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Research Interests: Medicine and Topiramate
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Malaria is associated with various forms of neurological complications. Weakness like paraparesis and quadriparesis is being described in malaria, the pathologies being polyneuropathy, hypokalaemia, hyperkalaemia, myelitis etc. Recurrent... more
Malaria is associated with various forms of neurological complications. Weakness like paraparesis and quadriparesis is being described in malaria, the pathologies being polyneuropathy, hypokalaemia, hyperkalaemia, myelitis etc. Recurrent hypokalaemic paralysis has not been described to the best of my knowledge in malaria. I hereby describe a young patient with recurrent episodes of weakness due to hypokalaemia who on investigation was found to be because of malaria. The case report is being described because of it is being novel or not described earlier.
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The article of Outteryck et al.1 shows the importance of optical coherence tomography (OCT) for detection of optic neuritis lesions in patients with multiple sclerosis (MS), which adds to early diagnosis and better management, especially... more
The article of Outteryck et al.1 shows the importance of optical coherence tomography (OCT) for detection of optic neuritis lesions in patients with multiple sclerosis (MS), which adds to early diagnosis and better management, especially in the clinically isolated syndromes. It would also help in the research purpose for early intervention in patients with MS, as earliest intervention is best. The prognosis of multiple sclerosis is improving day by day, which requires the diagnosis at the earliest possible time as highlighted in the editorial by Villoslada et al.2 Likewise, OCT can also diagnose the foveal macular lesion differentiating MS from neuromyelitis optica spectrum disorders (NMOSDs).3 The diagnosis of MS is hampered by lack of adequate facilities and accessibility of MRI, oligoclonal bands (OCBs), and evoked potentials (EPs) in resource-poor areas, whereas the availability and accessibility of the ophthalmologists and OCTs is better and likely more cost-effective in compar...
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I read the interesting study on correlation of thyroid antibodies and neurologic manifestations specially the encephalopathy, psychosis, refractory seizures, etc.1 The simultaneous editorial on the same issue is also enlightening.2 The... more
I read the interesting study on correlation of thyroid antibodies and neurologic manifestations specially the encephalopathy, psychosis, refractory seizures, etc.1 The simultaneous editorial on the same issue is also enlightening.2 The authors concluded that Hashimoto encephalopathy requires redefinition. Here, we would like to share our small but important experience. We found in a cohort of approximately 73 patients of noncompressive myelopathy and neuromyelitis optica spectrum disorder (NMOSD) and antibodies to thyroid peroxidase (TPOAb) positivity in 2 patients.3 The other antibodies relevant to NMOSD or myelitis and etiologic workup was noncontributory; hence, we connected it to the thyroid immune disorder or TPOAb. These patients had recurrent myelitis and required disease-modifying therapies besides steroids, and we concluded that this entity may be an independent marker of recurrence of the disease—i.e., myelitis. Similar to those patients implicated in earlier studies,4 they require disease-modifying therapy besides steroids because steroids alone are not sufficient.
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We thank Dr. Méndez-Guerrero, et al. for their article on Acute hypokinetic-rigid syndrome after SARS-CoV-2 infection.1 Since 1917, when the first description of encephalitis lithargica2 became available, the role of various viruses has... more
We thank Dr. Méndez-Guerrero, et al. for their article on Acute hypokinetic-rigid syndrome after SARS-CoV-2 infection.1 Since 1917, when the first description of encephalitis lithargica2 became available, the role of various viruses has been implicated in the etiopathogenesis of Parkinson's disease besides the environmental toxins and lifestyle, diet, pollution, etc.3 The interesting case report and details provided by Dr. Méndez-Guerrero, et al. are important in understanding the pathophysiology of hypokinetic rigid syndrome or Parkinsonian illnesses.
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The aim of this correspondence is to further carry forward the message of the eminent authors1 with some addi t iona l in format ion , so as to further enhance the relevance of such mini but otherwise quite informative articles. As PMNS... more
The aim of this correspondence is to further carry forward the message of the eminent authors1 with some addi t iona l in format ion , so as to further enhance the relevance of such mini but otherwise quite informative articles. As PMNS being a self-limiting complication or sequelae it is more important to know it so as to avoid costly investigations, drug treatment and, avoidance of side effects of antiepileptics in case of seizures.
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I read the interesting study on correlation of thyroid antibodies and neurologic manifestations specially the encephalopathy, psychosis, refractory seizures, etc.1 The simultaneous editorial on the same issue is also enlightening.2 The... more
I read the interesting study on correlation of thyroid antibodies and neurologic manifestations specially the encephalopathy, psychosis, refractory seizures, etc.1 The simultaneous editorial on the same issue is also enlightening.2 The authors concluded that Hashimoto encephalopathy requires redefinition. Here, we would like to share our small but important experience. We found in a cohort of approximately 73 patients of noncompressive myelopathy and neuromyelitis optica spectrum disorder (NMOSD) and antibodies to thyroid peroxidase (TPOAb) positivity in 2 patients.3 The other antibodies relevant to NMOSD or myelitis and etiologic workup was noncontributory; hence, we connected it to the thyroid immune disorder or TPOAb. These patients had recurrent myelitis and required disease-modifying therapies besides steroids, and we concluded that this entity may be an independent marker of recurrence of the disease—i.e., myelitis. Similar to those patients implicated in earlier studies,4 they require disease-modifying therapy besides steroids because steroids alone are not sufficient.
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I read with interest the review on optical coherence tomography (OCT) in various neurologic diseases by Maldonado et al.1 OCT is used extensively for clinical decision-making and monitoring of many posterior segment diseases based on... more
I read with interest the review on optical coherence tomography (OCT) in various neurologic diseases by Maldonado et al.1 OCT is used extensively for clinical decision-making and monitoring of many posterior segment diseases based on macular, optic nerve, and retinal nerve fiber layer (RNFL) imaging.2 It is a noninvasive imaging technique and provides high-resolution, cross-sectional images of the retina, the RNFL, and the optic nerve head.2 I would like to draw particular attention to another important role OCT …
ABSTRACT A case-control study to measure oxygen and carbon dioxide partial pressures in the legs in order to assess the involvement of peripheral hypoxia or hypercapnia in the pathogenesis of restless legs syndrome (RLS). RLS severity was... more
ABSTRACT A case-control study to measure oxygen and carbon dioxide partial pressures in the legs in order to assess the involvement of peripheral hypoxia or hypercapnia in the pathogenesis of restless legs syndrome (RLS). RLS severity was assessed with a standard questionnaire. Suggested immobilization tests were performed twice in 15 patients with RLS and 14 healthy controls. Patients with RLS participated in the tests with and without pramipexole medication. During the tests, peripheral oxygen and carbon dioxide partial pressures were measured noninvasively on the skin of the legs and the chest. During immobilization, the patients with RLS had lower partial pressure of oxygen in their legs (5.54 vs 7.19 kPa, p < 0.01) but not on the chest (8.75 vs 8.20 kPa, p = 0.355). More severe RLS correlated with high chest-to-foot oxygen gradient (ρ = 0.692, p < 0.01). Carbon dioxide levels did not differ between the groups. Pramipexole corrected the peripheral hypoxia toward the levels observed in the controls (from 5.54 to 6.65 kPa, p < 0.05). Peripheral hypoxia is associated with the appearance of RLS symptoms. Strong correlation with RLS severity suggests a close pathophysiologic link between peripheral hypoxia and the symptoms of RLS. This is further supported by the simultaneous reversal of hypoxia and discomfort by dopaminergic treatment.
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Guillain-Barre syndrome (GBS) can be described as a collection of clinical syndromes that manifests as an acute inflammatory polyradiculoneuropathy with resultant weakness and diminished reflexes. Regarding pathophysiology of GBS, it is... more
Guillain-Barre syndrome (GBS) can be described as a collection of clinical syndromes that manifests as an acute inflammatory polyradiculoneuropathy with resultant weakness and diminished reflexes. Regarding pathophysiology of GBS, it is believed that autoimmunity- molecular mimicry plays a role in its pathogenesis. As the vaccines have an effect on the immune system it is reasonable that immunizations may be associated with subsequent GBS. Although rabies vaccines containing neural elements are very well known cause for GBS, no such positive correlation has been proven after newer formulations of rabies vaccine, derived from chick embryo cells. Here we report a case of GBS which developed after 5 weeks of anti-rabies vaccination (Purified Vero cell rabies vaccine) which was given after dog bite. Keywords: Guillain Barre Syndrome, Antirabies vaccine, Purified Vero cell rabies vaccine
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I read an interesting case report of Plasmodium vivax malaria complicated by symmetrical peripheral gangrene. With the reemergence of malaria, such rare but unique complications of malaria have been observed from time to time and reported... more
I read an interesting case report of Plasmodium vivax malaria complicated by symmetrical peripheral gangrene. With the reemergence of malaria, such rare but unique complications of malaria have been observed from time to time and reported mainly from India. More frequently being described in falciparum malaria, however, a few such cases or complications are also reported in P. vivax and mixed malaria also. Exact pathogenesis could not be ascertained. Microcirculatory block due to sludging of the parasitized erythrocytes in capillaries is a well-known factor in heavy Plasmodium falciparum parasitemia. The blockage of terminal arteries/arterioles could be the important reason for the gangrene. The vascular flow in the organs is disturbed by vascular collapse, thrombosis, infarction, and similar effects brought about by clumping together of parasitized cells. All these factors slow down the circulation and cause “sludging.” In a patient presenting with dry gangrene and fever, a possibility of malaria must be kept in mind not only in endemic areas but also in nonendemic areas because of the resurgence of malaria in the last few years.
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I read an interesting case report of Plasmodium vivax malaria complicated by symmetrical peripheral gangrene. With the reemergence of malaria, such rare but unique complications of malaria have been observed from time to time and reported... more
I read an interesting case report of Plasmodium vivax malaria complicated by symmetrical peripheral gangrene. With the reemergence of malaria, such rare but unique complications of malaria have been observed from time to time and reported mainly from India. More frequently being described in falciparum malaria, however, a few such cases or complications are also reported in P. vivax and mixed malaria also. Exact pathogenesis could not be ascertained. Microcirculatory block due to sludging of the parasitized erythrocytes in capillaries is a well-known factor in heavy Plasmodium falciparum parasitemia. The blockage of terminal arteries/arterioles could be the important reason for the gangrene. The vascular flow in the organs is disturbed by vascular collapse, thrombosis, infarction, and similar effects brought about by clumping together of parasitized cells. All these factors slow down the circulation and cause “sludging.” In a patient presenting with dry gangrene and fever, a possibility of malaria must be kept in mind not only in endemic areas but also in nonendemic areas because of the resurgence of malaria in the last few years.
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The article by Domínguez et al.1 is a milestone article in the evolution toward understanding migraine, especially chronic migraine. Of course, it is worth appreciation, but we must travel miles further to evaluate in this direction.... more
The article by Domínguez et al.1 is a milestone article in the evolution toward understanding migraine, especially chronic migraine. Of course, it is worth appreciation, but we must travel miles further to evaluate in this direction. There is impairment of iron homeostasis in migraineurs,2 but it remains unclear whether iron accumulation has a causative role or is a result of chronic migraine headache as assumed by an earlier study.2
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220 Annals of Tropical Medicine and Public Health | Sep-Oct 2015 | Vol 8 | Issue 5 Dear Sir, I went through a case report of cerebellar ataxia after mixed infection of plasmodium vivax and falciparum malaria by Kumar et al.[1] There have... more
220 Annals of Tropical Medicine and Public Health | Sep-Oct 2015 | Vol 8 | Issue 5 Dear Sir, I went through a case report of cerebellar ataxia after mixed infection of plasmodium vivax and falciparum malaria by Kumar et al.[1] There have been reports of such cases for more than three decades.[2] Earlier, they were described with falciparum malaria but later on with plasmodium vivax or mixed infections as well. More such cases were described after outbreaks in India in the nineties.[3,4] Cerebellar ataxia has been reported as a presenting illness without loss of consciousness (i.e., cerebral malaria), as sequelae in survivors of cerebral malaria, and as a delayed complication of malaria, i.e., delayed cerebellar ataxia or post malaria neurological syndrome.[3] Optic neuritis is also being described in patients of malaria as retrobulbar neuritis, a complication of chloroquine that along with vitreous hemorrhage and cortical blindness is an important cause of visual impairment in patients of malaria. But such combination of optic neuritis with ataxia has been recently reported and is supposed to be either a variant of delayed cerebellar ataxia or an acute disseminated encephalomyelitis.[5]