bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.