Clinical Profile of Cerebral Venous Sinus Thrombosis

BACKGROUND AND OBJECTIVES

Cerebral venous sinus thrombosis (CVT) occurs due to occlusion of the veins and sinuses which drain the brain parenchyma. It is an uncommon form of stroke, predominantly found in young patients1 . Despite advances in the recognition of CVT in recent years, diagnosis and management can be difficult because of the diversity of underlying risk factors, presenting features and the absence of a uniform treatment approach. This study aimed to ascertain the clinical presentation, various aetiologies and prognostic indicators of cerebral venous sinus thrombosis.

METHODOLOGY

This hospital-based descriptive study was carried out on 30 eligible patients from December 2013 to July 2015 after approval of Institutional Ethics Committee. Detailed history, clinical findings and required relevant investigations were recorded and analysed.

RESULTS

CVT was commonly observed in younger persons, commonly between 21-30 years. Female: Male ratio was 2.33. Altered sensorium at presentation was a poor prognostic indicator. The most common etiology was pregnancy and puerperium, followed by hyperhomocysteinemia. Superior sagittal sinus was found to be the most common site of thrombosis in this study, in 17 (56.7%) of the patients. 17 patients (56.67%) recovered completely without any neurodeficit. 24 ( 80%) and 22 (66%) subjects had cerebral infarction secondary to CVT. 5 (16.67%) patients succumbed to thrombosis or complications, most commonly due to intracerebral haemorrhage and cerebral edema.

CONCLUSION

CVT is a disease with multifactorial, gender-related specific causes and has a wide and varied clinical spectrum.

Hidradenitis Suppurativa Complicating Epithelial Malignancy in Immunocompromised Patient

Hidradenitis suppurativa complicating epithelial malignancy in people living with HIV is very rare. Hidradenitis suppurativa is very rare seen in only 1% of general population and 4% of young adults. We report a case of Hidradenitis suppurativa complicating an epithelial malignancy in are immunocompromised (HIV reactive) patient.

Clinical profile of Guillain Barre syndrome

OBJECTIVES

To study clinical presentation, hospital care and outcome of patients of Guillain Barre Syndrome (GBS) and number of patients of respiratory failure and need for ventilators. To study efficacy of IVIg in patients of GBS.

MATERIAL AND METHODS

40 patients of GBS studied in detail including history, clinical examination and investigations (Nerve conduction velocity and C.S.F. examination). All patients were watched for respiratory insufficiency and those who developed respiratory paralysis were given assisted mechanical ventilation. Patients were treated with IVIG and outcome was observed. Outcome of 2 groups of patients one treated with IVIg and other not treated with IVIg (supportive line of treatment) were compared.

RESULTS

Commonest age group affected was 13-40 yrs. The male:female ratio was 1.5:1. Antecedent infection in form of fever, cough [11 patients], loose motions [10 patients] were present in 21 out of 40 patients. Quadriparesis was present in 39 patients and paraparesis in 1 patient. Cranial nerve involvement was seen in 25 out of 40 patients. Facial nerve was involved in 12 [30%] patients and Glossopharyengeal, vagus nerves were involved in 12 [30%] patients. Areflexia was found in all 40 patients. In CSF examination, albuminocytologic dissociation was present in 17 out of 26 patients. NCV findings show conduction velocity slowing, delayed f latencies in 90% patients. Out of 40 patients, 13 [30%] required mechanical ventilation. Out of 40 patients, 14 were treated with IVIg, 4 patients treated with plasmapheresis and 22 patients received only supportive treatment. Out of 40 patients 30 [75%] patients recovered completely, 8 [20%] patients died and 2 [5%] patients developed severe neurologic deficit.

CONCLUSION

GBS is more common in 13-40 yrs age group with male:female ratio of 1.5:1. Antecedent infection is seen in 55% patients. Commonest presentation was paresthesia in legs and ascending paralysis. One third [32.5%] patients developed respiratory paralysis and needed ventilatory support. Patients who received IVIg early in the course of disease had faster recovery as compared to patients who received only supportive line of treatment.

Metabolic syndrome in railway employees and its relation to lifestyle factors

BACKGROUND

Limited information is available about the prevalence of the metabolic syndrome(MeTS) in India. Railway employees provided a unique opportunity to study the prevalence of MeTS in a variety of jobs.

METHODS

A total of 995 railway employees, 872 males (mean age 42.96 +/- 7.91) and 123 females (mean age 44.28 +/- 7.91), underwent physical examination and anthropometric measurement for waist circumference; 605 males and 95 females also underwent biochemical examination. MeTS was diagnosed using ATP III criteria modified for Indians.

RESULTS

The prevalence of MeTs in males was 162/605 (26.77%) and in females 26/95 (27.36%). Amongst all components of MeTS, high waist circumference was most prevalent in females (89.83%) and systolic hypertension in males (61.12%). In multivariate analysis, waist circumference in both genders had good association with sedentary job (P < 0.02), high fasting blood sugar (P < 0.02), age 45 years or older (P < 0.001), high systolic blood pressure (P < 0.001), high diastolic blood pressure (P < 0.001), physical inactivity (P < 0.001), while the correlation of dyslipidemia (low HDL and high triglycerides) with high waist circumference was not statistically significant.

CONCLUSION

These results from a representative sample of Solapur division railway employees show that the MeTs is highly prevalent mainly in sedentary workers aged 45 years or older. The large numbers of Indian Railway employees with the MeTs may carry important implications for the health care sector.

Reversible cardiomyopathy

We report a case of reversible dilated cardiomyopathy, in a middle-aged male. The patient presented with severe left ventricular dysfunction and atrial fibrillation. Inspite of vigorous medical therapy there was only mild clinical improvement. Subsequently laboratory test results diagnosed it as hyperthyroidism and then specific thyrostatic treatment was added. There was a prompt clinical and hemodynamic improvement in the form of reversal of left ventricular dysfunction and achievement of sinus rhythm at the end of two weeks.

Papillon Lefevre syndrome

Papillon Lefèvre syndrome is a rare disease characterized by skin lesions caused by palmar-plantar hyperkeratosis, and severe periodontal destruction involving both the primary and permanent dentitions. It is transmitted as an autosomal recessive condition and consanguinity of parents is evident in about one-third of cases. Pyogenic liver abscess is an increasingly recognized complication. We report a new case of this association and review the current literature.