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@#Wallenberg syndrome (lateral medullary syndrome) is a type of posterior circulation stroke resulting in brainstem infarction which is most often caused by occlusion of vertebral artery or posterior inferior cerebellar artery or both.1 Here we report a case of right lateral medullary syndrome secondary to vertebral artery occlusion with associated left cerebellar and cervical cord infarct resulting in quadriparesis.
RESUMO
Klebsiella pneumoniae is a Gram-negative, non-motile, lactose fermenting, aerobic rod-shaped bacterium with three different subspecies, K. pneumoniae, Klebsiella ozaenae, and Klebsiella rhinoscleromatis. Here, we report the case of a 32-year-old male, chronic alcoholic presented with fever, hemoptysis, and headache of 20 days duration. Over a period of 4 days, the patient worsened with the development of altered sensorium and respiratory distress, connected to a mechanical ventilator. Computed tomography and chest X-ray showed consolidation involving the left lower lobe with an air-fluid level. Magnetic resonance imaging brain showed multiple metastatic brain abscess involving cerebrum and cerebellum and culture reports of sputum and blood showed K. pneumoniae. The patient was started on antibiotics along with anti-tubercular drugs. In spite of effective management, the patient developed recurrent episodes of hemoptysis and died of respiratory failure. For the concomitant involvement of both cerebrum and cerebellum for the first time.
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@#Central retinal artery occlusion and central retinal venous occlusion are rare entities of retinal vascular disorders that can cause sudden visual loss and combined occurrence results in devastating outcomes. The role of protein C deficiency is well established in venous thrombosis however the occurrence of concurrent arterial thrombosis is rare and the combination in association with carotid artery occlusion is an exceptionally rare occurrence. Here we report a case of protein C deficiency presenting as combined central retinal artery occlusion and central retinal venous occlusion with bilateral carotid artery disease
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@#Background & Objective: About 95% of the adult population has been infected with varicella zoster virus (VZV). It can involve any part of the nervous system. This study aimed to determine the spectrum of neurological manifestations in patients with primary varicella zoster virus infection, its clinical course and prognosis. Methods: This was an observational study of patients who presented with primary VZV infection in the Institute of Neurology, Madras Medical college, Chennai between August 2015 and February 2018. Patients with neurological manifestations due to VZV reactivation were not included in the study. Detailed history, clinical examination, blood investigations, MRI brain and whole spine, CSF analysis including viral studies, nerve conduction studies, EEG were analysed. All primary VZV patients were found to have characteristic chickenpox rash and/or its scar. The course of disease and clinical outcome after treatment were studied. Results:Among the 22 patients, 10 patients presented with VZV meningoencephalitis, 4 patients with Guillain-Barré syndrome (GBS), 2 patients with meningoencephalitis with cerebellitis, 2 patients with cerebellitis, 1 patient as acute disseminated encephalomyelitis ( ADEM), 1 patient as neuromyelitis optica (NMO), Two patients had acute stroke like deficits due to VZV vasculopathy. GBS and ADEM patients were treated with intravenous immunoglobulin and NMO patient was treated with intravenous methylprednisolone and they clinically improved after 4 weeks. There were two mortalities (9%). Conclusion: Meningoencephalitis followed by GBS were the main manifestations of primary VZV from Chennai, India