PPT is also sold under the names condyline and warticon. Adverse effects
The most common side effects of podophyllotoxin cream are typically limited to irritation of tissue surrounding the application site, including burning, redness, pain, itching, swelling. Application can be immediately followed by burning or itching. Small sores, itching and peeling skin can also follow, for these reasons it is recommended that application be done in a way that limits contact with surrounding, uninfected tissueNeither podophyllin resin nor podophyllotoxin lotions or gels are used during pregnancy because these medications have been shown to be embroytoxic in both mice and rats. Additionally, antimitotic agents are not typically recommended during pregnancy. Additionally, it has not been determined if podophyllotoxin can pass into breast milk from topical applications and therefore it is not recommended for breastfeeding women.Podophyllotoxin cream is safe for topical use; however, it can cause CNS depression as well as enteritis if ingested. The podophyllum resin from which podophyllotoxin is derived has the same effect. Mechanism of action
Podophyllotoxin destabilizes microtubules by binding tubulin and thus preventing cell division. In contrast, some of its derivatives display binding activity to the enzyme topoisomerase II (Topo II) during the late S and early G2 stage. For instance, etoposide binds and stabilizes the temporary DNA break caused by the enzyme, disrupts the reparation of the break through which the double-stranded DNA passes, and consequently stops DNA unwinding and replication. Mutants resistant to either podophyllotoxin, or to its topoisomerase II inhibitory derivatives such as etoposide (VP-16), have been described in Chinese hamster cells.
Middle cerebral artery lesions mostly affect the dominant hemisphere i.e. the left cerebral hemisphere. Signs and Symptoms
Hemiparesis or hemiplegia of the lower half of the contralateral face
Hemiparesis or hemiplegia of the contralateral upper and lower extremities*
Sensory loss of the contralateral face, arm and leg*
Ataxia of contralateral extremities*
Speech impairments/aphasia: Brocas area, Wernickes or Global aphasia as a result of a dominant hemisphere lesion (usually the left brain)
Perceptual deficits: hemispatial neglect, anosognosia, apraxia, and spatial disorganization as a result of a non-dominant hemisphere lesion (usually the right brain)
Visual disorders: déviation conjuguée, a gaze preference towards the side of the lesion; contralateral homonymous hemianopsiaNote: *faciobrachial deficits greater than that of the lower limb

Diagnosis
Diagnosis can be confirmed by CT Scan or MRI for advanced investigations. References


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