Shubhakaran Khichar

Malaria is associated with various forms of neurological complications. Weakness like paraparesis and quadriparesis is being described in malaria, the pathologies being polyneuropathy, hypokalaemia, hyperkalaemia, myelitis etc. Recurrent hypokalaemic paralysis has not been described to the best of my knowledge in malaria. I hereby describe a young patient with recurrent episodes of weakness due to hypokalaemia who on investigation was found to be because of malaria. The case report is being described because of it is being novel or not described earlier.   Keywords: Malaria, Hypokalaemia, Vivax, Falciparum

Guillain-Barré syndrome (GBS) can be described as a collection of clinical syndromes that manifests as an acute inflammatory polyradiculoneuropathy with resultant weakness and diminished reflexes. Regarding pathophysiology of GBS, it is believed that autoimmunity- molecular mimicry plays a role in its pathogenesis. As the vaccines have an effect on the immune system it is reasonable that immunizations may be associated with subsequent GBS. Although rabies vaccines containing neural elements are very well known cause for GBS, no such positive correlation has been proven after newer formulations of rabies vaccine, derived from chick embryo cells. Here we report a case of GBS which developed after 5 weeks of anti-rabies vaccination (Purified Vero cell rabies vaccine) which was given after dog bite.   Keywords: Guillain Barre Syndrome, Antirabies vaccine, Purified Vero cell rabies vaccine

A young male with ataxia since early childhood with Marfanoid features, normal intellect and no biochemical abnormality is reported. The syndrome has partial resemblance with previously described syndrome of arachnodactyle, cerebellar ataxia and other features, what has been named as "Bhaskar Syndrome". The documentation of such rare entities is worth for future research. Keywords: Marfanoid, Friedreich s ataxia, Babinski reflexes.

Autoimmune thyroiditis has been seen to be associated with other autoimmune neurological disorders. More over biopsy studies of patients with steroid responsive encephalopathy has shown that antithyroid antibodies (anti thyroid peroxidase-TPO antibodies) can lead to central nervous system demyelination. We are reporting two such cases. A 32 year female presented with longitudinally extensive transverse myelitis(LETM) with negative workup for other demyelinating and autoimmune diseases, and positive for anti TPO antibody. She was started with steroids and azathioprine and recovered completely over one month period, stopped treatment herself after 5 months, had relapse of myelitis and was put on immunosuppressive treatment, showing improvement. The second patient a 52 year female had recurrent attack of LETM with negative workup for other causes of LETM except positive anti TPO antibody. In her first attack she was given only steroids pulse. After relapse she was treated with steroids and cyclophosphamide pulse, and patient remained relapse free thereafter. So it suggests that in myelitis patients associated with anti TPO antibody steroids alone may not be sufficient and, such patients require long term immunosuppression. So anti TPO antibody may predict recurrence and may be considered an independent marker for relapsing disease though it require further studies. Keywords: Myelitis, Anti-TPO, antibodies, Recurrent myelitis, Longitudinally extensive transverse myelitis (LETM).

Objective: As there are wide differentials for longitudinally extensive transverse myelitis (LETM), its aetiology should be found to optimise therapy. Aims: Clinical profile of LETM. Settings and Design: ambispective observational study. Methods and Materials: 73 patients with acute to subacute myelitis involving 3 or more vertebral segments were properly investigated. Statistical analysis used: Student t test and Mann-whitney test used, and comparison of data done using SPSS version 22.0 Result: The etiology found were in form of neuromyelitis optica spectrum disorder (NMO-SD) in 18(24.6%), para-infectious in 13(17.8%), idiopathic in 17(23.2%), infectious in 9(12.3%), and rest were acute disseminated encephalomyelitis (ADEM), subacute combined degeneration (SACD), infarct, radiation myelitis etc. Conclusions: It is important to find etiology of LETM to optimise the therapy as the in inflammatory myelitis other than NMOSD, the line of management differs. Relapsing nature of some myelitides is an important aspect in management   Keywords: Longitudinally Extensive Transverse Myelitis, Neuro-myelitis Optica Spectrum Disorders, Acute disseminated encephalo-myelitis, Subacute combined degeneration