RESUMEN
INTRODUCTION: Catastrophic health expenditure (CHE) is a reliable measure of the financial unpreparedness of the studied population to meet unexpected health issues. The alarming proportion of patients who incur CHE in the wake of an acute neurological illness like Guillain Barre Syndrome (GBS) is of serious concern in a country like India where a large majority of households are uninsured. METHODOLOGY: Medical records of patients diagnosed with at a tertiary care centre in Delhi were analysed retrospectively to determine the rate of CHE. Clinical details and other contributory variables were also recorded. RESULTS: 53 patients with a median age of 29 years (10.5-46.5) were included in the study. Tow- third of patients were less than 40 years of age and 58.5% were male. 90.6% of patients incurred CHE with a median amount INR 273 300 spent out of pocket. CONCLUSION: The enormous magnitude of financial distress and crisis emerging out of an acute neurological illness needs to be addressed with urgency to prevent impoverishment of already weakened households.
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Síndrome de Guillain-Barré , Gastos en Salud , Adulto , Enfermedad Catastrófica/epidemiología , Composición Familiar , Síndrome de Guillain-Barré/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Epilepsia , Miastenia Gravis , Humanos , Corteza Insular , Miastenia Gravis/complicacionesRESUMEN
A patient presented with documented narrow QRS tachycardia. During electrophysiological study, he has orthodromic reciprocating tachycardia with atrial activation consistent with left free wall accessory pathway. With induction of tachycardia, beats with LBBB morphology have shorter cycle length than those with narrow QRS. What is the mechanism?
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Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/etiología , Síndrome de la Vena Cava Superior/etiología , Timoma/complicaciones , Neoplasias del Timo/complicaciones , Adulto , Anticoagulantes/uso terapéutico , Electrodiagnóstico , Electromiografía , Gastritis/inducido químicamente , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Masculino , Conducción Nerviosa , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/diagnóstico , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/tratamiento farmacológico , Síndrome de la Vena Cava Superior/diagnóstico , Síndrome de la Vena Cava Superior/tratamiento farmacológico , Timoma/diagnóstico por imagen , Neoplasias del Timo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/diagnóstico por imagen , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico por imagenRESUMEN
Aseptic meningoencephalitis (AME) constitutes a variable proportion of meningoencephalitis. Patients with AME are not routinely evaluated for autoimmune disorders. Primary Sjögren's syndrome (pSS) is a prevalent, but under suspected systemic autoimmune disease characterised by exocrinopathy, though sicca symptoms may not be the dominant or presenting feature. This study was undertaken to enumerate the clinical, radiological and laboratory features of meningoencephalitis related to pSS among the total cohort of meningoencephalitis admitted in our hospital. Retrospective patient records were screened for diagnosis of meningoencephalitis from April 2016 to March 2020. Those patients with anti-SSA positivity and clinical diagnosis of pSS were included. We have reviewed all cases of Sjögren's syndrome with meningoencephalitis available in literature. Four patients with meningoencephalitis with pSS were identified. Their clinical presentations, investigations, and good response to steroids have been described with special emphasis on evolving clinical features. In all patients, sicca features were absent. Anti-SSA was positive in all. The diagnosis of pSS was considered after ruling out all infectious and other autoimmune aetiologies. Two had extra-neurological organ manifestations and required addition of second line immunosuppressive agents for optimum disease control. Consistent with this case series, absent sicca symptoms have been described in pSS patients presenting with meningoencephalitis in literature. This case series is of special interest as it describes the initial presentation of pSS as meningoencephalitis with sicca features in absentia, thereby highlighting the need for a high index of suspicion and the need for workup for pSS in AME.
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Anticuerpos Antinucleares/sangre , Meningoencefalitis/complicaciones , Síndrome de Sjögren/complicaciones , Antibacterianos , Femenino , Humanos , Masculino , Meningoencefalitis/sangre , Estudios Retrospectivos , Síndrome de Sjögren/sangre , Síndrome de Sjögren/diagnósticoRESUMEN
Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a rare and unanticipated manifestation of CNS tuberculosis. A 28 years old female diagnosed case of tubercular meningitis (TBM), already on antitubercular therapy (ATT) for last nine months, developed sensory and motor weakness in lower limbs along with saddle anaesthesia. Magnetic resonance imaging (MRI) with contrast of the spine revealed the presence of multiple space occupying lesions in dorsal spinal cord. She received oral steroid therapy for six weeks with escalation of ATT after which neurological functions improved remarkably.
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Enfermedades de la Médula Espinal/diagnóstico por imagen , Tuberculoma/diagnóstico por imagen , Tuberculosis Meníngea/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Femenino , Glucocorticoides/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Enfermedades de la Médula Espinal/tratamiento farmacológico , Vértebras Torácicas , Tuberculoma/tratamiento farmacológico , Tuberculosis del Sistema Nervioso Central/diagnóstico por imagen , Tuberculosis del Sistema Nervioso Central/tratamiento farmacológico , Tuberculosis Meníngea/tratamiento farmacológicoRESUMEN
Moxifloxacin is a third-generation fluoroquinolone antibiotic with broad spectrum activity and also used as component of anti-tubercular therapy (ATT). Though frequently prescribed, moxifloxacin induced encephalopathy is uncommonly seen. Here we describe a forty four year old male, with features of disseminated tuberculosis (TB) and suspected case of multi-drug resistance (MDR), who developed acute encephalopathy. Extensive laboratory investigations, neuroimaging of brain, cerebrospinal fluid analysis was unremarkable. On stopping moxifloxacin, which was being administerd as part of ATT for MDR TB, encephalopathy resolved completely, thereby proving it to be a case of moxifloxacin induced encephalopathy. To conclude, by presenting this case, we wish to raise awareness about moxifloxacin induced encephalopathy among healthcare providers.
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Antituberculosos/efectos adversos , Discitis/tratamiento farmacológico , Encefalitis/inducido químicamente , Moxifloxacino/efectos adversos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis de la Columna Vertebral/tratamiento farmacológico , Adulto , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Deprescripciones , Electroencefalografía , Encefalitis/fisiopatología , Humanos , Masculino , Síndromes de Neurotoxicidad/etiologíaRESUMEN
The pathologic involvement of brainstem and midbrain nuclei and white matter tracts in various combinations may result in a spectrum of arithmetically derived syndromes. They include 'one and a half syndrome', 'eight and a half syndrome' and 'fifteen and a half syndrome'. We report a case of 'nine syndrome', which has been reported more recently, caused by caused by acute pontine infarcts and characterised clinically by a combination of internuclear ophthalmolplegia, ipsilateral horizontal gaze palsy, lower motor neuron type of facial palsy, contralateral hemiparesis and hemianesthesia. We highlight the genesis of this combination of clinical signs, revisit the different variants of INO and review the literature on 'Nine syndrome'.