Eales' disease with neurological manifestations.

Eales' disease is a primary retinal perivasculitis of an undetermined etiology seen predominantly in the Indian subcontinent. However, neurological involvement is rare. We report here a patient of retinal perivasculitis with neurological dysfunction. Our patient is a 39 years male who developed acute diminished vision right eye in March 99, which progressed for four days and remained static. In April 99 he developed acute diminished vision left eye, which progressed to near total blindness in 48 hours. He was undergoing ophthalmic evaluation. Fourty five days later he developed incoordination and weakness left half of body. The examination revealed bilateral retinal perivasculitis with pyramidal signs and left sided cerebellar signs. Investigations revealed an ESR of 40 mm at the end of first hour. His CT head revealed bilateral basal ganglionic infarcts. MRI head revealed enhancing lesions both basal ganglia and right parietal region. Cerebrospinal fluid examination showed xanthochromic fluid with markedly elevated protein and lymphocytic pleocytosis. His workup for connective tissue disorders was negative. He was put on ATT with steroids. Eales' disease is presumed allergy to tuberculoprotein. A trial of ATT with steroids has been tried with varying results. Our patient had bilateral retinal perivasculitis and neurological dysfunction. He had lymphocytic pleocytosis with markedly elevated protein in the CSF.

Adult subacute mountain sickness--a syndrome at extremes of high altitude.

BACKGROUND: Subacute mountain sickness is distinct syndrome of congestive cardiac failure seen in lowlanders during prolonged stay at extreme high altitude (> 5800 mtrs). OBJECTIVES: To study the clinical and investigative profile of subacute mountain sickness amongst Indian soldiers stationed at extreme altitude. MATERIAL AND METHODS: Symptomatic individuals who were stationed above 5000 mtrs were evacuated to 3000 mtrs and clinically screened for signs of congestive cardiac failure. ECG and X-ray chest; hematological and biochemical parameters were evaluated. Response to rest, oxygen and diuretics were studied and they were evacuated to the plains. They were followed up at the plains for a period of two weeks at the end of which chest X-ray and ECG were repeated. RESULTS: Eight patients were diagnosed over a period of one month who had classical features of congestive cardiac failure. The mean age was 28.75 years, the mean altitude 5828.47 mtrs and the mean duration of stay 17.35 weeks. The most common symptom was exertional dyspnea (6 of 8 cases) and the most common sign bilateral pedal edema (7 of 8 cases). Two patients had deep venous thrombosis. Clinical, ECG and X-ray evidence of pulmonary hypertension was seen in seven cases. The mean hemoglobin was 18 gm%. Response to oxygen and diuretics was dramatic. Clinical findings and investigations reverted to normal after two weeks of stay on the plains. CONCLUSION: This brief study of subacute mountain sickness reemphasizes the role of pulmonary hypertension as the initiating event. Other factors are salt and water retention and polycythemia. Brisk response to diuretics and oxygen and restoration of normalcy on deinduction to the plains establishes the reversibility of the syndrome.