Rectus sheath haematoma complicating dengue haemorrhagic fever-a case report

Dengue hemorrhagic fever manifests in various forms, ranging from petechial skin hemorrhages to life threatening hemorrhages. However it is very rare to have muscle hematomas in this condition. We report a case of spontaneous Rectus sheath hematoma complicating dengue hemorrhagic fever. Our patient was a 55 year old female positive for NS1antigen and anti-dengue IgM. She had thrombocytopenia with platelet counts as low as 12000 in the beginning. There was evidence of plasma leakage and acute dyspnoea during the course of illness. On the 5th day though the platelet count had recovered she developed haematoma in the left rectus sheath which was diagnosed on ultrasound and aspirated leading to relief of symptoms. This complication needs to be recognized so that it can be treated early

Patient of carcinoma cervix presenting with oculomotor palsy due to meningeal carcinomatosis- a case report

We report a case of isolated pupil involving oculomotor nerve palsy as the inaugural and the only clinical sign of meningeal carcinomatosis (MC) in a patient of carcinoma of cervix. There were no other neurological signs and symptoms except for headache. The first MRI was unremarkable but a repeat MRI after 15 days showed meningeal enhancement which pointed towards the diagnosis. The CSF was also normal. This case highlights the importance of considering MC in all patients who develop sudden ptosis due to oculomotor palsy in a cancer patient even if MRI is normal

Artery of percheron infarct: a case report

Artery of Percheron is a part of the posterior circulation occlusion of which is relatively uncommon. It is classically characterised by bilateral infarcts in areas involving the rostral midbrain and/or ventromedial thalamus best seen by a diffusion-weighted imaging (DWI) sequence using MRI. Clinical presentations are variable and include, amnesic impairment, aphasia, dysarthria, ocular movement disorders, motor deficit and cerebellar signs. Our case was a 60-year-old hypertensive and diabetic male with history of alcohol abuse who presented with sudden derangement of sensorium along with restriction of ocular movements and marked cerebellar signs. The diagnosis of werniche encephalopathy suggested initially by the radiologist was rejected because of the acute onset, history of hypertension and marked cerebellar signs which suggested a cerebrovascular accident. Bilateral infarcts with the occlusion of a single artery i.e. artery of percheron which supplies structures bilaterally can easily be confused with werniche encephalopathy which has similar clinical and radiological picture but are managed on different lines. This diagnosis should be kept in mind in drowsy patients with restricted ocular movements and bilateral thalamic and midbrain hyperintensities

Patient of carcinoma cervix presenting with oculomotor palsy due to meningeal carcinomatosis- a case report

We report a case of isolated pupil involving oculomotor nerve palsy as the inaugural and the only clinical sign of meningeal carcinomatosis (MC) in a patient of carcinoma of cervix. There were no other neurological signs and symptoms except for headache. The first MRI was unremarkable but a repeat MRI after 15 days showed meningeal enhancement which pointed towards the diagnosis. The CSF was also normal. This case highlights the importance of considering MC in all patients who develop sudden ptosis due to oculomotor palsy in a cancer patient even if MRI is normal

Artery of percheron infarct: a case report

Artery of Percheron is a part of the posterior circulation occlusion of which is relatively uncommon. It is classically characterised by bilateral infarcts in areas involving the rostral midbrain and/or ventromedial thalamus best seen by a diffusion-weighted imaging (DWI) sequence using MRI. Clinical presentations are variable and include, amnesic impairment, aphasia, dysarthria, ocular movement disorders, motor deficit and cerebellar signs. Our case was a 60-year-old hypertensive and diabetic male with history of alcohol abuse who presented with sudden derangement of sensorium along with restriction of ocular movements and marked cerebellar signs. The diagnosis of werniche encephalopathy suggested initially by the radiologist was rejected because of the acute onset, history of hypertension and marked cerebellar signs which suggested a cerebrovascular accident. Bilateral infarcts with the occlusion of a single artery i.e. artery of percheron which supplies structures bilaterally can easily be confused with werniche encephalopathy which has similar clinical and radiological picture but are managed on different lines. This diagnosis should be kept in mind in drowsy patients with restricted ocular movements and bilateral thalamic and midbrain hyperintensities