Self inflicted stab with a knife: An unusual mode of penetrating brain injury.

Self-inflicted penetrating injuries have been very rarely described in the medical literature. We describe a middle-aged woman, who had driven a long knife inside her skull with the help of a brick. She had done this to get relief from chronic headache, which was troubling her for 10 years.

"Person in the barrel" syndrome: Unusual heralding presentation of squamous cell carcinoma of the lung.

Paraneoplastic neurological syndromes (PNS) are rare and relatively unusual in day to day clinical practice. Occasionally, PNS may be the heralding manifestation of the malignancy. Paraneoplastic syndromes are most commonly associated with small cell lung carcinoma and are rarely seen with non small cell lung carcinoma.

Giant malignant peripheral nerve sheath tumor with cauda equina syndrome and subarachnoid hemorrhage: Complications in a case of type 1 neurofibromatosis.

Type 1 neurofibromatosis (NF1), which mainly involves ectodermal tissue arising from the neural crest, can increase the risk of developing malignant peripheral nerve sheath tumors (MPNSTs), soft tissue sarcomas and subarachnoid hemorrhage. We describe a patient with neurofibromatosis type 1 who developed soft tissue sarcoma, MPNST, and subarachnoid hemorrhage. A 22-year-old male reported right focal seizures consequence to severe headache.

Cysticercal encephalitis presenting with a "starry sky" appearance on neuroimaging.

A lady in her early forties was brought to our hospital in an unconscious state with history of generalized tonic-clonic seizures for last 6 h. She had multiple episodes of seizures in last 4 months, but did not receive any treatment. Relatives also gave a history of fever, headache, and vomiting for last 1 week.

Isolated intramedullary spinal cord cysticercosis.

Neurocysticercosis is a major cause of epilepsy in developing countries. Cysticercal involvement of the spinal cord is rare even in endemic areas and accounts for 0.7 to 5.

Gastrointestinal stromal tumour of small intestine presenting as a mesenteric mass.

Gastrointestinal stromal tumors (GISTs) are uncommon tumors; accounts for 0.1% to 3% of all gastrointestinal neoplasm. Most common site of involvement is stomach (60-70 %), small intestine (20-30 %) and rarely at extra-gastrointestinal sites like omentum and mesentery called as extra-gastrointestinal stromal tumor (EGIST).

Predictors of mortality in patients of poisonous snake bite: Experience from a tertiary care hospital in Central India.

Background And Aims: This study was undertaken, to assess the clinical parameters in patients of poisonous snakebite, complications which occurred in them, their outcome and to evaluate various clinical predictors of mortality.

Materials And Methods: Four hundred and thirty-two patients of snake bite were admitted, of which 172 did not show any signs of envenomation and excluded. Two hundred and sixty patients had signs of local or systemic envenomation and included.

Pituitary apoplexy syndrome as the manifestation of intracranial tuberculoma.

Pituitary apoplexy syndrome is characterised by acute neuro-ophthalmological features and usually occurs due to bleeding in a pituitary adenoma. It is an unusual presentation of tuberculoma, as only few similar cases have been reported previously. A 17-year-old girl presented with headache, vomiting, altered sensorium and vision loss.

Clinical predictors of acute kidney injury following snake bite envenomation.

Background: Snake bite envenomation is a major public health concern in developing countries. Acute kidney injury (AKI) is as important cause of mortality in patients with vasculotoxic snake bite.

Aims: This study was to evaluate the clinical profile of snake bite patients and to determine the predictors of developing AKI following snake bite.

Pure motor monoparesis: solitary cysticercus granuloma.

Solitary cysticercus granuloma (SCG) is the most common form of neurocysticercosis in India and usually presents with seizures. Pure motor monoparesis (PMM) due to cerebral cysticercus lesions has been rarely reported and it has not been seen with SCG. We describe a young girl with SCG who presented with PMM without any other neurological manifestations.

Acute myeloneuropathy: An uncommon presentation of Sjögren's syndrome.

Sjögren's syndrome is associated with central and peripheral nervous system involvement. The peripheral neuropathy is usually a sensory predominant neuropathy or a cranial neuropathy. Myelopathy is usually of focal, subacute, chronic or relapsing type.

Cerebral-autoregulatory dysfunction syndrome.

Reversible cerebral vasoconstriction syndrome and reversible posterior leukoencephalopathy syndrome are distinct clinicoradiological disorders which share certain features in terms of aetiology, pathogenesis and symptomatology. We present a case of a young primigravida with eclampsia who developed severe headache, vision loss and hemiparesis in the postpartum phase. MRI of the brain was suggestive of the involvement of anterior as well as posterior circulation and reversibility of widespread angiographic constrictions could be documented on follow-up.

Extensive acute disseminated encephalomyelitis in a young girl responding to intravenous methylprednisolone.

Acute disseminated encephalomyelitis (ADEM) is a monophasic clinical syndrome, characterised by immune-mediated demyelination of the central nervous system. Differentiating ADEM from acute viral encephalomyelitis may pose a difficult clinical challenge. We describe a 3-year-old girl who presented with fever, weakness in all four limbs, urinary retention, respiratory distress and altered sensorium.

A rare presentation of cerebral venous sinus thrombosis associated with tubercular meningitis.

Central nervous system (CNS) tuberculosis may manifest as meningitis, meningoencephalitis, tuberculoma, tubercular abscess, stroke due to tuberculous vasculitis and tuberculous encephalopathy. Occasionally, tubercular meningitis (TBM) can predispose to cerebral venous sinus thrombosis (CVST). We report a young man, who developed CVST as a complication of TBM.

Early treatment causes clinicoradiological reversal of myelopathy due to vitamin B12 deficiency.

Vitamin B12 deficiency has a wide spectrum of clinical presentation with a variety of neurological symptoms and signs. As a result, many patients lack classic features of advanced severe deficiency. Early diagnosis and treatment are crucial in order to prevent the irreversible damage to the nervous system.

Isolated thalamic tuberculoma presenting as ataxic hemiparesis.

Lacunar syndrome is a neurodeficit secondary to a deep cerebral lesion, usually because of microatheroma of small arteries. Ataxic hemiparesis (AH) is a lacunar syndrome with unilateral pyramidal weakness and ipsilateral ataxia. Thalamic tuberculoma, as a cause of AH, has not been previously described in the literature.

Disseminated tuberculosis manifesting as pulmonary, meningeal and spinal tuberculosis in an immunocompetent patient.

Disseminated tuberculosis is characterised by concurrent tubercular involvement of two or more non-contiguous organs. It is an unusual presentation of tuberculosis, especially in the absence of immunodeficiency. We describe a young, immunocompetent patient who presented with fever, cough, headache, diplopia and paraparesis.

Hirayama disease: a frequently undiagnosed condition with simple inexpensive treatment.

Hirayama disease is a non-progressive asymmetric juvenile muscular atrophy involving C7-T1 myotomes leading to weakness and atrophy of intrinsic muscles of hand and forearm with relative sparing of the brachioradialis muscle. This benign focal cervical poliopathy is believed to be caused by forward displacement of the posterior cervical dural sac. In this case report we highlight the importance of dynamic MRI of cervical spine for diagnosis of the above condition and the use of hard cervical collar to prevent further flexion injury.

Is blinking of the eyes affected in extrapyramidal disorders? An interesting observation in a patient with Wilson disease.

Blinking of eye is a routine human activity which seldom attracts any attention of clinicians in health and disease. There is experimental evidence that blink rate is affected in extrapyramidal disorders affecting the balance of these neurotransmitters. However, no observations regarding blink rate in Wilson disease (WD) have been reported previously.

Extensive extracranial and intracranial Varicella zoster vasculopathy.

Varicella zoster virus (VZV)-induced vasculopathy is an uncommon cause of stroke in a young immunocompetent host. Owing to scarcity of data of VZV-induced vasculopathy and lack of awareness about this condition and its diagnostic test, these cases may be easily missed. In this case, we report an immunocompetent host presenting right-side hemiplegia with motor aphasia and complete loss of vision in the left eye due to complete occlusion of the left common carotid artery without any history of skin rash preceding stroke.