Neuroleptic malignant syndrome (NMS) is a rare, life-threatening but potentially treatable condition. This study was performed to investigate the clinical spectrum, antecedent events and outcome of NMS patients admitted in the Neurology department of a large teaching hospital of North India. Fourteen cases of NMS were taken after a thorough search during a three-year period (May 2000 to April 2003). The Incidence of NMS was 1.40/ 1000 patients treated with neuroleptics and mortality rate was 14.28%. Amongst the neuroleptics Haloperidol (parenteral) was implicated as a most common drug for NMS in 57% of patients. An association with coexisting precipitating illness was clearly recorded in 71.4% patients. All the recorded patients of NMS received 500-700 mg CPZ equivalent/day of neuroleptics. NMS as an indiosyncratic phenomenon was noticed in 28% patients. 85.7% responded to dopaminergic drugs along with supportive treatment and showed partial or complete recovery within 7-14 days. In those with partial recovery residual deficits included Parkinsonian features, depression and diaphoresis in a small percentage of patients.
Simultaneous or sequential involvement of lungs is frequently encountered with neurological syndromes like meningoencephalitis, cerebellitis, aseptic meningitis, transverse myelitis, or multiple cranial nerve palsies. However, pulmonary involvement is frequently overlooked when all the attention of physician is diverted to neurological disorder. Prompt and early recognition of such potentially treatable association is required to improve diagnostic and therapeutic outcome. We report six patients presenting with various neurological manifestations like meningitis, meningoencephalitis, and myelits associated with atypical pneumonia. With proper clinical correlation and relevant investigations, all of them were diagnosed in time and had remarkable recovery with appropriate treatment.
Granular cell ameloblastoma is a rare variant, accounting for 1-5% (3.5%) of ameloblastomas. It has clinical behavior similar to other subtypes, and show high tendency to recur on conservative surgical approaches. It can also show metastasis, hence the treatment plan should include regular follow up of the patients, after radical surgery. Here we are presenting a case report of granular cell ameloblastoma occurring in a 45 years old male patient clinically, the lesion was occurring in the left posterior mandible creating soap bubble appearance on radiography. Histopathologically, granular cell changes were prominent. The granular appearance is due to lysosomal aggregation and their presence indicates degenerative change or related to aging phenomenon rather than aggressiveness. The lesion was treated by surgical resection and a period of 3 years follow up showed no recurrence.
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