Early detection of brain tumor has an important role in further developing therapeutic outcomes, and hence functioning in endurance tolerance. Physically evaluating the various reversion imaging (magnetic resonance imaging [MRI]) images that are regularly distributed at the center is a problematic cycle. Along these lines, there is a significant need for PC-assisted strategies with improved accuracy for early detection of cancer. PC-backed brain cancer detection from MR images including growth location, division, and order processes. In recent years, many inquiries have turned to zero in traditional or outdated AI procedures for brain development findings. Presently, there has been an interest in using in-depth learning strategies to detect cerebral growths with an excellent accuracy and heart rate. This review presents a far-reaching audit of traditional AI strategies and in-depth study methods for diagnosing brain cancer. This research paper distinguishes three main benefits i.e. exhibition, estimation and measurements of brain tumour detection.

Objective: The aim of this study was to evaluate the difference in mean serum 25-hydroxy vitamin D level between migraineurs and nonmigraineurs, the association between hypovitaminosis D and migraine, and the effects of oral vitamin D supplementation on migraine-related symptoms as compared to placebo. Methods: Relevant databases were searched for observational studies and randomized-controlled trials (RCTs) which evaluated the difference in mean serum 25-hydroxy vitamin D level between migraineurs and nonmigraineurs; the association between hypovitaminosis D and migraine; and the effects of vitamin D supplementation on migraine-frequency, duration, and severity. Pooled mean difference and odds ratio were calculated (random-effects model, RevMan version 5.3). Results: Ten observational studies and two RCTs were included. The serum 25-hydroxy vitamin D level in the migraineurs was significantly lower than that in the nonmigraineurs [mean difference − 4.44 ng/mL (95% CI: −6.11, −2.77)] (low-GRADE evidence). Hypovitaminosis D was found to be significantly associated with migraine [OR: 1.95 (95% CI: 1.07, 3.58)] (low-GRADE evidence). As compared to placebo, oral vitamin D supplementation significantly reduced the monthly migraine-frequency [mean difference: −2.20 (95% CI: −3.04, −1.36)], although it did not reduce the migraine-duration [mean difference: −16.00 hours per month (95% CI: −42.77, 10.76)] and migraine-severity score [standardized mean difference: −0.23 (95% CI: −0.79, 0.32)] (moderate-GRADE evidence). Conclusion: Serum 25-hydroxy vitamin D level was significantly lower in the migraineurs than that in the nonmigraineurs, and hypovitaminosis D was significantly associated with migraine. Oral vitamin D supplementation significantly reduced migraine-frequency, but not its duration and severity.

Background: Rathke's cleft cysts (RCCs) are benign epithelial lesions arising from the Rathke's pouch remnants that fail to regress during embryogenesis. Some RCCs become symptomatic and require treatment. Cyst fenestration and drainage of its contents is the preferred procedure to treat symptomatic cases but carries a risk of recurrence. We propose the use of a novel modified nasoseptal flap technique to partially line the cyst wall to avoid recurrence. Methods: This was a prospective, observational study that included all RCC patients admitted to the Department of Neurosurgery, Aster Medcity, from April 2015 to May 2018. The modified nasoseptal flap technique was performed in all patients. They underwent preoperative and postoperative ophthalmological, endocrine, endoscopic, and MRI evaluations to look for recurrence. Results: Ten patients underwent the modified nasoseptal flap technique. The median follow-up was 36 months. Postoperatively, all patients were relieved from headaches. Moreover, their visual fields and pituitary functions normalized. None of the patients developed recurrence of RCC on follow-up brain MRI. On endoscopic examination, all patients had retained patency of the fenestra. The longest follow-up was 72 months. Conclusions: The modified nasoseptal flap technique maintains patency and avoids recurrence of RCCs on long-term follow-up.

Background: Studies on insular gliomas (IGs) generally focus on the oncological endpoints with a relative scarcity of literature focusing on the seizure outcomes. Objectives: To study the predictors of long-term postoperative seizure control in IG and propose a novel risk scoring system. Methods: Histopathologically proven, newly diagnosed adult IGs (>18 years) operated over a 10-year period were studied for postoperative seizure control as per International League Against Epilepsy (ILAE) grades at 6 weeks and at last follow-up (minimum of 6 months, median 27 months). Logistic regression analysis was performed and regression coefficients with nearest integers were used to build a risk prediction model. Receiver operator curve (ROC) analysis determined the predictive accuracy of this model. Results: The 6-week postoperative seizure freedom dropped to 41% at the last follow-up. The seizure-free group lived longer (100.69 months, 95% CI = 84.3–116.99 (60%)) than those with persistent postoperative seizures (27.92 months, 95% CI = 14.99–40.86). Statistically significant predictors (preoperative seizure control status, extent of resection, tumor extension to temporal lobe, and lack of postoperative adjuvant therapy) were used to compute a risk score, the score ranging from 0 to 9. A score of four most optimally distinguished the risk of postoperative seizures with an area under the ROC of 91.4% (95% CI: 84.1%, 98.7%, P < 0.001). Conclusion: In our experience, around 60% of patients obtained seizure freedom after surgery, which reduces over time. Control of seizures paralleled survival outcomes. Our proposed scoring system may help tailor management strategies for these patients.

Background: There have been reports on the significant canal cross-sectional area (CSA) expansion difference between pre- and post-operation, but no comparison of CSA expansion between the hinge-side area (Area H) and the open-side area (Area O) has been reported. This study aimed to measure the spinal CSA expansion between Area H and Area O retrospectively after open-door laminoplasty using new titanium spacers and evaluated this common decompression procedure's effectiveness. Materials and Methods: This study included 27 patients diagnosed with cervical spondylotic radiculopathy or myelopathy, ossification of the posterior longitudinal ligament, and developmental canal stenosis from February 2021 to October 2022. The CSA difference between pre- and post-cervical laminoplasty (C4–C6 levels) was measured with cervical transverse computed tomography scan images. The CSA difference in Area H and Area O between pre- and post-laminoplasty was similarly calculated. Results: The spinal canal areas of each segment after open-door laminoplasty were significantly enlarged (P < 0.05). Area O was also significantly enlarged compared to that of Area H (P < 0.05). Conclusion: Area O was more enlarged than Area H, and both sides were statistically enlarged after open-door laminoplasty.

Background and Objective: In our study, we aimed to evaluate the sleep disturbances of patients diagnosed with restless legs syndrome (RLS) regarding their mental health according to the severity of the disease. Materials and Methods: The study included 166 patients diagnosed with RLS and 161 healthy controls in the same age interval as patients. Sleep disturbances of patients were defined with the “personal information form” (PIF) prepared by the researchers, while the mental health status of patients was defined with the “Brief Symptom Inventory” (BSI). Results: All RLS patients had an increase in BSI subscale points, with a positive correlation to disease severity, and subscale points were significantly higher than the control group (p < 0.05). Those with the “frequent waking” problem had higher BSI subscale points compared to those without the problem (p<0.01 or 0.001). Those with “waking with respiratory distress,” “daytime sleepiness,” “very early waking,” and “sleep disorder” problems had statistically significantly high BSI subscale points for all subscales, apart from hostility, compared to those without these problems (p<0.01 or 0.001). Conclusion: It is considered that assessment of sleep disturbances causing disrupted quality of life and mood disorders is beneficial for the treatment of patients with RLS. Our study data appears to be related to the result that sleep disturbances and mental health disruptions might be associated with the disease severity among RLS patients.

In patients with COVID-19, neurodegeneration may develop before clinical symptoms appear. Diffusion-weighted (DW) MRI is an important technique for analyzing microstructural changes such as gliosis. In this study, a quantitative evaluation of microstructural changes in the brain with apparent diffusion coefficient (ADC) values in patients presenting with a headache after the COVID-19 disease was analyzed and compared. DW MR images of patients of 20 COVID-19 patients (13 females, 7 males) who required imaging due to headache; 20 controls (16 females, 4 males) were retrospectively reevaluated. ADC measurements were taken from 16 regions of the brain, including right and left symmetrical in patients with COVID-19 infections and control groups. All regions of interest (ROIs) were taken from the hypothalamus, parahippocampus, thalamus, corpus striatum, cingulate gyrus, occipital gyrus, dentate nucleus, and medulla oblongata posterior. ADC values in the dentate nucleus right (784.6 ± 75.7 vs. 717.25 ± 50.75), dentate nucleus left (768.05 ± 69.76 vs. 711.40 ± 52.99), right thalamus (731.15 ± 38.14 vs. 701.60 ± 43.65), left thalamus (744.05 ± 39.00 vs. 702.85 ± 28.88), right parahippocampus (789.10 ± 56.35 vs. 754.75 ± 33.78), right corpus striatum (710.00 ± 39.81 vs. 681.55 ± 39.84) were significantly higher than those in the control group. No significant changes were observed in other areas. A significant increase in ADC values at many levels in the brain in patients with COVID-19 disease and headache was observed. Thus, this study indicates that cerebral involvement in COVID-19 disease may be related to microstructural changes that are not reflected in conventional MRI images.

Background: Post-stroke spasticity is common and an early predictor of the severity of spasticity can help track recovery trajectory helping to modify rehabilitation plans. Objectives: We explored the utility of the Alberta Stroke Program Early CT Score (ASPECTS) to predict functional motor capacity in patients after acute ischemic stroke. Methods: One hundred and one patients (mean age of 58.6 ± 7.6 years; M:F = 72: 29) with the first documented acute ischemic stroke were followed up for three to twelve months after the stroke. Cerebral lesions within the territory of the middle cerebral artery were evaluated using the ASPECTS. Spasticity was assessed using the Modified Ashworth Score (MAS) and walking with Timed Up and Go test (TUG). The associations between severity of spasticity and size/extent of infarct as derived from ASPECTS and between spasticity and functional walking in post-stroke survivors were analyzed. Results: Among the patients studied, 61.3% (n = 62) had infarct in the region of supply of the left middle cerebral artery (MCA) and 38.7% (n = 39) had infarct in the region supplied by the right MCA. Three percent (n = 3) had a low ASPECTS, 53.6% (n = 54) had an intermediate score and 44.4% (n = 44) had a high score. The majority of patients with no to mild spasticity had high ASPECTS. Worse spasticity was significantly associated with low ASPECTS (P = 0.001). High scores in Timed Up and Go test (TUG) were associated with low ASPECTS (P < 0.001). Patients with high ASPECTS had the propensity to have subcortical infarcts (P < 0.001) when compared to those with moderate ASPECTS, who had a mix of cortical and subcortical infarcts. Conclusion: ASPECTS at admission in patients with acute ischemic stroke is a good predictor of post-stroke spasticity and functional walking. Low ASPECTS is associated with higher spasticity and lower functional walking status on follow-up after stroke.

Background: Several studies have suggested the potential protective role of β2-adrenoreceptor agonist (β2AR-agonist) on the development of Parkinson's disease (PD). However, those could not reflect a different epidemiologic background in eastern countries. We explored β2AR-agonist's effect on PD development by controlling for smoking. Materials and Methods: We used the Korean national sample cohort data (from 2002 to 2013) containing 1,025,340 participants (2.2% of the whole population). The subjects over 60 years were included. PD was defined based on the ICD-10 code, which should be diagnosed by neurologists. Atypical Parkinsonisms or ataxic disorders were excluded. We made Set 1 (from 2003 to 2007) and Set 2 (from 2003 to 2008) based on the exposure period for the sensitivity analysis. We observed whether PD had developed during the follow-up periods in each subset. Results: The PD (Set 1, n = 742; Set 2, n = 699) and non-PD group (Set 1, n = 57,645; Set 2, n = 66,586) were collected. Old age, Medicaid, and asthma were risk factors, whereas smoking was a significant protective factor for PD development. The proportion of β2AR-agonist use was significantly higher in the PD group than in the non-PD group (Set 1, 3.6% vs. 2.4%; Set 2, 4.1% vs. 2.6%). β2AR-agonist use still was a risk factor in developing PD from the multiple logistic regression analysis. Conclusions: β2-AR-agonist looked like a risk factor rather than a protective factor for PD development. Well-controlled studies reflecting various epidemiologic backgrounds are required to confirm the role of β2AR-agonist.

We sought to evaluate whether the neuromelanin-sensitive magnetic resonance imaging (NM-MRI) features of the substantia nigra (SN) have utility in the differential diagnosis of Parkinson's disease (PD) and essential tremor (ET). This study enrolled 23 patients with PD, 20 patients with ET, and 18 healthy participants. All subjects underwent clinical examination, motor and cognitive assessments, and NM-MRI scans. The area and contrast-to-noise ratio (CNR) values of SN were defined according to NM-MRI images. Then, receiver operating characteristic (ROC) analysis was conducted to characterize the diagnostic power of the SN area and CNR values of SN. Compared with ET and control groups, the PD group showed a significant reduction of the area of SN (P = 0.003, PD vs. ET; P = 0.001, PD vs. control) and in the SN to midbrain area ratio in the same layer (P = 0.006, PD vs. ET; P = 0.005, PD vs. control). The SN area had a sensitivity of 65% and a specificity of 87% for distinguishing ET from PD, with an area under the curve (AUC) of 0.7630 and a Youden index of 0.5200, whereas the ratio of the SN area to midbrain area in the same layer had a sensitivity of 60% and a specificity of 87% for distinguishing ET from PD, with an AUC of 0.7478 and a Youden index of 0.4700. Compared with the ET group, the mean CNR value of the SN and the respective CNR values of the three subregions were all weakened in the PD group, and only the CNR in the middle part was significantly different from the control group (P = 0.006). The sensitivity of the CNR value of the middle part of the SN for differentiating ET from PD was 65%, the specificity was 87%, the AUC was 0.7500, and the Youden index was 0.5200.Based on our findings, we conclude that NM-MRI can improve diagnostic accuracy in PD and can be used as a specific and sensitive potential diagnostic biomarker for PD.

Background and Objective: For 1.3 billion population in India, there are only scarce reports on disability of epilepsy using disability-adjusted life year (DALY) as a measure. Our objective was to estimate DALY using real-life data over a period of time for a cohort of people with epilepsy (PWE) admitted to an Epilepsy Monitoring Unit (EMU) of a tertiary care epilepsy center. Materials and Methods: We ascertained survival status as on December 31, 2016 of all eligible admissions to the EMU between 01/01/2005 and 12/31/2015. We examined the medical records of randomly selected 200 of the 1970 survivors and all the expired PWE (n = 40) for clinical characteristics. The cumulative real-life DALY (cr-DALY) for individual was calculated as the sum of the years lost to disability (YLD) and the years of life lost (YLL). Annual population-based DALY (p-DALY) was estimated from the cr-DALY, total patient-years of follow-up, and regional population prevalence. Results: The cr-DALY per PWE was 17.63 (generalized seizures only). The cr-DALY increased by 23.7% when all seizure types were considered (23.12). PWE with epilepsy onset <10 years of age, focal epilepsy (particularly, extratemporal lobe epilepsy), and premature death had significantly higher cr-DALY. Those who underwent surgery for epilepsy or achieved remission had significantly lower cr-DALY. The computed p-DALY was 583/1,00,000 population (generalized epilepsy contributed 165/1,00,000 population; focal epilepsy contributed 418/1,00,000 population). Conclusion: Our study had identified, for the first time, several determinants that reduced DALY significantly. Real-life DALY, rather than prevalence-based DALY, captures the cumulative disability of affected individuals. Epilepsy leads to loss of 23 years of disability-adjusted life span for the affected person. This can be extrapolated to substantial economic benefits.

Background: Asterion is the junction of lambdoid, parietomastoid, and occipitomastoid sutures. In traditional anatomy teaching, it is believed that asterion sits over the transverse-sigmoid sinus junction (TSSJ). It is a significant surgical landmark for the placement of a burr hole in the retrosigmoid approach. Objective: The purpose of this study was to evaluate the asterion's accuracy as a TSSJ-specific external surgical landmark in the Indian population. Materials and Methods: 16 human dried skulls were obtained from the Department of Anatomy, AIIMS, New Delhi. The point of TSSJ was taken between the two lips and just posterior to the entry of the superior petrosal sinus. Asterion internally was localized with the help of a geometrical divider. The x- horizontal/ anterior and y- vertically superior (+)/ inferior (-) distances were measured from asterion (internally) to the TSSJ by a digital vernier caliper. Results: The mean horizontal distance (x) of the left side asterion & TSSJ was 10.3±1.0mm whereas the vertical distance (y) ranged between +2 to -4.3 mm. The mean horizontal distance (x) of the right side asterion & TSSJ was 13.5±1.4mm whereas the vertical distance (y) ranged between +3 to -4.2 mm. Conclusion: Asterion is not a reliable landmark for TSSJ in Indian skulls. The TSSJ with respect to asterion was found on average 10mm and 13.5mm anterior on the left and right side respectively, and mostly inferior (average 4.2mm) in 75% of the skulls. The TSSJ was closer to the asterion on the left side in comparison with the right side. However, further studies with a larger sample size will be needed to evaluate the population-specific relation of asterion with the TSSJ.

Background: There is an agreement among individuals from different cultures in how they judge the cuteness of a face. There are observations suggesting that some preferences may be neurobiological rather than cultural. Most of the studies conducted use adult faces with a neutral expression; however, the mechanisms involved in rating cuteness are not exactly the same as those involved in the perception of attractiveness. Furthermore, it is not always taken into account that emotional expressions influence the impression on the beauty of a face. The objective of the study is to evaluate the influence of the different emotions on the perception of cuteness of children's faces. Materials and Methods: We included 60 adults and 21 children who observed 150 photographs of children's faces expressing the six basic emotions and had to rate facial cuteness. Results: Participants gave the highest cuteness score to faces with happy emotions (mean [M] = 6.89, 95% confidence interval [CI] 6.48–7.30) and the lowest to those that expressed negative emotions (M = 5.32, 95% CI 4.87–5.78, t(160) = 5.08, P <.001). This was evidenced in adults and children of both genders, regardless of the gender of the stimulus. Conclusions: In our study, we found that facial expression generates an impact on the perception that a subject has on the cuteness of the face. The faces that show happiness were scored as more cute compared to those that expressed anger, disgust, or sadness. We suggest that expression of positive emotions, like a smile, could increase the conducts associated with caring, placing the child in a more favorable situation for the future.

Introduction: Neurons are highly energy-dependent and highly specialized cells, showing great sensitivity to oxidative stress (OS). Nitric oxide (NO) and its oxidation products play a central role in neurodegeneration. This study aimed to contribute to the further elucidation of the role of OS in the pathogenesis of amyotrophic lateral sclerosis (ALS). Methods: We assessed NO and superoxide dismutase (SOD) levels in cerebrospinal fluid (CSF) of 24 sporadic ALS (sALS) patients (13 of them presented with spinal form while 11 patients had bulbar form) and 20 controls (CG). Results: The obtained SOD levels in sALS patients were lower than those in CG (p < 0.001), while NO showed higher levels compared to CG (p < 0.001). Observed separately, there were no significant differences in the levels of NO and SOD in CSF between patients about their clinical presentations (p > 0.05). There were significant negative correlations between SOD and NO levels in all sALS patients (r = 0.31, P = 0.025). Significant correlation between SOD and functional rating scale as well as disease progression index was recorded in patients with sALS (r = 0.618. r = 0.425, P < 0.01), while NO levels were significantly associated with disease progression only (r = 0.348, P < 0.01). Conclusion: The data presented clearly support the role of impaired oxidant/antioxidant balance in the pathogenesis of ALS, where NO overproduction and decreased SOD defense activity seem to be particularly involved. The CSF SOD and NO level might serve as useful biomarkers for functional disorder and progression of the disease.

Background and Aim: Contemporary management of hydrocephalus involves various modes of cerebrospinal fluid (CSF) diversion, including shunt surgery and endoscopic ventriculostomy. However, there are times when either of these procedures have either failed or are not feasible. Highly invasive procedures aimed at internal CSF have been described previously, which, with the aid of modern microsurgical techniques, can be attempted in cases with very limited options. Our aim was to study the utility of extra-axial third ventriculostomy via lamina terminalis fenestration with multiple cisternostomies in the treatment of failed hydrocephalus. Materials and Methods: Forty-five patients with hydrocephalus were operated for extra-axial trans-lamina terminalis third ventriculostomy with multiple cisternostomies from January 2017 to January 2019. A minimally invasive supraorbital craniotomy was performed with subfrontal fenestration of the lamina terminalis and trans-lamina terminalis fenestration of the floor of the third ventricle with multiple cisternostomies including the optico-carotid cistern and opening of the Liliequist membrane. Results: Tuberculous meningitis was the most common etiology in the series, and multiple shunt procedures and incompatible CSF profiles were the most common reasons that necessitated this alternate rescue procedure. At a mean follow-up of 6 months, no patient required a revision shunt surgery. There was one death due to cardiac failure with anasarca, unrelated to the procedure. Conclusions: Extra-axial trans-lamina terminalis ventriculostomy with cisternostomies can safely be performed using minimally invasive micro-neurosurgical techniques, adding to the armamentarium of neurosurgeons in the management of complex cases of hydrocephalus.

Background: Bilateral thalamic infarction, especially the medial thalamus, has been characteristically described in the artery of Percheron (AOP) affection. However, bilateral thalamic restriction has been described in many entities beyond the AOP infarction. Objective: Here we describe a case series (three cases) with infection as an etiology for bilateral thalamic lesions in the topographic distribution of the AOP from a tertiary care center in tropical India. Materials and Methods: Case series during a 1-year period collecting cases with bilateral thalamic diffusion restriction on MRI who did not have thalamic infarcts and their outcomes. Results: Bilateral thalamic lesion can occur in both bacterial and viral infections such as tuberculosis, dengue, and SARS-COV-2. Thus, we intend to add infections as one of the etiologies in the ever-expanding list of conditions that produce bilateral thalamic restriction. Conclusions: All the acute symmetric thalamic lesions are not always secondary to vascular insult. Accurate assessment and prompt diagnosis can prevent unnecessary delays in treatment. To our knowledge, this is the first case series in the literature that throws light on the bilateral thalamic lesions in the topographic distribution of the AOP secondary to infections in a tropical country like India.

Spinal intradural extramedullary teratomas are rare tumors arising from more than one germ cell layers and are more common in children than in older age groups. Teratomas are more commonly seen in intracranial compartment and are extremely rare in the spine. They are difficult to diagnose pre-operatively and the definitive diagnosis is usually done by histopathologic evaluation. Intraspinal teratomas should be considered in the differential diagnosis of any intradural extramedullary tumor of the spine. We reviewed the literature and reported a rare case of intradural extramedullary teratoma in an adolescent located in dorsolumbar spine without any history of prior spinal procedure.

MELAS syndrome is defined as mitochondrial myopathy accompanied by encephalopathy, lactic acidosis, myoclonus, stroke-like episodes. It has a progressive course, multi-systemic effects and severe complications. Myoclonic contractions are unresponsive to many anti-epileptic drugs; these contractions and spasms may lead to severe pain. Systemic analgesic drugs are not sufficient to control pain. Therefore, continuous brachial plexus blockage may be preferred. Infraclavicular brachial plexus catheter is placed in our case. Local anesthetic injections through this catheter may be effective in pain management and results are to be discussed here.

We report a 24-year-old male with blepharophimosis, psychomotor retardation, brachycephaly, microstomia, immobile face, high arched palate, single palmar crease, kyphoscoliosis, talipes equinovarus, inguinal hernia, pyloric stenosis, recurrent infections, bilateral camptodactyly, wide-set eyes, decreased muscle mass, hypotonia, exotropia, and ptosis in the left eye, growth retardation, multiple congenital contractures, and hyporreflexia. Contractures improved with aging, but intellectual disability and blepharophimosis remained. He also presented epilepsy, outbursts of laughter, and predisposition to drug adverse effects (skin lesions with carbamazepine and secondary parkinsonism).

The introduction of air into cerebral venous or arterial circulation known as cerebral air embolism (CAE) is a rare clinical entity. CAE is commonly iatrogenic secondary to central venous catheter (CVC) placement or removal, various endoscopic procedures, or trauma or surgical scenarios. Here we report a case of spontaneous CAE in an unusual scenario. A 71-year-old male presented to emergency after developing giddiness following a yoga session. His MRI showed air embolism in the posterior fossa along cerebellar folia, prepontine, and suprasellar cisterns and tracking superiorly along the tentorium cerebelli. CAE is a rare clinical entity. Our case had CAE as a complication of cholesteatoma and possibly got triggered due to change in air pressor dynamics during yoga session.