<prompt> Neurological manifestation of Whipples disease is:SeizuresCerebellar ataxiaFocal neurological deficitsEncephalopathy  <response>: Ans. is a i.e., Seizures o Whipples disease is a rare disease caused by the bacterium Tropheryma whippeli.o It is a systemic condition that may involve any organ of the body but principally affects the Intestine Central nervous system JointsClinical features-o The onset of Whipple s disease is insiduous and it is characterized by Diarrhoea Steatorrhea Abdominal pain Weight loss Migratory large joint arthropathy Fever Ophthalmologic and central nervous system symptoms. Dementia is a relatively late symptom and is an extremely poor prognostic sign.o CNS symptoms have been reported in 10 to 43 of patients with intestinal whipples. more recent series reporting lower ratio. CNS manifestation can occur concurrently with intistinal manifestation at the time of diagnosis, but is more common at the time of clinical relapses which can occur during or after the treatment.o 2 recives summarized the CNS manfestation of whippless disease in 84 122 published cases suspectivity: -o Common finding are : -i Supranuclear ophthalmoplegia 32 to 51.ii Progressive dementia cognition changes 28 to 71.iii Altered level of conciousness 27 to 50.o Less common finding are:- Psychiatric symptoms, hypothalmic manifestions i.g., polydipsia, hyperphagia, insomnia, cranial nerve abnormalities, nystagmus, seizures Ataxia.Two signs that are characteristic of C.N.S. whipples disease are: Occulomasticatory myorhythmia Oculofacial skeletal myorhythmia.o Each consisting of slow rhythm synchronised contraction lsec of ocular, facial or other muscles.o They occur in 20 of cases.o They have not been documented in other CNS diseases.Diagnosiso The diagnosis of Whipples disease is suggested by a multisystem disease in a man with diarrhoea and steatorrhoea.o The primary approach to establish diagnosis in these cases is to obtain tissue biopsies from small intestine.o On biopsy the hallmark of Whipples disease is the presence of distended macrophages within the small intestine mucosa. These macrophages contains PAS positive diastase resistant granules which are lysosomes stuffed with partially digested microorganisms and rod shaped micro organism.o Earlier the diagnosis was entirely based on demonstration of these PAS positive macrophages with organisms but it is now recognized that PAS positive macrophages may also be seen in AIDS patients with mycobacterium avium complex. So, now PCR testing of infected tissue is the optimal way to confirm the diagnosis and monitor the tt. 