Dementia is a mental health disorder of global public health concern. The syndrome of dementia may be caused by various underlying diseases, each characterized by a specific constellation of signs and symptoms in combination with a presumed underlying substrate of neuropathology. Behavioral and psychological symptoms are integral part of dementia. They increase morbidity, influence quality of life and are major source of care giver burden. To be effective, dementia care need to focus on the early detection of BPSD and its management. The spectrum of behavioral and psychological symptoms in different each types of dementia are different and they should be managed accordingly to relieve care giver burden.
An attempt has been made to define clinically recognizable forms of cardiogenic shock. ‘Vasoreactive’ shock, characterized by a cold and sweaty skin, oliguria and moderate to gross mental dysfunction, was managed by reducing the vascular resistance with phenoxybenzamine. ‘Vasolytic’ shock, suggested by a grey or flushed facies, slightly reduced urinary output, and mild to moderate mental impairment, was treated with aramine. Patients with clinical features between these two extremes (‘intermediate’ group) were initially treated according to the most prominent clinical features. Further management was based on the assessment of easily measurable parameters such as central venous pressure, acid-base status, arterial pressure, temperature, etc. The mortality rate of the entire group of 31 patients was 42%.
Wilson’s disease is an autosomal recessive inborn error of copper metabolism characterized by inability of the liver to excrete copper into the bile, with excessive deposition of copper primarily in the liver and in the brain. To report a very rare acute presentation with rapidly progressive disease with some atypical imaging finding. Wilson’s disease was diagnosed on the basis of typical clinical picture, laboratory biochemical analysis and typical imaging finding. Apart from typical findings there were some atypical and rare findings which is the purpose of reporting these are a) very rare acute presentation and very rapid progression. b) Atypical Cerebral cortical enhancing lesion in both magnetic resonance imaging and computerized tomography scan with hyperintensity in diffusion weighted imaging in the corresponding areas. Aggressive presentation might be due to rapid accumulation of copper in the brain leading to cytotoxic edema in the accumulated area.
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