Neuro-cryptococcosis in an immunocompetent individual with radiologically atypical findings: a case report and review of literature.

We present a case of a 29-year-old immunocompetent female without any known comorbidities with intermittent headache and vomiting who was ultimately diagnosed with cryptococcal meningitis (CM). Though her neuroimaging findings were atypical to those commonly found in CM, she was diagnosed with CM with a cryptococcal antigen test. However, in contrast to the good prognosis as stated in the literature, she died during her course stay at the hospital. Therefore, cryptococcosis should be taken as differentials, even in an immunocompetent individual presenting with features suggestive of meningitis, to prevent the worst clinical outcome.

Benedikt syndrome in a 74-year-old hypertensive woman: A case report.

Benedikt syndrome is a rare neurological disorder of the midbrain. Herein, we present a case of Benedikt syndrome, who presented with left-sided body weakness, right oculomotor nerve palsy, cerebellar ataxia, and Holmes tremor in the left upper limb following midbrain infarction. She was treated with aspirin, clopidogrel, and amiodarone.

Seronegative neuromyelitis optica spectrum disorder with longitudinally extending transverse myelitis and optic neuritis: A case report.

Introduction: Neuromyelitis Optica (NMO; Devic syndrome,1894) is a CNS demyelinating syndrome. Significant proportion of neuromyelitis optica spectrum disorder is associated with Anti AQ4 Ab. The revised diagnostic criteria for neuromyelitis optica spectrum disorder (2015) has been proposed on the basis of Anti AQ4 Ab status. Most of cases reported has been found in females. It presents with multiple remissions. Common features of acute myelitis and optic neuritis seems to be the usual presentation. Case presentation: Herein we report a case of a 35-year-old male with longitudinally extending transverse myelitis and Optic Neuritis with confirmation of Anti AQ4 Ab negative status with presentation of bilateral below knee weakness and incontinence of bowel and bladder. It was confirmed by Magnetic Resonance Imaging. Clinical discussion: Seronegative neuromyelitis optica spectrum disorder recently classified by 2015 diagnostic criteria associated with strict clinical presentations neuroimaging findings and exclusions of differentials. It presents with a poor prognosis particularly in relapsing course. Conclusion: We report a case of seronegative neuromyelitis optica spectrum disorder. The prognosis of relapsing course is poor. Early diagnosis and immunomodulators are required to decrease chances of recurrence. Further development of diagnostic modalities in seronegative neuromyelitis optica spectrum disorder is required.

A Rare Case of Cryptococcal Meningitis in a Child with a Congenital Heart Disease.

Cryptococcal meningitis, which has a high mortality rate, is rare in immunocompetent children. Although many immunocompromised conditions are identified as predisposing factors, congenital heart disease in children is not well recognized as a predisposing factor for the disease. A 12-year-old female child presented with a progressively increasing headache for one month. There was history of vomiting and fever off and on. On examination, she had a pansystolic murmur and meningeal signs. Lumbar puncture was done; opening pressure was high (27 cm H2O) and white blood cell (WBC) count in cerebrospinal fluid (CSF) was slightly high. Gram staining, India ink preparation, and culture of CSF were negative. Cryptococcal antigen (CrAg) test was not available. Echocardiography showed a 12 mm ventricular septal defect (VSD). The patient was diagnosed as meningitis with VSD and treated with intravenous ceftriaxone and vancomycin; however, she did not improve after 7 days of antimicrobial treatment. She was then transferred to another hospital where India ink and culture of CSF showed cryptococcus; CrAg test was done, and it was positive. Despite the treatment with lyposomal amphotericin B and flucytosine, she died on 9th day of admission in pediatric intensive care unit. It is necessary for global advocacy for need of availability of CrAg test in resource-limited regions. Treating doctors should consider VSD, a congenital heart disease, as a predisposing factor for cryptococcal meningitis in children. As CrAg is more sensitive than India ink and culture, it should be the first line of investigation in suspected cases.

Disaster waste management after the 2016 Kumamoto Earthquake: A mini-review of earthquake waste management and the Kumamoto experience.

Millions of tons of debris can be generated by natural disasters, impacting the surrounding environment and posing health risks to the public. Proper handling and treatment of such waste is essential to overcome potential hazards as well as to reduce the burden on natural resources during the reconstruction phase. Disaster waste management can have social, economic, and environmental benefits if planned effectively. This mini-review focuses on the destruction caused and debris generated by the 2016 Kumamoto Earthquake in Japan. In addition, it elaborates upon the treatment of debris in Kumamoto at temporary and secondary storage sites by segregation and the adoption of a full-scale recycling system. It also shows that cooperative networks involving numerous organizations are important in managing a large amount of disaster waste. Finally, it presents comparative discussions of different aspects of disaster waste management in the Kumamoto Earthquake event and other disasters. The experience gained from the Kumamoto Earthquake is important for future disaster waste management planning.

Stroke mortality in intensive care unit from tertiary care neurological center.

INTRODUCTION: Stroke is the second most common cause of death and major cause of disability worldwide. About a quarter of stroke patients are dead within a month, about a third by six months, and a half by one year. Although the most substantial advance in stroke has been the routine management of patients in stroke care units, Intensive Care Unit has remained the choice for stroke patients' care in developing countries. This study explores the mortality of stroke patients in ICU setting in tertiary care neurological centre in a developing country. METHODS: We collected data of stroke patients admitted in our ICU from August 2009 to August 2010 and analyzed. RESULTS: Total 44 (10.25%) patients were admitted for acute stroke. Age ranged from 17-93 years. Low Glasgow Coma Scale (GCS), uncontrolled hypertension and aspiration pneumonia were common indications for admission in ICU. Total 23 (52.3%) patients had hemorrhagic stroke and 21 (47.7%) patients had ischemic stroke. Total 13 (29.54%) patients of stroke died within seven days, nine (69.23%) patients of hemorrhagic stroke died within six days, and four patients (30.76%) of ischemic stroke died within seven days and six (13.63%) patients left hospital against medical advice. All of these patients had ischemic stroke. CONCLUSIONS: Stroke mortality in ICU remains high despite of care in tertiary neurological center in resource poor settings. Stroke Care Unit, which would also help dissemination of knowledge of stroke management, is an option for improved outcome in developing countries.