Diagnosis of optochiasmatic tuberculosis revealed by computed tomography and magnetic resonance imaging

A woman had a sudden painful decrease in vision in the left eye and then the right eye. Computed tomography and magnetic resonance imaging revealed a “ring” lesion in the right parietal lobe. Further testing and a past history of pulmonary tuberculosis led to a diagnosis of optochiasmatic tuberculosis. Antitubercular treatment led to dramatically improved vision and a radiologic resolution. Although rare, optochiasmatic tuberculosis should be considered in the differential diagnosis of nonspecific optic neuritis and optic nerve and chiasmal tumors.     

Oxygraphy: An Unexplored Perioperative Monitoring Modality

Capnography waveforms and capnometry are useful perioperative monitoring tools. The paramagnetic oxygen analyzers incorporated in many clinical monitoring systems estimate oxygen concentration in the breathing circuit during various phases of ventilation. The oxygen concentration is plotted as a real-time waveform and displayed as an oxygraph. However, the clinical utility of oxygraphy is under evaluated. We are reporting four different clinical scenarios in neurosurgical patients, wherein the information yielded by oxygraphy were either not available on the capnograph or were revealed in a more promising way on the oxygraph than on the capnograph. A real-time oxygraphy waveform has four phases similar to a capnograph, although displayed in a reverse manner. Oxygraphy was useful in our patient to determine the adequacy of preoxygenation. Airway complications and unwanted neuromuscular recovery can be detected earlier by oxygraphy compared to capnography. The oxygraphy peak-to-baseline scale difference can be compressed to as low as to 6% of oxygen concentration. When the peak-to-baseline scale difference is 6 mmHg, the oxygraph becomes sensitive to even minute changes in respiratory flow characteristics. Oxygraphy may have a potential role in clinical monitoring. Gadhinglajkar S, Sreedhar R, Unnikrishnan KP. Oxygraphy: an unexplored Perioperative monitoring modality.     

Relief from episodic weakness with pyridostigmine in paramyotonia congenita: A family study

Pyridostigmine relieved episodic weakness in a family with paramyotonia congenita resulting from the R1448C mutation in the sodium channel gene. The transmission was autosomal dominant and the patients had paradoxical myotonia and exercise‐induced weakness. On electrophysiological studies there were myotonic potentials, and there was progressive reduction of compound muscle action potential (CMAP) amplitudes after short exercise associated with clinical weakness. Pyridostigmine in doses of 60 mg three times daily abolished the drop in the postexercise CMAP amplitude and reduced the amplitude decrement to slow rate repetitive stimulation, but there continued to be a drop in amplitude on exposure to cold. The decline of the CMAP amplitude on exposure to cold was controlled by treatment with phenytoin. The clinical and electrophysiological features are discussed in relation to therapy with pyridostigmine and phenytoin. Muscle Nerve, 2010     

Two cases of orbital tuberculosis in children with unique presentations

A 3-year-old boy and a 2-year-old girl were diagnosed with orbital tuberculosis. In our first patient the primary focus of tuberculosis was the cervico-thoracic spine, but could not be detected in the second. These are the youngest ever reported cases of orbital tuberculosis. Where tuberculosis is endemic, orbital tuberculosis should be considered as a differential diagnosis for orbital swellings in pediatric patients. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Congenital Yellow Nail Syndrome: A Case Report and Its Relationship to Nonimmune Fetal Hydrops

Abstract: Yellow nail syndrome (YNS) is an uncommon disorder characterized by a triad of nail dystrophy, lymphedema, and pleural effusion. It is rare in children and congenital occurrence of YNS has been very rarely described. We report a 2‐year‐old Arab boy having congenital yellow nail syndrome with mild facial dysmorphism and bilateral conjunctival pigmentation born to consanguineous parents. One of his older siblings had died of nonimmune fetal hydrops (NIFH). The case supports the genetic basis of yellow nail syndrome with a possible relationship to nonimmune fetal hydrops.     

Management of choroidal metastasis: a report

Cancers metastatic to the eye are the most common intraocular malignancy, the choroid being the most common site of affection. Breast and lung cancers are the two most common malignancies metastatic to the eye. Patients usually present with diminished visual acuity of field loss. Management of these cases is very gratifying with a large majority of patients showing resolution and maintenance of useful vision in the involved eye. This communication presents our experience in management of a case of choroidal metastasis from a breast primary. A combination of radiotherapy and chemotherapy lead to complete resolution of the lesion with no recurrences in a follow-up of over 6 months.     

Co-existence of atypical tuberculid with lupus vulgaris

Cutaneous tuberculosis (CTB) is an uncommon form of extra-pulmonary tuberculosis accounting for ≤2% of mycobacterium tuberculosis cases and is more often reported from developing countries. Tuberculid, a cutaneous hypersensitivity reaction to mycobacteria or its fragments, is a another rare cutaneous manifestation seen in association with tuberculosis of other organ systems including tuberculous lymphadenitis, pulmonary tuberculosis, etc. Co-occurrence of a tuberculid with CTB is extremely rare. Herein we report a childhood case of lupus vulgaris, a type of CTB, associated with an atypical presentation of tuberculid.