Sanjeev Jha

Dengue infection causing acute hypokalemic quadriparesis.

Dengue infection is endemic to India and an important public health problem. We report three confirmed cases of dengue infection with acute, pure motor, reversible quadriparesis due to hypokalemia. Clinicians should be aware of such an association and consider the clinical possibility in the differential diagnosis while evaluating acute quadriparesis in patients with dengue fever, especially in endemic areas.

Evaluation of cerebral infarction in tuberculous meningitis by diffusion weighted imaging.

BACKGROUND Ischemic complications are known to occur in tuberculous meningitis (TBM). They are usually seen in patients with TBM having a more severe disease. Diffusion weighted imaging (DWI) provides information regarding tissue ischemia at an early stage as compared to conventional magnetic resonance imaging (MRI). METHODS Ischemic complications in human immunodeficiency virus (HIV) negative TBM were evaluated using DWI and T2 weighted imaging in 30 patients in the present study. The imaging was performed at baseline within 7 days of admission and in case of any neurological deterioration during follow up. The outcome was assessed by the modified Barthels index at 1 year follow up. A score of >/=12 was taken as a poor outcome, while a score of <12 was considered as good outcome. RESULT Seventeen of these 30 patients had infarcts, and the total number of infarcts seen was 42. Thirty eight lesions were acute/sub acute and four were chronic infarcts. Out of the 38 acute/sub acute infarcts 34 were visible both on T2 weighted imaging and on DWI, while four were seen only on DWI. The volume of infarcts as seen by DWI was significantly larger as compared to conventional T2 weighted imaging (p = 0.019). Six patients had a poor outcome, five from the infarct group and one from the non-infarct group. CONCLUSION DWI demonstrates a larger area of infarction and may also be useful in the early detection of infarction. It should be used as an additional sequence along with conventional imaging in patients with TBM while they are on a follow up on anti tuberculous treatment. The information obtained by DWI may be of value in explaining the clinical condition of the patient as well as in the management and prognostication.

Lymphocyte transformation test: a new method for diagnosis of neurocysticercosis

Neurocysticercosis (NCC) is the commonest parasitic disease of the central nervous system. Neuroimaging tools are considered gold standard for the diagnosis of NCC, but its availability is restricted in developing countries. So, there is a definite need for reliable immunodiagnostic tool. The aim of the present study was to evaluate cyst fluid antigen-based lymphocyte transformation test (LTT) as a diagnostic tool for NCC. Tissue culture plates (96 wells) were coated with cyst fluid having protein concentration of 20 mug/well. Freshly isolated lymphocytes from 48 symptomatic NCC cases, 39 matched disease controls, and 40 healthy volunteers were seeded at a concentration of 1 x 10(6) cells/well. LTT was performed as per standard guidelines and (3)H-thymidine was used to measure cell proliferation. The cutoff stimulation index (SI) was defined as mean of controls +2 SD. The mean SI of the cell proliferation for NCC cases was significantly higher than controls (5.83 versus 1.29, P < 0.001). The sensitivity and specificity of LTT for diagnosis of NCC were 93.8% and 96.2%, respectively. The study shows that LTT can be used as an immunodiagnostic tool for NCC; however, it needs to be validated in other endemic areas.

MRI features of toxoplasma encephalitis in the immunocompetent host: a report of two cases.

Abstract. Central nervous system involvement due to toxoplasmosis in an immunocompetent host is rare. We describe MRI features in two immunocompetent patients with of cerebral toxoplasmosis and compare these with those for the immunocompromised host.

Transverse myelitis following spinal anesthesia

Spinal anesthesia is widely used during surgical procedures. It is generally safe and the frequency of severe, permanent neurological complications associated with it has been reported to be extremely low. We report a patient, who developed paraplegia following spinal anesthesia. A 29-year-old male was referred with acute, flaccid, sensory motor paraplegia, with bladder and bowel involvement. He developed this immediately after an operation for inguinal hernia under spinal anesthesia. Spinal magnetic resonance imaging revealed hemorrhagic myelitis in the conus at D12. He was referred after he did not respond to intravenous methylprednisolone for 10 days. This case brings up the difficulty encountered in determination of the interspace used for spinal anesthesia and the potential for traumatic injury to the spinal cord. It also demonstrates the tragic outcome after a clinician violates some important, standard and established guidelines.

Tuberculous brain abscess in an immunocompetent adolescent.

Tuberculous brain abscess (TBA) is one of the rare forms of central nervous system tuberculosis. A case of tuberculous cerebellar abscess in a young immunocompetent adult male is being described. There was no clinical or radiological evidence of active tuberculosis elsewhere in the body. The diagnosis of tubercular abscess was confirmed by demonstration of acid fast bacilli in the abscess material aspirated via a burr hole. High index of suspicion and timely intervention is required to diagnose and treat this potential fatal but easily treatable condition.