Raghunandan Nadig

Abstract

Introduction: Two common causes of ring/disc enhancing lesions in CT scan or MRI scan of brain are Cysticercosis and tuberculoma. It is often difficult to know the cause in a patient with ring/disc lesions.The gold standard being tissue diagnosis, which is often not done or not practical due to procedural complications and most of these lesions carry a benign course. The present study was undertaken to test the sensitivity and specificity of CSF antibodies in Definitive cases of Neurocysticercosis and Tuberculoma. Materials and Methods: A Cross-sectional descriptive study was conducted with a sample size of 50 patients. The duration of study was for 2 years. Consecutive patients visiting the neurology department with complaints of seizures, headache and focal neurological deficit and their neuroimaging demonstrating a ring/disc enhancing lesions, suggesting either a Cysticercosis or Tuberculoma were included. Patients were subjected to a detail clinical history and examination. Complete hemogram, complete blood chemistry, HIV serology and Neuroimaging either MRI or CT brain were done. Lumbar puncture was done in all patients if there were no contraindications.CSF analysis for antibodies against antigens of cysticercosis and anti-tubercular antibodies were done. Antibody estimation is done by ELISA method. Results: There were 52 patients in the study of which 26 patients were diagnosed as Neurocysticercosis and 11 patients as Tuberculoma. In all 26 patients with Cysticercosis CSF was showing less than 4 cells with normal glucose and protein. Out of 11 patients with tuberculoma only one patient CSF study was abnormal.CSF Elisa for anticysticeral and antitubercular antibodies were done in all patients and were negative in all them. Conclusion: CSF ELISA test for anticysticercal antibody and anti tubercular antibody test has a low sensitivity and is not helpful in the diagnosis of ring enhancing lesions in the brain. Keywords: Neurocysticercosis, Tubeculoma, CSF Antibodies.

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Abstract

Introduction: Hypernatremia can cause encephalopathy, rhabdomyolysis, and osmotic demyelination. Postpartum hypernatremia is an uncommon occurrence. The present study attempts to highlight clinical and radiological profile of three patients who had postpartum hypernatremia and to provide differential diagnosis of magnetic resonance imaging findings of postpartum hypernatremia. Aim:To study clinical and radiological profile of three patients who had postpartum hypernatremia and to provide differential diagnosis of magnetic resonance imaging findings of postpartum hypernatremia. Material and Methods:The present study was conducted in a tertiary care centre in South India between March 2014 to March 2018. Three patients had hypernatremia presenting in postpartum period. Demographic data, clinical details, results of laboratory examinations and neuroimaging details of these patients were recorded. Result:All three patients had hypernatremia presenting with encephalopathy. Spasticity was seen in all patients. Quadriparesis was seen in two patients. One patient had generalized tonic clonic seizures. Two patients had hypokalemia. All the three patients had Hyperchloremia, Azotemia and raised serum osmolality. Phosphorous levels was high in one patient. Creatine kinase levels was high in one patient. All patients had hypermagnesemia and normal calcium levels. Thrombocytopenia was seen in one patient. On neuroimaging, splenium of corpus callosum, hippocampus and posterior limb of internal capsule were involved in all patients. Cerebral peduncles in two patients. Corona Radiata and cerebellar white matter were involved in one patient. Conclusion:Early identification and meticulous management of hypernatremia is of paramount importance. Neuroimaging Findings in postpartum hypernatremia is distinct. Keywords: Postpartum, Hypernatremia, Encephalopathy, Osmotic demyelination, rhabdomyolysis.

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