Idiopathic Hypertension with Multiple Cranial Nerve Palsies: A Case Report and Literature Review.

We report a rare case of idiopathic intracranial hypertension (IIH) with multiple cranial nerve palsies involving cranial nerves VI, VII, IX, and X in a 32-year-old female who had no prior comorbidities. Her condition improved rapidly on a ten-day regimen of acetazolamide and tablet topiramate. IIH should be considered in every patient presenting with persistent headache and multiple cranial nerve abnormalities. This paper also includes a literature review of similar cases.

A Clinical Pharmacist-led Approach on Reducing Drug Related Problems Among Patients with Neurological Disorders: An Interventional Study.

Background: Neurological disorders are common in the general population and the majority of patients have other chronic diseases, necessitating the use of multiple medications, which increases the incidence of drug-related problems (DRPs). Studies from different countries discovered an average of 0.29-1.45 DRPs per patient admitted into the neurology unit. Objectives: To identify common DRPs and to evaluate the impact of clinical pharmacist's interventions in resolving the identified DRPs in patients with neurological disorders. Methods: A prospective interventional study was conducted in the Department of Neurology in a tertiary care teaching hospital in Southern India, for a period of six months. Patients aged ≥18 years and had been hospitalized for >24 h, were intensively monitored until discharge for the occurrence of any DRPs and pharmacist interventions were provided. The identified DRPs were classified according to Hepler and Strand's Classification. Results: A total of 310 prescriptions were reviewed, of which 174 patients (mean age 45.93 ± 2.49 years) experienced at least one DRP during their hospital stay. The average DRP per patient was found to be 1.75, with drug-drug interactions [254 (83%)] being the predominant DRPs, followed by adverse drug reactions [13 (4%)], and drug duplications [9 (3%)]. Most of the drug-drug interactions were pharmacokinetic [144 (56.69%)]. Hyponatremia [2 (15%)]; and nausea and vomiting [2 (15%)] were most commonly reported ADRs. All 306 DRPs involved active clinical pharmacist intervention, of which [275 (89.87%)] of pharmacists' interventions were accepted, which led to modification of the therapy. Conclusion: Monitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational drug prescribing, therapy optimization and enhanced patient safety.

Dual arterial thrombosis: A diagnostic enigma.

Cold agglutinin disease is a rare cause of arterial thrombosis leading to stroke, commonly encountered against a background of mycoplasma pneumonia infections. A 22-year-old patient presented with acute-onset left hemiplegia preceded by a short history of fever and cough. Magnetic resonance imaging (MRI) showed a right middle cerebral artery infarct. Serially repeated hemoglobin levels showed a progressive drop and peripheral smear showed evidence of hemolysis. Blood drawn for investigations would rapidly clot, suggesting a possibility of cold agglutinin-induced hemolysis. The patient was then worked up for all the possible causes of hemolytic anemia including secondary causes which were all negative except for significant immunoglobulin M mycoplasma levels with elevated cold antibody titers. The patient was then initiated on pulse steroids with azithromycin and doxycycline and hemoglobin levels stabilized. The patient also developed pulmonary thromboembolism which was managed with anticoagulation. The patient made a steady improvement, was discharged, and is on follow-up. Here, we present a unique case of mycoplasma associated cold agglutinin disease causing arterial thrombosis.

Résumé La maladie à l'agglutinine froide est une cause rare de thrombose artérielle conduisant à un accident vasculaire cérébral, couramment rencontré dans un contexte d'infections à la pneumonie des mycoplasmes. Un patient de 22 ans a présenté une hémiplégie gauche aiguë précédée d'une courte histoire de fièvre et de toux. L'imagerie par résonance magnétique (IRM) a montré une infarctus de l'artère cérébrale moyenne droite. Les niveaux d'hémoglobine répétés en série ont montré une baisse progressive et le frottis périphérique a montré des preuves d'hémolyse. Le sang prélevé pour les investigations allait rapidement, suggérant une possibilité d'hémolyse induite par l'agglutinine froide. Le patient a ensuite été élaboré pour toutes les causes possibles de l'anémie hémolytique, y compris des causes secondaires qui étaient toutes négatives, sauf pour des niveaux d'immunoglobuline M de Mycoplasma significatifs avec des titres élevés d'anticorps froid. Le patient a ensuite été initié sur des stéroïdes d'impulsion avec de l'azithromycine et des niveaux de doxycycline et d'hémoglobine stabilisés. Le patient a également développé une thromboembolie pulmonaire qui a été gérée avec l'anticoagulation. Le patient a fait une amélioration constante, a été libéré et est sur le suivi. Ici, nous présentons un cas unique de maladie d'agglutinine à froid associée aux mycoplasmes provoquant une thrombose artérielle. Mots-clés: Maladie d'agglutinine à froid, accident vasculaire cérébral, thrombose pulmonaire.

The Impact of Idiopathic Generalized Epilepsy on Executive Functions.

Background: Idiopathic generalized epilepsy is defined as seizures with a possible hereditary predisposition without an underlying cause or structural pathology. Assessment of executive dysfunction in idiopathic generalized epilepsies based on standard Indian battery is not available in the literature. Aims and Objectives: To assess specific executive functions affected in patients with idiopathic epilepsy and their association with various variables. Materials and Methods: Type of observational cross-sectional study, where clinical profile of all idiopathic epilepsy patients attending the neurology OPD was studied and their executive higher mental functions were assessed using the NIMHANS battery. Results: A total of 75 idiopathic generalized epilepsy patients were included in the study. Executive functions that were commonly found abnormal in our study were word fluency (P ≤ .001), category fluency (P < .001), verbal n-back (P < .001), Tower of London (p < 0.01), and Stroop test (P < 0.01). Executive functions showed a significant correlation with age at symptom onset, duration of epilepsy, and in those with uncontrolled seizures. Conclusion: Patients of idiopathic generalized epilepsy according to the present study were found to have significant executive dysfunction in multiple domains. This necessitates the screening for executive dysfunctions, which if detected should prompt the clinician to initiate cognitive retraining.