The practice of neurology in Thailand. A different type of medical specialist.

A survey of 1700 patient encounters during 1 week of practice by 23 neurologists in Thailand delineates a different scope of specialty practice compared with that of many Western nations. Thai neurologists had an average of 96 patient encounters per week of practice, with two thirds of all encounters in ambulatory care. However, one half of all encounters were for self-referred patients, three fourths of all encounters were regular patients for whom the neurologist provided continuing care, and about one half of all encounters were thought to reflect health problems that fall within the scope of general internal medicine. The data suggest that Thai neurologists function in health care delivery as general internists with special competencies and interests in the field of neurology. This balanced style of specialist practice serves to reinforce the primary care infrastructure of the health system in developing countries.

Eosinophilic myelomeningoencephalitis caused by Angiostrongylus cantonensis: a report of three cases.

Three members of a family developed eosinophilic myelomeningoencephalitis following ingestion of Pila snails. They were father, daughter and son and had similar clinical presentations. Two days after ingestion of snails, they developed a generalized itchy maculopapular rash followed by myalgia, marked paresthesia, fever and headache. Two days later there was weakness of the extremities which was progressive in severity involving the legs more than the arms. They later developed urine retention and cloudiness of consciousness. Two patients progressed to coma, one of whom died after 3 weeks and the other died at home 9 months after the onset. Autopsy of the fatal case revealed multiple tracks and cavities with the presence of Angiostrongylus cantonensis in the brain and various levels of the spinal cord.