ABSTRACT
INTRODUCTION: The diagnosis and management of narcolepsy in the Indian context needs to be revisited especially in the wake of concerns raised by sleep medicine experts that the entity could be formidably underdiagnosed, as well as undertreated in our setting. MATERIALS AND METHODS: The history, clinical records, polysomnographic/multiple sleep latency test data, and treatment records of five hundred consecutive patients attending a dedicated sleep clinic between the years 2013 and 2016 were retrospectively analyzed. The response to treatment measures and improvement in daytime functioning were periodically assessed by personal/telephonic interview and E-mail communication. RESULTS: Thirteen patients were diagnosed with narcolepsy based on the standard criteria of which three had cataplexy. The mean age of presentation was 23.23 years and the male:female ratio was 2.25:1. The mean duration from the onset of symptoms to diagnosis was 4.2 years. Two patients responded to nonpharmacological interventions alone, and six to modafinil, while two patients remained symptomatic and required treatment with methylphenidate. One patient was lost to follow-up, while two others are due for their first follow-up. CONCLUSION: A refurbished outlook of the diagnostic methodology and treatment paths tailored to our clinical scenario can potentially impact the future of narcolepsy management and research in our country.
ABSTRACT
Paraplegia is a rare complication after coronary artery bypass graft (CABG) surgery mostly caused by spinal cord ischemia. Even rarer is the paraplegia following infarction involving both anterior cerebral artery (ACA) territories caused by embolism during coronary artery bypass graft surgery. This case has become even more interesting as cerebral vasculature involving internal carotid and anterior cerebral arteries was absolutely normal.
