Postural orthostatic tachycardia syndrome in patients of orthostatic intolerance symptoms: an ambispective study.

BACKGROUND: A Postural orthostatic tachycardia syndrome (POTS) is infrequently diagnosed in routine practice because of the variable range of symptoms that could be seen in cardiac rhythm disorders, vertigo, chronic fatigue syndrome and anxiety panic disorder. POTS is a chronic debilitating condition that affects day to day efficient working of an individual. We have planned a study to look for POTS in patients who are having orthostatic intolerance symptoms and underwent a head-up tilt table test (HUTT). AIM: To study the prevalence of POTS in patients of orthostatic intolerance (OI) symptoms and to analyze symptomatology, its association with neurocardiogenic syncope (NCS), and its outcome. METHODS: We reviewed the medical records of 246 patients presented with symptoms of OI seen at our centre from January 2010 till March 2019. Out of them, 40 patients included, those qualifying the criteria for POTS on HUTT. RESULTS: The mean age of the cohort was 25.90 ± 10.33 years with a range of 15 to 55 years, and males comprised 52.5% (21/40) of total patients. The most frequent presenting orthostatic symptoms of POTS patients are loss of consciousness (77.5%), lightheadedness (75%), and palpitation (67.5%). A total of 18 patients (45%) had coexisting neurocardiogenic syncope. CONCLUSION: POTS is a prevalent condition and have a significant impact on the quality of life, and the majority of patients may not present with OI symptoms during HUTT. We have to keep this possibility in young patients of transient loss of consciousness because it may coexist with NCS.

Neurological Symptoms as Initial Manifestation of Covid-19 - An Observational Study.

BACKGROUND: Respiratory system involvement and fever are considered as a cardinal manifestation of Covid-19 infection for the screening of case detection. We (India) are into the fourth month of Covid-19 and cases are still rising, this could mean that fever and respiratory symptoms may not be the only initial symptoms. Therefore, we intend to investigate whether neurological symptoms can precede the cardinal symptoms. METHODS: Totally, 391 Covid-19 RTPCR positive hospitalized patients were enrolled. All included subjects were presented with a questionnaire pertaining to systemic symptoms. For analysis of the chronology of symptoms, the study population was sub-grouped according to onset of their systemic involvement e.g., (1) Fever (2) Respiratory symptoms (3) Neurological symptoms (4) Gastrointestinal symptoms. RESULTS: New-onset neurological symptoms were found in 106 (27.1%) out of 391 patients irrespective of their chronology to the onset of other symptoms. Of these 106 patients, altered taste (33.1%), altered smell (24.5%), and headache (22.6%) were the most common neurological symptoms. However, 38 (9.7%) subjects recognized neurological symptoms, as the initial manifestation of their illness. Mean duration of neurological symptoms before the onset of respiratory symptoms or fever was 2 ± 1.57 days. CONCLUSION: New-onset headache, altered taste, and smell were the most common neurological symptoms. In the context of the current pandemic, a high index of suspicion should be kept in patients presenting with these symptoms even in the absence of fever and respiratory symptoms. To the best of our knowledge, this is the first study from India comparing chronology of neurological symptoms with cardinal symptoms.

Twenty-and-a-half syndrome: a case report.

BACKGROUND: In the list of named numerical neuro-ophthalmological syndromes, such as one-and-a-half syndrome and others, we report for the first time twenty-and-a-half syndrome, which is characterized by one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy (1.5 + 7 + 7 + 5 = 20.5) in a patient with ischemic stroke. CASE PRESENTATION: A 45-year-old Asian Hindu woman presented with vomiting and imbalance of 1 day's duration. She had left-sided ataxic hemiparesis with one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy. Magnetic resonance imaging of her brain revealed acute non-hemorrhagic infarct in the right posterolateral aspect of pons and medulla, with normal brain vessels angiography. We described her disorder as twenty-and-a-half syndrome. She was put on antiplatelet therapy. CONCLUSIONS: Twenty-and-a-half syndrome is reported for the first time. It is due to posterior circulation stroke; in our case, it was due to lacunar infarcts in the pons and medulla, manifesting as one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy.

Guillain-Barre Syndrome following Tuberculosis: A Rare Association.

The co-occurrence of Guillain-Barre syndrome (GBS) and tuberculosis is rare. Even in countries like India, where tuberculosis is common, there is only one case report of co-occurrence of GBS with tuberculosis. We report a case of GBS in association with sputum-positive pulmonary tuberculosis. The earliest treatment with intravenous immunoglobulin in acute motor axonal neuropathy variant of GBS would show good early recovery despite associated pulmonary tuberculosis.

Outcome of Myasthenia gravis treated with high-dose prednisolone and azathioprine: A single centre ambispective study from India.

PURPOSE: Myasthenia gravis (MG) is treated with many disease modifying therapies, namely corticosteroids, thymectomy and immunosuppressants, alone or in various combinations. But still, till today no consensus over the optimum therapy for MG has been made. METHODS: Out of total 101 patients with MG, 37 patients fulfilled the inclusion criteria and in them we ambispectively studied factors affecting the outcome in MG treated, to induce leukopenia, with prednisolone (PSL) plus azathioprine(AZA), from January 1993 through July 2014. Patients were grouped according to the outcome: pharmacological remission (PR), complete stable remission (CSR), non-remitter and remitters with or without relapse. Their demographic characteristics, MGFA Class, dose of PSL and AZA, time to achieve remission, duration of remission, leukocyte counts, thymus status, follow-up duration, results of repetitive nerve stimulation, and side effects profile were compared. RESULTS: Total 81% patients remitted; PR (83%) was commoner than CSR (p=0.003). Factors favoring remission were early onset disease, therapeutic leukopenia (p=0.003) and longer follow-up (OR5, p=0.08); those associated with relapse were abnormal thymus (CI-1.1-3.4; p=0.09), MGFA class IIb (CI 0.9-3; p=0.09) and male gender. Side effects occurred in 48%. CONCLUSION: Aggressive therapy with prednisolone plus azathioprine induces remission in a high percentage of patients with generalized MG.