DESCRIPTIONA 35-year-old woman, apparently normal, who had participated in traditional Devithullal (a religious dance form involving violent head banging for hours at a time) on the evening of the following day developed vomiting, urinary incontinence, altered sensorium and quadriplegia. All blood investigations including thrombophilia workup were normal. CT scanning of the brain was normal. MRI diffusion-weighted image showed the characteristic bilateral ventral pontine hyper intensities ( figure 1A) and the apparent diffusion coeffient (ADC) map images showed bilateral ventral pontine hypointensities diagnostic of acute infarction (figure 1B). MR angiogram revealed basilar artery thrombosis ( figure 2A,B).'Head banging' denotes vigorous, rhythmical, rapid flexion and extension of the neck in time to music.1 It can cause vertebrobasilar ischaemia because the vertebral arteries are fixed in the
SUMMARYA 14-year-old girl was referred for evaluation of headache with episodes of transient blurring of vision, and intermittent fever for 4 weeks. On examination she was conscious and febrile, with multiple annular purpuric skin lesions present over the face and back. Neurological examination revealed a bilaterally extensor plantar response, with bilateral papilloedema. Lumbar puncture yielded clear spinal fluid with a very high opening pressure with a normal biochemistry and cytology. Neuroimaging showed evidence of raised intracranial tension. She was provisionally diagnosed to have idiopathic intracranial hypertension (IIH) and started on anticerebral oedema measures. Despite medication, she continued to be symptomatic. On the sixth day of admission, her antinuclear antibody and antidoublestranded DNA registered positively in high titres. She was diagnosed with systemic lupus erythematosus (SLE) with IIH and was started on corticosteroids, with dramatic recovery of her symptoms and clinical signs. Reports of SLE, the maiden presentation of which is IIH, are rare in the literature.
BACKGROUND
DESCRIPTIONA 74-year-old man was brought to emergency services when he was found lying unresponsive in his room. Nearest of the kin reported that his clothes were drenched with sweat and that he was a regular alcohol user who had consumed in excess the previous day. Vital signs were normal. There was decerebrate posturing of limbs with bilateral extensor plantar response. The doll's eye movement and corneal reflexes were preserved. There was no neck stiffness. Random blood sugar at admission was 34 mg/dl, which was corrected with 100 ml 25% dextrose bolus infusion which was maintained with dextrose infusion and glucagon 1 mg intramuscular as injection. His brain CT scan was normal. The spinal tap yielded normal results. The ECG, echocardiogram, four vessels Doppler neck including the aortic arch and Electroencephalogram were normal. MRI of the brain showed hyperintense signals in both hippocampi, right insular, temporal, occipital and frontal cortex in diffusion-weighted images with diffusion restriction in apparent diffusion coefficient mapping suggestive of laminar cortical necrosis. MR angiogram was normal. He did not improve with treatment and succumbed to the illness ( figures 1A, B, C and 2A, B, C).First described in a patient with anoxic encephalopathy, 1 it was found later that laminar cortical necrosis represented cytotoxic oedema affecting a particular layer of cerebral cortex neuropathologically characterised by delayed selective neuronal necrosis and is a consequence of hypoxic-ischaemic encephalopathy, hypoglycaemic encephalopathy, status epilepticus and ischaemic stroke.
2Mechanisms of laminar cortical necrosis are not well elucidated.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.