A young male who was a diabetic presented with gradually progressive hearing loss, recurrent episodic behavioral abnormality, easy fatigability, proximal weakness, and seizures. The patient was evaluated in detail to find out the etiology of encephalitis. The serum autoimmune encephalitis panel was negative. On magnetic resonance imaging of the Brain, there was temporoparietal T2 and fluid-attenuated inversion recovery hyperintensity. In the magnetic resonance spectroscopy study, a lactate peak was found. So, the patient was evaluated for mitochondrial illness mitochondrial encephalopathy lactic acidosis with stroke-like symptoms) and it was confirmed by a genetic study. This case illustrates that though it is a rare disease, always a strong clinical index of suspicion is required for the diagnosis of mitochondrial disorders in case of multisystem involvement so that diagnosis would not be missed.

Lateral epicondylitis (LE) commonly known as tennis elbow (as it affects 50% of tennis players) is also a general public health issue as it affects a high number of the general population.The preferred method of treatment most commonly is a local corticosteroid (CS) injection with or without the addition of a local anesthetic 6. Dry needling (DN) is another treatment modality which is commonly employed for the management of LE.The purpose of our study was to evaluate whether DN is as effective as CS injections in the management of LE. The number of patients included in our study was 146. Patients were divided into two groups. One that had been treated with corticosteroid injections (Group A) and one that had been treated with dry needling (Group B).Patient evaluation forms/records at 4 weeks and 12 weeks, were retrieved and analyzed. For this modified criteria of Verhaar et al was utilized.The study suggests that both the techniques, i.e dry needling as well as corticosteroid injections are reliable methods for treatment of lateral epicondylitis.

In India two vaccines were initially recommended for vaccination; Covaxin in the 3rd phase trial and Covishield in the 4th phase for coronavirus disease 2019 (COVID-19). Covaxin was approved to be given only in tertiary care health centers and urban areas. An adverse event is any untoward medical problem in a patient after the administration of a new drug or vaccine that may or may not be related to that product. There are several case reports of stroke followingCOVID-19 vaccination. Here, we have reported five cases of ischemic stroke following COVID-19 vaccination presenting to the neuro-outpatient department or casualty. We have taken three patients who were vaccinated with Covishield and presented with acute neurological deficit within 24 hours of vaccination. All patients were COVID-19 reverse transcription-polymerase chain reaction negative. Computed tomography brain, magnetic resonance imaging brain, echocardiography, carotid Doppler study, and other routine blood investigations were done on all patients. All the three patients were male in the age group of 30 to 60 years. All were ischemic strokes. All patients had associated other risk factors for stroke. None of them had thrombocytopenia. The proposed mechanism is vaccine-induced immune thrombotic thrombocytopenia. One patient had a posterior circulation stroke. Two patients recovered and one patient was in critical condition and left against medical advice. We cannot conclude that the thrombotic events were due to the vaccine only as other risk factors were also present. Weighing the beneficial effect of vaccines these complications can be called mere associations. But since these can be serious adverse effects of vaccines, more and more studies are required to prove vaccines as the causative agent of thrombotic stroke.