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Annals of Indian Academy of Neurology
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   Table of Contents - Current issue
Coverpage
January-February 2021
Volume 24 | Issue 1
Page Nos. 1-120

Online since Tuesday, February 16, 2021

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EDITORIAL  

World brain day 2020 – Challenges and opportunities in India Highly accessed article p. 1
Rajinder K Dhamija, Divyani Garg
DOI:10.4103/aian.AIAN_660_20  
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EDITORIAL COMMENTARY Top

Commentary on PSP subtypes in India p. 3
Madhuri Behari
DOI:10.4103/aian.AIAN_1047_20  
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Editorial commentary: Paraneoplastic syndromes p. 5
Sarosh M Katrak
DOI:10.4103/aian.AIAN_1148_20  
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Relevance of subtype classification of PSP p. 7
Koustav Chatterjee, Supriyo Choudhury, Hrishikesh Kumar
DOI:10.4103/aian.AIAN_1039_20  
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VIEW POINT Top

Electronic screen exposure and headache in children p. 8
Hüseyin Çaksen
DOI:10.4103/aian.AIAN_972_20  
Headache represents the most common neurologic disorder in the general population including children and is increasingly being recognized as a major source of morbidity in youth related to missed school days and activities. Electronic screens are becoming increasingly important in the lives of preteens and teens. In this review, we discussed effects of electronic screens on primary headache in childhood to emphasize the importance of electronic screen exposure in children with headache. Using digital and social media can bring some benefits and risks for mental and physical health. Time spent on screen-based activities contributes to the chance of reporting general physical complaints, in particular, headache and backache during early adolescence. We suggest that all children with primary headache should be evaluated for abuse of electronic screens in neurology practice. We also think that restriction of electronic screen should be advised in children with migraine and tension type headache before initiation of pharmacotherapy. As online classes are a reality, use of electronic screen may be allowed for school age children up to 2 h/day with taking time away from digital media every 20 min for 20 sec. In conclusion, we would like to emphasize that limiting the time spent on the screen is important for the reduction of headache symptoms of children and adolescents.
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Managing Non-COVID acute neurology amidst the pandemic: Challenges and work in progress p. 11
Anu Gupta, Venugopalan Y Vishnu, Mamta B Singh, Rohit Bhatia, Roopa Rajan, Deepti Vibha, Arunmozhimaran Elavarasi, Divya Radhakrishnan, Ayush Agarwal, Bhargavi Ramanujam, Animesh Das, Rajesh K Singh, Awadh K Pandit, Achal Srivastava, Manjari Tripathi, Kameshwar Prasad, MV Padma Srivastava
DOI:10.4103/aian.AIAN_999_20  
The ongoing COVID-19 pandemic has precipitated a global health crisis. Non-COVID diseases across specialties have been significantly compromised. The greatest challenge has been to continue providing care to non-COVID cases with minimum transmission risk to health care workers, patients, and caregivers. In this specter, better described as a medical holocaust, we present our experiences of dealing with acute neurological patients who could access our facility. We attempted to work on three key areas – initial screening using a more inclusive, dynamic checklist for COVID suspicion over and above the emergency triage, a mandatory initial holding on a separate floor of our inpatient service equipped with infection control strategies similar to a COVID-designated area, and daily screening of health care workers and caregivers for symptoms and possible exposures. It was a steep learning curve, a couple of close shaves, and many more lessons that went into the development of an algorithm that seems to be working well.
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AIAN REVIEW Top

Inherited manganese disorders and the brain: What neurologists need to know p. 15
Dipti Kapoor, Divyani Garg, Suvasini Sharma, Vinay Goyal
DOI:10.4103/aian.AIAN_789_20  
Although acquired manganese neurotoxicity has been widely reported since its first description in 1837 and is popularly referred to as “manganism,” inherited disorders of manganese homeostasis have received the first genetic signature as recently as 2012. These disorders, predominantly described in children and adolescents, involve mutations in three manganese transporter genes, i.e., SLC30A10 and SLC39A14 which lead to manganese overload, and SLC39A8, which leads to manganese deficiency. Both disorders of inherited hypermanganesemia typically exhibit dystonia and parkinsonism with relatively preserved cognition and are differentiated by the occurrence of polycythemia and liver involvement in the SLC30A10-associated condition. Mutations in SLC39A8 lead to a congenital disorder of glycosylation which presents with developmental delay, failure to thrive, intellectual impairment, and seizures due to manganese deficiency. Chelation with iron supplementation is the treatment of choice in inherited hypermanganesemia. In this review, we highlight the pathognomonic clinical, laboratory, imaging features and treatment modalities for these rare disorders.
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ORIGINAL ARTICLES Top

Pediatric glutaric aciduria type 1: 14 cases, diagnosis and management p. 22
Leema P Cornelius, Vivekasaravanan Raju, Asir Julin
DOI:10.4103/aian.AIAN_42_20  
Introduction: Glutaric aciduria type I is an autosomal recessive disorder of lysine metabolism due to the defect of the enzyme glutaryl-CoA dehydrogenase. The regression of milestones following an intercurrent infection with disabling dystonia is the common presentation. We report the clinical features, diagnosis, and management of 14 south Indian children with glutaric aciduria type I . Results: Males predominated the study (57.1%).The mean age of onset of the symptoms was 8.57 ± 3.57 months. The mean age at the time of diagnosis was 35.21 ± 48.31 months. The history of consanguinity was noted in 57.1%. Development was normal prior to the onset of acute crises in nearly three fourths. Acute crises triggered by infection followed by the regression of milestones was the major presenting feature in 10 children (71.4%). Macrocephaly was another prominent feature in an equal number. Bat's wing appearance (fronto temporal atrophy) was present in all children. Nearly 80% had moderate to severe disability in the form of dystonic movement disorder and spastic quadriparesis. Conclusion: Glutaric aciduria type Ihas to be identified and managed early to have a better outcome.
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Infarct volumes of patients with acute ischemic stroke receiving direct oral anticoagulants due to non-valvular atrial fibrillation p. 27
Nese G Yavasoglu, Yasemin Eren, Idil G Tatar, Irfan Yalcinkaya
DOI:10.4103/aian.AIAN_568_20  
Direct oral anticoagulants (DOACs) have been shown to decrease the risk of ischemic stroke in non-valvular atrial fibrillation (NVAF). This study aims to investigate whether DOACs result in a significant change in lesion volume and the severity of the subsequent disability in patients who have experienced a stroke. Methods: The study included a total of 137 patients with NVAF and acute stroke. The cohort included 76 patients using DOACs, 21 patients using acetylsalicylic acid (ASA), and 40 patients with newly diagnosed atrial fibrillation (NDAF) who did not use antiaggregants or anticoagulants. Diffusion-weighted MRI was performed 6–12 hours after the first stroke symptoms and infarct volumes were measured by two independent observers. Baseline National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score at discharge and period of hospitalization were calculated. Results: When patients using DOACs due to NVAF and patients with NDAF were compared, the volumes of patients using DOACs (median 7.8 vs 23.1 cm3; P ≤ 0.01) were statistically significantly smaller. However, there was no difference in volume between ASA users (median 16.9 cm3; P = 0.16) and patients with NDAF. The DOACs group was significantly different compared to the NDAF group in terms of NIHSS scores (median 4.4 vs 8.3; P ≤ 0.01) and mRS scores at discharge (median 1.7 vs 2.7; P ≤ 0.01), and period of hospitalization (median 6.4 vs 10.4 days; P ≤ 0.01). Conclusion: We observe, while using DOACs, the infarct volumes of patients who experience stroke are smaller than those with NDAF and using ASA, as well as mRS scores at discharge are low and length of hospital stay is short.
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Clinical spectrum, therapeutic outcomes and prognostic predictors in paraneoplastic neurological syndromes – Experiences from a tertiary care center in India p. 32
Asish Vijayaraghavan, Pullumpallil Thomas Alexander, Aditya Vijayakrishnan Nair, Ajith Sivadasan, Arun Mathai Mani, Donna Mathew, Atif Shaikh, Rohit Ninan Benjamin, AT Prabhakar, John Jude, Sunithi Mani, Sanjith Aaron, Vivek Mathew, Mathew Alexander
DOI:10.4103/aian.AIAN_975_20  
Background: Paraneoplastic Neurological Syndromes (PNSs) are a heterogeneous group of immune-mediated disorders that often precede tumor diagnosis. There are few systematic studies on the spectrum and follow-up of PNSs. Objective: To analyze the clinical spectrum, associated tumors, antibody profile, outcomes, and prognostic predictors in a cohort of PNSs admitted in a tertiary care center. Methods: This retrospective study included 97 patients (2008-2019). PNSs were further classified as “classical,” “nonclassical,” “definite,” and “possible.” Clinical profile, diagnostic strategies, therapeutic options, and predictors of outcomes were identified. Results: The median age was 54 years (range 17–81). Thirty-nine (40.2%) had classical PNS, and 58 (59.8%) had nonclassical PNS, 74 (76.3%) had “Definite” PNS while 23 (23.7%) had “Possible” PNS. Cerebellar degeneration, peripheral neuropathy, and encephalopathy were the three most common neurological syndromes. Tumors were diagnosed in 66 (68%) patients; Lung cancer was the most common primary tumor. Antibodies were positive in 52 (53.6%). Anti-Yo antibody and anti-Ma2 antibody were the most common antibodies. The majority (57.7%) received immunotherapy in addition to definitive treatment for the tumor. A good outcome was seen in 53 (54.6%). Factors associated with good outcome were: early diagnosis, mRS <3 at presentation, absence of metastatic disease, and adjuvant immunotherapy. Conclusion: A high index of clinical suspicion is essential for early diagnosis and prompt management of PNS, especially the nonclassical syndromes. Multimodality diagnostic imaging techniques and antibody profiling play a crucial role in the diagnosis. A favorable prognosis can be expected with the judicious use of immunotherapy and definitive treatment of malignancy.
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Cognitive dysfunction in Juvenile Myoclonic Epilepsy (JME) – A tertiary care center study p. 40
Tanushree Chawla, Neera Chaudhry, Vinod Puri
DOI:10.4103/aian.AIAN_663_19  
Background and Aim: Epilepsy often leads to cognitive impairment. Idiopathic generalized epilepsy as a group is considered to be benign in terms of its effects on cognition. Though, neuropsychological testing reveals subtle frontal impairment in patients with juvenile myoclonic epilepsy (JME). The aim of this study is to evaluate cognitive dysfunction in patients with JME. Method: We compared 50 JME patients and 50 age and sex matched healthy controls above 12 years of age on various cognitive tests which included Mini Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Executive Interview (EXIT), PGI Memory Scale (PGIMS), Clock Drawing Test (CDT), Cube copying test (CCT), and Nahor Benson Test (NBT). We correlated the cognitive dysfunction with education level, age of onset, duration of epilepsy, electroencephalogram (EEG) abnormalities, treatment, and seizure control status. Results: JME patients performed significantly worse on MMSE (P = 0.001), PGI MS (P value = 0.001), FAB (P =.001), EXIT (P =.001), CDT (P =.02), and CCT (P =.001) when compared to the controls. JME patients had impaired attention, verbal fluency, design fluency, verbal memory, visual memory, conceptualization, set shifting, mental flexibility, response inhibition, and visuospatial functions. Cognitive dysfunction correlated with education level, duration of epilepsy and EEG abnormality. No correlation was seen with seizure frequency or type of antiepileptic therapy. Conclusions: JME patients demonstrate both frontal and parietooccipital lobe dysfunction. Hence detailed higher mental function tests supplemented by functional neuroimaging studies should be done in JME patients for their comprehensive management. This would also enhance our knowledge about the pathogenesis of JME.
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Impact of COVID-19 on people suffering with epilepsy p. 51
Rajendra K Sureka, Vikas Gaur, Medha Gupta
DOI:10.4103/aian.AIAN_623_20  
Background: Epilepsy is one of the most common problems in neurology clinical practice and currently we are in the midst of the coronavirus outbreak. The coronavirus pandemic is an epidemiological and psychological crisis, which is likely to affect persons with epilepsy. Objectives: This study was designed to evaluate the impact of COVID-19 pandemic on patients with epilepsy and effects on their mental health. Materials and Methods: This was a cross-sectional web-based survey carried out at the department of Neurology at a tertiary care hospital. A questionnaire was designed in the local language using Google Forms to assess basic knowledge regarding epilepsy, coronavirus, effects of COVID-19 and lockdown on epileptic patients and also effects on their mental health. The link to the online survey was distributed via WhatsApp messenger to epilepsy patients. Results: One hundred fifty-six cases were enrolled with 69.1% were below 34 years of age and male: female ratio was 1.2:1. Only 34.3% of the participants were employed and 50% of patients had an income of less than Rs. 3000 per month. Of the patients enrolled, 20.5% reported the “devil” and superstitions as a cause of epilepsy and only 10% of patients thought that tantric (holy priest) could treat the disease better than doctors. 53.8% of patients worried about getting COVID-19 and could not stop thoughts about being infected by coronavirus bothering them. 30.3% patients had increased seizure frequency during COVID-19 pandemic, of which the most common reason was that they forgot to take regular antiepileptic drugs (22.7%) or they had faced difficulty in obtaining medicine due to lockdown (12.1%). During the pandemic, 17% of patients reported depression symptoms and another 21% reported anxiety symptoms. Conclusion: The current COVID-19 pandemic negatively affected patients with epilepsy and increased seizure frequency, depression, anxiety, unemployment, and financial difficulty in obtaining medication.
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Subtypes of PSP and prognosis: A retrospective analysis p. 56
Rohan R Mahale, Syam Krishnan, KP Divya, VT Jisha, Asha Kishore
DOI:10.4103/aian.AIAN_611_20  
Background: Progressive supranuclear palsy (PSP) is a clinically heterogeneous disease characterized by supranuclear gaze palsy and varying combinations of Parkinsonism, gait disturbances, postural instability, and fronto-limbic cognitive dysfunction. A major challenge in clinical diagnosis is the existence of subtypes whose clinical features overlap with those of other Parkinsonian disorders. Objectives: To categorize patients of PSP into its using the recently proposed movement disorder society criteria (2017) and to determine the prognosis of the PSP subtypes. Methods: Demographic and clinical data of patients diagnosed with PSP over a 21 year period were collected by review of medical records and categorized into its subtypes. Subtype prognosis was assessed from the interval between disease onset and attainment of the first of 5 clinical disability milestones namely wheelchair dependency, unintelligible speech, severe dysphagia, severe cognitive impairment, and urinary catheterization. Results: When categorized into subtypes, out of the 334 patients with PSP, PSP-RS predominated (72%), followed by PSP-parkinsonism (PSP-P) (13.5%), PSP-corticobasal syndrome (PSP-CBS) (5.1%), PSP-frontal (PSP-F) (4.2%), PSP-progressive gait freezing (PSP-PGF) (4.2%), PSP-postural instability (PSP-PI) (0.6%), and PSP-speech/language (PSP-SL) (0.3%). PSP-P reaches the milestones of wheelchair dependency, unintelligible speech, and dysphagia later than other subtypes. Conclusion: PSP-RS was the commonest and PSP-OM the rarest PSP subtype in our retrospective PSP cohort analysis. PSP-P had a better prognosis than all other subtypes of PSP. A large proportion of these cases would remain unclassified using NINDS-SPSP (1996) criteria.
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Bedside ultrasonographic assessment of optic nerve sheath diameter as a means of detecting raised intracranial pressure in neuro-trauma patients: A cross-sectional study p. 63
Amandeep Kaur, Parshotam L Gautam, Shruti Sharma, Vikram P Singh, Sarit Sharma
DOI:10.4103/aian.AIAN_51_20  
Background: Optic nerve sheath diameter (ONSD) measurement is emerging as a noninvasive method to estimate raised ICP. It is helpful in situations where imaging of brain or direct ICP monitoring is not available or feasible. Use of ONSD is still limited, so this study was planned to determine whether the bedside sonographic measurement of ONSD can reliably predict elevated ICP in neuro-trauma patients. Methodology: After approval from Hospital Ethics Committee, this cross-sectional study was conducted in hundred traumatic brain injury (TBI) patients with suspected elevated ICP, admitted to neurosurgical ICU. The severity of brain injury was assessed according to Glasgow coma scale (GCS), initial CT scan findings, and revised trauma score (RTS). All patients underwent ONSD sonography of the eye and CT scan subsequently. ONSD of ≥5.0 mm was considered as a benchmark of raised ICP. Results: Mean ONSD of the study group with ONSD ≥5.0 mm was 5.6 ± 0.3 mm. ONSD was raised in 46% of patients, more so in patients with low GCS (3-6). The relationship of ONSD with GCS, CT scan findings, and RTS was highly significant. The sensitivity of the bedside sonographic measurement ONSD to detect raised ICP was 93.2% and specificity was 91.1% when compared with CT scan. Positive Predictive Value of the ONSD measurement was 89.1% and the negative predictive value was 94.4%. Conclusion: Ultrasonographic assessment of ONSD is a reliable modality to detect raised ICP in neurotrauma patients. It can be helpful in the early initiation of treatment of elevated ICP, thus preventing secondary brain damage.
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Myelin Oligodendrocyte Glycoprotein (MOG)-IgG associated demyelinating disease: Our experience with this distinct syndrome Highly accessed article p. 69
Shripad S Pujari, Rahul V Kulkarni, Dattatraya B Nadgir, Pawan K Ojha, Shashank Nagendra, Vikram Aglave, Rashmi D Nadgir, Hemant Sant, Nilesh Palasdeokar, Satish Nirhale, Sunil Bandishti
DOI:10.4103/aian.AIAN_627_19  
Background: Discovery of serum myelin oligodendrocyte glycoprotein (MOG) antibody testing in demyelination segregated MOG-IgG disease from AQ-4-IgG positive NMOSD. Aims: To study clinico-radiological manifestations, pattern of laboratory and electrophysiological investigations and response to treatment through follow up in MOG-IgG positive patients. Method: Retrospective data of MOG-IgG positive patients was collected. Demographics, clinical manifestations at onset and at follow up and relapses, anti AQ-4-IgG status, imaging and all investigations were performed, treatment of relapses and further immunomodulatory therapy were captured. Results: In our 30 patients, F: M ratio was 2.75:1 and adult: child ratio 4:1. Relapses at presentation were optic neuritis {ON}(60%), longitudinally extensive transverse myelitis {LETM}(20%), acute disseminated encephalomyelitis {ADEM}(13.4%), simultaneous ON with myelitis (3.3%) and diencephalic Syndrome (3.3%). Salient MRI features were ADEM-like lesions, middle cerebellar peduncle fluffy infiltrates, thalamic and pontine lesions and longitudinally extensive ON {LEON} as well as non-LEON. Totally, 50% patients had a relapsing course. Plasma exchange and intravenous immunoglobulin worked in patients who showed a poor response to intravenous methylprednisolone. Prednisolone, Azathioprine, Mycophenolate and Rituximab were effective attack preventing agents. Conclusions: MOG-IgG related manifestations in our cohort were monophasic/recurrent/simultaneous ON, myelitis, recurrent ADEM, brainstem encephalitis and diencephalic Syndrome. MRI features suggestive of MOG-IgG disease were confluent ADEM-like lesions, middle cerebellar peduncle fluffy lesions, LETM, LEON and non-LEON. Where indicated, patients need to go on immunomodulation as it has a relapsing course and can accumulate significant disability. Because of its unique manifestations, it needs to be considered as a distinct entity. To the best of our knowledge, this is the largest series of MOG-IgG disease reported from India.
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CASE REPORT Top

Chromosome 1p31.1 deletion syndrome: Limited expression p. 78
Seba Biswal, Preetinanda Parida, Aranya Dubbudu, Indar Kumar Sharawat, Prateek Kumar Panda
DOI:10.4103/aian.AIAN_258_20  
Chromosomal microdeletion syndromes usually present with neurological abnormalities, developmental delays, and various systemic abnormalities. 1p31 microdeletion syndrome is one of the novel microdeletion syndromes that usually presents with developmental delay, intellectual disability, various craniofacial abnormalities, and other systemic abnormalities in a proportion of cases. NEGR1 and NFIA are few of the genes present in this locus responsible for these symptoms. However, none of the reported cases had only isolated intellectual disability. Here, we are reporting a case of 1p31 microdeletion syndrome with isolated moderate intellectual disability and hyperactivity in an 11-year-old boy. It is essential for clinicians to be aware of such an atypical presentation of 1p31.1 microdeletion syndrome, to maintain reasonable clinical suspicion in cases with unexplained intellectual disability.
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HISTORY OF NEUROLOGY Top

Chronic manganese toxicity in Indian Mines—An historical account of the contributions of Dr. T.P. Niyogi p. 81
Sanjay Sharma, Sarosh M Katrak
DOI:10.4103/aian.AIAN_630_20  
The mining of manganese ore in India started in the year 1899, in Nagpur district of the Central Provinces. Almost six decades later, in 1957, Dr. T. P. Niyogi examined several young men involved in dry drilling of Manganese ore, who had symptoms of muscular pain, weakness, clumsy movements, asthenia, anorexia, insomnia, and gait difficulties. These patients were also emotionally disturbed and prone to falls and accidents. He concluded that these symptoms were due to chronic manganese toxicity with parkinsonian features and psychiatric manifestations which he published in 1958.[1] This lead to the formation of an Enquiry Committee by the Ministry of Labour and Employment, Government of India which instituted corrective measures in mining of manganese in India. Very few reports of chronic toxicity due to inhalation of manganese have been reported subsequently. This paper highlights the contributions of Dr. T.P. Niyogi who was the Civil Surgeon in Chhindwara, MP during that period.
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IMAGES IN NEUROLOGY Top

Pure-sensory stroke in pons presented isolated perioral sensory symptoms p. 84
Young Seo Kim, Hyun Young Park
DOI:10.4103/aian.AIAN_595_20  
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Bilateral facial palsy in lymphomatous meningitis p. 85
Priyanka Madaan, Prashant Jauhari, Biswaroop Chakrabarty, Atin Kumar, Sarthak Tripathy, Nishikant Damle, Sheffali Gulati
DOI:10.4103/aian.AIAN_514_20  
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SECTION: LIGHTER MOMENTS-ARTWORK Top

“Emanating from Mastaba” p. 86
KP Divya
DOI:10.4103/aian.AIAN_758_20  
Just when the caterpillar thought it has been wound up into a mastaba , it became a butterfly.
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LETTERS TO THE EDITOR Top

Left ponto-mesencephalic infarcts causing an ocular tilt reaction with ipsilesional Torsional Nystagmus [TN] and Lateral Alternating Skew Deviation [LASD] p. 87
Boby Varkey Maramattom
DOI:10.4103/aian.AIAN_658_19  
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Remembering professor baldev singh: The budding Cryptococcus p. 89
Prahlad K Sethi
DOI:10.4103/aian.AIAN_148_20  
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Genotype–phenotype correlations in MPAN due to C19orf12 variants p. 90
Josef Finsterer
DOI:10.4103/aian.AIAN_383_20  
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A case of Marburg's variant of multiple sclerosis successfully treated with IVIg and mitoxantrone p. 92
Adarsh Manuel, Madabhushi Chakravarthy Vasudevan
DOI:10.4103/aian.AIAN_117_20  
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Viral antigen detection in blood (Serum) has no role in laboratory diagnosis of rabies Highly accessed article p. 94
Reeta S Mani, Ravi Vasanthapuram
DOI:10.4103/aian.AIAN_442_19  
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A case of isoniazid induced cerebellitis in a patient with chronic renal failure p. 95
Vaishal Sanjaybhai Shah, Vijay Sardana
DOI:10.4103/aian.AIAN_547_19  
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Neuromeliodosis—A tropical illness presenting as meningoencephalitis with unusual brain imaging p. 97
Shashank Nagendra, Arjun Gaurang Shah
DOI:10.4103/aian.AIAN_157_20  
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X linked infantile epileptic encephalopathy due to SMC1A truncating mutation Highly accessed article p. 98
Neeta Ajit Naik, Ami Rajesh Shah
DOI:10.4103/aian.AIAN_518_19  
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Corona of Webinars: Therapeutic and toxic effects p. 101
Man Mohan Mehndiratta, Natasha S Gulati, Abhijit Das
DOI:10.4103/aian.AIAN_426_20  
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New-onset seizures due to heroin addiction p. 103
Prateek Kumar Panda, Indar Kumar Sharawat, Shinjini Choudhury
DOI:10.4103/aian.AIAN_147_20  
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Arteriovenous malformation and hemifacial spasm: A rare presentation p. 106
Nihas R Mateti, Abhilash Thatikala, Gudimella S Rangalakshmi
DOI:10.4103/aian.AIAN_173_20  
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Trigeminal neuralgia due to Meckel's cave crowding in the setting of possible idiopathic intracranial hypertension without papilledema p. 107
Ananya Panda, Vance T Lehman, Ivan Garza, Felix E Diehn
DOI:10.4103/aian.AIAN_690_19  
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Unusual cerebral metallic emboli p. 110
Ankur Wadhwa, Piyush Ojha, Bijoy K Menon, Manish Joshi
DOI:10.4103/aian.AIAN_175_20  
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Ketogenic diet for super-refractory status epilepticus: A case series and review of literature p. 111
Sucharita Anand, Amar S Vibhute, Ananya Das, Shilpi Pandey, Vimal Kumar Paliwal
DOI:10.4103/aian.AIAN_170_20  
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Helmet tremor: A rare dystonic tremor p. 116
Jidhin Raj, Jacob George, Mohamed Raffique, Neethu Suresh, Ajay Radhakrishnan
DOI:10.4103/aian.AIAN_158_20  
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Stent-assisted coiling of a ruptured supraclinoid internal carotid artery aneurysm in tetralogy of fallot under conscious sedation p. 116
Jianing Xiong, Jian Tian, Yingqiang Li, Na Li, Xianli Lv
DOI:10.4103/aian.AIAN_142_20  
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Bee sting-induced acute ischemic stroke: A new manifestation of kounis syndrome? p. 118
Nicholas G Kounis, Ioanna Koniari, Panagiotis Plotas, Andreas Argyriou, George D Soufras, Grigorios Tsigkas, Periklis Davlouros, George Hahalis
DOI:10.4103/aian.AIAN_54_20  
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