Page 3 - Newsletter-o6

CATARACT
Cataract is defined as opacification of the human crystalline lens. It is
the most common cause of treatable blindness and it was treated in 6th
century BC by Indian physician, Sushruta when couching was done to
restore the vision.
The name 'Cataract' is derived from the Latin word 'cataracta' which
means waterfall because the vision becomes hazy (as if like seeing
through a waterfall).
The most common etiology is due to age in which oxidative stress
hampers the normal metabolism of lens and makes it opaque.
It can be congenital or infantile where some disturbance to the normal
development occurs. Maternal factors like smoking, alcohol intake and
CASE REPORT
TOXOPLASMIC CEREBELLITIS
A young 42-year-old male, resident of Nepal got admitted on 12th October,
2016 with complaints of headache for 1 month duration, dizziness since
20 days, occasional fever off and on, difficulty in walking since 1 week and
inability to sit or stand for 2-3 days. He was conscious, oriented, with mild Meanwhile, he tested positive for HIV serology and the CD4 count was
dysarthria and gaze evoked nystagmus right > left. The power was 4/5 in
all limbs and plantars were bilaterally flexor type. On testing, he showed
marked intentional tremors in both hands, incoordination on finger nose
testing, severe truncal ataxia in the form of head titubation, swaying on
both sides and unable to sit unsupported.
MRI (Brain) showed multiple nodular and ring enhancing granulomas
in cerebellum vermis and both hemispheres, bilateral thalami. CSF
examination showed 14 cells which were lymphomononuclear and initial
tests for Cryptococcus as well as mycobacterium were not contributory.
He was started on antitubercular treatment initially but his condition
worsened. He became drowsy, with severe dysarthria, ataxia and difficulty
in swallowing and breathlessness requiring ventilatory support.
Prior to starting the treatment After treatment for 15 days
drugs (anticonvulsant, steroid) and natal or prenatal infections with
TORCH group are other common causes.
The long list of systemic diseases – diabetes, atopic dermatitis,
galactosemia, Wilson's disease and galactokinase deficiency, etc.
also are implicated.
Ophthalmic factors include trauma (blunt or penetrating injuries to eye)
and eye diseases like anterior uveitis, high myopia, retinitis pigmentosa.
Symptoms of cataract includes diminution in quality and quantity of vision
which comprises blurring, glare in sunlight or night driving, decrease in
colour saturation and contrast sensitivity.
The treatment of cataract is only surgical by removing the opacified lens
and putting an artificial intraocular lens.
In the past few decades there have been major advancements in cataract
surgery. We have come a long way from couching in ancient times to
femtosecond laser assisted phacoemulsification in modern times.
Intraocular lens are also drastically improved and now we have a whole
plethora of lenses from non-foldable
to microincision lens, monocular, toric,
multifocal and aspheric. The goals
of the surgery have also changed
from restoration of vision to gaining
unaided normal vision with minimum
post-operative recovery time.
Dr. Neha Rathi
Consultant,
Mohan Eye Institute
A repeat MRI showed new multiple ring enhancing lesions in medulla,
thalami, cerebellar vermis and in the body of corpus callosum. All previous
lesions showed increase in size and edema meningeal enhancement of
tentorium cerebelli.
found to be 59. Additionally, the Toxoplasma serology was strongly positive
with IGg titres > 250iu/ml .
He was started on trimethoprim and cotrimoxazole and he started
improving the very next day, remained stable on ventilator, fully conscious
and responding well. However, he continued to have nystagmus on
right gaze with paresis of left gaze, right ptosis and marked limb ataxia
persisted in spite of initial good response. He was finally extubated on
27th October, 2016. The pre-treatment and post-treatment scans are given
to highlight the efficacy of timely treatment.
Dr. Dinesh Sareen
MBBS, MD, DM (Neuro)
Sr. Consultant,
Neurology