Background/Aims: Very little is known about the occurrence of tropical ataxic neuropathy (TAN) from southern India. This study describes the clinical spectrum of TAN from Kerala, southern India, and explores its etiology. Methods: We reviewed the clinical and laboratory profile of 40 TAN cases diagnosed in a tertiary referral center in central Kerala. We enquired the consumption of cassava foods and estimated the thiocyanate levels in the serum, urine and sural nerve. Results: The notable demographic characteristics included female preponderance, peak age at onset in the thirties, rural residence and poor socioeconomic status. The diet in the majority comprised a large amount of tapioca, which is low in protein. In addition to sensory peripheral neuropathy, 90% had decreased hearing, 50% had decreased vision, and 25% had spasticity involving the lower extremities. None had signs of overt vitamin deficiencies or malabsorption syndrome. Compared to the controls, the serum, urine and sural nerve thiocyanate levels were significantly elevated in the patients. With cessation of cassavaintake and better nutrition, improvement in the neurological disability occurred in the majority. Conclusions: This study, for the first time, provides evidence for the occurrence of TAN in south India and the possible etiological role of cassava intake.

Background:Diagnosis of tuberculous meningitis (TBM) is a challenge because of the manifold clinical presentation, and diagnosis is often delayed.Objectives:We wanted to share our experience of directly observed treatment short course (DOTS) in TBM. We did a retrospective analysis to look at the presentation, management and outcome of TBM patients from November 2006 to April 2008.Materials and Methods:TBM was diagnosed based on clinical criteria. We excluded patients with HIV.Results:We had 11 patients on DOTS regime. One died following hepatitis and another patient died of unrelated gastroenteritis. The only patient on daily regime died. Our patients generally presented late, at a median duration 20 days from onset of symptoms, and 50% had stage 3 disease at presentation. The median delay in diagnosis was 4.5 days.Discussion:We found DOTS to be effective in TBM but not without side effects.

Video 2. Patient with "true" AEO without lower eyelid elevation: Inability to open the eyes voluntarily is observed without lower eyelid spasm indicating ILPI alone, without associated pretarsal blepharospasm as the possible mechanism.

Madhusudanan M, Gracykutty M, Cherian M. Athetosis-dystonia in intramedullary lesions of spinal cord. Acta Neurol Scand 1995: 92: 308-312. 0 Munksgaard 1995.Athetosis and dystonia are well known clinical signs, described in disorders of basal ganglia. As opposed to pseudoathetosis, true athetosis was hitherto not reported in cord lesions. We here report three patients with athetosis and dystonia of hands due to intramedullary lesions of cervical cord: two patients with syringomyelia and one with glioma. Even though pseudoathetosis can be produced by lesions of posterior columns and likely to be confused with the involuntary movements of our patients, they had clinical and EMG findings consistent with true athetosis. A possible explanation for the athetosis and dystonia due to cord lesion is being