Acute reversible left ventricular dysfunction following general anesthesia.

Acute reversible left ventricular dysfunction due to myocardial stunning is a known phenomenon during acute myocardial infarction, coronary angiography, coronary angioplasty or after coronary artery bypass surgery. We report a rare case of acute reversible dysfunction of the myocardium as a complication of general anesthesia in a patient with normal coronary arteries. This is a potentially fatal complication unless recognized early and treated aggressively.

Importance of monitoring calcium & calcium related properties in carrier detection for Duchenne muscular dystrophy.

Calcium and calcium dependent enzymes viz., calcium ATPase, protein kinase C and calcium activated neutral protease (milli CANP mCANP) were studied in the erythrocytes, platelets and lymphocytes of obligate carriers, in order to assess the usefulness of these indices for detection of carriers for Duchenne muscular dystrophy (DMD). With the exception of mCANP and lymphocyte calcium ATPase, other calcium dependent enzyme activities showed considerable overlap between carriers and control. Since the increase in the level of platelet mCANP was found in all affected boys (no false negatives) and obligate carriers, and patients with other myopathic conditions and some neurogenic causes did not show high platelet mCANP activity, this parameter could be considered as a good phenotypic index. Unlike SCK, the platelet mCANP of carriers did not overlap that of controls, hence tests are to be carried out to verify its usefulness as an index of carrier state in mutations other than DNA deletion since testing of non-deletion is both costly and has practical limitations.

Transesophageal echocardiography for the detection of left atrial thrombus.

We performed transesophageal two-dimensional echocardiography (TEE) and compared its results with those of transthoracic echocardiography (TTE) in a series of 120 patients with rheumatic mitral stenosis (MS). The patients were selected from a pool of 2000 patients of rheumatic heart disease assessed earlier by clinical examination and TTE. The selection criteria for TEE included one or more of the following: 1. Atrial fibrillation, 2. Embolic episode, 3. Before closed mitral valvotomy or balloon mitral valvuloplasty, 4. Large left atrium (LA) and 5. Evidence of clot or spontaneous echo-contrast in LA. The aim was to study the usefulness of TEE as compared to TTE in the detection of thrombus in LA. LA thrombus was imaged in 34/120 TEE studies as compared to 21/120 TTE studies. In 12/13 patients in whom TTE failed, the clot was present in the left atrial appendage (LAA). In the remaining one patient, poor echo window for TTE was responsible. In 2/6 patients with embolic episode, neither TTE nor TEE could document the presence of clot in LA. The procedure of TEE was well tolerated and there were no complications. We conclude that TEE is a safe and valuable adjunct to TTE with better diagnostic ability for the detection of LA thrombus and should be performed in all patients with MS in whom a clot in LA is suspected or needs to be excluded.

Paramedian diencephalic syndrome. Report of 3 cases.

We report three patients who lapsed into coma and subsequently manifested hypersomnolence, amnesia and vertical gaze paresis. Computed tomography revealed bilateral paramedian thalamic infarcts. This clinical symptomatology comprises the paramedian diencephalic syndrome.

Cerebellar and thalamic infarctions in basilar artery migraine.

We report a 25 year old male who suffered thalamic and multiple cerebellar infarctions during infrequent attacks of basilar artery migraine. Migraine-related infarcts at these sites are uncommon.

Hemiplegic migraine.

Eight patients with hemiplegic migraine are described. Majority were in their second decade and suffered two or more episodes of dense hemiplegia outlasting the headache. Complete recovery was the rule.

"Top of the basilar" syndrome: a clinical and CT analysis.

Fifteen patients presenting with visual, oculomotor and behavioural disturbances were diagnosed to be suffering from "top of the basilar" syndrome. Computed tomography confirmed the distribution of infarctions in the vascular territory of the rostral basilar artery. The clinical profile comprised cortical blindness and visual field defects, vertical gaze paresis, memory and behavioural disturbances and in one patient, the paramedian diencephalic syndrome.