Cerebral venous sinus thrombosis (CVST) is a rare form of brain stroke which is often misdiagnosed. We present a case of CVST due to cerebellar tuberculous abscess. A 41-year female patient was admitted with chronic occipital headache, diminished vision, and fever. The initial brain CT scan was negative, but subsequent imaging (MRI with MRV) showed cerebellar abscess with sigmoid sinus thrombosis. Fundoscopy revealed bilateral optic atrophy. Marked improvement (subjective and objective) was noted after 4 weeks with anti-tuberculosis chemotherapy and anticoagulants. Vision loss was irreversible due to optic atrophy. The case is extremely rare due to the location, rare causative organism (tuberculosis) and complex clinical presentation (occipital headache with vision loss).
Low back pain accounts for a large amount of loss of productivity in the workforce. When the low back pain extends into the lower limb along the distribution of a dermatome then radiculopathy is said to be present. Although most people experience back pain during their lifetime, only a fraction experience lumbosacral radiculopathy as a consequence of nerve root compression or irritation. Almost 5% males and 2.5% females experience lumbosacral radiculopathy at some time in their lifetime. Magnetic resonance imaging (MRI) is the preferred investigation for the diagnosis of lumbosacral radiculopathy. So, in the evaluation of a patient of lumbosacral radiculopathy is essential to correlate clinical symptoms and signs with the finding detected in the MRI to arrive at a correct diagnosis and arrange an appropriate management. So this study was done to see the correlation between clinical and MRI finding of radiculopathy at different nerve root level in patients with lumbosacral radiculopathy. It was a cross sectional descriptive study. All 40 patients of lumbosacral radiculopathy who were presented to Rajshahi Medical College Hospital during the study period from 01/11/2011 to 30/10/2012 were included in the study. There were 30 males and 10 females having an M: F ratio of 3:1. Mean age of total patients 43 + 14.74 years. 67.5% patients were between 20 to 50 years and 60% patients were performing heavy work. 67.5% patients had unilateral involvement while 32.6% patients had bilateral involvement. 72.5% patients had muscle weakness and 27.5% had no muscle weakness. 67.5% patients had sensory impairment and 32.5% had no sensory involvement. Knee jerk changes were present in 60% patients and ankle jerk changes in 66.66% patients. As expected 52.18% had L5 and 32.61% had S1 radiculopathy. The difference in clinical and MRI detection of root involvement was statistically significant (p value < 0.05) in both sides at L4, L5 and S1 root levels but there was no significant difference at the L3 root level (p value 1.00) Intervertebral disc herniation was the commonest cause of lumbosacral radiculopathy (72.32%) and second common cause was spinal canal stenosis (19.44%). Others are intervertebral disc budging (61.52%), disc protrusion (23.08%) and disc extrusion (15.38%). Correlation between clinical severity and MRI grading of lumbosacral radiculopathy which was statistically significant. So, it is concluded that clinical findings correlate well with MRI finding, but all MRI abnormalities need not have a clinical significanceTAJ 2015; 28(1): 32-39
Introduction and objectives: A large proportion of patients with coronary disease have metabolic syndrome. The purpose of this research was to assess the association between the metabolic syndrome (MetS) and acute myocardial infarction in female patients.Methods: This was a case control study. Patients with a first time cardiac event of acute myocardial infarction (AMI) arriving in coronary care unit of Rajshahi Medical College Hospital, Rajshahi, Bangladesh during the period June 2013 to July 2014 were included. Metabolic syndrome and its five components were defined according to criteria set by Adult Treatment Plan III (NCEP ATP III) criteria. Blood sugars, triglycerides, HDL-C were measured within 24hrs of cardiac insult. Hypertension was defined as blood pressure ≥ 130/≥85 mmHg. Abdominal obesity measured by waist circumference which is defined for Asia-Pacific region as ≥ 80 cm for women.Results: Total 103 female patients were evaluated. Mean age was 54.28 ±11.78 and acute myocardial infarction was more in age group 50-59 (34%). More than 60% patients suffering from acute myocardial infarction was age group 40-60 years. The metabolic syndrome was present in 74 (71.8%) female patients with acute myocardial infarction and was more frequent in women than in men (71.8% vs 37.9%, P<.001). The most prevalent component was low HDL-C (n 76; 73.8%), followed by fasting plasma glucose level (n 73; 70.9%).Conclusions: The metabolic syndrome has a high prevalence in female patients with acute myocardial infarction. The most frequent components are low HDL-C levels and fasting plasma glucose level.TAJ 2013; 26: 74-78
Posterior reversible encephalopathy syndrome (PRES) is a reversible phenomenon diagnosed with both clinical and radiological criteria. We present anatypical case of PRES with unusual delayed reversal. A 29-year-old female presented withseizure and altered consciousness during post-partum periods. The initial computed tomographyscan of brain was normal. But subsequent magnetic resonance imaging of brain showed hyperintense lesion in rightparieto-occipital region. After 7 weeks of multidisciplinary team effort, the patient recovered both clinically and radiologically. High index of suspicion with long term follow up is crucial for this curable and reversible syndrome. Because of rarity in delayed recovery, this case of PRES is reported. Birdem Med J 2019; 9(3): 248-250
Idiopathic Intracranial Hypertension is a disease of unknown aetiology common in obese females and presents with headache, papilledema, raised CSF opening pressure, no abnormalities in CSF examination and no abnormality on CT scan or MRI of the Brain. Sinovenous abnormalities are commonly detected in patients of IIH by different neuroimaging techniques. But the exact role of these sinovenous abnormalities in the causation of the disease or whether they are an effect of the disease is not yet known. Nor has a ‘gold standard’ investigation been established yet for detection of the sinovenous abnormalities. This study was done to detect the presence of sinovenous abnormalities in IIH patients by performing a Magnetic Resonance Venography of the brain. All 33 patients of IIH who presented to Rajshahi Medical College Hospital during the study period from June 2009 to May 2010 were included in the study. There were 30 females and 3 males having a F:M ratio of 10:1. 91% of the patients were between 20 and 35 years of age and most of them were married housewives. 63.64% patients had history of use of oral contraceptives. Unusually 51.52% of the patients had a BMI less than 25 indicating that they were not even overweight (BMI 25 to 30). Only 6% of the patients had BMI > 30 indicating that they were obese. Headache and papilloedema were present in all patients but visual difficulties were present only in 54.54% of the patients. Abnormalities in MRV of the brain were detected in 27.27% (9/33) of the patients and transverse sinus hypoplasia was the commonest finding (88.89% - 8/9 patients). There was no statistically significant difference in the findings of MRV abnormalities between the males and females or among the patients having BMI less or more than 25TAJ 2013; 26: 53-56
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