Isolated Nodular Ischemic Infarcts: A Central Lesion That Presents as Peripheral Vertigo.

Aims and Objective: Giddiness is one of the commonest presenting complaints to the emergency physicians. Differentiation between ‘peripheral’ and ‘central’ etiologies is important to avoid unnecessary investigations and avoid missing a potentially serious diagnosis such as an ischemic stroke. Isolated nodular infarction can present with clinical signs that mimic a peripheral vestibular cause. We present the clinical findings in 14 cases of isolated nodular infarction and discuss their differentiating features. Study Design: Retrospective case series. Place and Duration: Tertiary care university hospital in Singapore between January 2007 to September 2012. Methods: We evaluated the clinico-radiological findings of all the patients diagnosed with isolated nodular infarction at our center during the study period. Their clinical presentations were extracted from the case records. We combined our cases to an existing series of 8 patients from Korea to strengthen the findings. Results: Of the 286 acute posterior circulation ischemic stroke patients admitted to our tertiary care center during the study period, 6 (2.1%) were found to have isolated nodular infarction. They typically presented with acute severe giddiness. Nystagmus was seen in all, which was unidirectional and beating towards the side of the lesion with no latency or fatigability. Walking was usually severely impaired due to imbalance and all patients had a negative head impulse test. All patients at our center achieved complete recovery at 3- months. Conclusions: We present the clinical spectrum of isolated nodular infarction. In addition to a high index of suspicion in patients with multiple vascular risk factors, a negative head impulse test despite severe vertigo and imbalance can help in establishing the correct diagnosis.

Stem cell through present and future.

Stem cell transplantation (SCT) has the potential to transform the lives of children with a wide variety of genetic diseases, ranging from inherent defects of hemopoietic cell production or function through to metabolic diseases mostly affecting solid organs. For these children life expectancy or quality of life would otherwise be very poor. It ranks as one of the most remarkable therapeutic advances of the past 40 years. Despite rapid technological improvements, however, there are still many short term risks and potential long term toxicities. Consequently, the rapid emergence of alternative therapies (including new drugs, enzyme and gene therapies), necessitate constant re-evaluation of the risk/benefit ratio for each disease and hence the appropriateness of SCT. This review describes the major aspects of the transplant process, indications for transplantation, outcome statistics, and areas where alternative therapies are becoming available. SCT remains a highly experimental therapy. Due to the relatively short history of the discipline no data exists on truly long term follow up. This is important as some organs benefit relatively poorly or problems may emerge which were never apparent as part of the untreated disease. The speed of technological change makes randomised trials on these diseases, which are individually quite rare, almost impossible to perform.