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0811 Neurological manifestations, sequelae and mortality rate of Plasmodium falciparum malaria in Indian adults
Poster Abstracts
Wednesday, November 9, 2005
$307
admitted in Hamidia Hospital, Bhopal were included in this study. They were subjected to biochemical investigations and C.T. Scan. Resull: 70"/0 patient were below 30 years of age. All presented with fever and altered sensoriunl, followed by headache and vomiting in 42% cases & seizures in 20"/0 cases. Meningeal signs were present in 72"/0 cases & focal neurological deficits in 26% cases of which 20?,'; had VI cranial nerve palsy, 4% hemiparesis and 2?,'; paraparesis. 12% patients had papilloedema & 2% optic atrophy. CSF examination was abnormal in all cases with increased leukocyte count (Lymphocyte Predominance) and proteins. On C.T. Scan hydrocephalus was seen in 76%, basal exudates in 56"/0, cerebral infarct in 20?,';, tuberculoma in 147,';. Hydrocephalus was communicating type during acute state of illness and becoming obstructive towards the terminal stage. Conclusion: There is a linear relationship between degree of hydrocephalus and duration of illness. Correlation of follow up C.T. Scan with clinical condition confirmed the presence of enhancing exudates having a poor prognosis. C.T. Scan is a valuable tool with a high diagnostic sensitivity, prognostic value & should be used as an early radiological investigation in tubercular meningitis patients for guidance of treating physician.
fundus examination but there is conflict regarding their prognostic significance among various workers all over the world. Very limited data is available on Indian adult patients of cerebral malaria. So we carried out a study to find the relative incidence and prognostic significance of various ophthalmologic findings on fundus examination in adult patients of cerebral malaria. Method: 60 adult ( > 12 years) patients satisfying WHO criteria for diagnosis of cerebral malaria, admitted to Hamidia Hospital, Bhopal were studied. Detailed Ophthalmological examination was done through dilated pupils at the time o f admission and at tire time of discharge. Result: Retinal haemorrhage was the most commonly observed findings, in 10-677,'8 patients on fundus examination. Other findings observed were papilloedema in 6.67?,'8 disc.pallor in 2.67?,'8 and hyperemia in 2% patients. Tire mortality associated with papilloedema & disc pallor was 30"/0 & 25% respectively which is statistically significant (z > 2%, p < 0.05). Conclusions:
0811 Neurological manifestalions, sequelae anti mortality tale of Pla$/nodiuin falciparum malaria in Indian adults
2.
Dubey, TN, Sharma, VK, Deopujari, K, Gopal, A, Dengra, A, Sarij a V, Hiranandani, H, Rajarajan, T, Gopal, R. Harnidia Hospital, Gandhi
Medical College, Bhopal, India Background: A prospective hospital based study over 14 month duration was carried out to investigate neurological manifestations and sequelae of Plasmodium falciparum malaria. Methods: 150 adult patients fulfilling inclusion criteria were enrolled and were entered on specially designed profotma. Results: Fever was the commonest presenting symptom in 98.67% and associated with headache in 53.33'%, vomiting in 41.33%. On neurological examination, 40% had altered sensorium of which 22?,'; were stuporous, 8?,'; delirious, 6% drowsy and 4?,'; comatose. 12 (8%) had convulsions, of which generalized tonic-clonic seizures in 10, simple partial seizure in 1 patient and complex partial seizure in 1 patient. 4 (2.67%) had cranial nerve involvement-VII nerve in 2 (1.33%), VI nerve in 1 (0.67%), IX, X and XII in 1 (10.67'%). Hemiparesis and paraparesis were observed in 2 (1.33%) each while Quadriparesis in 1 (10.677,';). Meningeal signs were observed in 8 (5.36%), cerebellar signs in 1 (0.67?,';), 2 (1.337,';) had decerabrate posturing, 1 (0.67%)was dysarthric, 1(0.67%)was aphasic, 2 (11.33'%) had Gnillain-barre syndrome like presentation and 1 (0.67%) had Acute disseminated encephalomyelitis like presentation. 24 patients (16%) died, those surviving were followed up weekly for a period of 12 weeks to study the sequelae. Convulsions were there in 2 (1.58%) and hemiparesis, involuntary movements, cerebellar atmxia and psychosis in 1 patient each (0.79%). Conclusion: Plasmodimn falciparum malaria can have myriad of neurological manifestations. Presence of focal neurological deficit and meningeal signs were uncommon. High index of suspicion for prompt diagnosis and early institution of treatment can cut down the mortality. 0812 Incidence and Prognostic significance of fumlus changes in cerebral malaria
Dubey, TN, Sharma, VK, Deopujari, K, Gopal, A, Dengra, A, Hirnandani, H, Sharma, H, Gopal, R, Satija, V, Rajarajan, T.
1Harnidia Hospital, Gandhi Medical College, Bhopal, India Background: Eye can be affected, like any other organ of the body in patients of cerebral malaria. A spectrum of findings are described on
1.
3.
Retinal haemorrhage was the most common fundus finding noted in patients of cerebral malaria, but it had no mortality significance. Mortality associated with papilloedema & disc pallor was statistically significant. Fundus examination is an important tool which should be done in all patients to identity high risk mortality groups of papilloedema & discpallor and should be managed very aggressively to cut down the high mortality rate associated with cerebral malaria.
0813 A clinical, bioeheulical, radiological and EEG study of Febrile Falcephalopathy patients admired in Haulidia Hospital, Bhopal
Dubey, TN l, Sharma, V K a, Jeevan, H l, Dengra, A ~, Gopal, A ~, Ratre, B ~, Gopal, R ~, Satija, V ~, Rajarajan, T ~. 1Hamidia Hospital,
Gandhi Medical College, Bhopal, India Backrouml: To study etiologies & their incidence in patients of febrile encephalopathy on basis of clinical, biological and radiological profile and their clinicoradiological correlation. Method: 115 cases of febrile encephalopathy above the age of 12 years of both sexes, admitted in Hamidia Hospital, Bhopal were included in study. Detailed clinical, biochemical, radiological and EEG study was done. Result: Patient < 30 years were most commonly affected with slight male preponderance, 517,'; patient were of cerebral malaria, 20?,'; of tubercular meningitis, 17?,'; ofpyogenic meningitis, 6?,'; of encephalitis, 4?,'; of typhoid encephalopathy. On admission maximum number of patients were stupurous. Examination revealed meningeal signs in 36"/0, fundus abnormalities in 14"/o and focal deficits in 12.7"/o. The peripheral smear was positive for P. falciparum in 39.13%, C.T Scan was abnormal in 45?,'; cases. One case of cerebral malaria showed a subdural hematoma, tubercular meningitis patients showed hydrocephahis, lacunar infarct, ring lesions and basal exudates. Pyogenic meningitis showed hydrocephalus and lacunar infarcts. Basal ganglia hypodensities were seen in viral encephalitis. E E G was abnormal in 70"/0 cases and showed diffuse slowing. Contusion: Cerebral malaria accounts for mmximum number of cases o f febrile encephalopathy. C.T Scan was abnormal in 45% cases. Mortality was mmximum in viral encephalitis. As the mortality of febrile encephalopathy is very high, the etiological diagnosis should be made as early as possible and intensive and proper therapy is the key to successful management. 0814 Profile of neurological manifestations of Acquired hmnunodefieiency syndrome (Neuro-AIDS) in Indian Subcontinent
Wednesday, November 9, 2005
$307
admitted in Hamidia Hospital, Bhopal were included in this study. They were subjected to biochemical investigations and C.T. Scan. Resull: 70"/0 patient were below 30 years of age. All presented with fever and altered sensoriunl, followed by headache and vomiting in 42% cases & seizures in 20"/0 cases. Meningeal signs were present in 72"/0 cases & focal neurological deficits in 26% cases of which 20?,'; had VI cranial nerve palsy, 4% hemiparesis and 2?,'; paraparesis. 12% patients had papilloedema & 2% optic atrophy. CSF examination was abnormal in all cases with increased leukocyte count (Lymphocyte Predominance) and proteins. On C.T. Scan hydrocephalus was seen in 76%, basal exudates in 56"/0, cerebral infarct in 20?,';, tuberculoma in 147,';. Hydrocephalus was communicating type during acute state of illness and becoming obstructive towards the terminal stage. Conclusion: There is a linear relationship between degree of hydrocephalus and duration of illness. Correlation of follow up C.T. Scan with clinical condition confirmed the presence of enhancing exudates having a poor prognosis. C.T. Scan is a valuable tool with a high diagnostic sensitivity, prognostic value & should be used as an early radiological investigation in tubercular meningitis patients for guidance of treating physician.
fundus examination but there is conflict regarding their prognostic significance among various workers all over the world. Very limited data is available on Indian adult patients of cerebral malaria. So we carried out a study to find the relative incidence and prognostic significance of various ophthalmologic findings on fundus examination in adult patients of cerebral malaria. Method: 60 adult ( > 12 years) patients satisfying WHO criteria for diagnosis of cerebral malaria, admitted to Hamidia Hospital, Bhopal were studied. Detailed Ophthalmological examination was done through dilated pupils at the time o f admission and at tire time of discharge. Result: Retinal haemorrhage was the most commonly observed findings, in 10-677,'8 patients on fundus examination. Other findings observed were papilloedema in 6.67?,'8 disc.pallor in 2.67?,'8 and hyperemia in 2% patients. Tire mortality associated with papilloedema & disc pallor was 30"/0 & 25% respectively which is statistically significant (z > 2%, p < 0.05). Conclusions:
0811 Neurological manifestalions, sequelae anti mortality tale of Pla$/nodiuin falciparum malaria in Indian adults
2.
Dubey, TN, Sharma, VK, Deopujari, K, Gopal, A, Dengra, A, Sarij a V, Hiranandani, H, Rajarajan, T, Gopal, R. Harnidia Hospital, Gandhi
Medical College, Bhopal, India Background: A prospective hospital based study over 14 month duration was carried out to investigate neurological manifestations and sequelae of Plasmodium falciparum malaria. Methods: 150 adult patients fulfilling inclusion criteria were enrolled and were entered on specially designed profotma. Results: Fever was the commonest presenting symptom in 98.67% and associated with headache in 53.33'%, vomiting in 41.33%. On neurological examination, 40% had altered sensorium of which 22?,'; were stuporous, 8?,'; delirious, 6% drowsy and 4?,'; comatose. 12 (8%) had convulsions, of which generalized tonic-clonic seizures in 10, simple partial seizure in 1 patient and complex partial seizure in 1 patient. 4 (2.67%) had cranial nerve involvement-VII nerve in 2 (1.33%), VI nerve in 1 (0.67%), IX, X and XII in 1 (10.67'%). Hemiparesis and paraparesis were observed in 2 (1.33%) each while Quadriparesis in 1 (10.677,';). Meningeal signs were observed in 8 (5.36%), cerebellar signs in 1 (0.67?,';), 2 (1.337,';) had decerabrate posturing, 1 (0.67%)was dysarthric, 1(0.67%)was aphasic, 2 (11.33'%) had Gnillain-barre syndrome like presentation and 1 (0.67%) had Acute disseminated encephalomyelitis like presentation. 24 patients (16%) died, those surviving were followed up weekly for a period of 12 weeks to study the sequelae. Convulsions were there in 2 (1.58%) and hemiparesis, involuntary movements, cerebellar atmxia and psychosis in 1 patient each (0.79%). Conclusion: Plasmodimn falciparum malaria can have myriad of neurological manifestations. Presence of focal neurological deficit and meningeal signs were uncommon. High index of suspicion for prompt diagnosis and early institution of treatment can cut down the mortality. 0812 Incidence and Prognostic significance of fumlus changes in cerebral malaria
Dubey, TN, Sharma, VK, Deopujari, K, Gopal, A, Dengra, A, Hirnandani, H, Sharma, H, Gopal, R, Satija, V, Rajarajan, T.
1Harnidia Hospital, Gandhi Medical College, Bhopal, India Background: Eye can be affected, like any other organ of the body in patients of cerebral malaria. A spectrum of findings are described on
1.
3.
Retinal haemorrhage was the most common fundus finding noted in patients of cerebral malaria, but it had no mortality significance. Mortality associated with papilloedema & disc pallor was statistically significant. Fundus examination is an important tool which should be done in all patients to identity high risk mortality groups of papilloedema & discpallor and should be managed very aggressively to cut down the high mortality rate associated with cerebral malaria.
0813 A clinical, bioeheulical, radiological and EEG study of Febrile Falcephalopathy patients admired in Haulidia Hospital, Bhopal
Dubey, TN l, Sharma, V K a, Jeevan, H l, Dengra, A ~, Gopal, A ~, Ratre, B ~, Gopal, R ~, Satija, V ~, Rajarajan, T ~. 1Hamidia Hospital,
Gandhi Medical College, Bhopal, India Backrouml: To study etiologies & their incidence in patients of febrile encephalopathy on basis of clinical, biological and radiological profile and their clinicoradiological correlation. Method: 115 cases of febrile encephalopathy above the age of 12 years of both sexes, admitted in Hamidia Hospital, Bhopal were included in study. Detailed clinical, biochemical, radiological and EEG study was done. Result: Patient < 30 years were most commonly affected with slight male preponderance, 517,'; patient were of cerebral malaria, 20?,'; of tubercular meningitis, 17?,'; ofpyogenic meningitis, 6?,'; of encephalitis, 4?,'; of typhoid encephalopathy. On admission maximum number of patients were stupurous. Examination revealed meningeal signs in 36"/0, fundus abnormalities in 14"/o and focal deficits in 12.7"/o. The peripheral smear was positive for P. falciparum in 39.13%, C.T Scan was abnormal in 45?,'; cases. One case of cerebral malaria showed a subdural hematoma, tubercular meningitis patients showed hydrocephahis, lacunar infarct, ring lesions and basal exudates. Pyogenic meningitis showed hydrocephalus and lacunar infarcts. Basal ganglia hypodensities were seen in viral encephalitis. E E G was abnormal in 70"/0 cases and showed diffuse slowing. Contusion: Cerebral malaria accounts for mmximum number of cases o f febrile encephalopathy. C.T Scan was abnormal in 45% cases. Mortality was mmximum in viral encephalitis. As the mortality of febrile encephalopathy is very high, the etiological diagnosis should be made as early as possible and intensive and proper therapy is the key to successful management. 0814 Profile of neurological manifestations of Acquired hmnunodefieiency syndrome (Neuro-AIDS) in Indian Subcontinent