Annals of Indian Academy of Neurology
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   2004| April-June  | Volume 7 | Issue 2  
    Online since April 23, 2009

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Atypical Neurological Manifestations Of Hypokalemia
P K pal, B Vengamma
April-June 2004, 7(2):375-380
A part from the well-established syndrome of motor paralysis, hypokalemia may present with atypical neurological manifestations, which are not well documented in literature. Methods: We treated 30 patients of hypokalemia whose neurological manifestations improved after corrections of hypokalemia. A retrospective chart review of the clinical profile was done with emphasis on the evolution of symptoms and occurrence of unusual manifestations. Results: Twenty-eight patients had subacute quadriparesis with duration of symptoms varying from 10hrs to 7 days and two had slowly progressive quadriparesis. Fifty percent of patients had more than one attack of paralysis. Early asymmetric weakness (11), stiffness and abnormal posture of hands (7), predominant bibrachial weakness (4), distal paresthesias (4), hemiparesthesia (1), hyperreflexia(4), early severe weakness of neck muscles (3), chorea (1), trismus (1),and, retention of urine (1) were the unusual features observed. The means level of serum potassium on admission was 2.1+0.6mEq/L.and the serum creatine kinase was elevated in 14 out of 17 patients. All patients except two had complete recovery.
[ABSTRACT]   Full text not available  [PDF]
  3,885 251 -
Effects in Oxygen saturation (SpO2) and Heart Rate (HR) In Hemiparetic Stroke Patients On The Affected Side
P C Mathur, Anushuman Somani
April-June 2004, 7(2):393-395
Hypoxia is common in C.V stroke patients and monitoring of SpO2 by pulse oximetry should be done in the acute phase. Many a time, it is felt that physical changes on the affected side or i.v infusions may alter oximeter readings. Thirty patients 18 men (60%) 12 women (40%) : 19 left hempiaresis (63.3%) were recruited. The maximum differences between simultaneous left and right arm readings was 1% SpO2. Heart rate fluctuated more but no affected/non-affected side pattern was seen. Mean SPO2 was 95% on both sides. Mean HR was 82 bpm on both sides. There was no significant difference between the two sides for either parameter.
[ABSTRACT]   Full text not available  [PDF]
  3,052 136 -
Hyperhomocysteinaemia And Vitamin B12 Deficiency In Ischaemic Strokes In India
R S Wadia, N C Edul, S Bhagat, S Bandishti, R Kulkarni, S Sontakke, S Barhadi, M Shah
April-June 2004, 7(2):387-392
Hyperhomocysteinemia is a recognised risk factor for stroke and ischemic heart disease (HID). Vit B12 Folate and pyridoxine deficiency are important causes of raised serum homocysteine. As a vegetarian diet is very poor in Vit B12 we sought to study the incidence of hyperhomocysteinaemia in our stroke populating and to measure Vit B12 and folate in these cases. Consecutive cases of ischaemic stroke, either arterial or venous, admitted over a period of 2 1/2 years were studied. Embolic strokes and those on vitamin supplements were excluded. cases were divided into vegetarian (including those taking milk and / Or eggs), those who took non-vegetarian 4 or less times a month, and frequent non-vegetarians taking 5 or more times a month. Serum total homocysteine, serum B12 and folate levels were studied along with all other routine parameters. For comparison we examined 101 controls without HID, stroke, peripheral vascular disease, rental failure or recent vitamin intake. With the international norm for homocysteine given as 5-15 umol/litre (1)we called serum homocysteine 16 umol/litre or more as raised. There were 147 cases of ischcmic stroke :119 arterial and 28 venous infarcts. In the arterial strokes 99 of 119 cases (83.19%) had raised serum Homocysteine including 25 of 27 (92.5%) of those with arterial stroke before age 45. Of 28 cases with venous infarct 21 (75%) had raised homocysteine (HCY). Hyperhomocysteinemia was the commonest risk factor for stroke in our populations. Out of the total 147 cases the exact dietary intake was not known for ten cases., 58 were vegetarians, 54 were occasional non vegetarians (NV) and 25 were frequent NV. In the 58 vegetarians, 55 had serum HCY> 16 umol/1 (94.8%) and of those vegetarians with HCY> 16, serum B12 <200pg/ml was seen in 44 (75.8%) and between 200-300 pg/ml in five (8.6%). Of the 54 occasional NV, 46 had HCY>16umo/1 (85.2%) Of those with HCY >16, serum B12 level of <200 pg/ ml was seen in 28 (51.85% occ. NV) and the level was 200-300 pg/ml in 12 patients (22.2%) . Of the 25 frequent NV 11 had increased HCY (44%), none had serum B12 <200 pg/ml and six had serum B12 between 200-300 pg/ml (24%). MCV (means corpuscular volume) was greater than 95fL in 51% of vegetarians, 4606% of occasional non- vegetarians and 6% of frequent NV. Low serum folate (<3 mg/ml) was uncommon and found in3 vegetarians, 3 occasional NV and 2 frequent NV and each time with B12 deficiency. In 101 controls homocysteine was raised in 52 (51.5%) including 86.6% of vegetarians and 17.1% frequent NV. Serum B12 <200 pg/ml was present in39 (38.6%). This included 56.6% of vegetarians and 5.7% of frequent NV. Raised serum homocysteine is common in India and is a major risk factor for strokes and this is mainly due to Vit B12 deficiency. The important predisposing factor is a vegetarians diet. A regular supplement, or fortification of food with vit. B12 (with or without folate) could be a very worthwhile preventive measure in this country.
[ABSTRACT]   Full text not available  [PDF]
  2,182 271 -
Factors Influencing Anti Epileptic Drug Non-Compliance
M Dhanaraj, A Jayavelu
April-June 2004, 7(2):369-374
Non-compliances to anti epileptic drug therapy is one of the commonest causes of relapse of seizure. The various factors influencing non-compliance in a state government hospital where patients below poverty line are issued free drugs once in 2 weeks are unknown. In this study, 200 adult epilepsy patients consisting 100 complaint and non- complaint in each group were interviewed with a structured questionnaire. The relevant demographic and clinical characteristics such as awareness of altitude towards purchasing the drugs were collected. The data was analyzed using student "t" test and chi square test. The factors influencing non-compliance were, a)difficulty in collecting the drugs once in 2 weeks from the hospital (45% vs. 21%:p value < 0.001), b) Lack of family supported (42%vs.29%:p value < 0.05), c) Mental adverse effects of the drugs (54%vs.33%: value <0.002) and d) Poor motivation. The attitude of the patients was negative towards purchasing drugs even at times of emergency (84% vs. 44%:p value <0.001). Measures to rectify the above factors are suggested.
[ABSTRACT]   Full text not available  [PDF]
  1,437 201 -
Belief Based Rituals And Their Relevance Towards Comprehensive Epilepsy Management
M Dhanaraj, A Jayavelu
April-June 2004, 7(2):381-385
One hundred consecutive adults with epilepsy attending the outpatient clinic for the first time were interviewed to find out the various belief-based rituals practiced by them for the control of epilepsy. They were compared with a control group consisting an equal number of patients with chronic daily headache. The various rituals practiced by them were 1. Exorcism to expel the demon in 22% of the study and 4% of the control group (p value < 0.00015). 2. Tying "Thayathu" around neck, loin or arm in 29% of the study and 10% of the control group(p value <0.00069), 3. wearing "Kappu" (a metal ring) around wrist in 13% of the study group and none in the control group and 4. Tying "Holi thread" around wrist, neck or loin in 22% of the study group and 10% of the control group(p value>0.021). Any one of the above rituals was performed by 51% of the study group and 17% of the control group (p value <0.0001). Most of the patients who practiced the rituals were from suburban towns and rural areas. The mean delay in seeking medical treatment for epilepsy was 26 months among those who performed rituals and 19 months in the rest. During the ictal phase of the seizure, iron made objects such as key, chain, a rod or pipe was thrust into the hand of 80% of patients by a bystander or a relative for the control of convulsion, without providing first aid. The importance of epilepsy awareness programmes for the rural and suburban community as well as health professionals is stressed.
[ABSTRACT]   Full text not available  [PDF]
  1,508 121 -
Role Of Cervical Paraspinal Electromyography In Cervical Spinal Root Avulsions And Its Correlations With Intra Operative Findings
T Arulmozhi, M Dhanaraj, A Jayavelu
April-June 2004, 7(2):397-402
The diagnosis of cervical spinal root avulsion in patients with brachial plexus injuries is major challenge of the present day with the available investigatory procedures. To validate the use of the paraspinal electromyography was done in20 successive patients who all had sustained injuries to their upper limb nerves following road traffic accidents. Electromyographic abnormalities indicative of root avulsion were identified. All of them underwent explorative surgery. The results of the paraspinal electromyography were correlated with the intra-operative findings. Paraspinal electromyography was abnormal in six and normal in 14. All the six patients with abnormal results had evidence of multiple spinal root avulsion. Among those with normal paraspinal electromyography, two showed single spinal root avulsion and in the remaining 12 they were intact. The sensitivity of this test was 75% specificity 100% positive predictive value 100% and negative predictive value 85%. Paraspinal electromyography is an useful test in identifying cervical root avulsions because of its high positive predictive value. However with single root avulsion the sensitivity of the test falls. Somato sensory evoked potential and magnetic resonance imaging studies may be valuable adjuncts in diagnosing such cases.
[ABSTRACT]   Full text not available  [PDF]
  1,310 169 -
Homocysteine And Stroke
D Nagaraja, Ritha Christopher
April-June 2004, 7(2):357-367
In recent years, a great deal of attentions has been focused on the role of homocysteine, a sulfur-containing amino acid, in the etiopathogenesis of atherothromobtic vascular disease. Multiple prospective and case-control studies have shown that a moderately elevated plasma homocysteine concentration is an independent risk factor for stroke. The exact molecular mechanism by which homocysteine or related metabolites promote atherothrombosis is unknown although several possible roles have been proposed. It is generally held that homocysteine promotes thrombosis by adversely affecting the functions of the vascular endothelium that maintain the blood's fluidity. Homocysteine concentrations are determined by genetic and nutritional factors including deficiencies of folate, vitaminB12 and B5 supplementation with the nutrient cofactors required for optimal functioning of the homocysteine metabolic pathways significantly impacts homocysteine levels, and offers a new integrated possibility for prevention of first and recurrent episodes stroke.
[ABSTRACT]   Full text not available  [PDF]
  1,245 169 -
Calvarial Thickening And Cerebellar Atrophy Following Chronic Phenytoin Usage
Sudhir Kumar
April-June 2004, 7(2):403-403
Full text not available  [PDF]
  850 98 -
Mimetic Facial Paresis
Sudhir Kumar, Ravi. P Kumar
April-June 2004, 7(2):405-405
Full text not available  [PDF]
  777 102 -
Homocysteine And Neurological Disease
D Nagaraja
April-June 2004, 7(2):355-356
Full text not available  [PDF]
  728 90 -
Annals Of Indian Academy Of Neurology
D Nagaraja
April-June 2004, 7(2):407-408
Full text not available  [PDF]
  612 63 -
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