Decompressive craniectomy in herpes simplex encephalitis: a case report

Herpes Simplex Encephalitis is the commonest form of sporadic encephalitis. Availability of effective antiviral therapy viz Acyclovir has significantly reduced the mortality of Herpes Simplex Encephalitis. Elevated intracranial pressure   resulting in herniation syndromes continues to be an important cause of mortality. Antiviral therapy and medical measures for managing raised intracranial pressure including osmotic diuretics, careful usage of steroids and controlled hyperventilation continue to be the cornerstones in management of these patients. Authors present a 38-year-old male patient with Cerebrospinal fluid Meningo-encephalitic panel positivity for herpes simplex virus 1 and bilateral temporal lobe lesions with secondary decline due to impending herniation syndrome despite osmotic diuretics and steroids with patient survival and complete recovery following decompressive hemicraniectomy.

Listeria monocytogenes brain abscess in an immunocompromised patient: a case report

Listeria monocytogenes is a facultative intracellular gram-positive bacillus which usually infects immunocompromised patients, though it can infrequently infect immunocompetent individuals, neonates and pregnant women as well. Neurological manifestations include meningitis and cerebritis. Brain Abscess is an extremely rare presentation with approximately 80 reported cases. Authors report a patient with a brain abscess identified on an MRI scan with positive blood culture for Listeria monocytogenes. Patient was managed conservatively with intravenous followed by oral antibiotics with resolution of the abscess.

Hypersomnia and Bilateral Horner's as a Initial Presentation in Multiple Sclerosis.

Multiple Sclerosis is characterized by recurrent neurological deficiet attributable to white matter tracts, at least initially. Deep grey matter nuclei can be rarely involved in early disease as seen in MRI studies. Clinical manifestations attributable to involvement of these grey matter nuclei are extremely rare especially in early disease and is usually considered as a red flag for the diagnosis of multiple sclerosis. We report a case of a young girl presenting as a clinically isolated syndrome with bilateral Horner's and hypersomnia with MRI evidence of hypothalamic involvement.

Intravenous - Thrombolysis in a 90 year Old.

Intravenous thrombolysis in acute ischemic stroke has been conventionally avoided in the elderly (>80years of age) with fear of higher incidence of complications like symptomatic intracranial hemorrhage (SICH) and possible loss of efficacy of thrombolysis in view of lack of evidence with most previous trials excluding this group of patients. There has been recent evidence suggesting benefit of IV thrombolysis in the elderly (>80 years) especially when treated within 3 hours of stroke onset. We report a successful thrombolysis in a 90 years old lady which to our knowledge is the first successful thrombolysis reported from India.