Top of basilar syndrome occurs due to the thrombotic occlusion of basilar artery. It is very rare in occurrence and constitutes about 1% of all strokes. Clinical manifestations commonly may have the hallmarks of basilar artery occlusion that include dysarthria, visual, oculomotor and behavioural abnormalities with or without significant motor dysfunction and non-specific symptoms like vertigo and headache. Here we report a case of 60year old male who presented with decreased responsiveness and slurring of speech since 2 days and history of vomiting since one day. Neurological examination revealed normal higher mental functions with MMSE score of 28/30, horizontal nystagmus was present, other cranial nerve examination was normal, tone was increased in all the four limbs, Power was 4/5 in all the 4 limbs and Plantar was mute bilaterally. Patient condition deteriorated later and on further evaluation patient was found to have Basilar Artery Occlusion.

Amyloidosis is a rare systemic disorder caused by abnormal folding of normal soluble proteins leading to fibril formation in one or more body organs, systems or soft tissues. Amyloid goiter is characterized by deposits of amyloid protein in the thyroid tissue. Amyloid infiltration of thyroid gland with development of secondary goiter is rare. Here we report a case of 36-year-old female presented with progressive painless swelling over neck. Thyroid profile was normal. Ultrasound neck showed enlarged bilateral thyroid gland and isthmus. Fine needle aspiration cytology suggestive of subacute thyroiditis (granulomatous thyroiditis). Total thyroidectomy was done and biopsy sample revealed amyloid goiter.

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease that causes severe demyelination, especially in the optic nerve and spinal cord with typical clinical manifestations of acute optic neuritis and transverse myelitis. Seventy to ninety percent of the cases of NMOSD test positive for aquaporin 4 IgG Antibodies (AQP4 IgG Ab). Here we report a case of 22-year-old female who presented with history of diffuse headache since 1 week, history of double vision since1 week and excessive day time sleepiness since2 months. Patient had a past history of bilateral and simultaneous optic neuritis 9 months back. On further evaluation patient was diagnosed as seronegative NMOSD (AQP4 IgG Ab–negative).

Kounis syndrome is an acute coronary syndrome of varying degrees induced by allergic or anaphylactic reaction leading to coronary vasospasm or atheromatous plaque erosion or rupture or global myocardial hypoperfusion occurring as a result of systemic vasodilation and decreased venous return in context of anaphylaxis. We reported a case of 33-year-old female who presented to emergency department in an irritable state with complaints of nausea, vomiting, abdominal pain, breathlessness and generalized itching which developed secondary to administration of diclofenac injection by intra muscular (IM) route. On evaluation, echocardiography revealed global LV systolic dysfunction. The patient was successfully treated with continuous noradrenaline infusion, fluid resuscitation and other supportive measures with repeat echocardiography revealing normal LV systolic function.

Infective endocarditis is an unconventional infectious disease nonetheless life-threatening. A roundabout of 3% to 5% cases of Streptococcal infective endocarditis is caused by nutritionally variant Streptococci (NVS). Granulicatella species is one of the atypical causes of infective endocarditis. In this context, the authors are disclosing a case of infective endocarditis in an underlying rheumatic heart disease patient, caused by Granulicatella adiacens. The patient had breathlessness for the past four months, on and off fever for two months anew and mid-diastolic murmur with vegetation in aortic valve as appeared by echocardiogram. The blood cultures were tested positive for Granulicatella adiacens. The patient was successfully treated with intravenous vancomycin for a period of six weeks.