Seizure Episodes Research Articles

Positivity of Lumbar Puncture for Acute Bacterial Meningitis among Children Presenting with First Febrile Seizure

OBJECTIVES: To determine the frequency of lumber puncture-proven acute bacterial meningitis among children with fever and seizures of first onset.METHODOLOGY From March 2020 to March 2021, a hospital-based descriptive cross-sectional study was conducted at the paediatrics department of Hayatabad Medical Complex Peshawar. The sample size for a total of 342 people was estimated using WHO software. The study included all children who had first-onset febrile seizures through OPD and the emergency department. All children underwent lumber punctures using a stringent aseptic procedure, and the hospital laboratory received the samples to look for bacterial meningitis. On a pre-made Proforma, details including name, age, and gender were entered. The gathered data were input into the computer for additional SPSS analysis (version 23).RESULTS Most individuals were male and were lies in the 21-40 months of age group. Mean weight and length/height were evaluated, respectively. The majority had a history of 6-10 days of disease duration. Bacterial meningitis was found significantly (p<0.05) associated with age, gender and neurological deficit, while non-significantly (p>0.05) associated with the duration of diseases.CONCLUSION All children between the ages of 6 months and 60 months who presented with episodes of fever and seizures were found to have a statistically significant (p<0.05) association found among bacterial meningitis and age groups.

Hypernatremic hemorrhagic encephalopathy as an unexpected critical complication in children: a case report from a tertiary hospital

Introduction: Hypernatremic hemorrhagic encephalopathy (HHE) is one of the complications of hypernatremic dehydration which is relatively uncommon in patients with hypernatremia. Severe hypernatremia might lead to brain shrinkage resulting in intracranial bleeding which can increase morbidity and mortality, especially in children. Hypernatremic hemorrhagic encephalopathy is harmful, but only limited cases are reported. This case highlights the role of cautious management of hypernatremic dehydration and the need for intense monitoring due to the unexpected complication of HHE. Case presentation: A 4 months old female infant presented with a decreased consciousness. She showed signs of shock along with acute diarrhoea and severe dehydration. Laboratory findings revealed severe hypernatremia and high septic marker. Rehydration and correction of hypernatremia were done, but during the process, several episodes of general tonic-clonic seizure occurred. A Head CT scan was done and showed subdural hemorrhage in the posterior interhemispheric fissure and intraventricular hemorrhage in the posterior horn of the right lateral ventricle. Conservative management was undertaken and the patient was clinically improved progressively. On the 11th day of hospitalization, the patient's condition had been significantly improved without neurological sequelae and was later discharged on the 11th day of hospitalization. Conclusion: Close monitoring of clinical, neurological, and laboratory examination is essential in the management of hypernatremic dehydration due to the possibility of HHE, even when on the right procedure. Once neurological complication is suspected, an immediate imaging study should be performed and modifying therapy is required.

Sudden and Unexpected Seizure during Emergency Cesarean Section in a Nonhypertensive Hypothyroid Primigravida

A 29-year-old primigravida parturient at term with a known case of hypothyroidism for the past 1 year was taken for emergency cesarean section in view of fetal distress. The patient's medical history showed a history of galactorrhea, for which magnetic resonance imaging of the brain and the routine blood investigations were normal. The parturient was posted for emergency cesarean section due to fetal distress. There was no significant comorbid illness or illicit drug intake. All the basic investigations including the thyroid-stimulating hormone were normal. Spinal anesthesia with 2.0 ml of 0.5% hyperbaric bupivacaine to achieve a level of T6 was performed. After the delivery of the fetus, there was a sudden seizure occurred, and the mother lost her consciousness. The hemodynamics remained stable. The patient was given oxygen, 2 mg of intravenous midazolam, and magnesium sulfate by the Pritchard regimen. The newborn's Apgar scores were normal. She had no recollection of the seizure attack after regaining consciousness and normal spontaneous respiration which occurred in a few minutes. Breastfeeding was recommended. To avoid another seizure episode, the Pritchard regimen was followed. The recovery period was uneventful. A cranial computed tomography scan of the brain was also performed, which revealed no abnormalities. Serum electrolytes were within the normal range when tested again. This case is being reported to raise awareness of seizures in nonhypertensive patients.

Minocycline prevents hypoxia-induced seizures.

Severe hypoxia induces seizures, which reduces ventilation and worsens the ictal state. It is a health threat to patients, particularly those with underlying hypoxic respiratory pathologies, which may be conducive to a sudden unexpected death in epilepsy (SUDEP). Recent studies provide evidence that brain microglia are involved with both respiratory and ictal processes. Here, we investigated the hypothesis that microglia could interact with hypoxia-induced seizures. To this end, we recorded electroencephalogram (EEG) and acute ventilatory responses to hypoxia (5% O2 in N2) in conscious, spontaneously breathing adult mice. We compared control vehicle pre-treated animals with those pre-treated with minocycline, an inhibitory modulator of microglial activation. First, we histologically confirmed that hypoxia activates microglia and that pre-treatment with minocycline blocks hypoxia-induced microglial activation. Then, we analyzed the effects of minocycline pre-treatment on ventilatory responses to hypoxia by plethysmography. Minocycline alone failed to affect respiratory variables in room air or the initial respiratory augmentation in hypoxia. The comparative results showed that hypoxia caused seizures, which were accompanied by the late phase ventilatory suppression in all but one minocycline pre-treated mouse. Compared to the vehicle pre-treated, the minocycline pre-treated mice showed a delayed occurrence of seizures. Further, minocycline pre-treated mice tended to resist post-ictal respiratory arrest. These results suggest that microglia are conducive to seizure activity in severe hypoxia. Thus, inhibition of microglial activation may help suppress or prevent hypoxia-induced ictal episodes.

Laminar heterotopia: A rare cause of epilepsy and mental retardation

Neuronal migration disorders are a category of developmental brain disorders leading to cortical dysplasia. Laminar heterotopia is a form of diffuse gray matter heterotopia, which can result from a failure of proliferation, migration, or organization of neuronal and glial cells in the developing cortex leading to cortical dysplasia. The etiopathogenesis of this malformation remains a subject of discussion. Band heterotopia or double cortex are frequently shown if not always of genetic origin (mutation of genes coding for neuronal migration). We report the case of a young patient who presented episodes of complex seizures since childhood and mild mental retardation.

Congenital hyperinsulinism in a Nigerian infant: A case report and review of literature

Congenital hyperinsulinism, a rare genetic disorder characterized by excess insulin secretion even during hypoglycemic episodes, has two histological subtypes; diffuse and focal. Genotypes denote which of the two subtypes presents, and this is the first case being reported in Nigeria. The aims of this study were to report the first case of genetically confirmed compound heterozygote inheritance for two non-sense mutations in the ABCC8 gene in a Nigerian child and her family. A full-term average weight (7.5 lb) female baby presented with severe hyperinsulinemic hypoglycemia [HH] after birth and failed medical treatment with dextrose infusion. She had several hypoglycemic seizure episodes and spastic diplegic cerebral palsy, despite frequent feeding. Following physiotherapy, her spasticity was regressing and she was also able to say polysyllabic words. Genetic testing done 2 years after birth showed that her father was heterozygous for the ABCC8 non-sense mutation, P.W143*, and her mother was heterozygous for the P.Q416* ABCC8 mutation. This report shows the need for quick and early genetic testing for rare disorders and the possibility of collaboration with more specialized genetic laboratories. When diagnosed, diffuse or focal diazoxide unresponsive hypoglycemia may be treated by partial or complete pancreatectomy with the potential complication of diabetes mellitus later in life.

Sentinel seizure heralding Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease

BackgroundIsolated seizure as a manifestation of myelin oligodendrocyte antibody-associated disease (MOGAD) has rarely been reported previously.Case presentationA 16-year-old-male presented with single episode of left focal onset motor seizure with secondary generalization and impaired awareness, without any other focal neurological deficits. There was a history of right focal onset motor seizure with secondary generalized tonic–clonic seizure and impaired awareness 4 years ago. Neurological examination showed bilateral gaze evoked nystagmus. Brain imaging revealed bilateral superficial and deep white matter lesions including the corpus callosum. Anti-MOG antibody was positive. The patient received steroids and Rituximab therapy without any further recurrence of seizure or any neuro-deficits and gradual improvement in lesion burden in brain imaging.ConclusionsThis case of an adolescent boy with sole manifestation of episodes of focal seizures 4 years apart, finally diagnosed to be a case of MOGAD, not only boosts the evidence of establishing the possibility of MOG antibody-associated autoimmune epilepsy but also reinforces the importance of unexplained seizure as a clinical phenotype in MOGAD.

Could we predict an episode of delirium tremens? Case report

IntroductionDelirium tremens is one of the most serious complications associated with alcohol withdrawal. It affects a percentage of 5 to 20% of users and is not related to the duration of consumption nor to the quantities taken. An early diagnosis will facilitate a quick treatment without putting at risk the vital prognosis.ObjectivesOur objective is to identify the different indicators mentioned in the existing literature and to compare these to the clinical and paraclinical data of our patientsMethodsWe present through clinical vignettes, the cases of two patients hospitalized in our department of addictology for a cure of alcohol withdrawal and who presented an episode of delirium tremens.Resultseveral clinical and paraclinical parameters have been linked to statistically significant differences in the published reports related to this subject. Thrombocytopenia remains the common element between the different publications and was the case in our two patients.Clinically, the presence of a previous episode of delirium or seizure during withdrawal , as well as tachycardia (>100 bpm) and low number of quit attempts were significantly related to the occurrence of delirium tremens. The majority of the predictors identified were paraclinical and included: hyponatremia, hypokalemia, elevated ALT and homocyctein levels, low pyridoxine levels, and the presence of structural brain damage.Conclusionsthe literature on predictors of delirium tremens remains poor. more studies are needed to confirm the data already mentionedDisclosure of InterestNone Declared

THE COMPLEXITY OF DUAL PATHOLOGY: REGARDING A CASE REPORT OF SEIZURES

IntroductionWernicke’s encephalopathy (WE) is a potentially reversible neuropsychiatric emergency caused by thiamine deficiency, whose classical triad consists of acute onset of confusion, gait ataxia, and oculomotor dysfunction. The diagnosis is missed in 75-80% of cases and approximately 80% of untreated patients develop Korsakoff Syndrome, which is characterized by memory impairment associated with confabulation. Early recognition of nutritional deficiency or any portion of the triad is critical and should prompt treatment, since WE is readily reversible if treated with adequate doses of parenteral thiamine.ObjectivesStarting from a case report of suspected WE, we pretend to discuss the differential diagnosis of seizures in dual pathology.MethodsNon-systematic review of the literature was performed in PubMed database using the keywords “Wernicke’s Encephalopathy”, “Seizures”, “Alcohol” and “Benzodiazepines”. The articles were selected according to their relevance. A patient´s clinical record was reviewed and presented.ResultsWe present a case of a 44-year-old Ukrainian man with suspected background of chronic alcohol abuse and psychiatric history of schizoaffective disorder, who presented with acute onset of confusion, psychomotor agitation, gait ataxia and nystagmus. Anamnesis was hampered by the language barrier and absence of past medical history and patient’s alcoholic habits remained unclear. After suspicion of WE it was introduced thiamine and diazepam, with significant improvement. After discontinuation of diazepam, the patient presented with several episodes of tonic-clonic seizures. He was medicated for seizures with clinical stabilization. At time of discharge the diagnostic discussion prevailed.Seizures are a common presentation of various conditions associated with alcohol use, whose differential diagnosis is difficult, especially in patients with dubious alcohol consumption. Alcohol abuse is a major precipitant of status epilepticus as seizure threshold is raised by alcohol drinking. Seizures may also occur during alcohol withdrawal, for which treatment with benzodiazepines is recommended, however carefully, since both abrupt cessation and high-dose use are critical for the appearance of seizures. Although very rare, WE may also present with seizures, whereby overdiagnosis and overtreatment are preferred to prevent persistent neurocognitive impairments.ConclusionsThis case illustrates the complexity of neuropsychiatric diagnoses in dual pathology. It requires a longitudinal assessment for a better understanding of clinical conditions and establishment of the best therapeutic approach.Disclosure of InterestNone Declared

The PHF21A neurodevelopmental disorder: an evaluation of clinical data from 13 patients.

Potocki-Shaffer syndrome (PSS) is a rare neurodevelopmental disorder caused by deletions involving the 11p11.2-p12 region, encompassing the plant homeodomain finger protein 21A (PHF21A) gene. PHF21A has an important role in epigenetic regulation and PHF21A variants have previously been associated with a specific disorder that, whilst sharing some features of PSS, has notable differences. This study aims to expand the phenotype, particularly in relation to overgrowth, associated with PHF21A variants. Analysis of phenotypic data was undertaken on 13 individuals with PHF21A constitutional variants including four individuals described in the current series. Of those individuals where data were recorded, postnatal overgrowth was reported in 5/6 (83%). In addition, all had both an intellectual disability and behavioural issues. Frequent associations included postnatal hypotonia (7/11, 64%); and at least one afebrile seizure episode (6/12, 50%). Although a recognizable facial gestalt was not associated, subtle dysmorphic features were shared amongst some individuals and included a tall broad forehead, broad nasal tip, anteverted nares and full cheeks. We provide further insight into the emerging neurodevelopmental syndrome associated with PHF21A disruption. We present some evidence that PHF21A might be considered a new member of the overgrowth-intellectual disability syndrome (OGID) family.

Epilepsy-associated open-lip schizencephaly with arachnoid cyst: a rare case report

BackgroundSchizencephaly is a rare congenital cerebral malformation characterized by clefts in the cerebral cortex. The traction effect and splitting of leptomeninges caused by schizencephaly potentially formed an arachnoid cyst.Case presentationWe present a case of an 18-year-old male with history of several episodes of complex partial seizure over the last 2 months, with an electroencephalogram signified an epileptic form in the right temporal lobe. Brain magnetic-resonance imaging revealed an arachnoid cyst in the right temporal fossa and a grey matter-lined right temporal cleft consistent with open-lip schizencephaly. To the best of authors’ knowledge, only two previous similar cases have been reported in 1997. Our patient underwent cystoperitoneal shunt and was given double anti-epileptic agents, which successfully resolved and prevented the seizure episode during further follow-up.ConclusionNew onset of seizure-associated schizencephaly in adult are very rare. In this case, space-occupying lesions effects from the enlarged arachnoid cysts caused seizure, which resolved after the cystoperitoneal shunt and double anti-epileptic agents.

Diagnosis Challenge of Neurocysticercosis in the Rural Area

Neurocysticercosis (NCC) is caused by infection with the larvae of Taenia solium and is the leading preventable cause of adult‑onset seizure worldwide. The most common route of transmission is by ingestion of T. solium eggs through the fecal–oral route. Common causes of this infection include consuming undercooked food, especially pork, water contaminated with T. solium or uncooked vegetables as well as poor hygiene habits. Epilepsy is the most common clinical manifestation of 70-90% in endemic areas. The case of a 45-years-old woman with history of 4 minutes episode of tonic-clonic seizure 30 minutes before go to the emergency department (ED). There is a history of 2 weeks of progressive headache and fevers with 3 day of acutely worsening headache, nausea and vomiting. Approximately 4-6 weeks earlier, the patient had begun to experience mild headache and fatigue. She was born and lived in East Nusa Tenggara and work as a farmer in Kupang. On physical examination, the patient had Babinski pathology reflexes is positive in left lower extremity. Patient have been head CT-Scan with contrast. Patients were treated with Albendazole, dexamethasone, phenytoin and omeprazole. Keywords: Neurocysticercosis, diagnosis, rural area

Tratamiento homeopático para la ansiedad por separación post-Covid-19 en perros. Reporte de un caso

Separation Anxiety Syndrome (SAS) in dogs has been one of the most common post-Covid-19-pandemic behavioral disorders, which usually presents destructive and aggressive behavior, excessive barking, urinating and defecating in inappropriate places, vomiting, anxiety, frustration, panic, fear, boredom and aggressiveness as some of the clinical signs. Treatment usually consists of environmental enrichment, behavioral training, allopathic treatment with anti-depressives, anxiolytics and integrative treatments such as Plactiplantibacillus plantarum PS128, the herbal medicine Ashwagandha, homeopathy and acupuncture. We present the clinical case of a male dog, Brazilian terrier breed, who showed separation anxiety when his tutors returned to work after the isolation brought on by the covid-19 pandemic; the dog has also presented seizures every-3-4 months and grade 3-4 periodontal disease. After repertorization, treatment with Arsenicum album 30 CH twice a day was instituted for 30 days for separation anxiety. For periodontal disease, Mercurius solubilis 6CH three times a day for 30 days and, for seizure crises, Cicuta virosa 200 CH once a week until further recommendations. After returning at 30, 60, 90 and 120 days for re-evaluation, noteworthy improvement in anxiety behavior was reported, as well as spacing in seizure episodes. The homeopathic medicines instituted in this clinical case report demonstrated effectiveness in the treatment of behavioral disorders, as well as the physical signs.

Progressive Ataxia, Memory Impairments, and Seizure Episodes in Spna2 R1098Q Mouse Variant Affecting Alpha II Spectrin’s Scaffold Stability

SPTAN1 spectrinopathies refer to a group of rare, inherited diseases associated with damage to non-erythrocytic α-II spectrin (α-II). They are linked to a range of mild to severe neuropathologies of the central and peripheral nervous systems, such as early infantile epileptic encephalopathy type 5, cerebellar ataxia, inherited peripheral neuropathy, and spastic paraplegia. Modeling human SPTAN1 encephalopathies in laboratory animals has been challenging partially because no haploinsufficiency-related phenotypes unfold in heterozygous Spna2 deficient mice nor stable transgenic lines of mice mimicking missense human SPTAN1 mutations have been created to date. Here, we assess the motor and memory performance of a dominant-negative murine Spna2 (SPTAN1) variant carrying a spontaneous point mutation replacing an arginine 1098 in the repeat 10th of α-II with the glutamine (R1098Q). By comparing groups of heterozygous R1098Q mice at different ages, we find evidence for progressive ataxia, and age-related deterioration of motor performance and muscle strength. We also document stress-induced, long-lasting seizure episodes of R1098Q mice and their poor performance in novel object recognition memory tests. Overall, we propose that the complexity of neuropathology-related phenotypes presented by the R1098Q mice recapitulates a number of symptoms observed in human patients carrying SPTAN1 mutations affecting α-II scaffold stability. This makes the R1098Q mice a valuable animal model for preclinical research.

Electroencephalogram characteristics of 26 children with febrile infection-related epilepsy syndrome

To investigate the electroencephalogram (EEG) characteristics and progression of febrile infection-related epilepsy syndrome (FIRES) in children, aiming to enhance diagnosis and treatment approaches. A retrospective analysis was conducted on 26 children with FIRES between May 2017 and December 2021. All 26 children (100%) presented with fever at the onset, followed by frequent convulsions that rapidly progressed into convulsive status. Ventilator support was required for 22 cases (85%). During the acute phase, EEG features demonstrated the disappearance of background activity and physiological sleep cycles in all children. Diffuse slow waves and multifocal slow spike slow waves were observed as abnormal waves during the interictal period. A characteristic pattern of focal low amplitude fast wave initiation was detected in all children during seizure episodes. In the chronic phase, the background EEG activity gradually recovered, and the presence of abnormal waves was relatively limited. The characteristic pattern of focal slow wave rhythm initiation was evident during seizure episodes. Additionally, extreme δ brushes were observed in four cases (15%). These findings suggest that EEG manifestations in children with FIRES exhibit distinctive patterns during the acute and chronic stages, providing significant value for early diagnosis and clinical staging. Extreme δ brushes may be one of the distinctive markers of children with FIRES.

Finding positive SARS-CoV-2 RT-PCR in cerebrospinal fluid of two pediatric patients with severe COVID-19: a brief case report

BackgroundThere is growing evidence of nervous system involvement and related complaints in children with coronavirus disease 2019 (COVID-19). However, it seems that attempts to track of the virus in the nervous system have so far been unsuccessful.Case presentationHere we describe two pediatric cases of severe COVID-19 who had positive cerebrospinal fluid (CSF) and nasopharyngeal polymerase chain reaction (PCR) tests for severe acute respiratory syndrome coronavirus disease 2019 (SARS-CoV-2). A 36-month-old girl who presented with fever, diarrhea, mild left ventricular dysfunction and bizarre movements, and a five-month-old boy who presented with fever, watery diarrhea, severe dehydration, mottling, and two episodes of seizure. Their CSF analyses and cultures were normal. They admitted in intensive care unit (ICU) for near four days and discharged after ten days without any complaint.ConclusionThis is one of the first reports of the presence of coronavirus in the central nervous system in COVID-19 pediatric patients, emphasizing the neurotropism and neuroinvasion characteristics of the virus.

Magnitude of uncontrolled seizures and associated factors among people with epilepsy. Data from a major teaching hospital in Southwest Ethiopia

BackgroundEpilepsy is a major public health problem affecting 70 million people worldwide. 90% of global people with epilepsy were living in developing regions like Ethiopia. Due to the lack of clear guidelines for treatment selection and the difficulty of individualizing care in resource-poor settings, achieving seizure control can be challenging. Seizure control status among epileptic patients is affected by different factors. Accordingly, this study aimed to assess the magnitude of uncontrolled seizures and associated factors among people with epilepsy attending the outpatient clinic of Jimma Medical Center, Southwest Ethiopia. MethodsA hospital-based retrospective chart review and a respective patient interview conducted among people with epilepsy from October 2020 to June 2021. Sociodemographic, behavioral-related factors, medication adherence, and medication belief were obtained through patient interviews. Seizure control status in the last two years before the study period was retrospectively evaluated and recorded from the charts. Data were entered into Epi Data manager version 4.6 and then exported to SPSS version 23.0 for analysis. A backward logistic regression analysis was done to identify factors associated with uncontrolled seizures. ResultsFrom a total of 314 medical charts reviewed, 149(47.5 %) of patients were with uncontrolled seizures. 28.7 %,12.8 %, and 6 % of the patients experienced 1–5,6–10, and >10 seizure episodes during the last two years respectively. Comorbidity [adjusted odds ratio [(AOR): 2.13, 95 % confidence interval (CI):1.26–3.58], nonadherence [AOR: 2.41, 95 %CI: 1.46–3.9], possible adverse drug reaction (ADR) [AOR:1.79, 95 %CI: 1.107–3.01], and drug interaction [AOR: 3.06, 95 %CI: 1.24–7.57] were associated with an uncontrolled seizure. Conclusion and recommendationOur study showed that a substantial proportion of the patients were with uncontrolled seizures. Epileptic patients with comorbidities, nonadherence, adverse drug reactions, and drug interactions were more prone to have uncontrolled seizures. Hence, to overcome these problems, strategies like community-based education, treatment intensification, and routine assessment of adverse drug reactions and drug interaction may help to improve seizure control status.

Clinical and laboratory characteristics of complex febrile seizures in the acute phase: a case-series study in Japan

BackgroundPatients with complex febrile seizures (CFS) often display abnormal laboratory results, unexpectedly prolonged seizures, and/or altered consciousness after admission. However, no standardized values have been established for the clinical and laboratory characteristics of CFS in the acute phase, making the management of CFS challenging. This study aimed to determine the clinical and laboratory characteristics of children with CFS during the acute phase. In particular, the duration of impaired consciousness and the detailed distribution of blood test values were focused.MethodsWe retrospectively reviewed medical records of a consecutive pediatric cohort aged 6–60 months who were diagnosed with CFS and admitted to Kobe Children’s Hospital between October 2002 and March 2017. During the study period, 486 seizure episodes with confirmed CFS were initially reviewed, with 317 seizure episodes included in the analysis. Detailed clinical and laboratory characteristics were summarized.ResultsAmong 317 seizure episodes (296 children with CFS), 302 required two or fewer anticonvulsants to be terminated. In 296 episodes showing convulsive seizures, median seizure duration was 30.5 min. The median time from onset to consciousness recovery was 175 min. Impaired consciousness lasting > 6, 8, and 12 h was observed in 13.9%, 7.6%, and 1.9% patients with CFS, respectively. Additionally, the distribution of aspartate aminotransferase, lactate dehydrogenase, creatinine, and glucose were clarified with 3, 10, 50, 90, and 97 percentile values.ConclusionThis study detailed the clinical and laboratory findings of acute-phase CFS using the data of the largest 15-year consecutive cohort of children with CFS. These results provide important information for appropriate acute management of CFS.

A young woman with intellectual disability, epilepsy, and psychosis of unclear prognosis

Intellectual disability is a known condition, but psychosis and its extension in functional areas of life, with episodes of seizures in between, make the case complex and leave clinicians with a limited choice of treatment and unpredictable outcomes. We present the case of a 20-year-old female with intellectual disability, episodes of seizures, and pattern of psychosis, with its course describing the perplexity of the treatment in the area of its outcome predictability, which also highlights the lack of a structured approach for clinicians' guidance in managing it as a multidisciplinary field.

Dengue Fever Presenting as Ischaemic Stroke: A Case Report

Several neurological manifestations are common in dengue fever. They are encephalitis, encephalopathy, Guillain Barre Syndrome (GBS), Intracranial haemorrhage, but, ischemic stroke is a rare complication. This is a case report of ischaemic stroke in a patient with dengue fever. A 39-year-old female patient presented to the emergency department with the chief complaints of fever, retro orbital pain since four days, and one episode of seizure on the day of presentation. Examination revealed left homonymous hemianopia. Diagnosis of dengue was made based on Immunoglobulin M (IgM) Enzyme-Linked Immunosorbent Assay (ELISA) positive for dengue. Magnetic Resonance Imaging (MRI) brain showed acute infarcts in right temporal, right occipital and right hippocampal region. Severity of hemianopia decreased as the days progressed and platelet count gradually improved to normal limits within five days. Adequate fluid management was given and the patient was discharged once stable. Anti-platelets were started after two weeks during the follow-up. Examination during follow-up showed decrease in hemianopia to just mild blurring of vision on left gaze. Ischemic stroke is even rarer entity and clinicians should be made aware of these complications.