A prospective study of seroprevalence of Toxoplasmosis in general population, and in HIV/AIDS patients in Bombay, India.

Two hundred and seventy nine sera (age group 13-50 years) were tested for antitoxoplasma IgG/IgM antibodies by ELISA techniques; the diagnostic titer for positive test is 10 iu/ml or > 1:100. Sera were obtained from (i) 165 (100 men/65 women) healthy adult voluntary blood donors (HIV, HBsAg, VDRL negative); (ii) 89 consecutive HIV/AIDS patients (82 men/7 women); and (iii) 25 patients (HIV negative: 12 men/13 women) treated for cerebral Tuberculoma or Neurocysticercosis during this study from January 1996-June 1997. The overall seroprevalence was 30.9% (51/165) in the immunocompetent adult (group i) 34% (34/100) men and 26.2% (17/65) in women [range: 10-899 iu/ml; (mean: 376.8)]. In HIV infected hosts the seroprevalence [range: 21-340 iu/ml; (mean; 180)] was 67.8% (56/82 men, 04/07 women). The seroprevalence was 20.5% (8/39), 32.8% (22/67), 34.8% (16/46) and 38.4% (5/13) in the 2nd, 3rd, 4th and 5th decades respectively in healthy adults. In HIV/AIDS patients, 69% (29/42) in the 3rd and 70.6% (24/34) in 4th decade were seropositive. The risk of cerebral Toxoplasmosis (encephalitis-02, granuloma-24) was 43.3% (26/60, mean 250 iu/ml). The seroprevalence was 28% in group iii (range 12-80 iu/ml, mean 21 iu/ml). Anti-toxo IgM was negative in all. Primary Toxoplasma infection appears to be subclinical and prevalent throughout life. T. gondii has emerged as an important opportunistic infection in HIV/AIDS patients in Bombay. Recrudescence of cerebral toxoplasmosis (CTOX) is observed with low IgG response during mid-late stage of the disease, as seen in our patients (mean IgG 250 iu/ml, CD4+ = 283/cmm (range 43-504 in 5 patients). Primary prophylaxis for CTOX seems rationale and can be targeted to asymptomatic HIV/AIDS population at risk who are seropositive for T. gondii (mean IgG 111.5 iu/ml in our study). The very high predictive value of a negative test for TOX remains the best serological parameter for excluding acute episode of TOX.

Acute paraplegia due to an extradural spinal lipoma: case report.

We describe a 20 year old man, who presented with an acute onset of transverse myelopathy evolving over 24 h at T6 spinal level; as yet, an unreported presenting symptom from a midthoracic intraspinal lipoma. The C.S.F. findings suggested a spinal block. MRI, imaging was not practical. Urgent myelography revealed extradural compression at the T5-6 vertebral level. The patient underwent surgical debulking of the tumor which on histopathology was found to be a lipoma, but there was no neurological improvement even at 3 months follow up. We believe that patients with intraspinal lipomas are at high risk of developing irreversible neurological dysfunction.

Cerebellar venous infarction in chronic suppurative otitis media. A case report with review of four other cases.

BACKGROUND: Cerebellar venous infarction is a rare condition. Thus far only four cases have been reported in the literature. We recently encountered a patient with chronic suppurative otitis media complicated by cerebellar venous infarction. The features of cerebellar venous infarction in the other four cases are also reviewed. CASE DESCRIPTION: A 20-year-old man presented with clinical features suggestive of chronic suppurative otitis media. Computed tomographic scan of the brain revealed left mastoiditis with cholesteatoma and moderate communicating hydrocephalus. The patient was subjected to left radical mastoidectomy, and an attico-antral cholesteatoma was removed. Subsequently the patient developed clinical features suggestive of cerebellar abscess. A repeat computed tomographic scan revealed normal posterior fossa. Four-vessel angiography revealed left sigmoid and lateral sinus thrombosis and nonopacification of the left-sided cerebellar veins. Magnetic resonance imaging showed a venous infarct in the left cerebellar hemisphere. The patient was treated with cerebral dehydration measures. The patient subsequently improved and had no neurological deficit 3 months after surgery. CONCLUSIONS: Although cerebellar venous infarction is rare, it can occur in chronic suppurative otitis media, pregnancy, antithrombin III deficiency, and diabetic osmolar coma. Sometimes no cause is found. Treatment includes correction of the underlying cause. The presence of a hemorrhagic lesion on computed tomographic scan and deep coma at presentation indicate poor prognosis.

Amyotrophy in young diabetics: clinical profiles.

Seven young patients presenting with diabetic amyotrophy, unusual at their age, are described. Besides symptoms suggestive of proximal muscle weakness and occasionally of diabetes, all patients were underweight; abdominal pain occurred in all the patients. The diagnosis of amyotrophy was confirmed on electromyography and nerve conduction studies in all patients, and muscle biopsy in two patients. All patients recovered fully on control of diabetes with insulin. Only two episodes of stress induced ketosis were recorded in these 7 patients. These patients were not ketotic though they were severely uncontrolled on omission of insulin. They had normal lipid levels, and had no other complications of diabetes. Pancreatic calculi were found in only one patient. We describe here the clinical profiles of these patients and discuss the possible aetiologies of diabetes and the clinical implications.

Interhemispheric empyema. An unusual form of subdural empyema.

A 16 year old male was admitted with a clinical picture suggesting an intracranial pyogenic infection. He also has focal convulsions and left abducens palsy. CT scan showed a subdural empyema with interhemispheric extension. Since the patient was improving clinically, neurosurgical intervention was deferred. Spontaneous interhemispheric empyema is an uncommon condition. In our case conservative management was curative in what is considered a neurosurgical emergency.