Harshad Arvind Vanjare

Nocardiosis is a bacterial infection predominantly seen in immunocompromised hosts, with patients mainly presenting with pulmonary involvement. Intracranial involvement is rare and is thought to be associated with high mortality. This study aims to evaluate the imaging appearance of intracranial nocardiosis and to assess clinical outcomes. In this retrospective study, 21 patients with intracranial nocardiosis were identified between 2009 and 2023 in a single tertiary care hospital in South India. The patient charts and imaging were assessed, and various radiological findings were documented. Clinical and imaging follow-up was also assessed. Four patterns of involvement were seen: large abscesses, smaller abscesses, ring-enhancing lesions, and meningitis. Clinical and radiological discordance was observed, with the Glasgow Coma Scale being normal in the majority of patients despite intracranial abscesses. The presence of lung involvement was common. Mortality was 9.5%, which is low compared to the literature, with good clinical outcomes on follow-up. Mortality with intracranial nocardiosis was found to be lower than reported in literature. Pulmonary disease, in the presence of intracranial abscess and immunocompromised status, should raise concerns about nocardial infection.

We evaluated low-dose infliximab (5 mg/kg) as adjunctive therapy in 20 patients with severe central nervous system tuberculosis. At 3 months, 60% achieved disability-free survival (modified Rankin Scale ≤ 2), and 75% showed clinically meaningful improvement. Our outcomes matched reports of high-dose infliximab. Randomized trials to optimize dosing are needed.

Affective blindsight, the capacity to discriminate emotional stimuli despite bilateral damage to the primary visual cortex (V1) and without conscious awareness, offers a unique model of non-conscious visual processing. Subcortical pathways involving the pulvinar and amygdala have been proposed, but putative cortical contributions remain unclear. We examined 182 patients, including 31 with bilateral V1 lesions. Among these, 15 had cortical visual loss and 7 showed affective blindsight. Using behavioral testing, lesion symptom mapping, and tractography, we found that preserved pulvinar connectivity with both the posterior superior temporal sulcus (STS) and the amygdala is necessary for affective blindsight. These findings provide causal evidence for a multi-route architecture, identifying the pulvinar–STS pathway, alongside the pulvinar–amygdala pathway, as a critical substrate for non-conscious affective processing.

Background: Invasive fungal disease (IFD) is a sinister complication encountered in patients with haematological disorders. When occurring in the central nervous system (CNS), IFDs can have catastrophic outcomes.Objectives: To study the clinical presentation, predisposing etiological factors, and prognosis of a CNS‐IFD in a patient with a haematological disorder.Patients and Methods: This is a retrospective study focusing on the clinical profile, diagnosis, treatment strategy and outcomes of 43 patients with an underlying haematological disorder, who were diagnosed with CNS‐IFD between 2018 and 2022.Results: Of the 43 patients, 18 were chemotherapy recipients, while 23 were stem cell transplant (SCT) recipients and 2 presented with CNS‐IFD at diagnosis. AML/MDS (37.2%) and ALL (18.6%) were the predominant underlying diagnoses. A sudden deterioration in sensorium (53.5%) was the earliest clinical sign, while T2 hyperintensities (26.8%), vascular involvement (26.8%) and ring‐enhancing lesions (16.3%) were the commonest radiological findings, with all patients exhibiting diffusion restriction in diffusion‐weighted images. Microbiological evidence of infection was obtained in all patients; however, culture positivity was established in only 25 patients. Rhizopus spp (23.2%) and Aspergillus spp (20.9%) were implicated in most cases. Overall survival of the cohort was 27.9% at a median follow‐up of 6 months. In patients who succumbed, the median time to death was 4 days (0–46).Conclusion: CNS‐IFD is associated with very poor survival in patients undergoing chemotherapy or an SCT, urging the need for prompt diagnosis and initiation of suitable antifungal therapy.

Background: Primary intracranial germ cell tumors (ICGCT) are often diagnosed with tumor markers and imaging, which may avoid the need for a biopsy. An intracranial germ cell tumor with mild elevat... Lay abstract Intracranial germ cell tumors (ICGCTs) are rare brain tumors, which often require markers in blood or cerebrospinal fluid, imaging and a tissue biopsy to establish a diagnosis. However... Tweetable abstract Central nervous system germinomas can often be diagnosed with tumor markers and imaging, and they may not always need a biopsy. A criterion for clinical diagnosis is elucidated i...

Liver abscess continues to be a major surgical burden in low-and mid-low-income countries like India. Spontaneous rupture into the anterior abdominal wall is an uncommon presentation of pyogenic liver abscess. A 53-year-old diabetic female presented with acute pain in the right, upper quadrant of the abdomen. On examination, she had an anterior abdominal wall abscess with tender hepatomegaly. On further evaluation with ultrasonography and plain computed tomography, a diagnosis of liver abscess in the right lobe with rupture into the anterior abdominal wall was made. She was treated successfully in a tribal secondary care hospital with an ultrasound-guided aspiration followed by surgical drainage under local anesthesia. This case report highlights that a considerable number of patients with liver abscess and its complications can be appropriately managed in resource-limited, rural, surgical centers.

Individuals presenting with sudden and focal neurological findings are usually suspected to have stroke. However, there are other conditions that can simulate stroke, which are often referred to as stroke mimics. Awareness and understanding these stroke-like disorders are of extreme importance as the treatment of each of them might be variable. We hereby briefly discuss these stroke mimics, common differentials, and key features to differentiate amongst the various causes of acute neurological event. Stroke is one of the neurological emergencies that needs urgent intervention to prevent significant mortality and morbidity. At the same time, it is important to realize the importance of other conditions which may mimic to stroke. In this letter, we aim to discuss a few key features that could probably help to distinguish stroke from mimickers thereby helping emergency doctors, neurologists, and hospitalists in streamlining the correct treatment at the earliest.

SUMMARY: Acute necrotizing encephalopathy after an acute febrile illness, although initially described exclusively in the pediatric age group, has been recently shown to have an adult onset as well. In this study, we describe 10 patients (16 years of age or older) with acute necrotizing encephalopathy. In our study, bilateral thalamic involvement with the trilaminar pattern of diffusion restriction on MR imaging was the predominant finding seen in all of the patients reviewed. Ancillary findings of cerebral white matter, brain stem, and cerebellum involvement with sparing of the basal ganglia were also noted. A poorer outcome was observed in patients with a higher degree of thalamic involvement. The cause of an underlying infection was identified in 4 patients (dengue in 3 and influenza in 1). Overall, a sizeable portion of young adults with acute necrotizing encephalopathy have shown a poorer outcome, with dengue being an important underlying trigger in an endemic region.