Wernicke's encephalopathy - An oddball complication of nephrotic syndrome.

Metabolic encephalopathies are a common cause of altered mental status in various states of malnutrition. However, a high index of suspicion is required to recognize them and differentiate Metabolic Disorders from other causes of altered mental status such as infections. A 6-year old with steroid-resistant nephrotic syndrome (NS), peritonitis, and prolonged diarrhea and vomiting, developed a brief episode of altered mental status six days after starting tacrolimus. On imaging, there were features suggestive of Wernicke's encephalopathy and it ruled out other causes of seizure in the given scenario. The child was treated with thiamine supplementation and the changes reversed four weeks after treatment. This is to emphasize that although an uncommonly reported complication of nephrotic state, one should have a high index of suspicion for these metabolic encephalopathies, especially in the setting of malnutrition, where these children are highly predisposed to multivitamin deficiency.

Giant cerebral cysticercosis in an infant confused with a thalamic glioma.

Neurocysticercosis is a common parasitic infection of the central nervous system. Intraparenchymal giant cysticercosis has been described in literature, but this is a rare report of a thalamic giant cysticercosis in a young child where the diagnosis could be made on follow-up. A 1½-year-old male child presented with seizures, hemiparesis, and features of raised intracranial pressure. Initial neuroimaging findings of thalamic swelling with minimal edema and contrast enhancement with choline peak on magnetic resonance spectroscopy were attributed to thalamic glioma. Subsequent imaging revealed a ring enhancing lesion with an eccentric nodule suggestive of neurocysticercosis. It later resolved with residual gliosis. The presence of a pathognomic scolex and the resolution of size and symptoms without definitive treatment helped in making the diagnosis. This report reinforces the importance of considering cysticercosis in diagnosis of acute presentations of large cerebral masses in infants, particularly in prevalent regions, and emphasizes the follow-up of these patients.