A RARE CASE OF SPACE OCCUPYING LESION OF BRAINSTEM IN AN ELDERLY MALE PATIENT

An elderly male patient aged 65 presented to us with history of swaying towards left side of the body since 1 month with normal higher mental functions and neurological examination suggestive of cerebellar ataxia. MRI Brain plus contrast was suggestive of an irregular, ill-defined heterogeneous enhancing lesion with few necrotic areas within and few foci of blooming on FFE (Fast Field Echo imaging technique) with significant perilesional oedema involving right thalamus and brainstem showing Choline peak on MR Spectroscopy. Keywords: Neurological examination; Cerebellar ataxia; MRI brain; FFE

A RARE CASE OF SPACE OCCUPYING LESION OF BRAINSTEM IN AN ELDERLY MALE PATIENT

An elderly male patient aged 65 presented to us with history of swaying towards left side of the body since 1 month with normal higher mental functions and neurological examination suggestive of cerebellar ataxia. MRI Brain plus contrast was suggestive of an irregular, ill-defined heterogeneous enhancing lesion with few necrotic areas within and few foci of blooming on FFE (Fast Field Echo imaging technique) with significant perilesional oedema involving right thalamus and brainstem showing Choline peak on MR Spectroscopy. Keywords: Neurological examination; Cerebellar ataxia; MRI brain; FFE

BARTTER\u27S SYNDROME

OBJECTIVE: Bartter\u27s syndrome is a rare genetic disorder characterized by renal salt wasting, hypokalemia and metabolic alkalosis. CASE REPORT: A 32 years old male patient presented to casualty with complaints of generalised weakness and chest pain of 15 days duration. Patient had pallor, with loss of buccal pad of fat, skin turgor was lost, and extremities were cold. PR-90bpm, feeble, BP-50/40mmHg. History of similar complaints 1 month back for which he was hospitalised for 15 days and was not completely relieved of symptoms. The differential diagnosis of metabolic alkalosis with hypokalemia without hypertension are; 1. Bartter\u27s syndrome, 2. Gitelman\u27s syndrome, 3. Surreptitious vomiting and 4. Diuretic abuse. CONCLUSION: Acquired Bartter\u27s and Gitelman\u27s like syndromes have been described with autoimmune disorders, sarcoidosis and various drugs. This patient could have a yet undetected or unknown mutation of a protein which has a structural or a functional role in renal tubular cells (of Loop of Henle). KEY WORDS: Bartter\u27s syndrome; Renal salt wasting; Hypokalemia; Metabolic alkalosis; Sarcoidosis

BARTTER'S SYNDROME

OBJECTIVE: Bartter's syndrome is a rare genetic disorder characterized by renal salt wasting, hypokalemia and metabolic alkalosis. CASE REPORT: A 32 years old male patient presented to casualty with complaints of generalised weakness and chest pain of 15 days duration. Patient had pallor, with loss of buccal pad of fat, skin turgor was lost, and extremities were cold. PR-90bpm, feeble, BP-50/40mmHg. History of similar complaints 1 month back for which he was hospitalised for 15 days and was not completely relieved of symptoms. The differential diagnosis of metabolic alkalosis with hypokalemia without hypertension are; 1. Bartter's syndrome, 2. Gitelman's syndrome, 3. Surreptitious vomiting and 4. Diuretic abuse. CONCLUSION: Acquired Bartter's and Gitelman's like syndromes have been described with autoimmune disorders, sarcoidosis and various drugs. This patient could have a yet undetected or unknown mutation of a protein which has a structural or a functional role in renal tubular cells (of Loop of Henle). KEY WORDS: Bartter's syndrome; Renal salt wasting; Hypokalemia; Metabolic alkalosis; Sarcoidosis