Classification of Vascular Anomalies Using Clinico- Radiological Parameters – Is It Sufficient?

To classify vascular anomalies using clinico-radiological parameters. Settings: Government Medical College Srinagar and Army Hospital Research and Referral New Delhi. Methods: 129 cases of vascular anomalies were studied and classified using clinical and radiological methods from March 2011 to June 2018. Outcome: Vascular anomalies were broadly classified into vascular tumours and vascular malformations and these anomalies were further sub-classified based on clinical and radiological parameters. Results: Among 129 vascular anomalies studied there were 51 vascular tumours which included 50 hemangiomas (H) and 1 case of pyogenic granuloma (PG). Among Hemangiomas there were 34 Hemangiomas of Infancy (HOI) and 16 Congenital Hemangiomas (CH). Among HOI there were 26 Simple (Localized-17, Segmental-2, Indeterminate-6, Multifocal-1), 8 complex visceral hemangiomas (Liver-2, Subglottic-2, Parotid-4). Among Congenital Hemangiomas there were 4 Rapidly Involuting Congenital Hemangiomas (RICH) and 12 Non involuting congenital hemangiomas (NICH). There were 78 vascular malformations which included 51 slow flow malformations and 27 fast flow malformations based on colour doppler studies. Among slow flow there were 42 Simple {2 Capillary Malformations, 26 Venous Malformations (VM), 14 Lymphatic Malformations (LM), 4 Combined (2 each of Lymphohemangiomas - LH and Lymphovenous Malformations – LVM} and 5 Complex-combined (4 Klipple Trenaunay Syndrome – KTS and 1 case of Blue Rubber Bleb Nevus Syndrome - BRBNS). Among fast flow there were 6 simple (Nasopharyngeal Angiofibromas), 20 combined (Arteriovenous Malformations - AVM) and 1 Complex combined malformation (Sturge Weber Syndrome - SWS). Conclusion: Newborn with birthmark should always be documented by the attending health care provider at birth and referral to an expert for proper evaluation and careful parental/Guardian counseling. Doppler US should be the first line of investigation in broadly classifying vascular anomalies whereas CT Scan, MRI/MRA/MRV, Angiography, Venography help in further sub-classification. Some confusion still persists in classifying few lesions like Lympho-hemangioma (LH), Complex combined Malformations (Syndromes) like Sturge Weber Syndrome (SWS), Blue Rubber Bleb Nevus Syndrome (BRBNS), and Nasopharyngeal Angiofibroma (NPA).

Atypicality in presentation of neuroleptic malignant syndrome caused by olanzapine.

Neuroleptic malignant syndrome (NMS) is the most serious of acute neurological side effects produced by antipsychotic medication, characterized by hyperthermia, rigidity, altered consciousness and autonomic dysfunction, the prevalence of which varies from 0.4-1.4%. NMS is usually seen in treatment with high potency typical antipsychotics and very rarely with atypical antipsychotics. However, NMS cases have been reported with risperidone, clozapine, olanzapine and quetiapine. The presentations of NMS have often varied and we report another atypicality in presentation of NMS due to olanzapine use.