Depression and Quality of Life after Cerebral Venous Sinus Thrombosis.

INTRODUCTION: Cerebral venous sinus thrombosis (CVST) is an important cause of stroke in young and has a favorable outcome. Long-term sequelae of CVST include motor disability, cognitive impairment, depression, anxiety, fatigue, impaired employment and poor quality of life. OBJECTIVE: To evaluate depression and quality of life after CVST. METHODS: Patients who completed at least 1 year after discharge were recruited for this cross-sectional observational study from our CVST cohort. Quality of life was assessed using Stroke-Adapted Sickness Impact Profile (SA-SIP 30) and depression using Hamilton Depression scale (HAM-D). RESULTS: A total of 100 patients (60 men and 40 women) were included in the study. Their age ranged from 14 to 60 years (34.97 ± 10.06). The interval from discharge to assessment of quality of life was 2.2 ± 1.6 years. In all, 98% of patients had good modified Rankin score at follow-up. SA-SIP 30 did not reveal any functional disability for physical functioning. Seven had impairment for psychosocial domain despite having good modified Rankin scores. Thirty patients had depression. Patients with higher mRS at discharge had increased presence of depression. Quality-of-life scores did not correlate with presence of seizure, headache, infarction and sinuses involved. CONCLUSION: This is the first Indian study demonstrating depression in patients with CVST and use of SA-SIP to assess quality of life in them. Occurrence of depression in CVST is as high as in arterial strokes.

Retrospective Hospital-based Study of Opportunistic Neuroinfections in HIV/AIDS.

BACKGROUND: Patients with retroviral disease are prone to opportunistic infections (OIs) of the central nervous system which cause significant mortality and morbidity. Cryptococcosis, tuberculosis, and toxoplasma are the most commonneuroinfections occurring at all stages of the disease. OBJECTIVE: This study was undertaken to evaluate the clinical pattern of OIs and in-hospital mortality in patients with acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: This retrospective analysis was conducted in a teaching hospital from 2001 to2014. Clinical data, laboratory investigations, and outcome of patients with meningoencephalitis were obtainedfrom case records. RESULTS: The total number of patients with human immunodeficiency virus (HIV) and AIDS with neurological manifestations was 277, among whom 167 (60.3%) had meningoencephalitis. There were 131 malesand 36 femaleswith a male-to-female ratio of 3.63:1andage ranging from 16 to 67 years (39.25 ± 8.85 years). Clinical presentation was acute in 58%, subacute in 32%, and chronic in 10%. Symptoms includedheadache (85.8%), fever (65.7%), altered sensorium (37.1%), and seizures (25.1%). Cryptococcal meningitis was the most commoninfection (67) followed by tuberculosis (32), mixed meningitis (24), and toxoplasmosis (10), and 16 patients had progressive multifocal leucoencephalopathy. Pathogenic organism could not be identified in 18 patients. Fifteen patients died during hospital admission. Mortality was the highest in mixed meningitis (16.7%) followed by cryptococcal meningitis (10.4%). Opportunistic neuroinfection occurred as AIDS-defining illness in 59.3%. Prior use of highly active anti-retroviral therapy did not affect the outcome. CONCLUSION: Opportunistic neuroinfections are the most commonneurological manifestation in patients with AIDS, with cryptococcal meningitis being the most commonopportunistic neuroinfection occurring as AIDS-defining illness in one-third of the patients with neuro-AIDS.

'Wine Glass' sign in recurrent postpartum hypernatremic osmotic cerebral demyelination.

Osmotic demyelination syndrome resulting from postpartum hypernatremia is a recently described entity wherein young women present with hypernatremic encephalopathy and white matter hyperintensities along with quadriparesis from rhabdomyolysis. It is an acute monophasic condition with acute hypernatremia occurring during puerperium with good recovery in majority of the patients with treatment. To the best of our knowledge, recurrent postpartum hypernatremia with encephalopathy, osmotic demyelination, and rhabdomyolysis has not been described. We present a young lady who had two episodes of reversible postpartum hypernatremic encephalopathy with rhabdomyolysis. Cerebral magnetic resonance imaging (MRI) before treatment revealed osmotic demyelination on both occasions. During first admission MRI revealed hyperintensities in internal capsule and corpus callosum, and at second admission revealed more extensive white matter hyperintensity, which simulated the 'wine glass' appearance.

Reversible electrophysiological abnormalities in acute secondary hyperkalemic paralysis.

Hyperkalemia manifests clinically with acute neuromuscular paralysis, which can simulate Guillain Barré syndrome (GBS) and other causes of acute flaccid paralysis. Primary hyperkalemic paralysis occurs from genetic defects in the sodium channel, and secondary hyperkalemic paralysis (SHP) from diverse causes including renal dysfunction, potassium retaining drugs, Addison's disease, etc. Clinical characteristics of SHP have been addressed in a number of publications. However, electrophysiological evaluations of these patients during neuromuscular paralysis are infrequently reported and have demonstrated features of demyelination. The clinical features and electrophysiological abnormalities in secondary hyperkalemia mimic GBS, and pose diagnostic challenges. We report the findings of nerve conduction studies in a middle-aged man who was admitted with rapidly reversible acute quadriplegia resulting from secondary hyperkalemic paralysis.