Introduction: The underlying mechanism of cerebral malaria alone or with multiple organ dysfunction (MOD) among patients with falciparum
malaria is not clearly understood. Though autopsy studies showed various types of pathological changes, during life Magnetic Resonance Imaging
(MRI) can identify structural and functional modication of brain during the disease process. There have been few MRI studies of brain among
adult patients with cerebral malaria (CM) but none with CM and MOD. Therefore, we have conducted this study to nd out and to compare the MRI
abnormalities among patients of CM and CM with MOD.
Methods: This prospective study has been conducted at VSSIMSAR, Burla in which 138 consecutive patients of severe falciparum malaria were
enrolled. 119 patients after exclusion were subjected to MRI within 10 hours of admission and it was repeated as per the protocol. The diagnosis of
P.falciparum malaria was done by peripheral smear or Rapid diagnostic test. The diagnosis of sever malaria was done by WHO criteria. Patients of
CM were grouped into Group-1 and of CM with MOD to Group-2.
Results: In the study CM and CM with MOD constituted 29 (24.4%) and 90 (75.6%) patients. MRI showed increased brain volume, vasogenic
oedema, and cortical thickening in all patients of severe malaria. Cytotoxic oedema also found in 37.9% of cases of CM and 75.5% of MOD
(p<0.001). Infarction and haemorrhage were found in less percentage of cases. Predominant posterior swelling consistent with posterior reversible
encephalopathy syndrome (PRES) is found in majority of cases of CM (48.3%) compared to frontal swelling (0.0%) (p<0.001). With treatment
MRI ndings improved within 72 hours of treatment. Patients who died did not show any improvement in MRI nding.
Conclusion: Different type of MRI ndings at different areas of brain is possible in CM and CM with MOD. It is due to dysfunction of blood brain
barrier (BBB) and it can be reversible with treatment. Therefore, intervention with drugs improving BBB may be benecial for survival.
25 years old female diagnosed to be having retro viral infection for past six months developed subacute onset of involuntary movements of left upper and lower limb in the form of flowing movements from proximal to distal parts of the limb. On examination vitals were stable, routine blood investigations were normal. CXR and ECG were normal. Patient CD4 count is 179. Neuro-imaging revealed T2 and flair hyper intensity and T1 hypo intensity with out any evidence of diffusion restriction noted in right thalamus. Possibility of TUBERCULOMA in right side of thalamus.
60 years old female diagnosed to be having CNS actinomycosis 3
years back presented with neurovisual loss for which she was treated
with penicillin. Her vision improved and she was discharged. Now she
presented with severe headache in the occipital region of 3 months
duration. On general examination she was conscious and alert. On
CNS examination she had bilateral papilloedema with secondary optic
atrophy. Her motor, sensory and cerebellar functions were normal.
BACKGROUNDInflammatory bowel disease (IBD) is an immune mediated chronic intestinal disease. It is of two major types, Ulcerative Colitis (UC) and Crohn's Disease (CD). Though IBD is primarily an intestinal disease, it involves various organ systems such as eyes, skin, musculoskeletal and hepatobiliary systems. Sensorineural hearing loss is one of such extraintestinal manifestations which is attributed to the autoimmune inner ear disease.The objective of this study is to find the prevalence of sensorineural hearing loss in patients of inflammatory bowel disease.
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