bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Outcomes of Paediatric-Onset Craniopharyngioma
Authors: Harsha Gunna Sri , Dabadghao Preeti , Sudhanshu Siddhnath
Published: August 2023

Background:

Craniopharyngiomas are associated with long-term morbidity in the form of hormone deficiencies, visual deficits, and hypothalamic obesity.

Objective:

To study the long-term outcomes, including cure rates, endocrine dysfunction, visual dysfunction, hypothalamic obesity, and mortality in pediatric-onset craniopharyngiomas.

Methods:

A retrospective data analysis of pediatric (onset <18 years) craniopharyngioma diagnosed between 2003 and 2018. Data were collected from electronic hospital records, case files, and direct patient interviews.

Results:

The mean age at presentation was 10.4 ± 4.5 years (n = 62). The median duration of symptoms at diagnosis was 6 months (3–13 months). At presentation, central diabetes insipidus was present in four (6.5%), central hypothyroidism in 27 (43.5%), secondary adrenal insufficiency in 20 (32%) and delayed puberty in 15 (24%) patients. Hypothalamus was involved in 59/60 patients (98%). At last visit, 22.6% were obese in comparison to 4.6% at presentation, and anterior pituitary deficiency was present in 90% of the patients. Sixty-one percent patients (n = 62) had delayed puberty and 67% (n = 53) had short-stature. Out of 35 short children, nine (14%) children who received growth hormone had significant increase in height SD score (−3.8 (1.4) at start vs. −2.9 (1.2) at last follow-up; P = 0.008). Tumor progression was significantly less in the group that received RT compared to those who did not (8% vs. 39%; P = 0.002).

Conclusion:

Childhood-onset craniopharyngioma results in significant morbidity. The prevalence of pituitary hormones deficiency, visual deficits, and obesity are high at long-term follow-up. Incomplete tumor removal is also frequent. Thus, long-term monitoring is necessary for the timely management of the morbidities associated with craniopharyngioma.
Schizencephaly and the Neurodevelopmental Model of Psychosis
Authors: Patwal Rahul , Pai Naveen Manohar , Ganjekar Sundarnag , Arshad Faheem , Alladi Suvarna , Sharma Manoj Kumar , Desai Geetha , Chaturvedi Santosh K
Published: August 2023

Background:

Schizencephaly is a rare congenital disorder of cerebral cortical development. Clinical features vary based on the areas and severity of cortical involvement. The most prominent manifestations being motor deficits, seizures, and cognitive impairment. MRI has been the diagnostic modality of choice. Till now, a handful of case reports associating schizencephaly with psychiatric manifestations have been reported.

Methods:

In this brief report, we review the available literature and present the summary of a 50-year-old gentleman who presented with paranoia, irritability, impulsive spending, emotional lability, and circumstantial speech with perseveration of themes.

Results:

MRI findings are suggestive of closed lip schizencephaly.

Conclusion:

This case helps us in understanding the neurodevelopmental model and functional neuroanatomy of psychiatric symptom dimensions.
Clival Tuberculosis
Authors: Gandhi Anish S , Nadkarni Trimurti D , Balasubramaniam Srikant
Published: August 2023

A 39-year-old female presented with complaints of occipital headaches, diplopia, numbness over left half of face and deviation of face to the right. On examination she had hypoesthesia over left half of face, associated with bilateral abductor and left facial palsy. Neuroradiology showed a well-defined lytic lesion involving the clivus and adjacent sphenoid sinus and sella. The patient underwent an endoscopic transnasal decompression of the clival lesion. Intraoperative squash preparation was reported to show tuberculous granulation, which was confirmed on postoperative histology. The patient was advised anti-tubercular therapy. At 12 months follow up neuroradiology showed a near total resolution of the clival lesion. The patient had completely recovered from her cranial nerve deficits. Tuberculous involvement of spheno-clival region is rare and the authors' literature search has yielded only three previous similar case reports. A surgical decompression followed by anti-tubercular therapy is the recommended approach for management of clival tuberculosis. The relevant literature on the subject is presented.
A Rare Genetic Cause of Young Onset Rapidly Progressive Dementia- First Report from India
Authors: Reddy Tallapalli Ashok Vardhan , Nashi Saraswati , Kamath Sneha D , Srijithesh PR , Kulkarni Girish B , Alladi Suvarna
Published: August 2023

We present a case of a 40-year-old man with rapid decline in cognition followed by Parkinsonism, apraxia and stimulus sensitive myoclonus within 9 months of onset. Magnetic Resonance imaging (MRI) showed periventricular confluent white matter changes with persistent diffusion restriction even after 9 months. Clinical exome sequencing showed colony stimulating factor 1 receptor (CSF1R) gene mutation. The phenotype, MRI and genotype are suggestive of adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP). This is the first case being reported from India. Differential diagnosis of young onset dementia is broad. Therefore, finding the exact etiology is challenging. Neuroimaging and genetic analysis greatly aid in the final diagnosis.
Preliminary Study on the Effect of Impaired Glucose Tolerance on Blood-Brain Barrier Permeability in Non-Neurosyphilis Patients
Authors: Wang Feng , Che Xingyu , Yang Qingwei , Wang Ru , Zeng Jianqi , Chen Yiqian , Su Xinhui , Miao Jiayin
Published: August 2023

Background:

Blood-brain barrier (BBB) is frequently disrupted in patients with diabetes mellitus (DM) and/or neurosyphilis (NS). Clinical cases reflect a trend that non-neurosyphilis (non-NS) patients with impaired glucose tolerance (IGT) are likely to develop NS and/or DM.

Objective:

To investigate whether IGT promotes BBB disruption in patients with non-NS.

Methods and Material:

A total of 21 subjects were enrolled, including six with IGT, nine with non-NS, and six with both IGT and non-NS. BBB permeability was evaluated by dynamic contrast-enhanced (DCE) MRI and the secretion of biomarkers from cerebrospinal fluid (CSF) were measured by colorimetric method, immune turbidimetric method, and enzyme-linked immunosorbent assay (ELISA) method.

Results:

The non-NS patients with IGT have higher BBB permeability at cortex superior frontal gyrus, white matter, and thalamus than non-NS patients without IGT or IGT patients without non-NS. The CSF-serum albumin-quotient (Qalb) levels and CSF secretion are highest in non-NS patients with IGT, including matrix metalloproteinase 9 (MMP9), soluble intercellular cell adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1).

Conclusions:

Significant correlations between CSF biomarkers and BBB permeability were found.
Unilateral Biportal Percutaneous Transforaminal Endoscopic Lumbar Foraminal Decompression and Discectomy
Authors: Gandham Edmond Jonathan , Uvaraj Nalli Ramanathan , Eum Jin Hwa
Published: August 2023

Background and Introduction:

Minimally invasive spine surgery (MISS) is a set of techniques and procedures that reduces the local tissue injury while achieving the same results through traditional open surgery. The techniques for the treatment of lumbar disc herniation and degenerative canal stenosis have evolved from tubular discectomy to endoscopic discectomy. This helps in preserving spine function. Good clinical outcomes have been reported with the use of an endoscope for degenerative lumbar disc disease.

Objective:

In this video abstract, we present a case lumbar foraminal stenosis in an elderly man that was treated successfully using unilateral biportal endoscopic spine surgery. (UBESS).

Surgical Technique:

A 70-year-old man presented with progressive neurogenic claudication and left L4 numbness and paresthesias. His claudication distance was 200 m. His MRI Lumbosacral spine showed severe left L4-5 foraminal stenosis due to a disc prolapse. The patient underwent a left-sided unilateral biportal endoscopic transforaminal decompression and discectomy at L4-5 successfully. Postoperative period was uneventful and the patient had significant relief in his symptoms. Postoperative MRI Lumbosacral spine showed no muscle damage with adequate decompression at left L4-5 level.

Results:

The patient had an uneventful recovery.

Conclusion:

Biportal percutaneous transforaminal endoscopic discectomy/decompression is an ideal alternative to the uniportal endoscopic and minimal invasive microsurgery for foraminal and paracentral disc herniations and lateral recess and foraminal stenosis.
Genetic Polymorphisms in DRD4 and Risk for Parkinson's Disease Among Eastern Indians
Authors: Dipanwita Sadhukhan , Arindam Biswas , Atanu Biswas , Kunal Ray , Jharna Ray
Published: August 2023

Background:

Genetic factors, including causal gene and modifier genes, contribute significantly in PD pathogenesis in an ethnicity-dependent manner. Dopamine Receptor 4 (DRD4), involved in dopamine metabolism is one such modifier locus for PD.

Objective:

To identify the potential association of DRD4 polymorphic variants with PD among Eastern Indians.

Methods and Materials:

PD-related DRD4 variants were genotyped among 291 PD patients and 265 ethnically matched controls from Eastern India.

Results and Conclusion:

Among the three DRD4 variants, only the 120 bp duplicated allele [P = 0.036; Odds ratio: 1.323; 95% CI: 1.014–1.725] and its homozygous genotype [P = 0.034; Odds ratio: 1.452; 95% CI: 1.025–2.057] were found as risk factors for overall PD and sporadic PD among Eastern Indians. However, no other disease-associated variant or haplotype was identified. Therefore, in conclusion, our study demonstrates that DRD4 plays a small role in PD pathogenesis among Eastern Indians.
Adult-Onset Subacute Sclerosing Panencephalitis
Authors: Panda Samhita
Published: August 2023

Subacute sclerosing panencephalitis (SSPE), an insidiously progressive slow viral infection of the central nervous system caused by the mutated measles virus, is invariably fatal. Various medications have been tried unsuccessfully till date with rare remissions. A case of 21-year woman with adult-onset SSPE who improved after treatment is reported. She had seizures, psychosis, and extrapyramidal symptoms and was on multiple anti-seizure medications without response. She was given a trial of levamisole with gradual escalation and achieved complete clinical remission by 21 months. This case demonstrates the curative potential of levamisole in adult-onset SSPE. A review of previous treatments attempted in cases who underwent remission of SSPE is also presented.
Protective Effect of L-Arginine in an Animal Model of Alzheimer's Disease Induced by Intra-Hippocampal Injection of AlCl3
Authors: Karami Manizheh , Geravand Samira , Rahimpour Mahnaz
Published: August 2023

Background and Objective:

Aluminum chloride (AlCl3) can impair spatial memory recovery. We investigated the protective effect of L-arginine, a precursor of nitric oxide (NO), on memory retrieval in an Alzheimer's animal model induced by AlCl3 at intra-hippocampal CA1 using a seeking behavior practice.

Materials and Methods:

Wistar rats were deeply anesthetized and cannulated at CA1 (AP: -3.8 mm, L: ±2.2 mm, V: 3 mm), and received once AlCl3 (1–200 μg/rat, intra-CA1), on day of cannulation under stereotaxic device. After a week of recovery, they experienced the novelty task with a three-stage paradigm and injected L-arginine (0.05–25 μg/rat) intra-CA1, pretesting. L-NAME, the neuronal NO synthase inhibitor was administered before L-arginine effective doses in the test stage. Also, a reference group exclusively received beta-amyloid 2 μg/rat. Control group solely received saline. Finally, after euthanasia of rat, the hippocampal sample was collected on ice and evaluated by immunohistochemical marking and specific staining.

Results:

AlCl3 caused novelty-seeking behavior without meaningful change in animal locomotor activity. βA (2 μg/rat, intra-CA1) affected the rat's grooming, causing it to stop further in the new side. Pretest injection of L-arginine restored behavior in AlCl3-treated rats; however, this effect was stopped by L-NAME pretreatment, indicating NO involvement. CA1 did not show necrotic change due to AlCl3 exposure; however, neurofibrillary tangles were accumulated in the region.

Conclusions:

Prophylaxis with L-arginine probably due to NO has a protective role against the dangerous effect of AlCl3 on the function of neurons in the cortical hippocampus.
Reconsidering the Relationship Between Hand Preference and Cerebral Vascular Dominance
Authors: Bülbül Nazlı Gamze , Demir Serkan , Özkan Suat , Samancı Cesur , Atmaca Murat Mert , Çelik Didem , Köse Ercan , Alparslan Funda , Altıner Ayşenur , Arı Selma Akkaya , Doğan Ceyda , Yavuz Cansu Gulcihan , Arslan Zeynep Meltem , Akşahin Okan , Özdağ Mehmet Fatih
Published: August 2023

Background:

To date, it has been suggested that there may be many genetic, environmental, and vascular factors that affect hand preference. In previous studies evaluating the relationship between cerebral dominance and hand preference, carotid and vertebral artery (VA) Doppler ultrasonography (USG) was generally preferred; and these studies only measured VA diameters. Unlike other studies, we aimed to reevaluate the relationship between hand preference and cerebral vascular dominance by measuring VA and internal carotid artery (ICA) diameters. In addition, we used carotid and VA computed tomography (CT) angiography instead of Doppler USG.

Methods and Material:

A total of 345 participants were included in the study. The results of carotid and VA CT angiography taken during hospitalization were retrospectively evaluated by two radiologists, and the Edinburgh Hand Preference Questionnaire was applied to these patients.

Results:

In right-handed patients, the diameter of the left VA was significantly larger than the diameter of the right VA (p = 0.005). In left-handed patients, the diameter of the left ICA was larger than the diameter of the right ICA, but the difference was not statistically significant (p = 0.055). There was no significant difference between the diameter of the right and left ICA in right-handed patients (p = 0.771).

Conclusions:

In our study, we found a correlation between the dominant hemisphere VA diameter and hand preference. Using CT angiography, we were able to eliminate many challenges of ultrasonography that make radiological evaluation difficult, such as differences of opinion between radiologists, and technical and anatomical reasons.
Therapeutic Plasma Exchange in Neuromyelitis Optica Spectrum Disorders—Experience from Tertiary Care Center in North India
Authors: Hans Rekha , Prakash Satya , Sharma Ratti R , Sankhyan Naveen , Takkar Aastha , Goyal Manoj , Saikia Biman , Lal Vivek , Marwaha Neelam
Published: August 2023

Background:

Therapeutic plasma exchange (TPE) is indicated in the acute presentation of neuromyelitis optica spectrum disorders (NMOSD) as category II indication as per American Society for Apheresis guidelines 2016.

Aim:

To assess the efficacy of TPE in symptomatic patients of NMOSD not responding to high dose intravenous steroids.

Patients and Methods:

We retrospectively reviewed the record of TPE procedures in NMOSD patients over a period of 3 years (2013–2016). TPEs were done on Cobe® spectra (Terumo BCT, Lakewood Co., USA) using 5% human serum albumin or fresh frozen plasma as replacement fluid. Clinical improvement was recorded post-procedure and adverse reactions if any was noted.

Results:

We performed TPE in 11 clinically diagnosed patients of NMOSD. Three (27%) patients had only visual symptoms, five (46%) had both visual as well as muscular symptoms, whereas three (27%) patients presented with only muscular symptoms. Out of seven tested, three patients were aquaporin-4-immunoglobulin-G-positive (AQP4-IgG positive). Visual symptoms improved from no vision pre-TPE therapy to finger counting or 6/24 post-therapy. The muscle power of the limbs improved by grade one to grade two post-therapy. Adverse events were observed in 8% (5/62) of the procedures; allergic reactions to replacement fluid as the most common event (n = 3) followed by hypotension (n = 2). Follow-up was available in 81% (9/11) patients. Two patients died at 3 and 12 months of follow-up. One patient had relapsed and underwent a second TPE cycle.

Conclusion:

The addition of TPE as a part of therapy is effective and safe in acute exacerbations of NMOSD.
Nasoethmoidal Schwannoma as a Mimicar of Esthesioneuroblastoma
Authors: Narang Amit , Aggarwal Varun , Jain Rahul , Maheshwari Chandni , Ramesh Athira , Singh Gurbax
Published: August 2023

Nasoethmoidal schwannomas are rare lesions and their presentation with intracranial extension is even rarer. Here, a patient presenting with rhinorrhea, epistaxis, and proptosis of left eye was diagnosed with giant nasoethmoidal schwannoma extending to frontal lobe and orbit, which was managed with bifrontal craniotomy with endoscopic transnasal gross total excision. This being predominantly a benign lesion has good prognosis if total excision is achieved.
Preoperative Third Ventricle Floor Bowing is Associated with Increased Surgical Success Rate in Patients Undergoing Endoscopic Third Ventriculostomy – A Systematic Review and Meta-analysis
Authors: Pranata Raymond , Yonas Emir , Vania Rachel , Rachmadian Cut Vanessa , July Julius
Published: August 2023

Background:

Endoscopic third ventriculostomy (ETV) is a procedure that involves devising an opening in the third ventricle floor, allowing cerebrospinal fluid to flow into the prepontine cistern and the subarachnoid space. Third ventricular floor bowing (TVFB) serves as an indicator of intraventricular obstruction in hydrocephalus and existence of pressure gradient across third ventricular floor, which is the prerequisite of a successful ETV.

Objective:

In this systematic review and meta-analysis, we aimed to synthesize the latest evidence on the TVFB as a marker for surgical success in patients undergoing ETV.

Material and Methods:

We performed a comprehensive search on topics that assesses the association of TVFB with the surgical success in patients undergoing ETV from several electronic databases.

Results:

There was a total of 568 subjects from six studies. TVFB was associated with 85% (81-88%) ETV success. TVFB was associated with OR 4.13 [2.59, 6.60], P < 0.001; I2: 6% for ETV success. Subgroup analysis on pediatric patients showed 86% (82-91%) success rate. In terms of value for ETV success compared to ETV Success Score (ETVSS), a high ETVSS does not significantly differ (P = 0.31) from TVFB and TVFB was associated with OR 3.14 [1.72, 5.73], P < 0.001; I2: 69% compared to intermediate/moderate ETVSS. Funnel plot analysis showed an asymmetrical funnel plot due to the presence of an outlier. Upon sensitivity analysis by removing the outlier, the OR was 3.62 [2.22, 5.89], P < 0.001; I2: 0% for successful surgery in TVFB.

Conclusions:

TVFB was associated with an increased rate of successful surgery in adults and children undergoing ETV.
Perioperative Management of Pediatric Brain Tumors
Authors: Mishra Nitasha , Rath Girija P. , Rajagopalan Vanitha , Doddamani Ramesh , Chaturvedi Arvind
Published: August 2023

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.
OFF-Period Purposeless Groaning in Parkinsonism
Authors: Agarwal Vikash , Rajan Jeyalakshmi , Ramli Norlisah , Santiago Cecilia , Jasti Dushyanth B , Tan Ai Huey , Lim Shen-Yang
Published: August 2023

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.

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.
Suprameatal Extension of Retrosigmoid Approach in Microvascular Decompression for Trigeminal Neuralgia with Petrous Endostosis
Authors: Agarwal Nitish , Kumar Amandeep , Singh Pankaj , Chandra P S , Kale Shashank S
Published: August 2023

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.
Familial Neuromyelitis Optica and Sjogren's Overlap Syndrome-A Rare Case Report
Authors: Ganaraja VH , Subasree R , Netravathi M
Published: August 2023

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.
Translation and Validation of Penn Acoustic Neuroma Quality of Life Scale for Hindi-Speaking Population
Authors: Mohanty Manju , Kaur Rupinder , Gupta Sunil Kumar , Tripathi Manjul , Sharma Akhilesh , Munjal Sanjay
Published: August 2023

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.
Is There a Role for Temozolomide in Glioma Related Seizures? A Systematic Review
Authors: Yue Jiong , Yin Cheng , Chen Longyi , Xu Ruxiang , Zhao Dongdong
Published: August 2023

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.
Rotational Occipital Scalp Flap for Occipital Pressure Ulcer
Authors: Bajaj Jitin , Agarwal Pawan , Sinha Pranjal M , Patidar Jayant , Hedaoo Ketan , Yadav Yad R
Published: August 2023

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.
Unilateral Left Frontal Lobe Lesion in a Marburg's Variant of Multiple Sclerosis Patient with Impaired Swallowing and Speech
Authors: Jovana Ivanovic B , Sarlota Mesaros T , Ivan Nikolic P , Jelena Drulovic S
Published: August 2023

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.
Stereotactic Radiosurgery with Gamma Knife in Recurrent Rathke's Cleft Cyst
Authors: Manzoni Andrea , Leocata Filippo , Picano Marco , Arienti Virginia Maria , Mainardi Hae Song , Cenzato Marco , Stefini Roberto , LA CAMERA Alessandro
Published: August 2023

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.
Prediction of Surgical Outcome for Acute Traumatic Brain Injury in Older Adults
Authors: Hazare Pooja , Shukla Dhaval , Bhat Dhananjaya , Devi Bhagavatula Indira , Jayan Mini , Konar Subhas , Ratna Nikhil , Pateriya Vibhor , Patel Kautilya , Thombre Bhushan
Published: August 2023

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.
Multi-domain Cognitive Testing
Authors: Kumar Gurja John Preetham , Muthukrishnan Suriya Prakash , Tripathi Manjari , Mehta Nalin , Sharma Ratna
Published: August 2023

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.
Community Acquired Staphylococcus Aureus Necrotizing Pneumonia and Guillain Barre Syndrome
Authors: Surve Rohini M , Das Badri P , Venkateswaran Pavithra , Kulanthaivelu Karthik
Published: August 2023

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.
Cerebral Ptosis
Authors: Vegda Monalisa , Panda Samhita , Tiwari Sarbesh , Shukla Kartikeya , Pamnani Jaya , Bhaskar Suryanarayanan
Published: August 2023

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.
Delayed Vasospasm in Endoscopic Transsphenoidal Pituitary Surgery
Authors: S Birua Gyani J , Tyagi Gaurav , Beniwal Manish , L Rao Narasinga K V , Saini Jitender , Dwarakanath Srinivas
Published: August 2023

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.
Surgical Outcome Analysis of Large and Giant Petroclival Meningiomas with Special Reference to Quality of Life Issues
Authors: Batish Aman , Gupta Sunil K , Mohanty Manju , Tripathi Manjul , Salunke Pravin , Aggarwal Ashish
Published: August 2023

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 5th 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.
Barriers to Thrombolysis at A Tertiary Care Public Hospital- A Prospective Observational Study from Southern Part of India
Authors: Kulkarni Girish Baburao , Mahajan Niranjan Prakash , Aravinda HR
Published: August 2023

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.
Specifics of Relationship within a Complex of Neurological Deficit, Quality of Life and Depression in the Phenotypic Spectrum of Multiple Sclerosis
Authors: Sahakyan Anahit Y , Mavelyan Hovannes M
Published: August 2023

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).
Reversal of Oral Vitamin K Antagonists Using Prothrombin Complex Concentration Prior to IV tPA Administration
Authors: Salt Irmak , Aslan Işıl Kalyonu , Özgenç Biçer Çisil İrem , Gözke Eren
Published: August 2023

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.
Surgical Treatment of IV Ventricle Calcifying Pseudoneoplasm of the Neuraxis (CAPNON) Operative Nuances
Authors: M. Giovannini Sebastian J , Ruella Mauro , Villamil Facundo , Lorefice Emiliano , Caffaratti Guido , Cervio Andrés
Published: August 2023

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.
A Rare Case of Postoperative Extradural Hematoma in the Posterior Fossa Complicated by Both Stunned Myocardium and Neurogenic Pulmonary Edema
Authors: Kumar Subodh , Prasad Chandrakant , Mahajan Charu , Chavali Siddharth , Madan Ankita , Rath Girija Prasad , Suri Ashish
Published: August 2023

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.