Adult-onset Rasmussen’s encephalitis.

Rasmussen’s encephalitis (RE) is characterised by refractory focal seizures, unilateral cortical deficits, and progressive unihemispheric focal cortical atrophy of undetermined aetiology. A majority of these cases present in childhood, and three disease stages have been recognised: a ‘prodromal stage’, an ‘acute stage’ and a ‘residual stage’. Adult-onset and variant forms have also been described but are rare, and we report one such case with frequent refractory focal seizures, right-sided hemiparesis, aphasia, and marked atrophy of the left perisylvian cortex with a slow disease progression over 17 years. Immunotherapy with corticosteroids, IVIG, plasma exchange, and tacrolimus has been tried in RE with variable results. Hemispherectomy and disconnective techniques like functional hemispherectomy and hemispherotomy are effective in achieving seizure freedom in 62.5% to 85% cases, but carry a risk of motor and language deficits.

Approach to a case of autonomic peripheral neuropathy.

Autonomic neuropathy is the term used to describe autonomic disturbances resulting from diseases of the peripheral autonomic nervous system. This is a group of disorders in which the small, lightly myelinated and unmyelinated autonomic nerve fibers are selectively targeted. Most often, autonomic neuropathies occur in conjunction with a somatic neuropathy (i.e. with motor weakness and/or sensory loss), but they can occur in isolation. Causes of autonomic neuropathies are immune-mediated, paraneoplastic, infectious, toxic and drug-induced, hereditary, nutritional and idiopathic. Amongst all, diabetes mellitus is the most common cause. Autonomic features, which involve the cardiovascular, gastrointestinal, urogenital, sudomotor, and pupillomotor systems, occur in varying combination in these disorders. Orthostatic hypotension is often the first recognized and most disabling symptom. Noninvasive, well-validated clinical tests of autonomic functions along with a host of laboratory tests are of immense value to diagnose the presence and to demonstrate the distribution of autonomic failure. Treatment aims to treat specific cause of the autonomic neuropathy (if possible) and to control symptoms of autonomic dysfunction. Present review attempts to outline clinical approach to a case of autonomic peripheral neuropathy.

Randomized prospective study of outcome of short term antiepileptic treatment in small single enhancing CT lesion in brain.

The study was conducted in 81 patients of epilepsy with small single enhancing CT (SSECT) lesion in brain to determine the clinical profile and duration of antiepileptic drugs (AEDs) treatment. The patients were randomly divided into group A (41 cases) and group B (40 cases). Group A patients were treated for 6 months and group B for 1 year with AEDS without cysticidal drugs. The most common mode of presentation was simple partial motor seizures with secondary generalization in both the groups. Repeat imaging of brain (CT/MRI) at 6 months showed disappearance of lesion in 82.94% in group A and 87% in group B, while persistence of lesion was present only in 4.87% in group A and 5% in group B. 87.81% patients in group A and 87.17% in group B were seizure free. The recurrence of seizure occurred in 12.19% cases in group A, and 12.82% in group B. 80% of these patients had calcified lesion in both the groups. This study reveals that SSECT lesion with epilpesy is a benign self-limiting disease. It also reveals that 6 months AED treatment is as effective as one year treatment. Patients having calcified lesion or persistence of lesion might require long term AED treatment.

Gastro-duodenal mucosal changes associated with low-dose aspirin therapy: a prospective, endoscopic study.

OBJECTIVES: The association of low-dose aspirin use and gastro-intestinal bleeding is well described. However, the gastroduodenal mucosal changes associated with low-dose aspirin therapy have not been properly evaluated. We undertook a prospective, endoscopic study to evaluate gastro-duodenal mucosal lesions produced by low-dose aspirin. METHODS: Forty-seven patients with non-hemorrhagic cerebral infarct or transient ischemic attacks and normal upper gastrointestinal endoscopy were randomized to receive either enteric-coated (n=25) or plain (n=22) aspirin (150 mg/day). Follow-up endoscopy was done at 2, 4 and 8 weeks; gastro-duodenal mucosal lesions, if present, were scored. Forty-seven patients with hemorrhagic infarct who were not treated with aspirin served as controls. RESULTS: Twenty eight (60%) of 47 patients receiving aspirin had mucosal lesions; stomach alone was the most frequent site (32%), followed by both stomach and duodenum (23%). Frequency of mucosal changes in the stomach at 8 weeks (19%) was significantly lower (p<0.05) than those at 2 weeks (53%) and 4 weeks (55%). Coated (56%) and plain (63.6%) aspirin induced mucosal lesions with similar frequency. CONCLUSION: Administration of low-dose aspirin, either plain or enteric-coated, induces endoscopic gastro-duodenal mucosal lesions in a large majority of patients. The frequency of damage decreased after 8 weeks of therapy.

Reversible posterior leukoencephalopathy syndrome: a report of 2 cases.

Reversible posterior leukoencephalopathy syndrome (RPLE) is an increasingly recognised disorder, most commonly associated with malignant hypertension, toxaemia of pregnancy or the use of immunosuppressive agents. Two cases of RPLE syndrome occurring in the setting of accelerated hypertension and eclampsia are described. Both patients had seizures, altered sensorium and typical findings on neuroimaging. They had complete clinical and radiological recovery. The clinical course, pathophysiology and neuroimaging features of RPLE syndrome are discussed.

Congenital myasthenic syndrome: report of four cases and brief review of literature.

The term 'congenital myasthenic syndrome' (CMS) encompasses a number of heterogeneous disorders characterised by myasthenic symptoms since birth, usually with positive family history and absence of acetyl choline receptor antibodies. Recent advances in electrophysiology and ultrastructural analysis of neuromuscular junction have made it possible to identify the various defects underlying these disorders. We report four cases of CMS, with a review of literature.

Intravenous thrombolytic therapy in unstable angina.

One hundred consecutive age and sex-matched patients of 3 different subsets of unstable angina (recent onset angina -65, crescendo angina -20, post-infarct angina-15) were randomized 1:1 after coronary angiography to receive I.V., either 1.5 x 10(6) units of streptokinase (SK) in 200 ml of normal saline or 200 ml of normal saline alone (control) in 1 hour. Repeat angiography was done in those patients having intra-coronary thrombi (37.3%) during the initial angiography. Both groups received optimal doses of heparin followed by warfarin, aspirin and other standard drugs and were followed up for 6 months. Anginal pain subsided significantly in the SK group-41 (82%) vs 25 (50%) (P < 0.005), especially in patients with recent onset angina (92.5% vs 60%, P < 0.005). Incidence of acute myocardial infarction (AMI) was much less in the SKgp (4(8%) vs 17 (34%) (p < 0.05). Four cases of fatal MI and four cases of sudden cardiac death (SCD) occurred in the control group against none in the SKgp. Requirements of mechanical revascularization was significantly less (P < 0.05) in the SK gp. Angiographic evidence of partial or complete clot lysis was noted in 90% of SK gp. vs 4.8% of control (P < 0.01). Echocardiographically assessed LV function improved significantly with SK-therapy in recent onset (P < 0.05) and crescendo angina (P < 0.001) subsets--however, the improvements in post infarct angina subset were not statistically significant. The beneficial outcome with SK therapy was observed in patients irrespective of angiographic evidence of thrombi.(ABSTRACT TRUNCATED AT 250 WORDS)

Antifertility effect of Piper betle Linn. extract on ovary and testis of albino rats.

Chronic administration (sc) of the extract of the stalk of P. betle at 30 mg/kg body weight daily for 21 days produced significant decrease in oestrogen and androgen dependent target organ weights along with increase in cholesterol in adrenal, ovary and testis. Acid and alkaline phosphatase activities in serum, liver and kidney did not exhibit any toxic effect. There was marked change in morphology of testis and ovary. Vaginal smear showed prolonged dioestrus in treated female. The treated male showed decreased number and motility of sperm. Both male and female remained infertile after treatment suggesting antifertility activity of the extract on both sexes of albino rats.