Cerebrovascular manifestations in scorpion sting: a case series.

Cerebrovascular manifestations are uncommon presentations of scorpion sting in the Indian subcontinent. A prospective study was carried out on 50 patients with scorpion sting referred to the Government General Hospital during the period from April 2004 to March 2005. In all the patients, detailed history, physical examination with a specific neurological examination and routine biochemical testing and fundus examination were done. Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) were done in cases with neurological deficit. All these patients also underwent a complete hematological, rheumatologic and cardiovascular work-up for stroke. Cerebrovascular involvement was noted in four patients (8%). Hemorrhagic stroke was noted in two patients (4%) and thrombotic stroke was noted in two patients (4%). The mean time of presentation of neurological symptoms was 2 days. Stroke has been a common presentation in our series (8%). Contrary to world literature, there have been no reports of cranial nerve palsies or neuromuscular involvement in our series.

A typical presentation of acute myeloid leukemia.

A young man who presented with fever, altered sensorium and sudden onset tachypnea, is described. Arterial blood gas analysis, revealed the presence of severe high anion gap metabolic acidosis, with compensatory respiratory alkalosis and normal oxygen saturation. A detailed neurological, nephrological, biochemical and hematological evaluation, revealed the presence of Acute myeloid leukemia, with lactic acidosis and hyponatremia. There are very few reports of presentation of leukemia as lactic acidosis. This case report highlights the need for emergency room physicians, to consider the possibility of lactic acidosis, as one of the causes of high anion gap acidosis and to meticulously investigate the cause of lactic acidosis. We describe a rare clinical instance of lactic acidosis as the presenting manifestation of Acute myeloid leukemia.