Covid-19 induced optic neuritis – A case report

COVID-19 illness is an evolving disorder, and many extrapulmonary manifestations have been reported. With this report, we are highlighting one of the neuro-ophthalmologic complications of Covid-19. We report a case of 16 years old boy who presented with complaints of rapid loss of vision and retroorbital pain in the Right eye during recovery from Covid -19 infection. Clinically, radiologically, CSF, Blood, and all other investigations suggest Probable Covid -19 Right Eye Optic Neuritis. The patient showed remarkable recovery following steroid therapy. This report aims to add a case to the limited literature available on Optic Neuritis following Covid-19 infection.

Severe ataxia uncovered Hodgkin’s lymphoma: do not forget CT neck when looking for covert malignancy

A 53-year-old woman without medical problems presented with 5-month history of dizziness, difficulty speaking, severe ataxia, which worsened a day before admission to inability to stand unsupported. An extensive workup was initiated to find the cause of ataxia. The laboratory investigations and imaging of the brain and whole spine revealed no lesions. She was found to have autoimmune thyroiditis, positive coeliac disease antibodies without clinical features and vitamin D deficiency. No intravenous steroids or immunosuppressive therapy was given. Cerebrospinal fluid showed lymphocytic pleocytosis. The workup for the cause of severe ataxia revealed an oropharyngeal lesion with cervical lymph nodes, and the biopsy showed classical Hodgkin’s lymphoma of mixed cellularity. She was treated with chemotherapy followed by radiation therapy and made a remarkable recovery, and currently, she is in remission without distant metastases, 5 years after the initial diagnosis. Her neurological status improved, and she remained with mild ataxia.

Ayurvedic Management of Pakshaghata (Left Hemiplegia) – A Case study

Hemiplegia is the commonest manifestation of a Stroke with neurological deficit affecting the face, limbs and trunk on one side or either side of the body. Stroke is one of the leading causes of death and disability in India. The aggravated Vata paralyze one side of the body either right or left , leads to immobility is called as Pakshaghata. The present case study deals with a 63years old male patient with chief complaints weakness in left half of the body and was unable to walk. He was a diagnosed case of Haemorrhagic Stroke presenting with Left Sided Hemiplegia with Acute Intraparenchymal Haemorrhage in C.T. brain. The Ayurvedic diagnosis of Pakshaghata was made and managed with treatment principle which is mentioned by Acharya Charaka. Snehana, Swedana and Mridu Virechana along with Panchakarma procedures Shirodhara, Shiropichu and Basti for 21 days. Samshamana Aushadhis(Oral medicines) and Physiotherapy were adopted at various stages of the diseases. Maximum improvement was noticed in upper and lower extremity functions at the end of the treatment. Patient showed remarkable recovery in Speech ability and Mobility. Panchakarma is a minimal invasive Bio-Cleansing procedure which can be adopted in life style, metabolic, autoimmune diseases and also periodic healthy individual as preventive measures.

Recovery of Severe Dialysis Disequilibrium Syndrome with Uncal Herniation Following Therapy with Mannitol, Hyperventilation and Hypertonic Saline

Dialysis disequilibrium syndrome (DDS) is a rare complication of dialysis, especially with the general application of preventive strategies. Severe DDS with brain herniation is believed to be fatal. We present a patient presenting with bilateral uncal herniation after receiving two dialysis sessions with low-efficiency settings. The serial brain magnetic resonance imaging studies showed the temporal evolution of DDS-induced cerebral edema. With aggressive treatment of hypertonic saline and mannitol, the patient made a remarkable recovery. This case highlights that we should be cautious about this severe complication of dialysis even with preventive strategies, and recovery is possible with prompt recognition and treatment.

A case report of tuberculous constrictive pericarditis necessitating total pericardiectomy

Background Constrictive pericarditis (CP) is one of the most serious sequelae of tuberculous pericarditis, which is characterized by heart constriction secondary to intense pericardial inflammation and thickening. Several invasive and non-invasive diagnostic modalities are crucial to address the challenges of confirming the diagnosis of CP and to expedite timely intervention. Case summary This study reports the case of a Bahraini male with tuberculous lymphadenitis diagnosed with CP as a result of various evaluations. The patient underwent urgent total pericardiectomy and showed remarkable recovery with complete resolution of heart failure symptoms. Discussion This case demonstrates the paramount importance of early diagnosis and treatment for patients with CP. In this unique case, the acoustic windows on echocardiography were suboptimal because of pericardial thickening. Further, computed tomography did not show significant calcification of the thickened pericardium. A novel approach of assessing haemodynamics through the right antecubital vein and right radial artery facilitated the accurate diagnosis of CP with confidence. Thereafter, successful pericardiectomy revealed a markedly thickened and stiff pericardium with many abscesses and dense adhesions encasing the heart, and pericardial biopsy showed large caseating granulomas. This case exemplifies the difficulty in diagnosing CP and the favourable outcomes achieved with well-timed surgical intervention.

Unravelling the Role of Glomus mosseae in the Alleviation of Salinity Stress in Mungbean [Vigna radiata (L.) Wilczek]

Background: Salinity stress remains a chronic threat to pulses productivity in India. Arbuscular mycorrhizal (AM) fungi play a major role which influences plant growth, nutrient uptake and contributes to ecosystem processes under salt stress. The present study aims, to demonstrate the impact of Glomus mosseae (Gm), on physio-biochemical attributes of mungbean exposed to salinity. Methods: Two highly tolerant, two moderately susceptible and two highly susceptible mungbean lines were subjected to salinity stress alone and in presence of Gm under greenhouse. Result: Results revealed that Gm alleviates the salinity stress related alterations by improving the nutrient uptake and by balancing the ratio between K:Na, which impact directly the osmoregulation of the plants. Mycorrhiza inoculation also increased the proline content (23%), water-use efficiency (38%) and activity of different antioxidant enzymes in a significant manner providing efficient protection against salinity stress. All these positive impacts of Gm were duly reflected in a significant increase in grain yield (more than 2 fold increase) in mungbean. Interestingly, salt-induced retarded growth and decline in other biochemical parameters in susceptible lines recorded remarkable recovery following Gm inoculation.

COVID-19-related diffuse leukoencephalopathy with microbleeds and persistent coma: a case report with good clinical outcome

A 60-year-old patient presented with respiratory distress, after recently being tested COVID-19 positive and was mechanically ventilated for 15 days. After cessation of sedation, he remained in deep comatose state, without any reaction on pain stimuli (Glasgow Coma Score 3). MRI of the brain showed diffuse leukoencephalopathy and multiple (>50) microbleeds. Diffuse COVID-19-associated leukoencephalopathy with microhaemorrhages is associated with a poor prognosis. However, 3 months later, our patient showed a remarkable recovery and was able to walk independently. This case report shows COVID-related leukoencephalopathy and intracerebral microbleeds, even with persistent comatose state, may have a favourable clinical outcome and prolonged treatment should be considered in individual cases.

IgA Nephropathy in a Patient Treated with Adalimumab

Immunoglobulin A (IgA) nephropathy (IgAN) is the most common glomerulonephritis worldwide, characterized by IgA deposits in the glomerular mesangium. It has a progressive nature and can eventually lead to end-stage kidney failure. It can occur as a potential side effect of treatment with tumor necrosis factor alpha antagonist that has been used for numerous chronic inflammatory conditions, such as Crohn’s disease. In this study, the case of a 33-year-old man with renal dysfunction, nephrotic proteinuria, and erythrocyturia is described. He had had a history of Crohn’s disease for 8 years and had been treated with adalimumab for the past 7 years. The diagnosis of IgAN was confirmed by kidney biopsy. After discontinuance of adalimumab and the induction of corticosteroid therapy, he made a remarkable recovery. Four years after the first presentation of IgAN and discontinuation of adalimumab, his renal function was normal with no proteinuria and only mild erythrocyturia.

Neuropsychiatric Derangement by Polycythemia Vera: A Case Report of an Unexpected Disease Presentation and Review of the Literature

Cerebral infarction as well as other thromboses, headaches, and visual complaints are well-known symptoms of polycythemia vera. However, chorea and neuropsychiatric disturbances are less recognized consequences of this chronic disease. Whereas chorea is a rare but acknowledged symptom of polycythemia vera, neuropsychiatric symptoms have only sporadically been reported. We depict 2 patients with an unusual presentation of polycythemia vera. Our first patient presented with right-sided hemiballism and psychosis, and the second patient had a long diagnostic trajectory of unexplained chorea. In both cases diagnosis of JAK2 positive polycythemia vera was established, and in both cases remarkable recovery occurred after the initiation of phlebotomies. The underlying pathophysiology of these symptoms has not been clearly elucidated. Because of the unfamiliarity of the link between especially neuropsychiatric symptoms and polycythemia, current reported numbers are probably an underestimation. Benefit of treatment appears to be large. We seek to create more awareness among physicians about this phenomenon.

Graves disease in infancy: a patient presentation and literature review

Summary We describe a case of an infant who presented with clinical features of hyperthyroidism. The child was found to be tachycardic, hypertensive and diaphoretic, she was noted to have poor weight gain and difficulty in sleeping. The child was admitted to the pediatric intensive care unit for care. She was found to have biochemical evidence of hyperthyroidism with positive thyroid stimulating immunoglobulin. She responded well to methimazole and propranolol and had a remarkable recovery. She is the youngest patient to be diagnosed with Graves disease in the English literature, at 12 months of life. Learning points Hyperthyroidism must always be considered even at very young age, for patient presenting with poor weight gain and hyperdynamic state. Autoimmune diseases are becoming more common in infancy. Craniosynostosis and increased height for age are well-documented consequences of untreated hyperthyroidism in developing children.