ABSTRACT
Neurocysticercosis commonly presents with seizures, raised intracranial tension and dementia. The unusual location of the cysts may result in uncommon manifestations mimicking a host of neurological disorders. Ten patients with neurocysticercosis with rare clinical presentations have been described in this series. These include dorsal midbrain syndrome, isolated bilateral ptosis, papillitis, cerebral hemorrhage, painful cervical radiculopathy, progressive swelling of arm, paraplegia due to intramedullary cyst, third ventricular cyst, dystonia and nominal aphasia masquerading as transient ischaemic attacks. The clinical details and possible mechanisms for these rare presentations are discussed.
Subject(s)
Brain Diseases/diagnosis , Cysticercosis/diagnosis , Adolescent , Adult , Animals , Anomia/diagnosis , Brain Diseases/parasitology , Cerebral Hemorrhage/diagnosis , Child , Child, Preschool , Cysticercosis/pathology , Cysts/diagnosis , Cysts/parasitology , Diagnosis, Differential , Dystonia/complications , Female , Humans , Male , Mesencephalon/pathology , Middle Aged , Neuritis/diagnosis , Optic Disk , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/parasitology , SyndromeABSTRACT
407 patients (248 men, 159 women) of epilepsy attending the neurology clinic were evaluated to find out the profile of epilepsy, cost-effectiveness of various investigations, therapeutic regimens and efficacy of referring physicians in a developing country. At the time of onset of seizures 67.2% of patients were in the second and third decade. Generalised tonic clonic seizures were the commonest seizure type seen. Specific aetiology was established in 20.8% cases only. Neurocysticercosis was the commonest cause observed. The main source of referral (50.1%) was general practitioners. Referral diagnosis was incomplete in 52.8% of the cases. Investigations did not alter the diagnosis in 62.5% cases. The EEG was useful in the management of 15.1% cases of epilepsy. The skull x-ray and chest x-ray were abnormal in 1.7% and 2% cases respectively. CT scan revealed abnormality in 39.4% cases. Most of the patients were treated with monotherapy. Phenytoin, phenobarbitone and carbamazepine were the common drug used. Out of 246 cases who were started on anticonvulsant therapy prior to referral, the choice of drug was wrong in 78 (31.7%) cases and dose was inappropriate in 121 (49.2%) cases. It was concluded that most important factor for cost effective management of epilepsy is proper clinical evaluation and education of general physicians in this direction.
Subject(s)
Epilepsy/drug therapy , Adolescent , Adult , Age Distribution , Anticonvulsants/therapeutic use , Child , Child, Preschool , Developing Countries , Electroencephalography , Epilepsy/physiopathology , Female , Humans , Infant , Male , Middle Aged , Prospective StudiesABSTRACT
Thirty nine confirmed cases of SSPE were analysed retrospectively to study the clinical profile and to look for any atypical presentations. There were 29 males and 10 females with the age ranging from 4-19 (mean 11.5 × 3.5) years. Sixteen patients (41.0 percent) had received measles vaccination. Definite history of measles was available in 33 (84.6 percent) cases. Onset of symptoms was after 10 years of age in 58.9 percent of cases. Majority (56.42 percent) had presented within six months of onset of symptoms but 5 patients (12.8 percent) had symptoms for more than 3 years prior to the presentation. Decreased scholastic performance (58.97 percent) and myoclonus (33.33 percent) were the common presenting symptoms. Generalized tonic clonic seizures (2 cases), visual deterioration (2 cases) and altered sensorium (1 case) were the unusual presenting features. Ophthalmological manifestations were seen in 6(15.4 percent) patients. One patient had diminution of hearing in earlier stages illness. Mean age of onset of symptoms was significantly different (p < 0.01) in vaccinated (13.10 × 2.84 years) and non-vaccinated (9.87 × 3.44 years) group. Oligoclonal bands in cerebrospinal fluid (CSF) revealed a positivity in 79.4 percent of cases. Antimeasles antibody titres in serum and CSF were significantly raised in 31 cases (79.5 percent). Electroencephalogram (EEG) revealed periodic complexes in 38 cases (97.4 percent).
ABSTRACT
Eleven patients of ipsilateral seizures or ipsilateral neurological deficit were studied under the heading of ipsilateral cerebral events. Ipsilateral localisation was based on electroencephalogram (EEG) and computed tomography (CT) scan or both. Group A had 4 patients who had predominantly motor neurological deficit and ipsilateral pathology was evident on CT scan. Surgery re-confirmed the lesion in one case. Group B had 7 patients who had partial motor seizures with or without generalisation. EEG showed ipsilateral focus in all but only 3 patients revealed ipsilateral lesion on CT scan. All patients showed improvement on medical treatment except one case which underwent surgery. Various hypotheses are put forward for the ipsilateral phenomenon and the mechanism implicated are discussed.
ABSTRACT
Palmomentalis reflex (PMR) is a superficial polysynaptic, primitive reflex seen in normal population with higher incidence at the extreme of ages. It is exaggerated in upper motor neuron lesions involving corticobulbar tracts. We describe palmolevator labii superioris reflex - new variant palmomentalis reflex. The mechanism, pathway and diagnostic applications of PMR are discussed on recent studies.