Cerebellar ataxia as presenting feature of hypothyroidism

SUMMARY Symptoms and signs of the hypothyroidism vary in relation to the magnitude and acuteness of the thyroid hormone deficiency. The usual clinical features are constipation, fatigue, cold intolerance and weight gain. Rarely it can present with neurologic problems like reversible cerebellar ataxia, dementia, peripheral neuropathy, psychosis and coma. Hypothyroidism should be suspected in all cases of ataxia, as it is easily treatable. A 40 year-old male presented with the history facial puffiness, hoarseness of voice and gait-ataxia. Investigations revealed frank primary hypothyroidism. Anti-TPO antibody was positive. Thyroxine was started and patient improved completely within eight weeks. Hypothyroidism can present with ataxia as presenting feature. Hypothyroidism should be considered in all cases of cerebellar ataxia as it is a reversible cause of ataxia.

Montelukast As An Adjunct To Treatment of Chronic Rhinosinusitis With Polyposis: A Prospective Randomized Controlled Trial.

In a prospective, randomized controlled trial, forty consecutive adult patients with bilateral nasal polyps were randomized into two groups. Twenty subjects in Group A were treated with oral prednisolone for 14 days and budenoside nasal spray for 8 weeks while the twenty subjects in Group B received a similar treatment with additional oral montelukast for 8 weeks. Subjects completed a modified nasal ICSD symptom score at the start of treatment and at 8 and 12 weeks after beginning the treatment. Symptom scores improved in both the groups after treatment. Subjects in Group B reported a statistically significant improvement in sense of smell (p = 0.0002), sneezing (p = 0.008) and overall score (p = 0.0006) at 8 weeks than controls. Four weeks after the completion of treatment, a statistically significant improvement was seen in the sense of smell (p = 0.0006), headache (p = 0.03) and overall score (p = 0.003) in patients in Group B when compared to Group A. Montelukast therapy may have clinical benefit as an adjunct to oral and inhaled steroid in chronic nasal polyposis.

Deep Neck Space Infections: A Profile of Fifty Nine Cases.

The present study was undertaken to analyse our experience with deep neck space infections and emphasize the importance of patient presentation, radiologic evaluation and early diagnosis and appropriate management. The records of 59 patients treated for deep neck space infections were evaluated. Odontogenic infections (35.59%) were found to be the most common cause of deep neck space infections followed by tonsillar infections (20.33%). Pain, fever, neck swelling and odynophgia were the most common clinical presentations. Radiological investigations were performed in all the patients (100%) while contrast enhanced CT - scan was performed in 35 patients (59.32%). The most commonly involved sites were the submandibular space and the parapharyngeal space, involving 14 patients and 11 patients respectively. All the patients (100%) were on intravenous antibiotics and fluids. Surgical intervention was done in 47 patients (79.66%) whereas 12 patients (20.33%) improved with conservative medical management alone. Despite the wide use of antibiotics, deep neck space infections are commonly seen. Early clinical and radiological diagnosis and appropriate management help to prevent the development of life threatening complications. Surgical drainage forms the mainstay of treatment, conservative medical therapy is also effective in selective cases.

Multiple Intracranial Hydatid Cysts: A Rare Presentation.

Cerebral hydatid disease is rare accounting for only 1-2% of intracranial space occupying lesion and usually manifests as solitary cystic nonenhancing lesions usually in the MCA territory distribution. It is even rarer to find multiple intracranial hydatid cysts or polycystic disease. We hereby report an interesting and unusual presentation of a patient with multiple intracranial hydatid cysts with a few showing inflammatory edema and minimal rim enhancement, a rare manifestation and review the literature.

Intravenous - Thrombolysis in a 90 year Old.

Intravenous thrombolysis in acute ischemic stroke has been conventionally avoided in the elderly (>80years of age) with fear of higher incidence of complications like symptomatic intracranial hemorrhage (SICH) and possible loss of efficacy of thrombolysis in view of lack of evidence with most previous trials excluding this group of patients. There has been recent evidence suggesting benefit of IV thrombolysis in the elderly (>80 years) especially when treated within 3 hours of stroke onset. We report a successful thrombolysis in a 90 years old lady which to our knowledge is the first successful thrombolysis reported from India.