A fatal case of traumatic brain injury with severe coagulopathy due to Rhabdophis tigrinus (yamakagashi) bites: a case report

Background Yamakagashi venom is a prothrombin activator, leading to disseminated intravascular coagulation. We report a fatal case of severe coagulopathy from head trauma assumed to be caused by a yamakagashi bite. Case presentation An 80-year-old man fell and developed systemic tonic–clonic convulsions. Head computed tomography revealed brain contusion and acute subdural hematoma. Physical examination revealed two bite marks with persistent bleeding on the right lower leg. The patient stated that he had been bitten by some creature 3 days prior, but the bite was left untreated. Laboratory tests showed fibrinogen levels below the detection limit. Although eighteen units of fresh frozen plasma were administered for coagulopathy, fibrinogen levels did not improve. He died about 18 h after a head injury. Conclusion In this case of a yamakagashi bite with active bleeding due to trauma, early administration of yamakagashi antivenom should be considered to control coagulopathy.

Evaluation of Antiepileptic Activity of Flowers of Cocos nucifera L. Against Experimentally Induced Convulsions in Rats

The report used to be planned to analyze the antiepileptic activity of Cocos nucifera flowers against special experimentally induced convulsions in rats. In the present study, antiepileptic activity was assessed by following experimental models. Anti-convulsant in vivo models: Maximal electroshocks (MES) induced models in rats, Pentylenetetrazole (PTZ) induced in rats. Pretreatment of animals with Cocos nucifera flowers extract has reduced by half the general continuance of tonic hind leg extension, the most commonly used endpoint in assessing clonic convulsions. MES provokes repetitive neuronal firing indicates epileptic neurons. MES is the widely accepted model to demonstrate the antiepileptic property of a drug. This property is antagonistic of the plant extract could flow from to blockade of voltage-gated sodium channel or due to effect on NMDA receptors. The Cocos nucifera flowers extract was also demonstrated potential anticonvulsant activity in PTZ induced convulsions and this may be due to its agonistic activity on the GABAA receptor. This is further supported by an elevated level of GABA by the plant extract in the PTZ model. Methanolic extract of Cocos nucifera flowers has shown significant anticonvulsant activity against MES and Pentlylenetetrazole induced convulsion models. This observed activity could also be the referable presence of flavonoids and other phytochemical constituents found in the powerful extract. Keywords: Cocos nucifera, antiepileptic activity, Maximal electroshock, Pentlylenetetrazole, Flavonoids,

Bovine Cerebral Theileriosis: First Molecular Confirmed Report in Cross Bred Cattle Calf in India

Bovine tropical theileriosis caused by Theileria annulata, is a serious constraint to Indian dairy industry with more fatal infections in exotic cattle and substantial losses to cross-bred and indigenous zebu cattle. The present communication is to place on record the first report of molecular based confirmed case of cerebral theileriosis caused by T. annulata coupled with its morphological detection, clinical manifestations, haematological alterations and therapeutic management in a cross bred cattle calf from India. After preparation of peripheral thin blood smear from cross bred cattle calf at the site of collection and fixation with methanol, blood sample brought to Department of Veterinary Parasitology, College of Veterinary Science and A.H, Jabalpur and stained by standard protocol for Giemsa staining. Genomic DNA was isolated from the collected blood sample using QIAamp® DNA blood mini kit following the manufacturer’s recommendations and PCR was performed. The cross bred cow calf revealed high rise in temperature (105.5°F), increased heart rate, labored breathing with seromucous nasal discharge, enlargement of prescapular lymph node and animal exhibited tonic clonic convulsions in response to any sudden noise. Giemsa stained thin blood smear revealed intraerythrocytic piroplasm and Koch blue bodies of T. annulata within the cytoplasm of lymphocytes. The species of Theileria was confirmed by molecular amplification of genomic DNA as T. annulata.

Investigating the Anticonvulsant Properties of Aqueous Ethanolic Extracts of the Leaves, Roots, and Fruits of Jatropha gossypifolia L. (Euphorbiaceae)

Convulsion is a typical symptom associated with epilepsy. Jatropha gossypifolia, a common plant in Ghana, has been used traditionally for the management of epilepsy. This study was carried out to ascertain the scientific basis for the traditional utility of Jatropha gossypifolia for various convulsive disorders and also determine the part of the plant with the most anticonvulsant activity. The anticonvulsant activity of the leaf, root, and fruit extracts in doses of 30–300 mg/kg was assessed using the picrotoxin-induced seizure models in mice. The drugs and chemical preparations used included diazepam, picrotoxin, ethanol (70%), and normal saline. GraphPad Prism 6 was used for all statistical analysis and plotting of graphs. Data were analyzed using one-way ANOVA, followed by Bonferroni’s multiple comparison test. The leaf extract significantly and dose-independently reduced the frequency of myoclonic jerks ( P = 0.0001 ) and decreased the duration of clonic convulsions ( P = 0.019 ). The root extract also significantly and dose-dependently reduced the frequency of myoclonic jerks ( P = 0.001 ) but only decreased the frequency of tonic convulsions at 100 mg/kg ( P = 0.006 ). It also significantly decreased the duration of tonic convulsions ( P = 0.0001 ). The fruit extract only significantly and dose-independently reduced the frequency of myoclonic jerks ( P = 0.0001 ). It, however, showed an increase in the duration of both clonic and tonic convulsions. The study shows that the leaves and roots of Jatropha gossypifolia produce anticonvulsant activity which may be through enhancement of GABAergic transmission or activation of GABA receptors which support the traditional use of the plant to treat epileptic fits.

Anticonvulsant activity of methanolic extract of Withania cogulans in mice

Mental and neurological diseases including depression, Parkinson’s disease, dementia, epilepsy, anxiety disorders and bipolar disorders account for a considerable amount of the world’s disease burden. Unfortunately, drugs used in the treatment of neurological diseases are expensive, symptomatic and they produce undesirable side effects. People from different cultures prefer to use medicinal plants for the treatment of various ailments ranging from plain to perplex disorders because they are most affordable, cost effective and easily accessible source of treatment in the primary healthcare system throughout the world. Withania coagulans, an erect grayish under-shrub belongs to family Solanaceae. It is common in Pakistan, East India, Iran and Afghanistan. The objective of this study was to analyze the anti-seizure activity of crude methanolic extract of Withania coagulans fruits (MeWc). For screening of this activity, maximal electroshock seizures model (MES) and chemically-induced seizures models were used. In maximal electroshock seizures test MeWc showed significant dose dependent percent protection against hind-limb tonic extension; significant and dose-dependent increase in latency to myoclonic jerks and tonic clonic convulsions and decrease in seizures duration were observed in PTZ-induced seizures. In strychnine-induced convulsions MeWc significantly increased latency to hind-limb tonic extension and percent protection from death in a dose-dependent manner. Thus, it was inferred from the experiments that extract of Withania coagulans showed anticonvulsant activity.

A Fatal Case of Traumatic Brain Injury With Severe Coagulopathy Due to Rhabdophis Tigrinus (Yamakagashi) Bites, A Case Report

Background Yamakagashi venom is a prothrombin activator, leading to disseminated intravascular coagulation. We report a fatal case of severe coagulopathy from head trauma assumed to be caused by a yamakagashi bite. Case Presentation: An 80-year-old man fell and developed systemic tonic–clonic convulsions. Head computed tomography revealed brain contusion and acute subdural hematoma. Physical examination revealed two bite marks with persistent bleeding on the right lower leg. The patient stated that he had been bitten by some creature 3 days prior, but the bite was left untreated. Laboratory tests showed fibrinogen levels below the detection limit. Even though 18 units of fresh frozen plasma were administered for coagulopathy, fibrinogen levels did not improve. He died approximately 13 hours after admission. Conclusion In this case of a yamakagashi bite with active bleeding due to trauma, early administration of Yamakagashi antivenom should be considered to control coagulopathy.

Sarcomatoid hepatocellular carcinoma in a young African female

Sarcomatoid hepatocellular carcinoma is a rare primary malignant liver cancer. The pathogenesis is unclear; however, the risk factors may be similar to that of conventional hepatocellular carcinoma. We present an 18-year-old female who was admitted due to generalized tonic–clonic convulsions. On examination, we palpated a large non-tender mass in the right upper quadrant. An abdominal computed tomography identified it as hepatocellular carcinoma, and spindle-shaped cells were seen on histopathology. She was counseled on her prognosis but opted for local herbal medications rather than chemotherapy, but unfortunately passed away. We present a rare subtype of hepatocellular carcinoma in a young female which is commonly seen in males above the age of 50 years, and despite its grade and stage, overall survival is poor.

Maternal and fetal outcome in cases of eclampsia

Background: Eclampsia refers to occurrence of generalized tonic clonic convulsions (GTCS) followed by confusion or coma during pregnancy or puerperium in patients with preeclampsia excluding other neurological conditions. Purpose of this study was to evaluate the risk factors, management protocols and determine maternal and perinatal morbidity and mortality in patients of eclampsia.Methods: This is retrospective study of 180 cases of eclampsia carried out from June 2017 to December 2019 including all the antepartum, intrapartum and postpartum cases at tertiary care centre. Immediate management was focused to control the convulsion and lower the blood pressure followed by NST and USG foetus with Doppler study.Results: In this study, 72.2% cases reported antepartum eclampsia while 27.8% cases were postpartum and overall incidence was 0.91% of total deliveries conducted during the study period. Incidence was higher in primigravida (74.4%) and below 25 years age (68.8%). Magnesium sulphate was effective in 94.4% cases. Study reports 63 normal vaginal delivery, 5 assisted vaginal delivery, 110 caesarean section and 2 women expired undelivered. There were 10 maternal deaths.Conclusions: Time interval between eclamptic seizures and initiation of therapy is an important prognostic factor affecting maternal and perinatal outcome. Public awareness regarding the importance of regular antenatal visits can help in reducing chances of development of eclampsia. Even though various drugs and methods have been tried for the treatment of eclampsia, the definitive management is the delivery of foetus after control of convulsion, hypertension and should be managed at tertiary care hospital.

V.A.Muratov. To pathological physiology and differential diagnosis of cortical epilepsy. Medical Review. 1896, n ° 1

The author cites the history of the illness of one patient with manifestations of cortical epilepsy: convulsions began on the face, then passed on to the arm and leg, for the most part the seizure was limited to one left side. Left n. facialis was paralyzed; in the left extremities - paresis with reduced rigidity and increased tendon reflexes, while in the arms paresis and rigidity were almost the same, and rigidity prevailed in the legs. After the seizure, the paralysis intensified sharply. Some seizures were preceded by a motor aura: clonic convulsions in the paralyzed limbs. Left side sensitivity was decreased; muscle feeling weakened, stronger in the arms, less in the legs. The patient died of tuberculous pneumonia. When opened, found in the right hemisphere softening, which occupied the lower third of the posterior central gyrus. Gyrus marginalis in the anterior part was destroyed. The softening into the depths did not extend equally. In the rear part, it went quite deep; the radiant end in the supramargi nalis area is softened, the system of long connecting paths, apparently, is not affected; small focus in the superior parietal gyrus In the middle of the focus, destruction is limited to the cortex. In the front part, the softening was located under the cortical layer and reached the inner capsule. Deep-lying gray masses, corpus callosum and cingulum have survived from destruction. Microscopic examination showed extensive degeneration in connective and adhesive pathways; the descending rebirth was barely expressed and was found only in Marchi.

Absence-to-bilateral-tonic-clonic seizure

ObjectiveTo test the hypothesis that absence seizures can evolve to generalized tonic-clonic seizures, we documented electroclinical features of this novel seizure type.MethodsIn 4 large video-EEG databases, we identified recordings of seizures starting with impaired awareness that, without returning to baseline interictal state, evolved to generalized tonic-clonic seizures. We extracted the detailed semiologic and electrographic characteristics of these seizures, and we documented the clinical background, diagnoses, and therapeutic responses in these patients.ResultsWe identified 12 seizures from 12 patients. All seizures started with a period of impaired awareness and bursts of generalized spike or polyspike and slow-wave discharges, the hallmark of absence seizures. Without returning to baseline, the nonmotor (absence) phase was followed by tonic-clonic convulsions. We called this novel generalized seizure type absence-to-bilateral-tonic-clonic seizure. Most patients had idiopathic generalized epilepsies, although with a high incidence of unusual features and poor therapeutic response.ConclusionsAbsence-to-bilateral-tonic-clonic seizures are a novel generalized seizure type. Clinicians should be aware of this seizure for correctly diagnosing patients. This novel seizure type may further elucidate generalized ictogenesis.