Cryptococcal meningoencephalitis (CM) is one of the major causes of mortality and morbidity in immunocompromised patients estimating 650,000 deaths each year. Across the globe, CM has been occasionally seen in apparently immunocompetent patients who otherwise don’t have established risk factors. The clinical presentation of CM in immunocompetent hosts is subtle and often results in complications including persistent neurological deficits and death. We present a case of Cryptococcal neoformans meningitis in a diabetic female with no other identified risk factors. Although her clinical presentation was atypical, her clinical course was uncomplicated. The pathophysiology in immunocompetent hosts appears somewhat different, so is the clinical presentation. Since there are no separate evidence-based treatment recommendations, it is challenging to treat this group of patients. There seems to be a need for further studies for management in CM for HIV negative, non-transplant immunocompetent patients.

Introduction Primary headache disorder, characterized by recurrent headache is the most prevalent disease leading to widespread ill health and impaired quality of life. In Nepal headache is one of the most common cause of patient attending neurology clinic. Amitriptyline, Flunarizine and Topiramate are common drugs in the treatment of primary headache. We conducted this study to compare the efficacy of drugs namely Amitriptyline, Flunarizine and Topiramate in the treatment of primary headache Materials and Methods This is the retrospective data analysis of primary headache patient treated with amitriptyline, flunarizine and topiramate. On their first, second and third subsequent visits, Headache Impact Test 6 Scoring was done by a medical person. Patient were treated clinically. After third follow up data were analyzed using SPSS version 20.0. Categorical variables were compared by chi-square test, paired sample t-test, ANOVA test and Welch test. Results A total of 142 patient data was analyzed. The most common age group were between 20 to 39 years (56.34%) followed by 40 to 59 years (33.80%). Female were predominant in the group 124 (87.32%).  All three medication Amitriptyline, Flunarizine and Topiramate were able to significantly lower Headache impact test  -17.23 ± 6.643, -14.06 ± 7.155, -15.82 ± 5.907 respectively (P- <0.001). Amitriptyline was found to be better than other two drugs in reducing Headache Impact Test. Conclusion All three drugs namely Amitriptyline, Flunarizine and Topiramate, are significantly effective in the treatment of primary headache. Though tension type of headache is the most common type of headache, amitriptyline seems to be equally effective in treatment with other primary headaches.

Bilateral internal carotid artery occlusion is a disease that is encountered rarely. We report a case of a 54 years old female smoker, who presented with acute onset right-sided limb weakness, facial deviation and slurring of speech. On computed tomography angiography occlusion of the bilateral internal carotid artery was seen and a high-flow collateral circulation was formed through the vertebrobasilar system. Computed tomography brain perfusion showed marked cerebral hypoperfusion on the left side. The patient was thrombolysed and kept on dual antiplatelet therapy. Post-medical treatment, motor power and speech significantly improved.

Currently, there is no cure for Human immunodeficiency virus /Acquired immunodeficiency syndrome (HIV/AIDS) but, there are medications to control HIV and prevent opportunistic infections. Clinicians must be vigilant enough to extract history and send relevant laboratory investigations to diagnose the disease in early stage. Patient may not have known his /her diagnosis or intentionally avoided to reveal the disease status which further complicates the diagnosis and treatment. This is case of a 51 years male, where social stigma forces the patient to hide his diagnosis and reluctant to seek medical treatment ultimately reaps the life. Hence, government and concerned authority must work up for wide availability of HIV/AIDS medications and motivate people to seek medical advices as soon as possible. Concerned authority must motivate people to consider it as any other treatable disease.