A 38-year-old lady presented with a two-week history of intermittent headache. She subsequently developed features of depression and cognitive decline. She had no focal neurological deficits. She was initially treated as a case of depression with pseudodementia. A diagnosis of acute disseminated encephalomyelitis (ADEM) was made later based on MRI brain and evoked potential studies. She was treated with intravenous methylprednisolone at a dose of 1 gram/day for three days, with which she made a good clinical recovery. This unusual presentation of ADEM is reported and the relevant literature reviewed.

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Serum immunoglobulins (IgG, IgA and IgM) and immune complexes IgG (IcG) were measured in 58 cases of acute inflammatory demyelinating neuropathy, popularly known as Guillian Barre' syndrome, and in 30 healthy controls using single radial immunodiffusion assay. Immunoglobulin and immune complex levels were significantly elevated in patients as compared to controls. The increased levels of immunoglobulins and immune complexes may contribute to the pathogenesis of the disease and provide rationale for therapeutic plasmapheresis.

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Diurnal variations in various physiological and biochemical functions and certain pathological events like myocardial infarction and stroke have been documented. We studied prospectively one hundred and seven patients of acute onset stroke confirmed by computed tomography for the exact time of onset, risk factors and type of stroke. Patients who were unclear of time of onset and with a diagnosis of cerebral venous thrombosis or sub-arachnoid hemorrhage were excluded. Infarction was detected in 71 patients and hemorrhage in 33 patients. Men out numbered women (1:6:1). Hypertension was more frequent in hemorrhage in the morning time (5 AM-12 noon) and more infarction between 12-6 pm. However there was no relation between the time of onset of stroke and various risk-factors of stroke.

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The diagnosis of myasthenia gravis in a patient with typical oculopharyngeal weakness with diurnal variation of symptoms and fatigability is easy and can often be made on clinical grounds. Patients who present with pharyngeal and proximal limb weakness without a definite diurnal variation of symptoms are occasionally treated with empirical corticosteroids with a presumptive diagnosis of inflammatory myopathy. We report a case where the diagnosis of myasthenia gravis was delayed due to empiric therapy with steroids.

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Full text not available  [PDF]

Full text not available  [PDF]