bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multimodal Imaging and Visual Evoked Potentials Reveal Key Structural and Functional Features That Distinguish Symptomatic From Presymptomatic Huntington's Disease Brain
Authors: Thota Sai Manohar , Chan Kimberly L , Pradhan Sai Sanwid , Nagabushana Bhavana , Priyanka GB , Sunil H V , Kanneganti Vidyasagar , Vasoya Pavan , Vinnakote Krishna Murthy , Viswamitra Sanjaya , Thambisetty Madhav , Kumar Dileep , Tiwari Vivek , Joshy E V , Sivaramakrishnan Venketesh 
Published: September 2024

Background:
Huntington's disease (HD) is a progressive neurodegenerative disorder characterized by motor, cognitive, and psychiatric abnormalities. Currently, matched analyses of structural and functional differences in the brain from the same study cohort and, specifically, in HD patients from an ethnically diverse Indian population are lacking. Such findings aid in identifying noninvasive and sensitive imaging biomarkers.

Objective:
The aim of the study was to understand the structural and functional differences between HD and control brain, and presymptomatic and symptomatic HD brain in the Indian population.

Materials and Methods:
Seventeen HD (11 symptomatic HD [S-HD] and six presymptomatic HD [P-HD], with comparable CAG repeats), and 12 healthy controls were examined. Macrostructural (volume), microstructural (diffusivity), and functional (neurochemical levels and glucose metabolism) imaging of the brain was done along with the determination of visual latencies.

Results:
HD brain showed increased intercaudate distance; significant subcortical volumetric loss; reduced fractional anisotropy; increased mean, axial, and radial diffusivity; lower levels of total N-acetyl aspartate; elevated total choline levels; and reduced glucose metabolism compared with control brain. Interestingly, compared with P-HD, S-HD patients demonstrated a strong inverse correlation between age at onset and CAG repeat length, and prolonged P100 latency. In addition, caudate and putamen in S-HD brain showed significant volumetric loss and increased diffusivity compared with P-HD brain.

Conclusions:
HD brain showed distinct macrostructural, microstructural, and functional differences compared with control brain in the Indian population. Interestingly, patients with S-HD had a significant volumetric loss, increased diffusivity, altered neurochemical profile, and delayed P100 latency compared with P-HD patients. Examining these alterations clinically could aid in monitoring the progression of HD.
En-bloc Resection of A Giant Solid Hemangioblastoma of The Vermis
Authors: Goda Revanth , Dey Subhashish , Doddamani Ramesh Sharanappa , Gaikwad Shailesh , Chandra Poodipedi Sarat 
Published: September 2024

Introduction:
Hemangioblastomas (HMB) are extensively vascularized and benign neoplasms that are diagnosed predominantly in adults. The solid type of HMB is technically challenging to operate. The piecemeal resection of the tumor has been shown to have devastating intraoperative complications. Therefore, en-bloc tumor resection was shown to be the safest procedure to reduce the risk of intraoperative bleeding and facilitate the removal of large solid tumors. Unfortunately, most of these tumours are also not amenable for embolization, as they are fed by multiple pial vessels. However, the large arterial feeders may be embolized.

Objective:
This video abstract presents a case of en-bloc resection of a giant solid type of Vermian HMB.

Surgical Technique:
A 38-year-old male patient presented with headache and vomiting for 1 year, imbalance during walking for 6 months, and hoarseness of voice for 2 months. He underwent a CSF diversion procedure in another hospital and was referred to our center for definitive surgery. Contrast-enhanced MRI showed a large heterogeneously enhancing solid lesion of size 46 × 33 × 40 mm3 with central necrotic area in the posterior fossa with perilesional edema and several large flow voids on T2-MR sequence. Preoperative embolization was performed; however, there was no significant reduction in the vascularity of the lesion. The patient underwent a wide midline suboccipital craniotomy with C1 laminectomy and gross total en-bloc resection of HMB.

Results:
The patient had an uneventful recovery in the postoperative period.

Conclusions:
The safest approach in the resection of giant solid HMB involves proper preoperative planning and understanding the vascular pattern of the lesion, wide exposure, circumferential dissection, and the en-bloc delivery of the tumor.
The Rationale of Yoga in Parkinson's Disease
Authors: Mailankody Pooja , Varambally Shivarama , Thennarasu K , Pal Pramod Kumar 
Published: September 2024

Background:
Patients with Parkinson's disease (PD) commonly use complementary and alternative medications. Yoga is a mind-body intervention that is being increasingly explored as a tool in the therapeutic armamentarium of PD.

Objective:
To critically evaluate the studies and summarize the utility of Yoga in PD.

Material and Methods:
We performed a systematic literature search in the Medline and Cochrane databases and included randomized controlled trials (RCT) of Yoga in PD. The studies were evaluated for internal validity and the relevant data were extracted.

Results:
A total of seven studies were included in the analysis. We collated the data on the changes in motor function, gait and balance parameters, anxiety, depression and quality of life scores observed after intervention (Yoga) in patients with PD and highlighted the limitations of these studies.

Conclusion:
Anxiety, depression, and balance issues in PD may benefit from Yoga. Yoga has potential as an add-on therapy in PD.
Paraclinoid Segment Aneurysms of the Internal Carotid Artery
Authors: Behari Sanjay , Dikshit Priyadarshi , Singh Suyash , Singh Gagandeep , Singh Vivek , Phadke Rajendra V , Bhaisora Kamlesh S 
Published: September 2024

Background:
Paraclinoid segment aneurysms arise from the internal carotid artery (ICA) between the distal dural ring and the origin of the posterior communicating (PComm) artery.

Objective:
This pictorial study presents videos showing clipping of paraclinoid segment aneurysms.

Materials and Methods:
The various subtypes of these aneurysms, the nuances in the technique of clinoidectomy, and methods of proximal control are presented.

Results:
Cavernous ICA is designated as C4, clinoidal segment (between the proximal and distal dural rings) as C5, and supraclinoid segment (between the distal dural ring up to the PComm artery as C6 segment. The techniques used for clipping various aneurysms are based upon their subtypes and location. In the first case, in a giant superior hypophyseal artery aneurysm directed toward the suprasellar region, an intradural clinoidectomy helped in accessing the neck of the aneurysm encroaching into the clinoidal segment of ICA. In the second case, concurrent bilateral “kissing” paraclinoid segment aneurysms were clipped using a unilateral approach. In the third case, clipping of a dissecting paraclinoid segment aneurysm is demonstrated.

Conclusions:
Surgery still represents the most definitive form of treatment. It may also be used to evacuate an intracerebral hematoma, with an extremely tortuous proximal vessel or in an aneurysm with complex anatomy, with blister aneurysms, or following aneurysm regrowth following a failed endovascular procedure. Assessing the three-dimensional anatomy of various segments of ICA is an important step.
Home Rehabilitation System in Chronic Stroke
Authors: Saggini Raoul , Veraldi Roberto , Carmignano Simona Maria , Palermo Tommaso , Russo Chiara , Barassi Giovanni , Bellomo Rosa G 
Published: September 2024

Introduction:
By 6 months following a stroke, approximately 65% of stroke survivors cannot incorporate into daily activities, resulting completely dependent. The aim of this study is to assess the overall outcome in psychological and physical well-being, increase in residual abilities, reintegration and social inclusion for people with chronic disabilities resulting from stroke, after home rehabilitation.

Materials and Methods:
We assessed the functional outcome of a group of 600 patients with disability related to several pathological conditions and undergoing home rehabilitation therapy (twice a week for 40 sessions per year) as granted by the Public Health. We evaluated the outcome with Barthel and Functional Independence Measure (FIM) scales. Furthermore, in a group of 73 persons with chronic stroke we also carried out an overall evaluation, by using specific rating scales (FIM, Stroke Impact Scale, Motricity Index, Tinetti Balance Scale, 10-m Walking Test, 6-min Walking Test, 5 Repetitions Sit-to-Stand Test, and Hamilton Depression Scale) after 120 days (114 ± 6) from the end of the home rehabilitation program.

Results:
The results highlighted a statistically significant improvement between T0 and T1 and a significant worsening between T1 and T2 (follow-up at 3 months). Hamilton Depression Scale is the only parameter that significantly improves both at the time T1 and T2.

Conclusions:
Territorial rehabilitation system should consider some fundamental aspects: centrality of the person and the individual health project; identification of specific and personalized rehabilitation plan and prognosis based on the results of a follow-up; ultra-specialization of interventions; multidisciplinary team; highlight of the emerging needs; and coordination of the different care pathways.
IgG4-Related Disease in Intradural Extramedullary Location- Detailed Case Illustration and Literature Review with Special Emphasis on Role of Surgery in its Management
Authors: Sharma Rajeev , Kaur Kavneet , Sasidharan Anju , Gupta Ranjan , Laythalling Rajinder Kumar 
Published: September 2024

Background:
IgG4-related disease (IgG4RD) is a multisystemic progressive fibroinflammatory and lymphoproliferative autoimmune disorder of unknown etiopathogenesis; and its occurrence in intradural extramedullary (IDEM) location is extremely rare.

Aim and Objective:
The aim of this study was to review all IDEM IgG4RD cases described in English literature and to signify the role of surgery in its management at this rare location along with the surgical technique and intraoperative findings.

Methods:
An Internet-based search (PubMed) for the published reports describing spinal cases of IgG4RD with IDEM involvement was done using the keyword: spinal IgG4-related disease. An illustration of a case of cranial IgG4-related disease in a young man who developed metachronous cervical involvement in intradural extramedullary (IDEM) location is also presented.

Results:
Amongst 45 spinal IgG4RD cases reported in English Literature, only 3 cases were IDEM IgG4RD. In the illustrated case, portion of the cervical lesion causing cervical cord encasement was intradural but extraarachnoidal- located between arachnoid and dura, without any pial involvement. All these 4 cases improved following surgery.

Conclusion:
Timely meticulous resection of mass lesion in situations of medical treatment failure or progressive neurological decline can lead to reversibility of mass effect-associated neurological manifestations of IgG4RD.
Innovative Microscope Drape to Mitigate Particulate Dispersion During High-Speed Drilling
Authors: Tandon Vivek , Raheja Amol , Garg Kanwaljeet , Kale Shashank S 
Published: September 2024

Background:
High-speed drilling during neurosurgical procedures lead to aerosol generation. Contaminated particles when dispersed can lead to transmission of disease in healthcare workers via air-borne route. We designed and validated the utility of an innovative microscope drape, in mitigating the dispersion of aerosol, while drilling on an ex-vivo model.

Methods:
Two consecutive high-speed drilling operative simulations were performed using a dry-model under operative-microscope with and without drape, respectively, to demonstrate the degree of particulate dispersion while high-speed drilling using a 10% Povidone-Iodine solution for irrigation.

Results:
There was significantly lower particulate dispersion and soiling of surgeon's gown, mask, and surrounding drapes outside the immediate operative field using the customized microscope mounted drape.

Conclusions:
Customized microscope mounted drape is effective in containing the widespread particulate dispersion associated with high-speed drilling under a microscope. The benefits of this specialized drape can translate into a safer micro-environment for operating surgeons during drilling procedures.
Clinical and Molecular Features of First Mexican Friedreich's Ataxia Patients with Compound Heterozygous FXN Mutations
Authors: Boll Marie Catherine , Gasca-Saldaña Dianela , Mayén-Lobo Yerye Gibrán , Dávila-Ortiz de Montellano David José , Monroy-Jaramillo Nancy 
Published: September 2024

Background:
Friedreich's ataxia (FRDA) is caused by homozygous GAA repeat expansions or compound heterozygous (CH) mutations in FXN gene. Its broad clinical spectrum makes it difficult to identify, thus an accurate diagnosis can only be made by genetic testing.

Objective:
This study aims to present data on FXN variants observed in patients with sporadic or recessive ataxia, including detailed data of the first CH Mexican patients.

Materials and Methods:
One hundred and eight patients with recessive or sporadic cerebellar ataxia were referred to our institution between 2009 and 2019 for FXN molecular testing. This was achieved using a combined methodology of triplet repeat-primed PCR (polymerase chain reaction), long PCR, FXN sequencing and multiplex-ligation probe-amplification.

Results:
Eighteen patients had a homozygous FXN genotype; whereas five were CH patients with a slow progression and phenotypic variability, including a late-onset case with spastic paraparesis, and a Charcot-Marie-Tooth-like case.

Conclusions:
These first Mexican CH patients pose important implications for genetic counseling and FRDA management.
Effect of Yogasanas Versus Gaze Stability and Habituation Exercises on Dizziness in Vestibular Dysfunction
Authors: Gazbare Preeti S , Rawtani Namrata D , Rathi Manisha , Palekar Tushar J 
Published: September 2024

Background:
Dizziness is a typical manifestation of vestibular pathologies. Clinical studies have shown that it affects 1.82% of young adults to more than 30% older adults. Habituation and compensation are some traditional rehabilitation protocols.

Objective:
Yoga is also known to have a significant effect on vestibulopathy. Hence, a need arises to compare the above two maneuvers.

Materials and Methods:
Participants were recruited (n = 32) after screening using the Dix–Hallpike and head impulse test. They were then divided into two groups (n = 16). The first one, Group A, received yogasanas, and the second one, Group B, received gaze stabilization and habituation exercises for 4 days a week for 3 weeks. Pre- and post intervention outcome measures were taken using the Motion Sensitivity Quotient (MSQ) score and Dizziness Handicap Inventory (DHI) scale.

Results:
In reducing symptoms of dizziness, the between-group comparison shows that Group A has shown greater improvement (12.37% ±1.43%) in MSQ and Group B has shown greater improvement (16.12 ± 3.56) in DHI. Within-group comparison shows that both the interventions are effective in reducing symptoms of dizziness (P < 0.05).

Conclusion:
Both yogasanas and gaze stabilization along with habituation exercises are effective in improving the symptoms in patients with peripheral vestibular dysfunction. When compared between the groups, yogasanas had a superior hand in the MSQ score, whereas gaze stabilization and habituation exercises had a superior hand in the DHI scale.
MITLIF Operative Nuances- Step by Step
Authors: Yerramneni Vamsi K , Kanala Ramanadha R , Kolpakawar Swapnil , Yerragunta Thirumal 
Published: September 2024

Background:
MITLIF is popular among minimally invasive lumbar interbody fusion procedures. The common indications of MITLIF are Grade I and selected cases of Grade II spondylolisthesis, Failed Back Surgery Syndrome, spondylodiscitis and deformity correction.

Objective:
To describe the technical nuances of MITLIF along with an operative video of a case of L4-L5 Grade I Spondylolisthesis.

Surgical Procedure:
Two incisions of 2.5 cm length are made on either side, at the level to be operated and further access is created by muscle splitting. Screws, rods and cage(s) are placed through this corridor under fluoroscopic guidance.

Results:
This procedure has the advantages of minimal blood loss, less muscular trauma, retention of intact posterior ligamentous anatomy, shorter hospital stay, lesser CSF leak and infection rates when compared to the open approaches.

Conclusions:
MITLIF has emerged as the standard procedure replacing open approaches. Mastery of this approach is strongly recommended to spine surgeons.
Catastrophic Presentation of COVID-19 with Solitary Large Denovo Tumefactive Demyelination
Authors: Panda Samhita , Patel Pratik , Jain Saksham , Sharma Sanjiv , Vegda Monalisa , Patel Apoorv , Tiwari Sarbesh , Anne Puneeth Babu , Suthar Navratan , Kumar Bharat , Nag Vijaya Lakshmi 
Published: September 2024

Background:
The ongoing Coronavirus disease-19 (COVID-19) pandemic has revealed a plethora of extrapulmonary manifestations including neurological presentations. To date, nervous system demyelination has been relatively infrequently reported in this setting. Also, while most data point toward immune activation as a causative process, few studies propound a direct effect.

Case Description:
A 35-year-old man presented with severe new-onset headache, hemiparesis, and focal seizures culminating in deeply altered sensorium. Radiological evaluation showed a large expansile demyelinating lesion in the right cerebral hemisphere. Nasopharyngeal swab COVID reverse transcription–polymerase chain reaction (RT-PCR) was positive. After initial non-response to steroids, the patient responded well to plasma exchange leading to complete recovery.

Conclusions:
This report highlights a case of active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting with tumefactive demyelination and subsequent response to therapy. It is important to recognize atypical presentations at this juncture as it may be crucial for planning treatment strategies.
Intracranial Large Artery Disease is Independently Associated with Poor Functional Outcome in a Cohort of Ethnic South Asian Ischemic Stroke Patients
Authors: De Silva Deidre A , Wee Chee-Keong , Woon Fung-Peng , Chang Hui-Meng , Wong Meng-Cheong 
Published: September 2024

Background:
Intracranial large artery disease (ICLAD) in ischemic stroke patients is associated with an increased risk for recurrent stroke; however, it is not known if ICLAD influences functional status following stroke. We studied the 6-month functional outcome in south Asian ischemic stroke patients and compared those with and without ICLAD.

Materials and Methods:
This is a prospective cohort study of consecutive south Asian ischemic stroke patients. ICLAD was assessed with transcranial color-coded Doppler ultrasound or magnetic resonance angiography. Functional outcomes were obtained via telephone interviews with poor outcome defined as modified Rankin scale of 3–6.

Results:
Of 216 ischemic stroke patients studied, 203 (93.9%) had follow-up data, of whom 50.7% (103) had ICLAD. Patients with ICLAD had a higher prevalence of hypertension (P < 0.001), hyperlipidemia (P = 0.047), ischemic heart disease (P = 0.030), and extracranial carotid disease (P = 0.005). A higher proportion of patients with ICLAD had poor functional outcome at 6 months (30.1%) versus those without ICLAD (13.0%) (P = 0.004). After adjusting for age, sex, hypertension, hyperlipidemia, diabetes, ischemic heart disease, atrial fibrillation, extracranial carotid stenosis, and recurrent vascular events, patients with ICLAD were 3.01 (95% confidence interval: 1.35–7.10) times more likely than those without ICLAD to have poor functional outcome.

Conclusions:
The presence of ICLAD rendered poorer functional prognosis after stroke. These findings support the specific evaluation of the benefits of known acute stroke treatments such as thrombolysis, as well as investigation of potential novel strategies such as acute stenting.
Correlation of DTI-Derived Measures to Therapy-Mediated Recovery after Stroke
Authors: Bhasin Ashu , Srivastava Padma , Kumaran Senthil S 
Published: September 2024

Introduction:
Corticospinal tracts (CST) forms the basis of motor neurophysiology after stroke. Motor skill recovery has been correlated well to the microstructural properties of CST in both hemispheres. Functional imaging has opened up new possibilities of imaging functionality of cortex and fiber tracts in the brain. We studied therapy-induced changes in blood oxygenation level-dependent (BOLD) and DTI imaging on 20 chronic stroke patients at baseline, 8, and 24 weeks.

Settings and Design:
All the patients were subjected to MR imaging on a 1.5 T MR scanner. We used block design for BOLD with alternate baseline and activation cycles (repetition time (TR) =4520 ms, echo time (TE) = 44 ms, slices = 31, slice thickness = 4 mm). DTI parameters were as follows: TE = 76 ms, TR = 10,726 ms, EPI factor = 127, resolution = 128 × 128 matrix, field of view = 230 mm and a slice thickness of 4.0 mm.

Statistical Analysis Used:
The data was analyzed on SPSS software and tractography/DTI processing software (M/s. Siemens Medical Solutions, Erlangen Germany.

Results:
The mean axial diffusivity (λ[INSIDE:1]) and radial diffusivity (λ[INSIDE:2]) in the affected hemisphere were 0. 30 and 0.18, respectively. The mean number (FN) ratio (± SD) was 0.27 ± 0.14 at baseline, 0.33 ± 0.19 at 8 weeks, and 0.41 ± 0.23 at 24 weeks. Multivariate regression analysis at baseline showed that rFA was well-correlated to the Fugl-Meyer score (regression coefficient: 0.198, F = 10.382, P = 0.001), MI followed by signal intensity.

Discussion:
All patients had high % signal intensity after 8 weeks of physiotherapy regime with a greater percentage change in rFA as compared at follow-up suggesting that a focused exercise regime in stroke patients helps in the reconnection of neural and myelin networks.

Conclusion:
Clinical and functional recovery after stroke is well-correlated with the DTI and BOLD parameters i.e., rFA ratios, CST involvement fiber numbers, and % signal intensity of the ipsilesional cortex.