bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolution of Microstructure and Mechanical Properties of the Rheo-Diecast Mg-12Gd-3Y-1Zn-0.4Zr Alloy during Heat Treatment
Authors: Li Da Quan , Chang Zhi Yu , Feng Jian , Wu Yu Juan , Peng Li Ming
Published: August 2023

The SEED (Swirled Enthalpy Equilibrium Device) process is the typical high solid fraction (with about 40-60% of solid) rheo-diecast process. The high strength Mg-12Gd-3Y-1Zn-0.4Zr magnesium alloy was successfully produced using SEED process. The microstructure and mechanical properties of rheo-diecast Mg-12Gd-3Y-1Zn-0.4Zr alloy during solution and ageing heat treatment process were studied in this paper. Optical microscopy (OM) and transmission electron microscopy (TEM) were employed to study the evolution of microstructure and mechanical properties. The cast alloy exhibited a microstructure consisting of equiaxed primary solidified grains and together with eutectics. The eutectics were partially dissolved into a-Mg matrix after solution heat treatment. The tensile properties of rheo-diecast Mg-12Gd-3Y-1Zn-0.4Zr alloy were substantially enhanced after T6 heat treatment.
On the Possibility of Replacing Scheil-Gulliver Modeling with Machine Learning and Neural Network Models
Authors: Li Ziyu , Tan He , Lattanzi Lucia , Jarfors Anders E.W. , Jansson Per
Published: August 2023

Resource-efficient manufacturing is a foundation for sustainable and circular manufacturing. Semi-solid processing typically reduces material loss and improves productivity but generally requires a better understanding and control of the solidification of the cast material. Thermal analysis is commonly used in high-pressure die casting (HPDC) processes to determine casting process parameters, such as liquidus and solidus temperatures. However, this method is inadequate for semi-solid casting processes because the eutectic temperature is also a crucial parameter for successful semi-solid casting. This study explores the feasibility of using machine learning and artificial neural networks to predict fundamental values in Al-Si alloy casting. The Thermo-Calc 2022 software Scheil-Gulliver calculation function was used to generate the training and the test datasets, which included features such as melting temperature, alpha aluminium solidification temperature, eutectic temperature, and the solid fraction amounts at eutectic temperature. The results show that both models have a symmetric mean absolute percentage error (SMAPE) of less than 2 % with temperature prediction, with the machine learning model achieving a better accuracy of less than 1 %. A case study comparing practical measurements with prediction results is also discussed, demonstrating the potential of AI methods for predicting semi-solid casting processes.
Semi-Solid Deformation Behavior, Flow Stress Prediction and Deformed Microstructure of GH3536 Superalloy
Authors: Huang Min Jie , Jiang Ju Fu , Wang Ying
Published: August 2023

In current work, the deformation behavior and deformed microstructures of GH3536 superalloy in semi-solid state were investigated, and the semi-solid flow stress was predicted by artificial neural network (ANN) model. The semi-solid compression deformation was carried out at 1320-1350 °C, and the solid deformation behavior at 1200 °C was tested for comparison. The peak stress under 0.01-1 s-1 semi-solid deformation was 45.6-161.9 MPa. The peak stress decreased with the increase of deformation temperature and the decrease of strain rate. The ANN model could well describe semi-solid flow stress. During semi-solid deformation, the apparent viscosity dropped as shear rate increased. At high temperature and low strain rate, more liquid phase was distributed at grain boundaries. The solid grains coarsened as deformation temperature increased.
Localized Giant Cell Tumor of the Tendon Sheath of the Upper Cervical Spine
Authors: Hu Yu , Chen Min , Richard Seidu A , Huang Siqing
Published: August 2023

Introduction:

Giant cell tumor of the tendon sheath (GCTTS) is commonly seen in the appendicular skeleton, and rarely arises from the axial skeleton. We describe a rare case of GCTTS in an adolescent in the upper cervical spine.

Case Presentation:

A previously healthy 16-year-old boy presented with a 6-month history of numbness of right upper extremity, and had experienced a neck pain 4 months ago. Spinal MRI demonstrated a small syrinx at C2 level and a well-circumscribed extradural mass with contrast enhancement extending from the posterior arch of C1 to C2. The extradural mass was totally resected, and the syrinx underwent clinical and imaging surveillance.

Discussion:

GCTTS should be considered in the differential diagnosis of the axial skeletal lesion although very rare. Gross-total resection is advocated in GCTTS of the upper cervical spine, and subtotal resection with meticulous lesion monitoring should be performed in unresectable cases.
Evaluation of MR-Tractography Findings in Hemifacial Spasm Patients Injected with Botulinum Neurotoxin
Authors: Çavuş Hakan , İşeri Pervin , Öztürk Onural , Anık Yonca
Published: August 2023

Background and Introduction:

Botulinum neurotoxin (BoNT) is a potent biological toxin extracted from Clostridium Botulinum bacteria. BoNT injection is mainly used for medical purposes; it is frequently used for cosmetic purposes as well. The hypothesis that frequent application of this treatment modality may also affect the central nervous system constitutes the subject of our study.

Objective:

We aimed to demonstrate the possible central effects of BoNT in hemifacial spasm patients.

Methods and Materials:

Diffusion tensor imaging was used for this study. Patients were divided into two groups, and the measured values for each determined bilateral neuroanatomic region were compared within the relevant group.

Results:

Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were found to be closer to the pathological values in the right motor cortex and in the left internal capsule areas of the patients who were injected with BoNT into the left side, in the left motor cortex area of the patients who were injected with BoNT into the right side. No significant changes were detected in other regions.

Conclusion:

Botulinum neurotoxin administration in patients with hemifacial spasms may cause some changes in the central nervous system as well as peripheral effects. In the case of similar studies supporting pathological changes, BoNT treatment modalities or appropriate indications may be reviewed, and regulation on excessive cosmetic use may be in question.
Clinical Study of High-Resolution C-Arm CT in Mechanical Recanalization and Stent Implantation for Chronic Cerebral Artery Occlusion
Authors: Li Teng-Fei , Shi Cheng-Cheng , Ma Ji , Fu Pei-Ji , Zhu Ming , Ren Jian-Zhuang , Han Xin-Wei
Published: August 2023

Background:

In recent years, among patients with chronic cerebral artery occlusion, recanalization can be achieved by an endovascular operation. However, complications and restenosis rates remain high.

Objective:

To evaluate the utility of high-resolution C-arm CT (Dyna micro-CT) for stent placement in patients with chronic cerebral artery occlusion.

Methods and Materials:

We retrospectively reviewed the clinical data of 27 patients with chronic cerebral artery occlusion who underwent mechanical recanalization and stent implantation. Images were reconstructed using conventional C-arm CT (Dyna CT) and Dyna micro-CT. Whether the stent was fully expanded and image quality was evaluated. Follow-up assessments included clinical and angiographic outcomes and complications.

Results:

Twenty-two patients successfully underwent stenting (22 stents; 14 cases: Neuroform EZ; eight cases: Enterprise); stenting failed in five patients. Compared to Dyna CT, Dyna micro-CT afforded improved visualization of the stent structure, providing significantly improved image quality (P < 0.05). In seven patients, the stent under-expanded and dilatation was performed; thereafter, stent malapposition improved. One patient experienced sudden headache 22 hours after the procedure; CT showed intraparenchymal hemorrhage. The remaining 21 patients did not have acute thrombosis or bleeding complications and were followed up by imaging for 3-6 months. In three patients, digital subtraction angiography showed mild in-stent stenosis.

Conclusions:

High-resolution C-arm CT can improve visualization of stent structures in chronic cerebral artery occlusion, making it easy to determine the extent of stent deployment and potentially reduce complications and stent restenosis.
Germline Biallelic Mismatch Repair Deficiency in Childhood Glioblastoma and Implications for Clinical Management
Authors: Mishra Avijeet K. , Achari Rimpa B. , Zameer Lateef , Achari Gopal , Gehani Anisha , Roy Paromita , Sudhaman Sumedha , Bianchi Vanessa , Edwards Melissa , Sen Saugata , Sukumaran Reghu K. , Bhattacharyya Arpita , Tabori Uri , Das Anirban
Published: August 2023

We report a case of a 9-year-old boy with glioblastoma with a past history of colon cancer. Germline bi-allelic DNA-mismatch repair deficiency was diagnosed by a lack of immunohistochemical staining for PMS2 in the tumor and normal tissue. Family history was lacking. Sequencing confirmed compound heterozygous PMS2 mutations. A second hit in the DNA-polymerase-ε gene led to complete DNA-replication repair deficiency. This contributed to an ultra-hypermutated phenotype. Temozolomide was excluded from the treatment. PD-1 immunotherapy at recurrence contributed to extending post-relapse survival up to 11 months. Challenges included managing initial immune “flare” related to “pseudo-progression” and access to drug. Family screening diagnosed the sibling with Lynch syndrome. This is the first report of a child with a brain tumor treated with immunotherapy from India. Our report supports the routine inclusion of immunohistochemistry for mismatch repair proteins in the evaluation of pediatric high-grade glioma as this may directly impact the clinical care of these children and families.
Association Between Stroke Characteristics and Post-Stroke Fatigue
Authors: Shu Jun , Ren Yiqing , Liu Guidong , Wei Wenshi
Published: August 2023

Background:

Post-stroke fatigue (PSF), a highly distressing symptom, could exert an influence on the quality of life of stroke survivors. A previous meta-analysis reported that PSF was associated with mood disturbances such as depressive symptoms and anxiety. However, the association between stroke characteristics (stroke type and location) and PSF remains unclear.

Objective:

We performed a meta-analysis to study the association between stroke characteristics and PSF.

Material and Methods:

We conducted a search of electronic databases (PubMed, Web of Science, Cochrane Library) from the inception of all databases up to July 9, 2019. The quality of eligible articles was evaluated. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were applied to represent the combined effect value of each study.

Results:

Eight eligible studies including a total of 1816 stoke patients were identified. Three studies discussed the association between stroke type and PSF, and five studies investigated the relationship between stroke location and PSF. The results demonstrated PSF had a strong correlation with stroke type (OR = 2.42, 95% CI = [1.27, 4.61], P = 0.007) but was not relevant to stroke location, indicating that PSF was a complex, heterogeneous syndrome and that stroke characteristics may play only a very small role in the risk of developing PSF.

Conclusions:

Our meta-analysis indicated that PSF was closely relevant to stroke type and had no significant relationship with stroke location. However, the findings should be interpreted cautiously. Thus, we suggest an updated meta-analysis on this subject when more comprehensive studies that explore the above issue are available.
Complex Regional Pain Syndrome after Carpal Tunnel Syndrome Surgery
Authors: A. Sousa Luis Henrique , Costa Caroline de O. , Novak Eduardo M. , Giostri Giana S.
Published: August 2023

Background:

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment. One of the most devastating complications is complex regional pain syndrome.

Objectivities:

The aim of this study was to systematically analyze available evidence about complex regional pain syndrome after carpal tunnel syndrome surgery (CTSS), its risks, associated factors, and treatments.

Material and Methods:

Research conducted from 1962 through December 31, 2018, in the following databases: PubMed, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. The quality assessment of the methodology followed the definitions by the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. The GRADE system (Grades of Recommendation, Assessment, Development, and Evaluation) was applied to evaluate the efficacy of the stellate ganglion block, one of the most cited and recurrent treatments.

Results:

Of the 246 studies retrieved, 44 articles were included. Concerning patients' gender, we identified a ratio of 5 females: 3 males. The mean age for women was 57.79, a standard deviation of 14.96, and for men 60.75, a standard deviation of 9.4. Considering the total of primary publications of CTSS outcomes, the accumulated incidence reached the maximum of 0.15 CRPS after CTSS patients/CTSS patients. The known risk factors for CRPS after CTSS: female gender, from the fifth decade of life, tourniquet time, immobilization and surgery on dominant hand.

Conclusion:

CRPS affects 2-5% of people undergoing CTSS. Its diagnosis is still a challenge and its risk factors are unclear, although it seems more likely to affect women, in the dominant hand. The most used treatments include physiotherapy and stellate ganglion block. Most patients show improvement of symptoms within one year. Further clinical trials comparing treatment modalities are required.
Cerebral Venous Thrombosis in COVID-19
Authors: Benny Rajesh , Singh Rakeshsingh K , Venkitachalam Anil , Lalla Rakesh S , Shah Amit M , Bolegave Vyankatesh , Shetty Ashutosh N , Panchal Keyur C , Choudhary Jitendra , Mathew Anita , Hunnur Manoj , Shetty Kishore V
Published: August 2023

Background:

COVID-19 causes a hypercoagulable state leading to thrombosis. Many of these thrombotic complications occur in those with severe disease and late in the disease course. COVID-19 has recently been associated with cerebral venous thrombosis (CVT).

Objective:

To study the onset of CVT in relation to COVID-19 and compare their characteristics and outcomes with non-COVID CVT patients admitted during the same period.

Materials and Methods:

This multicentric, retrospective study conducted between April 4 and October 15, 2020, included adult patients with CVT who were positive for the SARS-CoV-2 virus and compared them with CVT patients who were negative for the SARS-CoV-2 virus hospitalized during the same period. We studied their clinical profile, risk factors for CVT, and markers of COVID coagulopathy, imaging characteristics, and factors influencing their outcomes.

Results:

We included 18 COVID-19-infected patients and compared them with 43 non-COVID-19 CVT patients. Fourteen patients in the COVID-19 group presented with CVT without the other typical features of COVID-19. Thirteen patients had non-severe COVID-19 disease. Twelve patients had a good outcome (mRS ≤2). Mortality and disability outcomes were not significantly different between the two groups.

Conclusion:

Our study suggests a possible association between COVID-19 and CVT. CVT can be the presenting manifestation of an underlying COVID-19, occurring early in the course of COVID-19 and even in those with mild disease. Patients with worse GCS on admission, abnormal HRCT chest, severe COVID-19, and need for invasive ventilation had a poor outcome.
Balloon-Assisted Coiling of Intracranial Aneurysms
Authors: Vignesh S , Prasad Surya N. , Singh Vivek , Phadke Rajendra V. , Balaguruswamy Madan M. , Udiya Alok , Shetty Gurucharan S , Dhull Vedita
Published: August 2023

Background:

Wide-neck intracranial aneurysms need additional devices like balloons or stent for management. Balloon-assisted coiling has evolved both with interventionalist experience and device modifications.

Objective:

We discussed our experience, evolution, and complications with this novel technique.

Materials and Methods:

Data of 2014–2019 was retrospectively reviewed for type of balloon used along with complications in intracranial aneurysm coiling. Two hundred five aneurysms were detected in 188 patients, of which balloon-assisted coiling was planned for 198 aneurysms. Both single and double-lumen balloons were used. Aneurysms were divided into bifurcation and sidewall aneurysms. The complications were compared between bifurcation and sidewall aneurysms, and between single and double lumen balloons.

Results:

Balloon-assisted coiling was planned for 198 aneurysms but successfully done for 195 (98.5%) cases. Single-lumen balloons were used in 56 aneurysms (28.3%), and double-lumen balloons were used in 142 cases (71.7%). Procedural thromboembolism within parent vessel was seen in 28 cases (14.1%); however symptomatic were encountered in 5 cases (2.5%). Intraprocedural rupture of the aneurysmal sac was seen in 9 cases (4.5%). The procedure-related mortality in our series was 1.6% (3/188 patients), and morbidity was 4.3% (8/188 patients). The complications among bifurcation and sidewall aneurysms compared between single- and double-lumen balloons showed a greater number of symptomatic thromboembolic complications in sidewall aneurysms with the use of single lumen balloons.

Conclusions:

There are significant symptomatic thromboembolic complications in sidewall aneurysms with the use of single-lumen balloons which decreased as interventionalist experience evolved and better hardware developed.
Endovascular Thrombectomy Eligibility in the 0-24-Hour Time Window at a Large Academic Center in India
Authors: Vibha Deepti , Misra Shubham , Desai Shashvat M , Prasad Kameshwar , Srivastava Achal K , Pandit Awadh K , Jadhav Ashutosh P
Published: August 2023

Background:

The data regarding patients eligible for endovascular thrombectomy (EVT), especially in the developing world is lacking.

Objective:

To determine the proportion of patients with acute ischemic stroke (AIS) who are eligible for EVT in the 0-24-h time window.

Materials and Methods:

We performed a retrospective cohort study using prospectively collected AIS data between July 2017 and September 2019. Demographic, clinical, and management information were analyzed. EVT eligibility was explored using the following criteria: National Institutes of Health Stroke Scale (NIHSS) score ≥6, presence of anterior circulation large-vessel occlusion (ACLVO), Alberta stroke program early Computerized Tomography score (ASPECTS) ≥6, baseline modified Rankin Scale (mRS) score 0–2, and within 24 h of time last seen well (TLSW). EVT-eligible patients were further evaluated for in-hospital course and outcomes.

Results:

In the study period of 27 months, there were 221 patients with AIS who presented within 24 h. The mean age of the patients was 54.4 (16.0) years and 66.1% (146) were males. A majority (61.5% [136/221]) arrived within 6 h of TLSW. Of these, 81.6% (111/136) presented in the time window for thrombolysis (0–4.5 h). The patients with NIHSS ≥6 and ACLVO constituted 41.2% (91/221) of the patients. AIS eligible for EVT constituted 19.5% (43/221) of the patients.

Conclusion:

In our study, the proportion of AIS eligible for endovascular thrombectomy was comparable to the developed world. These data predict a large potential for the late-window EVT in India.
Cerebral Infarction and Remote Cerebellar Hemorrhage in Patients with Intracranial Hypotension
Authors: Kwon Sae-Min , Kim Du Hwan , Kim Young Je , Son Eun-Seok
Published: August 2023

Cerebrospinal fluid leakage is largely associated with spontaneous intracranial hypotension and iatrogenic events, such as complications associated with spinal tapping or durotomy. Intracranial hypotension causes a positional headache, neck stiffness, nausea, dizziness, or tinnitus. Although rare, intracranial hypotension can lead to serious complications, including subdural hematomas and cerebral infarction. Given its rarity, there is no consensus protocol for treating cerebrovascular complications after intracranial hypotension. We report two cases of intracranial hypotension with cerebrovascular complications, including acute cerebral infarction and cerebellar hemorrhage.
The Effect of Green Tea with EGCG Active Compound in Enhancing the Expression of M2 Microglia Marker (CD206)
Authors: Machin Abdulloh , Divamillenia Dinda , Fatimah Nurmawati , Susilo Imam , Purwanto D Agus , Subadi Imam , Sugianto Paulus , Hamdan Muhammad , Pratiwi O Galuh , Fauziah Dyah , Izzawa Kenia
Published: August 2023

Background:

Stroke is a neurological deficit due to vascular disorders. Microglia are the first line of defense against brain injury. Anti-inflammatory cytokines activate M2 microglia, which upregulate CD206. EGCG is abundant in green tea, which has an anti-inflammatory effect.

Objective:

To know the effect of green tea with its active compound EGCG on CD206 expression.

Settings and Design:

True experimental trial design.

Material and Methods:

Rattus Novergicus were divided into six groups: a negative control group (Sham), a positive control group (P0), MCAO mice given 10 mg/kg BW EGCG (P1), 20 mg/kg BW EGCG (P2), 30 mg/kg BW EGCG (P3), and 30 mg/kg BW standardized green tea extract (P4). CD206 expression was measured using immunohistochemistry and scored according to the Allred scoring guidelines.

Statistical Analysis Used:

Descriptive test, Levine test, Kolmogorov–Smirnoff test, Independent sample t test, Pearson correlation test

Results:

We discovered that there is a significant difference in CD206 expression between the Sham and P0 groups (P < 0.05). In addition, there are significant differences in expression between the sham group and the other two groups (P1 and P2) (P < 0.05). Furthermore, when we compared the P0 group with each treatment group, we found that CD206 expression between P0–P2, P0–P3, P0–P4 are significantly different. There is a significant correlation between green tea with its active compound EGCG and CD206 expression enhancement. The correlation is positive.

Conclusions:

Green tea with EGCG active compound increases CD206 expression as an M2 marker in the Rattus norvegicus with MCAO model.
Setting up a Neurosurgical Skills Laboratory and Designing Simulation Courses to Augment Resident Training Program
Authors: Sahoo Sushanta K. , Gupta Sunil Kumar , Salunke Pravin , Dhandapani Sivashanmugam , Aggarwal Ashish , Singla Navneet , Karthigeyan Madhivanan , Singh Apinderpreet , Tripathi Manjul , Gendle Chandrashekhar , Singla Raghav , Chhabra Rajesh , Mohindra Sandeep , Tewari Manoj Kumar , Rekhapalli Raja Sekhar , Kokkula Praneeth , Gupta Tulika
Published: August 2023

Background:

The surgical skill practice in neurosurgery is being compromised in the recent past owing to the duty time constraint, patient safety concerns, and medico-legal issues. Surgical practice outside the operating room is essential to enhance a resident's operative skills and to gain confidence.

Objective:

To discuss the experience of establishing an 'in-house neurosurgery skills laboratory' and various training sessions conducted with cadaveric and non-cadaveric simulation modules.

Methods:

A skills laboratory was set up in the existing resident teaching hall with nine workstations. Each station has been equipped with an operating table, surgeon's chair, basic microscope, endoscope, high-speed drill system, and a suction machine. Vascular anastomosis, high-speed drilling, and basic neuroendoscopy were planned on low-cost non-cadaveric modules. Craniotomy and various surgical approaches were designed on cadaveric modules obtained from the anatomy department.

Result:

A total of 18 residents in divided groups during their initial three semesters had participated in the non-cadaveric simulation courses. Twenty-six residents had participated and 12 sessions were conducted on the cadaveric modules. Three workshops were conducted and 20 residents and faculty members from five other institutions had participated in the cadaveric hands-on training session.

Conclusion:

A well-equipped skills laboratory provides an opportunity for the residents to acquire operative expertise in a similar atmosphere to that of the operating theater. A structured program comprising various operative practice sessions should be incorporated into the resident training program.
Comparison of Craniotomy and Stereotactic Aspiration Plus Thrombolysis in Isolated Capsulo-Ganglionic Hematoma
Authors: Kumar Sanjeev , Madhariya Satya Narayan , Singh Deepak , Agrawal Rakesh , Sahana Debabrata , Mourya Ashutosh
Published: August 2023

Background:

Published trials and meta-analyses have suggested the role of surgery in select patients of hypertensive intracerebral hematoma.

Objective:

This study compares two methods of hematoma aspiration, craniotomy, and stereotactic aspiration.

Methods and Material:

We conducted retrospective analyses of patients who underwent surgery for capsule-ganglionic hematoma during Jan-2015–Dec-2019. Surgical, intensive-care parameters, and neurological outcomes were compared. Patients operated for Capsule-Ganglionic hypertensive hematomas, Glasgow Coma Scale (GCS) 5-12, hematoma volume ≥30 ml, no concomitant IVH, age <80 years were included.

Results:

A total of 173 patients were included (90 craniotomy and 83 stereotactic aspiration groups). Both groups were equivalent in preoperative parameters (P > 0.5). There were no significant differences in residual hematoma volumes, surgical site infections/Meningitis, and chances of re-bleed between the two groups (P > 0.05). The number of days on ventilation, ICU-stay, and hospital-stay were higher in craniotomy group (P < 0.001). Mean Modified Ranking Score (MRS) was lower (P 0.01) in the stereotactic aspiration group. A higher number of patients in the stereotactic aspiration group achieved good MRS (0-2) (P 0.02). Overall case-fatality rate was 38/173 (21.96%) (craniotomy - 24/90 (26.66%), stereotactic aspiration - 14/83 (16.86%), P 0.12). In left-side hematomas, mean MRS was not different between both methods, whereas it differed in the right-side hematomas. On step-wise logistic regression analysis, predicting parameters for the poor outcome (MRS 3-6) were GCS 5-8 (Odds Ratio (OR) 2.38), Left-side (OR 1.75), and craniotomy as a method of evacuation (OR 1.70).

Conclusions:

Stereotactic aspiration of the hematoma has the superior edge over craniotomy. Neurological and care parameters are significantly better with stereotactic aspiration. Its safety and surgical performance parallel craniotomy.
Pattern and Severity of Leukoaraiosis and Microvascular Resistance- Inputs from a TCD Study from South Asia
Authors: Kumar Dhing H , Umesh Saraf U , Sinchu Maniangatt C , Savith Kumar , Sarma Sankara P , Sajith Sukumaran
Published: August 2023

Background and Purpose:

Leukoaraiosis is thought to be related to long-standing microvascular ischemia. The pathogenic mechanisms and hemodynamic changes could be different for periventricular and deep white matter leukoaraiosis. In this cross-sectional study, we examined whether the Pulsatility Index (PI) in Transcranial Doppler ultrasonography (TCD), which can give indirect information regarding downstream microvascular resistance and compliance, is different for leukoaraiosis in periventricular and deep locations. Correlation between presence of leukoaraiosis and PI was also studied since it was not studied in South-Asian patients before.

Methods:

Consecutive patients with suspected lacunar stroke or white-matter disease, undergoing MR brain imaging were included. Vascular imaging was done with CT or MR Angiography to rule out significant (>50%) stenosis. Fazeka's grading was done for severity of leukoaraiosis and mean PI in the middle cerebral artery (MCA) was obtained with trans-temporal TCD.

Results:

Ninety patients (Mean age 61 ± 10.9 years, 29% females) were available for final analysis. Age, hypertension, diabetes mellitus, CAD, and presence of leukoaraiosis were strongly associated with elevated mean PI in univariate analysis. In multivariate analysis, presence of leukoaraiosis was significantly associated with higher mean PI after adjusting for other variables. Mean PI strongly correlated with both periventricular (Spearman's correlation coefficient 0.56, P = 0.01) and deep white matter (Spearman's correlation coefficient 0.63, P = 0.01) leukoaraiosis.

Conclusions:

Our study confirms the correlation of Pulsatility Index with leukoaraiosis in South-Asian patients. Interestingly, changes in microvascular resistance appeared to be similar for both periventricular and deep white matter leukoaraiosis in spite of potential differences in etiopathogenesis.
Revisiting Surgery in the Current Era of Gamma Knife for Cavernous Sinus Lesions
Authors: Salunke Pravin , Karthigeyan Madhivanan , Rajasekhar Rekhapalli , Singh Apinderpreet , Wankhede Lomesh Shankarrao
Published: August 2023

Background:

The challenges associated with surgeries of cavernous sinus (CS) lesions have shifted the management trend towards upfront gamma knife radiosurgery (GKRS). Although GKRS is effective in arresting the progression of certain small residual/recurrent lesions, its efficacy in alleviating neurological deficits is less evident. Furthermore, GKRS without establishing the histopathological diagnosis, at times can be detrimental.

Objective:

We present our clinical experience to reemphasize the role of surgery for CS lesions in the current era of upfront GKRS.

Materials and Methods:

We reviewed our database of 32 patients with various CS lesions treated by surgery for progressive cranial nerve deficits. The follow-up data were analyzed for the extent of resection, and in particular for improvement in their symptoms.

Results:

The lesions were confirmed as hemangioma (CSH)-8, meningioma-8, trigeminal schwannoma-6, chordoma-3, residual pituitary with CS extension-3, fungal granuloma-3, and dysgerminoma-1. Symptoms improved in 23 (complete in 13) and remained at least static in six patients. Follow-up ranged from 4–36 months.

Conclusions:

The nature of pathology should determine the management modality in CS lesions. Excision of CS schwannomas and chordomas yields rapid clinical improvement and good long-term outcomes. Resection is preferred for large CSH and functioning pituitary tumors. Although the clinical improvement may be less dramatic, surgery debulks the meningiomas. Most importantly, surgery also establishes the histopathological diagnosis of CS lesions. Even with an easy alternative of upfront GKRS, resection has a definite role in the primary management of most CS pathologies.
P300 Wave Latency and Amplitude in Healthy Young Adults
Authors: Sorout Jitender , Kacker Sudhanshu , Saboo Neha , Soni Harsha , Buttar Karampreet K , Reddy Satyanath
Published: August 2023

Background:

Electrophysiological investigations are now very common in clinical investigations. Event-related potential (ERP) is also common in most electrophysiological recording in which P300 is considered as the best indicator of psychological status. P300wave latency and amplitude are the best indicators of superior mental function status. Variability in P300 has been demonstrated in diseases exhibiting cognitive abnormalities.

Objective:

The present study aimed to generate the normative data of P300 wave latency and amplitude in healthy young adults of 18–25 years age group in healthy young adults.

Material and Methods:

Hundred healthy young adults age (18–25 years) were analyzed for P300 using auditory oddball paradigm [Octopus NCV/EMG/EP-4 Channel Machine (Model name- CMEMG 01)], after taking anthropometric measurements (height, weight, and BMI). Whole data were collected after taking the willing consent of participants recruited for the study, and approval of Institute's ethics committee was taken before the start of study. Normally, distributive data were presented in the form of mean, standard deviation, and Pearson correlation was used to see check the correlation using MS-excel 2007.

Results:

The mean P300 latency and amplitude were 281.38 ± 33.39 ms and 4.53 ± 1.67μV, respectively, in healthy young adults with mean age 19.81 ± 1.80 years. With age the P300 latency was significantly positively correlated.

Conclusions:

This study results reflected normative data of P300wave latency and amplitude in healthy young adults of 18–25 years age group.
Clinical and Radiological Profile of 122 Cases of Idiopathic Intracranial Hypertension in a Tertiary Care Centre of India
Authors: Sharma Bhawna , Seervi Naveen , Sharma Vikas , Panagariya Ashok , Goel Divya
Published: August 2023

Background:

Idiopathic intracranial hypertension (IIH) is well-described entity in literature. However, large studies on clinical and radiological profile are still very few from the Indian subcontinent.

Aims:

To analyze the clinical and radiological profile of IIH and correlation of various clinical and radiological parameters with papilledema and CSF opening pressure.

Setting and Design:

Hospital-based observational, descriptive study.

Materials and Methods:

This study analyzed 122 patients admitted in the department of Neurology (from January 2014 to December 2018) for detailed history, clinical examination, and neuroimaging. CSF manometry and routine CSF analysis were done. All participants met the modified Dandy criteria. Patients with secondary causes of raised ICP and primary ocular pathology were excluded.

Statistical Analysis Used:

Descriptive statistics and Chi-square test.

Results:

Among 122 cases 86 (70.49%) were females. The mean age was 33 years. 62 (50.82%) cases were obese. Headache was the most common symptom (114/122; 93.44%). Bilateral papilledema was noted in 114 (93.44%) cases. Higher grades of papilledema had a correlation with higher CSF opening pressure. Empty sella was the most common radiological finding (100/122; 81.97%). All radiological findings except empty sella had a correlation with higher CSF opening pressure.

Conclusion:

IIH typically affects obese females of childbearing age group. However, it is not uncommon in the nonobese and male sex. Obesity may not be a dominant risk factor for the development of IIH in the Indian subcontinent. Cases with normal BMI and male sex with clinical features of raised intracranial pressure and normal neuroimaging should also be evaluated for IIH. Cases with refractory headache and empty sella on MRI should be evaluated for IIH.
The Influence of ADORA2A on Levodopa-Induced Dyskinesia
Authors: Ari Buse Cagla , Domac Fusun Mayda , Kenangil Gulay Ozgen , Imamova Nergis , Kuskucu Aysegul Cinar
Published: August 2023

Background:

Dopamine deficiency causes Parkinson's disease (PD), and on treatment, levodopa is the gold standard. Various drug-metabolizing enzymes and drug receptors are believed to be involved in prompting dyskinesias due to the extended usage of levodopa. Shreds of evidence in genomic studies have presented that ADORA2A receptor antagonism has beneficial outcomes to avoid these drug-induced side effects.

Objective:

The aim of this study was to study the polymorphisms of rs2298383, rs35060421, and rs5751876 in the ADORA2A in patients diagnosed as PD and describe their possible relationships with levodopa-induced dyskinesias (LID).

Methods:

One-hundred and seventy-two patients were recruited and separated as the study and the control group. DNA was achieved from peripheral venous blood, high resolution melting analysis, and reverse-transcriptase PCR was performed.

Results:

The allele differences among the groups were not statistically significant. Although it was not statistically significant, the rs35060421 allele was observed to repeat more frequently. However, we did not find an association between such polymorphisms of ADORA2A and LID.

Conclusions:

Although this result showed that a higher sample number might produce different results as possible, current results in the Turkish sample indicated that these alleles of ADORA2A might not be related to LID in patients.
Efficacy and Utilization Patterns of Anti-Epileptic Drugs in the Management of Neonatal Seizures
Authors: Thomas Rose B , Muttavarapu Spandana Siri , Shetty Prasanna K , Lewis Leslie E
Published: August 2023

Background:

Management of neonatal seizures with available limited guidelines across different gestation can cause long-term neurological and cognitive impairment.

Objectives:

To compare utilization and observe the efficacy of anti-epileptic drugs in the treatment of neonatal seizures. The association of hypoxic-ischemic encephalopathy with NS and the etiology of HIE were also determined.

Subjects and Methods:

A retrospective cohort study was conducted at a tertiary care hospital for a period of one year. It was approved by IEC prior to initiation.

Participants:

Neonates admitted for seizure management and perinatal asphyxia with hypoxic-ischemic encephalopathy were included in the study. Both term and preterm 267 neonates from January 2014 to July 2018 were retrospectively analyzed. The drugs with the fastest seizure resolution, least recurrence, and readmission rates were considered efficient. Phenobarbitone, levetiracetam, and phenytoin were compared as they were commonly prescribed. Inpatient medical records and hospital databases served as sources of information.

Results:

Phenobarbitone was commonly utilized, followed by phenytoin and levetiracetam. The commonly prescribed combination was phenobarbitone (first-line agent) and phenytoin (second-line agent). Phenobarbitone immediately resolved seizures (97, 75.1%) and had the least cases of seizure recurrences (53, 41.1%) and readmissions (20, 15.5%), making it most efficient. The best second-line agent was phenytoin, with the least seizure recurrence (4, 8.51%), least readmissions (7, 14.8%), and fastest resolution (25, 53.1%). Levetiracetam was an efficient third-line agent. Hypoxic-ischemic encephalopathy was the most observed cause of neonatal seizures.

Conclusion:

Phenobarbitone was observed as the most utilized and efficient anti-epileptic drug, followed by phenytoin and levetiracetam. Owing to limitations in this study, there is an alarming need for standardized clinical trials to establish thorough guidelines.
Unusual Magnetic Resonance Imaging Features of Scrub Typhus Encephalitis
Authors: Naik Shailendra S. , Bedadala Mayurnath R. , Sharma Manik , Sethi Himanshu
Published: August 2023

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The diagnosis of scrub typhus relies on the patient's history of exposure, clinical manifestations, and results of serological tests. Our patient had a history of altered sensorium, inability to walk, and macular rashes predominantly distributed over the chest and bilateral upper limbs. Post serological testing, the patient was referred to the radiology department for MRI brain. Radiologically, MRI being a superior modality helps in the evaluation of lesions in depth, helping to simplify the diagnosis of meningitis, scrub typhus encephalitis, and other related conditions. Various findings have been described in scrub typhus encephalitis in MR brain imaging, and our case shows an unusual finding in brain imaging.
Impact of Hearing Loss on Cognitive Abilities in Subjects with Tinnitus
Authors: Sharma Anuradha , Mohanty Manju , Panda Naresh , Munjal Sanjay
Published: August 2023

Background:

This study aimed to delineate the underlying pathophysiology of tinnitus between normal hearing and hearing loss subjects.

Objective:

The study aimed to characterize the neuropsychological aspects of two types of groups with tinnitus having variable hearing thresholds.

Materials and Methods:

The study sample comprises 75 subjects in a group with tinnitus and normal hearing, and 100 subjects in the tinnitus and hearing loss group. Subjects were matched to their respective controls for age, gender, and education levels. Subjects underwent verbal learning and memory tasks, visual learning, memory, listening attention, sustained visual attention, work memory, category control, phonemic mastery, response inhibition, and data processing velocity.

Results and Conclusions:

Subjects having hearing loss with bilateral tinnitus showed significantly reduced performance on total learning capacity (P = 0.02) and recognition (P = 0.05) (Rey's auditory verbal learning test), auditory attention tasks, digit forward span test (DFST) (P = 0.03), digit span test score (P = 0.01), and working memory (P = 0.02) (digit backward span test). For response inhibition tasks and Stroop interference (P = 0.03), subjects with normal hearing with bilateral tinnitus displayed lower performance. This study proves a relationship between poor working memory, auditory memory, total learning capacity, and recognition due to hearing impairment in bilateral Tinnitus subjects. The study has substantial implications for effective assessment and treatment recommendations in hearing loss with bilateral tinnitus subjects.
Large Vessel Occlusions By Free Floating Thrombi in Strokes During the COVID-19 pandemic- A Single Center Observational Study
Authors: Panda Samhita , Tiwari Sarbesh , Pamnani Jaya , Vegda Monalisa , Patel Apoorv , Sharma Sanjiv , Jain Saksham , Patel Pratik , Saroha Deepika , Khera Pushpinder , Midha Naresh , Garg Mayank , Nag Vijaya Lakshmi
Published: August 2023

Background:

An increased incidence of systemic macrothrombotic phenomena such as strokes has been observed in moderate and severe COVID. However, strokes have also been increasingly observed in mild COVID, post COVID, or without obvious COVID illness.

Objective:

To share our experience with a specific stroke type noted during the COVID pandemic period.

Materials and Methods:

A single-center observational study was conducted in Western India from January to December 2020, and data regarding stroke patients admitted under Neurology services were noted. Clinical, laboratory, and radiological characteristics of strokes and subtypes were documented.

Results:

A total of 238 stroke patients were admitted in 2020, 76.5% during the COVID pandemic period. Among 153 ischemic strokes, 16.3% and 56.2% had large vessel occlusion (LVO) in pre-COVID and COVID pandemic period, respectively. Of all ischemic strokes, 20.9% (18 patients) and 12% (3 patients) had free floating thrombus (FFT) in the COVID versus pre-COVID period, respectively. Only 44.4% of all FFT patients could be proven SARS-CoV-2 RT-PCR positive while 50% were COVID suspect with surrogate markers of heightened inflammation at time of stroke. All patients were given anticoagulation and average mRS at discharge was 3.1 (range: 1–6) and 1.84 (range: 0–4) at 3-month follow-up in survivors.

Conclusions:

This study highlights the presence of FFT causing LVO as a new stroke subtype during the COVID-19 pandemic. With renewed and steeper spike in COVID-19 cases, especially new variants, the resurgence of this stroke subtype needs to be actively explored early in the course of illness to reduce morbidity and mortality.
Comparison of Frozen Section and Squash Cytology as Intra-Operative Diagnostic Tool in Pediatric CNS Tumors
Authors: Jain Kavita , Sengupta Moumita , Maity Priyanka , Chatterjee Uttara , Chaudhuri Shubhamitra , Rajyalakshmi E , Datta Chhanda , Ghosh Subhashish , Chatterjee Sandip
Published: August 2023

Background:

Pediatric central nervous system (CNS) tumors have a different histological spectrum as compared to adults with the infantile group having even more varied and distinct histological profiles. Intra-operative diagnosis is especially important as it guides the neurosurgeon to tailor an approach which is best suited for a particular case. The aim of the study was to evaluate the diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value of frozen section (FS) and squash cytology and to find out the degree of correlation (kappa value) between the two procedures.

Materials and Methods:

A prospective study was conducted on 55 pediatric patients with clinicoradiologically diagnosed CNS lesions for a period of 2.5 years. Intra-operative squash smears and FS were made and stained with hematoxylin and eosin stain. Diagnosis made subsequently on paraffin embedded sections was taken as the gold standard.

Results:

Although the specificity (90%) and positive predictive value (96%) were comparable between the two procedures, sensitivity (91.4%) and negative predictive value (75%) of FS was more as compared to squash cytology. Both the diagnostic modalities showed substantial agreement (k = 0.728).

Conclusion:

Even though the histological spectrum of pediatric CNS tumors is more varied than adults, FS gives a reasonable intra-operative diagnosis and better results when compared to squash alone.
Understanding and Managing Autonomic Disorders in the Neurocritical Care Unit
Authors: Abraham Mathew , Bhattacharjee Siddharth , Ram Ananth , Maramattom Boby Varkey , Padmanabhan Sandeep , Soman Adithya
Published: August 2023

Background:

For a favorable outcome, patients admitted to critical care units require continuous monitoring and swift decision-making ability regarding management. One of the biggest challenges in neurocritical care units is the identification and management of autonomic dysfunction and in the worst-case scenario, autonomic storms.

Objective:

Most of the literature available focuses mainly on autonomic storms following traumatic brain injury. However, due to the myriad neurological presentations in a critical care setting, it is particularly important for physicians and intensivists to suspect and manage autonomic dysfunction in various neurological scenarios.

Methods:

Understanding the mechanism of paroxysmal sympathetic hyperactivity (PSH) is essential for early recognition and treatment. PSH-AM is an assessment measurement scale to diagnose and assess the severity of PSH in traumatic brain injury. However, this is not yet standardized across all neurological settings.

Conclusion:

We present a comprehensive report on understanding the mechanism of autonomic storms across various neurological disorders and outline the management.
Beta Amyloid and Malondialdehyde Serum Levels' Analysis in Atrial Fibrillation Patients with Cognitive Impairment
Authors: Syafrita Yuliarni , Amir Darwin , Susanti Restu , El Rasyid Hauda
Published: August 2023

Background:

Atrial fibrillation (AF) is the most commonly encountered cardiac dysrhythmia, and AF patients are five times more likely to have a risk of stroke. Although the effects of stroke on patients are quite severe, lately it has been recognized that AF is associated with the incidence of cognitive impairment and dementia.

Objective:

This study aims to analyze and determine the differences in two isoforms of amyloid beta (Aββ40 and 42) and malondialdehyde (MDA) serum levels in AF patients who experience and who do not experience cognitive impairment.

Methods:

An observational study with case-control design was carried out on 63 people with atrial fibrillation, consisting of 38 people with cognitive impairment and 25 people without cognitive impairment. Examination of MDA and the Aβ40 and Aβ42 levels was carried out by ELISA. The difference level of each variable in the two groups was tested by the Mann–Whitney and χ2 tests, at P ≤ 0.05 significance level.

Results:

Lower mean levels of Aβ42 and higher mean levels of MDA were found in the group with cognitive impairment rather than in the group without cognitive impairment. Lower mean levels of Aβ40 were found in the group with cognitive impairment rather than in the group without cognitive impairment but this difference was not statistically significant.

Conclusion:

Significantly lower levels of Aβ42 and higher levels of MDA were found in the AF patients with cognitive impairment rather than in the AF patients without cognitive impairment.