Staphylococcal septicaemia associated with peripheral neuropathy in three different clinical settings.

Among the various etiologies of peripheral neuropathy, S. aureus is a rare cause that is not even mentioned in standard textbooks. Here we like to report three clinical scenarios where patients with different manifestations of S. aureus infection developed peripheral neuropathy presenting as quadriparesis, which subsided gradually with control of infection and supportive care. No other known causes of peripheral neuropathy were present in these cases.

Assessment of insulin resistance in non-diabetic hypertensives in Eastern India.

To assess prevalence of insulin resistance in non-diabetic hypertensive patients in eastern part of India, a case-control study was undertaken among 112 patients of hypertension without diabetes mellitus or ischaemic heart disease and 76 age and sex matched controls. Anthropometric measurements (height, weight, waist circumference) were done and fasting blood sugar and fasting insulin levels were estimated. Among 112 patients, 50.9% (n = 57) have fasting hyperinsulinaemia, whereas in control population 12% had hyperinsulinemia (p < 0.001). Mean waist circumference was higher in hypertensive patients compared to control. No statistical difference of body mass index between cases and control found. In this study prevalence of fasting hyperinsulinaemia, considered as a surrogate marker for insulin resistance, was 50% in hypertensives. Body mass index was not associated with insulin resistance or hypertension.

Sudden onset quadriparesis after minor injury to neck in a male with OS odontoideum.

Os odontoideum is a rare anomaly of the second cervical vertebra. Here, a young male patient with quadriparesis secondary to myelopathy associated with os odontoideum is reported. The patient was totally asymptomatic prior to this episode which was precipitated by trivial neck injury. He started recovering with conservative measures and was referred to our neurosurgery department for further evaluation and definitive surgical intervention as there is always a chance of recurrence of symptoms in these patients. There is a role for conservative treatment of an asymptomatic incidentally found, radiologically stable, and noncompressive os odontoideum, however surgery has a definite role in symptomatic cases.

Early seizures in first-ever acute stroke patients in India: incidence, predictive factors and impact on early outcome.

BACKGROUND AND PURPOSE: Stroke-associated early seizures (ES) often complicate the initial course of acute stroke. This study intended to estimate the rate of and the predictive factors for ES and the impact of ES on the clinical outcome in patients with first-ever acute stroke. MATERIALS AND METHODS: Consecutive patients with first-ever acute stroke admitted in the Department of Medicine from June 2010 to December 2011 were prospectively included. ES were defined as seizures occurring within 7 days from acute stroke. Patients with history of epilepsy, transient ischaemic attack, subarachnoid haemorrhage and cerebral venous thrombosis were excluded. Clinical outcomes were measured under the subheadings of mortality and disability at discharge, according to modified Rankin score. RESULTS: Of the 441 (56.92% male patients, median age 55 years, 49.43% had haemorrhagic stroke) patients, 79 (17.91%, 95% confidence interval (CI): 14.61-21.78%) suffered from ES. At discharge, 37.64% were disabled, and 19.5% were dead. In multivariate analysis, alcoholism, NIHSS at admission, haemorrhagic stroke and cortical location were significant predictors of ES. Thirty-day mortality was predicted by NIHSS at admission [hazard ratio (HR): 1.14, 95% CI: 1.11-1.18, P < 0.001], history of hypertension (HR: 3.79, 95% CI: 2.1-6.85, P < 0.001), history of alcoholism (HR: 2.43, 95% CI: 1.49-3.95, P < 0.001) and early seizure (HR: 2.58, 95% CI: 1.54-4.34, P = 0.001). CONCLUSIONS: Early seizures occurred in about 18% acute stroke patients. Alcoholism, haemorrhagic stroke, cortical and severe strokes predict development of ES. ES are an independent important risk factor for early mortality.

Type 3 renal tubular acidosis.

Renal tubular acidosis (RTA) is a group of transport defects in the reabsorption of bicarbonate, the excretion of hydrogen ion (H(+)), or both, resulting in systemic acidosis and hypokalemia with a normal glomerular filtration rate. Although isolated proximal (type 2) or distal (type 1) tubular pathologies are well characterized, a combined pathology leading to type 3 RTA is very rare. Here, we report a case of type 3 RTA, using an algorithmic approach to classify a scenario of hypokalemic metabolic acidosis in the setting of episodic flaccid paralysis.

Diuretic loading test and use of Bartter's Normogram in diagnosing a case of Gitelman's syndrome: Relook into pathophysiology.

Gitelman's syndrome is a rare autosomal recessive, renal tubular disorder, characterized by chronic hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria, and normal blood pressure. Patients usually present at a later age with episodic mild muscle weakness. Unexplained hypokalemia arouses suspicion. The diuretic loading test with furosemide and thiazide and the use of Bartter's normogram provides a practical and simple tool in comparison to the complex and costly genetic analysis, to confirm the diagnosis. Here we report a case of Gitelman's syndrome to show the utility of these simple techniques to explain the pathophysiology of the disease, as well as to localize the site of the renal tubular defect, to confirm the diagnosis.

Subdural hematoma associated with immune thrombocytopenic purpura in two different clinical settings.

Subdural hematoma (SDH) is a rare complication of immune thrombocytopenic purpura (ITP) the incidence being around 2%. Although SDH usually occurs secondary to trauma, in bleeding disorders it may occur spontaneously. Here we report subdural hematoma in two uncommon settings, one patient with systemic sclerosis developing secondary ITP and consequently subdural hematoma and the other patient with chronic ITP developing subdural hematoma in the inter hemispheric region. In both the settings the patients recovered spontaneously without any surgical intervention.

Heart failure and acquired immune deficiency syndrome: report of 2 cases.

Acquired immune deficiency syndrome (AIDS) patients usually present with prolonged fever, chronic diarrhoea, weight loss and other opportunistic infections. Congestive heart failure is not a usual presentation of AIDS. Here two cases, one a female of 38 years and another a male of 22 years presented with fever and breathlessness. On examination they were found to have features of congestive heart failure. Echocardiography revealed dilated cardiomyopathy. Laboratory investigations suggested human immunodeficiency virus was reactive in both cases with immune deficiencies of different degrees. The first patient expired during hospital stay, but the second one is progressing well with antiretroviral therapy.

Carcinoma of the gall bladder presenting as dermatomyositis.

Dermatomyositis (DM), manifested as paraneoplastic syndrome, is not a very common clinical entity but its association with various internal malignancies is well-documented in literature. We present such a case of DM associated with characteristic skin lesions and subacute onset of proximal muscle weakness, acquired from a very rare malignancy like adenocarcinoma of gall bladder.