Koushik Pan | West Bengal University of Health Sciences (original) (raw)

Papers by Koushik Pan

New Zealand medical journal (Print), May 2, 2014

Metronidazole can produce neurological complications although it is not a common scenario. We pre... more Metronidazole can produce neurological complications although it is not a common scenario. We present a case where a patient developed features of encephalopathy following prolonged metronidazole intake. Magnetic resonance imaging (MRI) brain showed abnormal signal intensity involving both dentate nuclei of cerebellum and splenium of corpus callosum. The diagnosis of metronidazole toxicity was made by the MRI findings and supported clinically.

International Journal of Medical and Health Sciences, 2014

Areflexia and progressive flaccid weakness are considered essential for diagnosis of Guillain-Bar... more Areflexia and progressive flaccid weakness are considered essential for diagnosis of Guillain-Barre syndrome (GBS) .We hereby report a case of a 41 year old male presenting with acute onset flaccid quadriparesis. Diagnosis of GBS wasmade based on history and clinical findings supported by Cerebrospinal fluid(CSF) studies and Nerve Conduction Study(NCS). The significance of the case was the presence of frank hyperreflexia in all four limbs. Although reflex preservation and hyperreflexia can be noted in axonal variant of GBS in Chinese, Japanese, and European populations, it is uncommon in India. This case report is to stress upon the fact that a hyperreflexic variant of GBS though rare, should be kept in mind in an appropriate clinical setting.

Archives of Medicine, 2016

Dengue fever is identified as one of the most important mosquito-borne viral disease worldwide. E... more Dengue fever is identified as one of the most important mosquito-borne viral disease worldwide. Every year a large number of people belonging to urban populations suffer from this viral infection. Various presentations of dengue fever have been documented, however, neurological complications in dengue fever are relatively uncommon. Among these, Acute Disseminated Encephalomyelitis (ADEM) has been observed very rarely. Here we present a case of 15 year old boy suffering from ADEM following dengue fever.

International Journal of Medical and Health Sciences, 2014

Primary biliary cirrhosis is an autoimmune disease that tends to progress to fibrosis and cirrhos... more Primary biliary cirrhosis is an autoimmune disease that tends to progress to fibrosis and cirrhosis with hepatic failure. Primary biliary cirrhosis is often associated with other non- hepatic autoimmune diseases. A rare association with rheumatoid arthritis is found to coexist in 3-5% of patients with primary biliary cirrhosis. B cells seem to play a major role in the pathogenesis of both rheumatoid arthritis and primary biliary cirrhosis. We describe the case of a 46 year old man with severe erosive rheumatoid arthritis and primary biliary cirrhosis treated with rituximab. He was treated with rituximab.

The Journal of the Association of Physicians of India, 2018

On one side, pregnancy is a bliss, a beautiful journey for most women while on other, it increase... more On one side, pregnancy is a bliss, a beautiful journey for most women while on other, it increases the risk of several diseases which may cause considerable morbidity and mortality in young women in the most productive period of their lives. Neurological emergencies in pregnancy often have grave prognosis and so, must be promptly diagnosed and treated. This article reviews the clinical features and management of some of the common severe neurological emergencies in pregnancy.

Vein of Galen Malformation (VGM) is a rare vascular malformation representing less than 1% of vas... more Vein of Galen Malformation (VGM) is a rare vascular malformation representing less than 1% of vascular intracranial abnormalities. It is a congenital anomaly and frequently detected during the last trimester of gestational age, during neonatal period or early childhood. Clinical manifestations can appear at any age but mainly in the neonatal or infancy stage in the form of heart failure, delayed neuropsychomotor development, hydrocephalus and seizures. First presentation in adult age is very rare. We report a case where a patient remained symptom free until presentation following generalized tonic clonic seizures at the age of 47 years.MRI brain and MR Angiography confirmed the presence of VGM.

Multiple myeloma with isolated third nerve palsy as the presenting complaint is a rare entity. We... more Multiple myeloma with isolated third nerve palsy as the presenting complaint is a rare entity. We report a case of a 30-year-old man who developed sudden onset left-sided complete abducens nerve palsy without pain. Cranial and orbital magnetic resonance imaging and cerebrospinal fluid examination demonstrated no abnormalities. He was diagnosed as having IgG type multiple myeloma, based on the immunological and pathological investigation. After instituting chemotherapy, palsy resolved within 3 weeks. Etiology is not established beyond doubt but probably palsy was caused by nerve ischemia due to hyperviscosity of the serum.

Journal of Case Reports, 2014

Background: Hemichorea-hemiballism (HCHB) is a hyperkinetic movement disorder with features of bo... more Background: Hemichorea-hemiballism (HCHB) is a hyperkinetic movement disorder with features of both chorea and ballism occurring on the same side.

International Journal of Medical Research and Review

It is very rare for the primary presentation of a gastric malignancy to be with bone metastases. ... more It is very rare for the primary presentation of a gastric malignancy to be with bone metastases. Also it is equally rare for MAHA to be a presenting feature of gastric adenocarcinoma as a paraneoplastic syndrome. This is a case report is 55years old female who presented with widespread vertebral deposits with diffuse bone marrow infiltration along with Coomb's negative haemolytic anemia with thrombocytopenia and schistocytes in peripheral blood typical of MAHA. The combination of MAHA and bone infiltration in gastric adenocarcinoma is a very rare entity.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

International Journal of Medical Research and Review

Myotonic dystrophy (MD) or Steinert's disease is a rare cause of chronic diarrhoea and anal incon... more Myotonic dystrophy (MD) or Steinert's disease is a rare cause of chronic diarrhoea and anal incontinence. We present the case of a 37 year old man who presented with chronic diarrhoea and faecal incontinence as the initial symptoms to our outpatient clinic and was later diagnosed with MD. In the presence of chronic diarrhoea and faecal incontinence with muscle weakness, neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis.

Journal of Stroke and Cerebrovascular Diseases

The intracerebral hemorrhage (ICH) score is well established as a reliable prognostic score in IC... more The intracerebral hemorrhage (ICH) score is well established as a reliable prognostic score in ICH, whereas recently, Acute Physiology and Chronic Health Evaluation II (APACHE II) has been observed to have a better discrimination in predicting mortality in primary pontine hemorrhage. Further, physiological parameters of APACHE II have been associated with outcome in ICH. This study is the first to observe a direct comparison between APACHE II and ICH scores in predicting 30-day mortality in spontaneous intracerebral hemorrhage (SICH). This study was a prospective observational study where we compared the receiver operating characteristic (ROCs) of baseline ICH and APACHE II scores in patients with SICH for predicting 30-day mortality outcome. We observed that both APACHE II and ICH scores were good for predicting 30-day mortality with both having an area under the ROC curve of more than .8 (.831 [95% confidence interval {CI}, .740-.922; P <.001] and .892 [95% CI, .757-.932; P <.001], respectively). However, the ICH score was better discriminative (area under the curve AUC, .892 versus .831; P = .040) and better calibrated (P = .037 versus P = .089, Hosmer-Lemeshow goodness-of-fit test for logistic regression) for the same. Both APACHE II and ICH scores had a sensitivity of 87% at cutoff values of 19 and 3, respectively; however, the ICH score had a better specificity (90% versus 76.5%). The ICH score was observed to have a better discrimination and calibration for predicting 30-day mortality in SICH.

Tremor and other hyperkinetic movements (New York, N.Y.), 2016

Hemichorea-hemiballism (HCHB) is a hyperkinetic movement disorder with features of both chorea an... more Hemichorea-hemiballism (HCHB) is a hyperkinetic movement disorder with features of both chorea and ballism occurring on the same side. We present a case of HCHB due to nonketotic hyperglycemia (NKH) that was the initial presentation of diabetes and was irreversible clinically even after 6 months of optimal blood sugar control. Although HCHB due to hyperglycemia is a potentially reversible condition in the majority of patients, prolonged uncontrolled hyperglycemia may cause ischemic insult and persistent symptoms. Hyperglycemia should always be kept in the list of differentials while dealing with patients who are newly diagnosed with HCHB.

Tremor and other hyperkinetic movements (New York, N.Y.), 2016

In Response To: Lee D, Ahn, TB. Glycemic choreoballism. Tremor Other Hyperkinet Mov. 2016; 6. doi... more In Response To: Lee D, Ahn, TB. Glycemic choreoballism. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8QJ7HNF Original Article: Roy U, Das SK, Mukherjee A, et al. Irreversible hemichoreahemiballism in a case of nonketotic hyperglycemia presenting as the initial manifestation of diabetes mellitus. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8QZ2B3F.

Background of study: Hyponatraemia is a commonly encountered plasma electrolyte abnormality. As a... more Background of study: Hyponatraemia is a commonly encountered plasma electrolyte abnormality. As aggressive or inappropriate therapy of hyponatraemia can be more harmful than the condition itself, clinicians should be familiar with the diagnosis and management of various forms of hyponatraemia. Objective: To assess the socio-clinical profile of the patients admitted in the Intensive care unit with hyponatraemia & to assess predictors of mortality in the study population Research Methodology: This prospective observational study was done in the Intensive care unit of SSKM Hospital / IPGME&R, Kolkata during April 2011 to March 2012 among the patients having serum sodium level less than135 mmol/l. The data were collected on predesigned questionnaires which include age, gender, clinical findings, complications and laboratory tests. SPSS 16.0 version was used for statistical analysis Results: Males are more commonly affected than females. Chronic liver disease is most common underlying condition associated with hyponatraemia. On multivariate logistic regression analysis serum sodium was found to be statistically significant predictor for mortality (as p value < 0.05). Conclusion: Hyponatraemia could predict the mortality in intensive care unit patients, so proper emphasis should be given to address the situation

International Journal of Health Sciences and Research, 2013

International Journal of Medical Science and Public Health, 2013

Background: Dengue fever, the most common arbo viral illness transmitted worldwide. Dengue infect... more Background: Dengue fever, the most common arbo viral illness transmitted worldwide. Dengue infection in adolescents and adults is also a potential hazard in endemic areas, especially Southeast Asia. Aims & Objective: The present study was done to evaluate the magnitude of dengue death and its predictor factors in a tertiary care hospital of Kolkata. Material and Methods: This observational cross sectional study was conducted at a tertiary care centre of Kolkata over 1 year period with 77 patients with a diagnosis of dengue fever based on the serology positive for dengue IgM with fulfilling the inclusion and exclusion criteria. The data were collected on predesigned questionnaire which include gender, clinical findings, complications and laboratory test. Baseline laboratory tests obtained were complete blood count (CBC), partial thromboplastin time (PTT), serum glutamine pyruvate transaminase (SGPT), SGOT, bilirubin, urea, creatinine and IgM. SPSS 16.0 version was used for statistical analysis. Results: Dengue mortality rate was 28.57% in this study. Among 5 lab parameters chosen i.e. leukopenia, bilirubin > 6 mg/dl, thrombocytopenia, altered PT/APTT, enzyme > 4 fold rise, raised urea/cr. On multivariate logistic regression analysis hyperbilirubinemia (> 6 mg/dl) was statistically significant predictor for mortality (as p value < 0.05). Conclusion: The laboratory parameters could predict the dengue mortality, so proper emphasis should be given to address the situation.

Frontiers in Neurology, 2016

Neuromyelitis optica spectrum disorder (NMOSD) is a diverse condition which not only encompasses ... more Neuromyelitis optica spectrum disorder (NMOSD) is a diverse condition which not only encompasses isolated longitudinally extensive transverse myelitis (LETM) and optic neuritis but also includes area postrema syndrome, acute brainstem syndrome, symptomatic narcolepsy or acute diencephalic clinical syndrome, and symptomatic cerebral syndrome. Imaging may reveal periependymal lesions surrounding the ventricular system or involvement of corticospinal tracts, area postrema, diencephalon, and corpus callosum. Rarely, there may be hemispheric tumefactive lesions that enhance in a "Cloud-like" fashion on gadolinium injection unlike in tumefactive multiple sclerosis where there is incomplete ring enhancement. Here, we present a case of aquaporin-4 positive relapsing NMOSD who presented to us with recurrent episodes of paraparesis with LETM and tumefactive lesions of brain on imaging, which enhanced in an incomplete ring like pattern resembling multiple sclerosis.

New Zealand medical journal (Print), May 2, 2014

Metronidazole can produce neurological complications although it is not a common scenario. We pre... more Metronidazole can produce neurological complications although it is not a common scenario. We present a case where a patient developed features of encephalopathy following prolonged metronidazole intake. Magnetic resonance imaging (MRI) brain showed abnormal signal intensity involving both dentate nuclei of cerebellum and splenium of corpus callosum. The diagnosis of metronidazole toxicity was made by the MRI findings and supported clinically.

International Journal of Medical and Health Sciences, 2014

Areflexia and progressive flaccid weakness are considered essential for diagnosis of Guillain-Bar... more Areflexia and progressive flaccid weakness are considered essential for diagnosis of Guillain-Barre syndrome (GBS) .We hereby report a case of a 41 year old male presenting with acute onset flaccid quadriparesis. Diagnosis of GBS wasmade based on history and clinical findings supported by Cerebrospinal fluid(CSF) studies and Nerve Conduction Study(NCS). The significance of the case was the presence of frank hyperreflexia in all four limbs. Although reflex preservation and hyperreflexia can be noted in axonal variant of GBS in Chinese, Japanese, and European populations, it is uncommon in India. This case report is to stress upon the fact that a hyperreflexic variant of GBS though rare, should be kept in mind in an appropriate clinical setting.

Archives of Medicine, 2016

Dengue fever is identified as one of the most important mosquito-borne viral disease worldwide. E... more Dengue fever is identified as one of the most important mosquito-borne viral disease worldwide. Every year a large number of people belonging to urban populations suffer from this viral infection. Various presentations of dengue fever have been documented, however, neurological complications in dengue fever are relatively uncommon. Among these, Acute Disseminated Encephalomyelitis (ADEM) has been observed very rarely. Here we present a case of 15 year old boy suffering from ADEM following dengue fever.

International Journal of Medical and Health Sciences, 2014

Primary biliary cirrhosis is an autoimmune disease that tends to progress to fibrosis and cirrhos... more Primary biliary cirrhosis is an autoimmune disease that tends to progress to fibrosis and cirrhosis with hepatic failure. Primary biliary cirrhosis is often associated with other non- hepatic autoimmune diseases. A rare association with rheumatoid arthritis is found to coexist in 3-5% of patients with primary biliary cirrhosis. B cells seem to play a major role in the pathogenesis of both rheumatoid arthritis and primary biliary cirrhosis. We describe the case of a 46 year old man with severe erosive rheumatoid arthritis and primary biliary cirrhosis treated with rituximab. He was treated with rituximab.

The Journal of the Association of Physicians of India, 2018

On one side, pregnancy is a bliss, a beautiful journey for most women while on other, it increase... more On one side, pregnancy is a bliss, a beautiful journey for most women while on other, it increases the risk of several diseases which may cause considerable morbidity and mortality in young women in the most productive period of their lives. Neurological emergencies in pregnancy often have grave prognosis and so, must be promptly diagnosed and treated. This article reviews the clinical features and management of some of the common severe neurological emergencies in pregnancy.

Vein of Galen Malformation (VGM) is a rare vascular malformation representing less than 1% of vas... more Vein of Galen Malformation (VGM) is a rare vascular malformation representing less than 1% of vascular intracranial abnormalities. It is a congenital anomaly and frequently detected during the last trimester of gestational age, during neonatal period or early childhood. Clinical manifestations can appear at any age but mainly in the neonatal or infancy stage in the form of heart failure, delayed neuropsychomotor development, hydrocephalus and seizures. First presentation in adult age is very rare. We report a case where a patient remained symptom free until presentation following generalized tonic clonic seizures at the age of 47 years.MRI brain and MR Angiography confirmed the presence of VGM.

Multiple myeloma with isolated third nerve palsy as the presenting complaint is a rare entity. We... more Multiple myeloma with isolated third nerve palsy as the presenting complaint is a rare entity. We report a case of a 30-year-old man who developed sudden onset left-sided complete abducens nerve palsy without pain. Cranial and orbital magnetic resonance imaging and cerebrospinal fluid examination demonstrated no abnormalities. He was diagnosed as having IgG type multiple myeloma, based on the immunological and pathological investigation. After instituting chemotherapy, palsy resolved within 3 weeks. Etiology is not established beyond doubt but probably palsy was caused by nerve ischemia due to hyperviscosity of the serum.

Journal of Case Reports, 2014

Background: Hemichorea-hemiballism (HCHB) is a hyperkinetic movement disorder with features of bo... more Background: Hemichorea-hemiballism (HCHB) is a hyperkinetic movement disorder with features of both chorea and ballism occurring on the same side.

International Journal of Medical Research and Review

It is very rare for the primary presentation of a gastric malignancy to be with bone metastases. ... more It is very rare for the primary presentation of a gastric malignancy to be with bone metastases. Also it is equally rare for MAHA to be a presenting feature of gastric adenocarcinoma as a paraneoplastic syndrome. This is a case report is 55years old female who presented with widespread vertebral deposits with diffuse bone marrow infiltration along with Coomb's negative haemolytic anemia with thrombocytopenia and schistocytes in peripheral blood typical of MAHA. The combination of MAHA and bone infiltration in gastric adenocarcinoma is a very rare entity.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

International Journal of Medical Research and Review

Myotonic dystrophy (MD) or Steinert's disease is a rare cause of chronic diarrhoea and anal incon... more Myotonic dystrophy (MD) or Steinert's disease is a rare cause of chronic diarrhoea and anal incontinence. We present the case of a 37 year old man who presented with chronic diarrhoea and faecal incontinence as the initial symptoms to our outpatient clinic and was later diagnosed with MD. In the presence of chronic diarrhoea and faecal incontinence with muscle weakness, neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis.

Journal of Stroke and Cerebrovascular Diseases

The intracerebral hemorrhage (ICH) score is well established as a reliable prognostic score in IC... more The intracerebral hemorrhage (ICH) score is well established as a reliable prognostic score in ICH, whereas recently, Acute Physiology and Chronic Health Evaluation II (APACHE II) has been observed to have a better discrimination in predicting mortality in primary pontine hemorrhage. Further, physiological parameters of APACHE II have been associated with outcome in ICH. This study is the first to observe a direct comparison between APACHE II and ICH scores in predicting 30-day mortality in spontaneous intracerebral hemorrhage (SICH). This study was a prospective observational study where we compared the receiver operating characteristic (ROCs) of baseline ICH and APACHE II scores in patients with SICH for predicting 30-day mortality outcome. We observed that both APACHE II and ICH scores were good for predicting 30-day mortality with both having an area under the ROC curve of more than .8 (.831 [95% confidence interval {CI}, .740-.922; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001] and .892 [95% CI, .757-.932; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001], respectively). However, the ICH score was better discriminative (area under the curve AUC, .892 versus .831; P = .040) and better calibrated (P = .037 versus P = .089, Hosmer-Lemeshow goodness-of-fit test for logistic regression) for the same. Both APACHE II and ICH scores had a sensitivity of 87% at cutoff values of 19 and 3, respectively; however, the ICH score had a better specificity (90% versus 76.5%). The ICH score was observed to have a better discrimination and calibration for predicting 30-day mortality in SICH.

Tremor and other hyperkinetic movements (New York, N.Y.), 2016

Hemichorea-hemiballism (HCHB) is a hyperkinetic movement disorder with features of both chorea an... more Hemichorea-hemiballism (HCHB) is a hyperkinetic movement disorder with features of both chorea and ballism occurring on the same side. We present a case of HCHB due to nonketotic hyperglycemia (NKH) that was the initial presentation of diabetes and was irreversible clinically even after 6 months of optimal blood sugar control. Although HCHB due to hyperglycemia is a potentially reversible condition in the majority of patients, prolonged uncontrolled hyperglycemia may cause ischemic insult and persistent symptoms. Hyperglycemia should always be kept in the list of differentials while dealing with patients who are newly diagnosed with HCHB.

Tremor and other hyperkinetic movements (New York, N.Y.), 2016

In Response To: Lee D, Ahn, TB. Glycemic choreoballism. Tremor Other Hyperkinet Mov. 2016; 6. doi... more In Response To: Lee D, Ahn, TB. Glycemic choreoballism. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8QJ7HNF Original Article: Roy U, Das SK, Mukherjee A, et al. Irreversible hemichoreahemiballism in a case of nonketotic hyperglycemia presenting as the initial manifestation of diabetes mellitus. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8QZ2B3F.

Background of study: Hyponatraemia is a commonly encountered plasma electrolyte abnormality. As a... more Background of study: Hyponatraemia is a commonly encountered plasma electrolyte abnormality. As aggressive or inappropriate therapy of hyponatraemia can be more harmful than the condition itself, clinicians should be familiar with the diagnosis and management of various forms of hyponatraemia. Objective: To assess the socio-clinical profile of the patients admitted in the Intensive care unit with hyponatraemia & to assess predictors of mortality in the study population Research Methodology: This prospective observational study was done in the Intensive care unit of SSKM Hospital / IPGME&R, Kolkata during April 2011 to March 2012 among the patients having serum sodium level less than135 mmol/l. The data were collected on predesigned questionnaires which include age, gender, clinical findings, complications and laboratory tests. SPSS 16.0 version was used for statistical analysis Results: Males are more commonly affected than females. Chronic liver disease is most common underlying condition associated with hyponatraemia. On multivariate logistic regression analysis serum sodium was found to be statistically significant predictor for mortality (as p value < 0.05). Conclusion: Hyponatraemia could predict the mortality in intensive care unit patients, so proper emphasis should be given to address the situation

International Journal of Health Sciences and Research, 2013

International Journal of Medical Science and Public Health, 2013

Background: Dengue fever, the most common arbo viral illness transmitted worldwide. Dengue infect... more Background: Dengue fever, the most common arbo viral illness transmitted worldwide. Dengue infection in adolescents and adults is also a potential hazard in endemic areas, especially Southeast Asia. Aims & Objective: The present study was done to evaluate the magnitude of dengue death and its predictor factors in a tertiary care hospital of Kolkata. Material and Methods: This observational cross sectional study was conducted at a tertiary care centre of Kolkata over 1 year period with 77 patients with a diagnosis of dengue fever based on the serology positive for dengue IgM with fulfilling the inclusion and exclusion criteria. The data were collected on predesigned questionnaire which include gender, clinical findings, complications and laboratory test. Baseline laboratory tests obtained were complete blood count (CBC), partial thromboplastin time (PTT), serum glutamine pyruvate transaminase (SGPT), SGOT, bilirubin, urea, creatinine and IgM. SPSS 16.0 version was used for statistical analysis. Results: Dengue mortality rate was 28.57% in this study. Among 5 lab parameters chosen i.e. leukopenia, bilirubin > 6 mg/dl, thrombocytopenia, altered PT/APTT, enzyme > 4 fold rise, raised urea/cr. On multivariate logistic regression analysis hyperbilirubinemia (> 6 mg/dl) was statistically significant predictor for mortality (as p value < 0.05). Conclusion: The laboratory parameters could predict the dengue mortality, so proper emphasis should be given to address the situation.

Frontiers in Neurology, 2016

Neuromyelitis optica spectrum disorder (NMOSD) is a diverse condition which not only encompasses ... more Neuromyelitis optica spectrum disorder (NMOSD) is a diverse condition which not only encompasses isolated longitudinally extensive transverse myelitis (LETM) and optic neuritis but also includes area postrema syndrome, acute brainstem syndrome, symptomatic narcolepsy or acute diencephalic clinical syndrome, and symptomatic cerebral syndrome. Imaging may reveal periependymal lesions surrounding the ventricular system or involvement of corticospinal tracts, area postrema, diencephalon, and corpus callosum. Rarely, there may be hemispheric tumefactive lesions that enhance in a "Cloud-like" fashion on gadolinium injection unlike in tumefactive multiple sclerosis where there is incomplete ring enhancement. Here, we present a case of aquaporin-4 positive relapsing NMOSD who presented to us with recurrent episodes of paraparesis with LETM and tumefactive lesions of brain on imaging, which enhanced in an incomplete ring like pattern resembling multiple sclerosis.