Morvan syndrome: An interesting case of a rare disease

Morvan syndrome is a rare disorder of peripheral nerve hyperexcitability, autonomic and central nervous system hyperactivity. It is considered autoimmune and paraneoplastic in nature. The most common associated antibodies are voltage-gated potassium channel (VGKC) complex antibodies which target leucine-rich glioma inactivated 1(LGI-1) and contactin-associated protein 2 (CASPR-2). It is characterized by myokymia, burning pain, cramps, stiffness, weakness, hyperhidrosis, weight loss, insomnia, and hallucinations. Thymectomy, long-term immunosuppression, plasmapheresis, intravenous immunoglobulin (IVIG), steroids are the treatment options. Carbamazepine, phenytoin, amitriptyline, and benzodiazepine are useful in relieving symptoms. We report a rare case ofthis disease from western Rajasthan who presented with bilateral diffuse burning pain, cramps, insomnia, weight loss, hyperhidrosis, visual hallucinations, and continuous muscle twitching and rippling activity over the lower back paraspinal muscles. His serum VGKC antibodies were positive. He was treated with IV methylprednisolone (MPS) and IVIG and had a good response to therapy. We should look for rippling muscle movement in a high index of suspicion and should not be missed

Numb chin syndrome

Numb chin syndrome (NCS), also known as mental neuropathy, is a sensory neuropathy characterized by numbness involving the distribution of the mental nerve and is an uncommon, but underappreciated neuropathy. The clinical importance lies in its frequent association with malignancies, particularly lymphoma and breast cancer. We report a 30-year-old patient who presented with bilateral numb chin for few days for which no cause was found. Over 3 weeks, he developed systemic symptoms and neck swelling. Investigations revealed low platelet count, raised erythrocyte sedimentation rate, alkaline phosphatase, and lactate dehydrogenase. Biopsy of the swelling and Bone marrow confirmed Burkitt′s lymphoma. Imaging studies confirmed intracranial and hepatic metastasis. Within few days of initiation of therapy, patient succumbed to the disease. Here, we would like to emphasize that all clinicians should be aware of this entity and investigate thoroughly to rule out underlying malignancies as delay in diagnosis leads to the adverse outcome

A study of Guillain–Barré syndrome with reference to cranial neuropathy and its prognostic implication

Background: Focused studies on cranial neuropathy in Guillain–Barrι syndrome (GBS) and its prognostic implication are not done previously. Aim: To study the clinical profile of GBS patients with special reference to cranial neuropathy and its prognostic implication. Materials and Methods: The study included 61 patients with GB syndrome, fulfilling Asbury Cornblath’s criteria for GB syndrome. A pre-designed semi-structured questionnaire was used to obtain data regarding demographic profile and clinical profile. All patients underwent detailed neurological examination, investigations including nerve conduction studies and CSF examination and treated according to the severity of the illness. Patients were followed up for 6 months. During analysis two groups were made depending on cranial nerve involvement, and compared with respect to various parameters. Results: Out of 61 patients 38 (62.3%) patients had cranial nerve palsies, in that 25 had multiple cranial nerve palsies, and 13 had single isolated nerve palsy. A majority of 30 (49.2%) had bulbar palsy, 28 (46%) had facial nerve palsy, and all had bilateral involvement except 3 patients who had unilateral palsy. Hypoglossal nerve involvement was seen in six (10%) patients and four (6.5%) patients had ophthalmoplegia. Only one had bilateral vestibulocochlear nerve palsy. On comparing various clinico-electrophysiological parameters among patients of GB syndrome with and without cranial nerve involvement, the presence of respiratory paralysis, IVIg and ventilatory support requirement had significant association with cranial nerve involvement in GBS. Conclusion: Our study found a correlation between cranial nerve palsies and severity of the illness. Cranial nerve innervated muscles recover earlier as compared to distal limb muscles. No association was found between outcome at 6 months and cranial nerve involvement

SPY BOT:A BOOM FOR CAMOUFLAGING

ABSTRACT:-The objective behind making this project deals out with satisfying various functional needs such as secretly spying or keeping surveillance over a desired target location. We also aim to achieve a few more additional comprehensive needs such as detection of gas, temperature sensing, metal detection, displacing any suspected object from its original position.. We have leveraged our robot with an advantage of monitoring both audio and video parameters. The most eye catching feature of our bot along with enveloping the would be able to change its body colour that it treads along. We have achieved our main goal by aggregating individual robotic functions in a single robotic package. This bot can either be used for keeping an eye or a supervisory control on intrusion making it function like a spy bot or with the additional features as that we have added to this robot could serve as an important unmanned vehicle which could actually combat with the opponents or enemies in the war fields. Thus how making it a multifunctional, all in one bot that could be used to serve more than one application areas

Guillain-Barre syndrome with posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity commonly associated with eclampsia, septicemia, chemotherapeutic drugs etc. Concurrent occurrence of Guillain-Barre syndrome (GBS) with PRES is a rare entity. Dysautonomia is a proposed mechanism for such occurrence. Here we present a non-diabetic, non-hypertensive 63-year-old male patient, who came with acute onset flaccid quadriparesis, developing generalized seizures, altered sensorium and raised blood pressure on fifth day of illness. Magnetic resonance imaging (MRI) of brain showed altered signal intensities involving the parieto-occipital areas suggestive of posterior reversible encephalopathy. Cerebrospinal fluid analysis showed albuminocytological dissociation, nerve conduction studies revealed demyelinating type of polyneuropathy. The patient was treated with antihypertensives and antiepileptics. After resolution of the encephalopathy, intravenous immunoglobulin (IVIg) was given. The patient recovered gradually over few months. Our case concludes GBS as independent risk factor, for PRES may be secondary to dysautonomia and physicians should be aware of such rare coexistence so that early treatment can be done to reduce the mortality and morbidity

Lightning strike-induced brachial plexopathy

We describe a patient who presented with a history of lightning strike injury. Following the injury, he sustained acute right upper limb weakness with pain. Clinically, the lesion was located to the upper and middle trunk of the right brachial plexus, and the same confirmed with electrophysiological studies. Nerve damage due to lightning injuries is considered very rare, and a plexus damage has been described infrequently, if ever. Thus, the proposed hypothesis that lightning rarely causes neuropathy, as against high-voltage electric current, due to its shorter duration of exposure not causing severe burns which lead to nerve damage, needs to be reconsidered

Disseminated neurocysticercosis presenting as isolated acute monocular painless vision loss

Neurocysticercosis, the most common parasitic infection of the nervous system, is known to affect the brain, eyes, muscular tissues and subcutaneous tissues. However, it is very rare for patients with ocular cysts to have concomitant cerebral cysts. Also, the dominant clinical manifestation of patients with cerebral cysts is either seizures or headache. We report a patient who presented with acute monocular painless vision loss due to intraocular submacular cysticercosis, who on investigation had multiple cerebral parenchymal cysticercal cysts, but never had any seizures. Although such a vision loss after initiation of antiparasitic treatment has been mentioned previously, acute monocular vision loss as the presenting feature of ocular cysticercosis is rare. We present a brief review of literature along with this case report

Dyke-Davidoff-Masson syndrome: A study of clinicoradiological variability in hemiplegia, hemiatrophy and epilepsy patients

Context: Clinicoradiological variability expansion in Dyke-Davidoff-Masson syndrome (DDMS) or hemiplegia, hemiatrophy and epilepsy (HHE) patients. Aims: To explore clinicoradiological features, associated abnormalities and refractoriness issues to antiepileptic drugs (AED) on such kind of epilepsy syndrome. Settings and Design: Prospective and retrospective observational hospital based cohort study. Materials and Methods: Thirty-two patients of HHE were enrolled and interviewed. They were divided into 4 groups congenital versus acquired and seizure control group (SCG) versus seizure refractory group (SRG). We used Naranjo adverse drug reaction (ADR) probability scale for analyzed phenytoin and other drugs adverse reaction. All patients underwent clinicoradiological examination, electroencephalograms, magnetic resonance imaging for parenchymal and skeletal changes. Statistical Analysis Used: Fisher′s exact and Student′s t-test applied for P value. Results: A total of 32 patients (21 males, 11 females) out of 1182 epilepsy patients were enrolled with mean age of 26.84 ± 9.71 (range: 8-42) years. Twenty-eight patients presented with DDMS, three Rasmussen encephalitis and two HHE syndromes. Congenital type and seizure refractory groups were common presentation. Left lateralization with holo-hemispheric atrophy, cerebellar atrophy, calvarial thickening with frontal sinus hyperpneumatization were significant (P < 0.05) magnetic resonance imaging (MRI) findings. Epileptiform activity was concordant to lesion. Phenytoin adverse effects were significantly (P < 0.03) associated with HHE patients. Remarkable findings of our study included cerebral hemispheric plus cerebellar atrophy (28.12%), hippocampal sclerosis (16%), dystonia, hemiparkinsonism, mirror movement and Dandy-Walker syndrome (DWS). Conclusions: DDMS/HHE can present protean clinicoradiological manifestation, cerebellar atrophy, hippocampal sclerosis and phenytoin intolerance may be one of them

Study of cluster headache: A hospital-based study

Introduction: Cluster headache (CH) is uncommon and most painful of all primary headaches, and continues to be managed suboptimally because of wrong diagnosis. It needs to be diagnosed correctly and specifically treated. There are few studies and none from this region on CH. Materials and Methods: To study the detailed clinical profile of CH patients and to compare them among both the genders. Study was conducted at Mahatma Gandhi hospital, Jodhpur (from January 2011to December 2013). Study comprises 30 CH patients diagnosed according to International Headache Society guidelines (ICHD-II). Routine investigations and MRI brain was done in all patients. All measurements were reported as mean < SD. Categorical variables were compared using the Chi-square test, and continuous variables were compared using Student’s t-test. SPSS for Windows, Version 16.0, was used for statistical analyses with the significance level set at P = 0.05. Results: M: F ratio was 9:1. Age at presentation was from 22-60 years (mean - 38 years). Latency before diagnosis was 3 months-12 years (mean - 3.5 years). All suffered from episodic CH and aura was found in none. Pain was strictly unilateral (right-19, left-11), predominantly over temporal region-18 (60%). Pain intensity was severe in 27 (90%) and moderate in 3 (10%). Pain quality was throbbing in 12 (40%). Peak intensity was reached in 5 minutes-30 minutes and attack duration varied from 30 minutes to 3 hours (mean - 2.45 hours). Among autonomic features, conjunctival injection-23 (76.6%) and lacrimation-25 (83.3%) were most common. Restlessness during episode was found in 80%. CH duration varied from 10 days to 12 weeks. Circadian periodicity for attacks was noted in 24 (80%). Conclusion: Results are consistent with other studies on many accounts, but is different from Western studies with respect to low frequency of family history, chronic CH, restlessness and aura preceeding the attack. Detailed elicitation of history is paramount as misdiagnosis is common