Annals of Indian Academy of Neurology
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   2016| October-December  | Volume 19 | Issue 4  
    Online since November 21, 2016

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Godfrey Newbold Hounsfield (1919-2004): The man who revolutionized neuroimaging
Kalyan B Bhattacharyya
October-December 2016, 19(4):448-450
DOI:10.4103/0972-2327.194414  PMID:27994351
Godfrey Hounsfield, a biomedical engineer contributed enormously towards the diagnosis of neurological and other disorders by virtue of his invention of the computed axial tomography scan for which he was awarded the Nobel Prize in 1979. Working for the Electrical and Musical Industry (EMI) Limited and in collaboration with two radiologists, James Ambrose and Louis Kreel, he introduced the use of this machine in 1971 at the Atkinson Morley's Hospital in Wimbledon. He continued to improve the quality of the devise and the human head was scanned for the first time in 1972. He continued his work on imaging of the human body was later concentrated on the next step in diagnostic radiology namely, magnetic resonance imaging.
  22,756 257 3
Approach to a tremor patient
Soumya Sharma, Sanjay Pandey
October-December 2016, 19(4):433-443
DOI:10.4103/0972-2327.194409  PMID:27994349
Tremors are commonly encountered in clinical practice and are the most common movement disorders seen. It is defined as a rhythmic, involuntary oscillatory movement of a body part around one or more joints. In the majority of the population, tremor tends to be mild. They have varying etiology; hence, classifying them appropriately helps in identifying the underlying cause. Clinically, tremor is classified as occurring at rest or action. They can also be classified based on their frequency, amplitude, and body part involved. Parkinsonian tremor is the most common cause of rest tremor. Essential tremor (ET) and enhanced physiological tremor are the most common causes of action tremor. Isolated head tremor is more likely to be dystonic rather than ET. Isolated voice tremor could be considered to be a spectrum of ET. Psychogenic tremor is not a diagnosis of exclusion; rather, demonstration of various clinical signs is needed to establish the diagnosis. Severity of tremor and response to treatment can be assessed using clinical rating scales as well as using electrophysiological measurements. The treatment of tremor is symptomatic. Medications are effective in half the cases of essential hand tremor and in refractory patients; deep brain stimulation is an alternative therapy. Midline tremors benefit from botulinum toxin injections. It is also the treatment of choice in dystonic tremor and primary writing tremor.
  14,994 827 4
Serological markers associated with neuromyelitis optica spectrum disorders in South India
Lekha Pandit, Douglas Kazutoshi Sato, Sharik Mustafa, Toshiyuki Takahashi, Anitha D'Cunha, Chaithra Malli, Akshatha Sudhir, Kazuo Fujihara
October-December 2016, 19(4):505-509
DOI:10.4103/0972-2327.192389  PMID:27994362
Background: Neuromyelitis optica spectrum disorders (NMOSDs) represent 20% of all demyelinating disorders in South India. No studies have determined the seroprevalence to both antibodies against aquaporin-4* and antimyelin oligodendrocyte glycoprotein antibody (anti-MOG+) in this population. Objective: To identify and characterize seropositive patients for anti-aquaporin-4 antibody (anti-AQP4+) and anti-MOG+ in South India. Materials and Methods: We included 125 consecutive patients (15 children) who were serologically characterized using live transfected cells to human M23-AQP4 or full-length MOG. Results: Among a total of 125 patients, 30.4% of patients were anti-AQP4+, 20% were anti-MOG+, and 49.6% were seronegative. No patient was positive for both. Anti-MOG+ patients represented 28.7% (25/87) of seronegative NMOSD. In comparison to anti-AQP4+ patients, anti-MOG+ patients were commonly male, had less frequent attacks and milder disability on expanded disability status score scale. Seronegative patients were also predominantly male, 36% (9/25) had monophasic longitudinally extensive transverse myelitis and disability was comparable with anti-AQP4+ patients. Lumbar cord involvement was common in anti-MOG+ and seronegatives, whereas anti-AQP4+ patients had more cervical lesions. Conclusion: Anti-AQP4+/anti-MOG + patients accounted for nearly half of the patients suspected of having NMOSD in South India, indicating that antibody testing may be useful on the management of subgroups with different prognosis.
  3,913 183 6
A call for neurologists to take up stroke intervention
Vasantha M Padma, Rohit Bhatia, Gigy Kuruttukulam, Anand Alurkar, Kewal Krishan Talwar, Dheeraj Khurana, Subhash Kaul, Vinit Suri, Gagandeep Singh, Vikram Huded
October-December 2016, 19(4):429-432
DOI:10.4103/0972-2327.194408  PMID:27994348
Recent data have provided overwhelming evidence in favor of benefits of emergent endovascular intervention in large vessel acute ischemic stroke (AIS). India with its large population has a huge burden of AIS. Hence, neurologists need to gear up to the new challenge of providing interventional care to huge populations of AIS in the country. The best way to cover this unprecedented unmet need is to encourage neurologists to take up interventional subspecialty interests through new but sound training pathways.
  3,840 233 1
Retrospective analysis of multiplex polymerase chain reaction-based molecular diagnostics (SES) in 70 patients with suspected central nervous system infections: A single-center study
Rama Krishnan Tiruppur Chinnappan Ramalingam, Dipanjan Chakraborty
October-December 2016, 19(4):482-490
DOI:10.4103/0972-2327.192483  PMID:27994358
Background: Central nervous system (CNS) infections present a grave health care challenge due to high morbidity and mortality. Clinical findings and conventional laboratory assessments are not sufficiently distinct for specific etiologic diagnosis. Identification of pathogens is a key to appropriate therapy. Aim: In this retrospective observational study, we evaluated the efficacy and clinical utility of syndrome evaluation system (SES) for diagnosing clinically suspected CNS infections. Materials and Methods: This retrospective analysis included inpatients in our tertiary level neurointensive care unit (NICU) and ward from February 2010 to December 2013. Cerebrospinal fluid (CSF) samples of 70 patients, clinically suspected of having CNS infections, were subjected to routine laboratory tests, culture, imaging, and SES. We analyzed the efficacy of SES in the diagnosis of CNS infections and its utility in therapeutic decision-making. Results: SES had a clinical sensitivity of 57.4% and clinical specificity of 95.6%. Streptococcus pneumoniae and Pseudomonas aeruginosa were the top two bacterial pathogens, whereas Herpes simplex virus (HSV) was the most common viral pathogen. Polymicrobial infections were detected in 32.14% of SES-positive cases. SES elicited a change in the management in 30% of the patients from initial empiric therapy. At discharge, 51 patients recovered fully while 11 patients had partial recovery. Three-month follow-up showed only six patients to have neurological deficits. Conclusion: In a tertiary care center, etiological microbial diagnosis is central to appropriate therapy and outcomes. Sensitive and accurate multiplex molecular diagnostics play a critical role in not only identifying the causative pathogen but also in helping clinicians to institute appropriate therapy, reduce overuse of antimicrobials, and ensure superior clinical outcomes.
  3,787 129 2
A double-blind, randomized, controlled trial to compare the efficacy and tolerability of fixed doses of ropinirole, bupropion, and iron in treatment of restless legs syndrome (Willis-Ekbom disease)
Kirti Vishwakarma, Juhi Kalra, Ravi Gupta, Mukesh Sharma, Taruna Sharma
October-December 2016, 19(4):472-477
DOI:10.4103/0972-2327.194424  PMID:27994356
Background: We aimed to compare the efficacy of fixed doses of bupropion and ropinirole and iron alone for the treatment of restless legs syndrome (RLS) and to look for the tolerability of these medications. Materials and Methods: Patients diagnosed with RLS were randomly divided into three groups with thirty patients in each group (Group A: Bupropion [300 mg/day], Group B: Ropinirole [0.25-0.5 mg/day], and Group C: Oral iron [150 mg elemental iron] along with folic acid [500 μg]). Each participant was then assessed for severity of RLS, as well as RLS-related quality at the baseline, and thereafter, every 14 th day till 6 weeks based on the International Restless Legs Scale (IRLS) severity rating scale and Restless Legs Syndrome Quality of Life (RLSQoL) Questionnaire, respectively. Results: IRLS scores differed significantly from baseline visit to last (F = 4.85; P = 0.01). The interaction between the time x treatment group was significant (F = 10.37; P < 0.001) showing an improvement with the therapy in all the groups. Pair-wise comparison depicted that ropinirole group differed from other two groups in IRLS score (F = 7.06; P = 0.001), which were comparable to each other. Regarding quality of life of these cases, within each group scores differed among all the four visits (F = 5.12; P = 0.002). Unlike IRLS, there was no significant difference among the RLSQOL scores between groups at any point of time (F = 1.2; P = 0.28). Conclusion: RLS severity decreased across time in all three groups; however, the ropinirole treatment was better than the bupropion and iron-folate therapy. Moreover, RLS-related quality of life although improved among all groups, it was comparable among three groups.
  3,412 123 2
Clinical correlates of leukoaraiosis: A study of 175 patients
Rustom S Wadia, Sandesh K Ghiya, Joshita Singh, Santosh M Sontakke, Vishwas Bharadwaj, Rahul V Sonawane, Yogesh P Bade, K Shrikanth, Nikhil Goli, Rohit Singh Chauhan, Nilesh A Nadkarni
October-December 2016, 19(4):478-481
DOI:10.4103/0972-2327.194425  PMID:27994357
Background: In India, the correlates of leukoaraiosis (LA) have not been widely reported. This study was designed to investigate the factors which correlate with LA. Materials and Methods: We included patients with LA who consented for the study and graded their severity on the basis of Fazekas scale. We excluded patients with LA who did not consent/cooperate for the study as also patients with other white matter changes which mimic LA. Results: LA is a common and under-rated cause of disability. Presentations include cognitive decline, gait disturbance, dysarthria, bladder/bowel sphincter disturbances, and increased risk of stroke. The comorbidities include hyperhomocysteinemia, hypertension, dyslipidemia, tobacco use, ischemic heart disease, previous stroke, atrial fibrillation, chronic renal failure, and bariatric surgery.
  3,381 92 2
Role of brain natriuretic peptide as a novel prognostic biomarker in acute ischemic stroke
Bindu Menon, Krishnana Ramalingam, Jyoti Conjeevaram, K Munisusmitha
October-December 2016, 19(4):462-466
DOI:10.4103/0972-2327.194422  PMID:27994354
Aim: We investigated to study the prognostic importance of brain natriuretic peptide (BNP) in ischemic stroke. Materials and Methods: We prospectively enrolled 100 patients with acute ischemic stroke and measured plasma BNP levels and compared with age- and sex-matched healthy controls. Risk factors, biochemical parameters, lipid profile, carotid and vertebral Doppler, imaging, and cardiac evaluation were done. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) score on admission and functional disability by Barthel Index (BI) at 3 months. Ischemic stroke subtype was classified according to the Oxfordshire Community Stroke Project (OCSP). Data were entered in MS Excel, and appropriate statistical analysis was done using the SPSS software version 21.0. A P = 0.05 was considered as significant. Results: Mean age of patients was 55.17 ± 11.37 years with a male:female ratio 3:1. OCSP showed total anterior circulation infarct (TACI) 35, partial anterior circulation infarct 9, lacunar infarct 12, and posterior circulation infarct 44. NIHSS on admission was average 10 ± 7 and BI was 57 ± 30. BNP in patients (435 ng/ml) was very high as compared to controls (<60 ng/ml) (P < 0.001). There was a positive correlation between age and BNP (R2 = 0.34; P < 0.00); NIHSS and BNP (R2 = 0.255; P < 0.01), negative correlation between BI and BNP (R2 = −0.064; P < 0.01). Mean BNP levels across the OCSP showed higher values in TACI (F = 4.609 P = 0.005). Regression analysis showed that BNP can predict BI which was statistically significant. Conclusion: Plasma BNP levels was significantly elevated in patients with ischemic stroke. Our study concludes that high BNP levels are seen in large anterior circulation stroke and is a predictor for the poor functional outcome at 3 months. Determination of BNP levels as a biomarker could be helpful in predicting the outcome in stroke patients.
  3,329 144 1
A case of "main en succulente" in high cervical myelopathy
Sheetal Sajan, Madhusudanan Mohan, Reji Thomas, Finu Mathew Baby
October-December 2016, 19(4):535-536
DOI:10.4103/0972-2327.192387  PMID:27994375
  3,367 90 -
Validation of a modified Hindi version of the Epworth Sleepiness Scale among a North Indian population
Geetika Bajpai, Garima Shukla, Ravindra M Pandey, Anupama Gupta, Mohammed Afsar, Vinay Goyal, Achal Srivastava, Madhuri Behari
October-December 2016, 19(4):499-504
DOI:10.4103/0972-2327.194427  PMID:27994361
Background: Since a majority of population in India does not drive automobiles, one item on the Epworth Sleepiness Scale (ESS) requires modification and validation. In addition, data collected by us indicated that a majority of rural and urban Indians regularly spend time in prayer/spiritual activity. The main purpose of this study was to develop a cross-cultural adaptation of the ESS for a North Indian population, in Hindi language (ESS-I). The study also provides evidence of reliability and validity of the modified version. Methodology: The subjects included were normal volunteers aged 18-75 years (Group 1) (n = 70), compared with patients with complaints of excessive daytime sleepiness, who had undergone polysomnography (Group 2) (n = 22) and patients who had undergone multiple sleep latency test (Group 3) (n = 10). The study was carried out in four phases: Translation and retranslation of the original scale with modification of item 8 (mainly addition of option of question on "while offering prayers or in spiritual activity"); reliability (test-retest) (n = 30); internal consistency (using Cronbach's alpha index) (n = 102); and sensitivity to change (n = 8). Results: Group 1 showed spiritual activity as a significantly more commonly practiced activity than driving. The Cronbach's alpha for the modified version was 0.892 (excellent), and this was not improved by removing the modified item. The alpha value for Group 1 versus Groups 2 and 3 was 0.667 and 0.892, respectively. The scale was reliable over time (test-retest), and it was sensitive to sleepiness change in patients with obstructive sleep apnea during treatment. Conclusion: The ESS-I, is comparable to the original scale. It is reliable, valid, and change-sensitive. It is proposed that the modified version can be very useful for detecting sleepiness among Indian population, especially those who do not drive their own vehicles.
  3,328 124 5
Assessment of fatigue in Parkinson's disease: Indian perspective
Birinder Singh Paul, Amandeep Singh, Dinesh Jain, Gagandeep Singh, Sandeep Kaushal, Gunchan Paul, Karan Kaura
October-December 2016, 19(4):451-455
DOI:10.4103/0972-2327.194419  PMID:27994352
Context: Fatigue is one of the most frequent nonmotor manifestations in Parkinson's disease (PD), having a major effect on quality of life but is not reported in Indian patients. Aims: To evaluate the frequency of fatigue in a cohort of PD population and its correlation with disease. Settings and Design: Fatigue Severity Scale (FSS) was translated and validated in local vernacular language. All patients of PD visiting neurology outpatient department of a tertiary care hospital. Subjects and Methods: A total of 150 patients were screened, and 104 were included in this study. They were divided into - Group I with fatigue (score of >4 in each item) and Group II without fatigue. Statistical Analysis: Data were analyzed by SPSS software version 20.0. Spearman correlation was used to evaluate the convergent validity of the FSS-Ind score with PD-related variables. The principal components analysis was applied to detect the domain structure of the FSS. Results: Of the total 104 patients, 68 (65.3%) patients experienced fatigue. The duration of disease was significantly more (P = 0.021) in Group I (4.39 ± 3.8 years) than in the Group II (3.13 ± 1.6 years). The severity of disease also showed a positive correlation with fatigue with 50.9% patients in H and Y stage >3 experiencing fatigue. 69.1% patients of tremor phenotype experienced fatigue as compared to 32.3% of rigid phenotype. There was no relation of fatigue with age, gender, H and Y stage, levodopa equivalent dose and mean Unified PD Rating Scale motor III score. Conclusions: Translated version of the FSS, FSS-Ind has high internal consistency and validity which supports its application as an effective tool in detecting fatigue in patients with PD. Fatigue in PD was related to duration and phenotype of the disease.
  3,196 127 1
Diagnosis and management of narcolepsy in the Indian scenario
Sachin Sureshbabu, Abdul Muniem, Manvir Bhatia
October-December 2016, 19(4):456-461
DOI:10.4103/0972-2327.194421  PMID:27994353
Introduction: The diagnosis and management of narcolepsy in the Indian context needs to be revisited especially in the wake of concerns raised by sleep medicine experts that the entity could be formidably underdiagnosed, as well as undertreated in our setting. Materials and Methods: The history, clinical records, polysomnographic/multiple sleep latency test data, and treatment records of five hundred consecutive patients attending a dedicated sleep clinic between the years 2013 and 2016 were retrospectively analyzed. The response to treatment measures and improvement in daytime functioning were periodically assessed by personal/telephonic interview and E-mail communication. Results: Thirteen patients were diagnosed with narcolepsy based on the standard criteria of which three had cataplexy. The mean age of presentation was 23.23 years and the male:female ratio was 2.25:1. The mean duration from the onset of symptoms to diagnosis was 4.2 years. Two patients responded to nonpharmacological interventions alone, and six to modafinil, while two patients remained symptomatic and required treatment with methylphenidate. One patient was lost to follow-up, while two others are due for their first follow-up. Conclusion: A refurbished outlook of the diagnostic methodology and treatment paths tailored to our clinical scenario can potentially impact the future of narcolepsy management and research in our country.
  3,165 124 2
CD6 gene polymorphism rs17824933 is associated with multiple sclerosis in Indian population
Mary Anitha D'Cunha, Lekha Pandit, Chaithra Malli
October-December 2016, 19(4):491-494
DOI:10.4103/0972-2327.192384  PMID:27994359
Background: Multiple sclerosis (MS) prevalence has increased worldwide. The known genetic association for MS in the west has not been studied in detail in nonwhite populations and particularly Indians. Objective: The objective of this study was to evaluate some known genetic variations outside the major histocompatibility complex (MHC) region associated with MS in patients of Indian origin. Materials and Methods: We investigated 10 gene-associated single nucleotide polymorphisms (SNP's) outside the MHC region in 300 patients and 720 unrelated controls. Genotyping was performed on an ABI7500 real-time polymerase chain reaction genotyping platform using predesigned TaqMan SNP genotyping assays. Results: CD6 gene associated SNP (rs17824933) showed significant association with MS (P = 4.2 × 10−5 , odds ratio [OR] = 2.24, confidence interval (CI) = 1.51-3.33). A modest association was also noted for TMEM39A rs1132200 (P = 0.023, OR = 1.41, CI = 1.05-1.91) and IL2RA rs2104286 (P = 0.04, OR = 1.3, CI = 1.006-1.67). In the remaining SNPs, the allele frequencies were overexpressed in patients when compared to healthy controls. Conclusion: Our data illustrate the similarity in risk association between Indian and European populations for MS.
  3,157 52 2
An elderly male with tingly legs and a heavy heart: Persisting with the diagnosis!
Mudassar Kharadi, Sreenath Vedula Harsha, Gayathri Gopalakrishnan, GA Karthick, Vimal Raj, Subramanian Kannan
October-December 2016, 19(4):444-447
DOI:10.4103/0972-2327.194413  PMID:27994350
Pursuing a diagnosis despite a negative nerve biopsy report requires a strong clinical conviction. Paying attention to clinical details and a diligent review of medical records is needed to solve cases in which the diagnosis is not obvious despite numerous tests. We present once such case of an elderly man with chronic diarrhea, weight loss, and peripheral neuropathy and elaborate on a step by step basis on how the clinical thought process evolved after sifting through the reports of scan and tests done during his work up.
  3,109 97 -
Efficacy and tolerability of the modified Atkins diet in young children with refractory epilepsy: Indian experience
Ranju Mehta, Shaiphali Goel, Suvasini Sharma, Puneet Jain, Sharmila B Mukherjee, Satinder Aneja
October-December 2016, 19(4):523-527
DOI:10.4103/0972-2327.194463  PMID:27994368
Background: The modified Atkins diet (MAD) has been used predominantly in older children, adolescents, and adults. There is a paucity of data on the use of the MAD in refractory epilepsy in young children. Objectives: This study was planned to evaluate the efficacy and tolerability of the MAD in refractory epilepsy in young children. Methods: This study recruited children aged 9 months to 3 years with refractory seizures. Children received MAD for 6-month with the on-going anticonvulsant medications being continued unchanged. Reduction in seizure frequency was the primary outcome measure. Adverse effects were also studied. Results: Thirty-one children with daily seizures were studied with a median age of 18-month (range 9-30 months). West syndrome was the most common epilepsy syndrome (26, 86.6%). Twenty-one children remained on diet at 3 months and 13 at 6 months. The children who achieved >50% seizure reduction were 17 (54.8%) at 3 months and 9 (29%) at 6 months. Refusal to eat was a significant problem seen in eight children. Three children discontinued the diet due to adverse effects. Conclusion: The MAD was found to be feasible, effective, and well-tolerated.
  3,016 83 5
Brainstem dysfunction in patients with late-onset Lennox-Gastaut syndrome: Voxel-based morphometry and tract-based spatial statistics study
Kang Min Park, Yun Jung Hur, Sung Eun Kim
October-December 2016, 19(4):518-522
DOI:10.4103/0972-2327.194462  PMID:27994367
Background: There have been a few reports of patients who developed Lennox-Gastaut syndrome (LGS) in the second decades of their life. Objectives: The aim of this study was to investigate electroclinical presentation in patients with late-onset LGS. In addition, we evaluated structural abnormalities of the brain, which may give some clue about the common pathogenic pathway in LGS. Materials and Methods: We enrolled the patients with late-onset LGS. We collected electroclinical characteristics of the patients and evaluated structural abnormalities using voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) analysis. Results: The three subjects were diagnosed with late-onset LGS. The patients have no mental retardation and normal background activities on electroencephalography (EEG), and they had generalized paroxysmal fast activities on EEG, especially during sleep. The TBSS analysis revealed that fractional anisotropy values in the patients were significantly reduced in the white matter of brainstem compared with normal controls. However, VBM analysis did not show any significant difference between the patients and normal controls. Conclusions: Patients with late-onset LGS have different clinical and EEG characteristics from those with early-onset LGS. In addition, we demonstrated that brainstem dysfunction might contribute to the pathogenesis of late-onset LGS.
  3,000 81 2
Interaction of incidental microbleeds and prior use of antithrombotics with early hemorrhagic transformation: Causative or protective?
Konark Malhotra, Monica Khunger, Bichun Ouyang, David S Liebeskind, Yousef M Mohammad
October-December 2016, 19(4):467-471
DOI:10.4103/0972-2327.194423  PMID:27994355
Background: Gradient echo (GRE) sequence of magnetic resonance imaging (MRI) is a sensitive tool to detect hemorrhagic transformation (HT) and old cerebral microbleeds (CMBs). Presence of CMBs and prior use of antithrombotics pose a risk of HT in ischemic stroke. We evaluated the association of CMBs and antithrombotic use with resultant HT in acute ischemic stroke (AIS). Methods: This retrospective study included AIS patients admitted to our center between January 2009 and August 2010 who underwent GRE-weighted MRI within 48 h of admission. Demographic and clinical data including diabetes mellitus, hypertension, hyperlipidemia, prior intake of antiplatelets/anticoagulants/statins, and presence of CMBs at admission were collected and compared between patients who developed HT and those who did not. We did a multivariate analysis using logistic regression to assess the effect of CMBs and prior use of antithrombotic agents on the risk of development for early HT in ischemic stroke. Results: Of 529 AIS patients, 81 (15%) were found to have HT during the initial hospital course. CMBs were found in only 9 of 81 patients (11%) with HT and in 40 out of remaining 448 patients (9%) who did not develop HT. The presence of CMBs was not associated with increased risk of HT (P = 0.53). However, prior use of antiplatelets (33% vs. 47% in the patients without HT, P = 0.02) was associated with decreased risk of HT in ischemic stroke. Conclusion: Presence of incidental CMBs was not associated with increased risk for early HT of an ischemic stroke. Interestingly, the prior intake of antiplatelets was found to be protective against HT of ischemic stroke.
  2,945 88 -
Idiopathic intracranial hypertension with spontaneous cerebrospinal fluid leak into the orbit
Joe James, James Jose, V Abdul Gafoor
October-December 2016, 19(4):512-513
DOI:10.4103/0972-2327.194458  PMID:27994364
  2,863 80 1
The brightening splenium: An imaging hallmark of dengue encephalopathy?
Sachin Sureshbabu, Laxmi Khanna, Sudhir Peter, Elisheba Patras, Gaurav Kumar Mittal
October-December 2016, 19(4):516-517
DOI:10.4103/0972-2327.192385  PMID:27994366
  2,829 109 -
The clinical significance of brain microbleeds in patients with Alzheimer's disease: Preliminary study
Jae-Hyeok Heo, Dong-Gyu Im, Seung-Hyeon Lee, Jin-Young Ahn
October-December 2016, 19(4):495-498
DOI:10.4103/0972-2327.194426  PMID:27994360
Background: Microbleeds (MBs) are observed frequently in Alzheimer's disease (AD) and suggested to play a crucial role in the pathophysiology, but their clinical significance remains unclear. Materials and Methods: The study recruited 100 patients with AD who were diagnosed at the memory clinic in Seoul Medical Center in 2014. For each patient, baseline characteristics, neuropsychological tests, cerebrovascular risk factors, medial temporal lobe atrophy (MTLA), and severity of small vessel disease (SVD) according to the existence of MBs were evaluated. Results: The prevalence of MBs in patients with AD was 33%. The percentage of male gender, the severity of SVD and MTLA were significantly increased in MB(+) group. The MB(+) group showed more severe MTLA and SVD than MB(−) group. Conclusions: These results suggested that MBs might reflect the burden of amyloid and ischemic vascular pathology.
  2,701 81 1
Acute encephalopathy: A novel presentation of mineralizing microangiopathy of childhood
Mahesh Kamate, Mukul Malhotra, DH Gangamma, Virupaxi Hattiholi
October-December 2016, 19(4):528-530
DOI:10.4103/0972-2327.194465  PMID:27994370
  2,683 78 -
Case series of organophosphorus-induced polyneuropathy
Shalin Dipinkumar Shah, Pranav B Joshi, Kailash Mirche, Sudhir V Shah
October-December 2016, 19(4):530-531
DOI:10.4103/0972-2327.192401  PMID:27994371
  2,633 88 1
Cerebral venous thrombosis in refractory idiopathic thrombocytopenia treated with eltrombopag
Vivek Nambiar, TS Dhanya, Neeraj Sidharthan
October-December 2016, 19(4):532-533
DOI:10.4103/0972-2327.194468  PMID:27994373
  2,602 80 2
Bilateral "Swirl Sign": A predictor of rebleed
Biplab Das, Dheeraj Khurana, Chiraj Kamal Ahuja
October-December 2016, 19(4):514-515
DOI:10.4103/0972-2327.194460  PMID:27994365
  2,516 96 -
Bilateral abducens and facial nerve palsies as a localizing sign due to reduction in intracranial pressure after fourth ventriculoperitoneal shunting
Boby Varkey Maramattom, Dilip Panikar
October-December 2016, 19(4):510-511
DOI:10.4103/0972-2327.194457  PMID:27994363
A trapped fourth ventricle often requires fourth ventriculoperitoneal shunting (4VP). Complications of this procedure include shunt blockage, infection, shunt migration, and overdrainage. Cranial nerve palsies are very rare after 4VP shunting and have been described with over drainage and brainstem distortion. We present an unusual case of bilateral abducens and facial nerve palsies after 4VP shunting after normalization of 4 th ventricular parameters. Measurement of various brainstem angles presented us with a plausible hypothesis to explain the cranial nerve dysfunction.
  2,484 76 2
Vitamin D deficiency in antiphospholipid syndrome
Nataraja Pillai Venugopal
October-December 2016, 19(4):528-528
DOI:10.4103/0972-2327.194464  PMID:27994369
  2,428 63 -
A genetically proven case of Pelizaeus-Merzbacher disease: Clinicoradiological clues
Lokesh Saini, Biswaroop Chakrabarty, Atin Kumar, Sheffali Gulati
October-December 2016, 19(4):533-535
DOI:10.4103/0972-2327.194470  PMID:27994374
  2,325 81 -
Another gap in epilepsy care
Victor Patterson
October-December 2016, 19(4):531-532
DOI:10.4103/0972-2327.194467  PMID:27994372
  2,144 53 -
Erratum: Report: Stem cell applications in neurological practice, an expert group consensus appraisal

October-December 2016, 19(4):537-537
DOI:10.4103/0972-2327.194471  PMID:27994376
  1,827 77 -
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