Case Report: An Unusual Case of Subacute Sclerosing Panencephalitis with Distinctive Clinical and Neuroimaging Features.

Subacute sclerosing panencephalitis (SSPE) is a relentlessly progressive brain disorder with invariable mortality. Subacute sclerosing panencephalitis is common in measles-endemic areas. We report an unusual SSPE patient with distinctive clinical and neuroimaging features. A 9-year-old boy came with a 5-month history of spontaneously dropping objects from both hands. Subsequently, he developed mental decline, a loss of interest in his surroundings, decreased verbal output, and inappropriate crying and laughing along with generalized periodic myoclonus. On examination, the child was akinetic mute. The child demonstrated intermittent generalized axial dystonic storm with flexion of upper limbs, an extension of lower limbs, and opisthotonos. Dystonic posturing was more dominant on the right side. Electroencephalography revealed periodic discharges. Cerebrospinal fluid antimeasles IgG antibody titer was markedly elevated. Magnetic resonance imaging revealed marked diffuse cerebral atrophy, and periventricular T2/fluid-attenuated inversion recovery hyperintensity. T2/fluid-attenuated inversion recovery images also revealed multiple cystic lesions present in the region of periventricular white matter. The patient was given a monthly injection of intrathecal interferon-α. The patient is currently continuing in the akinetic-mute stage. In conclusion, in this report, we described an unusual case of acute fulminant SSPE in which neuroimaging demonstrated unusual multiple small discrete cystic lesions in the cortical white matter. The pathological nature of these cystic lesions currently is not clear and needs to be explored.

18FDG-Positron Emission Tomography in patients with Tuberculous Meningitis: A Prospective Evaluation.

Lower yield of available diagnostic tests for tuberculous meningitis (TBM) frequently causes delay in diagnosis. Recently, 18F-fluorodeoxyglucose positron emission tomography (FDG PET) has been used in infectious disorders such as pulmonary tuberculosis; however, it is rarely used in TBM. This study was aimed to ascertain the role of FDG PET in the diagnosis and determination of the extent of disease and prognosis in patients with TBM. After excluding unsuitable patients, 25 patients were subjected to whole-body PET-computed tomography (CT) image acquisition along with separate brain protocol with an integrated PET-CT device. FDG PET was found to be abnormal in 92% patients. Extracranial FDG uptake was observed in 80% patients. Most common extracranial site of involvement was lymph nodes (60%), followed by lung (56%), vertebral body (8%), genitourinary organs (8%), and spleen (4%). FDG PET observed extracranial involvement had 80% sensitivity and 20% specificity in detecting definite TBM cases. In conclusion, FDG PET may be a useful test in TBM evaluation.

Correlation and Comparison of Epicardial Adipose Tissue with Sagittal Abdominal Diameter and Other Anthropometric and Biochemical Variables of Metabolic syndrome.

OBJECTIVE: 1) To determine relation of epicardial adipose tissue (EAT) thickness with sagittal abdominal diameter (SAD) and other anthropometric measurements in metabolic syndrome (MetS). 2) To determine relation of epicardial adipose tissue with biochemical variables of metabolic syndrome. METHODS: Cases were recruited from the patients attending OPD in New Medical College Hospital, Govt. Medical College, Kota, Rajasthan, India between March 2015 to February 2016. Informed consent was obtained from all participants after taking permission from hospital ethical committee. Patients were categorized as cases and controls according to IDF criteria for MetS. We obtained receiver operating characteristic (ROC) curve of EAT for determination of cut-off values. RESULTS: Epicardial adipose tissue thickness had significant positive correlation with fasting blood sugar (r = 0.49), sagittal abdominal diameter(r = 0.48), body mass index (r = 0.47), LDL cholesterol(r = 0.34), waist circumference (r = 0.33), waist hip ratio (r = 0.32), triglycerides (r= 0.31) and total cholesterol (r = 0.29). Epicardial adipose tissue thickness had significant negative correlation to HDL cholesterol (r = -0.34). EAT thickness (cm) was greater in metabolic syndrome cases (0.515 ± 0.07 vs 0.338 ± 0.06; p < 0.0001). Optimal cut off of EAT in metabolic syndrome is 0.425 cm according to ROC curve at which test is 96% sensitive and 83 % specific. CONCLUSIONS: EAT has shown good correlation with SAD and other anthropometric measurements as well as biochemical parameters of metabolic syndrome. Optimal cut off value of EAT to predict metabolic syndrome is 0.425 cm. FBS and Triglycerides are more closely associated with EAT. HDL Cholesterol is better correlated to SAD while LDL cholesterol is best correlated to WC.

A Prospective Study on Utility of Exercise Treadmill Test in Type 2 Diabetes Mellitus Patients.

OBJECTIVE: Primary objective of this study was to access utility of exercise treadmill test in type-2 diabetes mellitus patients for detecting silent myocardial ischaemia and associated risk factors. METHODS: 75 DM-2 cases were enrolled in study of any age attending medical OPD. All cases were gone through detailed history and TMT procedure. RESULTS: There is higher prevalence of SMI in DM-2 patients. TMT positivity for inducible ischaemia in DM-2 patients were associated with increasing age, male sex, higher BMI, hypertension, smoking, alcoholism, microalbuminuria, macroalbuminuria and dyslipidemia. Duration of diabetes increases the development of CAD in diabetic patients. TMT is a safe procedure with no complication. CONCLUSIONS: For detection of silent myocardial ischaemia in diabetic patients TMT has a significant role. Prevalence of silent myocardial ischaemia in DM-2 patients is 37.3%. There is significant correlation between risk factors of CVD and evidence of ischaemia on TMT in diabetic patients. Duration of diabetic state has a strong correlation for inducible ischaemia on TMT. It may be a safer, cheaper, reliable and easily available non-invasive screening tool for earlier detection of CAD in diabetic patients.

Acute Scrotal Edema: An Atypical Manifestation of Dengue.

Acute scrotal edema associated with dengue fever is a rare and self limiting condition resolving in a few days without any complication or sequelae. We report two cases of dengue fever in father and son which presented simultaneously with acute scrotal edema.