Myeloma with GI ulcers only being described rarely. In this report we describe a case of a 58 year old lady presenting with weakness, palpitations, gum bleeding with recent onset melena. She had severe anaemia with thrombocytopenia and markedly elevated ESR. An UGI endoscopy revealed a 1x0.5 cm ulcer infiltrated by lymphoplasmacytic cells and histiocytes with a few neutrophils. Serum globulin fraction was markedly high and Serum protein electrophoresis revealed it to be a case of multiple myeloma with Igʎ secreting monoclonal cells. Bone marrow aspirate revealed 40 % plasma cells with some binucleate and trinucleate forms. The patient was diagnosed as stage III multiple myeloma (International staging system) and treated with dexamethasone, zoledronic acid and thalidomide. Our case highlights a very atypical presentation of multiple myeloma and alerts the clinician to keep an eye of suspicion in dealing with peptic ulcer cases especially in the elderly.