Multiple sclerosis is a chronic inflammatory disease of central nervous system that commonly affects young adults. Although ocular movement disturbances are commonly encountered in multiple sclerosis, bilateral horizontal gaze palsy is quite rare. We present a case of young woman presented with dizziness, intractable vomiting and visual disturbances for one week, on examination found to have complete bilateral horizontal gaze palsy while vertical gaze was intact. Brain MRI showed a small lesion in posterior part of medial pontine tegmentum bilaterally which was responsible for patient`s symptoms. She received five doses of one-gram methylprednisolone, her symptoms gradually improved over one week after treatment.
Ischemic stroke has been one of the major reason for morbidity and mortality all over the world. Anticoagulation treatment in patients with cerebral ischemic events caused by cardiac emboli is no longer a matter of debate. The problem is when to start. Because of a recurrence rate of 15 to 20% in the first few weeks after the initial event, direct anticoagulation by means of intravenous heparin followed by oral anticoagulants seems to be indicated. We are presenting 2 cases of patients who suffered cardio-embolic stroke due to cardiac thrombosis and had a therapeutic dilemma on when to start the anticoagulation treatment. Early anticoagulation treatment was associated with good clinical and neurological outcome. Keywords: anticoagulation; stroke; cardiac thrombus; cardio-embolic stroke; hemorrhagic stroke; warfarin.
Thrombotic thrombocytopenic purpura is a medical emergency with varied clinical manifestations. TTP is a rare condition, but one that carries a high mortality. High index of suspicion with careful evaluation of thrombocytopenia and hemolytic anemia is of paramount importance. Symptoms result from microthrombi affecting microcirculation and can be varied depending on the organs involved. Laboratory parameters of microangiopathic hemolytic anemia i.e. schitocytosis and increased LDH and indirect hyperbilirubinemia support the diagnosis. Plasma exchange is the treatment of choice. Other modalities that may provide therapeutic benefit in cases of relapsing TTP or in patients with slow or partial response to plasma exchange include vincristine and rituximab. Splenectomy done in remission may decrease recurrence in patients with relapsing TTP.
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