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2022| May-June | Volume 70 | Issue 3
Online since
July 1, 2022
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E-BRIEF REPORTS
Cerebral Ptosis: A Revisit
Monalisa Vegda, Samhita Panda, Sarbesh Tiwari, Kartikeya Shukla, Jaya Pamnani, Suryanarayanan Bhaskar
May-June 2022, 70(3):1166-1169
DOI
:10.4103/0028-3886.349612
PMID
:35864657
Ptosis, unilateral or bilateral, partial or complete, occurring in cases of cerebral ischemic or hemorrhagic stroke, trauma or tumor without involvement of brainstem or oculo-sympathetic mechanism can be termed as cerebral ptosis. Such eyelid dysfunction can occur with hemispheric involvement of either side. It is associated with higher frequency of gaze preference to side of lesion as well as upgaze limitation compared to patients without cerebral ptosis. Here, we present our observations in four such patients with stroke and discuss its evaluation and implications with a brief review of literature.
[ABSTRACT]
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4,232
41
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Challenges in Brain-Death Certification in India
Devprakash Choudhary, Ashish Sharma, Sarbpreet Singh, Ajay , Deepesh B Kenwar, Kajal Jain, Rajesh Chhabra, Manish Modi, Lokesh Saini, Navdeep Bansal
May-June 2022, 70(3):1162-1165
DOI
:10.4103/0028-3886.349609
PMID
:35864656
The determination of Brain Death (BD)/Death by neurological criteria (DNC) is now widely accepted among various international societies following the World Brain Death project recommendation. As per the World Brain Death project, ancillary testing should be performed when standard brain-death examination components are inconclusive or cannot be performed. BD was defined legally in 1994 under the Transplantation of Human Organs Act (THOA). However, even after 27 years of the formulated law, there are no guidelines in the THOA regarding the determination of BD using ancillary tests. The present brief report describes two instances where ancillary tests like four-vessel angiography and transcranial doppler-aided brain-death certification were done. It is the first available literature from our country where ancillary tests aided in confirmation of BD when the standard clinical components of DNC could not be performed.
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4,134
71
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E-LETTERS TO EDITOR
MRI-Induced Thermal Burn: A Rare, Unusual, Unrecognized Side Effect of MRI Scan
Thomas Mathew, Saji K John, Sai Kanth Deepalam, GG Sharath Kumar
May-June 2022, 70(3):1318-1319
DOI
:10.4103/0028-3886.349664
PMID
:35864708
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3,314
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EDITORIAL
Secondary Trigeminal Neuralgia- Surgery vs. Radiosurgery: Which is better?
P Sarat Chandra
May-June 2022, 70(3):843-844
DOI
:10.4103/0028-3886.349723
PMID
:35864606
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E-ORIGINAL ARTICLES
Disseminated Cysticercosis in Indian Scenario – Experience from a Teaching University Hospital
Harikrishna V Ganaraja, Anita Mahadevan, Jitender Saini, Atchayaram Nalini, Pramod K Pal, Parthasarathy Satishchandra, Manjunath Netravathi
May-June 2022, 70(3):1032-1040
DOI
:10.4103/0028-3886.349634
PMID
:35864635
Background and Objectives:
Neurocysticercosis (NCC) due to
Taenia Solium
is a major public health problem. Our objective was to study patients with disseminated cysticercosis (DCC) who had NCC in the brain along with an additional site in the body and assess their clinical, radiological profile, and response to therapy.
Materials and Methods:
A chart review of DCC with a high lesion load of NCC ≥20 (DNCC) in the brain was performed.
Results:
Sixteen (M:F = 13:3) patients were diagnosed with DNCC with a mean age of presentation of 35.1 ± 14.2 years. Headache was the predominant symptom, followed by seizures (93.75%), vomiting (43.75%), behavioral disturbances (31.25%), fever (12.5%), encephalopathy (12.5%), visual disturbances (6.25%), and muscle pain and limb weakness (6.25%). CT brain showed multiple active parenchymal cysts in all, and calcifications in 68.75%. MRI brain revealed involvement of cortex and subcortical structures in all, followed by cerebellum (81.25%) and brainstem (75%). Intramedullary spinal lesion was observed in 12.5% cases. Albendazole with steroids was used in 15 patients. In 93.3% patients, there was complete improvement in seizures; 12.5% subjects had persistent memory and behavioral abnormalities. One subject required decompressive craniectomy; mortality was observed in two subjects.
Conclusions:
We hereby report one of the largest case series on disseminated cysticercosis with a high lesion load of NCC in the brain. A comprehensive clinical, imaging, therapeutic response with repeat imaging and long-term follow-up has given us a better understanding of this difficult-to-treat neurological disorder. We suggest cautious use of anti-parasitic therapy under the cover of corticosteroids to prevent irreversible neurological sequelae.
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Quality of Communication Life (QoCL) In Persons with Expressive Aphasia With And Without Communication Intervention – A Comparative Study
Udayakumar Madhu Preetha, Radhakrishnan Chella Perumal
May-June 2022, 70(3):1125-1130
DOI
:10.4103/0028-3886.349635
PMID
:35864649
Background:
Communication difficulties in aphasia can result in social isolation, challenges with interpersonal relationships, emotional changes, inability to return to work, and lack of independence. Therefore, intervention is essential particularly in the context of functional communication for persons with aphasia (PwAs). Studies have also indicated that quality of communication life (QoCL) is a valid measure of the impact of communication difficulty on quality of life.
Objective:
To estimate the relationship between communication intervention and QoCL in individuals with expressive aphasia.
Methods and Material:
Twenty PwAs were divided into two groups: group I individuals had undergone at least 3 months of speech and language intervention whereas group II individuals did not have any formal communication intervention. Tamil version of the QoCL scale was administered for all participants. Statistical analysis was carried out using Mann–Whitney
U
test and Spearman's rho correlation coefficient.
Results:
Individuals with speech and language intervention in group I had higher scores in overall QoCL domains as well as in overall QoL when compared to group II. The results of correlation analysis indicated that individuals with greater therapy duration had significantly high scores.
Conclusions:
The results prove that communication intervention is necessary for PwAs to improve QoCL and can be used to raise awareness of its importance. The findings can also guide treatment planning, counseling the PwA, and caregivers. It also indicates the importance of using patient-related outcome measures during the intervention process. Aphasia, quality of communication life, speech therapy, stroke, Tamil
Key Message:
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REVIEW ARTICLES
Trigeminal Neuralgia Secondary to Meckel's Cave Meningoencephaloceles: A Systematic Review and Illustrative Case
Jaime L Martínez, Ricardo A Domingo, Nathan C Rowland, William A Vandergrift III
May-June 2022, 70(3):857-863
DOI
:10.4103/0028-3886.349629
PMID
:35864609
Background:
The culprit of trigeminal neuralgia (TGN) may occur at any point between the nerve's root entry zone (REZ) and Meckel's cave. Meckel's cave meningoencephaloceles are rare middle cranial fossa defects that usually remain asymptomatic but may contain prolapsed trigeminal nerve rootlets and result in TGN. Their management and surgical outcomes remain poorly understood.
Objectives:
To perform a systematic review of clinical presentation and surgical outcomes of middle fossa defects presenting with trigeminal nerve-related symptoms.
Materials and Methods:
A systematic review was conducted in accordance with the PRISMA guidelines for all reports of middle cranial fossa defects causing trigeminal nerve-related symptoms. The pathophysiology, presentation, surgical management, and outcomes are discussed and illustrated with a case.
Results:
Initial search from inception to March 2021 identified 33 articles for screening. After applying inclusion and exclusion criteria, 6 articles were included representing a total of 8 cases in addition to our case (n = 9). All 9 patients were females and 33.3% (n = 3) presented with classic trigeminal neuralgia. “Empty sella” syndrome and radiologic signs of intracranial hypertension were present in 40%–62%. No patient presented with cerebrospinal fluid leak. The preferred treatment modality was surgical with subtemporal extradural repairs using combinations of autologous fat and muscle grafts and synthetic dura. Postoperative outcomes were only available in 55.5% (n = 5) of the cases, and nearly all reported complete symptom resolution, except for one case in which the meningoencephalocele wall was incised, along with trigeminal rootlets adhered to it. Our patient had immediate and durable symptom relief after a 4-year follow-up.
Conclusions:
MEC containing prolapsed trigeminal nerve rootlets can cause typical trigeminal neuralgia from chronic pulsatile stress. This supports the hypothesis that the compressive or demyelinating culprit can locate more ventrally on the course of the trigeminal nerve. Subtemporal extradural surgical repairs can be safe, effective, and durable. Incising the MEC wall should be avoided as it may have trigeminal rootlets adhered to it.
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2,796
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E-BRIEF REPORTS
Fahr's Disease and Hypoparathyroidism – A Missing Link
Sridhar Subbiah, Vasanthiy Natarajan, Rameez Raja Bhagadurshah
May-June 2022, 70(3):1159-1161
DOI
:10.4103/0028-3886.349669
PMID
:35864655
Fahr's disease is an idiopathic basal ganglia calcification with autosomal dominant inheritance. Prior to diagnosing Fahr's disease based on computed tomography (CT) and/or magnetic resonance imaging (MRI) of the brain, one should rule out hypoparathyroidism (HP), and pseudohypoparathyroidism (PHP). Treatments of these conditions are entirely different. HP- and PHP-related hypocalcemia requires calcium, calcitriol, and vitamin D therapy in a long run to avoid recurrent seizures whereas Fahr's disease is treated with an antiepileptic alone.
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E-ORIGINAL ARTICLES
Which is the Most Common Physiologic Type of Cerebral Palsy?
Mahesh Kamate, Mayank Detroja
May-June 2022, 70(3):1048-1051
DOI
:10.4103/0028-3886.349640
PMID
:35864637
Introduction:
Spastic cerebral palsy (CP) is the commonest physiological type according to literature which comes mainly from the developed countries where prematurity is a common cause for cerebral palsy. In developing countries like India, the leading causes of cerebral palsy are birth asphyxia, infections, and hyperbilirubinemia and, hence, the physiological type of CP is likely to be different. However, the data from our country is scant.
Methods:
103 consecutive treatment-naive CP patients attending pediatric neurology clinic were evaluated in detail using an objective tool, hypertonia assessment tool (HAT) over a period of 6months. Based on the predominant tone, the cases were classified as spastic, dyskinetic, ataxic/hypotonic, and mixed. The type of cerebral palsy was correlated with perinatal details and neuroimaging findings.
Results:
Out of 103 children, the most common physiological type of CP seen was of dyskinetic type [54 (52.4%)], followed by spastic CP in 30 (29.1%) and mixed (dyskinetic+spastic) CP in 19 (18.4%) children. The most common cause for dyskinetic CP was perinatal asphyxia 33 (61%); for spastic CP was prematurity 17 (56.7%) and; for mixed CP, the main cause was perinatal asphyxia 12 (63.2%). The main neuroimaging finding in predominant dyskinetic CP was basal ganglia/thalamus involvement followed by pericentral and perirolandic gliosis, whereas in spastic CP, it was periventricular leucomalacia. In mixed CP, there was multicystic encephalomalacia.
Conclusions:
Dyskinetic CP either as predominant type or along with spasticity is the most common physiological type of CP in India and is due to birth-asphyxia, hyperbilirubinemia, hypoglycemia, and infections.
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E-REVIEW ARTICLE
Is Air Pollution Associated with Increased Risk of Dementia? A Meta-Analysis of Epidemiological Research
Vikas Dhiman, Tanwi Trushna, Dharma Raj, Rajnarayan R Tiwari
May-June 2022, 70(3):1004-1019
DOI
:10.4103/0028-3886.349654
PMID
:35864632
Background:
There are prevailing inconsistencies in epidemiological research about air pollution being a risk factor for dementia.
Objective:
We performed meta-analyses to calculate the pooled estimates of the risk of developing dementia due to air pollution exposure.
Methods and Materials:
We performed a systematic search in PubMed, Google Scholar, The Cochrane Library, and J-GATEPLUS databases for peer-reviewed epidemiological studies reporting the risk of developing all-cause dementia, cognitive decline, Alzheimer's disease (AD), and vascular dementia (VaD) due to exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM
2.5
) and less than 10 μm (PM
10
), ozone (O
3
), carbon monoxide (CO), nitrogen dioxide (NO
2
), nitrogen oxides (NO
X
) and sulfur dioxide (SO
2
) from the beginning until December 2020. Meta-analysis was performed by adopting the random-effects model using Meta-XL.
Results:
In all-cause dementia, the pooled hazard ratio (HR) for PM
2.5
and NO
2
exposure was 1.03 [(95%CI: 1.01–1.06; I
2
= 99% (
P
< 0.001)] and 1.00 [(95%CI: 1.00–1.01; I
2
= 96% (
P
< 0.001)], respectively. The pooled HR for NO
X
was 1.00 [(95%CI: 1.00–1.01; I
2
= 61% (
P
= 0.05)]. In AD, the pooled HRs for PM
2.5
and O
3
was 1.08 (95%CI: 1.01–1.15; I
2
= 99% (
P
< 0.001)]) and 1.02 (95%CI: 0.96–1.08; I
2
= 100% (
P
< 0.001)], respectively. In VaD, the pooled HR for PM
2.5
exposure was 1.03 (95%CI: 1.01–1.06; I
2
= 91% (
P
< 0.001)]. In NO
2
/NO
X
, the results were found to be equivocal. Meta-analysis could not be performed in cognitive decline because of wide variations in assessments methods.
Conclusions:
The present study showed exposure to PM
2.5
as a risk factor for all-cause dementia, AD, and VaD and exposure to O
3
as a possible risk factor for AD. These findings can be used for policy measures and further research.
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E-ORIGINAL ARTICLES
A Study of Neuromyelitis Optica Spectrum Disorders (NMOSD): Disease Pattern Based on Antibody Status
Pranav B Joshi, Shalin D Shah, Mayank A Patel, Sudhir V Shah, Shailesh H Darji, Kailash C Mirche
May-June 2022, 70(3):1131-1136
DOI
:10.4103/0028-3886.349679
PMID
:35864650
Introduction:
Neuromyelitis optica (NMO) is a central demyelinating disorder, predominantly affecting the optic nerves and spinal cord and autoimmune basis. We aimed to analyze the clinical, laboratory, and imaging features associated with NMO spectrum disorders (NMOSD) according to the aquaporin 4 antibody (AQP4-Ab) serology status.
Methods:
The inclusion of the patients was based on the Wingerchuk criteria (2006) for NMO, known antibody status and has minimum 1-year follow-up. We analyzed and compared 46 patients with known antibody status.
Results:
AQP4-Ab positivity was 56.5%. The male to female ratio in the seropositive group was 1:7.7 and 1:1.2 in the seronegative group. The mean age of onset in seropositive patients was 36.8 years (vs 28.8 years in seronegative NMOSD patients). Clinical feature, cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) features were also different, but data from two subsets did not reach statistical significance. The relapse rate was higher in AQP4 positive NMOSD (84.6% vs 55% in the seronegative group). The recovery rate for AQP4 positive patients was poor (15%).
Summary:
We found differences in age, gender, and prognosis between the two groups. Antibody status may be a guiding factor in deciding the treatment approach during the first attack of NMOSD.
[ABSTRACT]
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REVIEW ARTICLES
Hearing Rehabilitation After Treatment of Sporadic Vestibular Schwannomas
Sanjeev Kumar, Debabrata Sahana, Anirudh Nair, Lavlesh Rathore, Rajiv K Sahu, Amit Jain, Praveen Borde, Manish Tawari, Satya Narayan Madhariya, Suresh Nair
May-June 2022, 70(3):849-856
DOI
:10.4103/0028-3886.349600
PMID
:35864608
Background:
Hearing preservation in vestibular schwannoma resection is a much-discussed topic in these times of functional preservation. Irrespective of the mode of treatment of large tumors, this becomes possible only in a lucky few. The overall burden of such deaf patients is on a rising trend, and therefore, it is high time neurosurgeons look into this often-neglected area of hearing rehabilitation.
Objectives:
In this review, the authors intend to provide a glimpse of available hearing rehabilitation modalities in the present era.
Materials and Methods
: This review deals with both immediate and long-term hearing outcomes following both surgery and stereotactic radiosurgery for sporadic vestibular schwannoma and the need for hearing rehabilitation in these patients. Various databases, including PubMed, Medline/Medscape, Scopus, Cochrane, and Google Scholar were searched to find available literature on hearing rehabilitation after treatment of sporadic vestibular schwannoma. The searched MeSH terms were “Hearing”, “Vestibular schwannoma”, “Rehabilitation”, and “Acoustic Neuroma”, alone and in various combinations.
Results
: The authors were surprised to find a paucity of literature. Even though neurosurgeons are at the forefront in managing vestibular schwannoma, they are not actively involved in hearing rehabilitation techniques possible for those who are rendered deaf following treatment.
Conclusions
: The authors strongly believe that this review will be a wake-up call for neurosurgeons on a relatively untouched topic.
[ABSTRACT]
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ORIGINAL ARTICLES
Clinical and Molecular Spectrum of Degenerative Cerebellar Ataxia: A Single Centre Study
Surya Balakrishnan, Shagun Aggarwal, Mayandi Muthulakshmi, Angamuthu Kanikannan Meena, Rupam Borgohain, Kandadai Rukmini Mridula, Sireesha Yareeda, Prajnya Ranganath, Ashwin Dalal
May-June 2022, 70(3):934-942
DOI
:10.4103/0028-3886.349660
PMID
:35864621
Background:
Cerebellar ataxia is a disabling neurological symptom with extreme clinical and etiological heterogeneity.
Objective:
To study the clinical and molecular characteristics in patients with degenerative cerebellar ataxia.
Materials and Methods:
In this study, 150 South-Indian patients with degenerative cerebellar ataxia underwent a phenotype guided, sequential tiered testing. Phenotypic features studied included cerebellar symptoms, pyramidal and extrapyramidal features, and ophthalmic and systemic findings. Tier one included conventional tests such as short PCR/fragment analysis for spinocerebellar ataxia (SCA) subtypes 1, 2, 3, 6, 7, 8, 12, 17, and 36 and TP-PCR for Friedreich ataxia (FA). Tier two testing comprised next-generation sequencing (NGS)-based strategies reserved for select undiagnosed cases.
Results:
The clinical features were highly overlapping and had limited specificity, except in autosomal recessive ataxias and SCA 34. The overall diagnostic yield of our study was 49.3%. SCA 1, 2, and 3 were noted in 13 (12.6%), 12 (11.6%) and 14 (13.5%), respectively, out of the 103 tested, and FA was noted in 17/55 (30.9%) patients. SCA subtypes 6, 7, 8, 12, 17, and 36 were absent in the cohort studied. Targeted Sanger sequencing and NGS revealed some rare diagnoses in 17 among the 18 patients tested. Whole exome sequencing uncovered a novel genotype-phenotype association in a sibling-pair with ataxia, dysmorphism, and retinopathy.
Conclusion:
SCA 1, 2, 3 and FRDA were the most common causes of ataxia. SCA 6, 7, 8, 12, 17, and 36 were absent in the cohort studied. NGS testing revealed several rare forms of ataxia. Clinical features based testing is cost-effective, achieves good genotype-phenotype correlation, and prioritizes variants for further studies.
[ABSTRACT]
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E-ORIGINAL ARTICLES
Prediction of Surgical Outcome for Acute Traumatic Brain Injury in Older Adults
Pooja Hazare, Dhaval Shukla, Dhananjaya Bhat, Bhagavatula Indira Devi, Mini Jayan, Subhas Konar, Nikhil Ratna, Vibhor Pateriya, Kautilya Patel, Bhushan Thombre
May-June 2022, 70(3):1112-1118
DOI
:10.4103/0028-3886.349603
PMID
:35864647
Background:
Increasing patient age is strongly associated with a rising incidence of traumatic brain injury (TBI) and a higher mortality and morbidity rates.
Objective:
This study aimed to identify the predictors of mortality after craniotomy for TBI in elderly patients.
Material and Methods:
Data of all patients aged ≥65 years who underwent craniotomy for acute TBI, over a period from January 2015 to October 2019, were retrospectively reviewed. The standard clinical and imaging variables for TBI were recorded. The medical comorbidities, indication for surgery, and intraoperative complications were also recorded. The outcome of interest was survival at 6 months after surgery.
Results and Conclusions:
A total of 206 patients were available for analysis. The age of patients ranged from 65 to 80 years. The most frequent surgical procedure performed was craniotomy and evacuation of supratentorial subdural hematoma with or without evacuation of the traumatic parenchymal lesion. The in-hospital mortality was 46 out of 206 (22.3%), and 6 months mortality was 116 out of 206 (56.3%). Among the survivors at 6 months, good recovery was seen in 70.5%, moderate disability in 19.8%, and severe disability in 8.6% patients. Only 1.2% patients survived in a vegetative state at 6 months. The odds of death are nearly three times more for patients with dilated and nonreactive pupillary reaction. The odds of death are less by 72% for a unit increase in motor score. In older adults, the main determinants of survival after surgery for TBI are pupillary reaction and motor score.
[ABSTRACT]
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E-CASE REPORTS
Morvan's syndrome Presenting with Psychiatric Manifestations - A Case Report and Review of the Literature
PN Suresh Kumar, E Sajithlal, M Shamsudeen, R Praveen Kumar
May-June 2022, 70(3):1207-1209
DOI
:10.4103/0028-3886.349616
PMID
:35864667
The term “la chorιe fibrillare” was used by the French physician Augustine Marie Morvan to describe a syndrome showing hyperactivity features involving the central, autonomic, and peripheral nervous system. The central hyperactivity symptoms are confusion, behavioral problems, hallucinations, myoclonus, and insomnia; the autonomic hyperactivity symptoms are hyperhidrosis and variations in blood pressure; and peripheral hyperexcitability is characterized by painful cramps, myokymia, and neuromyotonia. Here, we present a case that has typical features of Morvan's syndrome and provides a brief description based on available literature.
[ABSTRACT]
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NI FEATURE: THE FIRST IMPRESSION
The Straight Road to Meckel's Cave: Endoscopic Excision Through Trans Pterygoid Approach
Sandeep Kandregula, Bharat Guthikonda
May-June 2022, 70(3):841-842
DOI
:10.4103/0028-3886.349724
PMID
:35864605
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
2,273
69
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ORIGINAL ARTICLES
Microsurgery versus stereotactic radiosurgery for small petroclival meningiomas presenting with intractable trigeminal neuropathy: A historical cohort study
Ahmed Hegazy, Hieder A Al-Shami, Biswas Arundhati, Ahmed Negida, Raef F A Hafez, Osama M Fahmy, Omar A Ragab, Amr M Elkatatny, Sameh M Amin, Mohammed F A Ali
May-June 2022, 70(3):890-896
DOI
:10.4103/0028-3886.349681
PMID
:35864615
Background:
Data on the outcomes of microsurgical resection (SR) and stereotactic gamma knife radiosurgery (GKRS) in patients with trigeminal neuralgia associated with small petrous apex meningiomas are scarce.
Objective:
We conducted this study to evaluate the pain relief, tumor control, and procedure costs following SR and GKRS for small petroclival meningiomas (less than 3 cm in maximal diameter) using real-world data from our center in Egypt.
Material and Methods:
We conducted a retrospective cohort study of 47 patients with small petrous apex meningiomas presenting with intractable trigeminal nerve pain (SR:
n
= 22 and GKRS:
n
= 25). Data regarding pain relief on Barrow Neurological Institute (BNI), procedure cost, and tumor control were retrieved and analyzed using appropriate statistical tests.
Results:
Patients who underwent SR had lower median BNI pain intensity scores compared to those patients who underwent GKRS, and a significantly higher proportion of patients in the SR group had good BNI scores compared to those in GKRS group (
P
< 0.05); however, the total costs of SR were significantly less than GKRS (30,519$ vs. 92,372$, respectively).
Conclusion:
Both SR and GKRS provide pain relief and tumor control in patients with trigeminal neuralgia associated with petrous apex meningioma. However, in the present study, SR achieved better pain control and was more affordable than GKRS.
[ABSTRACT]
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Preoperative 3D Image Evaluation of EC–IC Bypass by 3D Visualization Analysis Software Amira
®
Riki Tanaka, Boon Seng Liew, Yasuhiro Yamada, Mai Okubo, Tomoka Katayama, Kento Sasaki, Kyosuke Miyatani, Fuminari Komatsu, Yoko Kato, Yuichi Hirose
May-June 2022, 70(3):943-947
DOI
:10.4103/0028-3886.349625
PMID
:35864622
Background:
Careful evaluation of the preoperative imaging for extracranial–intracranial bypass performed for conditions like intracranial stenosis and Moya disease is important. The traditional use of 2D imaging has a significant limitation for neurosurgeons, primarily to determine the optimal location of the recipient artery for performing the surgical bypass. Therefore, many neurosurgeons use 3D angiograms more frequently to overcome these shortcomings.
Materials And Methods:
We performed the preoperative evaluation of the possibility of performing an anastomosis between the superficial temporal artery and the middle cerebral artery (STA–MCA) bypass by synthesizing images of computerized tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) using Amira
®
of 3D visualization analysis software (Thermo Scientific Co.).
Results:
The 3D images prepared before surgery using this software showed good agreement with the intraoperative findings.
Conclusion:
Preoperative image processing using tools like Amira provide optimal information for good planning and communication for performing STA–MCA bypass and may become a helpful tool.
[ABSTRACT]
[FULL TEXT]
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[PubMed]
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35
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A Comparison of Treatment Options in Focal Post-Stroke Spasticity of the Upper Extremity: A Prospective Longitudinal Cohort Study from Kerala, India
Ravi Sankaran, Manu Raj
May-June 2022, 70(3):913-917
DOI
:10.4103/0028-3886.349636
PMID
:35864618
Background:
Post-stroke 20%–40% of patients develop spasticity which can quadruple total cost of care. This impact can be reduced by affordable treatment options for focal spasticity.
Objectives:
The primary objective of the study was to compare changes in Passive Range of Movements in patients with focal post-stroke spasticity from pre-treatment to end of 1 month of treatment with anti-spastic agents. The secondary objectives were to measure the changes in Modified Ashworth, and Brunnstrom Recovery Staging during the same period.
Materials and Methods:
This prospective longitudinal cohort study was conducted in a tertiary level rehabilitation center. One hundred and three adults with post-stroke spasticity participated. The patients received one of the four options: Phenol, Onabotulinum toxin, Bupivacaine and Hyaluronidase.The main outcome measures were the following: Changes in Passive Range of Movement (PRoM), Brunnstrom staging (BRS) and Modified Ashworth Scale (MAS).
Result:
Post intervention testing at 1 month was done. Each agent significantly improved BRS (1.10, 95% CI 0.8–1.4,
P
= 0.001) and PRoM (32.28, 95% CI 27.66- 36.89,
P
= 0.001), while reducing MAS (0.39, 95% CI 0.01–0.77,
P
= 0.05). In addition, subgroup comparisons were done with phenol as a reference for all three outcome measures. There was a significant difference in the improvement of Brunnstrom staging for Bupivacaine (0.52, 0.094–0.95, 0.02) compared to phenol. Similarly, Hyaluronidase showed better improvement in MAS (0.39, 0.01–0.77, 0.05) compared to Phenol.
Conclusion:
There was a significant difference in PRoM, MAS and Brunnstrom staging from baseline to end of 1 month long anti-spasticity treatment.
[ABSTRACT]
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2,216
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Telomerase Reverse Transcriptase Promoter Mutations in A Cohort Of Adult Gliomas – Clinicopathological Correlates
Shailaja Balakumar, Rekha Pai, Ari G Chacko, Bimal Patel, Rachel Nancy, Rajesh Balakrishnan, Sauradeep Sarkar, Gowri Sampath, Geeta Chacko
May-June 2022, 70(3):953-959
DOI
:10.4103/0028-3886.349649
PMID
:35864624
Background:
Introduction: Gliomas were previously classified histologically, although now the latest WHO classification incorporates several molecular markers to classify these. Detection of TERT promoter mutations is assuming increased importance due to its relevance to prognostication.
Objective
: The aim of this study was to determine the frequency of TERT promoter mutations, association of TERT promoter mutations with other molecular alterations and to assess the role of TERT promoter mutations in overall survival and progression-free survival in relation to histological and molecular glioma subtypes.
Materials and Methods:
This study analyzed a cohort of 107 adult patients with diffuse gliomas, WHO grades II and III and glioblastoma, by immunohistochemistry for IDH and ATRX mutations, FISH for 1p/19q co-deletions and PCR sequencing for TERT promoter mutation. Further, five glioma molecular sub-groups were derived using three molecular alteration and included the sub-groups with: i) IDH mutations only, ii) IDH and TERT mutations only, iii) IDH and 1p/19q co-deletion only, iv) Triple negative, and v) Triple positive.
Results:
IDH mutations and 1p/19q co-deletions were individually and significantly associated with an improved progression free (
P
= 0.001 and
P
= 0.002, respectively) and overall survival (
P
= 0.000 and
P
= 0.005, respectively) in the present cohort of gliomas. TERT promoter mutations occurred frequently in anaplastic oligodendrogliomas (94%), oligodendrogliomas (87.5%) and glioblastomas (54%). Sub-division into molecular sub-groups showed that the triple-positive tumors carried the best prognosis, followed by IDH only, triple negative and finally the TERT mutation only tumors (
P
< 0.000).
Conclusion
: This indicates that sub-classification using these molecular markers separates tumors into prognostically relevant categories.
[ABSTRACT]
[FULL TEXT]
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2,197
42
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REVIEW ARTICLES
Is There a Role for Temozolomide in Glioma Related Seizures? A Systematic Review
Jiong Yue, Cheng Yin, Longyi Chen, Ruxiang Xu, Dongdong Zhao
May-June 2022, 70(3):864-871
DOI
:10.4103/0028-3886.349588
PMID
:35864610
Background:
Seizures often herald the clinical appearance of glioma. Temozolomide (TMZ) is the first-line chemotherapeutic agent that has been used to treat glioma.
Objective:
We conducted a systematic review to determine seizure outcomes in glioma patients treated with TMZ.
Methods and Material:
We searched EMBASE and PubMed databases (January 1, 2003–August 26, 2021) by using search terms closely related to glioma, seizure, and temozolomide. Titles, abstracts, and full texts were screened and selected using previously established inclusion and exclusion criteria. The research team members reviewed potential articles and reached a consensus on the final articles to be included.
Results:
Nine studies containing data from three continents met our inclusion criteria. From several descriptive studies on low-grade gliomas (LGGs), the percentage of patients with partial seizure control after TMZ treatment ranged from 29% to 89.7%, and the percentage of patients with complete seizure control after TMZ ranged from 19.4% to 72%. In a retrospective cohort study of patients with LGGs, there was a marked difference in decreased seizure frequency between patients receiving TMZ and those who did not receive TMZ. In a randomized trial, TMZ seemed to have little effect on seizure control in elderly patients with glioblastoma.
Conclusions:
At present, there are few high-quality and well-designed clinical studies on TMZ for gliomas-related seizures. In terms of the literature included in this review, TMZ has an inhibitory effect on epilepsy. More randomized controlled trials are needed to elucidate the clinical benefits of TMZ in the treatment of gliomas-related seizures.
[ABSTRACT]
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2,188
42
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E-LETTERS TO EDITOR
Probable Silodosin-Induced Diplopia
Maria Sofia Cotelli, Floriana Bandera, Giuseppe Bandera, Stefano Bonetti, Filippo Manelli, Marinella Turla
May-June 2022, 70(3):1285-1286
DOI
:10.4103/0028-3886.349650
PMID
:35864693
Diplopia, or double vision, is a symptom resulting from the perception of two images of a single object. We report a case of a possible silodosin-induced diplopia never reported before in the literature. We suggest that binocular diplopia should be considered in people assuming silodosin even if further studies should be conducted to explore possible pathogenetic mechanisms.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
2,166
50
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ORIGINAL ARTICLES
Simplifying the Surgical Strategy for Excising Medial Sphenoid Wing Meningiomas: A Stepwise Approach
VR Roopesh Kumar, Venkatesh S Madhugiri, Arunkumar Karthikayan, Vishwaraj Ratha, Suresh Bapu
May-June 2022, 70(3):928-933
DOI
:10.4103/0028-3886.349676
PMID
:35864620
Background:
Medial sphenoid wing meningiomas constitute 15%–20% of all intracranial meningiomas. These lesions have a propensity to encase the vessels of the circle of Willis and the surrounding cranial nerves. Thus, radical excision is a difficult proposition.
Objectives:
In this paper, we analyzed our series of sphenoid wing meningiomas. We describe our surgical strategy, which was based on zone-wise dissection of the tumor. We describe the complications and outcomes of surgery.
Materials and Methods:
This case series is a retrospective analysis of a single surgeon series of medial sphenoid wing meningiomas operated over a 13-year period. Clinical, radiographic, and outcome variables were studied. The surgical videos were analyzed in detail. The meningioma and its extensions were divided into several zones and a zone-wise strategy for tumor excision was evolved.
Results:
Twenty-four patients with medial sphenoid wing meningiomas were operated. In 14 patients, Simpson grade 3 excision could be achieved; 5 patients had Simpson grade 4 and 1 patient, grade 5 excision. Four (of 24 patients, 16.7%) had vessel injuries.
Conclusions:
Medial sphenoid wing meningiomas are difficult lesions to excise radically. Close follow-up of residual lesions (especially if attached to the basal dura) is warranted. Additional modalities of treatment like radiosurgery may be required in case of any progression and for higher-grade lesions.
[ABSTRACT]
[FULL TEXT]
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[PubMed]
2,151
41
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Effect of Tranexamic Acid on Blood Loss and the Quality of Surgical Field in Transsphenoidal Pituitary Surgeries: Double-Blind Placebo-Controlled Randomized Control Trial
Ritesh Lamsal, Nidhi B Panda, Jyotsna Wig
May-June 2022, 70(3):960-964
DOI
:10.4103/0028-3886.349622
PMID
:35864625
Background and Aims:
Pituitary adenomas are common intracranial neoplasms and several cases require surgery, radiotherapy or radiosurgery. Transsphenoidal access to the pituitary gland is the commonest surgical approach. In microscopic or endoscopic approach to the pituitary, even modest bleeding can significantly worsen the surgical field for the neurosurgeon, lengthen intra-operative time and lead to potentially catastrophic complications.
Methods:
The investigators hypothesized that administration of tranexamic acid (TXA) would improve the quality of the surgical field and reduce bleeding during transsphenoidal surgery (TSS) of pituitary tumors. Fifty American Society of Anesthesiologists (ASA) physical-status 1 or 2 patients undergoing TSS were randomized into two groups: T and P. Patients in Group T received 25 mg/kg bolus of TXA followed by intraoperative infusion of 1 mg/kg/hour, while those in Group P received a matching saline infusion. The operating neurosurgeon, and the anesthesiologist, who managed the patient and collected data, were blinded to the test drug. Surgical field quality was assessed using the Boezaart scale. A single neurosurgeon performed all the surgeries to ensure consistency in estimating the quality of the surgical field.
Results:
The median Boezaart score (interquartile range) was 3 (1.0) in Group T and 3.0 (1.5) in Group P (
P
= 0.03). There was an absolute blood loss reduction of nearly 32% with TXA use. Blood loss in Group T was 334 ± 101 mL, compared to 495 ± 226 mL in Group P (
P
= 0.002).
Conclusion:
The administration of TXA significantly improved the quality of surgical field and reduced blood loss in patients undergoing TSS.
[ABSTRACT]
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2,127
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E-ORIGINAL ARTICLES
Perioperative Management of Pediatric Brain Tumors: A Retrospective Analysis
Nitasha Mishra, Girija P Rath, Vanitha Rajagopalan, Ramesh Doddamani, Arvind Chaturvedi
May-June 2022, 70(3):1095-1101
DOI
:10.4103/0028-3886.349578
PMID
:35864645
Background:
Brain tumors are the second most common malignancy in childhood and the surgical excision remains the cornerstone of management. The objective of this study was to analyze the factors associated with the length of intensive care unit (ICU) and hospital stay, and postoperative outcome in such children.
Materials and Methods:
Three years of data were collected, retrospectively, by detailed review of medical records pertaining to pre-anesthetic evaluation and perioperative course of children less than 16 years of age who underwent excision of intracranial tumors.
Results:
One hundred sixty-eight medical records were analyzed. One third of the children were found to have developed various intraoperative adverse events; the most common were hemodynamic changes following brainstem handling and brain swelling. 58% of children required postoperative mechanical ventilation. 82.7% of patients had favorable neurologic outcome which was comparable between the two tumor locations (supratentorial vs infratentorial). On multivariate analysis, re-exploration surgery and electrolyte disturbances, such as serum sodium, were found to be the independent risk factors affecting hospital stay. The amount of intraoperative blood loss and postoperative pulmonary complications (POPCs) were independent risk factors affecting the neurologic outcome.
Conclusions:
Adverse events are fairly common after excision of brain tumors in children. Intraoperative complications did not affect the ICU stay or neurological outcome; however, the postoperative complications increased length of ICU and hospital stays. POPC was the single most important factor responsible for poor neurologic outcome and was more so in children who underwent infratentorial surgery, prolonged mechanical ventilation, and who had a lower cranial nerve palsy.
[ABSTRACT]
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2,132
39
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OPERATIVE NUANCES STEP BY STEP (VIDEO SECTION)
Rotational Occipital Scalp Flap for Occipital Pressure Ulcer
Jitin Bajaj, Pawan Agarwal, Pranjal M Sinha, Jayant Patidar, Ketan Hedaoo, Yad R Yadav
May-June 2022, 70(3):876-878
DOI
:10.4103/0028-3886.349590
PMID
:35864612
Occipital pressure ulcers and wound gaping may occur in unconscious and malnourished patients. Most of the time, a large defect requires wound coverage by scalp flaps. This video describes a rotational occipital scalp flap for occipital pressure ulcer and wound gaping in a patient of operated midline posterior fossa mass & ventriculoperitoneal shunt. The defect measured 2.25 × 2.5 cm with exposed inion. The wound was included in an imaginary triangle, and the horizontal and vertical incision lengths were about four times the base of the triangle. The flap was based on the left occipital artery and raised in an avascular plane above the periosteum. The wound margins were freshened and undermined. The flap was rotated to bring it over the defect, and suturing was done in the standard manner. The flap had good healing, and the patient continued to be under care for his cerebellar medulloblastoma.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
2,129
34
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ORIGINAL ARTICLES
Feasibility of Tailored Unilateral Disconnection vs Callosotomy for Refractory Epilepsy in Patients with Bilateral Parieto-Occipital Gliosis Following Perinatal Insult
Mohit Agrawal, Sarat P Chandra, Ramesh S Doddamani, Raghu Samala, Ajay Garg, Shailesh Gaikwad, Ravi Sharma, Bhargavi Ramanujan, Madhavi Tripathi, Chandrashekar Bal, Manjari Tripathi
May-June 2022, 70(3):918-927
DOI
:10.4103/0028-3886.349601
PMID
:35864619
Background:
Patients with perinatal hypoxia (PH) and drug-refractory epilepsy (DRE) often have bilateral parieto-occipital gliosis. Surgical management of such patients is a dilemma.
Objective:
To identify preoperative determinants for unilateral disconnection vs callosotomy, and analyze the surgical outcome in such patients.
Methods and Material:
This was a retrospective analysis of patients with DRE and history of PH, with MRI abnormalities restricted to bilateral posterior quadrants. Preoperative semiology, epilepsy duration and seizure frequency were recorded. Based on the concordance between the results of non-invasive tests, patients underwent either posterior quadrant disconnection (PQD) or corpus callosotomy (CC). Preoperative variables were analyzed and corelated to the postoperative seizure freedom.
Results:
Fourteen patients were identified, 6 underwent PQD and 8 underwent CC. At follow up of 39.17 ± 23.75 months, 66.66% of patients (4/6) in the PQD subgroup had an ILAE Class I outcome. While none in the CC group attained seizure freedom, 87.5% (7/8) had more than 50% reduction in seizure frequency (follow up: 42 ± 27.31 months). Patients with a poor outcome had significantly greater seizure frequency (
P
= 0.05) and history of drop attacks (
P
= 0.04) in both the groups. Magnetoencephalography (MEG) accurately localized the epileptogenic zone in all of the patients with good outcome (
P
= 0.015). Concordance with single photon emission tomography (SPECT) was also a predictor of favorable outcome (
P
= 0.041).
Conclusions:
A history of drop attacks with high seizure frequency is associated with poor postoperative seizure outcome. Unilateral PQD is feasible and leads to superior seizure-free outcomes, even in cases with widespread and bilateral imaging and electrical abnormalities, provided the other preoperative investigations are concordant in localizing the epileptogenic zone.
[ABSTRACT]
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[EPub]
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2,094
47
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E-BRIEF REPORTS
Needle Electromyography in the Acute Phase of Stroke: Correlation With Severity and Muscle Strength: Preliminary Findings
Ana Carolina Silva Bitencourt, Thiago Dias Fernandes, Rodrigo Bazan, Gustavo José Luvizutto
May-June 2022, 70(3):1170-1175
DOI
:10.4103/0028-3886.349656
PMID
:35864658
Background:
After the stroke, the development of the second motor neuron degeneration can reduce muscle strength and functional capacity.
Objective:
The aim of this study was to describe the electro-myographic findings in the acute phase of stroke and to correlate them with the severity and muscle strength.
Material and Methods:
Twenty patients were studied in the first 72 hours after stroke. The severity of the lesion was assessed using the National Institutes of Health Stroke Scale (NIHSS), and muscle strength was assessed using the Medical Research Council Scale (MRC). Sensory conduction and motor conduction were studied to exclude peripheral polyneuropathy, radiculopathies, or other neuro-muscular diseases, and electro-myography (EMG) was performed with co-axial needle electrodes in the deltoid, carpal radial extensor, vastus lateralis, and anterior tibialis at rest, slight effort and maximum effort. The associations between qualitative and quantitative variables were studied using the Chi-square test and Fisher's exact test.
Results:
Among the patients, 40% had abnormal EMG [positive sharp waves (PSWs), fibrillation, fasciculations, and abnormal patterns in maximum effort]. Positive correlations were found between NIHSS and PSW (p = 0.005; r = 0.65) and abnormal EMG (p = 0.017; r = 0.72), and negative correlations were found between MRC and PSW (p = 0.041; r = -0.83) and abnormal EMG (p = 0.027; r = -0.81).
Conclusion:
It was concluded that the main EMG findings in the acute phase of stroke were the presence of the denervation process and polyphasic motor unit potentials. These changes in EMG were correlated with stroke severity and lower muscle strength.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
2,110
26
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OPERATIVE NUANCES STEP BY STEP (VIDEO SECTION)
Microsurgical Excision of Vestibular Schwannoma with Facial Nerve Preservation: A Retrosigmoid Approach
VR Roopesh Kumar, Arunkumar Karthikayan, Venkatesan Sanjeevi, R Saranyan
May-June 2022, 70(3):872-875
DOI
:10.4103/0028-3886.349583
PMID
:35864611
Background:
This video highlights the standard surgical steps of retrosigmoid craniotomy and excision of a moderately sized vestibular schwannoma with facial nerve preservation, with basic technical nuances to guide young neurosurgeons.
Objective:
A systematic step-by-step approach to microsurgical dissection and removal of vestibular schwannoma that achieves gross total excision with good facial nerve preservation.
Methods:
The video starts with a note on clinical presentation of a 45-year-old male with unilateral sensorineural hearing loss and headache with MRI brain showing a 3.8 × 3.0 cm schwannoma arising from the left vestibular nerve. The surgery was performed in lateral position with neuromonitoring, using a conventional retrosigmoid craniotomy. The essential surgical steps of arachnoid opening and extra capsular dissection, identification and preservation of facial nerve, and drilling of the internal acoustic meatus (IAM) are demonstrated step by step achieving a gross total excision.
Results:
A systematic and meticulous approach to microsurgical excision of vestibular schwannoma is pivotal in the preservation of facial nerve and in preventing damage to surrounding neurovascular structures.
Conclusion:
Adopting microsurgical techniques in vestibular schwannoma with intraoperative facial nerve monitoring aids in achieving good functional outcome and tumor control.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
2,056
48
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E-CASE REPORTS
Inflammatory Myositis in a Child due to Anti-NXP2 Antibody, First Case Report from India
Ashok V Reddy Taallapalli, Sumanth Shivaram, Manisha Gupta, Saraswati Nashi, Seena Vengalil, Girish B Kulkarni, Suvarna Alladi, Atchayaram Nalini
May-June 2022, 70(3):1194-1196
DOI
:10.4103/0028-3886.349644
PMID
:35864663
We present a case of a 10-year-old boy with 1-month history of proximal more than the distal weakness of all four limbs with myalgias, contractures, and bulbar symptoms on a background history of exertional myalgias for 2 years. His power was grade two-three. Investigations showed elevated creatine phosphokinase (CPK). His auto-antibody profile showed anti- nuclear matrix protein 2 (NXP2) antibody positivity. Muscle magnetic resonance imaging (MRI) showed extensive T2 fat-saturated hyperintense signal changes in the glutei, thigh, and leg muscles suggestive of active myositis. He improved significantly with immunomodulation with steroids, intravenous immunoglobulins (Iv Ig), and mycophenolate mofetil (MMF). He was continued on monthly pulse steroids and MMF. He is on regular follow-up. This is a rare case of anti-NXP2 antibody-mediated inflammatory myositis and the first report from India.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
2,029
44
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E-BRIEF REPORTS
Recurrent IgG4-Related Meningeal Disease of the Cervicothoracic Spine: A Case Report and Review of the Literature
Dallas E Kramer, Mena G Kerolus, Karina Furlan, Sukriti Nag, John E O'Toole
May-June 2022, 70(3):1180-1186
DOI
:10.4103/0028-3886.349607
PMID
:35864660
Background:
IgG4-related disease is a rare, recently recognized chronic inflammatory disease. IgG4-related hypertrophic pachymeningitis (IgG4-RHP) of the central nervous system predominantly involves the cranial meninges. Spinal involvement remains rare.
Objective:
We report a case of recurrent cervicothoracic IgG4-RHP and review the surgical literature.
Methods and Materials:
A 35-year-old woman presented with a 6-month history of neck and right shoulder pain, progressive right triceps weakness and paresthesias in the right C8 and T1 dermatomes. MRI demonstrated a T2 hypointense epidural soft tissue mass extending from C6-T1. The patient underwent C6-T1 laminoforaminotomy and partial resection with near complete symptom resolution. Histopathology was consistent with diagnosis of IgG4-RHP. Eighteen months postoperatively, she experienced symptom recurrence necessitating re-operation and adjuvant postoperative prednisone with complete resolution at 40-months' follow-up.
Results and Conclusions:
Of the now nineteen confirmed cases of IgG4-RHP, fifteen underwent surgery. A majority achieved partial resection. Three surgical patients did not receive adjuvant therapy with symptomatic recurrence between 2 and 18 months.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
2,014
30
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E-CASE REPORTS
OFF-Period Purposeless Groaning in Parkinsonism
Vikash Agarwal, Jeyalakshmi Rajan, Norlisah Ramli, Cecilia Santiago, Dushyanth B Jasti, Ai Huey Tan, Shen-Yang Lim
May-June 2022, 70(3):1232-1234
DOI
:10.4103/0028-3886.349581
PMID
:35864675
Background:
Purposeless groaning is primarily encountered in patients with progressive supranuclear palsy and has also been reported to occur in advanced Parkinson's disease (PD).
Objective:
We describe a case of pronounced purposeless groaning occurring as a medication OFF-period nonmotor phenomenon in PD. To our knowledge, this has not been previously reported in the literature.
Methods and Materials:
We describe and provide video documentation of a patient with moderately advanced PD and motor fluctuations, in whom OFF-period groaning was reported by the family and observed during clinic consultations to be a prominent feature, occupying approximately 40% of his OFF periods as calculated from his PD diary.
Results and
Conclusions:
Although rare, OFF-period purposeless groaning in PD can be very disruptive and add significantly to caregiver burden. It is postulated to be a disinhibitory and perseverative behavior related to overactivation of the cingulo-periaqueductal circuit; further study is needed to delineate the underlying pathophysiological mechanisms.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
2,013
30
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REVIEW ARTICLES
Medicolegal Priorities for a Neurosurgeon/Neurologist in the COVID Era
George C Vilanilam, Jaypalsinh Gohil
May-June 2022, 70(3):845-848
DOI
:10.4103/0028-3886.349678
PMID
:35864607
Vulnerable moments, panic, and uncertainties are the hallmarks of pandemic outbreaks. Medicolegal challenges add further injury to the public health chaos. Although containing the pandemic is of prime concern, medicolegal and ethical uncertainties further complicate ideal standards of medical care. Constraints in the provision of medical care, resource limitations, infectivity risks, burgeoning costs, and pandemic control laws, create extremely precarious medicolegal situations. Ethics and medical negligence laws may, at times, be trampled upon by the overwhelming urgencies of the pandemic. Hence, we attempt to review basic ethical and medicolegal principles that are put to test by pandemic urgencies. We aim to study these vulnerable medicolegal moments in neurosurgeons'/neurologists' clinical and research practices during the COVID-19 times from our own practice and contemporary literature on COVID practices, medicolegal sciences, and pandemic healthcare directives. We also review supportive measures and safeguards to brace these vulnerable moments effectively. We compile medicolegally sound and ideal practice parameters, including the basic principles for a restructured informed surgical consent ensuring a medicolegally and ethically sound practice. Several ethical and medicolegal exigencies are part of medical practice during a pandemic. Special care should be taken to avoid violations of medicolegal and ethical proprieties during the urgencies of medical care and research. Restructuring of contracts like the informed consent would also count as an ideal practice modification in a pandemic.
[ABSTRACT]
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1,989
49
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ORIGINAL ARTICLES
Barriers to Thrombolysis at A Tertiary Care Public Hospital- A Prospective Observational Study from Southern Part of India
Girish Baburao Kulkarni, Niranjan Prakash Mahajan, HR Aravinda
May-June 2022, 70(3):972-977
DOI
:10.4103/0028-3886.349615
PMID
:35864627
Background:
Intravenous thrombolysis (IVT) is an effective treatment for carefully selected acute ischemic stroke (AIS) patients. However, very few eligible candidates access it in time around the world, including India, due to multiple barriers.
Objective:
We explored the barriers to IVT in patients of AIS presenting within a 4.5-h window period in our hospital.
Materials and Methods:
This was a prospective study of AIS patients presenting in <4.5 h of symptom-onset, aged >18 years at the Neuro-casualty, Department of Neurology, from May 2016 to November 2017. Assessment of barriers to intravenous thrombolysis was done, and an attempt to delineate the reasons for the pre-hospital and the in-hospital delay was made.
Results:
A total of 103 (M:F: 67:36) patients aged between 18 and 80 years, were recruited, with 28 (27.2%) patients aged <45 years. Among them, 29 (28.2%) were thrombolysed. The major reasons for the pre-hospital delay were ignorance about the need for stroke center consultation- 94 (90.3%), consultation elsewhere before the presentation- 84 (81.5%), and non-availability of an ambulance at referring hospitals- 50 (59.52% out of 84). Sixty-four patients (62.1%) could not name any symptoms of stroke, 84 (83.5%) could not name any risk factor, and only 4 (3.9%) were aware of IVT. Key in-hospital barriers were crowded emergency- 80 (77.7%), financial constraints- 79 (76.7%), and delay in CT scan- 62 (61.4%). Delay in arriving at a consensus for IVT by the patient/relative and the treating neurologist, was noted in 24 (43.6%) of the 55 eligible.
Conclusion:
Many eligible patients remain deprived of thrombolysis due to lack of awareness, financial constraints, and organizational elements, which should be addressed to improve IVT rates.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,968
61
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Surgical Outcome Analysis of Large and Giant Petroclival Meningiomas with Special Reference to Quality of Life Issues
Aman Batish, Sunil K Gupta, Manju Mohanty, Manjul Tripathi, Pravin Salunke, Ashish Aggarwal
May-June 2022, 70(3):897-904
DOI
:10.4103/0028-3886.349614
PMID
:35864616
Background:
Management strategies for petroclival menigiomas remain controversial
Objectives:
We share our experience in management of large and giant true petroclival meniongiomas with special emphasis on patient reported quality of life parameters.
Methods:
This is a single center study of 47 patients between 2008 and 2018. All patients were checked for tumor specific parameters, clinical parameters, extent of surgical excision, and outcome, as assessed by Karnofsky performance score (KPS), Glasgow outcome score, clinical status, and by SF-36 questionnaire.
Results:
32/47 patients' data were assessed. Symptoms included headache (62.5%), involvement of 5
th
nerve (47%), facial nerve (40.6%), lower cranial nerves (37.5%), cerebellar signs (84%), and long tract signs in (50%) of patients. The mean preoperative KPS was 83.75+/−6.59. Surgical approaches included retromastoid suboccipital craniotomy (50%), Kawase's approach (31.25%), and others in 18.25% patients. 40.625% (
n
= 13) had a gross total excision, near total resection (NTR) was achieved in 53.125% (
n
= 17), and 6.25% (
n
= 2) had a subtotal excision (STE). In 13 patients who had gross total resection (GTR), there were 12 (70.5%) new neurological deficits, while among the 19 patients with NTR, only 5 (29.5%) new neurological deficits were seen. No new onset neurological deficit was seen in patients with STE of tumor. Patient assessed QoL parameters were worse in patients with GTR and best in patients with NTR/STE + GKRS.
Conclusion:
In patients of large/giant petroclival meningiomas, NTE/STE with adjuvant GKRS provided better preservation of quality of life.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
1,952
42
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NI FEATURE: CENTS (CONCEPTS, ERGONOMICS, NUANCES, THERBLIGS, SHORTCOMINGS)
Balancing the Extent of Resection and Ischemic Complications in Insular Glioma Surgery: Technical Nuances and Proposal of a Novel Composite Postoperative Outcome Index
Kuntal Kanti Das, Jaskaran Singh Gosal, Deepak Khatri, Amanjot Singh, Aanchal Datta, Abhishek Kumar, Kamlesh Bhaisora, Pawan Kumar Verma, Arun K Srivastava, Awadhesh K Jaiswal, Sanjay Behari
May-June 2022, 70(3):983-991
DOI
:10.4103/0028-3886.349642
PMID
:35864629
Background:
Maximal safe resection remains the most desired goal of insular glioma surgery. Intraoperative surgical adjuncts provide better tumor visualization and real-time “safety” data but remain limited due to a high cost and limited availability.
Objective:
To highlight the importance of anatomical landmarks in insular glioma resection and avoidance of vascular complications. We also propose to objectify the onco-functional balance in insular glioma surgery.
Methods:
Forty-six insular gliomas operated upon by a single surgeon between January 2015 and February 2020 were reviewed, focusing on the operative technique and clinical outcomes. A novel composite postoperative outcome index (CPOI) was designed, comprising the extent of resection and permanent postoperative deficits, and utilized to assess the surgical outcomes.
Results:
Gross-total, near-total, and subtotal resections were achieved in 10.9%, 52.1% (n = 24), and 36.9% (n = 17) patients, respectively. The median overall survival (OS) was 20 months (95% CI = 9.56–30.43). CPOI was optimal in 38 patients (82.6%). A well-defined tumor margin (
P
= 0.01) and surgeon's experience (
P
= 0.04) were significantly associated with an optimal CPOI. Out of seven (15.2%) patients who developed permanent neurological deficits, three (6.5%) patients had severe disability. Favorable prognostic factors of survival included younger age (<40 years) (
P
= 0.002), tumors with only frontal lobe extension (
P
= 0.011), tumors with caudate head involvement (
P
= 0.04), and non-glioblastoma histology (
P
= 0.006).
Conclusion:
Tumor margin and increasing surgeon experience are critical to an optimal postoperative outcome. Respecting the basi-sulcal plane is key to lenticulostriate artery preservation. Caudate head involvement is a new favorable prognostic factor in insular gliomas.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
1,916
38
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E-CASE REPORTS
Crohn's Disease Presenting as Metabolic Myopathy: A Case Report
Sabu Kunnathuparambil George, Neena Baby, Prasanth Varghese, Thalakottur Kuriakose Joseph
May-June 2022, 70(3):1235-1237
DOI
:10.4103/0028-3886.349639
PMID
:35864676
Myopathies associated with systemic diseases results from several different disease processes. Myopathy as the initial presenting symptom in Crohn's disease is a rare presentation. We report a 20-yearr-old lady who presented with a painful proximal myopathy. On examination, she was malnourished with pallor, angular cheilitis, Bitots spots, and bilateral pitting pedal edema. Laboratory evaluation showed iron deficiency anemia, hypoalbuminemia, and very low vitamin D levels with elevated creatine phosphokinase levels. A possibility of osteomalacic metabolic myopathy due to vitamin D deficiency was considered. The malabsorption workup was negative. A colonoscopic biopsy showed noncaseating granulomatous inflammation suggestive of Crohn's disease. With supplementary therapy and specific treatment, she was asymptomatic at 6-months follow-up with no residual neurological deficits. A detailed history and an algorithmic approach will be very useful in making the differential diagnosis in any patient presenting with muscle weakness in myopathy associated with systemic illness.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,921
28
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E-ORIGINAL ARTICLES
Effectiveness of Peripheral Median, Radial, and Ulnar Nerve Block at Wrist along with Intra-Articular Steroid Injection in Shoulder Joint in Management of Complex Regional Pain Syndrome of Upper Limb: 1-Week Follow-Up Study
Ningthoujam J Singh, Meeka Khanna, Anupam Gupta, Partha Haldar
May-June 2022, 70(3):1064-1068
DOI
:10.4103/0028-3886.349618
PMID
:35864640
Background:
Complex regional pain syndrome (CRPS) of upper limbs is one of the under-recognized painful disabling condition seen in many neurological conditions.
Objective:
To see the effectiveness of peripheral nerve blocks (PNB) along with intra-articular injection in shoulder joint in the improvement of pain, swelling and range of motion (ROM) of the upper limb in CRPS.
Methods:
It was a single-center, prospective study in male and female patients between 18 and 70 years with CRPS of the upper limb due to any etiology, within one year of illness. Single-dose of the intra-articular shoulder joint injection and peripheral nerve blocks at the wrist with steroid, 2% lignocaine, and sterile water was given. The primary outcome measure was a reduction in pain in the upper limb, assessed with a visual analog scale (VAS). Secondary outcome measures were an improvement in passive ROM of joints and a decrease in swelling of the hand. The significance of the
P
value was adjudged against an alpha of 0.05.
Results:
Thirty-three patients (25 men), with a mean (SD) age of 55.2 (9.4) years, and mean (SD) duration of illness of 101.9 (76.8) days were included. After 1 week, there was a significant improvement (
P
< 0.05) in the ROM of joints. The decrease in pain scores on VAS [mean difference -5.1 (CI -5.7, -4.5)] and reduction in hand swelling [mean difference -0.9 (CI -1.1, -0.7)] was also significant.
Conclusion:
Peripheral median, radial, and ulnar nerve block at wrist along with intra-articular steroid injection in the shoulder joint is an effective method of management of CRPS of the upper limb.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,894
32
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Retinal Changes in Parkinson's Disease: A Longitudinal Follow-up Study
Pooja Mailankody, Rajani Battu, Abhishek Lenka, PM Mohammed Shereef, K Thennarasu, Ravi Yadav, Pramod Kumar Pal
May-June 2022, 70(3):1149-1153
DOI
:10.4103/0028-3886.349658
PMID
:35864653
Background:
There is definite evidence for the involvement of retina in Parkinson's disease (PD). However, a specific pattern has not been clear due to the cross-sectional nature of the majority of the previous studies.
Objective:
The aim of this work was to study the pattern of changes in the retinal layers in patients with PD on longitudinal follow-up.
Materials and Methods:
Twelve patients with PD (23 eyes) were evaluated at baseline with complete history, clinical examination, Unified Parkinson's Disease Rating Scale (UPDRS) motor part, visual acuity, and retinal imaging with spectral-domain Optical Coherence Tomography. After a mean duration of 3.7 ± 0.46 years, patients were re-evaluated.
Results:
The Central Macular Thickness (CMT) of the right eye was found to be significantly thicker during the follow-up (
P
= 0.002). The outer retinal layer in the temporal quadrant at 0.5 centimeters from the fovea of the left eye was found to be significantly thinner (
P
= 0.001).
Conclusion:
The serial evaluation of the retinal layers in patients with PD suggests a progressive loss of thickness of the outer retinal layer. The involvement of non-dopaminergic mechanisms, especially glutamatergic pathways, may be responsible for these changes.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,869
31
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Prevalence of Patent Foramen Ovale in North Indian Cryptogenic Young Strokes
Dheeraj Khurana, Gayathri Petluri, Mukesh Kumar, Ajay Bahl, Ashok Kumar, Jitender Gairolla, Sudesh Prabhakar
May-June 2022, 70(3):1077-1082
DOI
:10.4103/0028-3886.349647
PMID
:35864642
Background
: Strokes of the undetermined cause or cryptogenic strokes (CS) account for 30-40% of ischemic strokes. Paradoxical embolism secondary to patent foramen ovale (PFO) may be associated with CS. Transcranial Doppler (TCD) with bubble contrast is a noninvasive bedside tool for diagnosis of right-to-left shunt (RLS) with high sensitivity and specificity. Data on the prevalence of PFO in CS in India are lacking. We determined the prevalence of RLS likely secondary to PFO in cryptogenic young strokes of the north Indian population using TCD with bubble contrast.
Patients and Methods
: In this hospital-based prospective cross-sectional study, TCD with bubble contrast was performed in 57 young (age 15 > 45 years) CS and 50 healthy controls for the detection of RLS. The risk of paradoxical embolism (RoPE) score was calculated from various variables such as age, presence of cortical stroke on neuroimaging, and absence of vascular risk factors.
Results
: 57 young CS and 50 healthy controls were recruited. TCD with bubble contrast was positive in 31% cases vs 6% in controls (
P
= 0.001). All patients with TCD positive for RLS had superficial cortical infarcts (
P
= 0.03). The median RoPE score of our patients was 9 (range: 7–10).
Conclusions
: There is a high prevalence of RLS likely secondary to PFO in cryptogenic young strokes in north India. TCD with bubble contrast is an excellent bedside tool for the detection of RLS.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,864
34
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E-CASE REPORTS
Familial Neuromyelitis Optica and Sjogren's Overlap Syndrome-A Rare Case Report
VH Ganaraja, R Subasree, M Netravathi
May-June 2022, 70(3):1191-1193
DOI
:10.4103/0028-3886.349584
PMID
:35864662
Familial cases of NMO are rare; and there are very few reports in association with Sjogren's syndrome. To report a familial case of NMO-Sjogren's Overlap syndrome. Mother and daughter presented with phenotypically different neurological episodes; mother had recurrent optic neuritis and myelitis with brainstem episode while the daughter had diencephalic presentation. Both were found to have AQP4 positivity with Ro-52 antibodies and positive Schirmer's test. They responded to steroids and plasma exchange. NMO associated with Sjogren's syndrome association suggests that apart from ethnicity both may have similar genetic predisposition and HLA-linkage.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,838
44
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E-ORIGINAL ARTICLES
Multi-domain Cognitive Testing: A Biomarker for Classifying the Cognitive Status of Mild Cognitive Impairment and Alzheimer's Disease
John Preetham Kumar Gurja, Suriya Prakash Muthukrishnan, Manjari Tripathi, Nalin Mehta, Ratna Sharma
May-June 2022, 70(3):1057-1063
DOI
:10.4103/0028-3886.349605
PMID
:35864639
Context:
Cognition is impaired in Alzheimer's disease (AD) and patients with mild cognitive impairment (MCI) with varying levels of magnitude.
Aim:
The present study aimed to identify a biomarker for classifying MCI and AD using multi-domain cognitive testing.
Settings and Design:
This was a cross-sectional study.
Methods and Materials:
26 AD patients, 28 MCI patients and 25 controls were recruited. Cognitive assessment of different domains was done using standard questionnaires and cognitive function tests.
Statistical Analysis Used:
Cognitive task scores were compared between the groups using multivariate analysis of variance (MANOVA).
Results:
Patients with AD had significantly lower MMSE, CDR, cognitive task scores compared to controls and MCI. Cognitive scores of all tasks for MCI were significantly less than controls, except MMSE and digits forward score. ROC analysis showed that picture memory had 100% sensitivity, 91.6% specificity for AD and 88.4% sensitivity, 92.5% specificity for MCI. Word memory had 92.3% specificity, 100% specificity for AD and 80.7% specificity, 84.6% specificity for MCI.
Conclusions:
The global cognitive tools are less specific in bringing out the differences especially between MCI and control. Limitation of MMSE, heterogeneity of MCI and differential impairment of various domains of cognition, demands the inclusion of multi-domain cognitive evaluation especially picture and word memory tasks with high sensitivity and specificity into the existing diagnostic protocol. ROC results also suggested the continuum of cognitive impairment and MCI as a transitional stage leaving more scope on the quantum of research required for intervention to halt the structural and functional decline.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,847
31
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BRIEF REPORTS
Delayed Vasospasm in Endoscopic Transsphenoidal Pituitary Surgery: Two Case Reports and Reviews
Gyani J S Birua, Gaurav Tyagi, Manish Beniwal, Narasinga K V L Rao, Jitender Saini, Srinivas Dwarakanath
May-June 2022, 70(3):996-1003
DOI
:10.4103/0028-3886.349613
PMID
:35864631
Background:
Cerebral vasospasm (CVS) due to injuries to arteries of the circle of willies has been reported in transsphenoidal pituitary surgeries. However, the incidence of delayed vasospasm following endoscopic transsphenoidal surgery is rare.
Materials and Methods:
Total 569 pituitary adenomas were operated on by endoscopic transsphenoidal approach from January 2016 to February 2020. We retrospectively described two cases of vasospasm following pituitary surgery from our institution.
Objective:
To describe two cases of delayed cerebral vasospasm following endoscopic transsphenoidal surgery and review previous literature.
Results:
Out of two patients, the Glasgow outcome score (GOS) of one patient was favorable and the other was unfavorable.
Conclusion:
CVS is rare after transsphenoidal pituitary surgery, which makes its predictability difficult. The clinician should maintain a high index of suspicion in patients with suprasellar extension of the tumor and postoperative hematoma in the tumor bed. Similarly, care should be taken in patients with a subarachnoid hemorrhage in basal cistern, intraoperative arachnoid breach, and postoperative meningitis.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,836
40
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ORIGINAL ARTICLES
Risk Factors for and Outcomes of Postoperative Entrapped Temporal Horn in Trigone Meningiomas
Shuang Liu, Xueyou Liu, Meng Wang, Zhengfeng Wang
May-June 2022, 70(3):965-971
DOI
:10.4103/0028-3886.349637
PMID
:35864626
Background:
Meningioma in the ventricle triangle area is a benign tumor that can be cured by surgery, but postoperative entrapped temporal horn may seriously affect the patient's quality of life and even require a second operation. Currently, there are few reports on this complication.
Objective:
The risk factors and prognosis of postoperative ETH in trigone meningiomas were investigated.
Material and Methods:
A retrospective analysis of the clinical data of 87 patients with trigone meningioma from 2010 to 2018 was performed, and univariate and multivariate analyses were used to assess the risk factors associated with postoperative ETH. The degree of ETH was evaluated using the modified ventriculocranial ratio.
Results:
The incidence of postoperative ETH in trigone meningioma was 29.9% (26/87). Preoperative ETH [odds ratio (OR): 4.826, 95% confidence interval (CI): 1.820–12.796,
P
= 0.002] and postoperative meningitis (OR: 12.811, 95%CI: 1.615–101.605,
P
= 0.016) are independent risk factors for postoperative ETH. Of the 18 patients with ETH syndrome, 12 improved after medical treatment, and finally, a total of 6 patients received ETH surgery. The mean duration from tumor resection to the appearance of ETH syndrome was 3.1 ± 1.9 months (range: 9 days–7 months). Patients with ETH grade II and III are more prone to clinical symptoms.
Conclusions
: The incidence of postoperative ETH for trigone meningiomas is high, and clinical symptoms generally appear delayed after surgery. Reducing postoperative infections can reduce the occurrence of postoperative ETH. Patients with symptoms of ETH who have failed medical treatment have clear indications for surgery.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,846
29
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E-ORIGINAL ARTICLES
Susceptibility-Weighted MRI as an Imaging Marker for Reperfusion Injury in Acute Ischemic Stroke Following Mechanical Thrombectomy
Jenny M Gandhi, P Mathew Cherian, Pankaj Mehta, Shriram Vardhraj, P Santosh, S Elango
May-June 2022, 70(3):1041-1047
DOI
:10.4103/0028-3886.349638
PMID
:35864636
Background/Purpose:
Following endovascular intervention for stroke, hyperattenuated areas are common in brain parenchyma and it is difficult to differentiate on non-contrast CT whether it is contrast staining or reperfusion hemorrhage. Differentiation between contrast staining from reperfusion hemorrhage is of paramount importance for early initiation of antiplatelets and/or anticoagulants to prevent reocclusion of vessel. This study demonstrates signal characteristics of contrast-staining and reperfusion hemorrhage on susceptibility weighted MRI and its role to differentiate between two.
Materials/Methods:
Between July 2017 to March 2019, 36 patients who presented with acute ischemic stroke due to large vessel occlusion underwent mechanical thrombectomy. Low-osmolar non-ionic (Iopromide 300 mg/L) iodinated contrast was used in all patients who underwent endovascular intervention. All patients underwent noncontrast CT brain and SWI on 3T MRI within 30 minutes of endovascular intervention. MRI was evaluated by two neuroradiologists. Reperfusion hemorrhage was defined as ECASS criteria II. Symptomatic ICH was defined as hemorrhagic transformation temporally related to a negative shift in NIHSS score >/=4.
Results:
Out of 36 patients, 15 had hyperattenuated areas in brain on NCCT. Out of 15, 13 patients had blooming on SWI, suggestive of bleed. Two patients had no blooming on SWI, suggestive of contrast staining. Two patients didnot show any hyperdensity on NCCT but blooming on SWI, suggestive of bleed.
Conclusion:
All patients with hyperdensity on NCCT secondary to bleed showed blooming on SWI whereas those with contrast staining didnot show any signal changes on SWI. Thus, it is possible to differentiate reperfusion hemorrhage from contrast staining using SWI MRI. The significance of SWI in normal CT may be low where a small bleed maynot have any clinical significance.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,833
29
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Post-Covid Cerebral Mucormycosis, Varied Presentations and Surgical Strategies of a Newer Epidemic: An Institutional Experience
Manda Venkata Vijayasekhar, Vivek Nagappa, Kurumella Hema Swaroop, Gorre Mithun, Ediga Achuith, Kadali Satya Varaprasad
May-June 2022, 70(3):1052-1056
DOI
:10.4103/0028-3886.349604
PMID
:35864638
Context:
During the challenging second wave of the COVID-19 pandemic, we encountered a most dreadful fungal infection in the form of COVID-associated mucormycosis (CAM), with a varied pattern of presentation from previous experience. Patients presented with simple fungal sinusitis or more complicated brain abscesses, and newer manifestations such as skull osteomyelitis. We report our findings and innovative treatment strategies used to manage this morbid condition.
Objectives:
To study the various presentations and surgical strategies in treating post-COVID rhino-orbito-cerebral mucormycosis (ROCM).
Settings and Design:
Observational cross-sectional study.
Methods and Materials:
From May to October 2021, 270 patients with CAM were admitted to Andhra Medical College Department of Neurosurgery, King George Hospital, Visakhapatnam, India. A cohort of 61 cases with intracranial involvement was studied in detail. The varied presentations and different or innovative treatment modalities were analyzed.
Results:
The death rate was 30/270 in the whole cohort, and three deaths (4.9%) occurred in 61 cases with cranial involvement. Thirty-three (54.1%) of the 61 cases were treated surgically: 17 patients required bone excision (for focal osteomyelitis) and 16 cases required abscess drainage/excision.
Conclusions:
Post-COVID mucormycosis (especially with intracranial involvement) is a highly challenging entity. A multidisciplinary approach with early and aggressive anti-fungal medication combined with timely surgical interventions offers some hope of overcoming this complex infection in CAM patients. We identified some novel techniques during regular follow-up that have proven helpful in combatting this devastating condition.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,738
40
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Cerebrospinal Fluid Flow Analysis in Tuberculous Meningitis Using Phase Contrast Technique on 3 Tesla MRI: A New Paradigm and Our Initial Experience
Aanchal Ashta, Anjali Prakash, Rashmi Dixit, Naresh Kumar
May-June 2022, 70(3):1025-1031
DOI
:10.4103/0028-3886.349627
PMID
:35864634
Background:
Phase-contrast magnetic resonance imaging (PC-MRI) has been used for studying cerebrospinal fluid (CSF) dynamics in various CSF related disorders at aqueduct of Sylvius.
Objective:
To analyze the CSF flow dynamics qualitatively and quantitatively using PC-MRI across the aqueduct of Sylvius in diagnosed patients of tuberculous meningitis.
Methods:
Thirty patients, clinically diagnosed with tuberculous meningitis and mean age of 24 years (range: 12–60 years) were taken up to study the changes in CSF flow dynamics using PC-MRI with retrospective cardiac gating. Thirty age and sex matched healthy volunteers were also included for comparison and reference values. Flow quantification was done by through-plane scans acquired in the axial plane perpendicular to the aqueduct. For qualitative examination, in-plane phase contrast scans were acquired in the mid-sagittal plane. Encoding velocity was kept in craniocaudal direction. Calculated parameters were peak velocity (cm/s), average velocity (cm/s), average flow (mL/s), net forward volume (mL), and stroke volume (μL).
Results:
Qualitatively, loss of normal sinusoidal waveform of CSF flow was noted in two cases of hydrocephalus with exaggerated flows. Quantitatively, CSF flow parameters showed marked numerical difference in tuberculous meningitis patients with hydrocephalus on comparison with healthy volunteers and with cases without hydrocephalus.
Conclusion:
PC-MRI is a sensitive technique to analyze altered CSF flow dynamics in tuberculous meningitis patients. This is a useful adjunct in imaging these patients to extract both the qualitative and quantitative information about CSF flow for comprehensive evaluation.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,731
35
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E-LETTERS TO EDITOR
Remarkable Benefit of Infliximab Therapy in Recurrent Tolosa Hunt Syndrome
Usha , PR Sowmini, S Sakthi Velayutham, Malcolm K Jeyaraj, M Sathish Kumar, S Viveka Saravanan, K Mugundhan
May-June 2022, 70(3):1289-1291
DOI
:10.4103/0028-3886.349597
PMID
:35864695
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,726
36
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E-NEUROIMAGES
Pseudo-porencephaly With Structural Epilepsy After Perinatal Intracerebral Bleeding
Josef Finsterer
May-June 2022, 70(3):1331-1332
DOI
:10.4103/0028-3886.349580
PMID
:35864714
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,696
26
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E-LETTERS TO EDITOR
Posterior Fossa Arachnoid Cyst Following Trauma in an Adult
Brig Harjinder S Bhatoe
May-June 2022, 70(3):1270-1272
DOI
:10.4103/0028-3886.349602
PMID
:35864686
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,687
26
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E-CASE REPORTS
Primary Histiocytic Sarcoma of Brain—Illustration of Two Cases with Varied Histomorphological Features
Madhu Rajeshwari, Vaishali Suri, Chitra Sarkar, Ajay Garg, Mehar Chand Sharma
May-June 2022, 70(3):1254-1259
DOI
:10.4103/0028-3886.349657
PMID
:35864682
Histiocytic sarcoma (HS) is an aggressive hematolymphoid malignancy that arises from non Langerhans histiocytes and usually involves the skin, lymph nodes, and intestine. The involvement of the central nervous system (CNS) is a rare occurrence with around 30 cases being reported in English literature. Morphological and immunohistochemical evidence of histiocytic differentiation is essential for diagnosis. Prognosis is very poor and consensus on treatment is not available mainly due to its rarity. We report two cases of HS with varied clinical presentation and pathological findings and elucidate the diagnostic challenges of this rare entity.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,674
31
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Pituitary Involvement as a Primary Manifestation of Granulomatosis with Polyangiitis
Emine R Koc, Gizem Gullu, Altug Guner, Sahsene Tolunay, Rifat Ozpar, Huseyin E Dalkilic
May-June 2022, 70(3):1251-1253
DOI
:10.4103/0028-3886.349633
PMID
:35864681
Granulomatosis with polyangiitis is a systemic necrotizing granulomatous vasculitis that can predominantly affect systemic small- and medium-sized vessels. Isolated pituitary gland involvement at the onset of the disease is extremely rare in granulomatosis with polyangiitis and usually associated with other organ involvement, especially upper and lower respiratory tract and kidneys. This report highlights granulomatosis with polyangiitis -related pituitary dysfunction with clinical, radiological, and laboratory findings.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,670
33
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ORIGINAL ARTICLES
Development and Validation of a Multivariable Model to Predict Surgical Outcome in Patients with Chiari malformations
Shishir Kumar, Komal P Chandrachari, Kiran Mariswamappa, Shibu V Pillai, Vishwas H Vijayendra, Sathyanarayana Lale, Thimappa Hegde
May-June 2022, 70(3):905-912
DOI
:10.4103/0028-3886.349662
PMID
:35864617
Background:
Surgical outcome predictive models for Chiari malformations (CM) which are applicable to all age groups and simple enough to use on outpatient basis are lacking.
Objective:
The aim of this study was to develop and validate a preoperative index for predicting long-term outcomes in Chiari 1 (CM1) and Chiari 0 (CM0) malformations.
Materials and Methods:
It was a single-institution, ambidirectional, cohort study from 2014 to 2019, having patients between 5 to 70 years. Outcome was assessed using Chicago Chiari outcome score (CCOS) over 2 years follow-up. Preoperative clinical and radiological factors were analyzed using Chi-square test and Mann Whitney U test, in relation to CCOS and those attaining
P
value ≤0.05, were used to develop model - Chiari Outcome Predictive Index (COPI). COPI was internally validated using 10-fold cross-validation and c-statistic for discrimination.
Results:
A total of 88 patients (66 in development and 22 in validation cohort) were included in the study. Outcome was negatively associated with presence of motor, sensory or cranial nerve symptoms, poor functional status, basilar invagination, and tonsillar descent. It was positively associated with shorter duration of presenting symptom (<9 months) and syrinx diameter <6 mm. COPI predicted CCOS with 91.1% accuracy (10-fold cross-validation). It had excellent discrimination for improved outcome (c = 0.968 in development and 0.976 in validation cohort), at threshold index of -1.
Conclusions:
COPI is simple tool that can be administered in outpatient setting. It can facilitate evidence-based preoperative counseling of patients, to help them develop reasonable expectations regarding surgical outcomes.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,660
40
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OPERATIVE NUANCES STEP BY STEP (VIDEO SECTION)
Surgical Treatment of IV Ventricle Calcifying Pseudoneoplasm of the Neuraxis (CAPNON) Operative Nuances
Sebastian J M. Giovannini, Mauro Ruella, Facundo Villamil, Emiliano Lorefice, Guido Caffaratti, Andrés Cervio
May-June 2022, 70(3):879-883
DOI
:10.4103/0028-3886.349621
PMID
:35864613
Calcifying pseudoneoplasm of the neuroaxis (CAPNON) is a rare, slow growing, and generally benign fibro osseous mass that can emerge throughout the entire central nervous system (CNS). When diagnosed, prompt surgical treatment can determine a good neurological outcome and possibly curative resolution. The objective of the present work is to present a step by step technical report with its video. We present a 37 year old female presented with occipital headache and cervical pain associated with dysphagia, nausea, and gait disturbances. Computed tomography (CT) scan showed a focal calcified lesion on the floor of the IV ventricle projecting toward the vermis with associated supratentorial hydrocephalus and transependymal edema. The telovelar approach was chosen for the procedure. The outcome was favorable, with no complications. Postoperative CT was performed, which revealed no residual lesion. A step by step report of a IV ventricle CAPNON that manifested with hydrocephalus is described.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,652
34
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Endoscopic Endonasal Excision of a Meckel's Cave Dermoid Cyst
Biren K Patel, HR Darshan, Anand Binu, Tobin George, HV Easwer, Prakash Nair
May-June 2022, 70(3):884-889
DOI
:10.4103/0028-3886.349623
PMID
:35864614
Background:
Meckel's cave dermoid cyst is an extremely rare and a technically challenging lesion. The objective of the study is to show that endoscopic endonasal approach (EEA) has recently emerged as a better alternative to transcranial approach for this formidable tumor, owing to minimal retraction-related morbidity.
Method:
A 52-year-old male presented with numbness over the right side of the face and temporal area for the last 3 years. On examination, there was decreased sensation to touch, pain, and temperature over the right V1, V2, and V3 areas with an absent right corneal reflex. Imaging revealed a heterogenous extra-axial lesion in the right Meckel's cave. The tumor was resected by an extended endonasal transpterygoid approach.
Results:
The patient had improvement in his symptoms with no endocrine complication.
Conclusion:
This case demonstrates the surgical techniquenof endoscopic endonasal transpterygoid resection of a Meckel's cave dermoid cyst.
[ABSTRACT]
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1,650
36
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E-LETTERS TO EDITOR
Levetiracetam Use during Pregnancy in Women with Active Epilepsy: Possible Implications
Mahesh Kumar Balasundaram, Alok Singh
May-June 2022, 70(3):1277-1277
DOI
:10.4103/0028-3886.349668
PMID
:35864689
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,648
37
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E-ORIGINAL ARTICLES
Factors Associated with Outcomes in Patients with Chronic Subdural Hematoma who Underwent 'Burr Hole Craniotomy'
Faramarz Allahdini, Khaled Rahmani, Abdorrahim Afkhamzadeh
May-June 2022, 70(3):1142-1148
DOI
:10.4103/0028-3886.349645
PMID
:35864652
Background and Objective:
Chronic subdural hematomas (CSDH) is frequently encountered in neurosurgical practice. The aim of this study was to investigate the factors associated with the outcome of Burr Hole Craniotomy.
Methods:
This study was conducted on 116 patients with CSDH in Be'sat Hospital, an educational hospital, in Kurdistan province, Iran. We used Glasgow outcome scale (GOS) at times of discharge and 1 month after stitch removal as favorable outcome. Student
t
-test or corresponding nonparametric test (Mann–Whitney U test) and logistic regression were used to assess the relationship between investigated variables and favorable outcome.
Results
: The results indicated that the chance of success after surgery in patients with CSDH was different based on several variables. The chance of cure after surgery among CSDH male patients (OR = 12.5), patients who have no atrophy (OR = 25.0), patients with no cardiovascular diseases (OR = 7.14), patients who had no medical complications after surgery (OR = 2.08), and patients with higher GCS score at the time of hospitalization (OR = 1.31) was higher.
Conclusion
s:
Burr hole drainage technique is a simplified, efficient and reliable method of treating patients with CSDH. Our study highlights various factors including female gender, diffuse brain atrophy, postoperative medical complications, a previous history of cardiovascular disease, and lower GCS score at the time of admission can be related to patients' worse outcome.
[ABSTRACT]
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1,650
30
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Osteo-Cutaneous Trophic Changes in Complex Regional Pain Syndrome and their Reversal with Steroids
Sunil Pradhan, Robin Bansal, Animesh Das, Vibhor Pardasani, Hardeep Singh Malhotra, Suman Kushwaha, Vijay Nath Mishra
May-June 2022, 70(3):1119-1124
DOI
:10.4103/0028-3886.349675
PMID
:35864648
Background:
Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by autonomic and inflammatory features. There is paucity of data regarding sustained benefits of any treatment modality. We aimed to document the effect of steroids in CRPS on long-term basis.
Materials and Methods:
We came across five patients of CRPS in Out Patient clinics of super-speciality Institutes in North India. All five cases fulfilled the Budapest criteria for the diagnosis of CRPS. All of them received prednisolone and were prospectively followed up for 2 years. Treatment outcome was carefully recorded in all affected modalities.
Results:
All five cases were found to have excruciating neuropathic pain in defined regions along with cutaneous manifestations. Osseous changes in the form of surface erosion of underlying bones in four cases and marked marrow edema leading to considerable increase in bone thickness in one case were noted. All these features improved considerably following steroid therapy. Bone marrow edema and bone resorption showed improvement on serial imaging.
Conclusion:
Apart from pain relief, steroids therapy is capable of reversing the osteo-cutaneous autonomic changes of CRPS type I.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
1,620
35
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BRIEF REPORTS
Surgical Management of a Superior Orbital Fissure Cavernous Hemangioma
Fernando Padilla-Lichtenberger, Daniela S Massa, Pedro Plou, Alvaro Campero, Pablo Ajler
May-June 2022, 70(3):992-995
DOI
:10.4103/0028-3886.349630
PMID
:35864630
Background:
Cavernous sinus hemangiomas (CSHs) are intracranial extradural benign, well-demarcated neoplasms arising within dural sinuses. The orbital apex and superior orbital fissure (SOF) are common locations for these lesions. Because of the complex anatomy of this area and potential morbidity, SOF CSH surgical management is challenging.
Objective:
Describe a case of a SOF CSH and review of literature.
Material and Methods:
We present the case of a 44-year-old female with a 2-month history of right eye visual disturbances. A contrast-enhanced magnetic resonance imaging showed a right orbital apex nodular formation. A pterional craniotomy with a middle fossa mini peeling was performed.
Results:
Gross total resection was accomplished. No recurrences were observed 2 years after surgery.
Conclusion:
SOF CSH should be included in a differential diagnosis in cases of space-occupying orbital apex lesions with atypical features. Surgery is the gold standard treatment. Radiosurgery is a valid option for tumor remnants.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
1,621
29
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ORIGINAL ARTICLES
Validation of the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale for Hindi-Speaking Patients Recently Diagnosed with Vestibular Schwannoma
Sanjeev Pattankar, Omkar Churi, Basant K Misra
May-June 2022, 70(3):978-982
DOI
:10.4103/0028-3886.349775
PMID
:35864628
Background:
The Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale is a disease specific quality-of-life instrument for vestibular schwannoma, developed in English and subsequently validated in four major languages of the world. No such validated version of PANQOL exists for Hindi-speaking population.
Objective:
To translate and examine the validity of the PANQOL scale in a sample of Hindi-speaking patients recently diagnosed with vestibular schwannoma.
Materials and Methods:
A cross-sectional study was done at a corporate tertiary care hospital. The PANQOL questionnaire was translated into Hindi by a language expert according to the accepted rules of forward-backward translation. In total, 30 consecutive patients (n = 30) diagnosed with vestibular schwannoma between September 2017 and March 2018 were included in the study. Quality-of-life at the time of diagnosis was measured with the generic Short Form -36 (SF-36) and the disease-specific PANQOL questionnaires. The internal consistency and reliability of the PANQOL domains, as well as the relationship with SF-36 dimensions, were statistically analyzed.The PANQOL scores of the patients in the current study were compared with those of similar such published studies worldwide.
Results:
Mean age of the patients was 46.3 13.25 years. The sex ratio of male to female patients was 19:11. The mean PANQOL total score was 71.6. All its domains had good internal consistency except pain. Most PANQOL domains were correlated with those of the SF-36 dimensions, with the exception of facial dysfunction domain.
Conclusions:
Good internal consistencies and strong correlations between PANQOL domains and SF-36 dimensions in the current study support the validity of the PANQOL Hindi version.
[ABSTRACT]
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1,615
30
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E-CASE REPORTS
Reversal of Oral Vitamin K Antagonists Using Prothrombin Complex Concentration Prior to IV tPA Administration
Irmak Salt, Işıl Kalyonu Aslan, Çisil İrem Özgenç Biçer, Eren Gözke
May-June 2022, 70(3):1238-1239
DOI
:10.4103/0028-3886.349620
PMID
:35864677
Herein, we report two acute ischemic stroke cases that we used prothrombin complex to reverse the effects of warfarin in order to apply intravenous thrombolytic treatment. To the best of our knowledge, there are only limited amount of cases that prothrombin complex concentrates were applied prior to intravenous thrombolytic treatment administration. As one of the biggest acute stroke clinics in our country, we aim to open a discussion for this treatment to be fully researched and understood.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,582
41
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Dengue Associated Demyelinating Disorders – A Report of 2 Cases
Mimi Ganguly, Prabhas P Giri, Mausumi Mukherjee, Harshita Jagwani, Arundhati Banerjee
May-June 2022, 70(3):1244-1246
DOI
:10.4103/0028-3886.349659
PMID
:35864679
Dengue is a common viral infection worldwide, though its neurological manifestations are infrequent (2%–11% in recent years) and can be varied as the Dengue virus per se is a non-neurotropic virus. Neurological manifestations of Dengue usually result from multisystem dysfunction which may be secondary to vascular leak or it can be due to direct virus invasion (dengue encephalitis) or an immunological phenomenon which is triggered by dengue infection (demyelinating disorders). Here we present two cases of dengue fever associated demyelinating disorders in two pediatric patients aptly depicting the two spectra of the disease. One of them is a case of fatal acute hemorrhagic leukoencephalopathy (AHLE) in a 3-year-old girl, that developed severe neurological sequelae while the other one is a case of an Acute disseminated Encephalomyelitis (ADEM) in a 3-year-old boy who had recovered with timely immunomodulatory therapy and appropriate management.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
1,566
37
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A Rare Case Report of C1 Posterior Arch and C2 Laminae Hypertrophy Causing Cervical Myelopathy
Ravi Venkatesan, Srinath Pammi
May-June 2022, 70(3):1210-1212
DOI
:10.4103/0028-3886.349653
PMID
:35864668
Cervical canal stenosis, localized to upper cervical spine, is very rare which can be developmental or acquired. Hypertrophic osteoarthritis accompanied by dens hypertrophy, hypertrophy of the osodontoideum, ossification of the transverse atlantal ligament, aplasia or developmental defect of the posterior arches of Atlas, and unilateral lateral mass hypertrophy are some of the rare reported conditions causing cervical myelopathy. Localized upper cervical canal stenosis due to hypertrophied C1 posterior arch and C2 laminae hypertrophy as an isolated cause of cervical myelopathy has not been reported earlier to our knowledge. We report a case of cervical myelopathy in a 52-year-old gentleman due to the hypertrophied posterior arch of atlas and laminae of axis. C2 laminectomy along with removal of the posterior arch of Atlas and decompression is the treatment. No adjuvant radiotherapy or chemotherapy is needed. The knowledge of such an entity will avoid surprises in the diagnosis and facilitates the management.
[ABSTRACT]
[FULL TEXT]
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[EPub]
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1,575
26
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ORIGINAL ARTICLES
Translation and Validation of Penn Acoustic Neuroma Quality of Life Scale for Hindi-Speaking Population
Manju Mohanty, Rupinder Kaur, Sunil Kumar Gupta, Manjul Tripathi, Akhilesh Sharma, Sanjay Munjal
May-June 2022, 70(3):948-952
DOI
:10.4103/0028-3886.349585
PMID
:35864623
Background:
The Penn Acoustic Neuroma Quality-of-life Scale (PANQOL) was specifically developed for assessing the quality of life (QOL) in patients with vestibular schwannoma (VS). Its utility has been established in many populations, but it has not been validated for use in India.
Objective:
The objective of this study was to translate PANQOL into Hindi and validate it for use in India.
Materials and Methods:
PANQOL was translated into Hindi by using the standardized procedure. Its conceptual equivalence was established by administering. For validation, PANQOL-Hindi and SF-36 were administered to 78 patients aged above 18 years and recently diagnosed to have VS. Test–retest reliability was established by readministering PANQOL-Hindi on 15 patients after 2 weeks.
Results:
Internal consistency was good for the composite scale (α = 0.87). The Cronbach's alpha for all domains except facial dysfunction was in an acceptable range. Intercorrelations between various domains showed that anxiety and energy were strongly correlated. All domains except pain had a strong correlation with the total PANQOL score. The intraclass correlation coefficient test indicated high test–retest reliability for the composite scale (ICC = 0.97; 95% CI, 0.93–0.99). Test–retest reliability for various domains was also good. The construct validity of PANQOL was assessed by correlating its specific domains with SF-36 domains. The meaningful correlations between domains of PANQOL and SF-36 indicated good construct validity.
Conclusions:
PANQOL-Hindi has been adequately translated and has satisfactory psychometric properties.
[ABSTRACT]
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1,569
31
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E-CASE REPORTS
Proximal Dominant Hereditary Motor and Sensory Neuropathy with
TFG
Mutation: First Case Report from India
Afroz F Ansari, Kamlesh Jagiasi, Pawan Ojha, Raahil Ansari, Shashank Nagendra, Sumit Kharat
May-June 2022, 70(3):1220-1222
DOI
:10.4103/0028-3886.349586
PMID
:35864671
Hereditary motor and sensory neuropathy with proximal predominance (HMSN-P) is a rare degenerative disorder inherited in an autosomal dominant fashion. This disease was described first in Japanese descendants from Okinawa and Shiga prefectures in mainland Honshu in 1997. The disease is characterized by adult onset of proximal weakness and atrophy, muscle cramps, fasciculations, areflexia, high incidence of elevated creatine kinase, hyperlipidemia, and diabetes mellitus, resembling Kennedy disease, though the mode of inheritance is autosomal dominant, rather than X linked. We examined a 56-year-old male patient with clinical features suggestive of HMSN-P and positive family history in an autosomal dominant fashion. Clinical, electrophysiological, and genetic factors were also reviewed. The appearance of HMSN-P in India and elsewhere calls for clinicians in nonendemic regions to be familiar with this rare disorder, which has typically been geographically confined.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
1,546
30
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E-ORIGINAL ARTICLES
Clinical Profile, Pathology, and Molecular Typing of Gliomas with Oligodendroglial Morphology: A Single Institutional Experience
Garapati Lavanya, Megha Shantveer Uppin, Rajesh Alugolu, Suchanda Bhattacharjee, Mudumba Vijaya Saradhi, Vamsi Krishna Yeramneni
May-June 2022, 70(3):1020-1024
DOI
:10.4103/0028-3886.349641
PMID
:35864633
Background:
Diffuse gliomas are represented in the 2007 WHO classification of CNS tumors as astrocytomas, oligoastrocytoma, and oligodendroglioma of grades II/III and glioblastomas WHO grade IV, which was a pure morphologic classification. WHO 2016 classification combines morphology with molecular markers like IDH, ATRX, and 1p/19q codeletion to give an integrated diagnosis.
Methods:
The study was carried out on formalin fixed paraffin embedded tissues from 54 patients including three pediatric patients. Molecular studies were performed to know the 1p/19q codeletion status, IDH1R132H, and ATRX immunoexpression. Also, the IDH1R132H status was correlated with survival data.
Results:
The study included 54 tumors with oligodendroglial morphology. IDH1R132H positivity was seen in 85% of total cases and codeletion was seen in 72%. The integrated diagnosis revised the cases into oligodendroglioma (39), astrocytoma (5), and glioblastoma (6).IDH mutant tumors were found to have better survival than negative ones which was statistically significant.
Conclusion:
This study emphasizes the need for molecular work up of tumors with oligodendroglial morphology with readily available techniques like IHC and Fluorescence
in situ
hybridization.
[ABSTRACT]
[FULL TEXT]
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1,544
30
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E-CASE REPORTS
Calcific Miliary Brain Metastasis in Adenocarcinoma Lung Treated with Gefitinib
KP Divya, Ajith Cherian, Pranab K Prabhakaran, Bejoy Thomas, Kuldeep Shetty
May-June 2022, 70(3):1197-1199
DOI
:10.4103/0028-3886.349672
PMID
:35864664
Calcific miliary brain metastasis is an extremely rare form of brain secondaries. A 52-year-old man diagnosed with lung adenocarcinoma, on oncotherapy with gefitinib had a partial initial response to treatment. Later he was readmitted with seizures and cognitive dysfunction. His initial brain computed tomography (CT) and magnetic resonance imaging (MRI) were normal. However, his later CT images revealed multiple small calcified lesions over both hemispheres and contrast MRI revealed scattered tiny miliary nodules enhanced by gadolinium over bilateral cerebral, cerebellar hemispheres, thalami, and basal ganglia with foci of hypointensity in susceptibility-weighted images (SWI) and phase imaging suggesting calcification. A diagnosis of calcific miliary brain metastasis was made. Miliary calcification as an initial presentation of brain metastases in patients with lung cancer is uncommon. Use of oral tyrosine kinase inhibitor like gefitinib increases the likelihood development of calcific brain metastases due to the prolonged survival time contributed by its use.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,538
33
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Contralateral Acute Extradural Hematoma Following Decompressive Craniectomy for Subdural Hematoma Evacuation: A Rare Complication and a Short Literature Review
Shalendra Singh, P Sameer, Debashish Paul, Deepak Dwivedi, Vikas Marwah
May-June 2022, 70(3):1230-1231
DOI
:10.4103/0028-3886.349721
PMID
:35864674
Subdural hematoma (SDH) is a common intracranial lesion seen in severe traumatic brain injury (TBI). The development of contralateral delayed extradural hematoma (EDH) after surgery is well described. But limited literature available about immediate contralateral EDH after subdural hematoma (SDH) evacuation. We report a case of a young adult who developed contralateral EDH following decompressive surgery for acute SDH.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
1,523
26
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E-LETTERS TO EDITOR
Pathological Fractures and Management Dilemmas in Primary Intracranial Hemangiopericytoma with Diffuse Metastasis
Adnan H Shahid, Tejasvi S Randhawa, Manjul Tripathi, Balamurugan Thirunavukkarasu, Amanjit Bal, Sandeep Mohindra
May-June 2022, 70(3):1309-1311
DOI
:10.4103/0028-3886.349628
PMID
:35864704
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,516
29
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E-ORIGINAL ARTICLES
Prospective Study of Sinonasal Outcome Following Endoscopic Skull Base Surgery
Jaypalsinh A Gohil, Antony Stanley, Mohamed A Jamaluddin, Arvind K Singh, Shreykumar Shah, Tobin George, Ranjit D Rangnekar, Prakash Nair, Mathew Abraham
May-June 2022, 70(3):1137-1141
DOI
:10.4103/0028-3886.349666
PMID
:35864651
Background:
Endoscopic endonasal surgery (EES) requires wide sinonasal dissection to achieve adequate visualisation of anatomical landmarks. This can also result in nasal sequelae like crusting, nasal discharge, and anosmia.
Aim:
To use the sinonasal outcome test (SNOT) 22 questionnaire to study the postoperative sinonasal morbidity and its recovery in patients who have undergone EES.
Materials and Method:
Prospective study conducted from November 2017 to May 2018. SNOT-22 questionnaire was administered on patients operated between before EES and then re-administered during outpatient visits at 1 month, 3 months, and 6-12 months following surgery.
Results:
Results of 46 patients were analyzed. The mean duration of follow-up was 11.8 months. The mean preoperative SNOT-22 score was 2.69 ± 4.95. SNOT-22 score at 1 month was 5.52 ± 6.77, at 3 months follow-up was 0.39 ± 1.02, and after 6 months was 0.30 ± 1.00. In 32 patients with a nasoseptal flap, mean preoperative score was 3.34 ± 5.68 (
P
= 0.18), one month following surgery it was 6.68 ± 6.88 and at 3 and 6 months following surgery it was 0.56 ± 1.19 and 0.38 ± 1.15. The mean preoperative nasal domain score was 1.022 (±2.13), the postoperative 1 month score was 2.3 ± 3.7, at 3 months following surgery was 0.22 ± 0.82 and after 6 months of surgery was 0.28 ± 0.96.
Conclusion:
Patients undergoing EES experienced transient worsening of SNOT 22 scores in the first month following surgery and recovered within 3 months of surgery. The improvement was sustained in follow-up visits beyond 6 months of surgery.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,504
39
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E-CASE REPORTS
A Rare Pathologic Collecting and Hoarding Behavior Following Left Middle Cerebral Artery Territory Infarction
Minwoo Lee, Yeo Jin Kim, Yerim Kim
May-June 2022, 70(3):1263-1266
DOI
:10.4103/0028-3886.349595
PMID
:35864684
Background and Significance:
Punding is the term used to describe complex, purposeless abnormal behaviors that are thought to be related to either excessive dopamine stimulation or inhibition. We report a case of punding after cerebral infarction at the caudate nucleus.
Case:
A 70-year-old man presented with acute-onset motor aphasia. Upon examination, he showed no other neurological deficit. The computed tomography scan and magnetic-resonance imaging scan taken during admission were consistent with acute infarctions of the left caudate nucleus and multiple scattered areas of multiple cortices. Six months after the episode, he gradually became disruptive and ill-tempered. He began to buy and collect assorted repair tools. In addition, he presented hoarding behavior by acquiring unnecessary goods and stacking them at his house.
Conclusion:
To the best of our knowledge, this is the first case of punding following an ischemic stroke at the caudate nucleus. Our case strengthens the hypothetical pathophysiology of punding, which may involve not only direct dopaminergic stimulation but also the dysregulation of the dopamine system.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,482
35
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E-LETTERS TO EDITOR
Clinical Challenge: Dural Arteriovenous Fistula Presenting as Venous Encephalopathy
Birinder S Paul, Gagandeep Singh, Gunchan Paul, Anirudh Kulkarni
May-June 2022, 70(3):1299-1300
DOI
:10.4103/0028-3886.349661
PMID
:35864700
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,486
26
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E-ORIGINAL ARTICLES
Epilepsy-Related Injuries in Children: An Institution-Based Study
Jitin Bajaj, Pawan Soni, Namrata Khandelwal, Ketan Hedaoo, Ambuj Kumar, Mallika Sinha, Shailendra Ratre, Vijay Parihar, MN Swamy, YR Yadav
May-June 2022, 70(3):1091-1094
DOI
:10.4103/0028-3886.349663
PMID
:35864644
Background:
Epilepsy carries a lifetime risk of seizure-related accidents. The risk varies according to the socioeconomic profile of a place. Sufficient data is lacking for epilepsy-related accidents in the pediatric population.
Objective:
We aimed to identify the proportion of pediatric epileptic patients who met with accidents and their associated factors.
Methods:
A prospective study was done. Patients of less than 18 years with epilepsy of more than 1-year duration were included and were given a questionnaire modified for the pediatric population. The demography of accidents during seizures and drugs taken were recorded.
Results:
135 epileptic children were included. 70.4% of patients suffered seizure-related accidents ranging from 1-10 accidents in their epilepsy duration. Falls (83.15%) were the most common, 25.26% of them required hospitalization. Accidents due to missing of drug dosage were observed in 23% patients.
Conclusion:
Seizure-related accidents are common in the pediatric population, and may lead to major accidents. Better epilepsy management with extra care for high-risk epilepsy patients may decrease their incidents.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,483
29
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E-LETTERS TO EDITOR
Hydrocephalus: Missed opportunity
Nataraja P Venugopal
May-June 2022, 70(3):1298-1298
DOI
:10.4103/0028-3886.349624
PMID
:35864699
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,486
25
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E-CASE REPORTS
Community Acquired
Staphylococcus Aureus
Necrotizing Pneumonia and Guillain Barre Syndrome: An Unusual Presentation in An Adolescent Patient
Rohini M Surve, Badri P Das, Pavithra Venkateswaran, Karthik Kulanthaivelu
May-June 2022, 70(3):1200-1202
DOI
:10.4103/0028-3886.349608
PMID
:35864665
Community-acquired
Staphylococcus aureus
(SA) pneumonia can present with multiple complications but has not been reported earlier to present as or lead to Guillain Barre syndrome (GBS). However, there are few case reports of GBS following SA infective endocarditis, polymyositis, and meningitis. We report an unusual presentation of GBS most probably secondary to community-acquired SA necrotizing pneumonia in a young immunocompetent adult. The clinical course, challenges in the management, and unfortunate death of the patient due to an unforeseen complication have been discussed. This report adds to the clinical knowledge of rare association of community-acquired SA necrotizing pneumonia and GBS.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,476
33
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E-NEUROIMAGES
Images in Neuroscience: Crowned Dens Syndrome
Lichuan Zeng, Huaqiang Liao, Mingguo Xie, Fengchun Ren, Yudong Zhang, Qu Wang
May-June 2022, 70(3):1329-1330
DOI
:10.4103/0028-3886.349617
PMID
:35864713
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,477
28
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E-CASE REPORTS
An Unusual Case Presenting with New Onset Epileptic Seizure and Unilateral Temporal Lobe Lesion Diagnosed as Influenza Type A Associated Encephalitis
Seyma Ciftci Aykac, Burhanettin Uludag
May-June 2022, 70(3):1203-1206
DOI
:10.4103/0028-3886.349674
PMID
:35864666
Influenza A viruses, known etiological agents of seasonal outbreaks, epidemics, and pandemics, are RNA viruses of the Orthomyxoviridae family. They can manifest with a wide range of neurological complications. Influenza related encephalitis is rarely reported and poorly characterized in adults. Its diagnosis is hampered by significant variation in clinical presentation and difficulties in virus detection in the cerebrospinal fluid. Diffuse brain edema, symmetric involvement of thalamus, brain stem, and cerebellum, or normal findings in the acute phase followed by the appearance of diffuse low attenuation and mild brain atrophy are reported cranial magnetic resonance imaging findings, but unilateral temporal lobe involvement has not been observed before. Here we describe an unusual adult case who presented with new-onset epileptic seizures and unilateral temporal lobe lesion mimicking herpes simplex encephalitis but a polymerase chain reaction of cerebrospinal fluid confirmed influenza type A associated encephalitis.
[ABSTRACT]
[FULL TEXT]
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[EPub]
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1,448
32
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Unilateral Left Frontal Lobe Lesion in a Marburg's Variant of Multiple Sclerosis Patient with Impaired Swallowing and Speech: A 3-Year Clinical/Brain MRI Follow-up
Ivanovic B Jovana, Mesaros T Sarlota, Nikolic P Ivan, Drulovic S Jelena
May-June 2022, 70(3):1226-1229
DOI
:10.4103/0028-3886.349594
PMID
:35864673
Although the importance of bilateral cortical innervation in the control of swallowing is well known, neurogenic dysphagia caused by unilateral hemispheric ischemic lesion has been also reported. Our patient is a 41-year-old male who developed difficulty swallowing liquids, oral apraxia, and motor dysphasia, followed by right-hand ataxia. Brain magnetic resonance imaging (MRI) showed subcortical tumefactive conglomerate of cystic lesions in the left frontal, precentral region, which were sharp edged, with perilesional edema, concordant with lesions in Marburg's variant of multiple sclerosis. Steroid treatment and plasma exchange therapy led to disappearance of neurological symptoms. Treatment with interferon β-1a 40 mcg sc was initiated. During a 3-year follow-up, clinical/brain MRI scan showed no new neurological manifestations, a significant regression of lesion size, and no new brain lesions. To the best of our knowledge, this is a first case of dysphagia caused by unilateral hemispheric lesion in a multiple sclerosis patient.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
1,448
29
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E-LETTERS TO EDITOR
Frontal Bone Osteomyelitis: A Dreaded Complication of Post-COVID Mucormycosis
Sandip B Mavani, Sujai J Joshi
May-June 2022, 70(3):1283-1284
DOI
:10.4103/0028-3886.349670
PMID
:35864692
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,436
34
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E-CASE REPORTS
A Review of the Diagnostic Features of Posteriorly Migrated Lumbar Discs with Reports of Two Cases
Ajaya Kumar Ayyappan Unnithan
May-June 2022, 70(3):1213-1216
DOI
:10.4103/0028-3886.349665
PMID
:35864669
Background:
The radiological features of posteriorly migrated intervertebral discs mimic tumors, hematoma, and abscess.
Objective:
The aim is to analyze two cases of posteriorly migrated lumbar discs.
Cases:
Two males had features of cauda equina syndrome. Both had posterior lesions at L4/5 level in magnetic resonance imaging. The mass of the 41-year-old man had peripheral rim enhancement with gadolinium. The epidural mass was excised. The histopathology showed fibrocartilaginous disc. The 67-year-old man had mass with moderate enhancement. The mass had thinned the dura to appear as intradural tumor. The histopathology showed a fibrocartilaginous disc. Immunohistochemistry was negative for neoplasm.
Conclusion:
A migrated disc should be considered in the case of a posterior extramedullary mass. The granulation tissue around the disc produces peripheral enhancement with gadolinium. Thin enhancement is common. Thick enhancement is also reported. Neoplasms have intense enhancement and inflammatory changes are seen in abscess.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,413
32
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Stereotactic Radiosurgery with Gamma Knife in Recurrent Rathke's Cleft Cyst: Case Report and Literature Analysis
Andrea Manzoni, Filippo Leocata, Marco Picano, Virginia Maria Arienti, Hae Song Mainardi, Marco Cenzato, Roberto Stefini, Alessandro La Camera
May-June 2022, 70(3):1260-1262
DOI
:10.4103/0028-3886.349598
PMID
:35864683
Background:
Rathke's cleft cyst is a benign expansive lesion of the sella turcica. If related to clinical disorders, the patient needs surgical treatment.
Objective:
To demonstrate the efficacy of radiosurgery in the treatment of relapse of Rathke's cleft cyst as an alternative to surgery.
Methods and Material:
The stereotactic radiosurgical treatment was performed at the Gamma Knife Center of the Niguarda Hospital in a patient with Rathke's cleft cyst subjected to two subsequent neurosurgical resections with early regrowth of the cyst. The cyst underwent radiosurgery with a prescription dose of 12 Gy at 50% (minimum dose 9.8, mean 17.3 and maximum 24.4).
Results:
Three years after stereotactic radiosurgical treatment the patient is asymptomatic and does not present disorders of the hypothalamic-pituitary axis or further visual alterations. The control MRI shows a reduction of the cyst's volume.
Conclusions:
Stereotactic radiosurgery resulted in a reduction of the cyst's volume and avoided further recourse to surgery.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,400
27
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A Rare Case of Postoperative Extradural Hematoma in the Posterior Fossa Complicated by Both Stunned Myocardium and Neurogenic Pulmonary Edema
Subodh Kumar, Chandrakant Prasad, Charu Mahajan, Siddharth Chavali, Ankita Madan, Girija Prasad Rath, Ashish Suri
May-June 2022, 70(3):1217-1219
DOI
:10.4103/0028-3886.349626
PMID
:35864670
Acute neurological insult can trigger a cascade of events in other organ systems such as the heart and lung. Neurogenic stunned myocardium (NSM) and Neurogenic pulmonary edema (NPE) are mostly reported after stroke, subarachnoid hemorrhage, or seizures whenever sympathetic storm and autonomic dysregulation occurs. We report here for the first time, a case of postoperative infratentorial extradural hematoma in a patient triggering NSM and NPE at the same time. The challenges involved in the management of such a patient are described in this case report. The patient was successfully managed and discharged home with no new neurological deficits.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,389
32
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IgG4-related Pachymeningitis as a Cause of Spinal Epidural Compression: Can Intraoperative Frozen Sections Predict the Underlying Pathology?
Madhivanan Karthigeyan, Rekhapalli Rajasekhar, Pravin Salunke, Kirti Gupta
May-June 2022, 70(3):1223-1225
DOI
:10.4103/0028-3886.349589
PMID
:35864672
At times, spinal lesions are part of systemic manifestations of autoimmune disease. Awareness regarding their clinicopathological spectrum, particularly the lesions which usually respond to steroids/immunotherapy, is essential to avoid unwanted surgical morbidity. We discuss a case of a young-man presenting with thoracic spinal epidural compressive lesion which was indeed a manifestation of IgG4-related hypertrophic pachymeningitis. The mass was firmly adherent to the dura and extended into left neural foramen/paravertebral space which precluded complete excision. Frozen sections suggested fibro-inflammatory stroma with large areas of fibrosis and lymphoplasmacytic infiltrate. After subtotal excision, the patient improved with medical therapy at 1-year follow-up. Although uncommon, the case highlights the need to consider spinal presentation of this rare entity, especially in the context of autoimmune disorders or even in isolation. In this regard, intraoperative frozen section can hint the underlying inflammatory/autoimmune pathology, guide further course of surgery as well as limit unwarranted operative morbidity.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,388
31
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Suprameatal Extension of Retrosigmoid Approach in Microvascular Decompression for Trigeminal Neuralgia with Petrous Endostosis: Case Report and Literature Review
Nitish Agarwal, Amandeep Kumar, Pankaj Singh, PS Chandra, Shashank S Kale
May-June 2022, 70(3):1240-1243
DOI
:10.4103/0028-3886.349582
PMID
:35864678
Petrous endostosis or prominent suprameatal tubercle is a rare entity which may prevent adequate microscopic exposure of the trigeminal nerve root entry zone during microvascular decompression (MVD) for trigeminal neuralgia. We present a rare case of trigeminal neuralgia (TN) with petrous endostosis, which was managed adequately by partial removal of the prominent suprameatal tubercle to improve the obscured site of neurovascular conflict and enabled complete MVD. Through this manuscript, we additionally discuss the nuances involved in this extension of the standard retrosigmoid approach in light of the published literature. Petrous endostosis encountered during MVD for TN can impose an operative challenge. Suprameatal extension of the standard retrosigmoid approach improves exposure at the site of neurovascular conflict but requires utmost care and attention to avoid complications. We emphasize recognizing this anatomical variation in the preoperative period to predict an operative difficulty, ensure appropriate patient counselling, and avoiding surgical complications.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,388
31
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E-BRIEF REPORTS
Preoperative Transvenous Liquid Embolization for a Symptomatic Lumbar Spinal Epidural Varix Mimicking Radiculopathy
Mena G Kerolus, Dallas E Kramer, Mazda K Turel, Rabia Malik, Richard G Fessler, Michael Chen
May-June 2022, 70(3):1176-1179
DOI
:10.4103/0028-3886.349671
PMID
:35864659
Background:
Symptomatic spinal epidural veins (SEV) are a rare cause of neurologic dysfunction. Treatment is centered upon addressing the underlying venous pathology to relieve mechanical compression of the neurologic structures. However, open surgical ligation is often associated with considerable blood loss.
Objective:
We discuss a unique case of a large symptomatic epidural venous varix and potential treatment strategy.
Methods and Materials:
A 15-year-old female presented with a 1-year history of left L5 radicular pain and weakness. Lumbar MRI demonstrated a central L5/S1 herniated disc and a large extradural anomalous SEV compressing the exiting left L5 nerve root at the L5/S1 neuroformina. The SEV was treated using a transvenous liquid embolic agent providing symptomatic relief. At 16-months follow-up, she reported recurrent symptoms. She ultimately underwent a left L5/S1 MIS decompression without complication.
Conclusion:
Transvenous liquid embolization of large symptomatic SEV may provide temporary neurologic relief and decrease morbidity associated with open surgical treatment options.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,387
27
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E-LETTERS TO EDITOR
An Endoscopic Transcortical-Transventricular Approach to Septum Pellucidum Ganglioglioma
Gagandeep Attri, Ashutosh Kumar, Suyash Singh, Kamlesh Singh Bhaisora
May-June 2022, 70(3):1278-1280
DOI
:10.4103/0028-3886.349611
PMID
:35864690
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,386
28
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Suspecting Wernicke's Encephalopathy in Pregnancy
Madhurima Sharma, Uday J Thakkar, Tejas Padodara, Vishal Jogi
May-June 2022, 70(3):1304-1305
DOI
:10.4103/0028-3886.349673
PMID
:35864702
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,384
30
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Cortical Dysplasia with Associated Lipomatosis—A Rare Cause of Seizures
Shariq A Shah, Mohd Ilyas, Azher M Khan, Naseer A Choh, Feroze A Shaheen
May-June 2022, 70(3):1316-1317
DOI
:10.4103/0028-3886.349652
PMID
:35864707
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,386
24
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Role of Radiotherapy in Spinal Cord Compression Due to Extramedullary Hematopoiesis in Thalassemia Intermedia
Ankita Pandey, Himanshu Mishra, Ritusha Mishra
May-June 2022, 70(3):1294-1295
DOI
:10.4103/0028-3886.349587
PMID
:35864697
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,380
29
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E-ORIGINAL ARTICLES
Trans-Thoracic Extra-Pleural Percutaneous Spinal Fixation—A Technical Note
Shyam S Krishnan, Pulak Nigam, Madabhushi C Vasudevan
May-June 2022, 70(3):1154-1158
DOI
:10.4103/0028-3886.349593
PMID
:35864654
Study Design:
Cross-sectional analysis of defined parameters of patients who underwent the presented technique.
Patients undergoing thoracic spine fixation for various pathologies.
Objective:
This technique attempts to limit the incision size in extrapleural thoracotomy for multi-level spinal fixation.
Summary of Background Data:
Dorsal spine is traditionally approached by either transpleural or extrapleural approach. The extrapleural approach carries a limitation of being restricted in number of levels it can address. By incrementally modifying the present technique, we were able to employ the approach in greater number of levels with lesser morbidities.
Method:
Classical extrapleural thoracotomy approach is employed with incision size limited to the levels of pathology (~5 cm). Thereafter, proper exposure using Kittner dissection and defining of screw entry points follows. Stab incision is made and screws placed percutaneously through a K-wire-defined trajectory.
Results:
Eighteen patients underwent fixation through this technique, of which 11 were infectious, four were traumatic, and the rest were neoplastic in pathology. None except three patients had ICU stay of more than 1 day. All patients had a pain score of 6 or lower except for two.
Conclusion:
Combining the technique of percutaneous screw placement with traditional extrapleural thoracotomy reduces the size of the incision, tissue damage, and morbidity while reducing the cost and duration of hospitalization without comprising the extent of pathology that can be dealt with.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,358
28
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E-LETTERS TO EDITOR
Pure Artery Malformation of Posterior Cerebral Artery with Dysplastic Internal Carotid Artery
Gyani J S Birua, Gaurav Tyagi, Manish Beniwal, Dwarakanath Srinivas
May-June 2022, 70(3):1292-1293
DOI
:10.4103/0028-3886.349591
PMID
:35864696
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,354
28
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E-ORIGINAL ARTICLES
Specifics of Relationship within a Complex of Neurological Deficit, Quality of Life and Depression in the Phenotypic Spectrum of Multiple Sclerosis
Anahit Y Sahakyan, Hovannes M Mavelyan
May-June 2022, 70(3):1083-1090
DOI
:10.4103/0028-3886.349619
PMID
:35864643
Background:
The mechanisms, leading to depression development in multiple sclerosis (MS) include progressive demyelination and axonal degeneration along with neurological deficit and a certain similarity of mechanisms leading to the development of immunological disorders and neuroinflammation involved in the pathogenesis of MS and depression.
Objective:
The objective of the study was to examine the specifics of relationships within a complex of neurological deficit, depression, and quality of life in MS.
Materials and Methods:
For purposes of integral quantification of neurologic disability in various functional systems, the “Expanded Disability Status Scale” (EDSS) is used. The severity of depression was measured using the Beck Depression Inventory (BDI). The level of quality of life was measured through the MS Quality of Life (MSQOL)-54 Instrument and Physical Health Composite Score MSQOL-54. The study was conducted among patients with relapsing-remitting (RRMS (
n
= 52) and secondary-progressive (SPMS,
n
= 51) phenotypes of MS.
Results:
The study shows a positive correlation of depression with various indicators of the physical and mental components of the QOL of patients per course and progression of MS phenotypes. It was revealed that in SPMS patients' correlation is significant compared to patients with RRMS. It's proven that the risk of developing depression in patients with RRMS and SPMS depends on the level of neurological deficit.
Conclusions:
The infrastructure of the target parameters study evidenced that regardless of the type of MS course, depression was found to have a stable connection with neurological impairment (per EDSS scale), especially in the secondary-progressive course of MS (SPMS).
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,306
29
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E-BRIEF REPORTS
Ventriculocholecystal Shunt as a Salvage Procedure in Shunt Dependent Hydrocephalic Children with Compromised Peritoneal Cavity
Kaushik Sil, Sudip Ghosh, Sandip Chatterjee
May-June 2022, 70(3):1187-1190
DOI
:10.4103/0028-3886.349646
PMID
:35864661
Multiple shunt revisions are a formidable challenge in neurosurgery, as the surgeon faces progressive difficulties in finding suitable distal sites for implantation. Gallbladder offers an alternative safe implantation site of distal catheter in case of repeated peritoneal failures. We describe two such cases done in our institute in this brief report. One case has long term functioning shunt, whist other had complications. Relevant literature is also briefly reviewed here
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,306
26
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E-LETTERS TO EDITOR
MOG-Antibody Mediated Clinically Isolated Syndrome after COVID-19 in a Post Partum Woman- A Veritable 'Double Hit'!
Radhika Lotlikar, Ramshekhar N Menon, Bejoy Thomas, Rajalakshmi Poyuran, Deepti Narasimhaiah, Dinoop K Ponnambath
May-June 2022, 70(3):1281-1282
DOI
:10.4103/0028-3886.349651
PMID
:35864691
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,290
29
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E-BOOK REVIEW
Evolution of Neurosciences: A Historical Review with Brief Biographies of Some of its Selected Pioneers
Sunil K Pandya
May-June 2022, 70(3):1333-1334
DOI
:10.4103/0028-3886.349722
PMID
:35864715
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,268
37
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E-ORIGINAL ARTICLES
Gamut of Orbital Lesions in a Tertiary Neurocenter—A Clinicopathological Study of Lesions Seen Over a Period of One Decade
Anusha S Bhatt, Bevinahalli N Nandeesh, Radhika Mhatre, Anita Mahadevan, Vani Santosh, T Chickabasaviah Yasha
May-June 2022, 70(3):1069-1076
DOI
:10.4103/0028-3886.349632
PMID
:35864641
Background:
The orbital region is an anatomically complex area comprising crucial contiguous/adjacent structures. Since the eye has a neuroectodermal basis of embryogenesis, many of the lesions may be similar to those arising in the central nervous system.
Objective:
To record and describe the clinicopathological spectrum of orbital lesions presenting to a neurology center.
Study Setting:
The retrospective study included biopsy/resected specimens of patients with orbital/ophthalmic lesions referred to the Department of Neuropathology, between February 2007 and February 2018.
Materials and Methods
: The demographic, clinical, and radiological details were retrieved from the departmental archives and the slides were reviewed.
Results:
There were 99 cases in the period of the study (2007–2018) with a peak in fourth and fifth decades (age range: 5 months to 68 years; mean: 37.2 years; M: F =1.06: 1). Eighty-six (86.8%) cases had epicenter in the orbit, whereas 13 (13.13%) cases were extraorbital with orbital extension. The benign neoplasms predominated (50/99, 50.5%) followed by malignant neoplasms (24/99, 24.24%), infective conditions (11/99, 11.11%) and tumor like conditions (7/99, 7.07%). The most common benign tumor was vascular tumor (17/50, 34%) followed by meningioma (12/50, 24%), while epithelial malignant tumor (6/24, 25%) was the most common malignancy. Fungal infection was the most frequent infective condition (6/11, 54.5%).
Conclusion:
The spectrum of ocular-orbital lesions varies with the geographic area and the nature of the institute catering to the needs of patients. The spectrum of lesions that we encountered from a neurological institute was vastly different from that reported from ophthalmic centers with very low frequency of retinoblastomas.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,272
28
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E-NEUROIMAGES
Spinal Arachnoiditis Ossificans: A Chronic Sequela of Tuberculosis
Madhivanan Karthigeyan, Aastha K Takkar, Pravin Salunke, Rajender Kumar, Rajeev Ranjan, Vivek Lal
May-June 2022, 70(3):1322-1323
DOI
:10.4103/0028-3886.349606
PMID
:35864710
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,262
28
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E-LETTERS TO EDITOR
Rathke's Cleft Cyst Apoplexy—A Newly Introduced Terminology with Presentation of Seizure
Rajan Shah, Prashik Yashwant Waghmare, Sudhendoo Babhulkar, Shashank Sonkusare
May-June 2022, 70(3):1306-1308
DOI
:10.4103/0028-3886.349667
PMID
:35864703
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,250
27
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E-NEUROIMAGES
Skull Base Chordoma Extending into the Oropharynx and Upper Cervical Spine: A Diagnostic Dilemma
Pargyan Sarma, Manish Garg, Sujata Chaturvedi, Ishita Pant
May-June 2022, 70(3):1324-1326
DOI
:10.4103/0028-3886.349596
PMID
:35864711
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,245
28
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E-LETTERS TO EDITOR
Post ChAdOx1 nCoV-19 Corona Virus Vaccine (Recombinant) (Covishield) Pulmonary Thromboembolism with Multiple Intracranial Ischemic Infarcts
Rajendra S Jain, Kaavya Rao, Paresh Sukhani, Ashish Pemawat
May-June 2022, 70(3):1287-1288
DOI
:10.4103/0028-3886.349719
PMID
:35864694
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,238
29
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E-NEUROIMAGES
“Oculi Post Oculum”: An Appearance of a Ruptured Intraventricular Dermoid
Saswat K Dandpat, Tejas P Vaja, Survendra K Rai, Aadil Chagla, Amit Mahore
May-June 2022, 70(3):1327-1328
DOI
:10.4103/0028-3886.349599
PMID
:35864712
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,240
26
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E-LETTERS TO EDITOR
Superior Petrosal Vein Sacrifice in MVD Surgery
Krishnamurthy Sridhar
May-June 2022, 70(3):1273-1274
DOI
:10.4103/0028-3886.349720
PMID
:35864687
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,227
27
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E-CASE REPORTS
Intrameningioma Metastases – A Wolf among the Sheep
Nishant Lal, S Shajehan, Usha Shajehan, Rachel Abraham
May-June 2022, 70(3):1247-1250
DOI
:10.4103/0028-3886.349610
PMID
:35864680
Systemic metastases to primary tumors involving the brain are uncommon. Tumor-to-tumor metastasis involving meningioma from carcinoma breast is very rare. Neuroimaging may suggest the diagnosis—these are neither sensitive nor specific. Thus, the only way to diagnose it is through tissue biopsy.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,226
26
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E-NEUROIMAGES
Recurrence of an Intradural Lumbar Schwannoma 8 Years after Gross Total Resection
Mohit Patel, Manish K Kasliwal
May-June 2022, 70(3):1320-1321
DOI
:10.4103/0028-3886.349680
PMID
:35864709
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,216
25
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E-LETTERS TO EDITOR
Immediate Perioperative Stroke After Transcervical Excision of Carotid body tumor with Graft reconstruction of Internal Carotid Artery—Successfully treated with Mechanical Thrombectomy
Anshu Mahajan, Vinit Banga, Apratim Chatterjee, Gaurav Goel
May-June 2022, 70(3):1301-1303
DOI
:10.4103/0028-3886.349725
PMID
:35864701
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,179
27
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Greater Superficial Petrosal Nerve Schwannoma: A Common Pathology at an Uncommon Location
Sumit Bansal, Ayusman Satapathy, Suvendu Purkait, Rabi Narayan Sahu
May-June 2022, 70(3):1275-1276
DOI
:10.4103/0028-3886.349643
PMID
:35864688
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,155
25
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Neuropsychologists and Their Role in Developing an Awake Craniotomy Program
Aliasgar V Moiyadi
May-June 2022, 70(3):1296-1297
DOI
:10.4103/0028-3886.349579
PMID
:35864698
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,146
24
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Recurrent Traumatic Direct Carotid-Cavernous Fistula Associated with Rare Cerebellar Hemorrhage Caused by Venous Reflux
Jie Shen, Weiying Zhong, Wandong Su
May-June 2022, 70(3):1267-1269
DOI
:10.4103/0028-3886.349648
PMID
:35864685
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,114
29
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A 22-Year Course of a Case with Central Neurocytoma
Abhidha Shah, Ravikiran Vutha, Akshay Hawaldar, Atul Goel
May-June 2022, 70(3):1314-1315
DOI
:10.4103/0028-3886.349655
PMID
:35864706
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,102
27
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Cerebral Microbleeds Detected by Susceptibility-Weighted Imaging in a Patient with Idiopathic Normal Pressure Hydrocephalus: A Case Report
Rongrong Hua, Yan Xing, Jian Li, Youping Wei
May-June 2022, 70(3):1312-1313
DOI
:10.4103/0028-3886.349677
PMID
:35864705
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,100
26
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E-ORIGINAL ARTICLES
A Comprehensive Stemness Gene Expression Analysis Signifies the Role of ABC Transporters and Molecular Chaperons in Determining the Fate of Human Neural Precursor Cells
Sandeep Kumar Vishwakarma, Avinash Bardia, Syeda Sumaiya B Fathima, Syed Ameer Basha Paspala, Aleem Ahmed Khan
May-June 2022, 70(3):1102-1111
DOI
:10.4103/0028-3886.349631
PMID
:35864646
Background and Aim:
The major aim of this study was to identify the most common stemness genes across different stem cell types and further validate them in human fetal subventricular zone-derived primary and cultured neural precursor cells (NPCs). This study involved the use of a unique method of stemness meta-analysis (SMA) for investigating comprehensive upregulation and downregulation of differentially expressed genes (DEGs) among different stem cell populations.
Materials and Methods:
A total of 55 mouse and human data sets targeting crucial genes identified in seven different types of stem cells population were screened and subjected to independent DEGs analysis using SMA. Identified 30 meta-gene signatures were subjected to functional enrichment analysis based on their biological processes and molecular functions. Validation of enriched meta-gene signatures was performed using RT-qPCR. Cellular localization of
ABCB1
and
ABCG2
was identified using immunofluorescence staining, whereas functional assessment was performed using western-blot.
Results:
SMA analysis revealed that among 52 commonly expressed genes, 30 genes were either upregulated or downregulated in at least two stem cell populations. Further gene enrichment analysis showed nine genes (
ABCB1, ABCG2, HSPA4, HSPA9, HSPA14, Nestin, Sox-2, Oct-4, and Notch-
2) with the highest combined scores among 30 meta-gene signatures. RT-qPCR demonstrated that all the enriched gene signatures were significantly upregulated in primary NPCs and further downregulated during NPCs lineage differentiation in culture except
HSPA4, HSPA9
, and
HSPA14
gene transcripts.
Conclusions:
The stemness meta-gene signatures were abundantly expressed in human NPCs population which categorically suggest the involvement of these genes/pathways in pluripotency maintenance and molecular switches for lineage differentiation while HSP-70 had a neuroprotective effect.
[ABSTRACT]
[FULL TEXT]
[PDF]
[PubMed]
1,099
27
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