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2015| October-December | Volume 18 | Issue 4
Online since
November 17, 2015
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ORIGINAL ARTICLES
Clinicoanatomical correlation in stroke related aphasia
Vikram Bohra, Geeta Anjum Khwaja, Sneh Jain, Ashish Duggal, Vijay Vishwanath Ghuge, Abhilekh Srivastava
October-December 2015, 18(4):424-429
DOI
:10.4103/0972-2327.165469
PMID
:26713015
Context:
With advances in neuroimaging, traditional views regarding the clinicoanatomic correlation in stroke patients with aphasia are being challenged and it has been observed that lesions at a given cortical or subcortical site may manifest with different aphasia profiles.
Aims:
To study as to whether there is a strict clinicoanatomical correlation between the type of aphasia and lesion site in patients with first ever stroke.
Settings and Design:
Observational study, based in a tertiary care center.
Materials and Methods:
Stroke patient's ≥18 years of age were screened and those with first ever stroke and aphasia were subjected to a detailed stroke workup and language assessment using the Hindi version of Western Aphasia Battery (WAB). Statistical analysis was done with χ
2
test with Yates correction and Kruskal-Wallis test. The level of significance was set at
P
< 0.05.
Results:
Overall aphasia was detected in 27.9% of the 260 screened cases with stroke. Amongst 60 cases with first ever stroke and aphasia, the aphasia type was: Global (33.33%), Broca's (28.3%), transcortical motor (13.33%), transcortical sensory (10%), Wernicke's (8.33%), anomic (5%), and conduction (1.67%) aphasia. A definite correlation between the lesion site and the type of aphasia as per the traditional classification was observed in 35% cases only.
Conclusions:
No absolute correlation exists between the lesion site and the type of clinical aphasia syndrome in majority of the patients with cortical and subcortical stroke.
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REVIEW ARTICLES
Epilepsy in India II: Impact, burden, and need for a multisectoral public health response
Senthil Amudhan, Gopalkrishna Gururaj, Parthasarathy Satishchandra
October-December 2015, 18(4):369-381
DOI
:10.4103/0972-2327.165483
PMID
:26713005
Epilepsy is a common neurological disorder whose consequences are influenced socially and culturally, especially in India. This review (second of the two part series) was carried out to understand the social impact and economic burden to develop comprehensive program for control and prevention of epilepsy. Epilepsy is known to have adverse effect on education, employment, marriage, and other essential social opportunities. Economic burden associated with epilepsy is very high with treatment and travel costs emerging as an important contributing factor. A vicious cycle between economic burden and poor disease outcome is clear. There is no significant change in the perception, stigma, and discrimination of epilepsy across the country despite improvement in educational and social parameters over the time. The huge treatment gap and poor quality of life is further worsened by the associated comorbidities and conditions. Thus, a multidisciplinary response is needed to address the burden and impact of epilepsy which calls for an integrated and multipronged approach for epilepsy care, prevention, and rehabilitation. Service delivery, capacity building, integration into the existing program, mobilizing public support, and increasing public awareness will be the hallmarks of such an integrated approach in a public health model.
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LETTERS TO THE EDITOR
Stroke rehabilitation: Which factors influence the outcome?
Simic-Panic S Dusica, Devecerski V Gordana, Jovicevic N Mirjana, Platisa M Nedeljko
October-December 2015, 18(4):484-487
DOI
:10.4103/0972-2327.165480
PMID
:26713036
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CASE REPORTS
Complete ophthalmoplegia: A rare presentation of idiopathic intracranial hypertension
Irfan Yousuf Wani, Sawan Verma, Mushtaq Wani, Ravouf Asimi, Saleem Sheikh, Maqbool Wani, Nawaz Sheikh, Irfan Shah, Mudasir Mushtaq
October-December 2015, 18(4):468-470
DOI
:10.4103/0972-2327.160087
PMID
:26713027
Idiopathic intracranial hypertension (IIH) is a disorder defined by clinical criteria that include signs and symptoms isolated to those produced by increased intracranial pressure (ICP; e. g., headache, papilledema, and vision loss), elevated ICP with normal cerebrospinal fluid (CSF) composition, and no other cause of intracranial hypertension evident on neuroimaging or other evaluations. The most common signs in IIH are papilledema, visual field loss, and unilateral or bilateral sixth cranial nerve palsy. Here we report a case of IIH presenting as headache with vision loss, papilledema, complete ophthalmoplegia with proptosis in one eye, and sixth cranial nerve palsy in the other eye. Patient was managed with acetazolamide, topiramate, and diuretics. Symptoms remained static and she was planned for urgent CSF diversion procedure.
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LETTERS TO THE EDITOR
Author's Reply: "Dot sign" in dengue encephalitis
Thomas Mathew, Sagar Badachi, G.R.K. Sarma, Raghunandan Nadig
October-December 2015, 18(4):478-478
DOI
:10.4103/0972-2327.165475
PMID
:26713031
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ORIGINAL ARTICLES
Autoimmune encephalitis: Clinical diagnosis versus antibody confirmation
Asha Caroline Cyril, Sruthi S Nair, Annamma Mathai, Sudheeran Kannoth, Sanjeev V Thomas
October-December 2015, 18(4):408-411
DOI
:10.4103/0972-2327.165454
PMID
:26713011
Context:
Autoimmune encephalitis is a heterogeneous disorder which is being diagnosed with increasing frequency. The diagnosis of these disorders is based on the detection of autoantibodies and characteristic clinical profiles.
Aims:
We aimed to study the antibody profile in encephalitis patients with suspected autoimmune etiology presenting to a tertiary care center.
Settings and Design:
The subjects were selected by screening all patients with clinical profile suggesting autoimmune encephalitis admitted in the neuromedical intensive care unit (ICU) of a tertiary care center in South India.
Materials and Methods:
Patients who fulfilled modified Zuliani
et al
.'s, criteria for autoimmune encephalitis were identified during the period December 2009-June 2013. Blood samples from these subjects were screened for six neuronal antibodies.
Statistical analysis used:
Chi-square test was applied to compare the antibody positive and negative patients.
Results:
Out of 1,227 patients screened, 39 subjects (14 males: 25 females) were identified with a mean age of 15.95 years and 19 cases were assessed in the acute and 20 in the convalescent phase of the illness. Seizure (87.8 %) was the most common presenting symptom; status epilepticus occurred in 23 (60.5%) patients during the course of the illness. Fourteen (35.9%) patients were N-methyl-D-aspartate receptor (NMDAR) antibody-positive and all were negative for the other antibodies tested.
Conclusions:
One-third of patients presenting with acute noninfective encephalitis would be positive for NMDAR antibodies with the remaining two-thirds with clinically suspected autoimmune encephalitis being antibody-negative. There are few markers in the clinical and investigative profiles to distinguish antibody-positive and -negative patients.
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Correlation of intracranial atherosclerosis with carotid stenosis in ischemic stroke patients
Manas Ghosh, Kaushik Ghosh, Atri Chatterjee, Ambarish Bhattacharya, Amitava Acharya, Sisir Chakraborty, Bhaskor Ghosh
October-December 2015, 18(4):412-414
DOI
:10.4103/0972-2327.165473
PMID
:26713012
Introduction:
Carotid stenosis is a major risk factor for ischemic stroke. However, the effect of carotid stenosis on the site of stroke is still under investigation.
Aims:
This study aimed to elucidate how the presence of carotid stenosis influenced the pattern of stroke and also how it interacted with other risk factors for stroke.
Materials and Methods:
Thirty-eight patients with ischemic stroke were included in this study and were investigated with carotid artery Doppler and magnetic resonance angiography for carotid stenosis and intracranial stenosis in the circle of Willis, respectively. Other known risk factors of stroke were also studied in and compared between the subgroups with and without carotid stenosis.
Results:
In patients without carotid stenosis, anterior cerebral artery was the commonest site of stenosis. In patients with carotid stenosis, middle cerebral artery was the commonest site of stenosis. Overall, middle cerebral artery was the commonest territory of stroke. Patients with hypertension, diabetes and history of smoking had preferential stenosis of the anterior cerebral artery.
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Combining carotid endarterectomy with off-pump coronary artery bypass graft surgery is safe and effective
Arun Garg, Atma Ram Bansal, Dilip Singh, Manisha Mishra, Pooja Sharma, Ravi Ratan Kasliwal, Naresh Trehan
October-December 2015, 18(4):419-423
DOI
:10.4103/0972-2327.165457
PMID
:26713014
Background:
We, as neurologists, are frequently consulted to give neurological clearance for surgery in patients who are undergoing coronary artery bypass graft (CABG) surgery and have suffered from stroke or transient ischemic attack (TIA) in past. Similarly clearance is also sought in another group of patients who, though have not suffered from stroke or TIA, but found to have significant carotid stenosis on routine screening prior to surgery. Cardiac surgeons and anesthetists want to know the risk of perioperative stroke in such patients and should carotid endarterectomy (CEA) be done along with CABG. In absence of any clear-cut guideline, neurologists often fail to give any specific recommendation.
Aim:
To find out safety and efficacy of synchronous CEA in patients undergoing CABG.
Design:
Retrospective study.
Materials and Methods:
Out of 3,700 patients who underwent CABG, 150 were found to have severe carotid stenosis of >70%. Out of this, 46 patients with >80% stenosis (three symptomatic and 43 asymptomatic) and one patient with >70% symptomatic carotid stenosis (TIA within last 2 weeks) were taken for simultaneous CEA along with CABG. These three symptomatic carotid patients had suffered from stroke within last 6 months.
Results:
One patient with asymptomatic near total occlusion of carotid artery suffered from hyperperfusion syndrome. None suffered from ischemic stroke, myocardial infarction (MI), or death during perioperative period.
Conclusion:
Combining CEA along with CABG is a safe and effective procedure.
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Prevalence and risk factors of carotid intima-media thickness in asymptomatic individual subjects in a tertiary care center in India
Subhash Kaul, Suvarna Alladi, Rukmini K Mridula, Srinivasarao V. C. S. Bandaru, Demudu Babu Boddu, Darapureddy Anjanikumar, Matapathi Umamashesh
October-December 2015, 18(4):430-434
DOI
:10.4103/0972-2327.165481
PMID
:26713016
Background:
Carotid intima-media thickness (IMT) is increasingly identified as a marker of atherosclerosis and increased risk of cerebrovascular disease.
Aim:
We aimed to investigate the prevalence of carotid IMT in asymptomatic Indian individuals, more than 40 years of age, and correlate it with other risk factors for cerebrovascular ischemia.
Materials and Methods:
Individuals attending outpatient services of Nizam's Institute of Medical Sciences, who were asymptomatic for cerebrovascular ischemia underwent detailed history and carotid Doppler examination. IMT on mid common carotid artery (CCA) was measured. All subjects' blood was taken for biochemical estimation of fasting blood sugar and total cholesterol levels.
Results:
Out of 1,392 subjects, 571 (41%) had abnormal IMT and 821 (59%) had normal IMT. On comparison of the two groups, the factors significantly associated with abnormal IMT were mean older age (59 vs 50.7 years;
P
< 0.0001) and higher prevalence of hypertension (257 (45%) vs 236 (28.7%);
P
< 0.0001), diabetes (159 (27.8%) vs 139 (16.9%);
P
< 0.0001), and hypercholesterolemia (124 (21.7%) vs113 (13.7%);
P
= 0.0001). After adjustment with multiple logistic regression, significant predictors were age (odds 3.2; 95% confidence interval (CI) 2.5-4.1), male gender (odds 1.5; 95% CI 1.1-1.9), hypercholesterolemia (odds 1.5; 95% CI 1.1-2.0), hypertension (odds 1.4; 95% CI 1.1-1.8), and diabetes (odds 1.3; 95% CI 1.0-1.7).
Conclusion:
We found age, sex, hypertension, diabetes, and hypercholesterolemia to be independent risk factor for abnormal IMT in asymptomatic subjects over 40 years of age.
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N-terminal pro-brain natriuretic peptide levels and short term prognosis in acute ischemic stroke
Vandanapu Naveen, Bhuma Vengamma, Alladi Mohan, Velam Vanajakshamma
October-December 2015, 18(4):435-440
DOI
:10.4103/0972-2327.165478
PMID
:26713017
Background:
Sparse published data are available regarding the prognostic importance of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute ischemic stroke.
Materials and Methods:
We prospectively studied 74 consecutive patients presenting with acute ischemic stroke within 24 hours of onset. All of them underwent laboratory and imaging evaluation and were treated as per guidelines. In all subjects, plasma NT-proBNP levels were measured at initial admission and again on day 7.
Results:
Their mean age was 54 ± 13.5years; there were 49 males; 18 (24%) patients died during the hospital stay. A statistically significant negative correlation between log NT-proBNP and Glasgow coma scale (GCS) score (
P
< 0.001); and a significant positive correlation between log NT-proBNP and National Institutes of Health Stroke Scale (NIHSS) score (
P
< 0.001) were observed. Baseline log NT-proBNP levels were higher among non-survivors compared with survivors (6.7 ± 0.47 vs. 5.37 ± 0.62;
P
= 0.06); day 7 log NT-proBNP levels were significantly higher in non-survivors compared with survivors (7.3 ± 0.26 vs. 4.5 ± 0.4;
P
= 0.000). In survivors, there was a statistically significant decline in log NT-proBNP levels from baseline to day 7 (5.3710 ± 0.620 vs. 4.5320 ± 0.451;
P
< 0.001). In contrast, among non-survivors, log NT-proBNP levels showed a statistically significant increase from baseline to day 7 (4.5322 ± 0.451 vs. 7.2992 ± 0.263;
P
< 0.001). On receiver operator characteristic curve (ROC) analysis, at a cut-off value of ≥ 6.0661, log NT-proBNP had a sensitivity and specificity of 98.2 and 88.9, respectively, in predicting death.
Conclusions:
Plasma log NT-pro-BNP level appears to be a useful biological marker for predicting in-hospital mortality inpatients presenting with acute ischemic stroke.
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CASE REPORTS
Painful leg and moving toes syndrome
Sanjay Pandey
October-December 2015, 18(4):457-458
DOI
:10.4103/0972-2327.163827
PMID
:26713024
Painful leg and moving toes (PLMT) syndrome is a distinct clinical entity and in majority of the patients there are some underlying causes related to spinal cord, cauda equina, or peripheral neuropathy. However, some cases are cryptogenic with no identifiable underlying cause. Response to treatment is disappointing in most of the cases. We report a 60-year-old lady who presented with very severe type of painful legs and moving toes (PLMT) with no underlying cause.
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Clinical and neuroradiological approach to fucosidosis in a child with atypical presentation
Tanyel Zubarioglu, Ertugrul Kiykim, Cigdem Aktuglu Zeybek, Mehmet Serif Cansever, Gulcin Benbir, Ahmet Aydin, Cengiz Yalcinkaya
October-December 2015, 18(4):471-474
DOI
:10.4103/0972-2327.160090
PMID
:26713028
Fucosidosis is a rare lysosomal storage disease with clinical presentation of developmental retardation, coarse facial features, hepatosplenomegaly, dysostosis multiplex, and angiokeratomas. Here, a 7-year-old female patient with progressive dystonic movement disorder and loss of acquired motor skills is presented. Coarse facial feature and abnormal globuspallidus signaling in brain magnetic resonance imaging (MRI) led the patient to be investigated in terms of fucosidosis despite absence of hepatosplenomegaly, dysostosis multiplex, and angiokeratomas. Markedly decreased enzyme activity of alpha-fucosidosis led to the correct diagnosis.
Conclusion:
Various neurological findings have recently been reported in fucosidosis. However, neuroimaging findings have not been studied in detail except a few studies. It is critically important to discuss the wide neuroradiological spectrum of the disease and to highlight fucosidosis in differential diagnosis of bilateral pallidalhypointensity on T2-weighted images in brain MRI. In addition, description of atypical clinical findings of fucosidosis should avoid clinicians from diagnostic delay.
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IMAGES IN NEUROLOGY
Chiari 1.5: A lesser known entity
Amita Malik, Ranjan Chandra, Ritu Misra, Brij Bhushan Thukral
October-December 2015, 18(4):449-450
DOI
:10.4103/0972-2327.165485
PMID
:26713020
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5,471
120
LETTERS TO THE EDITOR
Urinary and fecal incontinence during levetiracetam therapy
Faruk Incecik, Ozlem M Herguner, Seyda Besen, Sakir Altunbasak
October-December 2015, 18(4):479-480
DOI
:10.4103/0972-2327.165476
PMID
:26713033
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14,411
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Radiation-induced secondary narcolepsy
Abdulkhader Shehna, Firosh Khan, Kakkanchery Sankaran Sandhya
October-December 2015, 18(4):488-490
DOI
:10.4103/0972-2327.157257
PMID
:26713038
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ORIGINAL ARTICLES
Adaptation and validation of stroke-aphasia quality of life (SAQOL-39) scale to Malayalam
Ria Raju, Gopee Krishnan
October-December 2015, 18(4):441-444
DOI
:10.4103/0972-2327.160068
PMID
:26713018
Background:
Aphasia, an acquired inability to understand and/or speak language, is a common repercussion of stroke that denigrates the quality of life (QOL) in the affected persons. Several languages in India experience the dearth of instruments to measure the QOL of persons with aphasia. Malayalam, the language spoken by more than 33 million people in Kerala, the southern state of India, is not an exception to this.
Objective:
This study aimed to adapt and validate the widely-used stroke-aphasia quality of life (SAQOL-39) scale to Malayalam.
Materials and Methods:
We required seven Malayalam-speaking Speech Language Pathologists (SLPs), hailing from different regions of Kerala, to examine the socio-cultural suitability of the original items in SAQOL-39 and indicate modifications, wherever necessary. Subsequently, the linguistic adaptation was performed through a forward-backward translation scheme. The socio-culturally and linguistically adapted Malayalam version was then administered on a group of 48 Malayalam-speaking persons with aphasia to examine the test-retest reliability, acceptability, as well as the internal consistency of the instrument.
Results:
The Malayalam SAQOL-39 scale showed high test-retest reliability (intraclass correlation coefficient, ICC = 0.91) as well as acceptability with minimal missing data (0.52%). Further, it yielded high internal consistency (Chronbach's ∝ = 0.98) as well as item-to-total and inter-domain correlations.
Conclusions:
The Malayalam version of SAQOL-39 is the first socio-culturally and linguistically adapted tool to measure the QOL of persons with stroke-aphasia speaking this language. It may serve as a potential tool to measure the QOL of this population in both clinical practice and future research endeavors.
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Hurdles in stroke thrombolysis: Experience from 100 consecutive ischemic stroke patients
Sagar Badachi, Thomas Mathew, Arvind Prabhu, Raghunandan Nadig, Gosala R. K. Sarma
October-December 2015, 18(4):415-418
DOI
:10.4103/0972-2327.165460
PMID
:26713013
Background:
Acute management of ischemic stroke involves thrombolysis within 4.5 h. For a successful outcome, early recognition of stroke, transportation to the hospital emergency department immediately after stroke, timely imaging, proper diagnosis, and thrombolysis within 4.5 h is of paramount importance.
Aim:
To analyze the obstacles for thrombolysis in acute stroke patients.
Materials and Methods:
The study was conducted in a tertiary care center in South India. A total of hundred consecutive patients of acute ischemic stroke who were not thrombolysed, but otherwise fulfilled the criteria for thrombolysis were evaluated prospectively for various factors that prevented thrombolysis. The constraints to thrombolysis were categorized into: i) Failure of patient to recognize stroke symptoms, ii) patient's awareness of thrombolysis as a treatment modality for stroke, iii) failure of patient's relative to recognize stroke, iv) failure of primary care physician to recognize stroke, v) transport delays, vi) lack of neuroimaging and thrombolysis facility, and vii) nonaffordability.
Results:
The biggest hurdle for early hospital presentation is failure of patients to recognize stroke (73%), followed by lack of neuroimaging facility (58%), nonaffordability (56%), failure of patient's relative to recognize stroke (38%), failure of the primary care physician to recognize stroke (21%), and transport problems (13%). Awareness of thrombolysis as a treatment modality for stroke was seen only in 2%.
Conclusion:
Considering the urgency of therapeutic measures in acute stroke, there is necessity and room for improvement to overcome various hurdles that prevent thrombolysis.
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Magnetic resonance angiographic evaluation of circle of Willis: A morphologic study in a tertiary hospital set up
Shankar Rao Naveen, Venkatraman Bhat, Gadabanahalli Ashok Karthik
October-December 2015, 18(4):391-397
DOI
:10.4103/0972-2327.165453
PMID
:26713008
Background:
Anatomy of circle of Willis (CW) shows wide variation in different individuals, population groups, and has vital clinical significance in causation and presentation of clinical disease. This study evaluates the anatomical variations, incidence of various common anomalies of CW in south Indian tertiary hospital set up, using three-dimensional time-of-flight (3D-TOF) magnetic resonance angiography (MRA).
Materials and Methods:
A total of 300 patients referred for neuroimaging study over a period of 2-year were included in the analysis. In this prospective and retrospective study, 198 men and 102 women; mean age, 55 years) underwent 3D-TOF MR angiograms of the CW using a 1.5-tesla MR scanner. Images were reviewed for anatomical configuration of the CW using maximum intensity projection (MIP) and 3D volume rendered images.
Results:
On analysis, a complete CW was seen in 50 (16.6%) of 300 subjects. An incomplete anterior and posterior CW was found in 66 (22%) The remaining 184 (61.3%) subjects had partially complete CW configuration. The most common type of CW in a single subject was anterior variant type A and posterior type variant E.
Conclusion:
We observed wide variation in CW configuration in our patients. The prevalence of complete configuration of the circle is 16.6%; slightly higher in females and younger subjects. Complete anterior circle was present in 77.3%. Most common anterior variant is type A (normal anterior configuration) with a prevalence of 66%. The most common posterior circle variant is type E (hypoplasia or absence of both PcomA) with 32.6%. Overall, CW variants are slightly more common among the women in comparison to men. Incidence of associated anomalies like aneurysm or arteriovenous malformation (AVM) was comparable to that described in literature.
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Muscle histopathology in today's era of molecular genetics: Role and limitations
Ishita Pant, Sujata Chaturvedi, Kiran Bala, Suman Kushwaha
October-December 2015, 18(4):398-402
DOI
:10.4103/0972-2327.165455
PMID
:26713009
Introduction:
Past few decades have seen an increasing application of techniques like electron microscopy, western blotting, and molecular genetics in the evaluation of muscle diseases. However, due to their limited availability, histopathological interpretation of muscle biopsies still remains an important component of diagnostic approach to muscle diseases. A systematic methodology is required in the evaluation and interpretation of muscle biopsies. This study was undertaken to analyze the histopathological spectrum of 164 muscle biopsies and to assess the diagnostic yield of basic histopathological procedures in the work up of muscle biopsy.
Materials and Methods:
Retrospective analysis was done for 164 cases of muscle biopsies. Step-wise approach was adopted to assess the efficacy of routine stains, enzyme histochemistry, and immunohistochemistry. Based on hematoxylin and rosin (H and E) appearance, biopsies were broadly categorized into destructive, nondestructive but myopathic, and inflammatory morphology. Role of special stains, enzyme, and immunohistochemical stains in each category was then evaluated.
Results:
On the basis of histopathological features, 164 muscle biopsies were broadly categorized into biopsies with abnormal histopathological features (115) and biopsies with normal histopathology (49). Abnormal muscle biopsies were further categorized into destructive morphology (56.5%), nondestructive but myopathic morphology (30.5%), and inflammatory pathology (13%). A near definitive diagnosis could be made in 115 cases out of 164 muscle biopsies on the basis of routine histopathology, enzyme histochemistry, and immunohistochemistry.
Conclusion:
Though advanced techniques like electron microscopy, western blotting, and molecular genetics are essential for confirmatory diagnosis, a substantive diagnostic yield can be offered with the basic armamentarium of routine (frozen) stains, enzyme histochemistry, and immunohistochemistry.
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Differential improvement of the sleep quality among patients with juvenile myoclonic epilepsy with valproic acid: A longitudinal sleep questionnaire-based study
Chetan Nayak, Sanjib Sinha, Chaitra T Ramachandraiah, Madhu Nagappa, Kandivali Thennarasu, Arun B Taly, Parthasarathy Satishchandra
October-December 2015, 18(4):403-407
DOI
:10.4103/0972-2327.165472
PMID
:26713010
Objectives:
The aim of this study was to assess the effect of sodium valproic acid (SVA) on the sleep quality of patients with juvenile myoclonic epilepsy (JME).
Materials and Methods:
Standardized sleep questionnaires viz. Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were administered to 30 drug-naïve patients with JME (male:female (M:F) = 14:16; age: 21 ± 3.7 years) and the changes following SVA monotherapy was analyzed using
t
- and chi-squared tests.
Results:
The mean age at onset of seizures and diagnosis was 15.43 ± 3.8 and 21 ± 5.1, years respectively. All had myoclonic jerks with mean duration of 5.23 ± 2.7 years, aggravated by sleep deprivation (23, 76.7%) and sleep-wake transition (29, 96.7%). Twenty-seven (90%) had generalized tonic-clonic seizures (GTCS), majority (70%) on awakening from sleep. Seizures were controlled in 25 patients (83.33%) with SVA monotherapy. Abnormal ESS was noted in five (16.66%) drug naοve patients compared to six (20%) patients while on SVA (
P
= 0.782). Mean ESS remained unchanged before and after SVA therapy (6.27 ± 4.4 vs 6.97 ± 4.7,
P
= 0.262). On the other hand, only four (13.3%) patients had abnormal PSQI scores at follow-up after initiation of SVA, as compared to 14 (46.7%) subjects in the drug naïve state (
P
= 0.037). Further, we also found significant reduction in mean PSQI scores after initiating SVA monotherapy (6.7 ± 5.6 vs 2.7 ± 2.84,
P
ͳ 0.0001).
Conclusion:
This study showed that the mean PSQI as well as the number of patients with abnormal PSQI significantly reduced after initiating SVA therapy, suggesting a significant improvement in night-time sleep quality with SVA treatment. However, SVA therapy did not alter ESS.
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CASE REPORTS
Clarithromycin Culprit of Benign Intracranial Hypertension
Habib Rehman Khan, Colin Mason, Riona Mulcahy
October-December 2015, 18(4):475-477
DOI
:10.4103/0972-2327.165477
PMID
:26713029
Benign intracranial hypertension is characterized with increase in CSF opening pressure with no specific etiology. It is predominantly found in women of child bearing age and particularly in individuals with obesity. Visual disturbances or loss and associated headaches are common and can lead to blindness if left untreated. Diagnosis can be achieved once other causes of visual loss, headaches and high opening pressures are excluded. Management consists of serial optic disc assessments although no specific treatment is available despite recent trials using carbonic anhydrase inhibitors. Diet modification and weight management can help in therapy.
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Autologous hematopoietic stem cell transplantation in progressive severe multiple sclerosis
Awadh Kishor Pandit, Kameshwar Prasad, Tulika Seth
October-December 2015, 18(4):459-463
DOI
:10.4103/0972-2327.165482
PMID
:26713025
Multiple sclerosis (MS) is a chronic inflammatory disease of central nervous system (CNS), which is disabling and majorly involves younger population. Various available treatments in forms of immunomodulation are not very effective; however, stem cell transplantation seems to be promising in recent literature. The current case report is a novel evidence for autologous hematopoietic stem cell transplantation (HSCT) in progressive MS. Case Summary: A 33 year old male with secondary progressive MS (SPMS), after being failed and/or intolerance to standard approved interferon (IFN) and mitoxantrone therapy, autologous HSCT was administered. At 2years of post-stem cell transplantation follow-up, he has remained stable with some improvement in functional status (Expanded Disability Status Scale (EDSS) reduced by 1.5), with no relapse, no treatment related complications, and no fresh magnetic resonance imaging (MRI) lesions. Conclusion: Autologous stem cell transplantation may be beneficial in progressive forms of MS, but needs to be tested in well-designed randomized trial.
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Reversible cerebral and brain stem dysfunction in n: Hexane neuropathy
Vinod Puri, Abhijit Das Gupta, Neera Chaudhry, Ravindra Kumar Saran
October-December 2015, 18(4):464-467
DOI
:10.4103/0972-2327.160088
PMID
:26713026
A 18-year-old male, screen printer by profession developed sensory motor polyneuropathy, change in his behavior, bilateral 6
th
and 7
th
cranial nerve palsies, down beat nystagmus and cerebellar dysarthria. He had bilaterally prolonged P100 latency; left: 137 ms; right: 144 ms. P 37 was not recordable on either side while N 20 was normal. The inter latency difference between Ipsilateral R2 and Contralateral R2 was 6.15 ms, on the left side and normal on the right side. In the follow-up, there was normalization of the blink reflex study, improvement in P100 latency [left: 114 ms; right: 120 ms.] but worsening of peripheral nerve conductions. The sequential clinical recovery was of the behavioral dysfunction, down beat nystagmus, 6
th
nerve, 7
th
nerve involvement and ataxia, in that order. Sural nerve biopsy showed loss of large diameter myelinated fibers.
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HISTORY OF MEDICINE
Adolf Hitler and His Parkinsonism
Kalyan B Bhattacharyya
October-December 2015, 18(4):387-390
DOI
:10.4103/0972-2327.169536
PMID
:26713007
Research works have suggested almost incontrovertibly, that Adolf Hitler suffered from Parkinsonism. However, the precise nature of his illness had always been controversial and post-encephalitic and idiopathic varieties were the ones which were most commonly thought as the possible etiology. He displayed features like oculogyric crisis, palilalia, and autonomic symptoms which strongly implicate post-encephalitic etiology in the genesis of his illness. Others on the contrary, observed premorbid personality traits like non-flinching mental rigidity, extreme inflexibility, and awesome pedantry; which are often observed in idiopathic Parkinson's disease. Moreover, nonmotor symptoms like disturbed sleep, proneness to temper tantrums, phases of depression, suspiciousness, and lack of trust on colleagues have also been described by various authors. Additionally, he was prescribed methamphetamine by his personal doctor and that might have led to the development of some of the later traits in his personality.
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IMAGES IN NEUROLOGY
Isolated deep peroneal nerve palsy: Role of magnetic resonance imaging in localization
Samhita Panda, Mandaville Gourie-Devi, Ankkita Sharma, Aditi Sud
October-December 2015, 18(4):451-453
DOI
:10.4103/0972-2327.169646
PMID
:26713021
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Giant perivascular space in the anterior superior temporal gyrus: Imaging characteristics to avoid misdiagnosis
Charlie Chia-Tsong Hsu, Dalveer Singh, Gigi Nga Chi Kwan, Sandeep Bhuta
October-December 2015, 18(4):454-454
DOI
:10.4103/0972-2327.169647
PMID
:26713022
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71
HHV-6 associated fulminant encephalo-myocarditis in an immunocompetent individual
Boby Varkey Maramattom
October-December 2015, 18(4):455-456
DOI
:10.4103/0972-2327.169650
PMID
:26713023
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74
LETTERS TO THE EDITOR
Group B streptococcal meningitis in children beyond the neonatal period in sub-Himalayan India
Mahmood Dhahir Al-Mendalawi
October-December 2015, 18(4):479-479
DOI
:10.4103/0972-2327.165464
PMID
:26713032
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3,151
62
Dot sign and dengue encephalitis
Sora Yasri, Viroj Wiwanitkit
October-December 2015, 18(4):478-478
DOI
:10.4103/0972-2327.160060
PMID
:26713030
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133
Utility of cerebrospinal fluid cortisol level in acute bacterial meningitis
Mahmood Dhahir Al-Mendalawi
October-December 2015, 18(4):491-492
DOI
:10.4103/0972-2327.169680
PMID
:26713039
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66
Errors in conducting screening for mild cognitive impairment with Hindi mental state examination
Sunil Kumar Raina
October-December 2015, 18(4):492-493
DOI
:10.4103/0972-2327.169681
PMID
:26713040
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68
Case-control studies and the misconceptions from cross-sectional studies
Amin Zarghami, Seyyed Hojjati
October-December 2015, 18(4):493-494
DOI
:10.4103/0972-2327.169682
PMID
:26713041
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64
Vitamin B12 and cognitive decline
Serdar Tasdemir, Umit Hidir Ulas
October-December 2015, 18(4):494-495
DOI
:10.4103/0972-2327.169683
PMID
:26713042
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Vocal cord palsy in a case of chronic progressive external ophthalmoplegia
Subasree Ramakrishnan, Ravi Yadav, Sikander Adwani, Veerendrakumar Mustare, Girish B Kulkarni, Gayathri Narayanappa, Govindaraj Periyasamy, Thangaraj Kumarasamy
October-December 2015, 18(4):481-483
DOI
:10.4103/0972-2327.165463
PMID
:26713034
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3,803
81
Cadasil coma: Unusual cause for acute encephalopathy
Venkatesan Prasanna Eswaradass, Balakrishnan Ramasamy, Ramadoss Kalidoss, Gnanashanmugham Gnanagurusamy
October-December 2015, 18(4):483-484
DOI
:10.4103/0972-2327.160072
PMID
:26713035
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3,602
86
Awareness of the warning symptoms and risk factors of stroke among adults seeking health care from a rural hospital of India
Lipilekha Patnaik, Himanshu Sekhar Sahoo, Trilochan Sahu
October-December 2015, 18(4):487-488
DOI
:10.4103/0972-2327.165479
PMID
:26713037
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3,698
96
RESIDENTS CORNER
An uncommon cause of bifacial weakness and non-length-dependent demyelinating neuropathy
Madhu Nagappa, Arun B Taly, Anita Mahadevan, Mailankody Pooja, Parayil Sankaran Bindu, Yasha T Chickabasaviah, Narayanappa Gayathri, Sanjib Sinha
October-December 2015, 18(4):445-448
DOI
:10.4103/0972-2327.169641
PMID
:26713019
Tangier disease is a rare metabolic disorder that causes neuropathy in half of the affected individuals. We present the clinical, electrophysiological, and histopathological findings in a middle-aged gentleman of Tangier disease who was initially diagnosed as leprosy and treated with antileprosy drugs. The presence of a demyelinating electrophysiology in a patient with predominant upper limb involvement and facial diplegia should raise the suspicion of Tangier disease. Estimation of serum lipids should form a part of routine evaluation in order to avoid misdiagnosis.
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REVIEW ARTICLES
Nanotechnology in neurology: Genesis, current status, and future prospects
Paurush Ambesh, Daniel Gregory Angeli
October-December 2015, 18(4):382-386
DOI
:10.4103/0972-2327.169535
PMID
:26713006
Nanotechnology is a promising, novel field of technological development. There is great potential in research and clinical applications for neurological diseases. Here we chronicle the inception of nanotechnology, discuss its integration with neurology, and highlight the challenges in current application. Some of the problems involving practical use of neuronanotechnology are direct biological toxicity, visualization of the nanodevice, and the short life expectancy of nanomachinery. Neuron cell therapy is an upcoming field for the treatment of challenging problems in neurology. Peptide nanofibers based on amphiphilic molecules have been developed that can autoregulate their structure depending on the conditions of the surrounding milieu. Such frameworks are promising for serving as drug delivery systems or communication bridges between damaged neurons. For common disabling diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS), recent developments have seen revolutionary nanotech-based novelties, which are discussed here in detail. Bioimaging integrated with nanoneuromedicine has opened up new doors for cancer and infection therapeutics.
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© 2006 - Annals of Indian Academy of Neurology | Published by Wolters Kluwer -
Medknow
Online since 1
st
March, 2006