Clinical Profile of Cerebral Venous Sinus Thrombosis.

BACKGROUND AND OBJECTIVES: Cerebral venous sinus thrombosis (CVT) occurs due to occlusion of the veins and sinuses which drain the brain parenchyma. It is an uncommon form of stroke, predominantly found in young patients1 . Despite advances in the recognition of CVT in recent years, diagnosis and management can be difficult because of the diversity of underlying risk factors, presenting features and the absence of a uniform treatment approach. This study aimed to ascertain the clinical presentation, various aetiologies and prognostic indicators of cerebral venous sinus thrombosis. METHODOLOGY: This hospital-based descriptive study was carried out on 30 eligible patients from December 2013 to July 2015 after approval of Institutional Ethics Committee. Detailed history, clinical findings and required relevant investigations were recorded and analysed. RESULTS: CVT was commonly observed in younger persons, commonly between 21-30 years. Female: Male ratio was 2.33. Altered sensorium at presentation was a poor prognostic indicator. The most common etiology was pregnancy and puerperium, followed by hyperhomocysteinemia. Superior sagittal sinus was found to be the most common site of thrombosis in this study, in 17 (56.7%) of the patients. 17 patients (56.67%) recovered completely without any neurodeficit. 24 ( 80%) and 22 (66%) subjects had cerebral infarction secondary to CVT. 5 (16.67%) patients succumbed to thrombosis or complications, most commonly due to intracerebral haemorrhage and cerebral edema. CONCLUSION: CVT is a disease with multifactorial, gender-related specific causes and has a wide and varied clinical spectrum.

Hidradenitis Suppurativa Complicating Epithelial Malignancy in Immunocompromised Patient.

Hidradenitis suppurativa complicating epithelial malignancy in people living with HIV is very rare. Hidradenitis suppurativa is very rare seen in only 1% of general population and 4% of young adults. We report a case of Hidradenitis suppurativa complicating an epithelial malignancy in are immunocompromised (HIV reactive) patient.

Clinical profile of Guillain Barre syndrome.

OBJECTIVES: To study clinical presentation, hospital care and outcome of patients of Guillain Barre Syndrome (GBS) and number of patients of respiratory failure and need for ventilators. To study efficacy of IVIg in patients of GBS. MATERIAL AND METHODS: 40 patients of GBS studied in detail including history, clinical examination and investigations (Nerve conduction velocity and C.S.F. examination). All patients were watched for respiratory insufficiency and those who developed respiratory paralysis were given assisted mechanical ventilation. Patients were treated with IVIG and outcome was observed. Outcome of 2 groups of patients one treated with IVIg and other not treated with IVIg (supportive line of treatment) were compared. RESULTS: Commonest age group affected was 13-40 yrs. The male:female ratio was 1.5:1. Antecedent infection in form of fever, cough [11 patients], loose motions [10 patients] were present in 21 out of 40 patients. Quadriparesis was present in 39 patients and paraparesis in 1 patient. Cranial nerve involvement was seen in 25 out of 40 patients. Facial nerve was involved in 12 [30%] patients and Glossopharyengeal, vagus nerves were involved in 12 [30%] patients. Areflexia was found in all 40 patients. In CSF examination, albuminocytologic dissociation was present in 17 out of 26 patients. NCV findings show conduction velocity slowing, delayed f latencies in 90% patients. Out of 40 patients, 13 [30%] required mechanical ventilation. Out of 40 patients, 14 were treated with IVIg, 4 patients treated with plasmapheresis and 22 patients received only supportive treatment. Out of 40 patients 30 [75%] patients recovered completely, 8 [20%] patients died and 2 [5%] patients developed severe neurologic deficit. CONCLUSION: GBS is more common in 13-40 yrs age group with male:female ratio of 1.5:1. Antecedent infection is seen in 55% patients. Commonest presentation was paresthesia in legs and ascending paralysis. One third [32.5%] patients developed respiratory paralysis and needed ventilatory support. Patients who received IVIg early in the course of disease had faster recovery as compared to patients who received only supportive line of treatment.