Annals of Indian Academy of Neurology
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   2007| January-March  | Volume 10 | Issue 1  
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Akinetic rigid syndrome: An overview
Praveen Gupta, Madhuri Behari
January-March 2007, 10(1):21-30
Akinetic-rigid syndromes can be caused by diverse etiologies. It is vital to separate idiopathic Parkinson's disease from other neurodegenerative diseases and causes of secondary parkinsonism as it has significant therapeutic implications. However even specialists may misdiagnose nonidiopathic parkinsonism as Parkinson's disease in a quarter of cases. Often the history may be nonspecific and all investigations may be normal. The diagnosis may thus rest entirely on clinical features. The etiological diagnosis of Akinetic rigid syndrome has critical therapeutic and prognostic implications. Therefore we will review the various etiologies of akinetic rigid syndrome and highlight critical clinical features to aid in differential diagnosis.
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A case of primary hypersomnia
Dinesh J John, Arun Manoharan, Roy Varghese
January-March 2007, 10(1):58-60
Primary hypersomnia (PH) is a disorder of presumed central nervous system etiology that is associated with a normal or prolonged major sleep episode and excessive sleepiness consisting of prolonged (one or two hour) episodes of non-rapid eye movement sleep. It has a similar presentation to narcolepsy, but is not generally associated with cataplexy or sleep-onset rapid eye movement. Although PH is a chronic disorder, fluctuations and spontaneous remissions are known to occur. Treatment with stimulants is beneficial in most patients. We present the case of a 32-year-old Caucasian woman with the classical features of PH. Her condition has progressed over the years and she sleeps for days on end or until aroused. She has been treated with multiple stimulants, with limited success. This case highlights the clinical presentation, diagnostic criteria and treatment modalities of this rare condition.
  12,063 274 -
Incidental intracranial aneurysm
S Nair, G Menon, BRM Rao, Khurshid , BJ Rajesh, A Mathew, HV Easwer
January-March 2007, 10(1):12-20
The management of of unruptured intracranial aneurysms is one of the most important issues confronting neurosurgeons today. The high mortality and morbidity associated with subarachnoid hemorrhage (SAH) has prompted interest in repair of aneurysms that are discovered before they have ruptured. A strong risk factor for intracranial aneurysm which causes SAH is a positive family history, polycystic kidney disease and patients who have survived a SAH. There is no cutoff size of aneurysm below which rupture is not possible. Presently there are no definitive guidelines in the management of incidental aneurysms and many centers consider each case individually with treatment offered for lesions more than 7 mm in diameter especially if patient is relatively young without major co-morbidities. Even though microsurgery offers the advantage of proven durability and higher rates of total aneurysm obliteration, the choice of treatment modality between open microsurgery and endovascular occlusion is flexibly adjusted to each case.
  8,794 358 1
Adult onset Leigh syndrome
Lekha Pandit, Gayatri Narayanappa, Lathika Shetty, Sree Krishna
January-March 2007, 10(1):55-57
Leigh syndrome is a rare progressive mitochondrial disorder of oxidative metabolism. Though it has been reported in infancy and childhood, it is rarely described in adults. The authors describe a patient who had clinical and magnetic resonance imaging features diagnostic of Leigh syndrome, with supportive biochemical and muscle histochemistry evidence.
  8,375 268 4
My tryst with women in neurology
Ambar Chakravarty
January-March 2007, 10(1):3-11
  7,739 282 -
An interesting case of hemiplegia in a child
Sadanandavalli Retnaswami Chandra, S Syamlal, Kavitha Ravi, A Somarajan, Krishnan Suresh
January-March 2007, 10(1):49-51
Hemiplegia in children occurs due to several causes. We report an interesting case who presented with prolonged fever, native valve endocarditis and infection triggered Macrophage activation syndrome. Macrophage activation syndrome (Hemophagocytic Lymphohistiocytosis syndrome) is a rare, potentially fatal inflammatory response syndrome characterized by fever, pancytopenia, rash, falling ESR, increased ferritin, increased triglycerides and hypofibrinogenemia. Central nervous system involvement is frequent with, seizures, irritability, stiff neck, cranial nerve palsy, ataxia and coma.
  6,367 237 1
Reversible paraneoplastic encephalomyelitis as the presenting feature of ovarian teratoma: A clinicopathological correlate
Senthil J Rajappa, Norman Bethune Naidu, Shantveer Uppin, Aruna K Prayaga, Rupam Borgohain, Raghunadharao Digumarti
January-March 2007, 10(1):52-54
Paraneoplastic encephalomyelitis (PEM) is a well-characterized neurological syndrome. Its association with ovarian teratoma is rare. A young lady presented with features suggestive of encephalomyelitis with predominant cerebellar syndrome. Magnetic resonance imaging brain was normal. Cerebrospinal fluid showed lymphocytic pleocytosis. Computerized tomography scan of the pelvis revealed a complex left ovarian cyst. With a clinical diagnosis of PEM she underwent a left salpingo-oopherectomy. This was followed by total recovery of the PEM in two weeks. The histopathology revealed immature teratoma. The interesting feature was the clinicopathological correlation between the finding of fetal cerebellar tissue in the tumor and the PEM with predominant cerebellar features.
  5,690 208 -
Anti epileptic drug usage and withdrawal in elderly persons with epilepsy
Nisha Jacob, Sanjeev V Thomas, PS Sarma
January-March 2007, 10(1):34-38
Background: Prevalence of epilepsy is highest among the elderly, but precise data on the clinical profile and response to pharmacotherapy are not readily available from the developing countries. Objective: To ascertain the clinical spectrum, pharmacotherapy, efficacy, tolerability and the outcome of treatment of epilepsy in the elderly. Materials and Methods: This study was carried out in a tertiary referral epilepsy center in Kerala State, India. We had restricted the analysis persons aged 60 years and above with two or more seizures, that we identified from the registers in the electroencephalography laboratory and medical records departments for the period 2001-2004. Data abstracted on standard forms was analyzed with SPSS package. Results: There were 116 persons (68 men) included in this study. The first seizure was after 60 years of age for 91 persons (78.4%) and the mean duration of follow up was 34.7 48.3 months. Seizures were generalized tonic clonic (GTCS) for 43 and partial with or without generalization for 72 patients. One year remission was 55.8% for patients with follow-up > 12 months. Anti epileptic drug was withdrawn in 59 patients during the follow-up period, the reasons being achievement of remission 29 (49.2%), poor efficacy 14 (23.7%), adverse drug effects 9 (15.3%) and other reasons 7 (11.9%). There were 77 patients who had other concomitant illnesses (mean 2.3 drugs per person) taking other medicines (mean 2.3 drugs per persons) with potential risk of adverse drug interaction. Conclusion: Epilepsy in the elderly can be due to several underlying causes and two-third of them are likely to have other concomitant disorders requiring other drug therapy. Potential risk of drug interactions needs to be carefully evaluated while initiating pharmacotherapy for epilepsy in the elderly.
  5,449 343 -
Computer-based literature search in medical institutions in India
Jayantee Kalita, Usha K Misra, Gyanendra Kumar
January-March 2007, 10(1):44-48
Aim: To study the use of computer-based literature search and its application in clinical training and patient care as a surrogate marker of evidence-based medicine. Materials and Methods: A questionnaire comprising of questions on purpose (presentation, patient management, research), realm (site accessed, nature and frequency of search), effect, infrastructure, formal training in computer based literature search and suggestions for further improvement were sent to residents and faculty of a Postgraduate Medical Institute (PGI) and a Medical College. The responses were compared amongst different subgroups of respondents. Results: Out of 300 subjects approached 194 responded; of whom 103 were from PGI and 91 from Medical College. There were 97 specialty residents, 58 super-specialty residents and 39 faculty members. Computer-based literature search was done at least once a month by 89% though there was marked variability in frequency and extent. The motivation for computer-based literature search was for presentation in 90%, research in 65% and patient management in 60.3%. The benefit of search was acknowledged in learning and teaching by 80%, research by 65% and patient care by 64.4% of respondents. Formal training in computer based literature search was received by 41% of whom 80% were residents. Residents from PGI did more frequent and more extensive computer-based literature search, which was attributed to better infrastructure and training. Conclusion: Training and infrastructure both are crucial for computer-based literature search, which may translate into evidence based medicine.
  5,413 316 6
Evaluation of role of steroid alone and with albendazole in patients of epilepsy with single-small enhancing computerized tomography lesions
Shri Ram Sharma, Atul Agarwal, AM Kar, Rakesh Shukla, RK Garg
January-March 2007, 10(1):39-43
This study was planned to evaluate the role of steroid alone and with albendazole in patients of single-small enhancing computerized tomography (CT) lesions in Indian patients presenting with new-onset seizures. In this study, 95 patients with new onset seizures and a single enhancing CT lesion were randomly divided in two groups to receive either antiepileptic drug and steroid alone (n=42) or antiepileptic drug with a steroid and albendazole (n=48). These patients were prospectively followed-up for six months. Repeat CT scans were performed after 30 days and six months of registration. The majority of patients were below 30 years of age. Simple partial seizure, with or without secondary generalization, was the commonest type of seizure encountered in these patients. Follow-up CT scans, after one month of registration showed complete disappearance of lesion in 16.7% of patients in Group I and in 25% of patients in Group II (χ2 =0.93, P =0.334). Follow-up CT scans, after six months of registration showed complete disappearance of lesion in 59.5% of patients in Group I and in 68.8% of patients in Group II (χ2=0.83, P =0.362). During the six months follow-up five patients (11.8%) in Group I and nine patients (18.7%) in Group II experienced seizures recurrence. Two patients in Group II experienced seizure recurrence despite complete disappearance of CT lesions. Seizure control and disappearance of lesion was same in both Groups. Albendazole does not seem to affect resolution.
  4,575 291 7
Basilar artery thrombosis
Sudhir Kumar
January-March 2007, 10(1):61-62
  3,633 218 -
It is premature to use recombinant activated coagulation factor VIIa in intracerebral hemorrhage
Kameshwar Prasad
January-March 2007, 10(1):31-33
  3,505 182 1
Clinical neurophysiology
Abraham Kuruvilla
January-March 2007, 10(1):63-63
  3,369 290 -
New year: New vista
Sanjeev V Thomas
January-March 2007, 10(1):1-2
  2,724 148 -
Snake boats of Kerala
Sanjeev V Thomas
January-March 2007, 10(1):62-62
  2,258 116 -
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