Browsing by Author "Paudel, Raju"
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Publication D-penicillamine Induced Myasthenia Gravis in Wilson’s Disease: A Case Report(Nepal Medical Association, 2022) Thapa, Lekhjung; Thapa, Monika; Bhattarai, Suman; Shrestha, Abhishek Man; Sharma, Nooma; Rai, Nilshan; Pokharel, Merina; Paudel, RajuAbstract Myasthenia gravis is a neuromuscular junction disorder characterised by fluctuating muscle weakness, improved by using anti-cholinesterase drugs. In addition to the autoimmune aetiology, various factors such as infections, surgery, and drugs are known to precipitate the condition. We report a case of a 15-year-old boy with D-penicillamine-induced myasthenia gravis who presented with facial diplegia, dysphagia, and drooling of saliva, 6 years after the initiation of treatment for Wilson’s disease. Therefore, clinicians should be more vigilant while prescribing patients with chelating drugs like D-penicillamine with regular monitoring of the new symptoms and keeping a very low threshold for the suspicion of myasthenia gravis.Publication The First Successful Endovascular Management of Posterior Fossa Arteriovenous Malformations in Nepal: Case Series(Nepal Medical Association, 2020) Phuyal, Subash; Agrawal, Pooja; Dawadi, Kapil; Paudel, Raju; Lamsal, RiteshAbstract: Posterior fossa arteriovenous malformations represent 7–15% of all intracranial AVMs. They carry a higher risk of rupture than supratentorial AVMs and are associated with considerable rates of morbidity and mortality. Available treatment options include conservative management, microsurgical resection, radiosurgery, endovascular embolization, or combinations of these modalities. Recent advances in endovascular techniques have revolutionized their management with better clinical outcomes. We illustrate two cases of posterior fossa AVMs treated by endovascular techniques with good clinical outcomes. The first patient also had associated flow-related aneurysms. One of these aneurysms had already ruptured, so it was coiled first followed by AVM nidus embolization using the same microcatheter. The second patient had a diffuse type of posterior fossa AVM for which staged-embolization was planned and the first-stage partial embolization was successfully performed.