Acute Autonomic and Sensory Neuropathy in a Patient with Atypical Stepwise Progression

Acute autonomic and sensory neuropathy (AASN) is very rare immune mediated neuropathy characterized by prominent dysautonomia and sensory involvement without motor weakness. Most of AASN patients have a rapid onset reaching its worst within four weeks like Guillain-Barré syndrome. The treatment response is variable. Recently, we experienced a patient diagnosed as AASN with progressive autonomic and sensory symptoms more than 1 year, and showed good response in immunotherapy.

Paraproteinaemic neuropathy: MGUS and beyond

Paraproteinaemic neuropathies comprise a heterogeneous group of neuro-haematological conditions with some distinct neurological, haematological and systemic phenotypes. The spectrum of disease varies from mild to severe, indolent to rapidly progressive and from small fibre sensory involvement to dramatic sensorimotor deficits. The haematological association may be overlooked, resulting in delayed treatment, disability, impaired quality of life and increased mortality. However, the presence of an irrelevant benign paraprotein can sometimes lead to inappropriate treatment. In this review, we outline our practical approach to paraproteinaemic disorders, discuss the utility and limitations of diagnostic tests and the distinctive clinical phenotypes and touch on the complex multidisciplinary management approaches.

The Great Masquerade: A Rare Presentation of Spinal Tuberculoma

Spinal tuberculomas form a meagre fraction of cases of Tuberculosis (TB). Most common presentation of spinal tuberculoma is weakness. A 45-year-old female presented with dysthesias, gait instability and numbness involving both lower limbs for a period of 7-10 days. Patient was vitally stable (blood pressure of 128/78 mm of Hg, pulse rate of 86 beats per minute and respiratory rate of 18 breaths per minute with a normal pattern), alert and co-operative. Neurological examination suggested non length dependant sensory involvement of lower limbs, sensory ataxia and areflexia, level of lesion being at the Dorsal Root Ganglia (DRG) (sensory neuronopathy). Contrast Enhanced Magnetic Resonance Imaging (CEMRI) spine revealed tuberculoma at D9 spinal level. Patient responded to Antitubercular Therapy (ATT) and recovered. The intention of sharing the clinical experience is with the sole purpose of remembering the fact that common pathologies may at times be great mimickers. In the present case, while a lot of rare causes (autoimmune, neoplastic) were searched for, tuberculoma happened to be the culprit.

Neurological Complication of Chikungunya Fever: Guillain Barre Syndrome - A Case Report

Chikungunya fever has been known as reemerging disease since 2005. Its feature is more or less like dengue fever. Major outbreak occurred in Bangladesh in 2017. Lot of complications can occur in patient suffered from it. We report a Chikungunya case presenting with Guillain-Barré syndrome (GBS) with sensory involvement and bowel- bladder dysfunction who responded to plasma pharesis. Laboratory parameters and temporality support that GBS in the complication of Chikungunya. Bangladesh Med J. 2017 Sep; 46 (3): 97-99

Progressive Numbness and Tingling

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a subacute progressive polyneuropathy thought to arise from an autoimmune origin. Patients most typically present with symmetrical, progressive weakness that often affects proximal and distal muscles equally. Sensory involvement is common. Confirmation of the likelihood of demyelinating polyneuropathy can be obtained by electrodiagnostic study, which should include all four limbs. Marked slowing of conduction velocity is found in the vast majority of cases. Electromyography will typically show signs of denervation and partial reinnervation, such as fibrillation potentials and giant, long-duration, polyphasic potentials. Corticosteroids, intravenous immunoglobulins, or plasmapheresis are the most typical first-line treatments for CIDP. Steroid-sparing immunosuppressants may be used if chronic therapy is necessary. Most patients will improve to some degree with treatment.

Dementia and sculpture-making: Exploring artistic responses of people with dementia

In its form, sculpture reveals not only the artist’s self-expression but also the transformative qualities through which it influences our senses. Frequent interactions with sculpture can provide creative awareness, which in turn leads to a better understanding and appreciation of artistic expressions. This paper examines possible ways in which the creative potential of people with dementia can be explored through meaningful artistic engagement with sculpture-making processes. A study was conducted involving seven participants diagnosed with the early stages of dementia who engaged and experimented with different types of sculpture-making processes, from clay and papier mâché to virtual and digital sculptures. In the collective and collaborative environment of the group sessions, the creative responses of the participants to each process were unique. Each sculpture created by the participants enfolded their self-initiated ideas and stories reflecting the conscious expressions of their presence in a particular time and space. This paper argues that while cognitive impairment may affect the behavioural, visual and perceptual abilities of people with dementia, there is ample evidence to suggest that the viewing and making sculpture may influence the sensory involvement and consequently the imagination and creativity of people with early stage dementia.

Posterior Circulation Ischemic Stroke

ABSTRACT Posterior circulation stroke syndrome has a lesser incidence compared with anterior circulation stroke with an incidence rate of 10 to 15%. Males are commonly affected than females. Patients most commonly present with symptoms of dizziness, diplopia, dysarthria, dysphagia, and dystaxia. The hallmark of posterior circulation stroke is crossed hemiplegia with cranial nerve involvement on the same side of the lesion and motor or sensory involvement on the opposite side. We report a case of a 60-year-old woman who presented with vertigo, nausea, vomiting, unsteady gait, and tendency to fall on either side. How to cite this article Vidyashree J, Patil MB. Posterior Circulation Ischemic Stroke. J Med Sci 2017;3(2):59-61.