Dr. Kumar Saurabh Neurologist Ranchi

10/04/2024

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29/03/2024

A case of Polymyalgia Rheumatica
Patient improved from the bed ridden state to being mobile because of the miraculous effect of single low dose of a cheap drug (Tab wysolone- 20 mg).

A 78 year old female patient presented with h/o inability to move and get up from bed for 2 days and drowsiness for 1 day. She is k/c/o OA knees and long standing Alzheimer's disease, independent in activities of daily living at present. At admission she was found to be in hepatic encephalopathy which improved over 1 day with management. After regaining full sensorium she was still unable to move because of severe painful restriction of both shoulder, hip and knee joints. This combined with her longstanding osteoarthritis made her unable to stand up. Lab studies showed extremely elevated CRP(158). USG showed subacromian bursitis. She was suspected to have Polymyalgia rheumatica and started on low dose Wysolone (20 mg). Next day all her pain and restricted movement around the shoulder, hip and knee joints were gone and she was able to get up and stand on her own. Her CRP also came down significantly.
The term Polymyalgia rheumatica (PMR) implies a myopathic process, but muscle in PMR is normal. Articular and particularly periarticular structures (bursae, tendons) are most severely involved in the disease. PMR is an inflammatory rheumatologic condition characterised by aching and stiffness around the shoulder, hip, neck and torso. It is almost exclusively a disease of adults over age 50. The incidence increases progressively with advancing age. It is invariably associated with significant elevation in ESR and CRP. The onset can be abrupt, sometimes startling so, seeming to occur almost overnight, as in this case. PMR is associated with prompt response to glucocorticoid in low doses.

26/03/2024

04/03/2024

A case of MSA (Multiple system atrophy) having saccadic pursuit eye movement.
65 year old male patient presented with 1 year h/o progressive slowness, imbalance in walking, difficulty in turning in bed, increased urinary frequency, urgency and incontinence. The patient was diagnosed as a case of MSA (Multiple system atrophy). MSA is characterised by varying degrees of parkinsonism, ataxia, autonomic and pyramidal signs. The video shows the patient having saccadic pursuit eye movements. Though saccadic pursuit can be found in typical and other atypical forms of Parkinson's disease apart from MSA, its frequency is more in MSA as compared to other forms of Parkinson's disease. Also saccadic pursuit in MSA are catch up saccades as opposed to anticipatory saccades in other forms of Parkinson's disease. Apart from saccadic pursuit other eye signs in MSA include dysmetric saccades, gaze evoked nystagmus, square wave jerks, etc. The patient also had significant post void residual urine in ultrasound, further strengthening the diagnosis of MSA.

04/03/2024

A case of vertebrobasilar insufficiency (posterior circulation TIA) due to thrombosed right vertebral artery.
38 years old male presented a 15 years history of recurrent episodes of acute onset vertigo with generalised weakness lasting 10 to 15 minutes and occurring at interval of 3 to 4 months. He was earlier diagnosed and treated as a case of temporal lobe epilepsy because of MRI lesion in right temporal lobe. However recent MRI showed new ischaemic lesion in right cerebellar hemisphere along with thrombosed long segment right vertebral artery, which together with typical history clinched the diagnosis of vetebrobasilar insufficiency.

04/03/2024

A case of secondary Trigeminal Neuralgia (secondary to large epidermoid cyst).
36 year old male patient presented with 5 year history of severe short lasting lancinating electric shock like pain in right side of face trigerred by activities like- eating, talking, brushing, shaving etc. He had severe exacerbation of above symptoms since last 3 months. MRI brain shows a large eidermoid cyst in right preontine region extending to cerebellopontine angle, compressing the 5th nerve complex. About 10 to 15 percent cases of Trigeminal Neuralgia are secondary to lesions such as epdermoid cyst, vestibular schwannoma, meningioma, multiple sclerosis, etc. Younger age of onset, sensory loss in Trigeminal distribution and bilaterality of symptoms are clues towards a secondary cause.

04/03/2024

Mirror movement in Writer's cramp.

Writer's cramp is a form of focal task specific dystonia usually with a gradually progressive course. In the video a phenomenon called ' mirror movement' associated with writer's cramp is shown. In mirror movement, there is appearance of dystonic movement in homologous muscles of affected upper limb induced by specific task performed by the unaffected hand.This is thought to be due to altered interhemispheric cortical inhibition.

04/03/2024

A case of bulbar onset ALS (amyotrophic lateral sclerosis).

Patient presented with a 6 month history of progressive slurred speech and hoarseness of voice. He also complained of left upper limb weakness since 2 months. ALS usually starts in one of the limbs (typical limb onset form in 2/3rd of cases), then progresses to contralateral limb and finally to other limbs. Other rare presentation apart from bulbar onset form (presenting feature in about 25 percent cases) include- primary lateral sclerosis, progressive muscular atrophy, flail arm or leg syndrome, presentation with respiratory distress or generalised weakness and ALS plus syndromes. The typical limb onset form usually progresses to bed bound state and eventual respiratory failure in 3 to 5 years. However, bulbar onset form of ALS is associated with much faster progression and poorer prognosis.

04/03/2024

A case of Corticobasal syndrome(CBS)
Patient presented with -1) tremor of right upper limb- 2 years, 2) slowly progressive difficulty in using right hand for skilled tasks since last 2 years. 3) abnormal jerky movement of right upper limb.
This patient is diagnosed as CBS (corticobasal sundrome), which is an atypical form of Parkinson's disease characterised by variable combination of rigidity, dystonia, apraxia, myoclonus and alien limb phenomenon.

01/10/2023

CME on 'Vision loss- Neurological perspective' in Jamshedpur

23/08/2023

Left job at TMH, Jamshedpur.