Annals of Indian Academy of Neurology
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   2005| October-December  | Volume 8 | Issue 4  
    Online since April 23, 2009

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Microalbuminuria In Nondiabetic Acute Ischaemic Stroke - An Indian Perspective
PC Mathur, Prashant Punckar, Rajesh Muralidharan
October-December 2005, 8(4):237-242
To investigate the incidence, relationship to risk factors and severity of stroke with microalbuminuria (MA) in nondiabetic acute ischaemic stroke in Indians. Methods : We studied 50 patients of nondiabetic acute ischaemic stroke within 24 hours of onset of symptoms for MA by dipstick urinalysis. Results: The incidence of MA was 68% (34 patients). Of all the traditional risk factors for stroke-age, male gender, hypertension, dyslipidaemia, smoking, obesity - only age of patients (>60 years) showed a positive correlation with the presence of MA (-<0.05). Patients with MA had more severe neurological deficit (Scandinavian Stroke Scale {SSS} < 30 vs. > 30; mean+S.D=24.3+8.66 vs. 30.3+10.3, p<0.03) and more severe depressed levels of consciousness {SSS < 4 vs. SSS > 6, 82.35 vs. 17.6, p<0.05). Conclusion: The incidence of MA in Indians with nondiabetic acute ischaemic stroke is significantly higher than that of western populations. Patients with MA in the first 24 hours after the onset of stroke have more severe neurological deficit and depressed levels of consciousness than patients without MA.
[ABSTRACT]   Full text not available  [PDF]
  1,230 201 -
Randomised Controlled Trial Of Two Doses Of Heparin In Cerebral Venous Thrombosis
G.K Sarma, D Nagaraja
October-December 2005, 8(4):233-236
Cerebral venous thrombosis accounts for 10-20% of strokes in the young in India. Over the past decade, heparin has become the mainstay of treatment of cerebral venous thrombosis. The conventional doses of heparin require strict monitoring of activated partial thromboplastin time. Efficacy of low doses of heparin in cerebral venous thrombosis has already been studied. Objective: The present study compared the low dose heparin to medium dose of heparin in cerebral venous thrombosis. Methods: A prospective, randomized controlled study including consecutive patients was conducted in the department of Neurology, a tertiary referral center in India from 1996 to 1998. Patients with cerebral venous thrombosis confirmed clinically and by neuroimaging were randomized to receive low dose (2500 units TID) or medium dose (5000 units TID) heparin. All patients were assessed periodically until discharge or death. Outcome was assessed using modified Rankin scale (good outcome <3, poor outcome 3 3). Patients who deteriorated without increase of hemorrhage or developed deep venous thrombosis were given higher doses of heparin. Results: Twenty-nine patients were randomized into each group. There was no increase or additional hemorrhage in either group. Five patients in the low dose group required increase in heparin dose (to 5000 units TID) due to deterioration. Good outcome was seen in 89% on medium dose and 44.8% on low dose heparin (p<0.05). Conclusions: the randomized controlled trial from an Indian center demonstrated that medium dose regimen of heparin is better than low dose regimen and also safe in the treatment of cerebral venous thrombosis.
[ABSTRACT]   Full text not available  [PDF]
  1,230 107 -
Proximal Limb Weakness Reverting After CSF Diversion In Intracranial Hypertension
S Sinha, A,B Taly, M.N Pramod, B Indira Devi, S Satish, JME Kovur, A.K Singhai, G.R Arunodaya
October-December 2005, 8(4):249-251
We report about two young girls who developed progressive visual failure secondary to increased intracranial pressure and had significant proximal muscle weakness of limbs. Patients with elevated intracranial pressure (ICP) may present with "false localizing signs", besides having headache, vomiting and papilledema. Radicular pain as a manifestation of raised ICP is rare and motor weakness attributable to polyradiculopathy is exceptional. Two patients with increased intracranial pressure without lateralizing signs' had singnificant muscle weakness. Clinical evaluation and laboratory tests did not disclose any other cause for weakness. Following theco-peritoneal shunt, in both patients, there was variable recovery of vision but the proximal weakness and symptoms of elevated ICP improved rapidly. Recognition of this uncommon manifestation of raised ICP may obviate the need for unnecessary investigation and reduce morbidity due to weakness by CSF diversion procedure.
[ABSTRACT]   Full text not available  [PDF]
  1,131 122 -
False Localizing Signs
D Nagaraja, Sanjib Sinha
October-December 2005, 8(4):231-232
Full text not available  [PDF]
  1,015 202 -
Sylvian Fissure Lipoma With Aneurysm Of Middle Cerebral Arterty - A Case Report
Gurjinder Pal Singh, Jagadish Rai Shahi
October-December 2005, 8(4):323-326
We present the case of an exceptional lipoma of the left sylvian region associated with saccular aneurysm of middle cerebral artery, in a 50 years old female patient who presented with right partial seizures with secondary generalisation. The sylvian fissure is a rare site of intracranial lipomas. The present case is probably the second in the world literature having association of sylvian fissure lipoma with saccular aneurysm of middle cerebral artery. The clinical presentation and findings of the imaging studies which include tomography of the brain, magnetic resonance imaging of the brain and magnetic resonance angiography of the cerebral vessels are described along with a brief review of the literature.
[ABSTRACT]   Full text not available  [PDF]
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Quantification In Neurology
M Netravati, AB Taly, KPS Nair
October-December 2005, 8(4):265-273
There is a distinct shift of emphasis in clinical neurology in the last few decades. A few years ago, it was just sufficient for a clinician to precisely record history, document signs, establish diagnosis and write prescription. In the present context, there has been a significant intrusion of scientific culture in clinical practice. Several criteria have been proposed, refined and redefined to ascertain accurate diagnosis for many neurological disorders. Introduction of the concept of impairment, disability, handicap and quality of life has added new dimension to the measurement of health and disease and neurological disorders are no exception. "Best guess" treatment modalities are no more accepted and evidence based medicine has become an integral component of medical care. Traditional treatments need validation and new therapies require vigorous trials. Thus, proper quantification in neurology has become essential, both in practice and research methodology in neurology. While this aspect is widely acknowledged, there is a limited access to a comprehensive document pertaining to measurements in neurology. This following description is a critical appraisal of various measurements and also provides certain commonly used rating scales/scores in neurological practice.
[ABSTRACT]   Full text not available  [PDF]
  1,015 114 -
Bilateral Facial Paralysis In Melkersson-Rosenthal syndrome
V.V Ashraf
October-December 2005, 8(4):317-319
Melkersson-Rosenthal Syndrome is a rare, idiopathic non caseating granulomatous condition characterized by a classic triad of recurrent facial/labial swelling, fissured tongue and recurrent facial palsy. Different therapeutic regimens have been attempted but with limited success. We report a 47-year-old woman with recurrent lip swelling, lingua plicata and recurrent peripheral facial nerve palsy on both sides who benefited from a short course of oral steroids. Literature on various aspects of the disease is reviewed and discussed.
[ABSTRACT]   Full text not available  [PDF]
  1,011 111 -
Comparative Studies On Visual Evoked Potentials In Normal And Diseased Subjects
G.B Mukartihal, S Radhakrishnan, M Ramasubba Reddy, S.S.K Ayyar
October-December 2005, 8(4):243-248
The paper describes a method to differentiate the VEP signals based on frequency domain analysis as normal (N), optic neuropathy (ON) and non-recordable (NR) groups for prognostic and therapeutic reasons. The frequency domain analysis provides valuable information on the overall composition of the VEP signal for all the three groups by time domain parameters of P100, latency and its peak. The spectrum of the VEP signal for all the three groups is calculated and various spectral parameters are extracted. Total power in the spectrum (TPS), mean power (MP) and summation of the frequency and the corresponding power products (SEPP) are the features extracted from the spectrum. Regression analysis is performed to establish a relationship between the means of the extracted feature and the three groups. A good correlation (r=-0.91 to -0.96) is observed with p< 0.05 for TPS, MP and SFPP for all the three groups. Follow-up VEP studies have been carried out to monitor the progress of optic neuropathy disease and therapeutic response to the treatment. One of the spectral parameter, TPS is used a quantification features to monitor the therapeutic response to the treatment for a case study in optic neuropathy. After medication a fifty percent improvement in TPS value is observed. Therefore TPS is an important features that can be used to quantify the recovery status of optic neuropathy subjects.
[ABSTRACT]   Full text not available  [PDF]
  1,019 92 -
Dense Basilar Artery Sign Preceding Basilar Artery Territory Infarction
Sudhir Kumar, G Rajshekher, Subhashini Prabhakar
October-December 2005, 8(4):321-322
Magnetic Reasonance Imaging (MRI) is considered to be superior to CT in cases suspected to have Basilar Territory (BAT) infactions. Here is a case where no neurological abnormality was noted when examined by the family physician, and the CT scan was also reported normal. However, nine hours later, the patient developed intense vertigo, vomiting, left-sided parasthesia and unsteadiness of gait and became unconscious an hour later. Review of the initial CT showed the "dense basilar artery sign" and the repeated CT showed the infarctions involving mid brain, pons, medulla and bilateral hemispheres.
[ABSTRACT]   Full text not available  [PDF]
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Treatment Of Seizures In The Elderly
MA Aleem, Samhita Panda, D Nagaraja
October-December 2005, 8(4):253-263
The increasing life expectancy over the preceding decades and trend towards further increase means that the elderly is now a growing section of the population. Seizures are a particularly common disorder in the age group. Considering that above the age of 50 years, one is prone to suffer from atleast one chromic illness, the interplay between associated medical and neurologic diseases and seizures need to be understood. These comorbidities like hypertension, cerebrovascular accidents, diabetes, renal failure and others not only contribute to seizures, they may also interfere with their appropriate treatment. Seizures, on the other hand, may be the cause of added morbidity like fractures, head injury and poor self esteem which may lead to poor quality of life. In addition, the unique pharmacokinetics, pharmacodynamics and side effect profile of the various antieplileptic drugs in the elderly and the multiple drug interactions, require judicious use along with regular monitoring. However, an ideal antiepileptic drug for the elderly is yet to be found.
[ABSTRACT]   Full text not available  [PDF]
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