Study design: Cervical spine tuberculosis is a relatively less frequent form of spinal tuberculosis. Cervical spine tuberculosis has a greater propensity to involve the spinal cord and results in major sensory motor deficit. In this prospective study, we aimed to evaluate the clinical and imaging predictors of outcome in conservatively managed patients. Methods: In this study, 42 patients of cervical spine tuberculosis were included. Patients were subjected to a detailed clinical evaluation and magnetic resonance imaging. Patients were treated with antituberculosis treatment and were followed up for 18 months. The Modified Barthel index (MBI) was used to assess the disability. Good outcome was defined as MBI 412 and poor outcome as MBI p12. Clinical and imaging characteristics were used to analyze the predictors of outcome, using univariate and multivariate analysis. Results: Four (9.5%) patients required surgery. Data from 38 patients, who were conservatively managed, were analyzed for predictors of outcome. Among conservatively managed patients, at presentation, 29 patients had an MBI score of p12. At 18 months, the majority of patients (81.6%) had a good outcome. On univariate analysis, a duration of illness 43 months, a major motor deficit, bladder involvement, flexor spasms, significant cord compression and spinal extension of the abscess were significantly associated with a poor outcome. However, on multivariate analysis significant cord compression (P ¼ 0.003) and spinal extension (P ¼ 0.02) showed a significant correlation with a poor outcome. Conclusion: Medical management was effective in cervical spine tuberculosis. Patients with significant cord compression and spinal extension of the abscess showed poorer outcome.

SUMMARYWe present a case of a 33-year-old woman who presented with phlyctenular conjunctivitis while on treatment for spinal intramedullary tuberculosis. She was treated with topical steroids along with continuation of antitubercular therapy, and improved on this treatment. BACKGROUND

Tuberculosis continues to remain a significant public health problem in developing nations, causing substantial morbidity and mortality. Central nervous system (CNS) tuberculosis is frequently observed in endemic zones of tuberculosis including India. The emergence of infections like HIV and malnutrition ruined the public health measures to restrain tuberculosis in developing countries. The incidence of intraspinal tuberculomas is reported to be 0.2–5% among CNS tuberculomas. To date, only a few cases have been reported of mixed intraspinal and intracranial tuberculomas. The clinical outcome in CNS disseminated tuberculomas is not well described in the literature. With this view, we report a case of a 25-year-old woman who presented with neck pain, triparesis and bladder incontinence, which finally proved to be a case of multiple cerebral and spinal tuberculomas. The antitubercular treatment with steroids and other supportive measures resulted in good recovery.

Wilson disease (WD) is one of the few inherited but treatable disorder mainly affecting the liver and brain resulting in severe disability or death if left untreated. Hence, it is important to keep a high index of suspicion for diagnosing this clinical entity in appropriate clinical settings. The clinical presentation can be quite variable and they may present solely with neurological features sans hepatic symptoms. Such neurological manifestations usually follow subacute to chronic course. Acute onset anarthria as the heralding and predominant presenting feature has been rarely reported in the literature. We reported a case of a 12-year-old girl who presented with acute onset anarthria and dystonia of 1-month duration. On further evaluation, a diagnosis of WD was made. The patient showed partial improvement after she was started on copper chelating agents and anticholinergics.

SUMMARYWe report the case of a 54-year-old hypertensive woman who presented with sudden onset left hemiparesis with facial asymmetry and inability to pass urine. Her bladder was distended and she had to be catheterised. MRI of her brain showed a large infarct in the right pontine region. Antiplatelet therapy was instituted and the patient showed good recovery and was able to walk with support after a fortnight at the time of discharge. She was discharged with a catheter in situ. After 6 months, she could walk with the support of a stick, but had increased frequency and urgency of micturition along with nocturia. Urodynamic study revealed detrusor hyper-reflexia, possibly due to involvement of the pontine micturition centre. BACKGROUND