Syndrome of spontaneous cerebrospinal fluid hypovolemia: Report of six cases.

Syndrome of spontaneous cerebrospinal fluid hypovolemia (SCH) is a rare cause of new onset headache. We report six cases of SCH presenting with new onset headache. All six cases were females. Acute onset orthostatic headache and neck pain were the chief characteristics of SCH in our cases. The MRI brain showed pachymeningeal gadolinium enhancement in all patients. Spinal extradural CSF collection was demonstrable on MRI in three cases. All cases improved with conservative therapy. High index of clinical suspicion and contrast enhanced MRI brain is the key to accurate diagnosis in the majority of cases.

Recurrent stupor due to lysinuric protein intolerance.

Recurrent stupor in children is an uncommon clinical problem with a wide differential diagnosis; inherited metabolic disorders account for a vast majority. We report a 9-year-old girl with recurrent episodes of stupor. Initial episode was treated as viral encephalitis and the second episode was managed as non-convulsive status epilepticus. Hyperammonemia was detected in the last episode. Metabolic work-up after dietary protein challenge revealed classical biochemical features of lysinuric protein intolerance. She was managed with protein-restricted diet, which resulted in marked neurological improvement. LPI is a rare inherited metabolic disorder due to membrane transport defect of cationic amino acids.

Brainstem abscess complicating tetralogy of Fallot successfully treated with antibiotics alone.

Medically treated brainstem abscess in a 11 year old boy with tetralogy of Fallot is reported. There was a complete resolution of the lesion without any neurologic sequelae during parenteral antibiotic therapy with crystalline penicillin, chloramphenicol and metronidazole. The pathogenesis and management of cardiogenic brain abscesses in general and brainstem abscess in particular has been reviewed.

Role of gastric lavage and broncho-alveolar lavage in the bacteriological diagnosis of childhood pulmonary tuberculosis.

OBJECTIVE: To compare the mycobacteriological yield from gastric lavage (GL) and bronchoalveolar lavage (BAL), in children with pulmonary tuberculosis. METHODS: 58 consecutive children with chest radiograph suggestive of tuberculosis and positive Mantoux test or a positive history of family contact with a case of tuberculosis were prospectively subjected to gastric lavage on three consecutive mornings and broncho-alveolar lavage on the last day. The samples were subjected to bacteriological isolation. RESULTS: Samples from 10 (17.2%) children grew Mycobaterium tuberculosis from gastric lavage and 12 children had their BAL positive for this bacteria(p>0.05). Overall mycobacterial isolation was possible in 20 patients (34.4%) as two children had grown Mycobacterim tuberculosis in GL as well as BAL. Addition of BAL to the diagnostic work up increased the mycobacteriological yield from 17.2% with gastric lavage alone to 34.4% when BAL was also performed (p=0.013). CONCLUSION: There is no difference in mycobacterial isolation rates from gastric lavage and BAL when studied in isolation. However, when both GL and BAL are used; these procedures complement each other to double the diagnostic yield.