Subject(s)
Polyneuropathies/complications , Polyneuropathies/therapy , Spastic Paraplegia, Hereditary/complications , Adolescent , Brain Mapping , Electroencephalography , Female , Follow-Up Studies , Humans , Neuropsychological Tests , Polyneuropathies/diagnosis , Rare Diseases , Risk Assessment , Severity of Illness Index , Spastic Paraplegia, Hereditary/diagnosis , Spastic Paraplegia, Hereditary/therapy , Sri LankaSubject(s)
Acanthocytes , Movement Disorders/diagnosis , Adult , Humans , Male , Movement Disorders/bloodSubject(s)
Leptospirosis/diagnosis , Adult , Humans , Leptospirosis/complications , Male , Myelitis, Transverse/etiology , Papilledema/etiologyABSTRACT
OBJECTIVE: To audit the process of stroke care. DESIGN: Retrospective case record evaluation using an audit package designed by the Royal College of Physicians of London. SETTING: Institute of Neurology, National Hospital of Sri Lanka, Colombo. PATIENTS: 263 patients with stroke admitted over a period of 3 years. MEASUREMENTS: Documentation of 60 audit items related to 13 aspects of stroke care. RESULTS: The process of care was considered 'very good' for only 11 (18.3%), and 'good' for only 9 (15%) of the audit items. Care was 'average' for 5 (8.3%), 'poor' for 9 (15%) and 'very poor' for 26 (43.3%) of the items. CONCLUSIONS: Stroke care was suboptimal in many aspects. Care related to rehabilitation oriented neurological assessments, initiation of secondary preventive measures, rehabilitation planning and discharge planning were especially deficient. Competing interests: none declared. Some of the data reported in this paper have been presented at the Annual Scientific Sessions of the Sri Lanka Medical Association, 1998.
Subject(s)
Medical Audit , Stroke/therapy , Humans , Retrospective Studies , Sri LankaSubject(s)
Brain Stem , Hyperventilation/etiology , Brain Diseases/complications , Fatal Outcome , Female , Humans , Middle AgedSubject(s)
Cerebral Infarction/etiology , Hemianopsia/etiology , Hemoglobinuria, Paroxysmal/complications , Hyperhomocysteinemia/complications , Paresis/etiology , Protein C Deficiency/complications , Stroke/etiology , Adult , Age Factors , Causality , Cerebral Infarction/diagnosis , Echocardiography , Hemianopsia/diagnosis , Hemoglobinuria, Paroxysmal/diagnosis , Hemoglobinuria, Paroxysmal/genetics , Humans , Hyperhomocysteinemia/diagnosis , Hyperhomocysteinemia/genetics , Male , Paresis/diagnosis , Protein C Deficiency/diagnosis , Protein C Deficiency/genetics , Stroke/diagnosis , Tomography, X-Ray ComputedABSTRACT
We describe a case of hereditary sensory and autonomic neuropathy (HSAN) type II in a child with a penetrating foot ulcer, acral sensory impairment, and anhidrosis. This is the first documentation of HSAN in Sri Lanka.
Subject(s)
Foot Ulcer/etiology , Hereditary Sensory and Autonomic Neuropathies/diagnosis , Neurons, Afferent/pathology , Action Potentials , Child , Diagnosis, Differential , Hereditary Sensory and Autonomic Neuropathies/complications , Hereditary Sensory and Autonomic Neuropathies/pathology , Hereditary Sensory and Autonomic Neuropathies/physiopathology , Humans , Hypohidrosis/etiology , Male , Nerve Fibers, Myelinated/pathology , Sural Nerve/physiopathology , Ulnar Nerve/physiopathologyABSTRACT
A case of eosinophilic meningitis is reported, a condition not previously reported from Sri Lanka. We propose Angiostrongylus cantonesis to be the most likely causative agent in this patient.
Subject(s)
Angiostrongylus cantonensis , Central Nervous System Helminthiasis/diagnosis , Central Nervous System Helminthiasis/parasitology , Eosinophilia , Meningitis/diagnosis , Meningitis/parasitology , Adult , Animals , Central Nervous System Helminthiasis/cerebrospinal fluid , Diagnosis, Differential , Eosinophilia/blood , Eosinophilia/cerebrospinal fluid , Humans , Male , Meningitis/cerebrospinal fluid , Spinal PunctureSubject(s)
Antiphospholipid Syndrome/complications , Cerebrovascular Disorders/etiology , Lupus Erythematosus, Systemic/diagnosis , Adolescent , Antiphospholipid Syndrome/diagnosis , Cerebral Angiography , Cerebral Infarction/diagnosis , Cerebral Infarction/etiology , Cerebrovascular Disorders/diagnosis , Diagnosis, Differential , Humans , Male , Sri LankaABSTRACT
INTRODUCTION: Neuropathy is considered to be a longterm complication of diabetes. AIMS: To determine the prevalence of peripheral neuropathy in 112 Sri Lankan patients with recently diagnosed non-insulin-dependent diabetes and a control population of 100 people. METHODS: A diagnosis of peripheral neuropathy was made using a clinical symptom score, clinical examination, quantitative sensory testing and electrophysiological studies. RESULTS: 9.8% of diabetic patients at diagnosis had peripheral neuropathy, 2.6% had foot ulcers, 7.1% had signs of neuropathy, abnormal vibration perception threshold and nerve conduction abnormalities and 15.1% had abnormal nerve conduction velocity without signs or symptoms of neuropathy. The peroneal nerve conduction velocity was higher in diabetic patients when compared to controls. There was an inverse correlation between nerve conduction velocity and fasting blood glucose in diabetic patients (p < 0/05). This association was stronger for peroneal nerve conduction velocity (r = -0.73) than for median nerve motor conduction velocity (r = -0.42). CONCLUSIONS: Symptomatic peripheral neuropathy is common among Sri Lankans with newly diagnosed non-insulin-dependent diabetes. This may be due to a later presentation of diabetes or a genetic predisposition.
Subject(s)
Diabetes Mellitus, Type 2/complications , Diabetic Neuropathies/epidemiology , Adult , Age Distribution , Aged , Case-Control Studies , Diabetes Mellitus, Type 2/diagnosis , Diabetic Neuropathies/diagnosis , Diabetic Neuropathies/etiology , Electromyography , Female , Humans , Male , Middle Aged , Prevalence , Sex Distribution , Sri Lanka/epidemiologyABSTRACT
Electroencephalograms (EEGs) were obtained for 26 patients with snake bite to observe the cerebral impact of snake venom. All snakes were identified; 19 (73%) were Russell's vipers, one (4%) was a common cobra, five (19%) were hump-nosed vipers, and one (4%) was a dog-faced fresh water snake. The EEG was abnormal in 25 patients (96%) and these results included all the snake species identified. The EEG abnormalities observed were reduced alpha activity, increased theta/beta activity or sharp waves (grade 1), sharp waves or spikes and slow waves (grade 2), or diffuse delta activity (grade 3). Grade 1 changes occurred in 16 patients (62%), grade 11 in eight patients (31%), and grade 111 in one patient (4%). Thus, grade 2 and 3 changes, which were moderately severe to severe abnormalities, occurred in nine patients (35%). One patient had acute renal failure and two others had mild jaundice and hyponatremia. These three patients had EEG abnormalities that were similar to those observed in the remaining 22 patients. The altered EEG, suggestive of an encephalopathy, appeared within hours of the bite and persisted for several days without clinical neurologic effects. The changes were seen mainly in the temporal lobe. Similar changes occurred in both patients with and without antivenom therapy. It appeared that the EEG abnormalities are a consequence of the effects of venom from the bites of a variety of snakes.
Subject(s)
Brain/physiopathology , Colubridae , Elapidae , Electroencephalography , Snake Bites/physiopathology , Viperidae , Adolescent , Adult , Animals , Child , Female , Humans , Male , Middle Aged , DaboiaABSTRACT
Scattered or diffuse myonecrosis is the histopathologic basis for muscle pain and tenderness due to bites by Vipera russelli pulchella in Sri Lanka. These lesions may even occur without any clinical symptoms. Subclinical lesions may form one end of continuous spectrum, with the other being severe pain and muscle tenderness with rhabdomyolysis and myoglobinuria. Electromyographic abnormalities, when present, are suggestive of a myopathic pattern, rather than inflammatory muscle disease. A subclinical motor neuropathy may also occur. Hence, there is evidence for subclinical envenomation following bites by Russell's viper. Early antivenom therapy does not prevent the histologic, electromyographic, or nerve conduction abnormalities.
Subject(s)
Daboia , Muscles/pathology , Snake Bites/pathology , Adult , Animals , Antivenins/therapeutic use , Electromyography , Female , Humans , Male , Middle Aged , Muscles/innervation , Muscles/physiopathology , Necrosis , Neural Conduction , Pain/etiology , Snake Bites/physiopathology , Snake Bites/therapy , Sri Lanka , Viper Venoms/immunologyABSTRACT
Observations are presented on 3 patients, including one autopsy report, with peripheral neuropathy due to perhexilene maleate (Pexid). Clinically and biochemically perhexilene neuropathy presents features unusual for a drug-induced neuropathy. Patients liable to develop neuropathy can be recognised from clinical criteria or by the use of routine electrophysiological determinations of nerve conduction velocities. At this stage the neuropathy is readily reversible if perhexilene therapy is discontinued. We have sought to examine the problems entailed in the future safety of perhexilene and allied drugs.
