Study of cerebrospinal fluid levels of lactate, lactate dehydrogenase and adenosine deaminase in the diagnosis and outcome of acute meningitis.

BACKGROUND: Meningitis is a serious clinical health issue in most developing countries. Late diagnosis and treatment result in significant morbidity and mortality. This research aims to study the utility of CSF lactate, lactate dehydrogenase (LDH), and adenosine deaminase (ADA) as diagnostic markers in acute meningitis, and to differentiate among varied aetiologies of acute meningitis and their outcomes. METHOD: A cross-sectional observational case-control study was conducted in 30 patients of suspected meningitis of varied aetiologies and 30 controls without any pre-existing neurological disorder and who underwent lumbar puncture during spinal anesthesia. A fresh CSF sample was collected in a heparinized vial following an aseptic lumbar puncture. The levels of lactate, LDH and ADA were estimated and recorded. RESULT: CSF lactate was significantly elevated in bacterial meningitis (BM) and cryptococcal meningitis, with 100% sensitivity when compared to controls. Elevated LDH was found only in BM, hence elevated LDH levels may strongly signify bacterial etiology. Significantly elevated ADA levels were noted in tuberculous meningitis. Significantly elevated levels of lactate and ADA were suggestive of slower clinical recovery and a prolonged hospital stay (p < 0.001). CONCLUSION: Estimation of CSF lactate, LDH, and ADA levels is a rapid, inexpensive and simple procedure and can play a major role in the early differentiation of bacterial, viral, tuberculous, and fungal meningitis. This would facilitate the initiation of appropriate treatment as early as possible, thereby decreasing mortality and complications.

Wake-Up Sleepyhead: Unilateral Diencephalic Stroke Presenting with Excessive Sleepiness.

Altered sleep architecture and stroke share a reciprocal relationship. More than half of the stroke patients display sleep abnormalities including hypersomnia, insomnia, parasomnia, periodic limb movements, or sleep-disordered breathing. Conversely, one of the major causes of severe organic hypersomnia is acute brainstem strokes, involving thalamic infarctions, which may be reversible over 6-12 months. Here, we report a patient with increased lethargy and drowsiness who was diagnosed to have a right thalamic and hypothalamic ischemic stroke.

Clinical impression and Western Aphasia Battery classification of aphasia in acute ischemic stroke: Is there a discrepancy?

BACKGROUND: Language disturbance is a common symptom of stroke, a prompt identifier of the event, and can cause devastating cognitive impairments. There are many inconsistencies and discrepancies between the different methods used for its evaluation. The relationship between Western Aphasia Battery (WAB) and a simple bedside clinical examination is not clear. AIM: The aim of this study is to determine if bedside clinical impression of aphasia type can reliably predict WAB classification of aphasia and to describe the discrepancies between them. MATERIALS AND METHODS: Eighty-two consecutive cases of acute ischemic stroke and aphasia were evaluated with bedside aphasia assessment, handedness by Edinburgh Handedness Inventory and WAB scoring was done. Kappa statistics was used to find the overall agreement of clinical impression and WAB. RESULTS: Disagreement was seen predominantly for the nonfluent aphasias when the clinical impression was compared with WAB classification. WAB also had diagnosed three cases as having anomic aphasia using taxonomic classification, but same cases had normal language by aphasia quotient scoring of WAB. There was an overall agreement of 63.4% between patient's bedside clinical impression and WAB classification of aphasia, with a P < 0.001. CONCLUSION: Clinical impression was fairly reliable, as compared to WAB in assessing the type of aphasia. Clinical impression was appropriate in an acute setting, but WAB was required to quantify the severity of deficit, which may help in accessing prognosis, monitoring progression, and rehabilitation planning. Along with WAB, a bedside clinical impression should be done for all the patients to strengthen the description of aphasic deficit.

A comparative study of brainstem auditory evoked potentials in preterm and full-term infants.

BACKGROUND: Preterm infants can have many neurological problems. An enormous amount of fetal brain development occurs during the last trimester of pregnancy. They include myelination, glial cell migration and the development of a complex gyral pattern. The brain doesn't show the normal growth after birth in preterm infants. Brainstem auditory evoked potentials (BAEPs) are a noninvasive neurophysiologic assessment of brainstem maturation in babies. METHODS: BAEPs in 25 preterm and 25 full-term infants were considered for the study. Infants having history of birth trauma, metabolic disorders or intracranial infection were excluded. BAEP waveforms (absolute and interpeak latencies) were recorded and analyzed. Student t test was used to analyze the data thus acquired. RESULTS: Analysis of data revealed a significant increase in latency of BAEP waveform V (P<0.05). Other latencies and interpeak latencies of BAEP waveforms were comparable. CONCLUSION: The preterm infants have a prolonged latency of BAEP waveform V suggestive of a retarded myelination of the central auditory pathway. Thus BAEP could be a useful electrophysiological test to assess neuronal myelination and maturation in preterm infants.

Heidenhain variant of Creutzfeldt-Jakob disease: An autopsy study from India.

Prion diseases are rare, progressive and fatal neurodegenerative diseases characterized by long incubation period and short clinical course. We present a rare case of Heidenhain variant of Creutzfeldt-Jakob disease, occurring in a 55-year-old lady presenting with dementia, cortical blindness, and myoclonic jerks. She succumbed to the disease within 8 weeks of onset of symptoms. MRI revealed hyperintense signals on T2WI and fluid attenuated inversion recovery (FLAIR) images in basal ganglia and fronto-temporal and parietal cortex, sparing thalamus, striate cortex and globus pallidum. Abundant abnormal prion protein deposits (PrP(sc)) were detected in caudate, putamen, thalamus, cingulate and striate cortex, in comparison to frontal and parietal cortex while no deposits were found in globus pallidum. MRI changes did not correlate with degree of spongy change, gliosis or prion protein deposition. The cause for abnormal signal changes in MRI and FLAIR images remains unclear.

Recovery from paraplegia following aortic saddle embolism. Case report.

An aortic saddle embolus causing paraplegia is rare and even rarer is a documentation of neurological recovery from this event. A 47 year old male presented with absent pulsations in the lower limbs and paraplegia, both of sudden onset. He underwent immediate bilateral transfemoral embolectomy. The postoperative period was stormy. The paraplegia recovered over a period of 2 months and he could walk to his place of work after 6 months. The rare combination of saddle embolus and paraplegia is discussed. An attempt has been made to verify the hypothesis of Dickson et al which states that a low origin of the great radicular artery (GRA) below T12 level may be responsible for paraplegia when obstructed by a saddle embolus. We found the GRA arising at L2 vertebral level in this patient. Postoperative selective spinal arteriogram and magnetic resonance imaging (MRI) of the spinal cord showed a patent GRA and normal spinal cord structure respectively. Early surgical intervention in restoring the blood flow into the GRA may prevent severe histological changes hitherto responsible for nonrecovery from paraplegia in the earlier reports.

Electrolyte studies after intra-amniotic instillation of 20 per cent sodium chloride.

PIP: Electrolyte studies following intraamniotic instillation of 200 ml of 20% sodium chloride are reported. In 300 cases of second trimester termination of pregnancy, sodium, potassium, and chloride in the blood, urine, and liquor were analyzed over 24 hours. There was no marked difference in blood electrolytes though abnormally elevated serum sodium concentrations were occasionally noted but no adverse effects were observed. The excretion of sodium and chloride in the urine increased slowly and most was excreted in 24 hours. Urinary potassium increased in the 1st 2 hours, followed by a progressive fall to lower than baseline values at the end of 24 hours. The data showed rapid clearance of instilled hypertonic saline without adverse effects. It is suggested that this method is simple, sure, and safe when a careful assessment of patients is made before induction, and when precautions are taken for proper instillation of saline.^ieng