Camphor ingestion: an unusual cause of seizure.

Camphor is a pleasant smelling cyclic ketone with propensity of causing neurologic side-effects especially seizures. We report two patients who after inadvertent consumption of camphor experienced an episode of generalized tonic clonic seizure. These cases highlight the importance of enquiring any intake of material (medicinal or otherwise) in every patient presenting with seizure.

Falls in the elderly--clinician's approach.

Fall is an involuntary event producing a change in posture resulting in the individual adopting an unplanned supine position. Globally more than one-third of persons 65 years of age or older fall each year and in half of such cases the falls are recurrent. Several predisposing factors for such falls have been recognised like age related changes in posture control, reduced visual acuity, anxiety, drugs, environmental hazards and underlying neurological diseases. It is the interplay of predisposing and precipitating factors that really matter and not exactly a single cause. Evidence based interventions have been suggested from recent clinical trials and certain preventive guidelines are present to reduce the rate of falling, provided a periodic targeted approach is followed.

Left atrial myxoma presenting as pseudobulbar palsy.

A case of left atrial (LA) myxoma presenting as pseudobulbar palsy, due to multiple cerebral infarcts, without any cardiac manifestations, is presented. LA myxoma is rare cause of embolization to CNS causing ischemic infarcts. Due to multiple CNS infarcts patient can present with varied clinical picture and pseudobulbar palsy is not a very common presentation. It was a real diagnostic dilemma before LA myxoma was diagnosed on echocardiography.

Reversible neurologic manifestations after glycerol: a short report.

A 46 year old male inadvertently consumed 500 ml of glycerol and presented with altered sensorium, focal neurologic signs and generalised seizures. He was managed conservatively and recovered fully within 48 hours. The case highlights the rare presentations of overdosage and neurologic effects with glycerol, an otherwise safe drug used in neurology.

Electrocardiographic changes during upper gastrointestinal endoscopy in ambient hypoxia.

Electrocardiographic (ECG) changes were studied in 120 consecutive subjects during and after upper GI endoscopy done in ambient hypoxia (PO2-120 mmHg) at Shimla (2200 m). No premedication was given to any of the subjects. There were 75 men and 44 women. Fifty three subjects were aged 40 years or below (Group I) and 67 subjects were above 40 (Group II). There were 29 subjects with and 91 subjects without cardiac diseases. Increase in heart rate was seen in 96.6% of subjects. Maximum rise in heart rate was found in cardiac patients. ST depression was seen in 14.2%, T wave inversion in 13.3%, supraventricular tachycardia in 5.8% and ventricular ectopics in 1.6%. ST depression was more frequent in cardiac than in non cardiac patients (P less than 0.001) and T wave inversion was more frequent in women than in men (P less than 0.001). All the changes reverted to normal within 10 minutes. ECG changes notwithstanding, upper GI endoscopy without premedication in the presence of ambient hypoxia is a safe procedure.

Hemiplegia as a manifestation of acute mountain sickness.

A young mountaineer who developed right sided hemiplegia with aphasia at high altitude is reported. This is an uncommon nervous system manifestation in acute mountain sickness.

Acute renal failure due to leukaemic infiltration of kidneys.

Three patients with acute lymphatic leukaemia who presented with non-oliguric acute renal failure resulting from leukaemic infiltration of the kidneys are reported. Chemotherapy resulted in clinical remission of leukaemia with regression of renal size and prompt improvement in renal function in two cases. The third patient died on the second day of therapy and a post-mortem renal biopsy revealed dense leukaemic infiltration of the kidneys. Early institution of specific chemotherapy for leukaemia, maintenance of fluid and electrolyte balance, and dialytic support whenever indicated may prove helpful in prevention of serious complications associated with renal failure and in halting further ischaemic injury to the kidney.