Study of Non-Thyroidal Illness Syndrome and Its Recovery in Critically Ill Patients at a Tertiary Care Centre in South India.

Background and Objectives: Transient thyroid hormone alterations are common during critical illness and are termed non-thyroidal illness syndrome (NTIS). We studied the prevalence of NTIS in the ICU setting and its impact on predicting mortality and other outcomes and compared it to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Materials and Methods: The study included 119 consecutive patients admitted with a critical illness. APACHE II score was calculated. Total T3, total T4, TSH, free T3, and free T4 were measured at admission and after six weeks of discharge. NTIS and euthyroid groups were studied for ICU, hospital stays, mortality, readmission, and recovery. Predictors of mortality were compared between survivors and non-survivors. Results: The mean age was 60.15 ± 14.50 years with M:F = 84 (71%):35 (29%). NTIS was observed in 84 (71%), low T3 being the most common abnormality in 53 (63%). The occurrence of NTIS was significantly higher among non-survivors (28/30, 93%) versus survivors (56/89, 63%) (P = 0.002). Non-survivors showed significantly lower T3, TSH, and FT3/FT4 ratios and higher readmissions. NTIS group showed significantly greater ICU stay (P = 0.02) and had higher readmission rates (P = 0.032). Baseline T3 had the greatest power to predict mortality. APACHE II score also correlated significantly with mortality (19.60 ± 10.58 vs 11.99 ± 6.80, P < 0.001). The area under the curve (0.677) for the T3 level was lower than the APACHE II score (0.760). After six weeks, 61% had recovered from NTIS. Conclusions: NTIS was common amongst critically ill patients (71.5%), which reversed in 61% at six weeks. Low T3 was the most common abnormality and independently predicted mortality. Free T3/free T4 also significantly predicted mortality. The correlation between thyroid dysfunction and the severity of primary illness makes it an additional attractive low-cost marker of mortality.

Vasculitic neuropathy : clinical electrophysiological and histopathological characterstics.

The clinical, electrophysiological and pathological features of 16 patients with vasculitic neuropathy were evaluated. Vasculitic neuropathy accounted for 5.3 of biopsy proven cases of various neuropathies. They included 7 cases of systemic vasculitic neuropathy (SVN) and 9 cases of nonsystemic vasculitic neuropathy (NSVN). Mononeuritis multiplex, both clinically and electrophysiologically was seen in neoropathy in 11 (69.7) patients. Three patients had sensory neuropathy. All the patients had anecrotizing vasculitis on nerve biopsy. Axonal degeneration was seen in teased fibers in all the patients. Fifteen patients were treated with steroids and one patient with cyclophosphamide. Seven patients with NSVN recovered completely. Two patients withSVN were left with asymmetical foot drop and one patient with NSVN developed bilateral mild claw hands. There were no deaths.

Brachial plexus and related lesions after median sternotomy.

A prospective study was undertaken in 459 cases, undergoing open heart surgery which necessitated media sternotomy, to see the frequency of brachial plexus and peripheral nerve related complications in the upper limbs. Seven cases (1.53) had such complications. These included lower trunk injury (3 cases), ulnar neuropathy at the elbow (3 cases), and radical neuropathy at the level of radical groove (one case). The youngest patient was aged 12 years and the remaining 6 patients were more than 30 years of age. There was no relation between the type of heart disease and these complications. The difference between patients with or without preparation of the internal mammary artery for graft was not significant. All the complications occurred on the left side. Ulnar and radical nerve palsy could be due to the positioning of the left limb. The barchial plexus injury was related to retraction of the sternum during operation. AA : Y.

Neurological complications of varicella inflection : a clinical, electrophysiological and MRI study.

Twenty three cases of neurological complications following varicella infection are reported. These include pre rash seizures (2), encephalomyelitis (12), Guillain-Barrel syndrome (GBS) (7) and cranial neuropathy (2). There were 3 cases of encephalitis form, 7 cases of cerebellar form and 2 cases of pure myelitic form of the 12 cases of encephalomyelitis. There were no distinct clinical or electrophysiological features which serve to distinguish the GBS seen in association with varicella infection from that seen in other clinical settings. Lack of white matter lesions on magnetic resonance imaging in acute cerebellar ataxia following varicella infection may suggest probably different pathogenic mechanisms in this form of encephalitis when compared to cerebral form.

Prospective study of cortical sinovenous thrombosis value of CT scan and imaging.

Forty two consecutive cases of cortical sino venous thrombosis (CSVT) diagnosed by computerised tomographic scan (CT scan) and or magnetic resonance imaging (MRI) constituted the study material. Clinical features are similar despite of varied aetiology. Stroke like presentation was seen in 20 (48 percent) patients, features of raised intracranial pressure were seen in 14 (33 percent) patients and the remaining presented with diffuse encephalopathic features. No definitive aetiological factor could be found in 7 (17 percent) patients. Main CT scan features included empty delta sign (43 percent), cord sign (31 percent) and haemorrhagic or non haemorrhagic infarcts (62 percent), and CT scan was non diagnostic in 6 (14 percent) patients. The MRI imaging features included hyperintense signals in the sinuses more often in sagittal sinus with or without haemorrhagic infarct.

Carpal tunnel syndrome : how common is the problem in South India.

The relative frequency of carpal tunnel syndrome (CTS) among the patients referred for electrophysiological studies was studied. The case material included both inpatients and outpatients with various peripheral nerve disorders during the study period. CTS constituted 7 percent of all the peripheral nerve disorders and 83.6 percent of entrapment neuropathies. Eighty four patients were referred with the diagnosis of CTS and only 49 percent could be confirmed electrophysiologically. The presentation was that of acral and /or brachial paraesthesiae or pain.

Motor evoked potentials by magnetic stimulation in acute ischaemic stroke : prognostic significance.

Motor evoked potentials were recorded in 25 patients with ischaemic stroke within 72 hours of onset by transcranial magnetic stimulation. Motor power was graded according to MRC grading and the disability by Ranking scale. The patients could be grouped into those with normal MEPs (Group I) - 5 (20 per cent), those with prolonged CMCT and/or abnormal MEP/CMAP ratios or prolonged interside difference in CMCT on the hemiparetic side (Group II) - 12 (48 per cent) and those with no elicitable cortical MEPs on the hemiparetic side (Group III) - 8 (32 per cent). Patients with greater weakness and disability tended to have more abnormal or absent MEPs. No definite correlation could be seen with the site of infarct and MEP abnormalities. Patients with no elicitable cortical MEPs (Group III) showed no significant improvement in motor deficit at six months follow up. Where as patients in whom normal or abnormal cortical MEPs could be elicited (Group I & II) showed significant improvement. Evaluation of MEPs by transcranial magnetic stimulation early in acute ischaemic stroke can be used to predict stroke outcome.

Alexia without agraphia : a case report with CT demonstration of the lesion and review of literature.

A case of alexia without agraphia with CT demonstration of the lesion is reported. The various types of occipital alexia and their anatomic bases have been reviewed.

Anterior cerebral artery territory infarctions : a clinico-radiologic study based on CT.

Clinical features of acute infarcts in the anterior cerebral artery territory are correlated to the topography of lesions on CT Scan in 15 patients. The most common clinical feature, hemiparesis with crural dominance correlated well with the involvement to the contralateral paracentral lobule in all 12 patients. Patients who had facio-brachial weakness and hemiparesis showed infarcts limited to the periventricular white matter around anterior horn of lateral ventricle. Large medial-basal frontal lesions were associated with behavioural disturbances in 5 patients. In 3 patients who had patchy lesions involving the paracentral lobule, supplementary motor area and medial frontal areas with sparing of the fronto-polar areas had bladder disturbances in3 patients, while 3 other patients who had involvement of the same areas did not show bladder disturbances. The size of the infarct seems to have not much correlation as compared to the site and structures involved. Supplementary motor area lesions had associated speech disturbances like mutism, transcortical motor aphasia and decreased nonfluent verbal output, in one case each. Clinical features in anterior cerebral artery territory have more often fair correlation with topographic lesions on CT.