Pain abdomen and cardiac arrest as peculiar presenting symptoms in AIDP- AMSAN variety

AIDP (Acute Inflammatory Demyelinating Polyneuropathy) is a heterogenous condition encompassing several variants. It is a post infectious neurological disorder with an autoimmune pathogenesis with molecular mimicry mechanism. They present commonly with symmetrical ascending type paralysis and absent or diminished deep tendon reflexes. Cranial nerve palsies may or may not be present. The diagnosis is based on the clinical signs and symptoms, nerve conduction studies and cerebrospinal fluid analysis. We herewith report a rare case of AIDP, where the patient came walking to the emergency room with pain abdomen as the only complaint and had no neurological deficits at the time of presentation, hours later, the patient went into cardiac arrest, the cause of which was later thought to be dysautonomia and respiratory failure. The next day, patient developed motor weakness and multiple cranial nerve palsies which is an overlap of AMSAN and Acute Ophthalmoplegia. It is extremely uncommon to present with pain abdomen and cardiac arrest as presenting features in AIDP, AMSAN (Acute Motor Sensory Axonal Neuropathy) variety.

A study of clinical profile, etiology, therapeutic outcomes of patients with cerebral sinus venous thrombosis in men

Cerebral sinus venous thrombosis (CSVT) is very rare in men compared to women. There are many causes but they are very rare in men, and it is an uncommon cause of cerebral infarction. Patients usually present with Headache, Focal deficits such as Monoparesis, Hemiparesis, Paraparesis and Hemisensory disturbances, seizures, impairment of level of consciousness. Now it is recognized as a non-septic disorder with various clinical presentations with a favorable outcome, and low mortality rate below. CT scan, MRI and Magnetic Resonance Venography (MRV) are the best diagnostic methods for diagnosis and low molecular weight heparin is the first-line treatment. Results of this study, clinical profile, etiology, therapeutic outcomes of patients with cerebral sinus venous thrombosis in men are discussed.

The significance of proteinuria in essential hypertension

The prevalence of hypertension is reported to be about 29% in India. Proteinuria is often the earliest marker of hypertension mediated renal damage, occurring even before a reduction in glomerular filtration rate (GFR). It can also be used to predict risks of chronic kidney disease (CKD) progression, cardiovascular disease, and all-cause mortality in general population. Thus monitoring proteinuria is a key aspect of assessing disease progression and treatment response in a variety of kidney diseases, including hypertensive renal damage. Target organ damage is common in microalbuminuric patients. They can have high left ventricular mass, a high prevalence of retinopathy , and an increased thickness and presence of plaques in the carotid artery. It is also interpreted as a marker of early intra renal vascular dysfunction in essential hypertension. Microalbuminuria is an independent predictor of cardiovascular morbidity and mortality in patients with essential hypertension. Microalbuminuria seems to constitute a simple and accurate method to detect a hypertensive patient at a high risk for cardiovascular and probably renal damage. The present study is comprised of 50 cases of essential hypertension. Microalbuminuria and Proteinuria was estimated. 27 patients i.e. 54% had microalbuminuria. Microalbuminuria had a positive correlation with severity of Hypertension with p value of 0.047 (< 0.05). Prevalence of microalbuminuria increases with the age and duration and severity of hypertension. Microalbuminuria had a statistically significant correlation with the presence and severity of target organ damage. Screening for microalbuminuria should be performed in hypertensives to start treatment early to minimize morbidity and mortality.