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Hashimoto's encephalopathy is an under-recognised and rare disease, associated with autoimmune thyroiditis and is relapsing, yet exquisitely corticosteroid-sensitive. It includes various neurological symptoms such as stroke-like episodes or diffuse neuropsychiatric manifestations. Here we present a case of middle-aged female with history of long term generalised epilepsy that presented with fever, status epilepticus and altered behaviour and responded well to steroids. A negative microbiological screen of the CSF and serum along with raised CSF protein, elevated serum antithyroid antibodies, characteristic EEG and neuroimaging findings yielded the diagnosis. Copyright © 2014, Indian Journal of Medical Specialities. Published by Reed Elsevier India Pvt. Ltd. All rights reserved.

Subacute sclerosing panencephalitis (SSPE) is a chronic progressive encephalitis of childhood and young adults due to persistent measles virus infection. The usual age of onset is between 5 and 15 years. There are wide varieties of presentations of SSPE described in the literatures. Variable clinical presentations may lead to diagnostic dilemma and unnecessary investigations especially in developing countries, where the measles is quite endemic and vaccination status is not up to the mark because of poor literacy and socioeconomic status. Good clinical correlations, neuroimaging findings, EEG and cerebrospinal fluid (CSF) marker for SSPE yield the clue to diagnosis. This case illustrates a 13-year-old boy presented with short history of intellectual decline, headache, papilloedema, cranial nerve palsy, myoclonus with suggestive neuroimaging mimicking acute disseminated encephalomyelitis (ADEM) and pseudotumour cerebri. Subsequently he was diagnosed to be a case of SSPE on the basis of CSF and serum measles antibody titer.

Study objective: The standard daily dose of rifampin in directly observed treatment of Mycobacterium tuberculosis (TB) is 600 mg, taken orally. The purpose of this study was to assess the efficacy of standard dose rifampin therapy in patients who were slow to respond to routine directly observed therapy (DOT). Methods: Patients with non-drug-resistant pulmonary TB who were receiving 600 mg of oral rifampin by DOT were eligible for inclusion. Patients were deemed slow to respond if their sputum smears and cultures remained positive for M tuberculosis and if the patient’s condition did not improve clinically or radiographically after 3 months of treatment. Serum rifampin levels were ascertained to determine the adequacy of the standard rifampin dosing. Patients with subtherapeutic blood levels had their rifampin dose increased to 900 mg, and rifampin levels were repeated. Rifampin dosage was increased again if blood levels were still subtherapeutic. No antitubercular medications were added to the treatment regimen. The total weekly dose of the other standard treatment drugs was not increased. Results: Of 124 new patients with active pulmonary TB, 6 patients were identified as slow to respond to the standard antitubercular DOT. All six patients had subtherapeutic serum rifampin levels. All six patients responded clinically, radiographically, and mycobacteriologically after an increase in rifampin dosage to reach target drug blood level. Conclusions: Standard dosing with rifampin resulted in a poor clinical response and subtherapeutic serum levels in six patients. Increasing the dosage of rifampin improved the outcome without additional side effects. In TB patients who are slow to respond to standard treatment, an inadequate dose of rifampin should be suspected. Current antituberculer drug administration does not include adjusted dosage for rifampin. (CHEST 2001; 120:1520–1524)

This study set out to compare the growth patterns and morphological characteristics of human fallopian tube epithelial cells isolated: (1) mechanically; and (2) enzymatically. Cells were cultured in medium supplemented with fetal bovine serum and antibiotics and their epithelial nature was established by immunocytochemistry for cytokeratins. Primary cultures were polygonal in shape with centrally located nuclei, irrespective of the isolation method. Cells isolated enzymatically exhibited a higher growth rate, but the survival rate was poor after more than 2-3 passages. Mechanical isolation gave a lower yield of cells, but had a higher survival rate when sub-cultured, even beyond 8 passages. Thus, mechanically isolated cells might be useful for longer term cultures, whereas enzymatically isolated cells are best only for short-term work.

Introduction: Neuroacanthocytosis (NA) is a heterogeneous neurodegenerative genetic disorder caused by disease specific genetic mutation. Being an extremely rare disorder, only a few thousand cases have been reported till date. This clinical entity was described by Citchley et al. and was initially named Levine-Citchley syndrome. It is characterized by movement disorder due to degeneration of the basal ganglia along with cognitive and behavior changes. The classical clinical presentation includes the troublesome abnormal involuntary movements in form of chorea, dystonia and dyskinesia. Self mutilation of the lips and tongue is characteristic of choreoacanthocytosis. The NA syndromes have been broadly divided into two subtypes, (i) core NA syndromes, and (ii) conditions with alterations in the lipoprotein metabolism. The genes of the different NA syndromes have been identified but the mechanism of these genetic mutations is not known. The management of NA is primarily symptomatic and rehabilitative. Case Report: We are describing a case of neuroacanthocytosis with typical phenotype of choreoacanthocytosis. The phenomenon of feeding dystonia is classically being discussed in this report. Neuroimaging demonstrated the atrophy of the caudate nucleus resembling Huntington's chorea. Acanthocytic red blood cells were seen in peripheral smear in our patients. Conclusion: The recognition of neuroacanthocytosis is improved due to better characterization of the clinical symptoms and investigations of this heterogeneous entity. The presented case describes the typical clinical characteristics and investigations supporting the diagnosis of this under diagnosed clinical syndrome.