Topiramate-induced ocular complications: case series.

Several ocular adverse effects have been attributed to Topiramate, a sulfonamide derivative. It can cause problems in the eye such as choroidal effusion syndrome, acute angle closure glaucoma, myopic shift, visual field defects, and Myokymia. If not identified early, it can be vision-threatening. It is commonly used for migraine prophylaxis, partial onset, and generalized tonic-clonic seizures. It has also been prescribed for bipolar disorder and alcoholism. The risk of adverse reactions with this drug is 3%. The prognosis is favorable if it is discontinued early and prompt therapy is initiated. OBJECTIVE: This article reported a case series of topiramate-induced ocular complications. MATERIALS AND METHODS: The patients presented with high intraocular pressure and blurred vision following a topiramate prescription for headache. CONCLUSION: Timely recognition and intervention can prevent potential visual loss in such cases.

Postoperative CSF Leak: Blood Patch-A New Avenue.

Introduction Cerebrospinal fluid leak (CSF) after a neurosurgical procedure is a known complication that may result in bad outcomes (1). The incidence of CSF leak varies based on the site involved; it ranges from 4 to 32% for transsphenoidal to posterior fossa procedures. The costs involved in treating postoperative CSF leaks increases exponentially that becomes a barrier in continuing optimum treatment. There are many studies that compare the different treatment modalities and even use of sealing agents but none give an algorithm of management. Our study aims at known technique that can help to treat these kinds of low-pressure CSF leaks. Materials and Methods This was a prospective study done over a period of 5 years from January 2014 to January 2019. All patients who underwent procedures in which durotomy was done were included in the study. Results A total of six patients were enrolled for the study. The duration of the study spanned 5 years from January 2014 to January 2019. All the patients after taking informed consent underwent the necessary investigations and a blood patch was done. Five of the patients the CSF stopped but in one patient it persisted. This patient again underwent investigation and under image guidance another blood patch was put after which the CSF leak stopped. Conclusion Blood patch under imaging guidance is a safe and simple technique. The success rates of cessation of CSF leaks are good. Also, it is a cost-effective method using an autograft (patient's blood).

V-Y Plasty or Primary Repair Closure of Myelomeningocele: Our Experience.

BACKGROUND: Open neural tube defects in the spine most commonly are in the lumbo-sacral region. Surgical closure is the treatment, but in primary closure the chances of CSF leak are more. Hence a novel technique of using an advancement flap called the V-Y plasty for closure of these defects(6). Our study compares the outcomes of primary closure and V-Y plasty in the closure of Myelomeningocoeles. METHODS: A prospective study of the infants who underwent surgical repair for MMC at our hospital from August 2014- January 2018 were included in the study. Total of 22 infants were treated, 9 underwent primary repair and 13 underwent V-Y plasty. RESULTS: The time taken for primary closure was a mean of 120 min, while the advancement flap took longer of 190.7 min. All the 9 who underwent primary closure had CSF leak, 3 developed hydrocephalus, 6 had wound dehiscence, 3 had neurological deficits and 1 died. Of the 13 infants who underwent V-Y plasty 3 had CSF leaks, 1 had hydrocephalus, 5 had neurological deficits and no wound dehiscence or deaths. CONCLUSION: The aim of surgical repair is to cover the exposed neural tissue, prevent CSF leak and reduce CNS infections. V-Y plasty a plastic surgical technique of advancement flaps with intact pedicles improves the outcome of skin closure once the neural placode is placed in the dura and closed. This reduces the morbidity in a one-time procedure.

Primary dura-based synovial sarcoma of the parafalcine region of brain.

Dura-based intracranial neoplasms include a wide range of primary and metastatic tumors, varying in their clinical, radiologic, morphologic, and immunophenotypic characteristics. At this anatomic location, sarcomas are rare, however, they exhibit close morphologic resemblances to meningioma. Herein we describe the third case of primary synovial sarcoma of the parafalcine region in a50-years-old female, who presented with left-sided hemiplegia. The radiologic survey revealed a 5.5cm×5.8cm contrast enhancing dura-based mass at the right parafalcine region with meningeal enhancement and edema in the surrounding areas. Morphologic evaluation exhibited a high-grade spindle cell neoplasm, with focal hemangiopericytomatous pattern. The tumor cells were diffusely immunoreactive for CD99, Bcl2, TLE-1, and vimentin. The Ki-67 proliferation index was 40%. Pancytokeratin was focally positive. Epithelial membrane antigen, progesterone receptor, CD34, S-100, and glial fibrillary acidic protein were negative. Fluorescence in situ hybridization confirmed tumor specific translocation t(X;18)(p11.2;q11.2). Hence, final diagnosis of synovial sarcoma was rendered. Primary meningeal synovial sarcoma should be considered in the differential of aggressive and high-grade dura-based tumors in view of their relative chemosensitivity and future prospect of a molecular target-based therapy. The index case highlights the importance of an extensive pathologic analysis of high-grade mesenchymal lesions of the meninges to arrive at a definitive diagnosis and differentiate such tumors from other usual dura-based tumors, which has important therapeutic and prognostic implications.

Truth under a masquerade!

A 32-year-old woman presented with bilateral periorbital oedema of 2 days duration which progressed to proptosis, chemosis with diminution of vision rapidly within a week. She was a known case of adenocarcinoma of the rectum who was treated with surgery and chemotherapy 6 months earlier. Metastasis workup carried out then was negative. On examination, she had bilateral axial proptosis with sluggish pupillary reactions with restricted extra ocular movements. Fundus examination was normal. Systemically, the patient was of poor build and was undernourished. Haemogram showed raised total counts and erythrocyte sedimentation rate. CT orbit and brain showed metastasis to the frontal bones and orbit. On investigating further, the patient had liver and lung metastasis. The patient was started on chemotherapy, but she succumbed to the disease within a week. This case is reported to highlight how bilateral orbital cellulitis can be a presenting sign of systemic metastasis in treated malignancies.

A Comparative Study on Fine Needle Aspiration Cytology versus Fine Needle Capillary Cytology in Thyroid Nodules.

OBJECTIVES: Fine needle aspiration cytology (FNAC/FNA) is the primary investigation for thyroid nodules. Fine needle capillary cytology (FNCC/FNC) is an alternative technique not commonly used, though it is easy to perform. Both the techniques have their own advantages and disadvantages. This study aims to compare these two cytological techniques for better specimen and cytological diagnosis. METHODS: This prospective study was conducted on 50 patients attending the FR Muller Medical College Hospital from May 2006 to April 2008. The patients with thyroid nodules (diagnosed by palpation) were subjected to both the cytological techniques; FNA and FNC. The specimen and results were compared and then correlated with the final histopathological findings wherever surgical specimens were available (38 cases). RESULTS: The mean age of the patients was 39.16 with a female predominance. The majority of cases were diagnosed to have nodular goiters. The FNC technique yielded 88% diagnostic superiority and adequate specimens compared to 94% by FNA. Sensitivity was 50% for FNC and 100% for FNA while specificity was 100% for both techniques; accuracy score was 97.4% for FNC and 100% for FNA in predicting malignancy. While sensitivity was 75% for FNC and 100% for FNA; specificity was 100% for both techniques, and accuracy score was 97.4% for FNC and 100% for FNA in the prediction of neoplasia. CONCLUSION: The results indicated that there was no significant difference between the two techniques; if done in tandem can give better and accurate cytological diagnosis. In highly cellular lesions, in which abundant material was obtained, FNC was more likely to be diagnostically superior, but FNA can diagnose most of the lesions. In less cellular lesions, FNA is more likely to be diagnostically superior to FNC.

Tuberculous mastitis presenting as breast abscess.

Tuberculous mastitis is a rare clinical entity and usually affects women from the Indian sub-continent and Africa. It often mimics breast carcinoma and pyogenic breast abscess clinically and radiologically, may both co-exist. Routine laboratory investigations are not helpful in its diagnosis. Fine needle aspiration cytology (FNAC) / biopsy are essential for diagnosis and tuberculosis culture when positive may be very useful to guide antimicrobial therapy. Antitubercular drugs in combination with aspiration or surgical drainage are usually associated with an excellent outcome.