Cerebral venous thrombosis (CVT) is a rare complication of lumbar puncture. Occasionally, the clinical picture of CVT may mimic post-dural puncture headache (PDPH) resulting in delayed diagnosis. A case of PDPH progressing to CVT is presented and the pathophysiology, diagnostic challenges and management options discussed in this article.

Cow dung, which has germicidal property, was used in ancient days to clean living premises in South India. Nowadays, people are using commercially available synthetic cow dung powder. It is locally known as “saani powder” in Tamil Nadu. It is freely available in homes and is sometimes accidentally consumed by children. It is available in two colors - yellow and green. Cow dung powder poisoning is common in districts of Tamil Nadu such as Coimbatore, Tirupur, and Erode. We report two cases of yellow cow dung powder poisoning from our hospital.

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BACKGROUNDPain after endoscopic urological surgeries differs from other open surgeries as the pain is mainly due to bladder spasms or catheter related. Pre-emptive analgesia decreases the analgesic requirements perioperatively. The purpose of this study is to evaluate the pre-emptive analgesic effect of oral paracetamol 1000 mg in patients undergoing ureteroscopic lithotripsy procedures. METHODSThis is a double blinded randomised controlled study. The study included 60 ASA I -II patients admitted for ureteroscopic lithotripsy procedures. Patients were randomly allocated into two equal groups: group P received oral Paracetamol 1 gm and group C received oral Vitamin C 500 mg as placebo, 1 hour before surgery. The intensity of postoperative pain was measured with 0-10-point Numerical Rating Scale (NRS). Rescue analgesia was given if patients had NRS scores of 4 or more. Time to first rescue analgesia was noted. Statistical analysis was done with Chi square and independent sample t test. RESULTSAt 3 rd , 4 th and 5 th hour, the pain scores were low in paracetamol group compared to placebo group. Time to rescue analgesia was more in paracetamol group compared to placebo group. Both the parameters were statistically significant. CONCLUSIONSOral paracetamol 1 gm used as a pre-emptive analgesia in patients undergoing ureteroscopic lithotripsy procedures, provides excellent analgesia compared to control group with no side effects.

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