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H. Sathyanarayana Swamy , S. K. Shankar , A. Chandramuki , R. Ravikumar , Atul Prasad , V. Anisya

Abstract

Fifty-five patients with neurological complications due to Salmonella typhi (S. typhi) infection were studied. Seven (12.7%) of them presented with pyogenic meningitis, 2(3.6%) with cerebral abscess and 46(83.6%) had neurological deficits without pyogenic meningitis. The mean age was 19.24 ± 12 years. The mean duration of illness at the time of admission was 16.4 ± 13 days. Fever was the initial and most prominent symptom in 46(83.6%) and most of them had headache, vomiting, myalgia and/or loose motions. Hepatomegaly and/or splenomegaly was present in 27(49%). The mean interval between the onset of fever and the development of neurological deficits was 9.5 ± 9 days. The neurological deficits included those of pyramidal, extrapyramidal, cerebellar, brain stem, spinal cord and/or peripheral nerves. One had polymyositis. Blood Widal was done in 45 cases and was positive in 43 (95%) of them. The S. typhi was isolated from blood in 21, CSF in 3, cerebral abscess pus in 2, and from other sources in 4. The phage and biotype of isolates was done in 17 patients. The antibiotic sensitivity studied in 25 cases revealed resistance to ampicillin in 5 and to chloramphenicol in 10, while all were sensitive to co-trimoxazole and gentamycin. The lumbar CSF analysis done in 47 patients, was abnormal in 14 (29.7%). The EEG done in 29, was abnormal in 19 (66%) and the abnormalities were subclinical in 1. The ENMG done in 7 patients, was abnormal in 4. The mean duration of hospital stay of 54 patients was 14.8 ± 14 days. At the end of hospital stay 46 of them (83.6%) recovered (completely or partially) and 9 of them (16.4%) died. Seven of them were autopsied. At autopsy, brains showed features of pyogenic meningitis in 3 cases, while the other four had degenerative changes involving the dentato-olivary pathway.

Keywords

Typhoid, Salmonella Typhi, Pyogenic Meningitis, Cerebral Abscess, Bacterial Encephalomyeloradiculopathy

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H. Satyanarayana Swamy , K. S. Anand , M. N. Subhash , V. Anisya , Hariharan Mohan

Abstract

The CSF HVA and 5-HIAA levels and their changes with drug treatment studied in 30 patients with idiopathic parkinson's disease (PD) and 30 patients with chores. Twenty cases of non neurological diseases formed the control for both groups and in them the mean CSF HVA level was 35.7 ± 12.5 ng/ml and the mean 5-HIAA level was 32.4 ± 1.4 ng/ml. The mean age of PD was 52.5 ± 10.4 years. The CSF HVA and 5-HIAA levels were estimated thrice in them: before starting treatment, 10 days after treatment with trihexiphenidyl 2 mg/three times a day and orphenadrine 50 mg/three times a day and the third estimation was made after another 10 days of treatment with amantadine 100 mg/twice a day in addition to the other two drugs. In them, before starting treatment the HVA levels were low, mean value being 13.3 ± 7.3 ng/ml (P < 0.001). It increased to 22.8 ± 8 ng/ml (P < 0.001) after 10 days and it further increased to 31.0 ± 22.8 ng/ml (p < 0.001) after 20 days of treatment . Patients with akinesia had lower levels of HVA compared to those with tremors but was not statistically significant. The mean 5-HIIA levels were low in all the 3 samples; 13.4 ± 6.2 ng/ml, 16.1 ± 5.2 ng/ml, 16.5 ± 5.9 ng/ml (P < 0.001) respectively. The mean age of patients with chorea was 11.5 ± 3.1 years. Seventeen of them fulfilled Jone's criteria for Sydenham's chorea (SC) and 13 did not fulfil the criteria but resembled rheumatic chorea. HVA and 5-HIIA levels in them was estimated twice, before starting treatment and after cessation of choreic movements following treatment with trifluperidl 10 mg/day. The mean duration of treatment was 4 days. The mean HVA levels were high in them before treatment, 71.18 ± 23.0 ng/ml (P < 0.001) and decreased to 49.0 ± 29.5 ng/ml (P < 0.001) after treatment. The mean 5-HIAA levels were low both before and after treatment, 23.4 ± 9.4 ng/ml (P < 0.001) and 22.6 ± 10.2 ng/ml (P < 0.05) respectively.

Keywords

Homovanillic Acid, Hydroxy Indoleacetic Acid, Parkinson's Disease, Chorea, Trifluperiodol, Trihexiphenidyl, Orphenadrine

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