Stiff person syndrome is a rare neurologic disorder characterised by rigidity of the truncal and proximal limb muscles with intermittent superimposed spasms. It’s unique because it lacks similarity to any other neurologic disorder. Possibly tetanus is the closest related condition with both inhibiting central gamma-aminobutyric (GABA) systems. Stiff person syndrome is extremely rare with less than 20 cases reported from South Asia which has a population of nearly 2 billion. In its classic form, it is associated with the presence of high titres of glutamic acid decarboxylase (GAD) antibodies. Paraneoplastic stiff person syndrome comprising of around 5% of the patients has been reported with malignancies of the breast, colon, lung, thymus and Hodgkin’s lymphoma. Antibodies against amphiphysin and gephyrin are detected in paraneoplastic stiff person syndrome. We report a 58 year old Sri Lankan male with stiff person syndrome with a high GAD antibody titre and classical electromyographic changes, who was found to have an underlying carcinoid tumour. We postulate that stiff person syndrome was a paraneoplastic phenomenon secondary to the carcinoid in this case. Although neurological syndromes such as sensory neuropathy, limbic encephalitis and, myelopathy have been described as paraneoplastic features in carcinoid, we believe this is the first report of stiff person syndrome associated with carcinoid tumour.

Reversible splenial lesion syndrome (RESLES) is frequently observed in encephalitis or encephalopathy caused by various pathogens such as influenza virus A, rotavirus, and measles. It is also associated with epileptic seizures, anti-epileptic drug withdrawal and neuroleptic malignant syndrome. We report here a Sri Lankan woman with RESLES associated with anti-NMDAR antibody encephalitis and neuroleptic malignant syndrome.

Marchiafava–Bignami disease (MFBD) was first described by Italian pathologists Amico Bignami and Ettore Marchiafava in 1903 in an Italian Chianti wine drinker. Clinical presentation is variable, and include impaired consciousness, disorientation, aggression, seizures, depression, hemiparesis, ataxia, apraxia, psychosis, personality changes and coma.1 Magnetic Resonance Imaging (MRI) is the most sensitive diagnostic tool for MFBD and reveals corpus callosal demyelination, necrosis and subsequent atrophy. No specific treatment is available but thiamine, folate, and other B vitamins (especially vitamin B12) are commonly used with some success. We report here a man with possible MFBD with features of interhemispheric disconnection on serial MRIs. Written informed consent was obtained from the patient’s legal guardian for publication of this report.