Two unusual neuro-psychiatric manifestations of malaria in a tertiary care hospital: a review of literature

Malaria, a highly prevalent parasitic disease in tropical country, have some atypical neuro-psychiatric manifestations seen in both vivax and falciparum malaria. We are reporting two cases of unusual neuro-psychiatric manifestations of malaria admitted in our hospital, one with intralobar haemorrhage and other with atypical psychiatric features. The rarity of the presentation has been highlighted with possible pathogenesis discussed after literature review

Quadriparesis due to Gitelman′s syndrome diagnosed with thiazide diuretic test response

Gitelman′s syndrome is characterized by hypocalciuria, severe hypomagnesemia, and prominent muscular involvements such as fatigue, weakness, cramps, and tetany. It is due to mutations in the thiazide sensitive NaCl co-transporter in the distal convoluted tubule. The administration of thiazide diuretics may induce a subnormal increase of urinary Cl− excretion in patients with Gitelman′s syndrome, consistent with the hypothesis that less than normal Cl− is reabsorbed by the thiazide-inhibitable transporter in Gitelman′s syndrome. Thus, we report a case of Gitelman′s syndrome presenting with quadriparesis diagnosed by using thiazide clearance test

Twiddler′s syndrome revisited

Twiddler′s Syndrome, first described by Bayliss, refers to a permanent malfunction of the pacemaker as a result of rotation of the device causing lead dislodgement. Since then, various cases of Twiddler and its variants such as Reel, Ratchet, and reverse Twiddler have been reported. This article reports two variants of Twiddler and reviews the literature on this interesting yet life-threatening complication of permanent pacing