Myasthenia gravis (MG) has a cosmopolitan distribution and can affect people of all age group. Sometimes atypical presentation causes difficulty in the early diagnosis and management. Our aim is to study the clinical subtypes and manifestations of MG along with serological and electrophysiological diagnostic methods. Patients who were admitted in Neurology department or presented in Neurology outpatient department of Tribhuvan University Teaching Hospital from 2015 March to 2016 November were retrospectively reviewed. Out of 28 patients reviewed, 23 patients were included in the study. Their mean age of onset was 40.4±19.2 years; range=12 – 78 years, and 12 of them were female (52.2%). Eight patients (34.8%) were diagnosed with ocular myasthenia and 15 were patients (65.2%) of General Myasthenia. Seventeen patients (73.9%) were acetylcholine receptor (AChR) antibodies positive, one female patient was found to be muscle specific kinase (MuSK) positive. Decremental pattern in Repetitive Nerve stimulation (RNS) was reported in 11 patients (47.8%) and ice pack test was positive in 16 patients (69.3%). Ophthalmological findings are the most common presentation of MG patients. Icepack test is an easy clinical diagnostic tool for outpatient department which has both high sensitivity and specificity. RNS and antibody tests are the supporting tests useful for confirming the diagnosis.Nepal Journal of Neuroscience, Volume 14, Number 1, 2017, Page: 14-17
Organophosphate-induced delayed neuropathy, a central-distal axonopathy, passes through latent, progressive, static and improvement phases. During the improvement phase, the peripheral nerves regenerate unmasking the spinal cord lesion with myelopathic features. We report a case of a 16-year-old male who developed myelopathy 6 weeks following chlorpyrifos poisoning. He had a motor weakness of 4/5 in bilateral hips and 3/5 in bilateral knees and ankles. Spasticity and exaggerated reflexes with ankle clonus were present in the lower limbs. Sensory and the upper limb motor examinations were all normal. Pertinent blood, cerebrospinal fluid and nerve conduction tests were normal. Magnetic resonance imaging of the spine showed features of cord atrophy. Three months following physiotherapy, his power improved to 5/5 in bilateral knee and hip joints and 4/5 in bilateral ankles with spasticity. Organophosphate-induced delayed neuropathy can present as earlier as 6 weeks with myelopathy. Previous history of organophosphorous exposure is important in myelopathy or peripheral neuropathy.
Abstract Symptoms of Guillain–Barre Syndrome (GBS) may be mistaken for typical puerperal changes, delaying diagnosis. Surgery and anesthesia may be triggers for GBS with an overall increase in pro‐inflammatory cytokines in the postpartum period. We report a unique case of GBS in the postpartum period who made a good recovery with supportive measures.
Abstract When a patient presents with undulating fever and neuropsychiatric features, neurobrucellosis should be considered as a differential diagnosis. If diagnosed early, neurobrucellosis is a treatable disease with a favorable outcome.
Introduction: Cryptococcal meningoencephalitis is the most frequently encountered manifestation of cryptococcosis and prevalent throughout the globe. The majority of patient suffering from cryptococcosis is immunocompromised and AIDS account for most of the case. We aimed to determine the spectrum of cryptococcal meningoencephalitis at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. Methods: A retrospective study was performed among all the patients (n=15) who were admitted with cryptococcal meningoencephalitis at TUTH over a period of one fiscal year July 2017 to June 2018. Data on patient’s demography, history, complaints, clinical findings, neuroimaging, cerebrospinal fluid (CSF) investigation, hospital medication information, complications, mortality and Left Against Medical Advise (LAMA) were extracted from patient medication records of the hospital. Descriptive statistics was performed using IBM-SPSS 20.0. Results: Of total 15 patients with Cryptococcal meningoencephalitis, majority (9, 60%) had HIV infection. The most common complaints were vomiting (12, 80%) and headache (11, 73%) and clinical findings showed meningeal irritation (8, 53%) and papilledema (4, 27%). Only two neuroimagings among all patients were abnormal. CSF investigation depicted high total cell count (>5cells/mm3), high protein (>45 mg/dl) and positive cryptococcal antibody in all patients while lymphocytic predominance and lower sugar levels (<3 mmol/dl) in 93% along with ADA of <10 U/L in 67%. Amphotericin-B (mean duration 17 days) and fluconazole antifungals were used in all the patients. Twenty seven percent patients died during hospital stay. Pancytopenia, hydrocephalus and hospital acquired pneumonia were observed in 7 percent of patient from each group and 13 percent of cases left against medical advice. Conclusion: Cryptococcal meningoencephalitis is common in People Living with HIV (PLHIV) and caused substantial mortality.
INTRODUCTION: Cerebral palsy is a disorder apparent at birth or in childhood due to damage in the neonatal period, leading to non-progressive deficits. Handicaps like complete or partial loss of hearing, speech and/or sight may also be present in children with cerebral palsy. The study was conducted to determine ocular morbidity in children and adults with cerebral palsy.
METHODS: A cross-sectional study was conducted at Self Help Group for Cerebral Palsy, Dhapakhel with a sample size of 38. All patients underwent orthoptic evaluation, anterior segment evaluation, dilated fundus examinati on, dry refracti on and cycloplegic refracti on
Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents.
Abstract Apart from the usual differentials of transverse myelitis and cord compression, paraparetic GBS should be considered when sudden, flaccid paralysis of the lower limbs occurs, as prompt diagnosis and management can minimize sequel and unnecessary procedures. We do report a case wherein we managed a similar situation without the use of an immunomodulatory therapy.
Neuromyelitis optica spectrum disorder (NMOSD) is an immune-mediated inflammatory condition involving spinal cord and optic nerves. Diagnosis of NMOSD is done by aquaporin-4 antibody (AQP4) in patients with optic neuritis. Myelin oligodendrocyte glycoprotein (MOG) expressed on the oligodendrocyte cell surface and on the outermost cell surface of the myelin sheath may also be present in patients with NMOSD bilateral optic neuritis. Here, we describe a case of a thirty-nine-year-old-female with recurrent bilateral optic neuritis with positive anti-MOG antibody, and anti-MOG syndrome has not previously been reported from Nepal.
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