The study aimed to develop the Tamil (Sri Lanka) version of the Montreal Cognitive Assessment (MoCA) and investigate its reliability and validity as a briefscreening tool for mild cognitive impairment (MCI). Tamil-speaking Sri Lankan elderly with normal cognition and MCI were recruited from a neurology clinic.Adaptation of the English MoCA to the Tamil (Sri Lanka) involved context-specific content modification and translation. The content validity, reliability, sensitivity,and specificity of the tool were evaluated. Study participants were 184 older adults, comprising 85 with normal cognition and 99 neurologist-diagnosed MCI.The tool had high internal consistency (Cronbach's alpha = 0.83). Receiver operating characteristic curve analyses showed an area under the curve of 0.87(95% CI = 0.83 - 0.91) for detecting MCI. The optimal cut-off score for detection of MCI was 23/24, yielded a sensitivity and specificity of 84.7% and 76.4%,respectively. The Tamil (Sri Lankan) version of the MoCA maintains its core diagnostic properties rendering it a valid and reliable tool for screening of MCIamong Tamil speaking Sri Lankan older adults.
Idiopathic hypertrophic pachymeningitis (IHP) is a chronic progressive diffuse inflammatory fibrosis of the dura-mater, leading to its diffuse enlargement. The following describes a case of IHP presenting with a superficial soft tissue mass. A 40-year-old female came to hospital with a subcutaneous lump over the left face and frontal headache for 6 months. An excision biopsy revealed chronic inflammation. Magnetic resonance imaging (MRI) of the brain showed left mastoiditis and early dural inflammation of the left temporal region. A few months later, she developed diplopia, complex partial seizures, and retrobulbar neuritis of the left optic nerve. Repeat MRI brain demonstrated meningeal thickening on both sides of the tentorium cerebelli extending to the left tempero-parietal meninges. The meningeal biopsy revealed markedly thickened fibro-connective dural tissue with infiltration of chronic inflammatory cells. There was no evidence of bacterial, fungal, tuberculous or neoplastic infiltration. IHP was diagnosed and steroid therapy initiated. Within weeks, she showed marked clinical improvement. IHP is a diagnosis of exclusion. The absence of underlying infective, neoplastic, or systemic autoimmune disease favors IHP. The above patient had headache, neuro-ophthalmic signs, seizures, which are features of IHP. However, superficial soft tissue involvement is rare.
A 33 year-old gentleman came with a progressive flaccid paraparesis, patchy hyperhidrosis and polyuria following an acute gastro enteritis, ultimately diagnosed
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