Superficial siderosis of the nervous system.

A male patient had been operated in 1990 at a different hospital for a suprasellar mass lesion causing progressive blindness. At exploration, the mass was felt to be inflammatory in nature with arachnoiditis and hydrocephalus. Deep yellow staining of tissues round the mass was recorded at the time of first surgery. The patient was readmitted in 1996 for progressive visual failure, ataxia, mental changes and deafness. MRI confirmed persistence of suprasellar mass and showed the characteristic findings of superficial siderosis of CNS. On reexploration, the mass had multiple vessels over the walls and contained xanthochromic fluid. It was excised and histologically examined to be an epidermoid with a cyst. The patient developed chest infection, became drowsy and died. The MRI picture, the CSF finding and the yellow staining of tissue confirmed the diagnosis of superficial siderosis of the CNS, which was first thought of after seeing the diagnostic MRI. The cause of the superficial siderosis was recurrent bleeding from the tumour.

Overlap myasthenic syndrome.

This is a report of a case of overlap myasthenic syndrome i.e. one which has the feature of both myasthenia gravis and lambert Eaton myasthenic syndrome (LEMS). The patient had first thyrotoxicosis and then was seen with bulbar and limb weakness andEMG showed decrement on repetitive tests at 3Hz. A second admission was for what appeared to be an axonal degeneration neuropathy with respiratory embarrassment. This was based on nerve conduction studies showing low muscle action potentials in all muscles with normal conduction velocities. There was a good response to steroids and relapse on stopping steroids and on the third admission all the electrophysiologic features of LEMS were noted. At his time the patient had bulbar and facial weakness and an excellent response to Prostigmine suggesting associated myasthenia gravis. This is the first overlap myasthenic syndrome reported from India.