Therapeutic Challenge in a Case of Recent Onset Refractory Cluster Seizures.

A dilemma exists in context to the timing of surgery in a case presenting with explosive onset seizures secondary to a focal cortical dysplasia (FCD). This case report highlights the challenges faced in the management of a 4-year-old child with recent onset cluster seizures refractory to anti-epileptic drugs. A 4-year-old girl presented with an acute onset of cluster seizures (up to 32 in a day), semiologically characterized by tonic upper limb extension and laughter lasting for few seconds with no response to multiple anti-epileptic drugs.

Paying for Hemodialysis in Kerala, India: A Description of Household Financial Hardship in the Context of Medical Subsidy.

Introduction: Many low- and middle-income countries are implementing strategies to increase dialysis availability as growing numbers of people reach end-stage renal disease. Despite efforts to subsidize care, the economic sustainability of chronic dialysis in these settings remains uncertain. We evaluated the association of medical subsidy with household financial hardship related to hemodialysis in Kerala, India, a state with high penetrance of procedure-based subsidies for patients on dialysis.

Reversible "Pulvinar sign" in Wernicke's encephalopathy.

Young onset dementia is a challenge. We describe a case, where a patient presented with psychosis, dementia and MRI showing pulvinar sign, all of this typical of variant Cruetzfelt Jacob disease (CJD). Subsequent investigations lead to the diagnosis of a treatable illness and patient was improved and MRI sign reversed, underlining again the importance of search needed for treatable diseases in any "typical" case of fatal illness.

Sparing phenomena in dermatology.

Despite considerable overlap, the confusion hovering over the four common sparing signs can be cleared as follows: Reverse Koebner relates to sparing by physical trauma; isotopic non-response/reverse isotopic response relates to sparing over an already healed dermatosis; Renbok Phenomenon relates to sparing among two concomitant active diseases often with autoimmune etiology; anatopic phenomenon relates to sparing caused by presence of certain infectious diseases of skin. In conclusion, sparing phenomenon of dermatology seems to command our attention by their sheer number, variety, and clinical implications. Therefore, it may be said that astute clinician is the one who will look, not only for the presence of lesions in the patient but also for the conspicuous absence thereof.