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NI FEATURE - COMMENTARY: THE FIRST IMPRESSION |
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The cover page |
p. 903 |
DOI:10.4103/0028-3886.236978 PMID:30038065 |
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NI FEATURE - COMMENTARY: TIMELESS REVERBERATIONS |
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The human brain, human mind and consciousness connectome: An unresolved enigma |
p. 904 |
Ashok Panagariya DOI:10.4103/0028-3886.236985 PMID:30038066 |
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NI FEATURE: JOURNEY THROUGH THE EONS - COMMENTARY |
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Second career: Life after superannuation |
p. 907 |
Prakash N Tandon DOI:10.4103/0028-3886.236983 PMID:30038067 |
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The two Drs. Edinger who deserve greater recognition |
p. 914 |
Sunil K Pandya DOI:10.4103/0028-3886.236982 PMID:30038068 |
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Evolution of concepts in the management of cysticercosis of the brain: Then (1970) and now (2018) |
p. 919 |
Vedantam Rajshekhar DOI:10.4103/0028-3886.236969 PMID:30038069 |
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GUEST COMMENTARY |
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Rational approach to prescription writing: A preview |
p. 928 |
Angelika Batta, Bhupinder Singh DOI:10.4103/0028-3886.236960 PMID:30038070
Prescription writing has to be properly addressed with regard to its correctness and appropriateness. Any errors in the procedure have to be eliminated. Electronic prescribing has abolished most of typographical prescription errors but the rationality involved in prescription of drugs is more of a thought process, which is still not optimum. Irrationality in prescriptions leads to medication errors causing increased morbidity or hospitalization and an economic loss. The rational use of medicines should be practiced which begins with defining the therapeutic objective, choosing the right medicine which is specific to the patient's needs, followed by monitoring of response to therapy. Compliance and outcome of therapy is totally dependent upon the doctor-patient relationship, a proper information and communication with the patient, and the physician's commitment and empathy towards the patient.
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Artificial intelligence in neurosciences: A clinician's perspective  |
p. 934 |
Krishnan Ganapathy, Shabbir Syed Abdul, Aldilas Achmad Nursetyo DOI:10.4103/0028-3886.236971 PMID:30038071
Even after making allowance for an unprecedented hype, it is an undeniable fact that, in the coming decade, deployment of Artificial Intelligence (AI) will cause a paradigm shift in the delivery of healthcare. This paper will review the practical utility of AI in neurosciences from a clinician's perspective. Steering clear of the complex, technical, computational jargon, the authors will critically review the exponential development in this area from a clinical standpoint. The reader will be exposed to the fundamentals of AI in healthcare and its applications in different areas of neurosciences. Powerful AI techniques can unlock clinically relevant information, hidden in massive amounts of data. Translating technical computational success to meaningful clinical impact is, however, a challenge. AI requires a thorough and systematic evaluation, prior to integration in the clinical care. Like other disruptive technologies in the past, its potential for causing a great impact should not be underestimated. A scenario in which medical information, gathered at the point of care, is analyzed using sophisticated machine algorithms to provide real-time actionable analytics seems to be within touching distance.
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NI FEATURE: THE EDITORIAL DEBATE I-- PROS AND CONS |
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Basilar invagination, syringomyelia and Chiari formation and their relationship with atlantoaxial instability |
p. 940 |
Atul Goel DOI:10.4103/0028-3886.236992 PMID:30038072 |
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Congenital craniovertebral junction anomalies: The issues |
p. 943 |
Vijendra K Jain DOI:10.4103/0028-3886.236999 PMID:30038073 |
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Review of controversies or a ‘controversial review’ on the surgical management of congenital craniovertebral junction anomalies |
p. 947 |
Pravin Salunke DOI:10.4103/0028-3886.236988 PMID:30038074 |
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NI FEATURE: THE EDITORIAL DEBATE II-- PROS AND CONS |
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Early post-stroke seizures with first-ever stroke |
p. 949 |
Lakshmi Narasimhan Ranganathan, Shubha Subramanian, Guhan Ramamurthy, MM Arun Shivaraman DOI:10.4103/0028-3886.237004 PMID:30038075 |
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Not to forget: Seizures in acute stroke |
p. 952 |
Achal Kumar Srivastava, Anand R Warrier DOI:10.4103/0028-3886.237006 PMID:30038076 |
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NI FEATURE: THE EDITORIAL DEBATE III-- PROS AND CONS |
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Intraoperative visual evoked potential monitoring for a safer endoscopic transsphenoidal surgery |
p. 955 |
Anna Teresa Mazzeo, Deepak Kumar Gupta DOI:10.4103/0028-3886.236996 PMID:30038077 |
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Visual evoked potentials for visual function monitoring during endoscopic sphenoidal surgery: Advancement and challenges |
p. 958 |
Parthasarathy D Thirumala DOI:10.4103/0028-3886.237010 PMID:30038078 |
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Visual evoked potentials during surgery of the sellar-suprasellar region: The unaddressed issues and the vital caveats |
p. 960 |
Lokendra Singh DOI:10.4103/0028-3886.237009 PMID:30038079 |
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NI FEATURE: THE EDITORIAL DEBATE IV-- PROS AND CONS |
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Olfactory groove meningiomas: The expanding spectrum of operative approaches |
p. 962 |
VP Singh DOI:10.4103/0028-3886.237008 PMID:30038080 |
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Olfactory groove meningiomas: The surgical approaches and factors influencing prognosis |
p. 964 |
Ramesh C Mishra, Shashwat Mishra DOI:10.4103/0028-3886.236997 PMID:30038081 |
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REVIEW ARTICLES |
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Impulse control disorders in Parkinson's disease: Review of pathophysiology, epidemiology, clinical features, management, and future challenges  |
p. 967 |
Shakya Bhattacharjee DOI:10.4103/0028-3886.237019 PMID:30038082
Impulsive–compulsive behavior (ICB) in Parkinson's disease (PD) suggests a combination of impulse control disorders (ICDs), such as pathological gambling, hypersexuality, compulsive eating, excessive buying, and compulsive behaviors, such as punding, dopamine dysregulation syndrome (DDS), hoarding, and hobbyism. Hypersexuality and gambling are common in male patients while compulsive buying is common in women patients. Recent studies reveal the prevalence of ICB to be more than 25% among the PD patients. The nigrostriatal, mesocortical, and mesolimbic dopaminergic pathways play a crucial role in the pathogenesis of ICDs in PD patients. The greater tonic release of dopamine creates a state of relative dopamine deficit and reduced reward sensation and impulsive behaviors. The major risk factors for ICB are the use of dopamine agonist (DA), male gender, young patient, depression, smoking, drug abuse, Parkin mutation, and family history of ICDs. Single nucleotide polymorphism in dopamine receptors D1, D2, and D3 also acts as a major risk factor. Questionnaire for impulsive–compulsive disorders in PD is the most widely adopted screening tool for the detection of ICB in PD. The major treatment for PD is to discontinue DAs and use prolonged release formulation of the DAs. The role of deep brain stimulation (DBS) and apomorphine in the treatment of ICB is still uncertain. Though DBS can reduce the risk of DDS, it can precipitate new ICBs such as hypersexuality.
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Pattern of reporting and practices for the management of traumatic brain injury: An overview of published literature from India |
p. 976 |
Amit Agrawal, Amey Savardekar, Mitasha Singh, Ranabir Pal, Dhaval P Shukla, Andres M Rubiano, Virendra D Sinha, Geetha R Menon, Sagar Galwankar, Luis Rafael Moscote-Salazar, Prashant Bhandarkar, Ashok Munivenkatappa, Ugan Meena, Amit Chakrabarty DOI:10.4103/0028-3886.237027 PMID:30038083
Background: Published literature regarding the demographics and mechanism of injury for traumatic brain injury (TBI) in India has not been analyzed in an organized sample.
Objectives: The objective of this systematic review was to organize the published literature from India related to TBI and analyze it in a very specific sample to identify the specific patterns of injury and associated mortality.
Materials and Methods: A search strategy with specific inclusion criteria was performed in PubMed, Cochrane, Web of Science, and the World Health Organisation (WHO) Global Health Library. The process included an additional search within the indexed literature and the website-based population survey reports.
Results: Our review identified 72 studies from 300 potentially relevant articles based on the broad criteria that defined the demographics of the patients suffering from TBI and the details of trauma sustained, including the mechanism of injury as well as its diagnosis, management, and outcome. Changes in demographic patterns, the patterns of the body regions involved, the associated injuries, the clinical presentation, the follow-up status of patients suffering from TBI, who may or may not have shown clinical improvement, the overall outcome, as well as the mortality and disability status reported in the literature were analyzed. A high incidence of TBI in the productive population is of serious concern. Extremes of ages are more vulnerable to severe injury and a poor outcome.
Conclusion: Quantitative analysis of injuries and outcomes of TBI victims shows a bigger health impact in the economically active population and in patients in the extremes of age groups.
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Controversies in the surgical management of congenital craniocervical junction disorders – A critical review |
p. 1003 |
Andrei F Joaquim, Helder Tedeschi, P Sarat Chandra DOI:10.4103/0028-3886.237025 PMID:30038084
Introduction: Congenital disorders of the craniovertebral junction (CVJ) include a wide range of conditions, such as Chiari malformation (CM), basilar Invagination (BI), and atlantoaxial dislocation (AAD). The objective of this paper is to critically review the literature related to the management of congenital CVJ disorders focusing on: the significant developments in the past (from anterior open ventral decompression to modern CVJ realignment); the diagnosis of CVJ instability; the role of atlantoaxial fixation without posterior fossa decompression in patients with tonsillar herniation and no evidence of CVJ instability; use of C1-2 inter-articular spacers and use of C1-2 interarticular spacers with intra-operative manipulations to correct BI with AAD along with its deformity.
Materials and Methods: We performed a review of articles showing up on PubMed database without time restriction. Articles were included according to the purpose of our review and selected by two authors (AFJ and PSC).
Results: CVJ instability may be inferred when there is atlantoaxial abnormal motion seen on dynamic studies, facet joint subluxation or severe symptomatic CVJ kyphosis; routine fixation of patients with CM without clear CCJ instability, while based on an interesting hypothesis, still requires further studies; use of C1-2 inter-articular spacers for re-establishing CVJ alignment is probably the most effective surgery for posterior CVJ realignment and reduction of AAD and BI, potentially avoiding the need for an open or endoscopic anterior odontoidectomy (AO); current development of deformity correcting surgeries and the measurement of joint indices to plan surgery have provided new strategies for treatment.
Conclusion: We present a critical review of important new concepts involved in the surgical treatment of CVJ congenital disease.
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ORIGINAL ARTICLES |
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Homocysteine and vitamin B12: Other causes of neural tube defects in Eastern Uttar Pradesh and Western Bihar population |
p. 1016 |
Rashmi Gupta, Preeti Kumari, Sharad Pandey, Deepika Joshi, Shiv Prasad Sharma, Sunil Kumar Rai, Royana Singh DOI:10.4103/0028-3886.236968 PMID:30038085
Background: Neural tube defects (NTDs) are congenital malformations with an incidence of 1–10/1000 live births. Homocysteine and vitamin B12 metabolism have been shown to be associated with NTDs.
Aim: To investigate the status of maternal and neonate's folic acid, homocysteine, and vitamin B12 levels and their association with the risk of development of NTDs in the population of Eastern Uttar Pradeshand Western Bihar, India.
Materials and Methods: This study is a cross-sectional, retrospective study where 96 mothers who either had a first NTD child or had a history of NTD child in the family and 126 neonates with spina bifida were recruited during the period 2012-2015. Eighty-four control mothers whose previous and current pregnancies were normal, and 87 control neonates who had no defects and were within the same age range as the NTD affected neonates, recruited from the department of pediatric surgery, were enrolled in the study. Plasma concentrations of folic acid, vitamin B12, and homocysteine were compared between cases and controls.
Results: The folic acid level in the mothers and neonates was within the normal limit. A significant increase in the level of homocysteine in mothers with affected pregnancy and in neonate cases in comparison to control mothers was obseved. Further, a significant decrease in the level of vitamin B12 in mothers with NTD neonates and in the affected neonates was noted. A negative correlation was found between homocysteine and vitamin B12 levels in case and control mothers.
Conclusion: A correlation of an increase in serum homocysteine with a decrease in vitamin B12 was seen in mothers of neonates with NTD. A similar observation as made in the neonates with NTDs. It may be suggested that maternal decrease in vitamin B12, in mothers who have normal folic acid may be associated with NTD in their children.
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Evaluation of the diagnostic yield of ARQIP: A new restless legs syndrome diagnostic questionnaire and validation of its Hindi translation |
p. 1020 |
Garima Shukla, Geetika Bajpai, Anupama Gupta, Jyoti Katoch, Afsar Mohammed, RM Pandey, Vinay Goyal, Achal Srivastava, Madhuri Behari DOI:10.4103/0028-3886.236962 PMID:30038086
Background: Restless legs syndrome (RLS) is misdiagnosed due to a variety of clinical presentations and lack of a diagnostic biomarker. Sociocultural differences in patients' reporting of symptoms further contribute to this under diagnosis. We developed an expanded diagnostic tool for RLS, incorporating all International RLS Study Group (IRLSSG) diagnostic criteria with a number of additional questions mainly focusing on specific sociocultural influences in RLS symptom reporting among Indians. The purpose of this study was to examine the change in the diagnostic yield of RLS, if any, through administration of this expanded questionnaire.
Materials and Methods: The AIIMS RLS questionnaire for Indian patients (ARQIP) was developed in English language, and then translated into Hindi. All consecutive patients attending Neurology and sleep disorders clinic with complaints of leg discomfort were recruited in the study. Two examiners evaluated all patients with complaints of leg discomfort seen by a senior Sleep Medicine expert, one using only IRLSSG diagnostic criteria and the other using the ARQIP. Patients were categorized as RLS or “no-RLS” by the expert, and this was considered as the “standard” for analysis.
Results: A total of 155 participants (78 males, 50.3%) with a mean age of 44.1 ± 14.5 years were enrolled. A total of 105 patients were diagnosed as having RLS (group 1) and the rest as having “non-RLS” (group 2). The ARQIP was found to have a much higher sensitivity (100% vs 73%), specificity (44% vs 32.7%), negative predictive value (100% vs 36.4%), and positive predictive value (79% vs 70%) compared to the standard questionnaire. The diagnostic yield of this tool was 26.7% (Confidence interval = 100–73.3).
Conclusions: The ARQIP for RLS diagnosis, validated in this study, has been observed to have a high sensitivity and a negative predictive value with a high diagnostic accuracy.
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COMMENTARY |
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Restless legs syndrome: A continuing search for better diagnostic criteria |
p. 1028 |
Priyanka Tater, Sanjay Pandey DOI:10.4103/0028-3886.236993 PMID:30038087 |
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ORIGINAL ARTICLES |
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Early post-stroke seizures in a sample of Egyptian patients with first-ever stroke |
p. 1031 |
Nahed Shehta, Rasha M Fahmi, Bothina M Ramadan, Engy M Emad, Ahmed F Elsaid DOI:10.4103/0028-3886.236973 PMID:30038088
Background: Cerebrovascular stroke is considered as the most common cause of symptomatic seizures. Post-stroke seizures herald a poor functional outcome, a high mortality rate, and a long in-hospital duration of stay.
Aim: To assess the incidence and risk factors responsible for early seizures after the first-ever cerebral stroke, and its relation to the functional outcome and the in-hospital mortality following stroke as well as the duration of stay.
Patients and Methods: 150 patients with first-ever stroke, who were admitted in an intensive care and stroke unit of the Neurology Department of Zagazig University Hospitals, Egypt, within the first 24 hours of stroke onset were included in the study. Early seizures (within 7 days of stroke onset), stroke severity (National Institutes of Health stroke scale; NIHSS), radiological data, functional outcome (Barthel index), in-hospital mortality and duration of stay were collected and analyzed.
Results: The incidence of early seizures associated with first-ever stroke was 9.3%. Risk factors for early seizures were intracerebral hemorrhage (ICH) [odds ratio (OR) = 3.2, P = <0.001), cortical lesions (OR = 2.8, P = <0.05), and a large lesion size (OR = 2, P= <0.05). Patients with early seizures had lower scores on the Barthel index than those without seizures (7.5 ± 4.1 versus 10.5 ± 3.5), had higher discharge National Institutes of Health Stroke scale (NIHSS) scores, had a higher in-hospital mortality rate (35.7% versus 6.6% in patients without seizures) and duration of stay (19.4 ± 6.5 versus 10.7 ± 4.2 days respectively).
Conclusion: The incidence of early post-stroke seizures was high in our study and was positively associated with a poor functional outcome, a higher in-hospital mortality rate and a longer duration of in-hospital stay. The most important risk factors were ICH, the cortical site of involvement and a large size of the lesion.
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Clinical features and response to botulinum toxin in primary and secondary hemifacial spasm |
p. 1036 |
Sanjay Pandey, Shruti Jain DOI:10.4103/0028-3886.236959 PMID:30038089
Background: Hemifacial spasm (HFS) is a hyperkinetic movement disorder of adults. The condition is usually primary, but may be secondary to facial nerve damage, and responds well to botulinum toxin therapy.
Aim: To study the demographic and clinical features of primary and secondary HFS and assess its response to botulinum toxin therapy.
Materials and Methods: A retrospective study of 40 patients of primary (33) and secondary (7) HFS, who attended our botulinum toxin clinic over the last 18 months, was conducted. We collected the data including the demographic profile, clinical features of primary and secondary HFS, severity measured by Likert scale, etiology, details of magnetic resonance imaging (MRI) of the brain, and a detailed account of the botulinum toxin injection.
Results: Thirty-three out of the 40 patients had primary HFS. The mean age at presentation was 48.4 ± 12.6 years whereas the mean duration of symptoms was 57.4 ± 39.3 (6-144) months. The onset of spasm on the upper part of face was seen in 31 patients (77.5%). An ipsilateral ear click was found in 17 (42.5%) patients. Mild spasms were seen in 18 patients, whereas 12 patients had severe spasms. The severity of spasm was lower in patients with secondary HFS. Five out of 22 magnetic resonance imaging (MRI) results showed an abnormality. The mean dosage of botulinum toxin was 21.86 ± 4.19 units in primary spasm and 17 ± 4.16 units in secondary spasm (P =0.018). The mean duration of response was 112.6 ± 55.7 days (median: 90 days; range: 30-240 days) in primary spasm and 135 ± 63.6 days (median: 135 days; range: 90-180 days) in secondary spasm (P = 0.29).
Conclusion: Ipsilateral auditory clicks are fairly common in primary and secondary HFS. The patients with secondary HFS have a milder intensity of disease and they may have the onset of spasm from the upper part of face. Both primary as well as secondary HFS patients respond well to botulinum toxin injection; however, the adverse effects are more likely to occur in secondary HFS, and therefore, these patients require lower dosages of toxin.
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COMMENTARY |
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Treatment of hemifacial spasm: Botulinum toxin versus microvascular decompression |
p. 1043 |
Suchanda Bhattacharjee DOI:10.4103/0028-3886.237005 PMID:30038090 |
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ORIGINAL ARTICLE |
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Epidemiology, clinical profile and role of rapid tests in the diagnosis of acute bacterial meningitis in children (aged 1-59 months) |
p. 1045 |
Divya Chauhan, Kiran Mokta, Anil Kanga, Neelam Grover DOI:10.4103/0028-3886.236972 PMID:30038091
Objectives: To study the epidemiology, clinical profile, and the role of rapid tests in the diagnosis of acute bacterial meningitis (ABM) in children (1-59 months).
Materials and Methods: A total of 250 cerebrospinal fluid (CSF) and 187 blood samples received from clinically suspected cases of ABM were processed based on standard microbiological protocols. CSF samples were also subjected to antigen and nucleic acid detection. Antibiotic susceptibility testing was done according to the Clinical Laboratory Standards Institute guidelines. Children were also evaluated for outcomes and were followed up until 6 months after discharge.
Results: Eighty one cases were reported to be having clinically confirmed ABM, out of which group B Streptococcus was the most common pathogen detected in 49.3% (40) patients followed by Streptococcus pneumoniae, Staphylococcus aureus, Hemophilus influenzae type b, Escherichia coli, Klebsiella pneumoniae, and Neisseria meningitidis ACYW135 in 23.4% (19), 7.4% (6), 6.1% (5), 6.1% (5), 6.1% (5), and in 1.2% (1) patients, respectively. Complications were observed in 54.3% of the children. A follow-up of 6 months after discharge was possible in 39.5% (32) patients among whom sequelae were recorded in 93.7% (30) patients.
Conclusion: ABM remains a major cause of neurological sequelae worldwide. Although culture is the gold standard test for its detection, the investigation takes a longer time and the results are influenced by prior antimicrobial therapy. In such cases, rapid tests aid in the early diagnosis of ABM for instituting appropriate management.
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COMMENTARY |
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Clinical utility of latex agglutination test for the rapid diagnosis of acute bacterial meningitis |
p. 1050 |
Vimal K Paliwal, Nidhi Tejan DOI:10.4103/0028-3886.237007 PMID:30038092 |
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ORIGINAL ARTICLE |
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Clinical predictors of treatment outcome in North Indian patients on antiepileptic drug therapy: A prospective observational study |
p. 1052 |
Chitra Rawat, Debleena Guin, Puneet Talwar, Sandeep Grover, Ruchi Baghel, Suman Kushwaha, Sangeeta Sharma, Rachna Agarwal, Kiran Bala, Achal K Srivastava, Ritushree Kukreti DOI:10.4103/0028-3886.237000 PMID:30038093
Background: Nearly 40%–50% of the individuals fail to respond to first line antiepileptic drug (AED) monotherapy and 30% are refractory, which calls for the need to recognize predictive markers for treatment failure. This study aims to identify clinical factors predictive of a poor prognosis in patients on AED therapy.
Materials and Methods: A prospective follow-up study involving 1056 patients with epilepsy (PWE) aged 5–67 years from North India on phenytoin (PHT, n = 247), carbamazepine (CBZ, n = 369), valproate (VA, n = 271), phenobarbital (PB, n = 50), and multitherapy (MultiT, n = 119) was conducted between 2005 and 2015. Seizure and epilepsy types were diagnosed based on the classifications by the International League Against Epilepsy (ILAE). Patients remaining seizure-free during the past 1 year were assigned to the “no seizure” group and patients experiencing seizure recurrence were assigned to the “recurrent seizures” group.
Results: Of the total, 786 (74.4%) patients were successfully followed up with 60% achieving 1-year seizure remission. Seizure recurrence was observed in the remaining 40% of the patients with a high likelihood in patients with the disease onset at ≤5 years of age [55% vs. 38%, P = 0.0016, odds ratio (OR) = 2.02 (95% confidence interval (CI) = 1.31–3.13)], in patients with cryptogenic epilepsy than with idiopathic/symptomatic epilepsy (48% vs. 32%, P = 0.0049, OR = 1.61 [95% CI = 1.16–2.24]), and in patients with pretreatment seizure frequency ≥12/year (46% vs. 27%, P < 0.0001, OR = 2.21 [95% CI = 1.61–3.05]). Logistic regression analysis also revealed a significant association of seizure recurrence (P < 0.05) with the three variables.
Conclusion: Our findings suggest that an early disease onset, cryptogenic epilepsy, and a higher pretreatment seizure frequency are related to a poor prognosis or poor remission in people with epilepsy (PWE) on AED therapy.
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COMMENTARY |
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Epilepsy in India: Bridging the treatment gap |
p. 1060 |
Malla Bhaskara Rao DOI:10.4103/0028-3886.237003 PMID:30038094 |
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ORIGINAL ARTICLES |
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C4d as a marker of complement activation in dermatomyositis muscle tissue |
p. 1062 |
Sundaram Challa, Megha S Uppin, Meena A Kannan, Liza Rajasekhar DOI:10.4103/0028-3886.237014 PMID:30038095
Aim: To study C4d expression as a marker of complement activation in the diagnosis of dermatomyositis
Material and Methods: Muscle biopsies from patients diagnosed as definite dermatomyositis (10), nonspecific myositis associated with connective tissue disease (9), necrotizing autoimmune myositis (1), inclusion body myositis (1), and normal muscle (1) according to European Neuromuscular criteria 2004 were studied for C4d expression and capillary loss on CD 34 immunohistochemistry.
Results: C4d was expressed in all biopsies of definite dermatomyositis in the perimysial vessels and in 3/10 endomysial capillaries corresponding to capillary loss on CD 34.C4d expression was seen in 2/3 perimysial and endomysial vessels in nonspecific myositis (2/3 overlap myositis), and 1/1 of nectrotizing autoimmune myositis.Necrotic muscle fibers in all biopsies showed positivity irrespective of the diagnosis.
Conclusion: C4d can be used as a marker of complement activation for the diagnosis of dermatomyositis.
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Endovascular management of internal carotid artery pseudoaneurysms: A single-centre experience of 20 patients |
p. 1067 |
Ajay Kumar, Anuj Prabhakar, Vivek Gupta, Niranjan Khandelwal, Chirag K Ahuja, Manphool Singhal, Sameer Vyas, Naresh K Panda, Pankaj C Vaidhya DOI:10.4103/0028-3886.236958 PMID:30038096
Background: Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) are uncommon lesions. Various surgical and endovascular options are available for the management of these lesions. We describe our experience in using a spectrum of endovascular management strategies for ICA-PSA and present their outcome.
Aims: To evaluate the role and efficacy of endovascular intervention in the management of ICA PSA.
Materials and Methods: The clinical and angiographic data of 20 ICA PSAs from January 2008 till July 2016 were reviewed retrospectively. A meticulous evaluation of all the patients regarding their clinical symptoms, imaging findings (Ultrasound Doppler/CTA/MRI) and the endovascular techniques was performed. Clinical and imaging follow up for at least 1 year was also assessed.
Results: There were 15 (75%) male and 5 (25%) female patients, with their age ranging from 11 months to 60 years. Eleven patients (55%) were of the paediatric age group. PSAs were seen in the cervical ICA in 12 patients (60%) and in the intracranial ICA in 8 patients (40%). The most common causes of PS formation were iatrogenic (n = 8), followed by trauma (n = 7), and infection (n = 5). Parent artery occlusion was performed in 10 patients (50%), stenting in 7 patients (35%), and PSA coiling in 3 patients (15%). Immediate and complete obliteration of the PSAs was achieved in all cases without any major procedural complication. Recurrence was diagnosed at 2 years, in one patient who had undergone parent artery occlusion. This was successfully retreated. None of our patients had immediate or delayed major neurological deficits.
Conclusions: Endovascular treatment provides a safe and minimally invasive management option in patients with ICA PSA. It helps in the prevention of rupture of the PS and also its thromboembolic complications.
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Efficacy of the visual evoked potential monitoring in endoscopic transnasal transsphenoidal surgery as a real-time visual function |
p. 1075 |
Fumihiko Nishimura, Daisuke Wajima, Young-Soo Park, Yasushi Motoyama, Ichiro Nakagawa, Shuichi Yamada, Hiroshi Yokota, Kentaro Tamura, Ryosuke Matsuda, Yasuhiro Takeshima, Tsunenori Takatani, Hiroyuki Nakase DOI:10.4103/0028-3886.236963 PMID:30038097
Background: Visual evoked potential (VEP) is used as a means of intraoperative visual function monitoring. It remains unclear, however, whether intraoperative VEP monitoring is a means of real-time visual function monitoring that has satisfactory effectiveness and sensitivity. To evaluate this, the relationships between VEP waveform changes in endoscopic transsphenoidal surgery and postoperative visual function were analyzed retrospectively.
Materials and Methods: Intraoperative VEP monitoring was carried out during 82 endoscopic transnasal transsphenoidal surgeries for 164 eyes at Nara Medical University Hospital, Nara, Japan under total intravenous anesthesia. Red light flash stimulation was provided to each eye independently. The VEP recording and postoperative visual function were then analyzed.
Results: In 160 of 164 eyes (98%), steady VEP monitoring was performed. Stable VEP was acquired from eyes with a corrected visual acuity >0.1. VEP was not recorded in four eyes that had a corrected visual acuity under 0.05. A transient VEP decrease was observed in 26 eyes, 8 of which had improved visual acuity and 18 of which had no change in visual acuity. A permanent gradual VEP decrease occurred in eight eyes; this finding did not correspond to a change in visual function. The visual acuity of the patients who underwent the transsphenoidal operation in our study did not worsen.
Conclusion: Intraoperative monitoring of VEP predicts postoperative visual function, and a reversible change in VEP indicates that visual function will be preserved. Intraoperative VEP monitoring will be mandatory for surgeries harboring a risk of visual impairment.
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Olfactory groove meningiomas: An analysis based on surgical experience with 129 cases |
p. 1081 |
Atul Goel, Amresh Bhaganagare, Abhidha Shah, Amol Kaswa, Survendra Rai, Prahlad Dharurkar, Sandeep Gore DOI:10.4103/0028-3886.236989 PMID:30038098
Objective: The surgical strategy and outcome for 129 patients operated for an olfactory groove meningioma is retrospectively analyzed.
Material and Methods: One hundred and twenty nine patients with an olfactory groove meningioma operated between the years 1987 and 2016 were analyzed on the basis of clinical and radiological factors that appeared to affect the conduct of surgery and its outcome. Each factor was given points, and the points were added to obtain a score. On the basis of the score, the tumors were divided into three grades. The grades determined the difficulties that could be anticipated during surgery. In the initial part of the series, a bifrontal craniotomy was done to resect the tumor in all patients. In the later half of the series, majority of the patients were operated by the use of a unifrontal craniotomy. The aim of surgery was to resect the tumor completely.
Results: Total tumor resection was achieved in 86 patients, and subtotal tumor resection with less than 10% tumor left behind was achieved in 43 patients. Seven patients died in the immediate postoperative period. All patients where a subtotal tumor resection was done and where the patient died after surgery had a higher grade tumor. The average follow-up period was 82 months. There was non-symptomatic recurrence in 11 patients.
Conclusions: The location and size of the tumor, extent and duration of visual symptoms, extent of tumor adjoining cerebral edema, encasement of anterior cerebral artery complex and extension in the extracranial compartment were more important factors that affected the outcome of surgery.
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What you see and what you don't - Utility and pitfalls during fluorescence guided resections of gliomas using 5-aminolevulinic acid |
p. 1087 |
Aliasgar V Moiyadi, Epari Sridhar, Prakash Shetty, Venkatesh S Madhugiri, Sohan Solanki DOI:10.4103/0028-3886.236998 PMID:30038099
Background: Fluorescence guided resections have been increasingly used for malignant gliomas. Despite the high reliability of the technique, there remain some practical limitations.
Methods: We retrospectively reviewed our experience with 50 consecutive cases of 5-aminolevulinic acid (ALA)-guided resections. Clinico-radiological features and intraoperative variables (pattern and type of fluorescence) were recorded. In a subset (12 cases), we performed annotated biopsies to calculate the diagnostic accuracy of the technique. We recorded and analysed the patterns of excision and residual fluorescence and correlated this with postoperative magnetic resonance imaging (MRI).
Results: Majority of the tumours (92%) were resectable and predominantly enhancing. Though strong fluorescence was seen in most of them, there were 2 cases with a non-enhancing tumor which showed fluorescence. Visualized strong fluorescence had a very high predictive value (100%) for detecting the pathological tissue. However, it was not always possible to resect all the fluorescing tissue. Proximity to critical neuro-vascular structures was the commonest reason for failure to achieve a gross total excision (16 cases). Additionally, there were some cases (5 of 8) where the non-fluorescing residue was resected intraoperatively with the help of ultrasound. Despite the presence of residual fluorescence, overall radiological gross total resection was achieved in 66% cases.
Conclusions: ALA guided resections are very useful in malignant gliomas, even if these lesions do not enhance signi cantly. Although ALA reliably depicts the tumour intraoperatively, it may not be possible to resect all this tissue completely. Additionally, non-fluorescing tumor may be completely missed out and may require additional imaging tools. Working within the limitations of the technique and using complementary modalities (ultrasound or brain mapping) may be ideal for achieving a radical resection of malignant gliomas.
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CASE REPORTS |
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Hirayama disease/cervical flexion-induced myelopathy progressing to spastic paraparesis: A report on three cases with literature review  |
p. 1094 |
Veeramani Preethish-Kumar, Kiran Polavarapu, Saraswati Nashi, Kajari Bhattacharya, Jitender Saini, Seena Vengalil, Nupur Pruthi, Dhananjay I Bhat, Atchayaram Nalini DOI:10.4103/0028-3886.236966 PMID:30038100
Hirayama disease (HD)/cervical flexion-induced myelopathy (CFIM) is a lower motor neuron disease conventionally affecting a single upper extremity. We describe three men progressing after a long stable period to develop severe spastic paraparesis and bladder disturbances as a protracted implication of HD. The age at onset was 20, 24, and 15 years, while the age at presentation was 27, 41, and 57 years, respectively. The second phase of disease progression occurred after 4, 13, and 28 years of stationary period. All had CFIM with characteristic magnetic resonance imaging features as observed during progressive stages. The anterior dural shift extended variably from C4 to D4 levels with a median value of 5 mm and was maximum at C6 to C7 levels, pushing the cord anteriorly causing compression. This study emphasizes the need to recognize this unusual subgroup of HD and mandates long-term follow-up with timely intervention in arresting the progression/improving the deficits.
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Melioidosis mimicking tuberculous vertebral osteitis: Case report and review of literature |
p. 1100 |
Anil Pande, P Senthur Nambi, Senguttuvan Pandian, Sreevidya Subramanian, Siddhartha Ghosh DOI:10.4103/0028-3886.236976 PMID:30038101
Whitmore's disease or melioidosis is an infectious disease caused by Burkholderia pseudomallei. The reported cases are but the tip of the iceberg. This pathogenic saprophyte is commonly found in wet soil and water. An accidental or occupational exposure (in field workers, farmers, gardeners or villagers) to B. pseudomallei contaminated soil or pooled water is the primary source of infection. Neurosurgeons need to consider this as a possible rare cause of back pain and possible neurological deterioration. A diabetic type 2 rice farmer with severe lumbago and fever, misdiagnosed as vertebral tuberculous osteitis based on his radiological findings, was confirmed to harbour Burkholderia Pseudomallei, which was diagnosed using laboratory cultures. He made a remarkable recovery with antibiotic therapy. The empiric anti-tuberculous (ATT) drugs were stopped. The rare differential diagnosis of melioidosis should be thought of in diabetic patients with a psoas abscess and vertebral osteitis, especially in rice farmers from endemic regions that includes India.
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NI FEATURE: PATHOLOGY PANORAMA - ORIGINAL ARTICLE |
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MGMT gene promoter methylation and its correlation with clinicopathological parameters in glioblastomas |
p. 1106 |
Iteeka Arora, Mamta Gurav, Rachna Rumde, Sandeep Dhanavade, Vinayak Kadam, Hetakshi Kurani, Omshree Shetty, Jayant Sastri Goda, Prakash Shetty, Aliasgar Moiyadi, Tejpal Gupta, Rakesh Jalali, Sridhar Epari DOI:10.4103/0028-3886.236974 PMID:30038102
Background: MGMT (O6-methyl guanine DNA methyl transferase) promoter hypermethylation is a prognostic and predictive biomarker for glioblastomas (GBM).
Aims: To evaluate the frequency of MGMT methylation status in a single institute series of 134 GBMs and correlate it with clinical (age, sex, location, survival) and other molecular parameters [such as p53 expression, alpha thalassemia/mental retardation syndrome X-linked (ATRX) expression, isocitrate dehydrogenase (IDH) 1R132H mutation, and epidermal growth factor receptor (EGFR) gene amplification].
Results: One hundred and thirty-four GBMs were evaluated by methylation-specific polymerase chain reaction (MSP) for MGMT promoter methylation status. The results were correlated with the above mentioned clinicopathological parameters. MGMT gene promoter methylation was identified in 49.2% (66/134) GBMs, and was significantly associated with IDH1R132H mutation (14/66; 21%; P - value, 0.01) and ATRX loss (15/66; 23%; P - value, 0.01). Confluent necrosis was found to be significantly associated with MGMT unmethylation status (P - value: 0.002). Multivariable logistic regression analysis showed confluent necrosis as a single independent predictor (odds ratio [OR], 2.5; confidence interval [CI], 1.0–5.8; P - value, 0.04) of MGMT unmethylation status among all the parameters studied.
Conclusions: The frequency of MGMT promoter methylation in GBMs was 49.2%, which was significantly associated with IDHR132H mutation and ATRX loss. In addition, the presence of confluent necrosis was significantly associated with MGMT unmethylation and was found to be an independent predictor of the same.
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COMMENTARY |
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MGMT promoter methylation in glioblastoma |
p. 1115 |
Vani Santosh, P Sravya DOI:10.4103/0028-3886.236995 PMID:30038103 |
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NI FEATURE: THE QUEST - COMMENTARY |
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Postoperative nausea and vomiting in neurosurgical patients: Current concepts and management  |
p. 1117 |
Kiran Jangra, Kamlesh Kumari, Nidhi B Panda, Navneh Samagh, Ankur Luthra DOI:10.4103/0028-3886.236970 PMID:30038104
Postoperative nausea and vomiting (PONV) is a significant complication for neurosurgical patients. PONV affects patient satisfaction, prolongs hospital stay, and increases the economic burden and morbidity. In addition to these problems, there are certain consequences of PONV specific to the craniotomy, including increased intracranial pressure and increased risk of tumor bed hematoma formation. Expert panels have suggested that, if the consequences of PONV are deleterious to the patients, then prophylaxis should be instituted. This article describes the pathophysiology, risk factors, prevention, and management of PONV in neurosurgery patients as per the recent guidelines.
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NI FEATURE: CENTS (CONCEPTS, ERGONOMICS, NUANCES, THERBLIGS, SHORTCOMINGS) - COMMENTARY |
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High-resolution magnetic resonance vessel wall imaging in cerebrovascular diseases  |
p. 1124 |
Rajendran Adhithyan, Praveen Kesav, Bejoy Thomas, PN Sylaja, Chandrasekharan Kesavadas DOI:10.4103/0028-3886.236964 PMID:30038105
Most intracranial vascular disorders like atherosclerosis, vasculitis, and reversible cerebral vasoconstriction syndrome (RCVS) share similar lumenographic findings in traditional imaging modalities like computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiographic studies. Hence, there is a need for an advanced imaging modality like vessel wall imaging (VWI) to confirm the diagnosis so that appropriate clinical management could be done. Now, currently vessel wall imaging could be done in a high resolution manner with three dimensional (3D) imaging sequences. The aim of this article is to deal with the protocol as well as the current imaging applications of the high resolution VWI.
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NI FEATURE: CITADELS SCULPTING FUTURE - COMMENTARY |
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Sixty years of Neurosurgery at Andhra Medical College and King George Hospital, Visakhapatnam: The (hi) story of the department |
p. 1133 |
Subba Rao Bhavaraju, Satyavaraprasad Kadali, Vijayasekhar Manda, Hayagrivarao Bhaganagarapu, Raman V S Bhavana DOI:10.4103/0028-3886.236967 PMID:30038106
The trials and trepidations of an emerging department, uncertainties of its survival midway through its course, the innovative ideas that initiated its development, a regimental discipline, addition of newer technological advances with changing times, and its blossoming as the one of the best departments in the region, mark the origin and development of the Department of Neurosurgery at Andhra Medical College (AMC) and King George Hospital (KGH) Visakhapatnam. AMC and KGH are getting ready to celebrate their centenary in 2023. This history of the department is derived from the knowledge of the immense effort and academic discipline that was required to bring it to its current stature. Dr. Sunkara Balaparameswara Rao (SBP Rao) established the Neurosurgical Unit at the AMC and the KGH, Visakhapatnam on 2nd April 1956. He has had the unique privilege of witnessing the entire history of the department, from the inception till today, which represents 60 years of continuous progress of the department after its establishment. He also took a very active role in organizing its Diamond Jubilee function held on 23rd September 2016. The first author of this article has also had the privilege of witnessing and being a part of the history of the department during the past half a century. This is a narration of what may be better termed 'the (hi) story of 60 years of Neurosurgery at AMC and KGH', Visakhapatnam, India.
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NI FEATURE: THE FOURTH DIMENSION - COMMENTARY |
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A summary of some of the recently published, seminal papers in neuroscience |
p. 1141 |
Mazda K Turel, Manjul Tripathi, Ashish Aggarwal, Navneet Singla, Aastha Takkar, Sahil Mehta, Chirag K Ahuja, Anant Mehrotra, Kuntal K Das DOI:10.4103/0028-3886.237001 PMID:30038107 |
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NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - ORIGINAL ARTICLE |
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Complications associated with diagnostic cerebral angiography: A retrospective analysis of 644 consecutive cerebral angiographic cases  |
p. 1154 |
Jie Shen, Mohan Karki, Tao Jiang, Bing Zhao DOI:10.4103/0028-3886.237018 PMID:30038108
Aim: This study was conducted to evaluate complications (minor and major) that occurred in patients who underwent modern cerebral angiography.
Materials and Methods: A retrospective assessment of 644 consecutive cerebral angiographic cases was undertaken with specific emphasis on complications.
Results: The most common complication of diagnostic cerebral angiography was groin hematoma seen in 10 (1.55%) patients. One patient had complications arising from the development of a femoral artery pseudoaneurysm. Neurologic complications occurred in 4 (0.62%) cases. Three (0.47%) cases had transient complications which resolved completely within 24 h. One patient (0.16%) was left with permanent hemiplegia. There were 6 (5%) cases of contrast-induced nephropathy out of the 120 cases in whom subarachnoid hemorrhage had occurred and who possessed complete data of kidney function tests. Five of them were reversible, and one was permanent. One patient (0.16%) died from air emboli.
Conclusions: Neurologic complications following cerebral angiography are rare but must be minimized by careful case selection and training. Although the risk is small, complications such as permanent disability or even death cannot be completely obviated.
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LETTERS TO EDITOR |
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Magnetic resonance imaging neurography depicting radiological anticipation in a family with PMP22 duplication |
p. 1159 |
Satish V Khadilkar, Madhu Bala, Sonali Shah DOI:10.4103/0028-3886.236961 PMID:30038109 |
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Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids and human leukocyte antigen |
p. 1160 |
Rie Tohge, Masahiro Nagao DOI:10.4103/0028-3886.237020 PMID:30038110 |
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Identification of a novel SLC12A6 pathogenic variant associated with hereditary motor and sensory neuropathy with agenesis of the corpus callosum (HMSN/ACC) in a non-French-Canadian family |
p. 1162 |
Rocío Rius, Ariadna González-del Angel, José A Velázquez-Aragón, Luz M Cordero-Guzmán, Silvia E Muñoz-Hernández, Miguel A Alcántara-Ortigoza DOI:10.4103/0028-3886.236987 PMID:30038111 |
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Eosinophilic meningitis caused by consumption of meat of monitor lizard (Varanus bengalensis) |
p. 1166 |
Joseph Johny, Anil Kumar, Vinod Vishwanath Kolar, Abdoul Hamide DOI:10.4103/0028-3886.237031 PMID:30038112 |
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Glucocorticoid treatment of myeloneuropathy induced by nitrous oxide toxicity |
p. 1167 |
Renjie Ji, Zenghua Xie, Kang Wang, Xuning Zheng DOI:10.4103/0028-3886.237029 PMID:30038113 |
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Cerebral syphilis mimicking metastatic tumors: Report and review of the literature |
p. 1170 |
Shen Ying, Lao Li-Min DOI:10.4103/0028-3886.237026 PMID:30038114 |
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Tigroid and leopard skin appearance in acute disseminated encephalomyelitis |
p. 1172 |
Sunil Pradhan, Animesh Das DOI:10.4103/0028-3886.236954 PMID:30038115 |
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Moyamoya disease associated with hereditary spherocytosis |
p. 1174 |
Saraf U Umesh, K Arun, Sapna E Sreedharan, P Rajalakshmi, PN Sylaja DOI:10.4103/0028-3886.237016 PMID:30038116 |
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Pituitary aspergillosis - A report and review of the literature |
p. 1176 |
S Divyashree, Rajiv Karthik, Krishna Prabhu, Geeta Chacko DOI:10.4103/0028-3886.236975 PMID:30038117 |
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A rare case of ochronosis presenting with cervical compressive myelopathy |
p. 1178 |
Mohan Nelanuthala, Sridhar Kotta, Sandeep Talari, Vijay K Terapalli DOI:10.4103/0028-3886.236956 PMID:30038118 |
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Spinal cryptoccoma mimicking a spinal cord tumor complicated by cryptococcal meningitis in an immunocompetent patient |
p. 1181 |
Lai Carol, Mei-Ling Sharon Tai, SM Yusoff, N Rose, MH Rafia, S Viswanathan DOI:10.4103/0028-3886.237012 PMID:30038119 |
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Primary granulocytic sarcoma presenting as a lumbar plexopathy in a nonleukemic patient |
p. 1183 |
Mishaal Talish, Boby Varkey Maramattom, Nanda Kacchare DOI:10.4103/0028-3886.237013 PMID:30038120 |
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Chronic pachymenigitis with dural venous sinus thrombosis: An unusual presentation of cranial melioidosis |
p. 1185 |
Raghavendra Nayak, Bimal Patel, Krishnaprabhu Raju DOI:10.4103/0028-3886.237015 PMID:30038121 |
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Modification in MRI contrast myelogram by instillation of intrathecal preservative-free normal saline to demonstrate CSF spinal leaks |
p. 1187 |
Scherazad Kootar, Abhijeet Walavalkar, Abhaya Kumar, Chinmaya Bhave, Darshana Sanghvi DOI:10.4103/0028-3886.237023 PMID:30038122 |
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Ischemic polyradiculoneuropathy with an aortic aneurysm masquerading Guillain–Barré syndrome |
p. 1189 |
Lobo M Alexander, Vivek J Philip, Ashish Gosar DOI:10.4103/0028-3886.237030 PMID:30038123 |
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An interesting and rare association of paraneoplastic myelopathy with Hurthle cell neoplasm |
p. 1191 |
Darakhshan Naheed, Neeraj Balaini, Sahil Mehta, Rajesh Kumar, Amanjit Bal, Vivek Lal DOI:10.4103/0028-3886.237028 PMID:30038124 |
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Pleomorphic xanthoastrocytoma arising from the pituitary stalk |
p. 1193 |
Zhi-Jie Chen, Ji Zhang, Ying-Hua Rao, Ji-Cheng Sun, Shu-Xin Sun, Ke Sai DOI:10.4103/0028-3886.236957 PMID:30038125 |
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Rupture of spinal dermoid cyst with intracranial dissemination: Report of a case and review of the literature |
p. 1195 |
G Lakshmi Prasad, Sumit Sinha, Gopal Krishna DOI:10.4103/0028-3886.236984 PMID:30038126 |
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COMMENTARY |
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Rupture of spinal dermoid cyst with intracranial dissemination |
p. 1200 |
Dattatraya Muzumdar DOI:10.4103/0028-3886.237017 PMID:30038127 |
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NEUROIMAGES |
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Magnetic resonance imaging findings in Tay–Sachs disease |
p. 1201 |
Laxmikant Gupta, Arif Mirza, Aishwarya Gulati, Parveen Gulati DOI:10.4103/0028-3886.236955 PMID:30038128 |
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Terson's syndrome diagnosed on ocular ultrasound |
p. 1202 |
Gentle Sunder Shrestha, Gopal Sedain DOI:10.4103/0028-3886.237011 PMID:30038129 |
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Electrocution-induced skull bone lysis |
p. 1203 |
Omair Ashraf Shah, Haseeb Wani, Arhed Parry, Faiz Shera, Aadil Malik, Waseem Sheikh, Musaib Dar Tariq Gojwari DOI:10.4103/0028-3886.237002 PMID:30038130 |
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Acanthocytosis in progressive childhood dystonia |
p. 1204 |
Indar Kumar Sharawat, Swarup Ghosh, Prateek Bhatia, Vikas Bhatia, Arushi Gahlot Saini DOI:10.4103/0028-3886.237021 PMID:30038131 |
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Fat embolism following a liposuction procedure |
p. 1206 |
Zhou Zhibin, Sun Peng, Cui Fang DOI:10.4103/0028-3886.236965 PMID:30038132 |
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CORRESPONDENCE |
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Cerebral organoids: A new approach to understanding drug resistant epilepsy |
p. 1208 |
Vikas Dhiman DOI:10.4103/0028-3886.236986 PMID:30038133 |
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Primary lymphoma of the radial nerve presenting as a nerve sheath tumor |
p. 1210 |
Mahmood Dhahir Al-Mendalawi DOI:10.4103/0028-3886.237022 PMID:30038134 |
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Author's reply: Association of HIV status of the patient and peripheral nerve lymphoma |
p. 1211 |
Vengalathur G Ramesh DOI:10.4103/0028-3886.236994 PMID:30038135 |
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Enhanced resection of primary high grade gliomas using a combination of intraoperative magnetic resonance imaging and intraoperative fluorescence (5-aminolevulinic acid): Detecting the presence of glioma cells in ventricular ependymal walls |
p. 1212 |
Satoshi Tsutsumi DOI:10.4103/0028-3886.237024 PMID:30038136 |
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NI FEATURE - BOOKS FROM MY SHELF - COMMENTARY |
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Jacob Chandy: Reminiscences and reflections. Memoirs. |
p. 1213 |
Sunil Pandya DOI:10.4103/0028-3886.236990 PMID:30038137 |
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BOOK REVIEW - COMMENTARY |
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EEG in clinical practice |
p. 1217 |
Jerome Engel DOI:10.4103/0028-3886.236979 |
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Minimal invasive spine surgery |
p. 1219 |
Jayesh Sardhara, Sudhir Dube DOI:10.4103/0028-3886.236991 |
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OBITUARY |
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Prof. M Sambasivan (1936-2018) |
p. 1222 |
K Rajasekharan Nair DOI:10.4103/0028-3886.236980 PMID:30038138 |
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A memory indelibly etched in mind: Dr Sanjiv Bhatia (February 22, 1958 - May 24, 2018) |
p. 1227 |
Deepak Gupta DOI:10.4103/0028-3886.236981 PMID:30038139 |
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Sir Roger Gilbert Bannister (1929 – 2018) |
p. 1230 |
Sunil K Pandya DOI:10.4103/0028-3886.236977 PMID:30038140 |
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