This document describes a case of diphtheritic polyneuropathy in a 53-year-old man who developed weakness, numbness, and bulbar palsy several weeks after a sore throat. Diphtheritic polyneuropathy results from the toxin produced by Corynebacterium diphtheriae inhibiting protein synthesis. It initially causes local effects like bulbar palsy followed by a generalized demyelinating peripheral neuropathy. The patient's symptoms followed the typical progression and resolved over several months. The diagnosis was difficult but important to differentiate from Guillain-Barré syndrome given differences in treatment and prognosis. Diphtheritic polyneuropathy highlights the need for continued vaccination and awareness of this condition.
This case report describes a 48-year-old Sri Lankan farmer who presented with symptoms of diphtheria including sore throat, difficulty swallowing, eye problems, and numbness in his hands and feet. Examination found swelling in his neck and problems moving his eyes. Tests later found severe inflammation and coating in his throat. He was treated with antibiotics and diphtheria antitoxin, and recovered fully. This rare case suggests that diphtheria may still occur occasionally in non-immunized adults in Sri Lanka, though childhood vaccination programs have largely eradicated it. Proper laboratory testing and rapid treatment are important to diagnose and manage any future cases.
Prosper Meniere first accurately described Meniere's disease in the 19th century. He identified the site of lesion as the labyrinth. Since then, little has been added to the understanding of the disorder. The exact etiology is unknown, but theories include genetic factors, anatomical abnormalities, trauma, viral infection, allergy, and autoimmunity. The pathophysiology involves endolymphatic hydrops due to impaired absorption or excessive secretion of endolymphatic fluid leading to distention of the membranous labyrinth, starting in the cochlear duct and saccule. Dysfunction of the endolymphatic sac may also contribute by reducing fluid absorption capacity.
Ménière's disease it’s definition ,etiopathogenesis and managementsritama1988
Meniere's disease is characterized by spontaneous attacks of vertigo accompanied by fluctuating hearing loss, tinnitus, and aural fullness. It is caused by endolymphatic hydrops, or a buildup of fluid in the inner ear. Attacks typically involve severe vertigo that lasts hours and progresses through irritative, paretic, and recovery phases with associated nystagmus. Hearing loss is usually low frequency and fluctuating at first but becomes progressively worse over time. The pathophysiology is thought to involve ruptures in the inner ear membranes allowing toxic endolymph to leak out and cause sustained neuron activation during attacks.
Abir, an 8-year-old boy, was admitted to the hospital with difficulty swallowing, talking, and weakness in his upper and lower limbs. He had a fever 20 days prior. Acute flaccid paralysis (AFP) is characterized by rapid onset weakness that can include respiratory and bulbar weakness. Differential diagnoses for AFP include Guillain-Barré syndrome, transverse myelitis, poliomyelitis, traumatic neuritis, and hypokalemic paralysis. Proper management of AFP requires assessing respiratory function, bulbar weakness, cardiovascular stability, and ruling out electrolyte imbalances or spinal cord compression.
This document discusses several common tropical diseases seen in surgery, including filariasis, leprosy, tropical chronic pancreatitis, and poliomyelitis. Filariasis is caused by a parasitic worm and can lead to lymphedema and elephantiasis. Leprosy is caused by Mycobacterium leprae and can result in skin lesions and nerve damage leading to claw hand deformities. Tropical chronic pancreatitis has unknown causes but is linked to poor nutrition and affects young people in developing countries. Poliomyelitis is caused by an enterovirus and while most cases are mild, it can also lead to paralysis requiring rehabilitation and surgical intervention.
This document provides information about poliomyelitis (polio). It defines polio as a viral illness caused by poliovirus that can lead to paralysis. There are 3 types of poliovirus. Polio spreads through the gastrointestinal tract and sometimes to the central nervous system. Most polio infections are asymptomatic, but some cause abortive or nonparalytic illness. Rarely, it causes paralytic polio. Treatment involves supportive care, while vaccines can prevent the disease.
Meniere's disease is characterized by episodes of vertigo, tinnitus, and hearing loss caused by endolymphatic hydrops, or swelling of the inner ear fluid compartments. The exact cause is unknown but may involve defective fluid absorption, vasomotor disturbances, or sodium/water retention. Diagnosis is based on symptoms and ruling out other causes. Treatment focuses on managing vertigo attacks, reducing fluid pressure through diet/diuretics, and surgery such as endolymphatic sac decompression for severe cases. Prognosis varies but many patients experience stabilization over time.
This case report describes a 48-year-old Sri Lankan farmer who presented with symptoms of diphtheria including sore throat, difficulty swallowing, eye problems, and numbness in his hands and feet. Examination found swelling in his neck and problems moving his eyes. Tests later found severe inflammation and coating in his throat. He was treated with antibiotics and diphtheria antitoxin, and recovered fully. This rare case suggests that diphtheria may still occur occasionally in non-immunized adults in Sri Lanka, though childhood vaccination programs have largely eradicated it. Proper laboratory testing and rapid treatment are important to diagnose and manage any future cases.
Prosper Meniere first accurately described Meniere's disease in the 19th century. He identified the site of lesion as the labyrinth. Since then, little has been added to the understanding of the disorder. The exact etiology is unknown, but theories include genetic factors, anatomical abnormalities, trauma, viral infection, allergy, and autoimmunity. The pathophysiology involves endolymphatic hydrops due to impaired absorption or excessive secretion of endolymphatic fluid leading to distention of the membranous labyrinth, starting in the cochlear duct and saccule. Dysfunction of the endolymphatic sac may also contribute by reducing fluid absorption capacity.
Ménière's disease it’s definition ,etiopathogenesis and managementsritama1988
Meniere's disease is characterized by spontaneous attacks of vertigo accompanied by fluctuating hearing loss, tinnitus, and aural fullness. It is caused by endolymphatic hydrops, or a buildup of fluid in the inner ear. Attacks typically involve severe vertigo that lasts hours and progresses through irritative, paretic, and recovery phases with associated nystagmus. Hearing loss is usually low frequency and fluctuating at first but becomes progressively worse over time. The pathophysiology is thought to involve ruptures in the inner ear membranes allowing toxic endolymph to leak out and cause sustained neuron activation during attacks.
Abir, an 8-year-old boy, was admitted to the hospital with difficulty swallowing, talking, and weakness in his upper and lower limbs. He had a fever 20 days prior. Acute flaccid paralysis (AFP) is characterized by rapid onset weakness that can include respiratory and bulbar weakness. Differential diagnoses for AFP include Guillain-Barré syndrome, transverse myelitis, poliomyelitis, traumatic neuritis, and hypokalemic paralysis. Proper management of AFP requires assessing respiratory function, bulbar weakness, cardiovascular stability, and ruling out electrolyte imbalances or spinal cord compression.
This document discusses several common tropical diseases seen in surgery, including filariasis, leprosy, tropical chronic pancreatitis, and poliomyelitis. Filariasis is caused by a parasitic worm and can lead to lymphedema and elephantiasis. Leprosy is caused by Mycobacterium leprae and can result in skin lesions and nerve damage leading to claw hand deformities. Tropical chronic pancreatitis has unknown causes but is linked to poor nutrition and affects young people in developing countries. Poliomyelitis is caused by an enterovirus and while most cases are mild, it can also lead to paralysis requiring rehabilitation and surgical intervention.
This document provides information about poliomyelitis (polio). It defines polio as a viral illness caused by poliovirus that can lead to paralysis. There are 3 types of poliovirus. Polio spreads through the gastrointestinal tract and sometimes to the central nervous system. Most polio infections are asymptomatic, but some cause abortive or nonparalytic illness. Rarely, it causes paralytic polio. Treatment involves supportive care, while vaccines can prevent the disease.
Meniere's disease is characterized by episodes of vertigo, tinnitus, and hearing loss caused by endolymphatic hydrops, or swelling of the inner ear fluid compartments. The exact cause is unknown but may involve defective fluid absorption, vasomotor disturbances, or sodium/water retention. Diagnosis is based on symptoms and ruling out other causes. Treatment focuses on managing vertigo attacks, reducing fluid pressure through diet/diuretics, and surgery such as endolymphatic sac decompression for severe cases. Prognosis varies but many patients experience stabilization over time.
Critical Illness Polyneuromyopathy (CIPNM) is frequently present in critically ill as a certain degree of symmetric extremity paresis and respiratory muscle weakness. The consequences of this complication may last for months or years after severe illness. It prolongs the stay in ICU and dependence onmechanical ventilation, increases long-term disability and care costs. We report a 58-year old female patient admitted to our Intensive Care Unit for acute respiratory insuffi ciency due to infl uenza pneumonia and acute respiratory distress syndrome. Thirty-three days of mechanical ventilation and 11 days of extracorporal membrane oxygenation were complicated by severe CIPNM, tetraparesis, mental disorders, and diffi culties in weaning off mechanical ventilation. No specifi c therapy is available for treatment of CIPNM. Preventive, supportive and rehabilitation measures are discussed in the article.
This document describes the case of a 13-year-old boy who presented with a one month history of progressive headaches, left-sided weakness, and mild bilateral papilledema. Imaging revealed a cystic lesion in the right parieto-occipital region. The patient underwent a neurosurgical procedure to remove the intact cyst, which was confirmed to be an isolated intracranial hydatid cyst based on pathology. Hydatid cysts are caused by the tapeworm Echinococcus and most commonly involve the liver and lungs. Intracranial involvement is rare but can cause signs of increased intracranial pressure like this case.
This document provides an overview of central nervous system (CNS) infections including distinct clinical syndromes such as acute bacterial meningitis, viral meningitis, encephalitis, focal infections, and infectious thrombophlebitis. It discusses the epidemiology, etiology, risk factors, clinical manifestations, diagnosis, and treatment of various CNS infections with a focus on bacterial meningitis. Common causes of bacterial meningitis are outlined for different age groups and risk factors. The diagnosis involves CSF and blood analysis as well as imaging studies. Treatment depends on the suspected pathogen and involves antimicrobial therapy. Viral encephalitis is also overviewed including definition, clinical manifestations, diagnosis involving CSF analysis and imaging, and generally
Encephalitis and other brain infection final (autosaved)Ahmed Hassan
This document provides an overview of encephalitis, including its causes, types, diagnosis, and clinical features. Encephalitis is defined as inflammation of the brain, most commonly caused by viral infections like herpes simplex virus. It can present acutely over hours or chronically over weeks/months. Diagnosis involves examining cerebrospinal fluid for signs of infection and inflammation, imaging the brain, and testing for viral or bacterial presence through culture, antibody tests, or nucleic acid detection methods. Common symptoms include fever, headache, confusion, seizures, and focal neurological deficits. Differential diagnosis includes other infections, demyelinating diseases, tumors, and vascular or metabolic encephalopathies.
This document provides definitions and information about idiopathic sudden sensorineural hearing loss (ISSNHL). It discusses the epidemiology, potential causes including viral, vascular, autoimmune and Meniere's disease. It outlines the clinical assessment process including history, examination and investigations. Prognosis factors and treatment approaches are summarized, including steroid therapy options and complications. Standard treatment is oral corticosteroids, though intratympanic injections are gaining popularity for refractory cases to reduce side effects. More research is still needed on efficacy of treatments.
Encephalitis among children, Child Health NursingLaxmiDahal7
Encephalitis is an inflammation of the brain caused by viruses in most cases. It can cause symptoms ranging from irritability and fever to seizures and coma. Diagnosis involves lumbar puncture to analyze cerebrospinal fluid and neuroimaging. Treatment focuses on supportive care and specific antiviral drugs. Complications can include seizures, increased intracranial pressure, and long term neurological deficits. Prevention is through vaccination against viruses known to cause encephalitis like measles, mumps and Japanese encephalitis. Prognosis depends on the virus but 10-40% of patients may die and survivors often face neurological sequelae.
Lateral medullary syndrome (LMS) is a type of ischemic stroke
which occurs due to disruption of the blood flow in vertebral artery, or posterior inferior cerebellar artery. LMS can present with
various sign and symptoms, depending on the site of infarct at the
medullary area. Typical LMS often affects the pain and temperature sensation over the contralateral extremities and ipsilateral face
of the infarct area. We illustrate a case of LMS with predominant
bulbar symptoms which is sparse the sensation and our treatment
experience.
Bronchiectasis and other lung suppurative diseasesHisham Alrabty
1. Bronchiectasis is a chronic lung condition defined by abnormal dilatation of the bronchi caused by destruction of the elastic and muscular components of the bronchial walls.
2. It has various etiologies including infections, genetic disorders, immune deficiencies, and other acquired conditions.
3. Patients typically present with chronic cough and sputum production along with signs of lung disease on examination and imaging studies like CT scan show characteristic bronchial wall thickening.
This document provides information about Meniere's disease, including its definition, symptoms, diagnosis, and treatment. Some key points:
- Meniere's disease is a disorder of the inner ear that causes episodes of vertigo, hearing loss, tinnitus, and a feeling of ear fullness. It is caused by endolymphatic hydrops.
- The classic triad of symptoms includes hearing loss, tinnitus, and vertigo, though some patients may experience fewer than all three. Attacks typically last hours.
- Diagnosis is based on ruling out other causes and observing recurrent vertigo spells along with audiometric evidence of hearing loss. There are no definitive tests.
Neonatal tetanus is caused by Clostridium tetani bacteria entering the body of a newborn baby through an open wound like the umbilical stump. It causes painful muscle spasms and can lead to death in some cases. It is particularly common in developing countries where unhygienic birthing practices are prevalent. Prevention focuses on immunizing women of childbearing age and ensuring all births occur under clean conditions.
Hypoparathyroidism - Not Only after StrumectomyUnusual Presentations of the R...AnonIshanvi
Hypoparathyroidism (HypoPT) is an endocrine disease with low calcium and inappropriately low (insufficient) circulating PTH levels. HypoPT may have an autoimmune pathogenesis, however, the most common causes of chronic HypoPT are iatrogenic: mostly thyroid or parathyroid surgery. Much less frequently HypoPT...
Hypoparathyroidism - Not Only after StrumectomyUnusual Presentations of the R...semualkaira
Hypoparathyroidism (HypoPT) is an endocrine disease with low calcium and inappropriately low (insufficient) circulating PTH levels. HypoPT may have an autoimmune pathogenesis, however, the most common causes of chronic HypoPT are iatrogenic: mostly thyroid or parathyroid surgery. Much less frequently HypoPT.
Hypoparathyroidism - Not Only after StrumectomyUnusual Presentations of the R...semualkaira
Hypoparathyroidism (HypoPT) is an endocrine disease with low calcium and inappropriately low (insufficient) circulating PTH levels. HypoPT may have an autoimmune pathogenesis, however, the most common causes of chronic HypoPT are iatrogenic: mostly thyroid or parathyroid surgery. Much less frequently HypoPT...
Hypoparathyroidism (HypoPT) is an endocrine disease with low
calcium and inappropriately low (insufficient) circulating PTH
levels. It is a rare condition
Hypoparathyroidism - Not Only after StrumectomyUnusual Presentations of the R...NainaAnon
This document discusses two cases of hypoparathyroidism presenting in unusual ways. The first case is a man who developed hypoparathyroidism after neck irradiation for lymphoma who experienced respiratory symptoms. The second case is an elderly man who developed hypoparathyroidism after laryngectomy 30 years prior who experienced fainting spells. Hypoparathyroidism can present atypically and be overlooked, so monitoring of calcium levels is important, especially after neck surgeries or radiation.
This document discusses complications that can arise from otitis media, including both acute and chronic otitis media. It covers extracranial complications like facial nerve paralysis, labyrinthitis, petrositis, and mastoiditis. Intracranial complications discussed include CSF otorrhea, meningitis, brain abscess, thrombophlebitis, and otitic hydrocephalus. The document provides details on the pathophysiology, presentation, diagnosis, and treatment of each complication.
This document presents a case study of a 39-year old female patient diagnosed with Wergner's Granulomatosis (WG). She presented with left ear itching and drainage. Testing showed positive ANCA and PR3 antibodies. Imaging found lesions in the lung, ear, and sinus involvement. She was diagnosed with WG based on her clinical presentation and test results. She was treated with cyclophosphamide, corticosteroids, antibiotics, and other medications. WG is a rare autoimmune disease that involves inflammation and damage of small blood vessels. It commonly involves the upper respiratory tract, lungs, and kidneys. Without treatment, it can be fatal but prognosis has improved with immunosuppressive therapies.
This document discusses ocular tuberculosis. It begins with an introduction to tuberculosis as a systemic disease caused by Mycobacterium tuberculosis. It then covers the clinical criteria for systemic TB disease and laboratory diagnostic criteria. It discusses the pathophysiology, transmission, and pathogenesis of TB infection. The document outlines various clinical presentations of ocular TB including anterior uveitis, intermediate uveitis, posterior segment manifestations, neuro-ophthalmic manifestations, adnexal involvement, and drug-related ocular toxicity. Investigations for diagnosing ocular TB such as the Mantoux test, chest imaging, and ocular exams are also summarized.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Critical Illness Polyneuromyopathy (CIPNM) is frequently present in critically ill as a certain degree of symmetric extremity paresis and respiratory muscle weakness. The consequences of this complication may last for months or years after severe illness. It prolongs the stay in ICU and dependence onmechanical ventilation, increases long-term disability and care costs. We report a 58-year old female patient admitted to our Intensive Care Unit for acute respiratory insuffi ciency due to infl uenza pneumonia and acute respiratory distress syndrome. Thirty-three days of mechanical ventilation and 11 days of extracorporal membrane oxygenation were complicated by severe CIPNM, tetraparesis, mental disorders, and diffi culties in weaning off mechanical ventilation. No specifi c therapy is available for treatment of CIPNM. Preventive, supportive and rehabilitation measures are discussed in the article.
This document describes the case of a 13-year-old boy who presented with a one month history of progressive headaches, left-sided weakness, and mild bilateral papilledema. Imaging revealed a cystic lesion in the right parieto-occipital region. The patient underwent a neurosurgical procedure to remove the intact cyst, which was confirmed to be an isolated intracranial hydatid cyst based on pathology. Hydatid cysts are caused by the tapeworm Echinococcus and most commonly involve the liver and lungs. Intracranial involvement is rare but can cause signs of increased intracranial pressure like this case.
This document provides an overview of central nervous system (CNS) infections including distinct clinical syndromes such as acute bacterial meningitis, viral meningitis, encephalitis, focal infections, and infectious thrombophlebitis. It discusses the epidemiology, etiology, risk factors, clinical manifestations, diagnosis, and treatment of various CNS infections with a focus on bacterial meningitis. Common causes of bacterial meningitis are outlined for different age groups and risk factors. The diagnosis involves CSF and blood analysis as well as imaging studies. Treatment depends on the suspected pathogen and involves antimicrobial therapy. Viral encephalitis is also overviewed including definition, clinical manifestations, diagnosis involving CSF analysis and imaging, and generally
Encephalitis and other brain infection final (autosaved)Ahmed Hassan
This document provides an overview of encephalitis, including its causes, types, diagnosis, and clinical features. Encephalitis is defined as inflammation of the brain, most commonly caused by viral infections like herpes simplex virus. It can present acutely over hours or chronically over weeks/months. Diagnosis involves examining cerebrospinal fluid for signs of infection and inflammation, imaging the brain, and testing for viral or bacterial presence through culture, antibody tests, or nucleic acid detection methods. Common symptoms include fever, headache, confusion, seizures, and focal neurological deficits. Differential diagnosis includes other infections, demyelinating diseases, tumors, and vascular or metabolic encephalopathies.
This document provides definitions and information about idiopathic sudden sensorineural hearing loss (ISSNHL). It discusses the epidemiology, potential causes including viral, vascular, autoimmune and Meniere's disease. It outlines the clinical assessment process including history, examination and investigations. Prognosis factors and treatment approaches are summarized, including steroid therapy options and complications. Standard treatment is oral corticosteroids, though intratympanic injections are gaining popularity for refractory cases to reduce side effects. More research is still needed on efficacy of treatments.
Encephalitis among children, Child Health NursingLaxmiDahal7
Encephalitis is an inflammation of the brain caused by viruses in most cases. It can cause symptoms ranging from irritability and fever to seizures and coma. Diagnosis involves lumbar puncture to analyze cerebrospinal fluid and neuroimaging. Treatment focuses on supportive care and specific antiviral drugs. Complications can include seizures, increased intracranial pressure, and long term neurological deficits. Prevention is through vaccination against viruses known to cause encephalitis like measles, mumps and Japanese encephalitis. Prognosis depends on the virus but 10-40% of patients may die and survivors often face neurological sequelae.
Lateral medullary syndrome (LMS) is a type of ischemic stroke
which occurs due to disruption of the blood flow in vertebral artery, or posterior inferior cerebellar artery. LMS can present with
various sign and symptoms, depending on the site of infarct at the
medullary area. Typical LMS often affects the pain and temperature sensation over the contralateral extremities and ipsilateral face
of the infarct area. We illustrate a case of LMS with predominant
bulbar symptoms which is sparse the sensation and our treatment
experience.
Bronchiectasis and other lung suppurative diseasesHisham Alrabty
1. Bronchiectasis is a chronic lung condition defined by abnormal dilatation of the bronchi caused by destruction of the elastic and muscular components of the bronchial walls.
2. It has various etiologies including infections, genetic disorders, immune deficiencies, and other acquired conditions.
3. Patients typically present with chronic cough and sputum production along with signs of lung disease on examination and imaging studies like CT scan show characteristic bronchial wall thickening.
This document provides information about Meniere's disease, including its definition, symptoms, diagnosis, and treatment. Some key points:
- Meniere's disease is a disorder of the inner ear that causes episodes of vertigo, hearing loss, tinnitus, and a feeling of ear fullness. It is caused by endolymphatic hydrops.
- The classic triad of symptoms includes hearing loss, tinnitus, and vertigo, though some patients may experience fewer than all three. Attacks typically last hours.
- Diagnosis is based on ruling out other causes and observing recurrent vertigo spells along with audiometric evidence of hearing loss. There are no definitive tests.
Neonatal tetanus is caused by Clostridium tetani bacteria entering the body of a newborn baby through an open wound like the umbilical stump. It causes painful muscle spasms and can lead to death in some cases. It is particularly common in developing countries where unhygienic birthing practices are prevalent. Prevention focuses on immunizing women of childbearing age and ensuring all births occur under clean conditions.
Hypoparathyroidism - Not Only after StrumectomyUnusual Presentations of the R...AnonIshanvi
Hypoparathyroidism (HypoPT) is an endocrine disease with low calcium and inappropriately low (insufficient) circulating PTH levels. HypoPT may have an autoimmune pathogenesis, however, the most common causes of chronic HypoPT are iatrogenic: mostly thyroid or parathyroid surgery. Much less frequently HypoPT...
Hypoparathyroidism - Not Only after StrumectomyUnusual Presentations of the R...semualkaira
Hypoparathyroidism (HypoPT) is an endocrine disease with low calcium and inappropriately low (insufficient) circulating PTH levels. HypoPT may have an autoimmune pathogenesis, however, the most common causes of chronic HypoPT are iatrogenic: mostly thyroid or parathyroid surgery. Much less frequently HypoPT.
Hypoparathyroidism - Not Only after StrumectomyUnusual Presentations of the R...semualkaira
Hypoparathyroidism (HypoPT) is an endocrine disease with low calcium and inappropriately low (insufficient) circulating PTH levels. HypoPT may have an autoimmune pathogenesis, however, the most common causes of chronic HypoPT are iatrogenic: mostly thyroid or parathyroid surgery. Much less frequently HypoPT...
Hypoparathyroidism (HypoPT) is an endocrine disease with low
calcium and inappropriately low (insufficient) circulating PTH
levels. It is a rare condition
Hypoparathyroidism - Not Only after StrumectomyUnusual Presentations of the R...NainaAnon
This document discusses two cases of hypoparathyroidism presenting in unusual ways. The first case is a man who developed hypoparathyroidism after neck irradiation for lymphoma who experienced respiratory symptoms. The second case is an elderly man who developed hypoparathyroidism after laryngectomy 30 years prior who experienced fainting spells. Hypoparathyroidism can present atypically and be overlooked, so monitoring of calcium levels is important, especially after neck surgeries or radiation.
This document discusses complications that can arise from otitis media, including both acute and chronic otitis media. It covers extracranial complications like facial nerve paralysis, labyrinthitis, petrositis, and mastoiditis. Intracranial complications discussed include CSF otorrhea, meningitis, brain abscess, thrombophlebitis, and otitic hydrocephalus. The document provides details on the pathophysiology, presentation, diagnosis, and treatment of each complication.
This document presents a case study of a 39-year old female patient diagnosed with Wergner's Granulomatosis (WG). She presented with left ear itching and drainage. Testing showed positive ANCA and PR3 antibodies. Imaging found lesions in the lung, ear, and sinus involvement. She was diagnosed with WG based on her clinical presentation and test results. She was treated with cyclophosphamide, corticosteroids, antibiotics, and other medications. WG is a rare autoimmune disease that involves inflammation and damage of small blood vessels. It commonly involves the upper respiratory tract, lungs, and kidneys. Without treatment, it can be fatal but prognosis has improved with immunosuppressive therapies.
This document discusses ocular tuberculosis. It begins with an introduction to tuberculosis as a systemic disease caused by Mycobacterium tuberculosis. It then covers the clinical criteria for systemic TB disease and laboratory diagnostic criteria. It discusses the pathophysiology, transmission, and pathogenesis of TB infection. The document outlines various clinical presentations of ocular TB including anterior uveitis, intermediate uveitis, posterior segment manifestations, neuro-ophthalmic manifestations, adnexal involvement, and drug-related ocular toxicity. Investigations for diagnosing ocular TB such as the Mantoux test, chest imaging, and ocular exams are also summarized.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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NYSORA Guideline
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
1. See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/12732743
Diphtheritic polyneuropathy
Article in Journal of Neurology, Neurosurgery, and Psychiatry · January 2000
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2. LESSON OF THE MONTH
Diphtheritic polyneuropathy
J H McAuley, J Fearnley, A Laurence, J A Ball
The very low incidence in the United Kingdom
of diphtheritic infection with neurological com-
plications is a testament to the eYcacy of public
health and vaccination programmes carried out
over the past 50 years. Since 1990, only 19 cases
of toxigenic diphtheria have been reported in
England and Wales and most of these were
acquired abroad.1
However, recent large out-
breaks spreading from eastern Europe indicate
that increased awareness of the condition may
be important in the near future. We report an
instructive case of diphtheritic polyneuropathy
that provides an opportunity to review its typical
presentation and management.
Case history
A 53 year old man developed a severe sore
throat and malaise on returning from a Spanish
holiday. He was found to have a pyrexia,
sloughing tonsillitis, and marked cervical lym-
phadenopathy. A bacterial throat swab culture
(not cultured for Corynebacteria) was negative.
He was treated with intravenous benzyl penicil-
lin for a presumed bacterial throat infection
and the condition resolved after 2 days.
Four weeks after the initial onset of symp-
toms, he experienced an episode of retrosternal
chest pain lasting 30 minutes. An ECG and
subsequent exercise test were normal. How-
ever, it was noted at that time that his voice had
developed a nasal quality and he began to have
nasal regurgitation.
Seven weeks after symptom onset, he devel-
oped proximal leg weakness which worsened
over the next 4 weeks and became generalised.
During this time, his feet became numb and his
bulbar problems progressed so that he was no
longer able to swallow safely. A diagnosis of
Guillain-Barré syndrome was initially made
but his weakness and sensory loss continued to
deteriorate slowly despite treatment with intra-
venous immunoglobulin.
He was transferred to the National Hospital,
Queen Square, where he was found to have
bilateral palatal weakness, reduced palatal sen-
sation, and tongue weakness. Visual accommo-
dation, pupil reactions, eye movements, and
facial movements were normal. Neck and
trunk flexion were mildly weak and there was
global limb weakness (MRC grade 4). Tendon
reflexes and plantar responses were absent. He
had distal sensory loss for all modalities in a
glove and stocking distribution. General exam-
ination was normal with no abnormal fall in
postural blood pressure. His vital respiratory
capacity was never impaired.
Nerve conduction studies showed a demyeli-
nating polyneuropathy. His CSF had a raised
protein at 1.03 g/l, a normal glucose, and no
pleocytosis or oligoclonal bands. Diphtheritic
antitoxin serology was found to be strongly
positive at 0.512 iu.
He continued to deteriorate until, at the nadir
of his illness 13 weeks after the onset of sore
throat, he was only able to walk a few steps with
a Zimmer frame and had sensory loss to the
elbows and midthighs with sensory ataxia. After
this, his voice and swallowing, the second,
assessed by video fluoroscopy, began to improve
slowly, as did strength and sensation in the
limbs. By 23 weeks after onset, with continued
physiotherapy, recovery was complete.
Diphtheritic neuropathy was diagnosed on
the basis of a pseudomembranous tonsillitis, a
delayed bulbar palsy sparing the face, and a
demyelinating peripheral neuropathy that
eventually recovered completely over a period
similar to that of the initial deterioration.
Although the serological test is primarily
conducted to check immune status rather than
exposure to toxin, the result was supportive of
the diagnosis as he had not been vaccinated
against diphtheria.
Discussion
Diphtheria classically presents with a primary
infection followed by biphasic secondary toxic
eVects (early local and late remote).2
The
primary infection is usually tonsillar, laryngeal,
or nasal and is often accompanied by a charac-
teristic membranous exudate. A “bull neck”
may arise due to cervical lymphadenopathy
and soft tissue swelling. Occasionally the initial
site is cutaneous, vaginal or, in neonates,
umbilical.
The secondary toxic eVects of diphtheria
arise by inhibition of protein synthesis through
the ADP ribosylation and inactivation of ribos-
omal GTP-ase by toxin subunit A.3
Local toxic
eVects occur by direct spread of toxin and
result in the early bulbar problems while the
ensuing generalised demyelinating neuropathy
arises from haematogenous dissemination. The
delay in onset of generalised neurological
symptoms, the lack of eYcacy of diphtheritic
antitoxin given after such symptoms have
developed and the proximal to distal spread of
weakness all relate to the action via intracellu-
lar toxin and the long time for transport of
J Neurol Neurosurg Psychiatry 1999;67:825–826 825
Department of
Neurology, National
Hospital for Neurology
and Neurosurgery,
Queen Square, London
WC1N 3BG, UK
J H McAuley
J A Ball
Department of
Neurology, Royal
London Hospital,
Whitechapel, London
E1, UK
J Fearnley
Department of
Haematology,
University College
Hospital, London, UK
A Laurence
Correspondence to:
Dr J H McAuley, National
Hospital for Neurology and
Neurosurgery, Queen
Square, London
WC1N 3BG, UK
Received 28 April 1999
Accepted 28 May 1999
3. newly synthesised protein down the axons. The
latter determines the time for eVects on myelin
sheath integrity to become manifest and subse-
quently resolve. Thus the clinical course of
complications of diphtheritic infection follows
a stereotypical pattern with onset of bulbar
symptoms 3–6 weeks after initial infection,
onset of polyneuropathy at around 8 weeks,
and a slow deterioration with subsequent reso-
lution over a similar period.2
In addition to a peripheral motor and
sensory neuropathy, generalised eVects include
oculomotor palsy, further bulbar problems,
and phrenic nerve involvement. The toxin also
aVects myelinated parasympathetic autonomic
nerves, resulting in blurred vision from im-
paired accommodation, abnormal pupil reac-
tions, and vagal block. The last, in conjunction
with direct myocardial involvement, may cause
serious cardiovascular complications.
Nerve conduction and CSF findings are
similar to those in Guillain-Barré syndrome.
Pathologically, there is segmental demyelina-
tion mainly of the nerve roots and ganglia but
also of peripheral nerves, with phagocytic mac-
rophages and proliferation of Schwann cells.4
Management of diphtheritic infection in-
volves administration of intravenous penicillin
and diphtheritic antitoxin at the time of the
initial illness. Corynebacterium should therefore
be included as part of all routine throat swab
cultures. The only management for the subse-
quent neurological complications is conserva-
tive, with attention paid to protection of the
airway and to active physiotherapy.
This case has provided an opportunity to
review the typical presentation and manage-
ment of diphtheritic polyneuropathy. Diagnosis
was diYcult largely due to the lack of exposure
of today’s physicians to this once common
condition. However, especially in view of the
increasing number of European outbreaks,
correct diVerentiation from Guillain-Barré
syndrome (table) and other neuropathies is
important because the treatment and prognosis
are diVerent and because of the importance of
contact tracing.
We thank Professor R A C Hughes and Professor P K Thomas
for helpful comment on the cases.
1 CDR. Toxigenic Corynebacterium diphtheriae acquired in
England. Commun Dis Rep CDR Weekly 1996;6:231.
2 McDonald WI, Kocen RS. Diphtheritic neuropathy. In:
Dyck PJ, Thomas PK, eds. Peripheral neuropathy. Vol II.
Philadelphia: WB Saunders, 1991:1412–17.
3 Taussig MJ. Processes in pathology and microbiology: Oxford:
Blackwell, 1984:414–19.
4 Solders G, Nennesmo I, Persson A. Diphtheritic neu-
ropathy, an analysis based on muscle and nerve biopsy and
repeated neurophysiological and autonomic function tests.
J Neurol Neurosurg Psychiatry 1989;52:876–80.
DiVerential diagnosis of diphtheritic neuropathy
Diphtheritic neuropathy Guillain-Barré syndrome
Phases Biphasic Monophasic
Time course Onset time equals recovery time Rapid onset, slower recovery
Facial muscle involvement Rare Common
Autonomic Cardiac vagal denervation, tachycardia Sympathetic and parasympathetic
Other important features Blurred near vision, palatal weakness, myocarditis
826 McAuley, Fearnley, Laurence, et al
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