Tumour-like presentation of central nervous system tuberculosis: a retrospective study in Kingdom of Saudi Arabia

To differentiate the tumour-like presentation of central nervous system [CNS] tuberculosis [TB] from CNS tumours. We conducted a retrospective chart review of all cases of CNS TB seen at King Abdulaziz Medical City, Jeddah, between January 2002 and January 2012. No symptoms or signs of pulmonary or systemic TB were found. Of the 125 patients with CNS TB, 9 [7.2%] presented with clinical and radiological features suggestive of a brain tumour. A diagnosis of tuberculoma was established either intraoperatively in frozen sections [three patients] or postoperatively when the masses were resected [six patients]. After surgery, seven patients recovered after receiving anti-TB treatment; one patient died, and another developed a severe neurological deficit. CNS TB is a great mimicker of brain tumours, and the index of suspicion should be high, especially in endemic areas. A diagnosis is based on clinical presentation and the results of investigations. In patients with CNS TB that present with a mass lesion, a biopsy should be taken to avoid morbidity and mortality from an unnecessary surgical intervention. Greater use should be made of magnetic resonance spectroscopy in the evaluation of brain space-occupying lesions, and CNS TB should be included in the differential diagnosis of such lesions in all areas endemic for TB. The absence of constitutional or pulmonary symptoms of TB is deceiving. More nationwide epidemiological studies are needed to establish guidelines for early detection and successful outcomes of this rising health problem

Memory boosting effect of citrus limon, pomegranate and their combinations

Memory is greatly influenced by factors like food, stress and quality of sleep, hence present study was designed to evaluate the effect of Citrus limon and Pomegranate juices on memory of mice using Harvard Panlab Passive Avoidance response apparatus controlled through LE2708 Programmer. Passive avoidance is fear-motivated tests used to assess short or long-term memory of small animals, which measures latency to enter into the black compartment. Animals at MCLD showed highly significant and significant increase in latency to enter into the black compartment after 3 and 24 hours respectively than control, animals at HCLD showed significant increase in latency only after 3 hours. Animals both at low and moderate doses of pomegranate showed significant increase in test latency after 3 hours, while animals at high dose showed highly significant and significant increase in latency after 3 and 24 hours respectively. There was highly significant and significant increase in latency in animals at CPJ-1 combination after 3 and 24 hours respectively; however animals received CPJ-2 combination showed significant increase in latency only after 3 hours as compare to control. These results suggest that Citrus limon and Pomegranate has phytochemicals and essential nutrients which boost memory, particularly short term memory. Hence it may be concluded that flavonoids in these juices may be responsible for memory enhancing effects and a synergistic effect is observed by CPJ-1 and CPJ-2 combinations

Cervical gouty myelopathy in two cases at King Abdulaziz medical city

Gout is a rheumatological disorder found exclusively in human species. It is caused by deposition of crystals of monosodium urate in joints, cartilages, tendons, and soft tissues. Involvement of the spine, however, is rare. In this report, we describe two patients presented to King Abdulaziz Medical City in Jeddah with clinical features of cervical myelopathy, including neck pain, L'hermitte phenomena, quadriparesis and sensory deficit [shoulder level]. Magnetic resonance imaging confirmed the presence of cervical cord compression with intrinsic cord signal abnormalities. Both patients had laminectomy and intraoperatively; severe canal stenosis was identified. A whitish cheesy material was noticed causing significant root compression. The pathology was diagnostic of gout. In this article, we present two difficult cases with interesting clinical, radiological and pathological findings. We emphasize on the importance of early diagnosis to prevent morbidity

Inability to walk due to scurvy: a forgotten disease

Scurvy has become rare in modern societies, but should be considered in malnourished persons, alcoholics, and in infants on unsupplemented milk diets who present with musculoskeletal pain or a bleeding tendency. The diagnosis of scurvy can be challenging because of the rare incidence and vague and nonspecific early symptoms. We report here a case of scurvy in a young boy who presented with an inability to walk and severe musculoskeletal pain. The diagnosis was established based on his clinical picture, radiological appearance, and low serum level of vitamin C. The patient responded well to vitamin C supplementation with full resolution of his symptoms. He regained his ability to walk and his family was happy and satisfied with the outcome of treatment. Although the incidence of scurvy has become low in Saudi Arabia, it can still occur and early recognition is important because of the excellent prognosis

Central pontine myelinolysis due to rapid correction of hyponatremia induced by excessive water intake

We report a 25-year-old female with a recent diagnosis of gastric B-cell lymphoma based on imaging and pathological findings. She was discharged against medical advice after it was recommended to her, by an "alternative medicine practitioner," to restrict her diet to excessive ingestion of the "Holy water Zamzam" [natural well water in Makkah]. She presented back with altered level of awareness and severe, new-onset hyponatremia. The hyponatremia was corrected rapidly and her condition improved. Six days later, she developed the classical pyramidal and extrapyramidal features of central pontine myelinolysis, documented by MRI. The patient succumbed to her original disease 3 months later

Sporadic creutzfeldt Jacob disease

We report a 65-year-old lady who presented with rapidly progressive dementia and was found to have Creutzfeldt-Jacob disease [CJD]. On reviewing the literature, there have been only 3 case reports of CJD from Saudi Arabia. Our aim is to report this rare disease and to include it in the differential diagnosis of rapidly progressive dementia in our practice