Background:Emergence agitation (EA), although well documented in the clinical literature, still has uncertainties and confusion abound on this subject because of the absence of a clear definition and lack of reliable and valid assessment tools.Aim:To compare the incidence and severity of EA and recovery characteristics in paediatric patients under isoflurane, sevoflurane or desflurane anaesthesia and evaluate the effect of age and duration of anaesthesia on the incidence of EA.Settings and Design:Randomized prospective double-blinded study.Methods:Seventy-five American Society of Anaesthesiologists I and II patients, aged between 4 months and 7 years, were included in the study. Patients were induced with sevoflurane and oxygen. Anaesthesia was maintained with O2 + N2O and isoflurane, sevoflurane or desflurane according to randomization. Caudal block and paracetamol suppository was administered before the surgical incision. In the Post-Anesthesia Care Unit (PACU), degree of agitation was assessed using the Paediatric Anaesthesia Emergence Delirium Scale. Aldrette score, Face, Legs, Activity, Cry, Consolability score and any adverse events were noted.Statistical Analysis:Chi-square/Fischer exact test was applied for categorical variables; for continuous variables, the analysis of variance/non-parametric Kruskall–Wallis test was applied. Two-sample t-test/non-parametric Wisconsin Mann–Whitney test was applied between the two groups. Statistical significance was determined at P<0.05.Results:Incidence and intensity of EA were comparable in all three groups. Age and duration of anaesthesia do not appear to have any bearing on the incidence of EA. Rapid emergence with sevoflurane and desflurane did not translate into early discharge from PACU.Conclusions:EA is a multifactorial syndrome. More well-conducted studies using validated scales and standardized protocols should be carried out to better understand this phenomenon.

Key Clinical MessagePrompt serum copper and zinc in addition to vitamin B12 levels should be measured in patients suffering from refractory anemia with neurological symptoms. A timely copper supplementation can help revert the hematological and possibly the neurological manifestations.

Steroid cell tumor not otherwise specified (NOS) is a rare subtype of sex cord stromal tumor of the ovary and contributes less than 0.1% of all ovarian neoplasms. The majority of tumors occur in pre-menopausal women (mean age: 43 years), in which 56-77% of patients present with virilization due to excess testosterone. An 80-year-old woman with worsening alopecia and excessive growth of coarse hair on abdomen and genital area was found to have elevated serum testosterone level (462 ng/mL). Radiologic studies were consistent with bilateral adrenal adenomas. Bilateral adrenal venous sampling ruled out the adrenal gland as origin of hormone secretion. A diagnostic and therapeutic bilateral salpingo-oophorectomy confirmed steroid cell tumor NOS of the left ovary. Post-operatively, the patient had complete resolution of her symptoms and normalization of testosterone level. Our case emphasizes the importance of a clinical suspicion for an occult testosterone secreting ovarian tumor in a symptomatic patient without obvious ovarian mass on imaging.

Neurocysticercosis is an important parasitic disease of the central nervous system and constitutes a public health challenge for most of the developing world. Radiological findings may be quite variable. A 50 year old man presented with recent onset generalized tonic-clonic seizures. CT scan revealed a lobulated cystic lesion in the right fronto-temporal lobe compressing the lateral and third ventricle and upper brainstem. Clinico-radiological diagnosis of right fronto-temporal space occupying lesion with possibility of cystic glioma was made. He underwent craniotomy with cyst decompression and excision of cyst wall. Histopathology showed features of Racemose variant of Neurocysticercosis. This is an uncommon variant of neurocysticercosis characterized by extraparenchymal involvement, an aggressive clinical course and requiring surgical management. This case is being presented because of its rare occurrence and potential diagnostic difficulties on clinico-radiological grounds.