Annals of Indian Academy of Neurology
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   Table of Contents - Current issue
March-April 2022
Volume 25 | Issue 2
Page Nos. 171-328

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Asymptomatic carotid stenosis: Several guidelines with unclear answers Highly accessed article p. 171
Pachipala Sudheer, Deepti Vibha, Shubham Misra
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Recanalisation and outcome in cerebral venous-sinus thrombosis p. 177
D Nagaraja
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Idiopathic intracranial hypertension- The eyes and beyond p. 179
Sucharita Ray, Aastha Takkar, Vivek Lal
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Central Nervous System (CNS) and systemic autoimmune disease: Coexistence or more? p. 181
Deepti Vibha, Rajesh Kumar Singh
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Utility of stapedial reflex in idiopathic intracranial hypertension: The proof is in the pudding p. 183
Sanjay Prakash, Kaushik Rana, Chaturbhuj Rathore
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Mechanical thrombectomy- Where do we stand now ? p. 184
Debabrata Chakraborty, Sanjay Bhaumik
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Editorial commentary on the article “Neurological Disorders Seen During Second Wave of SARS-CoV-2 Pandemic from Two Tertiary Care Centers in Central and Southern Kerala” p. 185
Lakshmi Narasimhan Ranganathan, S Kaushik, R Shrivarthan, Guhan Ramamurthy
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Scrub typhus for the neurologist: Forget me not p. 187
Tamilarasu Kadhiravan
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Neurology exit examination system in India: A survey of examiners' perceptions and recommendations p. 189
GR K Sarma, Saji K John, Thomas Mathew, Venkatesh Aiyagari, Sivaraman Nair, Gareth J Parry, Satish Khadilkar, Parthasarathy Satishchandra
Background: The traditional Neurology exit examination in India has remained unchanged over the last few decades. In developed countries, objective evaluation methods have replaced the traditional ones. A need for such methods has not been explored in India. Objective: We aimed to study the perceptions and key recommendations of Neurology examiners on the existing examination pattern. Material and Methods: We conducted an online survey of examiners perceptions and recommendations using a set of 10 multiple-choice questions and an open-ended question. Results: 46 examiners provided completed responses suitable for analysis. Nearly equal proportions (30%) of the examiners had 10 years, 10–25 years and >25 years' experience. 92% were not satisfied with current system, 95% did not find adequate time for correction of theory scripts, 90% felt that theory questions were random, and 95% had legibility issues. 84% felt that the practical exams do not test true learning, 98% felt the examination stress impairs the performance and 85% felt that there are no objective criteria to pass the candidate. 83% felt the current system-needed changes. The key suggestions provided by the examiners to improve the system included objective assessments like MCQ, OSCE, OSLER and DOPS, inclusion of larger number of short answer type questions and periodic internal assessments of the candidates. Conclusions: A vast majority of examiners favoured changes to the current examination system and provided key recommendations. A larger study is needed to extrapolate these findings to the rest of India.
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The spectrum of Neuro-COVID: A study of a comprehensively investigated large cohort from India p. 194
Seena Vengalil, Rohan Mahale, N Chakradhar, Swathi Alluri, PR Sagar Navanith, VH Ganaraja, KR Haripriya, Holla Venkappayya Vikram, Ajay Asranna, Pooja Mailankody, Doniparthi V Seshagiri, H Manoj Cheerla, VN Maturu, CR Vaddepally, Raghavendra Kenchaiah, PR Srijithesh, Jaydip Ray Chaudhuri, M Netravathi, Suvarna Alladi
Background: Though reports of neurological manifestations of COVID-19 have emerged from various parts of the world, the cohorts reported are from the West and mostly derived from electronic databases. Much remains unknown regarding neuro-COVID in developing countries. India is the second-worst affected country, and this study reports the neurological manifestations of COVID-19 in a comprehensively evaluated cohort. Objective: The aim of this study was to describe the range of neurological manifestations of COVID-19 in India with an emphasis on the risk factors, laboratory and imaging findings and short-term outcome. Methods: Retrospective review of hospital records of all confirmed COVID-19 patients with neurological manifestations, receiving inpatient care in two neurology referral hospitals were done. All demographic, clinical details, investigations, and treatment were analysed. Results: A total of 120 confirmed COVID-19 cases presenting with neurological symptoms were included. The mean age of illness and duration of illness was 48.03 ± 17.3 years and 10.9 ± 17.3 days respectively. New onset of neurological symptoms occurred in 100 cases while 20 patients had worsening of pre-existing neurological illness. Stroke was the commonest neurological disorder (43%), followed by encephalopathy (23%) and Guillain-Barre syndrome (10%). Other unusual neurological manifestations included new-onset headache (7%), seizures including denovo status epilepticus (5%) and meningo-encephalitis (5%). Nearly half of the patients had preceding COVID-19 symptoms. Poor outcome at discharge was seen in 40% and mortality occurred in 15%. Conclusion: Stroke and encephalopathy constitute the most common neurological manifestations. The absence of preceding COVID-19 symptoms in nearly half the cases is striking. Poor outcome was seen in nearly 50% despite early recognition and management.
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Guillain-barre syndrome and antibodies to arboviruses (Dengue, Chikungunya and Japanese Encephalitis): A prospective study of 95 patients form a tertiary care centre in Southern India p. 203
Hariswar Pari, S Deepak Amalnath, Rahul Dhodapkar
Objective: The aim of this study was to detect the presence of IgM antibodies against dengue (DEN), chikungunya (CHIK) and Japanese encephalitis (JE) in the serum and CSF of patients with Guillaine-Barre syndrome (GBS). Methods: GBS patients (>12 years of age) were included after informed consent. Data on history, clinical manifestations, treatment details, and outcome were collected. Serum and CSF were tested for IgM antibodies against DEN, CHIK, and JE. Results: From April 2018 to December 2019, 95 patients were included in this study. Anti-arboviral IgM antibodies were detected in 30 patients (31.5%) (CSF 11, serum 13, both CSF and serum 6). Serum IgM antibody was present in 19 patients (JE 8, DEN 5, CHIK 2, more than 1 virus 4). Of the 66 patients who underwent CSF studies, antibodies were present in 17 (CHIK 14, DEN 1, more than 1 virus 2). Antibody positivity did not affect the outcome of GBS. Conclusion: One-third of the GBS patients had evidence of recent infection by arboviruses. This suggests that DEN, CHIK, and JE could be the inciting event for GBS in endemic regions.
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Post-varicella neurological complications: A preliminary observation from a tertiary care centre of Eastern India p. 207
Subhadeep Gupta, Atanu Biswas, Atanu Chandra, Biman Kanti Ray, Arpan Dutta, Alak Pandit
Objectives: The objective of this study is to analyse detailed clinical presentations, imaging findings, and outcome in a series of 17 cases (n = 17) with neurological complications following acute varicella infection. Methods: It is an observational study on the patients who presented to the neurology outpatient department of our institute with neurological abnormalities following acute varicella infection within the last 3 months. Results: Neuroimaging, either computed tomography or magnetic resonance imaging, cerebrospinal fluid analysis, electroencephalography and nerve conduction studies were performed in all the patients along with other specialized investigations as per clinical context. The age of presentation varied from childhood to middle age (median age was 23 years) and range of clinical spectrum was also wide. Peripheral nervous system involvement was more common in the form of Guillain–Barré syndrome (29.4%) and isolated lower motor neuron facial nerve palsy (23.5%) compared to central nervous system (CNS) involvement. CNS involvement was documented in the form of ataxia (11.76%), myelopathy (17.6%), stroke (5.88%) and encephalitis (5.88%). Conclusion: Chickenpox is a common viral disease and most patients recover without any complication. Although rare, neurological complications following acute varicella infection may have myriad presentations ranging from lower motor neuron facial palsy to life-threatening encephalitis. Compared to other studies, varicella encephalitis and ataxia were not so common in our study group. Response to therapy was uniformly good except in the patients presenting with ataxia. Response was particularly good to central and peripheral demyelinating disorders.
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The potential significance of reversed stapes reflex in clinical practice in idiopathic intracranial hypertension p. 214
Halil Onder
Background: Stapes reflex test is a method of evaluating the involuntary muscle contraction of the stapedius muscle in response to a high-intensity sound stimulus. The formation of this reflex involves the intact function of the 7th nerve, brain stem, 8th nerve, and middle ear. Due to ease of administration and information yielded, the stapedial reflex is considered one of the most powerful differential diagnostic audiological procedures. Numerous studies have remarked on the fluid communication between the intracochlear and intracranial spaces through the cochlear aqueduct. Currently, the potential significance of a noninvasive audiological technique in the discrimination of raised intracranial pressure constitutes a crucial topic of interest. Methods: We have performed the pre-LP and post-LP detailed otorhinolaryngological investigations, including the detailed inspection, audiometric testing, tympanometry, and stapedial reflex in a total of four consecutive patients with IIH. Results: We found that the stapedial reflex was bilateral absent initially in two of the patients. However, the second stapedial reflex investigations after LP showed reversal of the reflex responses in both of the patients. Conclusions: We suggest some hypotheses and propose some clinical applications. Future studies focusing on the potential utility of this reflex in the monitorization of IIH may provide crucial perspectives.
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Comparison of disease profiles and three-month outcomes of patients with neurological disorders with and without COVID-19: An ambispective cohort study p. 218
Kanchana S Pillai, Deepti Vibha, Pranjal Gupta, Pachipala Sudheer, Biswamohan Mishra, Rahul S Oinam, Ayush Mohan, Kamalesh Tayade, Padma Srivastava, Manjari Tripathi, Achal K Srivastava, Rohit Bhatia, Roopa Rajan, Awadh K Pandit, Rajesh K Singh, Arunmozhimaran Elavarasi, Ayush Agarwal, Anu Gupta, Animesh Das, Divya M Radhakrishnan, Bhargavi Ramanujam, Kapil D Soni, Richa Aggarwal, Naveet Wig, Anjan Trikha
Objective: Neurological emergencies saw a paradigm shift in approach during the coronavirus disease-2019 (COVID-19) pandemic with the challenge to manage patients with and without COVID-19. We aimed to compare the various neurological disorders and 3 months outcome in patients with and without SARS-CoV-2 infection. Methods: In an ambispective cohort study design, we enrolled patients with and without SARS CoV-2 infection coming to a medical emergency with neurological disorders between April 2020 and September 2020. Demographic, clinical, biochemical, and treatment details of these patients were collected and compared. Their outcomes, both in-hospital and at 3 months were assessed by the modified Rankin Scale (mRS). Results: Two thirty-five patients (235) were enrolled from emergency services with neurological disorders. Of them, 81 (34.5%) were COVID-19 positive. The mean (SD) age was 49.5 (17.3) years, and the majority of the patients were male (63.0%). The commonest neurological diagnosis was acute ischemic stroke (AIS) (43.0%). The in-hospital mortality was higher in the patients who were COVID-19 positive (COVID-19 positive: 29 (35.8%) versus COVID-19 negative: 12 (7.8%), P value: <0.001). The 3 months telephonic follow-up could be completed in 73.2% of the patients (142/194). Four (12.1%) deaths occurred on follow-up in the COVID-19 positive versus fifteen (13.8%) in the COVID-19 negative patients (P value: 1.00). The 3-month mRS was worse in the COVID-19 positive group (P value <0.001). However, this was driven by higher in-hospital morbidity and mortality in COVID-19 positive patients. Conclusion: Patients with neurological disorders presenting with COVID-19 infection had worse outcomes, including in-hospital and 3 months disability.
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Transcultural adaptation and validation of Kannada version of the National Institute of Health Stroke Scale (NIHSS) p. 224
Priya Baby, PR Srijithesh, Ashok V Reddy, Aravind K Rajasekaran, Mariamma Philip, Preetie S Akkunje, Surbhi Chaturvedi
Background and Purpose: The National Institute of Health Stroke Scale (NIHSS) is widely used in clinical practice to evaluate stroke-related neurological deficits. The aim of this study was to develop Kannada language version of the NIHSS (Ka-NIHSS) and determine its validity and reliability. Materials and Methods: In the first phase of the study, Ka-NIHSS was adapted based on cultural and linguistic peculiarities. In the next phase, 51 acute stroke patients were prospectively enrolled in the study. The concurrent validity of the Ka-NIHSS was evaluated by comparison with the Glasgow Coma Scale (GCS) and the modified Rankin Scale (mRS). The predictive validity was assessed by comparison with Barthel Index (BI) score and mRS at a 90-day telephonic follow-up. The reliability was evaluated using the kappa statistics for inter-rater agreement between two independent raters and intra-class correlation coefficient (ICC) analysis. The inter-rater agreement of videotaped assessment of items 9 and 10 between four independent raters was evaluated using kappa statistics. Results: Ka-NIHSS scores highly correlated with GCS (P = –0.74 P < 0.001) and mRS (P = 0.85, P < 0.001) at baseline. It moderately correlated with mRS (P = 0.67, P < 0.001) and BI (P = –0.64, P < 0.001) at 90 days follow up. Inter-rater reliability was high between the two examiners, with kappa values ranging from 0.66 to 0.95. The inter-rater agreements of the video assessment of items 9 and 10 for nine patients among four raters were 0.81 and 1 respectively. Conclusions: Ka-NIHSS is a valid and reliable tool for assessing neurological deficits in Kannada-speaking stroke patients.
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Clinical characteristics, etiology, recanalization rates and neurological outcomes in CVT: A prospective cohort study p. 229
Rajendra Singh Jain, PV Sripadma, Shankar Tejwani
Background: Recanalization rates in cerebral venous thrombosis (CVT) and its effect on neurological outcome have been debated worldwide and are inadequately addressed in studies from India. Our objective was to study the clinical profile of CVT and determine recanalization rates with its predictors and its effect on outcome. Methods: A prospective single centre cohort study on 101 patients with radiologically confirmed acute CVT between October 2018 and June 2021 was conducted. Anticoagulation was given for 3-12 months or lifelong for thrombophilias. Recanalization status of vessels was assessed between 3-6 months and at 12 months after ictus. Outcome was defined as favorable (mRS 0-1) or unfavorable. Patients with atleast one CT/MR venogram on follow up were included. Results: Of the 101 enrolled patients, 83 completed study protocol. Mean age of patients was 34.2 ± 11.7 years. Clinical characteristics included headache (75.9%),seizure (66.2%), altered mentation(20.4%) with clustering of cases during summers. Transverse- sigmoid sinuses were predominantly involved (66.2 %) followed by superior sagittal sinus (SSS,65.0%). Commonest etiologies were thrombophilia (27.7%) and postpartum state (15.6%). Complete recanalization was achieved in 67.4%, partial in 26.5% and no recanalization in 6.02% at end of 12 months. Recanalization rates improved from 83.09% between 3-6 months to 93.9 % at 12 months. Median time to last follow-up was 12months and at last follow up 95.1% had favorable mRS with recurrence in two patients with raised factor VIII levels. Conclusion: Recanalization occurred in more than 90% of CVT patients. Isolated superior sagittal sinus thrombosis and age <50 years were predictors of complete recanalization. Most patients, except few achieved a favorable mRS.
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Exploring caregiver burden and health condition of dementia patients during lockdown due to COVID-19 pandemic p. 235
Ruchira Mukherjee, Bidisha Bhattacharyya, Adreesh Mukherjee, Goutam Das, Sujata Das, Atanu Biswas
Background: To combat the COVID-19 pandemic, several countries imposed strict lockdown to ensure social distancing to limit the spread of the virus. This caused difficulties in the management and care of patients with various chronic disorders including dementia. Objectives: The objective of the study was to explore the health condition of patients with dementia and assess their caregivers' burden during the lockdown. Methods: A total of 57 caregivers of patients with dementia who had attended the cognitive clinic of the institute for a follow-up within 1 year preceding the lockdown were assessed through telephonic interviews. Caregivers' details were noted following an interview related to the patients' health condition during lockdown and caregiver concerns. Results: Findings showed a deterioration in memory in 66.7% of patients with dementia and an increase in symptoms like agitation, sleeplessness, low mood, restlessness, aggression, etc., Caregivers felt helpless and had to manage new concerns and they were not sure as to how to deal with the situation. Conclusion: The lockdown situation disrupted the health conditions of dementia patients and caregivers faced novel challenges while managing them.
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A comparative analysis of clinical and imaging features of Aquaporin 4 (AQP4) antibody positive, Myelin Oligodendrocyte Glycoprotein (MOG) antibody positive and double seronegative subtypes of Neuro Myelitis Optica Spectrum Disorder (NMOSD) p. 239
Salil Gupta, Varun Rehani, Pawan Dhull, Manoj Somasekharan, Amit Sreen
Objectives: Study was conducted with aim of comparing subtypes types of NMOSD based on serology. Methods: In this retrospective study, patients ≥18 years were included satisfying IPND 2015 criteria. Three groups were created based on seropositivity for AQP4 antibody, MOG antibody or double seronegative. Demographic, clinical and imaging were compared using regression analysis. Results: Forty-six patients, 28 (60.9%) AQP4+, 11 (23.9%) MOG + and remaining 7 (15.2%) double seronegative were included. Thirty-seven patients (80.4%) had presenting symptoms localized to optic nerve and/or cord [AQP4 + 22 (78.5%), MOG + 9 (81.8%) and double seronegative 6 (85.7%)]. Presentation with bilateral optic neuritis was more common in AQP4- patients. Twenty (86.8%) out of the 23 patients who had relapsing disease localized to optic nerve and/or spinal cord [AQP4 + 13/14 (92.8%), MOG + 3/5 (60%) and double seronegative 4/4 (100%)]. Relapses were more common in AQP4+ (77% vs 12% vs10%). In AQP4 negative group disability (EDSS 4.2 vs 3.3) and progression index was relatively less (1.6 vs 1.1). CSF pleocytosis (38.8% vs 17.9%) and raised proteins (66.6% vs 32.1%) were also more common. Optic nerve MRI (>50% optic nerve and chiasma involvement) was more commonly abnormal in AQP4 negative (52.9% vs 31.2%). Regression analysis revealed females to be significantly higher in AQP4 positive NMOSD (89.3%) when compared to MOG positive (36.4%) and double seronegative (42.9%). Conclusion: Gender was the only significant difference between the three groups. There was trend towards greater disability and more relapses in AQP4 + groups.
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Comparison of clinical and radiological features of Aquaporin4 (AQP-4) antibody positive Neuromyelitis Optica Spectrum Disorder (NMOSD) and Anti Myelin Oligodendrocyte Glycoprotein (Anti-MOG) syndrome-our experience from Northwest India p. 246
Rajendra Singh Jain, Deepak Jain, Sourabh Murarka, Arvind Vyas, Bhawna Sharma, Trilochan Srivastava, Kamlesh Kumar, Yavnika Jain, Kavya Rao, Jitesh Agrawal, Shankar Tejwani
Background: More and more cases of myelin oligodendrocyte glycoprotein (MOG) antibody are being diagnosed with the availability of laboratory tests helping us to know the differing patterns from AQP-4 antibody disease and we need to understand the natural course, treatment, and prognosis in a better way. Objectives: Neuromyelitis optica spectrum disorder (NMOSD) and anti-MOG syndromes are immune-mediated inflammatory demyelinating conditions of the central nervous system (CNS) that mainly involve the optic nerves and the spinal cord. We conducted this study to compare demographic, clinical, laboratory, and radiological features of AQP-4 antibody and MOG antibody positive patients. Methods: A single-centre retrospective observational study from a large tertiary care university centre of Northwest India conducted during 2019--2021. We screened all patients presenting with acute CNS demyelinating attacks and recruited total 47 patients of which 25 were positive for AQP4 antibody and 22 were positive for MOG antibody. No patient tested positive for both antibodies. Data were collected using a standardized format including demographic, clinical, laboratory, and neuroimaging data. Results: In our study, total 47 patients were included, amongst which 25 patients were AQP4 antibody and 22 patients were MOG antibody positive. Though there was no gender preponderance, pediatric patients were more frequently affected in MOG antibody positive group. In AQP-4 antibody positive patients, myelitis was most common presenting clinical feature followed by optic neuritis (ON), simultaneous ON with myelitis, and brainstem syndrome. In MOG antibody positive group, myelitis was the commonest phenotype followed by ON, brainstem syndrome, and cerebral syndrome. The neuroimaging revealed involvement of medulla mainly area postrema, cervicodorsal spinal cord and extension of cervical lesion up to brainstem more commonly in AQP4 antibody group, on the other hand involvement of upper brainstem (midbrain and pons), cortex, and conus was more common in MOG antibody group. Conclusion: We have made an attempt to find differentiating features in AQP-4 vs. MOG antibody positive cases but they were of no statistically significance value as the numbers were small. Further larger studies may prove helpful in planning better strategies in two groups.
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The impact of time to reperfusion on recanalization rates and outcome after mechanical thrombectomy: A single center experience p. 256
Sapna Erat Sreedharan, K Arun, Santhosh Kannath, ER Jayadevan, Jissa V Thulaseedharan, PN Sylaja
Background: Timely and effective recanalization to salvage the penumbra is the main determinant of outcome in acute ischemic strokes. Randomized controlled trials on late window mechanical thrombectomy (MT) have proved its safety and efficacy upto 24 h after stroke onset. We looked at the impact of time to reperfusion on vessel recanalization rates and short-term outcome in patients undergoing MT for large vessel occlusion. Methods: The clinical, imaging, and outcome of all patients undergoing MT upto 24 h from last seen normal was extracted from a prospectively maintained ischemic stroke database from January 2012 till September 2019. Results: There were 145 patients with a mean (SD) age of 58.2 (±14) years. Of them, 28 had wake up/unknown time of onset stroke and 9 presented beyond >360 min. There were 23 vertebrobasilar strokes. Median National Institute of Health Stroke scale score (NIHSS) at admission was 16.4 (Inter quartile range (IQR) 12–21). CT-Alberta Stroke program early CT score (CT-ASPECTS) was excellent (8–10) in 39 (31.6%) and fair (5–7) in 77 (63.6%) patients in anterior circulation strokes. About 25% underwent bridging therapy. Recanalization rates did not differ between those presenting early (<6 h) versus wake up strokes and late presenting patients (81.79% vs 71.9%). Symptomatic Intracerebral hemorrhage (ICH) occurred in 5%. At 3 months, excellent outcome (modified rankin scale <2) was observed in 28.9%. While Admission NIHSS remained strong predictor of poor outcome at 3 months, delay in presentation did not impact MT outcome (37.5% vs 45.79% and P = 0.460). Conclusions: The recanalization rates were similar in patients irrespective of the time to reperfusion from stroke onset. The functional outcome was not inferior in late presenters selected by advanced imaging.
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Isolated medullary tumefactive demyelination masquerading as tumor p. 261
, Sushant Agarwal, Leve Joseph, Awad Kishore Pandit, Achal Srivastava, Ajay Garg
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Zuckerguss sign: Sugar-coated cerebellum in a case of gastric adenocarcinoma p. 263
Kiran K Ramineni, G Vamshi Krishna Reddy, G Dayakar Rao, Ravi K Jakkani, Abhijeet Ingle
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Single ring-enhancing lesion with the lipid peak on MR spectroscopy p. 265
Vinay Goel, Leve Joseph, Deepa Dash, Sushant Agarwal, Ajay Garg
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MRI brain features in nitrobenzene toxic encephalopathy p. 267
Delon Dsouza, Rohit Baddala, GG Sharath Kumar, Raghunandan Nadig
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An often unnoticed aspect of caregiving: Let's shake up our conscience for the well-being of family caregivers p. 269
Pallerla Srikanth
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Anti-IgLON5 disease beyond the realm of snores and slumber: Case reports and review of the literature p. 270
Laxmi Khanna, Ankkita Sharma Bhandari
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Effect of mask on doctor–Patient relationship during COVID-19: Indian perspective p. 272
Sattwika Banerjee, Banashree Mondal, Vaishali Bagrodia, Souvik Chakraborty, Praveen Kumar, Subrata Naskar, Purba Basu, Supriyo Choudhury, Hrishikesh Kumar
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Refractory status epilepticus in a patient with SARS-CoV2 infection: Possible mechanisms p. 274
Shyam K Jaiswal, Jagarlapudi M. K. Murthy, Lalitha Pidaparthi, Muralidhar R Yerasu, Srikanth R Yeduguri
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Concurrent periodic alternating gaze deviation and periodic alternating nystagmus in brainstem glioma Highly accessed article p. 277
Boby V Maramattom
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Pseudo-neonatal adrenoleukodystrophy: A rare peroxisomal disorder p. 278
Cheshta Arora, Hansashree Padmanabha, Rita Christopher, Rohan Mahale, Maya Bhat, Gautham Arunachal, Ravi Shekhar, Pooja Mailankody, PS Mathuranath
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Linear morphea: A mimicker of motor neuron disease p. 281
Rajat Manchanda, Govind Madhaw, Ritu Shree, Divya M Radhakrishnan, Arvind Kumar, Niraj Kumar
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Seronegative autoimmune encephalitis: A challenge for the neurologist p. 283
Laxmi Khanna, Chandrashekar Agrawal, Mandaville Gourie-Devi, Ankkita Sharma Bhandari
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Rare cause of west syndrome secondary to tubulinopathy due to Congenital Symmetric Circumferential Skin Creases (CSCSC) kunze type due to a novel variant in MAPRE2 gene p. 286
Vykuntaraju K Gowda, Varunvenkat M Srinivasan, Varsha Reddy, Maya Bhat
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Quality of life among patients with epilepsy: Institutional-based survey, Western Rajasthan, India p. 288
Shweta Sharma, Ashok Kumar, Nimarta Rana, Samhita Panda
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KCNQ2 encephalopathy and effect of early treatment on the clinical phenotype p. 292
Mahesh Kamate, Anuraag N Reddy, Mayank Detroja
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Bone mineral density and body composition in males with motor neuron disease: A study from teaching hospital in Southern Part of India p. 294
Mahmood D Al-Mendalawi
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Stress-induced Childhood Onset Neurodegeneration with Ataxia and Seizures (CONDSIAS) presenting with torticollis attacks: Phenotypic variability of the same mutation in two Turkish patients p. 295
Gulten Ozturk, Akif Ayaz, Yasemin Topcu, Gülcan Akyuz, Olcay Unver, Ismail Hakk Akbeyaz, Gazanfer Ekinci, Dilsad Turkdogan
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Post COVID-19 vaccination GBS—Association or causation? p. 297
Rajendra S Jain, Arvind Vyas, PV Sripadma, Kaavya Rao
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Granulomatous panuveitis in multiple sclerosis: A rare occurrence p. 299
Rutul Shah, Rohan R Mahale, Kalpana Babu, Dhwani Shah, Manu Vincent, Satabdi Nanda, TA Sangeeth, Neeharika Sriram, Ravindu Tiwari, Hansashree Padmanabha, Pooja Mailankody, Mathuranath S Pavagada
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If nothing goes right, it goes to the left: A case of left anterior cerebral artery stroke due to right internal carotid artery stenosis p. 301
Harikrishnan Ramachandran, Harini Pavuluri, Sapna Erat Sreedharan, PN Sylaja
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MTHFR deficiency: A potentially treatable cause of adult-onset hereditary spastic paraparesis p. 303
Pachipala Sudheer, Ayush Agarwal, Ajay Garg, MV Padma Srivastava, Venugopalan Y Vishnu
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Neuromelioidosis presenting as bells palsy in a child p. 305
Leema P Cornelius, E Neeraj, KJ Venkateswaran, K Gopinathan
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Only pathogenic SURF-1 variants cause leigh syndrome p. 307
Josef Finsterer
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Sui(s) generis: A unique meningitis p. 308
Boby V Maramattom, S Ananth Ram, Anup Warrier, Rachana Babu
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Thoracic ganglioneuroma presenting with paraneoplastic cerebellitis and ROHHAD-NET syndrome p. 310
Sarbesh Tiwari, Mufeed Arimbrakkunnan, Taruna Yadav, Varuna Vyas, Kirti K Rathod, Vikarn Vishwajeet
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Hereditary diffuse leukoencephalopathy with spheroids: Diffusion restriction on magnetic resonance imaging and novel mutation in an Indian patient p. 312
Varun Manjunath, Swaleha Nadaf, Rahul T Chakor, Vyankatesh Bolegave
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CSF1R related leukoencephalopathy - Rare childhood presentation of an autosomal dominant microgliopathy! p. 314
Neeharika Sriram, Hansashree Padmanabha, Sadanandavalli R Chandra, Rohan Mahale, Bevinahalli Nandeesh, Maya D Bhat, Rita Christopher, Manisha Gupta, Gautham A Udupi, Pooja Mailankody, Pavagada S Mathuranath
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Long-term efficacy of pallidal deep brain stimulation in a patient with DYT-THAP1 (DYT-6) dystonia from India p. 317
Charulata Savant Sankhla, Milind Sankhe, Jharna Ray
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Stroke awareness among hypertensive patients: Institutional based survey in Western Rajasthan, India p. 319
Sunita K Chaudhary, Ashok Kumar, Nimarta Rana, Samhita Panda, Naresh K Midha
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“Double Protection Closed Compartment” Aspiration technique for Left Internal Carotid Artery (ICA) free floating thrombus p. 323
Piyush Ojha, Gaurav Goel, Apratim Chatterjee, Vasudha Singhal, Anshu Mahajan
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Accelerated hypertension and intracerebral haemorrhage following first dose of ChAdOx1-nCOV-19 vaccination p. 325
Shweta Pandey, Ravindra K Garg, Hardeep S Malhotra, Neeraj Kumar, Ravi Uniyal
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Neurodegeneration with progressive dystonia: Juvenile-onset Tay–Sachs disease p. 327
Jasmine Kaur, Singanamalla Bhanudeep, Ramprabhu G Suresh, Arushi G Saini, Vikas Bhatia
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