Hyperammonemic coma presenting as Hashimoto's encephalopathy.

Hyperammonemia is commonly encountered in active liver disease. Evaluation of patients having hyperammonemia with normal liver function is difficult. We present a case referred to us as undiagnosed hyperammonemic coma with normal liver function, who was subsequently diagnosed to have Hashimoto's encephalopathy. In patients with hyperammonemia without hepatic dysfunction, one must search for the presence of hypothyroidism. Hashimoto's encephalopathy though described to be rare in literature, is often underlooked. In patients with undiagnosed coma, one must look for it as it is easy to diagnose and treat.

Comprehensive stroke care: an overview.

Stroke is a global epidemic and an important cause of morbidity and mortality. It ranks next to cardiovascular disease and cancer as a cause of death. "India is likely to suffer huge social and economic burden in the rehabilitation of stroke patients owing to increased life expectancy" and urbanization. Though, there are national programs in malaria eradication and tuberculosis control, there is hardly any governmental support in stroke management and rehabilitation. We propose to formulate stroke-prevention strategies specific to our national needs and covering all the age groups. Allocation of resources towards the stroke management and research is needed. Emphasis on stroke awareness in community should be stressed and should be inclusive of means of primordial and primary prevention apart from management of stroke and its recurrence. Recent international experience in stroke management has suggested the need of specialized stroke units (comprehensive stroke care under one roof). We wish to establish the need of creating awareness regarding the urgency of specialized care in acute stroke. We also wish to motivate our national health institutions to offer affordable, evidence based management of stroke and offer opportunities in stroke training and research.

Abulia: no will, no way.

Abulia refers to impaired ability to perform voluntary actions, show initiative, make decisions along with decrease in movements, speech, thought and emotional reactions. We describe here two patients who developed this condition following bilateral insult to different sites in the centromedial core of the brain, the first following the cerebral venous thrombosis and the second after the right ACA and MCA infarct. Both these patients improved following treatment with Bromocriptine. These cases are described for proper identification and management by the clinicians.

Treatment of memory impairment, vertigo and tinnitus in the elderly with piribedil in an Indian general practice setting.

Age-related dopamine decline leads to memory impairment, vertigo or tinnitus leading to a reduced quality of life in the elderly. This study demonstrates the efficacy and acceptability of piribedil, a dopamine agonist, in improving these conditions. Of the 515 patients included in the study, there was complete resolution of memory impairment, vertigo and tinnitus in 103 patients (20%), improvement in 374 cases (72.6%), with 38 cases (7.4%) showing no change after one month's treatment with piribedil. The treatment was well accepted with a low frequency of side-effects and full compliance with daily medication.

Relevance of stroke units to stroke care : from nihilism to cautious optimism.

Many studies have shown definite reduction in the mortality and morbidity of patients treated in the stroke unit when compared to the general medical ward. The beneficial effect of treatment in a stroke unit is achieved in completely unselected patients independent of their age, sex, co-morbidity, and stroke severity. Better outcome has been atributed to prevention of serious events like aspiration, infection, electrolyte imbalance and consequent early mobilization. In India, at present, there are 8 to 10 stroke units which can serve as models for further expansion of acute stroke care.