Balloon Plasty of Pseudoaneurysm of AV Fistula in CKD.

Arteriovenous fistula is a procedure done for long-term haemodialysis in patients with end stage renal failure. Aneurysms are a common and often difficult complication seen with arterio venous vascular access for haemodialysis. In this case report we describe middle aged male patient who was a known case of chronic kidney disease on maintenance haemodialysis through left arm brachio-basilic AV fistula and had developed a pseudo aneurysm of the AVF. We performed an Endovascular intervention for salvaging haemodialysis AV fistula in which balloon plasty was done and flow was obtained. To ensure adequate haemodialysis treatments, a well-functioning vascular access (VA) is a prerequisite in dialysis patients. Arteriovenous fistula (AVF) has become a long-term haemodialysis treatment in patients with renal failure in the end stage and this has not changed until now.(1) For long-term haemodialysis with low morbidity levels, arteriovenous fistula should provide a convenient repeated vascular access line. The development of aneurysm may occur due to frequent punctures that in some patients may weaken the vein wall. Proximal stenosis often speeds up the process by increasing the pressure in the AVF.(2) Such patients may have a large, painful aneurysm sac, which can lead to dermal tissue necrosis. It may become compromised as a result of vascular or traumatic events. The aneurysm sac can split, which may result in fatal haemorrhage.

Neurocysticercosis Presenting as Complex Partial Seizures

Neurocysticercosis (NCC) occurs in 60-90 percent of cases when parasite disease cysticercosis affects the central nervous system. This disease occurs when an organism becomes the intermediate host to the larvae form of Taenia solium, the pork tapeworm. The clinical features, diagnostic modalities, and management of the condition all differ depending on the position and quantity of cysts, whether the parasite is functional and living or dormant and died, as well as the immune response of each person to the disease. The most common clinical feature when central nervous system is affected is seizures, and the most common seizure types being generalized tonic-clonic seizures seen in 30-60% patients followed by simple partial seizures seen in 8-50% patients. Complex partial seizures (CPS) are the rare type of seizure presentation seen in 2-20% patients. We present a case of 30 year old male who presented with complex partial seizures and severe bilateral headaches. Magnetic resonance imaging was done which showed multiple ring enhancing lesion throughout the brain parenchyma suggestive of neurocysticercosis. Ultrasound of subcutaneous nodules also showed presence of scolex which confirmed our diagnosis. He was started on albendazole, steroids in tapering doses, clobazam and levetiracetam. He was symptom free at 2 months after follow-up.

Primary Sjogren s Syndrome Presenting as Hypokalaemic Periodic Paralysis- A Rare Case Report

Sjogren’s syndrome is “an autoimmune disorder which is characterized by lymphocytic infiltration of salivary and lacrimal glands”. The commonest presenting symptoms are dryness of eyes, mouth and parotid gland enlargement. SS also has extra glandular manifestation in the form of RTA (renal tubular acidosis) seen in one-third cases. RTA presenting as hypokalaemic periodic paralysis is described in few cases in the literature as a rare presentation