Background: Published literature on intracerebral haemorrhage (ICH) from the Indian subcontinent is very scarce. The study aims to assess the prognostic factors influencing outcome and validating the ICH score which is widely used to prognosticate the disease in this financially constraint population. Prognosticating the outcome at the time of admission is important to customize treatment in a cost-effective manner. Materials and Methods: We conducted a prospective study of all Spontaneous ICH patients admitted from February 2015 to May 2016. Data pertaining to patient demographics, clinical findings, biochemical parameters and cranial computed tomography (CT) findings were recorded. mRS (modified Rankin score) was used to assess outcome at discharge and at three month follow up. Results: A total of 215 patients with hypertensive haemorrhage were analysed. The mean age of our cohort was 57.64 years and volume of bleed was 24.5ml. 73% pf patients with GCS<8, 46% with Intraventricular extension and 57% with hematoma volume >30 were died at the end of 3 months. Twenty eight patients succumbed during hospitalization while 38 died after their discharge. Mortality rates were 5%,16%, 33%, 54% and 93% for ICH Scores of 0, 1, 2, 3 and 4. The rICH score after modifying the age parameter in the ICH score to 70 years had mortality rates of 6%,15%,25%,51%,75% and 100%. Conclusion: ICH Score failed to accurately predict mortality in our cohort. ICH is predominately seen at a younger age group in our country and hence have better outcomes in comparison to the west. We propose a minor modification in the ICH score by reducing the age criteria by 10 years to prognosticate the disease better in our population.

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Parkinson's disease (PD) is common, age-dependent neurodegenerative disorder caused by a severe loss of the nigrostriatal dopaminergic neurons. Given the projected increase in the number of people with PD over the coming decades, interventions aimed at minimizing morbidity and improve quality of life are crucial. There is currently no fully proven pharmacological therapy that can modify or slow the disease progression. Physical activity (PA) can complement pharmacological therapy to manage the inherent decline associated with the disease. The evidence indicates that upregulation of neurotrophins and nerve growth factors are potentially critical mediators of the beneficial effects associated with PA. Accumulating evidence suggests that patients with PD might benefit from PA in a number of ways, from general improvements in health to disease-specific effects and potentially, disease-modifying effects. Various forms of PA that have shown beneficial effects in PD include – aerobic exercises, treadmill training, dancing, traditional Chinese exercise, yoga, and resistance training. In this review, we explored available research that addresses the impact of exercise and PA on PD. The original articles with randomized control trials, prospective cohort studies, longitudinal studies, meta-analysis, and relevant review articles from 2005 to 2017 were selected for the present review. Many gaps remain in our understanding of the most effective exercise intervention for PD symptoms, the mechanisms underlying exercise-induced changes and the best way to monitor response to therapy. However, available research suggests that exercise is a promising, cost-effective, and low-risk intervention to improve both motor and nonmotor symptoms in patients with PD. Thus, PA should be prescribed and encouraged in all PD patients.

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Paraneoplastic syndromes are a rare heterogeneous group of disorders that are indicators of the underlying occult malignancy. Subacute cerebellar ataxia in a patient with a known cancer is often due to metastatic invasion or other complications of the cancer, such as infection, coagulopathy, metabolic and nutritional deficits, or side effects of treatment. When tumor- and treatment-related causes have been excluded, the patient is considered to suffer from paraneoplastic cerebellar degeneration (PCD). We report a case of PCD that presented before any evidence of tumor, but early diagnostic workup and clinical vigilance helped us to find the underlying high-grade ovarian adenocarcinoma which was surgically removed later.

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The pathologic involvement of brainstem and midbrain nuclei and white matter tracts in various combinations may result in a spectrum of arithmetically derived syndromes. They include ‘one and a half syndrome’, ‘eight and a half syndrome’ and ‘fifteen and a half syndrome’. We report a case of ‘nine syndrome’, which has been reported more recently, caused by caused by acute pontine infarcts and characterised clinically by a combination of internuclear ophthalmolplegia, ipsilateral horizontal gaze palsy, lower motor neuron type of facial palsy, contralateral hemiparesis and hemianesthesia. We highlight the genesis of this combination of clinical signs , revisit the different variants of INO and review the literature on ‘Nine syndrome’.

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Background: Aphasia is a neurogenic communication disorder with significant deficits in various domains of language and communication. One such type of aphasia, which impacts the quality of life significantly is Broca's aphasia, where the individual is aware of the communication difficulty. Objective: To compare the Quality of Communication Life (QoCL) between individuals with Broca's aphasia and normal individuals. Methods: The first phase of the study translated and validated QCL scale in Tamil. The second phase involved administration of the Tamil QCL scale on 12 individuals with Broca's aphasia and 12 age matched normal adults. The marked responses were analysed on a visual analogue scale independently. Statistical Analysis: Three domains of QoCL were compared between the two groups using Mann–Whitney U-test. Results: The QoCL scores across three domains were observed to be lower in individuals with Broca's aphasia, when compared to normal adults. Individuals with Broca's aphasia expressed greater challenges in socialization/activities domain of QoCL than confidence/self-concept and roles and responsibilities domains. Conclusions: Information obtained on self-reported QCL scale in familiar or native language will facilitate in planning client-oriented management of aphasia.

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Background: There are few community-based neuroepidemiological studies based in tribal communities. This cross-sectional community-based study explored the prevalence rates of neurological disorders in the tribal region of Kaparada in Gujarat. Methodology: A two-stage methodology was used. Door-to-door surveys were conducted in the villages of Moti Vahiyal, Arnai, and Chavshala in Kaparada taluka in the Valsad district. Trained volunteers administered a questionnaire that assessed demographic details and common neurological symptoms in children and adults. Data were obtained from 8217 individuals from 1464 households using the questionnaire in stage 1. A number of 615 individuals reported at least one symptom. In stage 2, a team of neurologists conducted a medical camp to assess those “screened in” for neurological disorders. Results: The crude prevalence rate for neurological disorders in general was found to be 2592.19/100,000. The prevalence rates for lower motor neuron diseases were highest (1010.1), and the rates of epilepsy, movement disorders, stroke, vertigo, headaches, upper motor neuron diseases, and mental and behavioral disorders were found to be 255.6, 133.9, 109.53, 170.38, 511.4, 109.53, and 292.08/100,000, respectively. Age- and sex-specific rates and patterns varied for different disorders. Conclusion: The prevalence rates of most disorders were found to be lower than those reported elsewhere, but age and sex prevalence patterns were similar to existing research. Challenges in conducting such a study in a remote population are discussed.

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Introduction: Giant axonal neuropathy (GAN) is an inherited neurodegenerative disorder caused by mutations in the GAN gene. It affects both the central and peripheral nervous systems. We discuss clinical, electrophysiological, radiological and genetic features in three new unrelated patients with GAN. Methods: Three pediatric patients with suspected GAN were included. The diagnosis was considered in patients with early onset polyneuropathy and characteristic hair with central nervous system involvement or suggestive neuroimaging findings. Biochemical, metabolic and electrophysiological investigations were performed. Diagnosis was confirmed by targeted sequencing of the GAN gene. Results: All the three patients were found to have biallelic mutations in GAN gene. Peripheral neuropathy, characteristic hair, and cerebellar dysfunction were present in all three while bony deformities, cranial nerve involvement and intellectual disability were seen variably. Neuroimaging showed a spectrum of findings which are discussed. Conclusion: GAN is a clinically and radiologically heterogeneous disease where genetic testing is necessary for a definite diagnosis and counselling. With facilities for testing becoming increasingly available, the spectrum is likely to expand further.

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Scrub infection is an important differential of undifferentiated febrile illness in the subtropical and tropical countries. Neurological complications of scrub infection have a varied spectrum of presentation involving both the central nervous system, among which meningitis and meningoencephalitis are the most common presentations. The peripheral nervous system manifestations include Guillain–Barre syndrome (GBS) is not commonly reported. The coexistence of both central and peripheral involvement is rare, and we would like to report a case of a patient who was diagnosed with scrub infection and presented with meningoencephalitis and later developed GBS in the course of the disease on treatment for scrub infection.

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The recent supreme court of India judgment on autonomy makes it necessary for all practicing neurologists to appraise themselves of the changing legal framework for End-of-Life decision-making in India. A pathway has been prescribed for advance care planning and medical futility decision-making. This is an evolving landscape and in a diverse country may vary substantially by geography. Living wills and advance medical directives can be prepared by our patients, and we will be required to honor these instruments. Catastrophic brain injury and life-limiting neurologic illness both require us to maintain our commitment to care when cure is no longer possible.

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Background and Purpose: One of the most important patient-centered outcomes in patients with stroke is quality of life. Apart from physical affection, stroke affects cognitive, emotional language along with social functioning. Stroke-specific quality of life (SSQOL) is a measure to assess the quality of life in patients with stroke. The aim of this study is to investigate the reliability and validity of Marathi version of SSQOL in patients with stroke. Methodology: Translation of SSQOL in Marathi language was performed in accordance with the published guidelines. Validation of Marathi version of SSQOL was carried out by 130 patients with stroke with minimum 1 year of duration of stroke. Reliability was measured with the help of 36 volunteers diagnosed with stroke. Results: There were no major changes in the translated version, except in three items. Reliability was found to be 0.82 and validity was found to be 0.93. Floor and ceiling effects were found to be 11.3% and 6.3%, respectively. Conclusion: Marathi version of SSQOL is a valid, reliable instrument for measuring self-reported health-related quality of life in patients with stroke.

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Objectives: Many community-based and hospital-based studies across the world have yielded contradictory results regarding association of positive Toxocara canis serology and epilepsy. The present study was planned to analyze disease burden of epilepsy in rural community of North India and its association with exposure to T. canis in this part of the world. Methods: A door-to-door screening survey was carried out in the rural community using a validated questionnaire for epilepsy by trained field workers, which was finally confirmed by trained neurologists. The risk factors for epilepsy and for predisposing infections were also enquired. The results were compared with an equal number of age- and sex-matched healthy controls enrolled from the same community. Serologic evaluation was carried out to detect antibodies against T. canis. Results: A total of 41,973 persons from the rural community in 49 villages were enrolled in the study. Two hundred and eleven persons were confirmed to be suffering from active epilepsy, resulting in a crude prevalence of 5 per 1000 population. More than 50% of people with epilepsy were in the second or third decade of life. The prevalence of antibodies to T. canis was similar in people with epilepsy (13.7%; 29 of 211 individuals) and controls (9.95%; 21 of 211 individuals). Of the 151 persons with epilepsy, who underwent CT scan, 34 people (22.3%) had evidence of inflammatory granuloma, thereby confirming high incidence of this infestation in rural Northern India. Significance: Our study does not support the association between epilepsy and exposure to T. canis in rural Northern Indian population.

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There are reports of co-occurrence of obsessive–compulsive disorder (OCD) in patients with temporal lobe epilepsy (TLE). We present a report of a patient with refractory TLE due to hippocampal sclerosis with concomitant OCD on pharmacotherapy for both. She underwent surgery for standard anterior temporal lobectomy with amygdalohippocampectomy and reported improvement in obsessive–compulsive symptoms subsequently. We seek to further evidence of interaction between the two conditions and argue to undertake future research exploration on the same.

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Background: Freezing of gait (FOG) is a common and debilitating symptom in Parkinson's disease (PD); the pathogenesis and natural course of which has not been fully understood. Objectives: This study was performed to evaluate patients with FOG in PD and ascertain factors contributing to an early onset of FOG in patients with PD. Methodology: A chart review of 100 patients with PD (FOG [+] 50, FOG [−]: 50) was performed. FOG (+) patients were subdivided by a median split of time from motor onset to development of FOG (median: 6 years) into early onset FOG (EOFOG [n = 24]) and late onset FOG (n = 26). Results: The FOG (+) group had a significantly longer duration of motor symptoms, a higher Hoehn and Yahr stage, and greater severity of disease. Festination, falls, and wearing off were more prevalent in the FOG (+) group. Several nonmotor symptoms (NMS) such as constipation, psychosis, fatigue, weight loss, drooling, excessive sweating, depression, and postural giddiness were significantly higher in the FOG (+) group. The EOFOG group had a later age at onset of motor symptoms. There were no significant differences observed in the NMS, with the exception of fatigue in EOFOG. Conclusions: FOG is associated with longer disease duration and higher severity of disease. FOG (+) patients have distinct NMS which are contributory to disease morbidity. EOFOG might be associated with an accelerated disease progression and is linked with older patients and shorter disease duration.

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Introduction: Transcranial magnetic stimulation is a new tool that has been employed to modulate the neuronal activity of brain by its excitatory and inhibitory property. In cerebral palsy (CP) learning of any new task is an extremely slow process due to damage in sensory and motor areas of brain affecting the cognitive ability of the child and putting constraints in achieving timely developmental milestones. For such patients the electroencephalogram (EEG) is one of the most cost effective diagnostic tools used that minimizes hospital stay. Its analysis helps to identify various neurological disorders determining the role of brain waves outlining the present status of mind. Materials and Methods: This study evaluated the EEG power spectrum density (PSD) of CP children both pre and post rTMS intervention to identify significance changes in signal patterns arising from different brain regions. thirty CP children participated in this study. Fifteen individuals underwent repetitive TMS (rTMS) therapy for 20 session comprising of 10 Hz frequency for 5 days a week for 4 weeks and another fifteen individual participated in activities of daily living for 20 sessions where they were administered mandatory standard therapy only. pre- EEG versus post EEG data recorded and analyzed employing the standard montage configuration. PSD was extracted employing fast fourier transform post acquisition of artifact free signal to undermine changes in signal pattern. Discussion and Conclusion: The results revealed that rTMS improves learning ability in CP children and it shows higher power peak at frequency of 50 Hz and lower power peak frequency at 100 Hz. The power intensity in gamma wave region shows significant reduction post-rTMS therapy between 38-24 power peak frequency and 7-4 range in 100 Hz power peak frequency. In future, it will be used as effective tool as memory enhancers, especially for children with neurological disorders.

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Background: Neurocysticercosis (NCC) produces a progressive organic brain damage by altering brain function with alterations in memory, difficulties in learning, and behavioral changes. The present study was designed to compare the cognitive and behavioral profile of school-going children aged 6–14 years with newly diagnosed NCC with their age-matched controls. Materials and Methods: A descriptive cross-sectional study was conducted among children aged 6–14 years with newly (<7 days) diagnosed NCC. Age- and gender-matched typically developing children with minor illness attending outpatient facility served as control. Intelligence and behavioral assessment were performed using Malin's Intelligence Scale for Indian Children and Childhood Behavior Checklist (CBCL) (school age version CBCL/6–18). CBCL T- scores were computed and scores < 60 were considered as normal, 60–63 as borderline, and > 63 as clinical range. Results: A total of 35 cases and 35 controls were enrolled. Baseline demographic characteristics were comparable between the two groups. Verbal intelligence quotient (IQ) scores were comparable between the cases (96.14 [10.23]) and controls (100.17 [10.89]) (P = 0.11). The behavioral assessment revealed normal T- scores (<60) in both the groups. Conclusions: The study revealed comparable IQ and normal behavioral profile of treatment-naïve children with recently diagnosed NCC to their age-matched peers. Further studies with larger sample size and longitudinal study design are required to evaluate the role of NCC on cognition and behavior in Indian children.

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Context: Published data on genetic characterization of Toxoplasma gondii (T.gondii) from clinical cases of toxoplasmosis from India is lacking. Aims: The present study was aimed at identifying genetic types of T. gondii in fatal cases of cerebral toxoplasmosis (CT) associated with HIV, from India. Settings and Design: Archived tissues of CT were obtained postmortem from 25 acquired immunodeficiency syndrome patients between 2000 and 2014. Subjects and Methods: Direct amplification of eight different loci, namely, SAG1, 5'-3'SAG2, Alt. SAG2, SAG3, BTUB, GRA6, C22-8, and L358 followed by restriction fragment length polymorphism was used to genotype the parasite. Results: The canonical Types I, II, or III were not found in our study. More than 96% of the cases harbored atypical genotypes–likely recombinants of the canonical types; one case closely corresponded to Type II genotype. Conclusions: Thus, a majority of T. gondii causing CT in South India belonged to a noncanonical lineage. These nonarchetypal genotypes differed from the conventional Types I, II, and III and caused devastating severity in patients with CT in the background of HIV. These results are a step further to deciphering the population genetics of this important zoonotic parasitic infection in Indian patients, information that has thus far been lacking.

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Guillain–Barré syndrome (GBS) is an infrequent neurological complication of dengue viral infection. It is broadly divided into either acute inflammatory demyelinating variety or an axonal variety (acute motor axonal and acute sensory and motor axonal variants). Axonal variants are distinctly infrequent. Two brothers (18 years and 15 years) were hospitalized on the same day with complaints of acute symmetric upper- and lower-limb weakness of 7 days' duration. They did not have overt manifestations of dengue fever which preceded the neurological presentation. They had flaccid areflexic pure motor quadriparesis. Dengue IgM serology was positive in both. Nerve conduction study showed predominant axonopathic changes in both the patients. Both the patients showed significant improvement with conservative treatment during hospital stay of 7 days. This is unusual report of dengue-associated axonal GBS in two brothers. Whether simultaneous occurrence of GBS in two siblings is a coincidence or genetically determined is still a question.

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Objective: The aim of this study is to compare the images obtained from standard ultrafast magnetic resonance (MR) imaging sequences with gradient (GRE) sequence images in identifying fetal intracranial hemorrhage (ICH). Materials and Methods: MR images of fetal brains with ICH done between October 2012 and September 2015 were reviewed. The images obtained from four ultrafast MR sequences– Turbo Fast Low Angle Shot (Turbo FLASH) T1-weighted images, Half Fourier Acquisition single-shot turbo spin echo (HASTE) T2-weighted images, b0 images of diffusion-weighted imaging (DWI) and b800 images of DWI were compared with images obtained from GRE sequence in depicting fetal ICH. Results: Out of the 212 fetuses during the study period, 15 fetuses had ICH. In the 15 fetuses with ICH as detected on GRE, Grade1 germinal matrix hemorrhage was seen in 5 fetuses, Grade 2 in 4 fetuses, Grade 3 in 3 fetuses, and Grade 4 in two fetuses. Subdural hemorrhage was seen in 1 fetus. In comparison to GRE sequence, b0 of DWI sequence was almost equal in the depiction of ICH. T2 HASTE sequence also delineated hemorrhage, although not as effectively as GRE and b0 images of images DWI. T1 Turbo FLASH and b800 images of DWI were less reliable in the depiction of fetal ICH but were useful in predicting the stage of hemorrhage. Conclusion: As compared to GRE sequence, b0 images of DWI followed by HASTE are the two preferred ultrafast sequences in the diagnosis of fetal ICH.

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