Carbamazepine Toxicity-Induced Spindle Coma: A Novel Case Report.

A 9-year-old girl presented with alleged history of deliberate ingestion of 4 g of carbamazepine, following which she became comatose. A bedside electroencephalogram (EEG) was performed to rule out nonconvulsive status epilepticus, which showed presence of spindle coma (SC), not reactive to noxious stimuli. Following hemodialysis, a second EEG showed absence of SC and complete clinical recovery. We present this unique case of carbamazepine-induced SC, thereby highlighting the extent of the etiologic spectrum of SC and discussing the literature related to this association.

Late onset reversible cortical blindness following electrocution.

An elderly gentleman presented with acute onset of bilateral visual blurring and generalized headache after 1 week post electrocution injury. Clinically, the symptoms were attributed to cortical lesion. Magnetic resonance imaging (MRI) of brain revealed bilaterally symmetrical diffusion restriction in parietal and occipital areas. Treatment with intravenous steroids resulted in remarkable improvement in symptoms. Neurological injury secondary to electrocution is a well described entity having a variety of clinical presentation. We put forward our experience with this unique case presenting as post electrocution delayed onset of visual symptoms. Discussion and review of literature related to this clinical entity will also be presented.

Mechanical Thrombectomy Using Solitaire in a 6-Year-Old Child.

A six-year-old boy was diagnosed as recurrent posterior circulation stroke secondary to basilar artery occlusion with rapid progression of symptoms. Etiology of stroke was a dissection of V3 segment of left vertebral artery, which was treated using endovascular technique 26 hours after worsening of symptoms. Since the guidelines for acute revascularization in pediatric stroke are not well established, there is limited experience in the use of mechanical devices for acute ischemic stroke revascularization in children. To our knowledge, this is one of the youngest reported cases of acute ischemic stroke from Asia managed with newer mechanical clot removal devices.

Bright splenium of a psychotic mind.

A twenty-one-year old primigravida presented two weeks postpartum with new onset of behavioral alteration and irrelevant talking without fever, headache, or seizures. Magnetic resonance imaging (MRI) of brain showed a lesion with diffusion restriction in splenium of corpus callosum. A possibility of postpartum psychosis was considered after ruling out various etiologies for splenium hyperintense lesion. Near complete resolution of symptoms was noted after initiation of antipsychotic medications. Literature has described multiple etiologies for lesions involving splenium of corpus callosum on brain imaging. We present this case as a unique clinical presentation of splenial pathology in the form of postpartum psychosis.

Stent-assisted coiling of wide-necked intracranial aneurysms using the Solitaire AB stent.

CONTEXT: Stent-assisted coiling of wide-necked and complex intracranial aneurysms is an effective and feasible treatment option. The self-expanding, fully retrievable Solitaire AB (eV3, Irvine, CA, USA) stent is the latest neurovascular remodeling device available. To the best of our knowledge, there are no studies of Solitaire AB-assisted coiling of wide-necked intracranial aneurysms from India. AIM: Solitaire AB-assisted coiling of wide-necked intracranial aneurysms. MATERIALS AND METHODS: The study was conducted in a tertiary care center with a dedicated Interventional Neurology division from 2009 to 2013. Consecutive patients with wide-necked aneurysms who underwent coiling assisted by the Solitaire AB stent were enrolled in the study. Axium 3D and Helix (eV3, Irvine, CA, USA) platinum coils were used to densely pack the aneurysm sac after deploying the stent across the neck. All patients were pretreated with antiplatelets according to protocol. Subsequently, dual antiplatelets were given for 6 months followed by continued aspirin. Outcome was assessed at 3 months using the modified Rankin Scale. STATISTICAL ANALYSIS USED: Statistical analysis was done using the SPSS 17.0 software. RESULTS: A total of 16 patients underwent stent-assisted coiling. The most common site was the internal carotid artery (nine patients), median aneurysm size was 7 mm and median neck diameter was 5 mm. Thirteen patients presented with ruptured aneurysms. We achieved complete occlusion in all patients with no major complications. Thirteen patients were followed up, all have an mRS score of zero or one. CONCLUSION: We conclude that for wide-necked aneurysms, stent-assisted coiling using the Solitaire AB is a safe and effective treatment option.