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Annals of Indian Academy of Neurology
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   2009| April-June  | Volume 12 | Issue 2  
    Online since July 1, 2009

 
 
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ORIGINAL ARTICLES
Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?
Anupam Gupta, Arun B Taly, Abhishek Srivastava, Murali Thyloth
April-June 2009, 12(2):104-107
DOI:10.4103/0972-2327.53078  PMID:20142855
Objective: Assessment of bladder by urodynamic study (UDS) in patients with urinary incontinence following stroke, and correlation with site of lesion. Study Design and Setting: Retrospective cross-sectional study in the neurological rehabilitation unit of a tertiary care institute. Materials and Methods: Forty patients (22 males) with arterial or venous, ischemic or hemorrhagic stroke, with urinary incontinence in the acute phase following the event, underwent UDS. Seventeen patients had right hemiplegia, 18 had left hemiplegia, and five had posterior circulation stroke with brainstem/cerebellar features. Bladder type was correlated with age, side, and site of lesion. Results: The mean age was 46.80 16.65 years (range: 18-80 years). Thirty-six patients had arterial stroke and four had cortical venous thrombosis. UDS was performed after a mean of 28.32 10.27 days (range: 8-53 days) after the stroke. All but one patient had neurogenic bladder dysfunction, with 36 patients (90%) having overactive detrusor (OD) and three having underactive/areflexic detrusor. Among the 36 patients with OD, 25 patients (62.5%) had OD without detrusor-sphincter dyssynergy (DSD) and 11 (27.5%) had OD with DSD. Bladder management was advised based on the UDS findings. No significant correlation ( P > 0.05) was found between type of bladder and age or side and site of lesion. Conclusions: UDS is a useful tool to assess and manage the bladder following stroke with urinary incontinence. In this study, no significant correlation was found between UDS findings and site of lesion.
  13 7,342 278
Radial neuropathy due to occupational lead exposure: Phenotypic and electrophysiological characteristics of five patients
N Shobha, Arun B Taly, Sanjib Sinha, T Venkatesh
April-June 2009, 12(2):111-115
DOI:10.4103/0972-2327.53080  PMID:20142857
Lead is a ubiquitous and versatile metal that has been used by mankind for many years. It is a toxic heavy metal that ranks as one of the most important environmental poisons in the world. Research conducted in recent years has increased public health concern about the toxicity of lead at low doses and has supported a reappraisal of the levels of lead exposure that may be safely tolerated in the workplace. Neuropathy is one complication of lead poisoning. The aim of this study is to describe the phenotypic and electrophysiological profile in five male patients working in a battery factory who developed radial nerve neuropathy due to lead exposure. All patients had elevated blood lead levels that were in the toxic range. The concerned regulatory bodies should make it mandatory for workers to undergo regular health checkups to detect signs of lead poisoning and must ensure that workers are aware about the ill effects of exposure to this metal. Chelation therapy removes lead from the blood and soft tissues and chronic lead exposure often requires repeated courses of treatment.
  9 18,245 281
CASE REPORTS
Primary Sjögren's syndrome manifesting as multiple cranial neuropathies: MRI findings
VV Ashraf, Ramesh Bhasi, R Praveen Kumar, AS Girija
April-June 2009, 12(2):124-126
DOI:10.4103/0972-2327.53083  PMID:20142860
We report a case of primary Sjögren's syndrome presenting with multiple cranial nerve palsies and radiological evidence of cranial pachymeningitis and hypophysitis. A 47-year-old woman developed right sensory neural hearing loss followed, 2 months later, by right facial palsy. Cranial magnetic resonance imaging showed features of pachymeningitis and pituitary gland infiltration. The diagnosis of primary Sjögren's syndrome was confirmed by demonstrating positive SS-A and SS-B antibodies and histological evidence of lymphocytic infiltration of the sublabial salivary gland. During the 2-year follow-up, the patient had transient VI th , IX th , X th , and XII th cranial nerve palsies. Sjögren's syndrome should be considered in the differential diagnosis of patients presenting with multiple recurrent cranial nerve palsies, even if prominent sicca symptoms are absent.
  7 6,250 234
IMAGES IN NEUROLOGY
Madelung's disease with myopathy
CJ Suresh Chandran, YR Godge, PJ Oak, SH Ravat
April-June 2009, 12(2):131-132
DOI:10.4103/0972-2327.53086  PMID:20142863
  6 4,434 193
REVIEW: PROGRESS IN MEDICINE
Role of multidrug transporters in neurotherapeutics
Manna Jose, Sanjeev V Thomas
April-June 2009, 12(2):89-98
DOI:10.4103/0972-2327.53076  PMID:20142853
Acquired resistance to antibiotics and other chemotherapeutic agents is a major problem in the practice of neurology and other branches of medicine. There are several mechanisms by which drug resistance is acquired. Multidrug transporters are important glycoproteins located in the cell membrane that actively transport small lipophilic molecules from one side of the cell membrane to the other, most often from the inside to the outside of a cell. They have important protective role yet may prove inconvenient in chemotherapy. In epilepsy and other disorders this mechanism augments the elimination of drugs from their target cells and leads to drug resistance. In this review, we have discussed the biochemical characteristics of multidrug transporters and the mechanisms by which these membrane bound proteins transport their target molecules from one side to the other side of the cell membrane. We have also briefly discussed the application of this knowledge in the understanding of drug resistance in various clinical situations with particular reference to neurological disorders. These proteins located in the placenta have important role in preventing the transplacental movement of drugs in to the fetus which may result in congenital malformations or other defects. The molecular genetic mechanisms that govern the expression of these important proteins are discussed briefly. The potential scope to develop targeted chemotherapeutic agents is also discussed.
  6 4,826 309
ORATION
Classification and diagnosis of the inherited neuropathies
Mary M Reilly
April-June 2009, 12(2):80-88
DOI:10.4103/0972-2327.53075  PMID:20142852
  5 6,518 739
ORIGINAL ARTICLES
Clinical, electrophysiological, and prognostic study of postinjection sciatic nerve injury: An avoidable cause of loss of limb in the peripheral medical service
Maqbool Wani, Saleem Sheikh, Asrar Ahmed
April-June 2009, 12(2):116-119
DOI:10.4103/0972-2327.53081  PMID:20142858
Background: Post injection sciatic nerve injury is a common cause of sciatic nerve mononeuropathy in the developing world largely due to inadequate health care facilites in the rural regions. Objective: The study was conducted to analyse the pattern of this nerve lesion in clinical and electrophysiological parameters and also to study the outcome in a conservatively treated cohort. Materials and Methods: One hundred and six patients who underwent evaluation at our laboratory from 2000 to 2006 for post injection sciatic neuropathy formed the study population. Twenty two of these were followed up (mean 6.6 months) for the outcome. Results: In the cases with full data, common peroneal division of the sciatic nerve was affected alone or predominantly. On follow up, 72% cases showed little or partial recovery. Thirty two percent patients had residual trophic changes and causalgia at their last visit. Conclusion: The majority of cases of postinjection sciatic nerve injury have poor prognosis on conservative treatment.
  5 7,584 232
Comparison of psychosocial factors between patients with benign fasciculations and those with amyotrophic lateral sclerosis
Sandeep S Rana, Carol J Schramke, Amandeep Sangha, Aryn C Karpinski
April-June 2009, 12(2):108-110
DOI:10.4103/0972-2327.53079  PMID:20142856
In this retrospective study, we compared the initial presentation of patients who were eventually diagnosed with either benign fasciculations (BF) or amyotrophic lateral sclerosis (ALS). We found a significantly higher number of patients with BF reporting a past history of psychiatric symptoms, life stressors, and concurrent psychosomatic symptoms. There was no difference between the two groups in patient report of current anxiety or depression symptoms. These findings support our hypothesis that BF are a manifestation of psychological distress due to somatization and that reviewing psychosocial history is important when patients are being evaluated for fasciculations. Patients seeking medical attention for fasciculations and who do not report a history of underlying psychiatric or psychosomatic disorders should be followed closely as fasciculations have been reported to be a presenting feature of ALS.
  4 6,481 179
CASE REPORTS
Apraxic agraphia: An insight into the writing disturbances of posterior aphasias
Gopee Krishnan, Soorya Narayana Rao, Bellur Rajashekar
April-June 2009, 12(2):120-123
DOI:10.4103/0972-2327.53082  PMID:20142859
Background: Reading and writing disturbances are common accompaniments of aphasia following brain damage. However, impaired writing in the absence of apparent primary linguistic disturbances is infrequently reported in the literature. Materials and Methods: A 67-year-old right-handed subject underwent neurological, neuroradiological, and linguistic investigations following development of a minimal right upper limb weakness. Result: The patient had polycythemia and the neurological investigation revealed right upper limb paresis. The neuroradiological investigation revealed hypodense areas involving the gray-white matter of the left postero-parietal and frontal lobe, left caudate and lentiform nuclei, and the anterior limb of the internal capsule, suggesting an infarct. The linguistic investigation revealed a mild anomic aphasia with apraxic agraphia. This mild anomic aphasia resulted primarily from the relatively poor scores on the verbal fluency tests. Discussion: The marked writing impairment, even with the left hand, points to disturbances in written output - apraxic agraphia - in the presence of near-normal spoken output. This finding should raise suspicion about hidden apraxic agraphia in subjects with posterior aphasias.
  3 7,594 234
Flail arm-like syndrome associated with HIV-1 infection
A Nalini, Anita Desai, Simendra Kumar Mahato
April-June 2009, 12(2):127-130
DOI:10.4103/0972-2327.53084  PMID:20142861
During the last 20 years at least 23 cases of motor neuron disease have been reported in HIV-1 seropositive patients. In this report we describe the clinical picture of a young man with HIV-1 clade C infection and flail arm-like syndrome, who we were able to follow-up for a long period. We investigated and prospectively monitored a 34-year-old man with features of flail arm syndrome, who developed the weakness and wasting 1 year after being diagnosed with HIV-1 infection after a routine blood test. He presented in 2003 with progressive, symmetrical wasting and weakness of the proximal muscles of the upper limb of 2 years' duration. He had severe wasting and weakness of the shoulder and arm muscles. There were no pyramidal signs. He has been on HAART for the last 4 years and the weakness or wasting has not worsened. At the last follow-up in July 2007, the patient had the same neurological deficit and no other symptoms or signs of HIV-1 infection. MRI of the spinal cord in 2007 showed characteristic T2 hyperintense signals in the central part of the spinal cord, corresponding to the central gray matter. Thus, our patient had HIV-1 clade C infection associated with a 'flail arm-like syndrome.' The causal relationship between HIV-1 infection and amyotrophic lateral sclerosis (ALS)-like syndrome is still uncertain. The syndrome usually manifests as a lower motor neuron syndrome, as was seen in our young patient. It is known that treatment with antiretroviral therapy (ART) stabilizes/improves the condition. In our patient the weakness and atrophy remained stable over a period of 3.5 years after commencing HAART regimen.
  2 5,711 167
IMAGES IN NEUROLOGY
Similar calcifications of the brain on computed tomography, but different etiologies
Bindu Menon, CV Harinarayan
April-June 2009, 12(2):134-135
DOI:10.4103/0972-2327.53088  PMID:20142865
  2 3,956 241
VIEW POINT
Taare Zameen Par and dyslexic savants
Ambar Chakravarty
April-June 2009, 12(2):99-103
DOI:10.4103/0972-2327.53077  PMID:20142854
The film Taare Zameen Par (Stars upon the Ground) portrays the tormented life at school and at home of a child with dyslexia and his eventual success after his artistic talents are discovered by his art teacher at the boarding school. The film hints at a curious neurocognitive phenomenon of creativity in the midst of language disability, as exemplified in the lives of people like Leonardo da Vinci and Albert Einstein, both of whom demonstrated extraordinary creativity even though they were probably affected with developmental learning disorders. It has been hypothesized that a developmental delay in the dominant hemisphere most likely 'disinhibits' the nondominant parietal lobe, unmasking talents-artistic or otherwise-in some such individuals. It has been suggested that, in remedial training, children with learning disorders be encouraged to develop such hidden talents to full capacity, rather than be subjected to the usual overemphasis on the correction of the disturbed coded symbol operations.
  2 10,483 247
EDITORIAL
The National Health Bill 2009 and afterwards
Sanjeev V Thomas
April-June 2009, 12(2):79-79
DOI:10.4103/0972-2327.53074  PMID:20142851
  - 4,346 440
IMAGES IN NEUROLOGY
'Hummingbird' sign in progressive supranuclear palsy
Rakesh Shukla, Manish Sinha, Rajesh Kumar, Dilip Singh
April-June 2009, 12(2):133-133
DOI:10.4103/0972-2327.53087  PMID:20142864
  - 7,306 357
LIGHTER MOMENTS
No footprints, yet after the leader
Jacob George
April-June 2009, 12(2):130-130
PMID:20142862
  - 2,472 123
My fellow
Mahesh Pundlik Kate
April-June 2009, 12(2):135-135
PMID:20142866
  - 2,273 123
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