Tuberculous encephalopathy: a rare complication of pulmonary tuberculosis

A case of tuberculous encephalopathy, a rare form of neurotuberculosis, is reported in a 16-year-old girl who had pulmonary tuberculosis and extensive cerebral demyelination. The clinical, laboratory and pathological features of this entity are highlighted and the pathogenesis discussed.

Tropical spastic paraparesis ocurring in HLTV-1 associated infective dermatitis: report of two cases

An association between HTLV-1 infection and infective dermatitis(ID), a relapsing eczematous condition of Jamaican children, was reported in 1990. These patients are at a risk of developing other known HTLV-1 related diseases. We have observed the development of HTLV-1 associated myelopathy/tropical spastic paraparesis im two patients, ages 14 and 35 years, who were diagnosed with ID at ages 2 and 10 years, respectively. Infective dermatitis of children serves as an early marker of HTLV-1 infection and may predict later development of either the malignant outcome, adult T-cell leukaemia/lymphoma or the neurologic manifestation HAM/TSP among adult carriers of HTLV-1 infection

Primary antiphospholipid syndrome: a case report

A case of the primary antiphospholipid syndrome (PAPS) in a 21-year-old Jamaican female is described. Recurrent abortions, thrombocytopenia and neurological complications as well as lupus anticoagulant positivity in the absence of features of systemic lupus erythematosus (SLE) were the main clinical findings. Diagnostic criteria, treatment and prognosis are discussed. When the antiphospholipid syndrome (APS) is present in the primary form, the diagnosis may be difficult but its recognition may prevent those vascular events which can lead to significant morbidity and foetal wastage.

Fat embolism syndrome following long bone fractures

During the period August, 1979 to December, 1992, 14 patients with the fat embolism syndrome (FES) were admitted to the University Hospital of the West Indies (UHWI). Two were females and 12 males, their ages ranging from 18 to 78 years, with a median age of 23.5 years. All had lower limb long bone fractures. Clinical features included fever, tachypnoea, confusion and drowsiness. They were all hypoxaemic; 9 required Intensive Care Unit (ICU) admission and, of these 4 needed ventilatory support. Five patients became comatose, 4 of whom developed decerebrate posturing. There was one death from Klebsiella septicaemia, and 13 patients recovered fully. The FES is a serious life-threatening complication of long bone fractures whether simple or compound, usually occurring within 72 hours of the injury. A high index of suspicion is needed for its prompt detection, and early attempts at maintaining adequate tissue oxygenation most be instituted if serious neurological complications and death are to be avoided.

Thymectomy in myasthenia gravis. The Jamaican experience

Forty-five patients with myasthenia gravis (MG) were subjected to thymectomy by the median sternotomy technique and were followed up for 4,380 patient months. No operative deaths occurred and 93.3%of the patients benefited from surgery with 28.8%achieving remission. Forty pptients (88.5%) showed improvement within one month, and 73%of those who achieved remission did so in the first 2 years. Outcome was not affected by thymic pathology except in one patient who had a thymoma removed. These results confirm the value of thymectomy in the management of MG patients with generalised disease and the efficacy of the simple median sternotomy procedure.

Thyrotoxic periodic paralysis in a Jamaican male patient

A case of thyrotoxic periodic paralysis occurring in a Black Jamaican male patient is described. Diagnosis is based on history and confirmed by evaluation of serum electrolyte during attacks and thyroid function studies. The physiopathology, associations, therapy and prognosis are discussed. It is important that clinicians recognise the condition as all forms of periodic paralysis are amenable to treatment, and progressive weakness can be prevented or even reversed.

Amyotrophic lateral scherosis and antecedent poliomyelitis

Motor neurone disease may occur in patients with antecedent, sometimes remote, paralytic poliomyelitis. A Jamaican patient with this sequence is described. Research exploring the relationship between the two diseases is giving a new insight into the aetiology of motor neurone disease.