Amrish Saxena

Performance of DHI Score as a Predictor of Benign Paroxysmal Positional Vertigo in Geriatric Patients with Dizziness/Vertigo: A Cross-Sectional Study

Background Dizziness/vertigo is one of the most common complaint and handicapping condition among patients aged 65 years and older (Geriatric patients). This study was conducted to assess the impact of dizziness/vertigo on the quality of life in the geriatric patients attending a geriatric outpatient clinic. Settings and Design A cross-sectional study was performed in a geriatric outpatient clinic of a rural teaching tertiary care hospital in central India. Materials and Methods In all consecutive geriatric patients with dizziness/vertigo attending geriatric outpatient clinic, DHI questionnaire was applied to assess the impact of dizziness/vertigo and dizziness associated handicap in the three areas of a patients’ life: physical, functional and emotional domain. Later, each patient was evaluated and underwent Dix-Hallpike maneuver by the physician who was blind of the DHI scoring of the patient. Statistical Analysis Used We compared means and proportions of variables across two categories of benign paroxysmal positional vertigo (BPPV) and non-BPPV. For these comparisons we used Student’s t-test to test for continuous variables, chi-square test for categorical variables and Fisher’s exact test in the case of small cell sizes (expected value<5). Results The magnitude of dizziness/vertigo was 3%. Of the 88 dizziness/vertigo patients, 19 (22%) and 69(78%) cases, respectively, were attributed to BPPV and non-BPPV group. The association of DHI score ≥50 with the BPPV was found to be statistically significant with x2 value = 58.2 at P<0.01. Conclusion DHI Score is a useful tool for the prediction of benign paroxysmal positional vertigo. Correct diagnosis of BPPV is 16 times greater if the DHI Score is greater than or equal to 50. The physical, functional and emotional investigation of dizziness, through the DHI, has demonstrated to be a valuable and useful instrument in the clinical routine.

Scrub typhus complicated by acute respiratory distress syndrome and multiorgan failure; an unrecognized alarming entity in central India: A report of two cases

Scrub typhus is an acute infectious illness, distributed throughout the Asia Pacific rim. In India, it has been reported from northern, eastern, and southern India. However, cases of scrub typhus have not been well-documented from Vidarbha, an eastern region of Maharashtra state in central India. We report two cases of complicated scrub typhus from Vidarbha region. These cases admitted in unconscious state with 8-10 days history of fever, body ache, cough, and progressive breathlessness. The diagnosis in both cases was based on presence of eschar, a positive Weil-Felix test, and a positive rapid diagnostic test (immunochromatographic assay). Both cases were complicated by acute respiratory distress syndrome (ARDS) and multiorgan failure. Both of them presented in their 2nd week of illness and died during the hospital course in spite of intensive supportive care. The main cause of mortality was delayed referral leading to delay in diagnosis and treatment.

Guillain-Barre syndrome complicated by acute fatal rhabdomyolysis.

Guillain-Barre syndrome (GBS) is a heterogenous group of peripheral-nerve disorders with similar clinical presentation characterized by acute, self-limited, progressive, bilateral and relatively symmetric ascending flaccid paralysis, which peaks in 2-4 weeks and then subsides. The usual complications, which occur in a patient of GBS are pneumonia, sepsis, pulmonary embolism, respiratory insufficiency and cardiac arrest. The clinical course of GBS complicated by acute rhabdomyolysis is extremely rare. We present the case of GBS with marked elevation in serum creatine kinase, serum myoglobin levels and persistent hyperkalemia as a result of associated acute rhabdomyolysis.

Magnitude and determinants of depression in acute stroke patients admitted in a rural tertiary care hospital

Background: Depression is one of the most frequent neuropsychiatric disturbances after a cerebrovascular stroke. The frequency of depression in stroke patients has varied widely in different populations. Post stroke depression is an important factor limiting recovery and rehabilitation in acute stroke patients. Settings and Design: A cross-sectional hospital-based study was performed in acute stroke patients admitted in the department of Medicine of a rural teaching tertiary care hospital in central India. Materials and Methods: In all consecutive acute stroke inpatients, the intensity of depression was assessed by a trained person through a questionnaire, Montgomery-Asberg Depression Rating Scale (MADRS), who is blind of the diagnosis and investigations of the patient. Another study person collected the data including demographics, co-morbid diseases or risk factors. Radiological imaging data was noted from the CT/MRI head reports of stroke patients. Results: Of the total 107 stroke patients, 60 (56%) were males and 47 (44%) were females. Sixty-one (57%) of the 107 stroke patients had depression. Of the 107 stroke patients, 35 (33%) had mild depression, 22 (20%) had moderate depression and 4 (4%) had severe depression. The age, gender, education status and co-morbidities of the stroke patient were not associated with depression. The association of socio-economic status and left-sided lesions with depression was found to be statistically significant (P < 0.05). Type and location of the lesion were not associated with depression. Conclusion: Post-stroke depression was present in more than half of the stroke patients and was related to socio-economic status and left-sided hemisphere lesions.

Herpes zoster encephalitis presenting as multiple cerebral hemorrhages – a rare presentation: a case report

IntroductionAn infection by herpes zoster virus is a common and important cause of encephalitis. Herpes zoster virus encephalitis if not treated promptly can result in significant morbidity and mortality. The diagnosis of herpes zoster virus encephalitis is based on clinical history, examination, neuroradiological imaging (magnetic resonance imaging and/or computed tomography scan), cerebrospinal fluid analysis and identification of the pathogen in cerebrospinal fluid by polymerase chain reaction amplification and/or anti-herpes zoster virus immunoglobulin G antibody in cerebrospinal fluid. Although ischemic intracerebral infarcts in patients with herpes zoster virus encephalitis or vasculopathy are reported in the literature, multiple intracerebral hemorrhages as a complication of herpes zoster virus encephalitis in an immunocompetent individual are extremely rare.Case presentationA 40-year-old Indian man presented with an acute history of four episodes of seizures, fever, headache, drowsiness, focal neurological deficits and vesicular eruptions over the abdomen in a typical dermatomal distribution. His head computed tomography scan revealed multiple cerebral hemorrhages. Investigations (positive ratio between the cerebrospinal fluid/serum quotients for anti-herpes zoster virus immunoglobulin G and total immunoglobulin G antibodies) established its infective origin due to herpes zoster virus. He developed bilateral pneumonia during the hospital course. He had an excellent recovery following a 2 weeks’ course of intravenous acyclovir.ConclusionHerpes zoster virus encephalitis or vasculopathy is a rare cause of multiple intracerebral hemorrhages and must be considered in the differential diagnosis of patients presenting with an acute history of fever, altered consciousness, and focal neurologic deficits with history of a typical herpetic rash. Its prompt recognition and treatment could alter the course of illness.

Catatonia as a first presentation of systemic lupus erythematosus: A case report

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease characterized by multisystemic involvement. Neuropsychiatric manifestations are found in 50-70% of SLE patients. These manifestations include mild cognitive dysfunction, mood disorders, headache, depression, anxiety, seizures, psychosis, acute confusional states, and delirium, to life-threatening coma. Psychiatric symptoms as an initial presentation of SLE are rare and difficult to diagnose. We present the case of a 23-year-old woman, who developed the catatonic syndrome for the first time during hospitalization for lower respiratory tract infection, and she was eventually diagnosed with SLE. Her catatonia responded well to oral corticosteroids, lorazepam, risperidone, and modafinil. This case illustrates the importance of considering medical causes (SLE) in the diagnosis and treatment of the catatonic syndrome. The recognition of SLE as a cause of catatonia is essential for its optimal management.

Acute Myocardial Infarction with Left Ventricular Failure as an Initial Presentation of Takayasu's Arteritis.

Takayasus Arteritis (TA) is an uncommon chronic inflammatory and stenotic disease of medium and large-sized arteries characterized by a strong predilection for the aortic arch and its major branches. We report a rare manifestation of TA in a 16-year-old female with no previous history of heart disease who presented with heart failure. She was found to have hypertension and discrepancies of pulses in upper and lower limbs. She developed ST elevated anterior wall myocardial infarction (MI) during hospitalization. Her aortography revealed narrowing of descending thoracic, upper abdominal and infrarenal aorta with significant stenosis of both renal arteries. She was diagnosed as a case of TA on the basis of her clinical profile and arteriography. Her coronary angiography did not reveal any stenosis or occlusion or aneurysm in coronary arteries or at coronary ostia which is in contrast to patients of TA with MI reported in the literature who had focal or diffuse stenosis or aneurysm in the coronaries.

Acute myeloid leukemia presenting as polyserositis and leukemia cutis

Acute leukemia generally present with nonspecific symptoms such as fatigue, weakness, malaise, anorexia, weight loss, fever, bone pains, bruising, or bleeding that begin gradually and are the consequence of associated cytopenias. Polyserositis with predominant pericardial effusion clinically manifested as heart failure as the presenting feature of acute myeloid leukemias (AMLs) has been rarely described. In this report, we describe a case of a 21-year-old male, who presented with symptomatic serositis and leukemia cutis and was subsequently diagnosed as AML-myelomonocytic type (AML-M4).

Thrombocytopenia and hemorrhagic pleural effusion as an initial presentation of polycythemia vera

Polycythemia vera (PV) is a chronic myeloproliferative disorder in which there is an alteration in the pluripotent progenitor cell leading to excessive clonal proliferation of erythroid, myeloid and megakaryocytic progenitor cells. The natural history of PV can be divided into several stages, beginning with asymptomatic, isolated erythrocytosis, progressing to more generalized myeloid proliferation, splenomegaly, and thrombosis, followed by myelofibrosis, leukoerythroblastosis, cytopenia, and myeloid metaplasia and sometimes, acute leukemia. Isolated erythrocytosis, leukocytosis, or thrombocytosis or in combination are usually present at the onset of disease. We present the case of a 65-year-old man, who developed thrombocytopenia and hemorrhagic pleural effusion as an initial presentation of PV that is extremely rare.

Acute hypopituitarism - a rare complication of vasculotoxic snake bite: A case report

Venomous snake bite is an important public health hazard in tropical countries including India. Vasculotoxic snake bites are well known to cause local cellulitis, local tissue necrosis, bleeding manifestations, disseminated intravascular coagulation (DIC), acute kidney injury (AKI), shock, cardiac arrhythmia, neurotoxicity, coma, and death. We present the case of a 30-year-old female who was bitten by a Russell′s viper snake and complicated by AKI, DIC, and acute hypopituitarism during her hospital course. Acute hypopituitarism as a complication of snake bite is a rare entity.