Anil Nepali1,2, Satyam Kharga1, Malavika Jayan2,3, Prakriti Adhikari4, Amit Shah1, Vivek Sanker2,5

INTRODUCTION: Tourette’s syndrome is a neurodevelopmental disorder commonly presenting in young males below 18 years of age and persisting for more than one year with multiple motor and vocal tics [1]. Tics are sudden, rapid, recurrent, and non-rhythmic motor movements or vocalizations commonly preceded by an urge [2]. Most cases of Tourette syndrome show significant improvement or resolve entirely by adulthood [3]. Patients whose tics persist into adulthood suffer from higher anxiety, low self-esteem, socioeconomic status, and poor quality of life [4]. Tourette syndrome is frequently associated with other common childhood disorders such as attention deficit hyperactivity disorder (ADHD) (60-80%), obsessive compulsive disorder (OCD) (11-80%), anxiety, depression (13-76%), migraine (25%) and self-injurious behaviour [5,6].According to the American Academy of Neurology’s practice guidelines, Tourette syndrome can be managed with behavioural, pharmacological, and surgical modalities [7]. Behavioural therapy includes exposure and response prevention therapy (ERP), habit reversal therapy (HRT), and comprehensive behavioural intervention for tics (CBiT), which is considered the safest and first line of treatment [4,7].CBiT is typically a behavioural intervention that includes psycho-education, HRT, functional analysis, and relaxation training and improves the patient’s recognition of the initial urge by providing a competing response or motor movement incompatible with the corresponding tic [8,9].

A document by MOHAMAD SAFWAN A. Click on the document to view its contents.

INTRODUCTION:Tuberculosis remains a significant global health burden, with central nervous system (CNS) involvement being a rare but serious manifestation. While pulmonary tuberculosis is the most common form, extrapulmonary manifestations can affect various organs and systems. The CNS involvement in developing countries constitutes nearly 10% of all tuberculosis patients [1]. Tuberculomas with compressive myelopathies without bone involvement are an even rarer occurrence. In the differential diagnosis of extensive spinal cord injuries, particularly in young patients with a history of pulmonary tuberculosis or tuberculous meningitis, it is important to consider the possibility of an intradural extramedullary tuberculoma [2].Here we will be discussing a case of intradural extramedullary tuberculosis of the thoracic spine, with progressive neurological dysfunction. Surgery aims to decompress the spinal cord and remove the tuberculoma, thereby relieving the pressure on the neural tissues and preventing further neurological deterioration [3-5]. The specific surgical technique employed depends on the location and extent of the tuberculoma.Following surgery, anti-tubercular therapy is initiated to target the underlying tuberculosis infection. This typically involves a combination of multiple anti-tuberculosis medications, such as isoniazid, rifampicin, ethambutol, and pyrazinamide [2]. The duration of anti-tubercular therapy may vary but generally lasts several months to ensure complete eradication of the infection. Continual postoperative monitoring assumes paramount importance in assessing neurological recovery and treatment response. Concurrently, physiotherapy and rehabilitation assume significance in facilitating the functional restoration and enhancing the overall quality of life [1].This report aims to discuss the diagnostic challenges, treatment strategy, and clinical outcomes, highlighting the importance of a multidisciplinary approach in managing this uncommon condition.

USE OF INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING(IONM) IN A NEONATE WITH LIMITED DORSAL MYELOSCHISISShyam Duvuru1, Nisha B2, Vivek Sanker3, Yusra Arafeh4, Rnad Alajarmeh5, Wireko Andrew Awuah61Department of Neurosurgery, Apollo Specialty Hospitals, Tamil Nadu, IndiaEmail: [email protected] & Critical Care, Apollo Specialty Hospitals, Tamil Nadu, IndiaEmail: [email protected] Fellow, Society of Brain Mapping and Therapeutics, CA, USAEmail: [email protected] of Medicine, Jordan University of Science and Technology, Irbid, JordanEmail: [email protected] of Pediatrics and Neonatology, Istiklal Hospital, Amman, JordanEmail: [email protected] of Medicine, Sumy State University, Sumy, Ukraine, [email protected]

INTRODUCTION:Tuberculosis (TB) is still one of the most prevalent infections, especially in the developing world. The World Health Organisation (WHO) estimates that there are 8 million new cases annually [1,2]. Cough, sputum with or without haemoptysis, fever, and constitutional symptoms are the hallmark manifestations of an active tuberculosis infection. In patients with pulmonary TB, an increase in haemoglobin levels is regarded as an indicator of a positive response to treatment. Furthermore, Omar et al. found that a fall in platelet count, white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR) were strong indications of clinical response [3]. Despite the possibility of an increase in white blood cells (WBC), which results in lymphocyte predominance, in clinical practice, eosinophilia is a usual finding that is self-limiting in moderate cases, but it is exceedingly infrequent in TB [4,5].Many allergic, viral, and neoplastic conditions may produce peripheral blood eosinophilia, necessitating a variety of examinations and subsequent therapy. Common causes of eosinophilia in children include infections with helminthic parasites, allergic diseases, malignancies, and adverse drug reactions [1,6]. One of the primary goals of the early evaluation is to identify an underlying cause that needs specific therapy. Even though difficulties linked with eosinophilia are more prevalent in individuals with higher eosinophil counts (>1500 eosinophils/uL), the peripheral blood eosinophil count does not accurately assess the risk of organ damage in each patient. A patient with modest peripheral blood eosinophilia may also have significant eosinophil organ involvement. Normal eosinophil counts in the human blood range between 0-350/mm3. This quantity accounts for between 1 and 3% of the differential leukocyte count [7]. Most reports of eosinophilia in tuberculosis describe local eosinophilia as opposed to peripheral eosinophilia [8]. To the best of our knowledge, reported cases are very rare. As a consequence, we describe one case of TB with considerable peripheral eosinophilia and the treatment outcome.

PULMONARY TUBERCULOSIS IN AN ADULT PRESENTING WITH SEVERE HYPONATREMIA: A CASE REPORT AND REVIEW OF LITERATUREShailes Paudel1,2 , Maulik Dhanani  2,3, Krish Hitesh Patel2,4, Naga Praneeth Vakkalagadda2,5, Vivek Sanker2,6, Abhiram Rao Damera2,7, Umang Gupta2,8, Prakriti Bhandari1,21Patan Academy of Health Sciences, Lalitpur, Nepal2 Team Erevnites, India3Southwestern University School of Medicine, Cebu City, Philippines4Government Medical College, Surat, India5Guntur Medical College, Andhra Pradesh, India6Noorul Islam Institute of Medical Sciences, Kerala, India7Mediciti Institute of Medical Sciences, Ghanpur, Telangana, India8 Nepalgunj medical college, BP Chowk-12, Nepalgunj Banke, Nepal

Brugada syndrome is a genetic arrhythmia syndrome characterized by a coved type of ST segment elevation in the ECG.The patients are usually asymptomatic, with unmasking of the disease under certain conditions.We are reporting the case of such a patient who was diagnosed during an attack of dengue fever

PEDIATRIC PRIMARY INTRAVENTRICULAR HEMORRHAGE: A CASE REPORT OF ISOLATED 4TH VENTRICLE HEMORRHAGE IN A 10-YEAR-OLD BOY

A document by Shyam Duvuru. Click on the document to view its contents.

A document by Vivek Sanker. Click on the document to view its contents.

Chronic kidney disease associated with incidental tuberculoma represents one of the rarest conditions occurring worldwide. Among tuberculous patients, only 1% show Central Nervous System involvement. We present a case of 45-year-old male with CKD who presented with seizure, diagnosed to have incidental Tuberculoma