Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder of motor neurons. Spread of pathology to other brain areas leads to development of non-motor symptoms (NMSs). These usually remain undiagnosed because of overwhelming motor problem and are responsible for significant distress to the patient. Our objective was to explore the burden of various NMSs of patients with ALS, compare between limb-onset and bulbar-onset patients, and to correlate with severity and duration of disease. Methods: Fifty patients with ALS diagnosed according to revised El Escorial Criteria and 50 healthy controls were included in this study. They were assessed with NMS Questionnaire, Beck's Depression Inventory, Center for Neurologic Study-Lability Scale, Drooling Frequency and Severity Scale, Epworth Sleepiness scale, Bengali Mental State Examination, and Frontal Assessment Battery and relevant statistical analyses were carried out. Results: The patients with ALS had significantly increased prevalence of almost all NMSs compared to controls. There was also significant increase in depression, suicidal ideation, pseudobulbar affect, and daytime sleepiness in patients with ALS. The bulbar onset subgroup had significantly increased daytime drooling, dysphagia, nausea and vomiting, whereas the limb onset subgroup reported increased frequency of leg swelling. Executive dysfunction was detected in 24% of patients with ALS and 9.8% had mild cognitive impairment. Weight loss, frequency of falling, insomnia, unpleasant nocturnal leg sensations, difficulty having sex, depression, and cognitive impairment increased significantly with an increase in severity of the disease. Conclusion: NMSs were significantly more prevalent in patients with ALS. Some NMSs worsened with advancement of the disease.
Background: There are several methods for obtaining samples in patients of lung tumors, of which bronchoscopic biopsy is the most common. In most of Indian scenario, however, histopathology diagnosis is time taking. Aims and Objectives: To evaluate imprint cytology as a tool for rapid diagnosis of lung carcinoma and its histopathological correlation. Study Type: Prospective study on accuracy of a diagnostic test. Materials and Methods: A total of 175 cases were included in the study, and all of them were subjected to brochoscopic biopsy. Imprint smears were prepared from all the bronchoscopy specimens obtained from 175 cases. Imprint smears were stained with Leishman-Giemsa cocktail and Pap stain, and histopathology sections were stained with hematoxlin and eosin. Histopathological findings were confirmed by immunohistochemistry. Results: Sensitivity and specificity of imprint cytology was 84.9% and 72.4%, respectively when compared to histopathology as standard. Conclusion: Imprint cytology can be used as a preliminary tool for diagnosis in lung tumor bronchoscopic biopsies.
Background: Abnormal involuntary movement of paralyzed upper limb during yawning is a rare phenomenon termed as parakinesia brachialis oscitans. Case Report:We describe a 59-year-old gentleman with abnormal involuntary movement of paralyzed right upper limb during yawning 2 weeks following ischemic stroke of left middle cerebral artery territory.Discussion: This is a rare post-stroke phenomenon and its pathophysiological mechanism is poorly understood but this entity highlights possible preserved extrapyramidal pathway which might help in rehabilitating stroke survivors.
Skin Involvement is seen in nearly 76 per cent of Systemic lupus erythematosus (SLE) patients, but bullous lesion however accounts for less than one per cent of cutaneous manifestation of lupus erythematosus. A 21-year-old female presented with fever, polyarthalgia and vesicobullous skin lesion and acute renal failure. Clinico-pathological evaluation imparted that she was having bullous systemic lupus erythematosus (BSLE) with lupus nephritis. She was put on rituximab after initial resuscitation. She responded dramatically with resolution of skin lesion and recovery from acute renal failure. She was followed up for one year without complication with stable disease course.
Background Neurocysticercosis is the most common parasitic infection of the central nervous system, brain being the most frequent site. Intramedullary location of cysticercus is a rarely described entity in literature. Widespread dissemination of cysticercus is also considered a rare occurrence, and only a handful of cases are documented, almost exclusively from tropical nations. Here we present a case of disseminated cysticercosis with rare initial presentation as acute dorsal myelopathy resulting from intramedullary cysticercus. Case presentation A 62-year-old male patient from India (Asian) presented with features of dorsal myelopathy as manifested by acute-onset symmetric paraparesis, sensory loss below umbilicus, and double sphincter dysfunction. General physical examination revealed pea-sized nodules in skin and tongue. On spinal cord imaging, it was found that he had intramedullary cysticercus with diffuse perilesional edema. Brain and muscle imaging showed extensive cysticercosis suggestive of dissemination. Histological examination from skin nodule and antibody assay confirmed the diagnosis of cysticercosis. Following steroid administration, our patient showed improvement with observable increase in power of the lower limbs. He was subsequently discharged with antiepileptics, symptomatic therapy, and regular physiotherapy. Antihelminthic agents were initially avoided in view of extensive cysticercosis in brain including crucial areas such as brainstem. Conclusion Rare manifestation of a rare but treatable disorder makes it an important reportable observation in the context of tropical medicine.
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