Wild honey poisoning: A case report from western Nepal.

Wild honey has been used for several purposes in South-Asia and Eastern Europe since long ago. One of the commonest is medicinal purposes, especially for gastrointestinal disorders (peptic ulcer disease, dyspepsia, and gastritis), hypertension, and an aphrodisiac (sexual stimulant). However, honey produced from the nectar of few rhododendron species contains a toxin known as grayanotoxin, which acts on the sodium channel and prevents its inactivation leading to vagal activation, causing hypotension and bradycardia. Here, we report a case of 55 years woman who reported to our Emergency Department with complaints of dizziness and vomiting as well as bradycardia and hypotension. Most of the cases of wild honey poisoning resolve within the first 24 h, but in our case, the symptoms persisted for 72 h. So, we must observe patients for 72 h as some cases may last longer. Timely management of the patient can prevent fatal complications.

Moyamoya Disease in an adult female from Nepal: A case report.

INTRODUCTION AND IMPORTANCE: Moyamoya is a progressive vasoocclusive disease of large intracranial arteries with characteristic collaterals formation. It has a bimodal distribution and more frequent in females compared to males. CASE PRESENTATION: We present a case of 38 years female who presented with a loss of consciousness following headache. She was investigated with a head CT, cerebral angiogram, and digital subtraction angiography which led to a diagnosis of Moyamoya disease. She was treated conservatively and scheduled for follow-up. CLINICAL DISCUSSION: Although ischemic attacks are the common presenting symptoms in cases of Moyamoya disease, hemorrhagic forms are seen too especially among adults compared to children. Identifying Moyamoya disease can significantly affect the treatment options and give insight into managing the chronic nature of the disease to both the physicians and patients. CONCLUSION: This case highlights the importance of searching for underlying cause in a young female presenting with intracranial haemorrhage for the first time and keeping Moyamoya disease as a differential.