Bilateral optic disc edema is most commonly associated with raised intracranial pressure, but systemic causes such as severe anemia can occasionally mimic this presentation. Identifying these reversible causes is essential to avoid unnecessary neurological interventions. A 21-year-old female presented with headache, vertigo, and diplopia for 10 days. Ophthalmic examination revealed bilateral optic disc edema, while neuroimaging showed no intracranial pathology. Laboratory investigations demonstrated severe iron-deficiency anemia with markedly low ferritin and elevated total iron-binding capacity. A detailed menstrual history revealed chronic irregular cycles with prolonged heavy menstrual bleeding, prompting pelvic ultrasonography, which showed polycystic ovarian morphology as the underlying cause of chronic blood loss. The patient was managed with intravenous iron therapy, acetazolamide, hormonal treatment, and dietary modification. Her visual symptoms and optic disc edema resolved completely on follow-up. Severe anemia can cause optic nerve head hypoxia and venous congestion, leading to disc swelling. Coexisting polycystic ovarian disease may exacerbate anemia through menorrhagia and metabolic dysregulation. Correction of anemia results in the rapid resolution of ocular manifestations. Bilateral optic disc edema secondary to iron-deficiency anemia is a rare but reversible condition. Comprehensive evaluation for systemic causes, particularly in young women with menstrual irregularities, is vital for timely diagnosis and effective management.

This case report discusses an uncommon presentation of miliary tuberculosis as tubercular meningitis (TBM) and long-segment cervical tuberculous myelitis in a 32-year-old man from rural India. The patient presented with symptoms of fever, headache, neck stiffness, and gradual weakness in all four limbs. Hydrocephalic changes secondary to meningitis and involvement of the spinal cord were observed on neuroimaging and were correlated with clinical findings of cervical myelitis, confirming the diagnosis of TBM with cervical myelitis. TBM, together with cervical myelitis in patients with miliary tuberculosis (TB), is a rare manifestation in tubercular endemic countries, such as India. It is crucial to confirm the diagnosis and initiate antitubercular therapy (ATT) promptly in order to prevent neurological complications. In this context, the present case highlights the importance of considering TB in patients with neurological manifestations that are not characteristic of the most common diseases. This report also emphasizes the need to raise awareness and improve the management of tuberculosis in rural areas where there are few opportunities to access tertiary centers.

Background: The patients with cerebral venous thrombosis (CVT) having raised intracranial pressure and seizures require admission to the intensive care unit (ICU). We report the outcomes of ICU admitted CVT patients, and compare the in-hospital death and 3-months disability between mechanically ventilated (MV) and non-MV groups. Methods: Forty-five CVT patients admitted to ICU were included. Their clinical details, MRI and MRV findings were noted. The patients were intubated based on arterial blood gas analysis. All the patients received heparin followed by an oral anticoagulant. In-hospital death and functional outcomes at 3 months were recorded. Results: 18/45 (40%) CVT patients required MV for a median of 6.5 (1-15) days. 9(20%) patients died; MV group had an insignificantly higher deaths compared to non-MV group [2(27%) vs 4(14.8%); P=0.45]. On Cox regression analysis, the GCS score independently predicted death (adjusted hazard ratio 0.75; 95% CI 0.59-.0.96; P=0.02) but not MV (HR 1.78; 95%CI0.47-6.77; P=0.39). Amongst the survivors, 30(85.7%) had a good outcome which was comparable between the two groups. Conclusion: 40% of CVT patients in ICU require MV. The overall mortality is 20%, and 85.7% of patients have a good outcome at 3 months, which is comparable between MV and non-MV groups.

Background: Patients with cerebral venous thrombosis (CVT) requiring mechanical ventilation (MV) may have a severe procoagulant state, extensive venous sinus thrombosis, and a worse outcome, but there is a paucity of studies on this topic. We compare the clinical risk factors, radiological findings, and outcomes between CVT patients requiring MV and the non-MV group. Methods: Consecutive CVT patients admitted to our service were included. Their clinical details, prothrombotic states and MRI and MRV findings were noted. The patients were admitted to the intensive care unit (ICU) if the Glasgow Coma Scale (GCS) score was below 14 and intubated if arterial blood gas analysis was abnormal. All the patients received heparin followed by an oral anticoagulant. In-hospital death was noted, and functional outcomes at 3 months were assessed using the modified Rankin Scale (mRS). Results: Ninety-eight patients with CVT were admitted during the study period; 45 (45.9%) required ICU care, and 18 of them required MV for a median of 6.5 (1–15) days. The MV patients had a shorter duration of illness, a lower GCS score, and protein C deficiency. Twelve (12.2%) patients died: five (27.8%) in the MV, four (14.8%) in the non-MV ICU, and three (5.7%) in the non-MV non-ICU groups. Poor outcomes were 5.5%, 14.8%, and 5.7%, respectively. On Cox regression analysis, the MV had an association with death [adjusted hazard ratio (AHR) 0.40, 95% confidence interval 0.21–0.77; p = 0.007] and poor outcome at 3 months (AHR 0.45, 95% CI 0.27–0.76; p = 0.003). Conclusions: About 18.4% of CVT patients require MV with a mortality of 27.8%. Amongst the survivors, 90.7% of patients have a good outcome at 3 months.

Wilson’s disease is an autosomal recessive disorder caused by a mutation of the Wilson's (global) disease (ATP7B) protein produced by chromosome 13 [1]. It manifests as an inability to excrete copper in bile, leading to copper deposition in the liver, brain, and other organs. Clinical signs and symptoms include liver dysfunction and neuropsychiatric disorders [2]. While copper accumulation primarily occurs in the basal ganglia, it can affect all parts of the brain. Magnetic Resonance Imaging (MRI) is an effective tool for assessing disease severity and treatment response [3].

Background: Thyrotoxicosis is a metabolic state of excessive thyroid hormones which include tetraiodothyronine (FT4) and/or triiodothyronine (FT3). The most common causes of thyrotoxicosis are either autoantibody-mediated hyperfunction of thyroid gland (Graves’ disease) or inflammation-induced destructive thyroiditis (subacute thyroiditis and postpartum thyroiditis). The correct diagnosis of thyrotoxicosis is important as management differs according to etiology. The radioactive iodine uptake test and technetium pertechnetate thyroid scan are the gold standard for diagnosis of thyrotoxicosis. However, these tests are limited by their availability and high cost. Therefore, it is important to look for other parameters which can help in the diagnosis of hyperthyroidism. The non-invasive thyroid color flow Doppler sonography (CFDS) is an easily available, highly informative, safe, and comparatively low-cost investigation which can be used as an alternative. Aims and Objectives: The aim of the study was to assess the role of CFDS in the differential diagnosis of thyrotoxicosis. Materials and Methods: A total number of 120 newly diagnosed thyrotoxic patients were enrolled. On the basis of clinical, laboratory evaluation, and thyroid scan, patients were diagnosed with either Graves’ disease or thyroiditis. All the patients underwent CFDS in the radiology department. Results: Ninety patients of Graves’ disease and thirty patients of thyroiditis were enrolled in our study. The mean peak systolic velocity (PSV) of inferior thyroid artery (ITA) from both lobes of thyroid gland were used as markers of thyroid vascularity. The difference in mean PSV-ITA in Graves’ and thyroiditis patients was statistically significant (P < 0.001). Using receiver operating characteristic analysis for diagnostic accuracy of PSV, we demonstrated that the cutoff 50 cm/s had 98.9% sensitivity and 96.7% specificity in differentiating Graves’ disease from thyroiditis with positive predictive value and negative predictive value being 99% and 96%, respectively. Conclusion: A non-invasive CFDS is an inexpensive and easily available procedure which provides the functional status of the thyroid gland. The PSV of ITA can help to differentiate the etiologies of thyrotoxicosis and can be considered as an alternative to nuclear scanning where such modality is not present or contraindicated.

Background:Coronary artery disease (CAD) that encompasses acute myocardial infarction (AMI), chronic stable angina (CSA), and unstable angina (UA) has numerous known risk factors. Genetic predispositions contribute as major risk in the development of CAD and the genes regulating atherosclerosis are important for disease prevention. Nitric oxide synthase 3 (NOS3) gene responsible for nitric oxide (NO) production is of special importance. Aim:To evaluate the role of three NOS3 polymorphisms (-786C/T, 894G/T, and 4a4b) in patients with CAD, particularly in AMI and CSA and their comparison with healthy controls. Materials and Methods:One hundred patients in each AMI and CSA group and 100 controls were included and were typed for three NOS3 polymorphisms (-786C/T, 894G/T, and 4a4b) by polymerase chain reaction-restriction fragment length polymorphism. Plasma NO metabolites (NOx) were also evaluated. Results:A significant association of 894G/T polymorphism with AMI in dominant model (P = 0.052) and with CSA in dominant and codominant models was detected (P = 0.008 and P = 0.006, respectively). Plasma NO levels were found to be significantly higher (P < 0.0001) in healthy controls (43.80 ± 6.28) compared to AMI and CSA patients (37.05 ± 6.75 and 38.67 ± 5.61). No significant association of -786C/T and 4a4b polymorphism with AMI and CSA risk under recessive, dominant, and codominant models was detected. Conclusion:Our study revealed a significant association of 894G/T polymorphism with AMI and independent association of NOx levels with CAD, indicating high risk of CAD in the North Indian population. Our findings will be helpful in identifying the genetic risk factors associated with CAD and better management of the diagnostic as well as therapeutic measures.

BACKGROUND:Hemisensory syndrome is characterized by a nondermatomal sensory deficit involving one half of the body. With the conventional imaging techniques, researches find low diagnostic yield in this condition; however, with the advancements in MRI imaging, there is hope to find the pathophysiological basis of hemisensory symptoms. OBJECTIVE:To evaluate microstructural and perfusion changes in brain parenchyma in patients with hemisensory syndrome on MRI with diffusion tensor imaging (DTI) and arterial spin labeling (ASL). MATERIAL AND METHODS:A total of 20 patients with hemisensory symptoms and 10 age-matched controls were enrolled and divided in two study groups - a) case vs. control and b) affected vs. nonaffected cerebral hemisphere in cases. Quantification of absolute cerebral blood flow (aCBF), fractional anisotropy (FA), and mean diffusivity (MD) was done in both groups. RESULTS:On ASL, there was significantly increased aCBF in thalamus on the contralateral-affected side. DTI revealed significantly decreased FA in the thalamus and increased FA in corona radiata of the affected side. There was a significant difference for MD of corona radiata between affected and nonaffected hemisphere. The mean value of MD in corona radiata is decreased on the affected side. CONCLUSION:Changes in advanced neuroimaging techniques like ASL and DTI along the pain processing pathway suggest an alteration in neuronal density and activity at the microstructural level. These findings may provide an insight into the etiopathogenesis of pain syndromes.

To evaluate deep learning-based calcium segmentation and quantification on ECG-gated cardiac CT scans compared with manual evaluation. Automated calcium quantification was performed using a neural network based on mask regions with convolutional neural networks (R-CNNs) for multi-organ segmentation. Manual evaluation of calcium was carried out using proprietary software. This is a retrospective study of archived data. This study used 40 patients to train the segmentation model and 110 patients were used for the validation of the algorithm. The Pearson correlation coefficient between the reference actual and the computed predictive scores shows high level of correlation (0.84; P < .001) and high limits of agreement (±1.96 SD; −2000, 2000) in Bland–Altman plot analysis. The proposed method correctly classifies the risk group in 75.2% and classifies the subjects in the same group. In total, 81% of the predictive scores lie in the same categories and only seven patients out of 110 were more than one category off. For the presence/absence of coronary artery calcifications, the deep learning model achieved a sensitivity of 90% and a specificity of 94%. Fully automated model shows good correlation compared with reference standards. Automating process reduces evaluation time and optimizes clinical calcium scoring without additional resources.

Takayasu's disease (TD) also known as pulseless disease is an arteriopathy characterized by vasculitis affecting the aorta and its branches. It is also known as aortic arch syndrome, nonspecific aorto-arteritis, and young female arteritis. Pulmonary artery involvement in Takayasu's arteritis is a rare phenomenon. Pulmonary artery vasculitis leads to pulmonary arterial hypertension and rarely manifests as pleural effusion. Patients with pulmonary arteritis and pleural effusion usually present as chest pain, cough, and dyspnea. Percentage of involvement of pulmonary artery in TD is variable. Pleural effusion occurs as sequelae of pulmonary artery involvement. We report the case of a 46-year-old female who presented to us with fever, weight loss, dyspnea, and chest pain. Clinical examination and investigations revealed Takayasu's arteritis and tubercular empyema. This case report is a rare presentation of Takayasu's arteritis with tubercular empyema without pulmonary arteritis.

Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that affects mostly young women in which tissue-binding autoantibodies and immune complexes cause damage to organs and tissues. SLE is characterised by aberrant immunological responses that result in the release of higher levels and immunogenic nucleic acids, proteins, and other self-antigens. Autoimmune Haemolytic Anaemia (AIHA) is a condition in which antibodies against red blood cells are present. It is classified as a warm and cold antibody AIHA. The causes of warm antibody AIHA are autoimmune illnesses, infections, or even malignancy. The presence of Immunoglobulin G (IgG) antibodies can indicate warm autoimmune haemolytic anaemia (warm agglutinin anaemia), which is characterised by fatigue and other constitutional symptoms. Although, autoimmune haemolytic anaemia can be a component of the SLE spectrum, warm autoimmune haemolytic anaemia as the first manifestation of SLE is exceedingly rare. This case report describes a case of a 23-years-old female who presented to the hospital with complaints of breathlessness and chest pain. After evaluation she was found to have pericardial tamponade and AIHA. Pericardiocentesis was done and further investigations confirmed the diagnosis of SLE. She was treated with injectable methylprednisolone, injectable antibiotics, Tab. hydroxychloroquine, Tab. febuxostat ,Tab. colchicine, oral antidiuretic, oral levothyroxine and other supportive management. The lack of unambiguous pathognomonic characteristics or tests, coupled with the variable presentation of SLE, makes diagnosis tricky. Overall, AIHA can be an initial presentation as well as a part of other disease processes, emphasising the significance of a comprehensive work in patients with AIHA.

The uveal tract consists of three parts: iris, ciliary body and choroid. Iris is the colored part of the eye, which makes the pupil regulate the light rays. The ciliary body consists of a ring of muscles tissue that changes the shape of the lens and secretes the clear fluid (aqueous humor) that fills the inside of the eye (anterior segment). And the choroid tissue is thin filled with blood vessels that are part of the middle layer of the eye ball between the sclera (white outer layer of the eye) and the retina (the inner layer of nerve tissue at the back of the eye). The choroid is a layer of blood vessels and connective tissue that lines the back of the eye and supplies nutrients to the retina. Together, these three structures make up the uveal tract and play important roles in the anatomy and function of the eye. This book chapter will explain about the Uveal anatomy and Physiology, its understanding.

The global incidence of TB in 2016 was 10.4 million and India accounts for a quarter of the global burden of TB. It is estimated that there are 2.79 million people with TB in India. About 10% of extra pulmonary TB involves bone and joints. Spinal TB accounts for half the cases of skeletal TB. The incidence of spinal TB is 1-4% of total TB cases, then it is estimated that only in India approximately 60,000 spinal TB cases exist. To report the pattern of recovery and predictors of outcome of Pott's spine. The intervention comprised of four drug antitubercular treatment, rest, immobilization, and ultrasonography or computerized tomography guided aspiration or biopsy as indicated outcome measures were six months Nurick grade, and mRS and complications like drug induced hepatitis (DIH) and paradoxical worsening. Seventy-three patients with Pott's spine, median age 36 (11-73) years, 32 (43.8%) females were included. The neurological signs were present in 44 (64.4%) patients. At six months, median Nurick grade improved from 4 to 2 and;and 70% patients had a good outcome as defined by mRS.The predictors of poor outcome were weight loss, non-ambulatory state on admission and paradoxical worsening. It is concluded that neurological involvement in Pott's spine was present in 64% patients, paradoxical worsening (deterioration in symptoms after one month of ATT) in 11% and DIH in 16%. Weight loss, non-ambulatory state on admission and paradoxical worsening predicted poor outcome.

Sir, Bronchial arteries are the culprit for the majority of patients presenting with hemoptysis in tuberculosis. Ruptured bronchial artery pseudoaneurysm secondary to pulmonary tuberculosis causing massive hemothorax is rarely seen. Clinical diagnosis is often difficult as patient symptoms can mimic a wide variety of diseases with high suspicion of malignancy. However, imaging tools such as contrast-enhanced computed tomography (CECT) chest and computed tomography angiography aid in the diagnosis. Interventional radiology is considered to be a key diagnostic as well as therapeutic procedure as an urgent endovascular approach is most commonly preferred for its nonsurgical management. This report describes a rare case of a 60-year-old male smoker with a history of pulmonary tuberculosis presented with sudden onset left-sided chest pain, hemoptysis, and shortness of breath with substantially low hemoglobulin levels. CECT chest revealed a pseudoaneurysm of a left bronchial artery with large mediastinal hematoma which was further confirmed on digital angiography and the patient was managed with endovascular embolization. A 60-year-old male smoker with a past medical history of pulmonary tuberculosis presented with sudden onset left-sided chest pain, hemoptysis, and shortness of breath for 1 day. The patient also had an episode of loss of consciousness following hemoptysis of ~100 ml. General examination findings of the patient on admission revealed tachycardia, hypotension, and reduced SpO2 (88%). Routine blood investigations revealed low hemoglobulin (6.6 g/dl). Chest examination revealed decreased air entry on the left side with crepitations. The sputum culture demonstrated acid-fast bacilli. The patient was transfused whole blood and was stabilized. For diagnosis, CT angiography was performed and scanogram revealed a large mediastinal mass on the left side with areas of bronchiectasis in the retrocardiac region [Figure 1a]. Noncontrast CT (NCCT) chest revealed a large mixed density lobulated lesion in the anterior mediastinum with areas of hemorrhage [Figure 1b]. CT angiogram revealed hypertrophied left bronchial artery measuring 3.5 mm at the origin arising from descending thoracic aorta at T4-T5 IVD level with the presence of large fusiform multilobulated aneurysmal outpouching of size ~4 cm × 1.8 cm. The aneurysm was narrow necked and was pointing anterolaterally toward the left side with a large perianeurysmal hematoma of size ~11.5 cm × 10 cm × 19. 2 cm causing mild mediastinal shift to the right side. The hematoma was extending along the anterior mediastinum and into the left side, causing mass effect over the adjacent mediastinal structures was extending inferiorly up to the left hemidiaphragm and superiorly extending up to the arch of the aorta. CT findings were suggestive of a ruptured large bronchial artery pseudoaneurysm with associated hematoma [Figure 1c and d]. Bilateral lung parenchyma showed emphysematous changes with areas of cystic bronchiectasis in the left lower lobe with areas of consolidation. There were areas of ground-glass attenuation in the left upper lobe, right middle, and lower lobe with interlobar septal thickening giving a crazy-paving appearance which was suggestive of pulmonary hemorrhage [Figure 2a and b].Figure 1: (a) Scannogram shows a large lobulated lesion in left lower and mid lung zones with broad base towards mediastinum, silhouetting left heart border, left hemidiaphragm, and descending thoracic aorta (large white arrow). Cystic bronchiectasis (small white arrow).(b) Axial noncontrast computed tomography scan through the chest shows large mediastinal hematoma (HU ~ 66) (red circle) along the anterior and left para mediastinum. (c) Computed tomography aortogram. Coronal image depicts contrast-filled pseudoaneurysm (large white arrow) with hematoma causing mass effect over left inferior pulmonary vein (small white arrow) and left ventricle (large black arrow). (d) Volume rendered image showing bronchial artery pseudoaneurysm (large white arrow) arising from the descending thoracic aorta.(small white arrow)Figure 2: (a and b) Axial and sagittal reformatted computed tomography chest (lung window) show cystic bronchiectasis in left lower lobe (black arrow in a and b) poster with surrounding consolidation (small black arrow) and areas of ground-glass opacities in lingular lobe and right middle lobe (black arrowhead) likely due to pulmonary hemorrhageA transcatheter bronchial angiogram with embolization for bronchial artery pseudoaneurysm was performed. Access was gained through the right common femoral artery, and with the help of a diagnostic angiographic catheter (Shepherd catheter 5 Fr), the left bronchial artery was cannulated. A selective angiogram revealed a pseudoaneurysm arising from the left bronchial artery [Figure 3a]. Using a 2.1 Fr microcatheter, pseudoaneurysm was reached embolized using glue mixed with lipiodol (1:7 ratio). Postembolization angiogram revealed complete thrombosis of the pseudoaneurysm sac [Figure 3a and b]. No immediate complication was noted. Hemostasis was achieved at the groin by manual compression, and the patient was discharged after 2 days, with antitubercular treatment. The patient was followed up telephonically, however, follow-up imaging could not be obtained due to the COVID pandemic and later, it came to know that the patient succumbed to coinfection with COVID-19 pneumonia.Figure 3: (a) Digital subtraction angiography spot image of the selective left bronchial artery using microcatheter shows pseudoaneurysm (black arrow). (b) Final fluoroscopic spot image after glue embolization of aneurysmal sac, showing glue cast within the pseudoaneurysm sac in the left bronchial artery with the patent distal flowDISCUSSION Bronchial artery aneurysm is either primary in which the cause is unknown while the secondary aneurysm can be associated with inflammatory lung diseases, bronchiectasis, atherosclerosis, bronchitis, and systemic vascular abnormalities such as Osler–Weber–Rendu syndrome. By definition, a pseudoaneurysm is the hematoma outside the arterial wall due to injury to the wall and contains either tunica adventitia or media or contained by surrounding tissue. The hematoma must communicate through the artery through the defect in the arterial wall. Various causes of pseudoaneurysm include trauma, infections, vasculitis, connective tissue disorder, malignancies, coagulopathies, rupture of an aneurysm, and iatrogenic.[1] In our patient, the probable etiology may be likely due to spontaneous rupture of a bronchial artery aneurysm. Bronchial artery aneurysms, and pseudoaneurysms can be either asymptomatic and are detected incidentally or present with varied symptoms due to mass effect or rupture that can mimic other medical pathologies, the index case simulates mediastinal mass on the radiograph. Patients can present with hemoptysis[23] or hematemesis when there is a rupture into the bronchus or esophagus, respectively. Chest pain occurs if the pseudoaneurysm ruptures into the mediastinum and can mimic aortic dissection. Ruptured aneurysm with large mediastinal hematoma compresses the mediastinal structures and causes dysphagia or superior vena cava syndrome due to compression of esophagus or superior vena cava, respectively.[4] In our case, the HRCT chest done from outside raises the suspicion of mediastinal mass due to large mediastinal hematoma and referred to our institute. Noncontrast and CT angiography revealed large mediastinal hematoma due to rupture of pseudoaneurysm of the left branchial artery. CT angiography plays a significant role in the diagnosis as well as in providing a roadmap for angiography. Digital Subtraction Angiography (DSA) is the gold standard for the diagnosis of pseudoaneurysms because of its ability to assess real-time contrast filling. According to Habib et al., DSA has the highest sensitivity (100%), followed by CT (67%).[5] Any diagnosed visceral artery aneurysm or pseudoaneurysm whether symptomatic or asymptomatic should be managed electively as the risk of mortality is considerably high after the rupture of an aneurysm.[6] The risk of rupture of an aneurysm is not dependent on the size of the lesion. Risk of rupture of a pseudoaneurysm is higher than aneurysm as the vessel wall is already disrupted. All visceral artery aneurysms and pseudoaneurysms are treated either by an endovascular approach or an open surgical repair, however, an endovascular approach is desired due to its much less invasive nature. Postoperative pain and wound complications are particularly less with reduced hospital stay and improved quality of life.[7] Embolization is done using various embolizing agents or by stenting depending upon the presence or absence of collateral circulation, respectively.[89] The index patient was managed with transcatheter bronchial artery embolization using glue. Complications of this procedure are rare and include local complications such as groin hematomas, pseudoaneurysms, and arterial thrombosis. Other methods for endovascular embolization include coiling or covered stent. Complications of coil embolization are recanalization due to revascularization or collateral circulation or migration of the coil. To conclude, ruptured nontraumatic bronchial artery pseudoaneurysm secondary to pulmonary tuberculosis causing massive hemothorax is rarely seen and suspicion should be made after exclusion of other causes of hemothorax. CECT thorax can aid in the detection of pathology, however, DSA is the quintessential technique both for diagnosis and management. Endovascular embolization under DSA is preferred over surgical management, and early management is crucial for preventing mortality and morbidity in these patients. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Intraparenchymal brain hemorrhage is not uncommon and results from a wide variety of causes ranging from trauma to tumor. Many a time, it is not possible to determine the exact cause of non-traumatic hemorrhage on conventional magnetic resonance imaging (MRI). Susceptibility-weighted imaging (SWI) is a high-resolution (3D) gradient-echo sequence. It is extremely sensitive to the inhomogeneity of the local magnetic field and highly useful in identifying the small amount of hemorrhage, which may be inapparent on other MR pulse sequences. In this review, we present different pattern of an intra-parenchymal brain hemorrhage on SWI with emphasis on differential diagnosis.

The development of tuberculoma is a process of inflammation, necrosis, and apoptosis. Therefore, the pro-inflammatory cytokines and apoptosis biomarkers are likely to play an important role. In this study, we report the expression of TNFα, IL6, and caspase-3 at the mRNA level in the patients with tuberculous meningitis (TBM) and compare these biomarkers in the patients with and without tuberculoma. A total of 134 patients with TBM and 35 matched healthy controls were included. The clinical, cerebrospinal fluid (CSF), and cranial magnetic resonance imaging (MRI) findings were noted. The mRNA expression of TNFα, IL6, and caspase-3 in peripheral blood mononuclear cells was evaluated by reverse transcriptase polymerase chain reaction. On cranial MRI, 89 (64.2%) patients had tuberculoma, and their level of consciousness, severity of meningitis, CSF findings, and blood counts were not significantly different from those without tuberculoma. Patients with tuberculoma had a higher expression of TNFα and IL6 compared to the controls, but had lower expression compared to the patients without tuberculoma. TNFα expression positively correlated with the expression of caspase-3, but not with IL6. Twenty-five (18.6%) patients died: 12 (13.5%) in tuberculoma and 13 (28.9%) in the non-tuberculoma group. Death was related to higher expression of TNFα and caspase-3. The lower expression of TNFα and IL6 in intracranial tuberculoma suggests that these patients are unlikely to be benefited with TNFα blockers.

Background: Pulmonary regurgitation is imminent after transannular patch (TAP). We analyze the long-term performance of untreated autologous pericardium (UAP) as valve substitute at pulmonary position in patients requiring TAP. Material and Methods: This cross-sectional study include patients operated between 2007 and 2012 (n = 92). A sample of 19 patients was selected for this study which had a follow-up of more than 3 years. This includes patients with no TAP (n = 4) and with TAP and valve substitute, a monocusp (n = 11) or a tricuspid valve (n = 4) at neopulmonary annulus. Patients underwent echocardiography for assessment of right ventricle function and 18 fluoro-deoxyglucose PET CT scan for measurements of valve substitute at neopulmonary annulus. The target to blood ratio (TBR) of uptake of glucose by monocusp was measured at the cooptation edge of the neopulmonary valve. Results: The median age of the patients is 14 (9 – 37). RV function is preserved (TAPSE 18.9 (10.6 – 22.8)) at a mean follow-up of 4 years (3-9). The measurements of monocusp shows a shrinkage in height of the cusp by 35.5% (70% – 1.0%) and length by 7% (-44% - +104%). There was less shrinkage observed in patients below 15 years of age. The TBR of monocusp was 0.945 (0.17 – 3.35) with a strong correlation between the TBR values of aortic valve leaflet and monocusp leaflet of same patient. Conclusion: The UAP is functional and successful as a valve substitute at neo pulmonary annulus at long-term follow-up. It has resisted calcification and has shown uptake of glucose in physiological limits.

Annals of Indian Academy of Neurology ¦ Volume 24 ¦ Issue 3 ¦ May-June 2021 432 serotonergic drugs had been started. Such clinical situations may be noted in various other clinical scenarios. The most common indication to use serotonergic agents (SSRI) is a behavioral or psychiatric disorder.[1,2] Therefore, the cognitive impairment of SS may be overlapped with the preexisting psychiatric disorder. Nausea and vomiting are the part of autonomic manifestation in SS.[2,3] However, various antiemetic agents (including ondansetron, granisetron, and metoclopramide) may cause SS.[1] Linezolid is a serotonergic agent that is used for various bacterial infections (presenting as fever or febrile encephalopathy).[1] However, SS may have fever with or without encephalopathy.

Pulmonary arteriovenous malformation (PAVM) is one of the rare pulmonary vascular anomalies. Pulmonary arteriovenous malformation results in right to left shunt due to the abnormal communications between the pulmonary arteries and the pulmonary veins bypassing the normal capillary bed.1 This condition being rare could be easily missed, hence, it is essential for clinicians to suspect it based on the classical clinical features. This helps in early diagnosis and deciding further appropriate treatment option. Here we report the case of a patient affected by a large idiopathic pulmonary arteriovenous malformation in the right lung. Most patients with pulmonary arteriovenous malformation are asymptomatic. This is due to the chronic compensation and secondary erythrocytic response. Dyspnoea due to PAVMs are a result of right-to-left shunt. Initial diagnostic tools include chest radiography and contrast enhanced computed tomography but the gold standard is pulmonary angiography.2 Because AVM has substantial morbidity rates associated with it, all patients with PAVMs who can undergo embolization should be treated with transcatheter embolization. In rest of the patients, surgical excision should be considered. The main objective of this study was to highlight the early suspicion and diagnosis of pulmonary arteriovenous malformation as this is easily missed and leads to undue delay of treatment.