Acute-Onset Quadriplegia Presenting With Hyperreflexia: A Dilemma in Diagnosis.

An autoimmune polyradiculoneuropathy, Guillain-Barré syndrome (GBS) is an acute, rapidly progressive, and fulminant one. Rapidly developing motor weakness along with absent reflexes, with or without sensory impairment, is the hallmark of GBS. GBS is never a hereditary entity; it is always acquired by the individual. Here, we present an interesting case of GBS in a 37-year-old male patient presenting with lower limb weakness for one day which had progressed to upper limb weakness in a day. There was a history of fever and loose stools four days back. On examination, vitals were within normal limits including single breath count. Central nervous system (CNS) examination revealed as follows: bicep jerk, tricep jerk, and supinator jerk were National Institute of Neurological Disorders and Stroke (NINDS) scale grade 2 in bilateral upper limbs. Knee jerk was NINDS scale grade 3 in bilateral lower limbs, which was unusual considering that GBS presents with areflexia or reduced reflexes. Ankle jerk was absent in bilateral lower limbs. Plantars were mute bilaterally. Nerve conduction study was suggestive of axonal and demyelinating motor neuropathy involving all four limbs. The patient was planned for intravenous immunoglobulin at a dose of 2 g/kg/day for five days but developed an allergic reaction to the first dose; hence, the therapy was discontinued, and the option of plasmapheresis was given to which the patient refused. This is a report of a case of GBS with hyperreflexia which is an uncommon entity in the Indian subcontinent.

An Unusual Case of Fever in Paralytic Ileus.

Still's disease is frequently a condition of exclusion for patients with an unidentified cause of fever. Accompanying symptoms typically include fever, arthralgia, and a transient skin rash. The underlying pathophysiology indicates an autoimmune origin. Diagnosis is primarily clinical, often utilizing the Yamaguchi criteria. The case in question involves a 19-year-old male presenting with high-grade fever and paralytic ileus. The patient received intravenous glucocorticoids and cyclophosphamide, resulting in a rapid clinical improvement. During the follow-up, tofacitinib was initiated based on the clinical response observed.

A Study of Lipid Profile and the Correlation of Serum Uric Acid Levels in Patients With Hypertension.

Aim We examine the lipid profile and correlation of serum uric acid (SUA) levels in cases of hypertension and normotensives. Methods The current observational study spanned between April 2022 and April 2024. Throughout the research, 200 patients were examined; 100 of these patients were classified as Stage 1 or Stage 2 hypertensive (as per the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure), while the other 100 served as controls, meaning they did not have hypertension or any other medical condition that could lead to elevated SUA levels. Results It was revealed that the proportion of hypertension was higher in males compared to females. Of the total male patients, most (41.1%) patients had grade 1 hypertension and grade 2 hypertension, while among females, 20% had grade 1 hypertension. It was seen that as age increases, systolic blood pressure (SBP) and diastolic blood pressure (DBP) also rise among the two study groups, although the correlation was not statistically significant between blood pressure level and age of study subjects. The hypertensive patients have increased SBP and DBP levels when compared to the control group, which is significant. The lipid profile shows that the hypertensive subjects had significantly higher mean low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), and triglyceride levels than controls. SUA levels were observed to be elevated in the hypertensive subjects implying a positive correlation between the level of uric acid and blood pressures. Conclusion We found evidence that hyperuricemia and hypertension go hand in hand. A statistically noteworthy positive connection was found between the systolic blood pressures and lipid profiles of the patients. Hypertensive patients were found to have hyperlipidemia, whereas normotensive controls had normal lipid profiles. Moreover, it was seen that there was a positive correlation between SBP and chronological age in hypertensive cases, although this was statistically not significant.

Acute Intestinal Obstruction in a Case of Cerebrovascular Accident.

Ogilvie's syndrome represents an acute form of intestinal obstruction that occurs in the absence of a detectable mechanical blockage impeding fecal passage. Hence, it is also given the name of intestinal pseudo-obstruction. It has been deemed a disease of imbalance between the arms of the autonomic nervous system with an increase in parasympathetic outflow. Most often, it has an antecedent surgical or medical illness. There is evidence for the use of IV neostigmine in such cases to prevent imminent intestinal ischemia and perforation. In the case of a non-responder, decompression of the bowel using a colonoscope and surgery have also been tried to relieve the symptoms. In the case that follows, a middle-aged man developed progressive abdominal distension in the course of his recovery from an ischemic cerebrovascular accident. Initially, he received conservative treatment for 48 hours. Subsequently, he was given IV neostigmine, which relieved his symptoms.

Antineutrophil Cytoplasmic Antibodies Associated Vasculitis Presenting As Neuropathy.

Antineutrophil cytoplasmic antibody-related vasculitis (AAV), is a group of diseases marked by systemic symptoms and severe small vessel inflammation. The three subtypes of AAV are eosinophilic GPA (EGPA), Microscopic Polyangiitis (MPA), and Granulomatosis with Polyangiitis (GPA). The organs that get involved in the disease process are the kidneys and the upper and lower respiratory tracts, with a spectrum of neurological manifestations. Here, we present a case report of a 68-year-old man who came with complaints of tingling and numbness over bilateral lower limbs for two months accompanied by difficulty in walking and bilateral foot drop without any respiratory complaints or involvement of sensory or autonomic system who was diagnosed with AAV (c-ANCA +) on further workup. A sural Nerve biopsy was done for confirmation which was suggestive of chronic, asymmetrical axonal neuropathy with perivascular inflammation, suggestive of vasculitic neuropathy. The patient had no other organ involvement. The patient was started on glucocorticoids and cyclophosphamide therapy for 6 cycles after which his symptoms and quality of life improved drastically.

An Unusual Presentation of Wilson's Disease.

Wilson's disease affects the metabolism of copper and is a rare hereditary disorder that is inherited autosomally recessively. The liver and brain are the main organs affected by this disorder, which causes progressive hepatolenticular degeneration. A 15-year-old male patient arrived at the outpatient department (OPD) with mild abdominal pain on the right side, and both eyes showed Kayser-Fleischer (KF) rings. An abdominal ultrasound showed that the spleen was enlarged. Copper levels in urine were found to be higher. After a liver biopsy, cirrhosis, and mild chronic active hepatitis were found. The majority of hematological indicators were normal; however, a peripheral blood smear revealed mild thrombocytopenia. Wilson's disease is uncommon, so diagnosing it requires a high degree of suspicion. In circumstances of inexplicable liver cirrhosis or isolated neurological symptoms, it could go unnoticed. The only primary complaint in the case being presented was abdominal pain. However, the age upon presentation, the existence of KF rings in both eyes, and other tests helped us get the diagnosis.