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Coverpage
January-February 2019
Volume 67 | Issue 1
Page Nos. 1-349

Online since Thursday, March 7, 2019

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NI FEATURE: THE FIRST IMPRESSION - COMMENTARY  

The cover page Highly accessed article p. 1

DOI:10.4103/0028-3886.253583  PMID:30860084
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NI FEATURE: TIMELESS REVERBERATIONS - COMMENTARY Top

Reminiscences on the evolution of neurosciences in Central India Highly accessed article p. 2
Hemant G Deshpande
DOI:10.4103/0028-3886.253604  PMID:30860085
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NI FEATURE: JOURNEY THROUGH THE EONS - COMMENTARY Top

Women in the neurosciences p. 6
Sunil K Pandya
DOI:10.4103/0028-3886.253584  PMID:30860086
The term 'scientist' was coined to describe Mary Somerville (1780-1872) as her contributions to astronomy commanded recognition of her excellence in science. Up to then, the term 'man of science' had been in use. In fields traditionally considered the province of males, the entry of women was viewed with consternation, apprehension and alarm. Resistance was instinctive in most leading scientists. This attitude was strengthened by illogical and pseudoscientific statements on the frailty of women. The pioneers blazing trails in medicine for their sisters to follow braved ridicule, hostility, and discrimination. At times they used subterfuge. The example of Dr. James Barry (Margaret Ann Bulkley) is well-known. Thanks to them, we now have nationally and internationally eminent scientists from the gentler sex, and some of them in commanding positions. The neurosciences developed in India as a result of the efforts made by pioneer neurosurgeons such as Drs. Jacob Chandy (Vellore), B. Ramamurthi (Madras), R.G. Ginde (Bombay), Dr. Prakash N. Tandon (New Delhi) and neurophysicians such as Drs. Baldev Singh (New Delhi), T.K. Ghosh (Calcutta) and Noshir H. Wadia (Mumbai). They and others such as Drs. V.R. Khanolkar, Darab K. Dastur, B.K. Bachhawat and Obaid Siddiqui encouraged individuals like Dr. Vimla Virmani, Dr. Devika Nag, Dr. T.S. Kanaka and Dr. Gourie Devi in the clinical neurosciences and Drs. Kamal Ranadive, V.S. Lalitha, Veronica Rodrigues and Gomathy Gopinath in the basic neurosciences. Two eminent neuroscientists from abroad (Drs. Nancy Kopell and Indira Raman), and three from India (Drs. Vijaylakshmi Ravindranath, Chitra Sarkar and Vidita Vaidya) have been chosen by me as representatives and their careers, contributions and views on discrimination against women in science discussed in brief. (This is not to deny outstanding work by others but limitations of space have made this choice necessary.) The factors favouring the blossoming of women in science include encouraging and stimulating parents, a conducive environment at home and mentors. A compelling drive to excel, hard work and sincerity are crucial to success. Nasty forms of experiences demoralise women. Sexual harassment by seniors and colleagues in the laboratory and elsewhere can lead to the victim leaving the field altogether. Discrimination in selection, promotion and publication lower morale and impact output in terms of research and contributions to journals and books. Suggestions made by the five eminent neuroscientists named above to liberate women from such negative behaviour by males are presented. The Indian Women Scientists' Association is playing an important role in helping their members, making their work known to society and generally empowering them. Since unity strengthens, collaborative activities with other similar organisations will augment efficacy. One such organisation is the much older Association of Medical Women of India.
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Remembering India's first, “unrecognized” neuroscientist: Acharya Jagdish Chandra Bose p. 17
Prakash N Tandon
DOI:10.4103/0028-3886.253581  PMID:30860087
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Changing paradigms in the surgical management of brainstem gliomas. Lessons learnt from Prof Nagpal's paper published in 1983 p. 20
Vishwaraj Ratha, I Vijay Sundar, Nishanth Sampath, V R Roopesh Kumar
DOI:10.4103/0028-3886.253617  PMID:30860088
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GUEST COMMENTARY Top

Neurological changes in outer space Highly accessed article p. 37
Krishnan Ganapathy, Michele da Rosa, Thais Russomano
DOI:10.4103/0028-3886.253647  PMID:30860089
Space travel, once considered esoteric and part of science fiction, is becoming a reality in our lifetime. Closely monitoring health parameters in real-time and providing health care to Vyomanauts 200 km above the Earth's surface will be a reality in India, in just another 40 months. This will be the ultimate feat in Telemedicine! This review article gives an overview of what a “Space Doctor” needs to know with specific reference to the nervous system.
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The pursuit of wellness in neurosurgery: Investing in residents' current and future health: Spouses' perspectives p. 44
Melba Estrella, Betsy G Henderson, Sarah Cisewski Porto, Mary Vargas, Ebony Hilton Buchholz, Stephanie M Ellens, Vicki Spiotta, Alejandro M Spiotta
DOI:10.4103/0028-3886.253612  PMID:30860090
Neurosurgery residency is daunting and all-consuming to those who undergo it, and the spouses of those residents are not exempt from the challenges it presents. In light of our institution's implementation of a wellness initiative in neurosurgery residency education, the spouses of various participants offer their insights on the program, shedding light on the full extent of its benefits.
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NI FEATURE: THE EDITORIAL DEBATE I-- PROS AND CONS Top

Visual perceptual abnormalities in Parkinson's disease p. 53
Ashwin Kumar Panda, Sanjay Pandey
DOI:10.4103/0028-3886.253588  PMID:30860091
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Visual symptoms in Parkinson's disease p. 56
Charulata Savant Sankhla
DOI:10.4103/0028-3886.253603  PMID:30860092
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NI FEATURE: THE EDITORIAL DEBATE II-- PROS AND CONS Top

Far lateral approach to anterior foramen magnum meningiomas – When should condyle be drilled? p. 59
Laligam Sekhar, Qazi Zeeshan
DOI:10.4103/0028-3886.253594  PMID:30860093
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Far-lateral skull base approaches: Shades of grey p. 61
Vinayak Narayan, Pankaj Agarwalla, Fareed Jumah, Anil Nanda
DOI:10.4103/0028-3886.253596  PMID:30860094
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Foramen magnum meningiomas – Understanding the requirement and extent of condylar resection p. 65
Manas Panigrahi, Sudhindra Vooturi
DOI:10.4103/0028-3886.253593  PMID:30860095
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NI FEATURE: THE EDITORIAL DEBATE III-- PROS AND CONS Top

Preoperative facial nerve diffusion tensor imaging tractography for preservation of facial nerve function in surgery for large vestibular schwannomas p. 67
Allan Taylor
DOI:10.4103/0028-3886.253595  PMID:30860096
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Sketching the facial nerve on vestibular schwannoma p. 69
Dhaval Shukla
DOI:10.4103/0028-3886.253589  PMID:30860097
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NI FEATURE: THE EDITORIAL DEBATE IV-- PROS AND CONS Top

Endoscopic transpterygoid repair of cerebrospinal fluid leaks from lateral recess of sphenoid p. 71
Narayan Jayashankar
DOI:10.4103/0028-3886.253590  PMID:30860098
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Endonasal transpterygoid approach for lateral sphenoid recess cerebrospinal fluid leaks: Technical aspects p. 73
Anandh Balasubramaniam
DOI:10.4103/0028-3886.253591  PMID:30860099
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NI FEATURE: THE EDITORIAL DEBATE V-- PROS AND CONS Top

Three-dimensional double inversion recovery magnetic resonance sequence detects perilesional gliosis better than 3D-FLAIR and postcontrast T1 imaging in calcified neurocysticercosis p. 74
Vijay Sawlani, Markand Patel
DOI:10.4103/0028-3886.253592  PMID:30860100
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Double inversion recovery in detection of perilesional gliosis in calcific cysticercosis p. 76
Amit Herwadkar
DOI:10.4103/0028-3886.253601  PMID:30860101
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REVIEW ARTICLES Top

Bibliometric analysis of the top-cited articles on idiopathic intracranial hypertension p. 78
Yavuz Samanci, Bedia Samanci, Erdi Sahin
DOI:10.4103/0028-3886.253969  PMID:30860102
Objective: To identify and characterize the top-cited articles on idiopathic intracranial hypertension. Methods: We used “Web of Science database” to identify the top-cited articles published between the years of 1975-2017. The articles were evaluated using citation count and other factors that have an effect on the citation count. Results: The search yielded a total of 2,141 articles and the most frequently cited articles received between 58-476 citations. Most articles were published between the years 1990-1999. The most popular study design involved natural history studies. USA ranked first in productivity with 72 articles and the leading institution was University of Iowa. The journal “Neurology” published the greatest number of articles. In assessing the specialties, neurology contributed to 32% of top 100 articles. There was no correlation between the citation count and number of references, years since publication, number of authors, authors' H-index, and number of institutions that had collaborated. There were positive correlations between the citation count and journal impact factor, Scimago journal rank and journal source-normalized impact per paper values. While descriptive keywords were more frequent between 1980s and 1990s, keywords describing surgical management options such as “nerve sheath decompression” and “cerebrospinal-fluid diversion” were top-listed keywords after the year 2000. Conclusions: Our study can help researchers identify the most significant and impactful articles on idiopathic intracranial hypertension, as well as to provide insight into the most noteworthy scientific trends and to visualize future research needs of the topic.
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Shunt migration in ventriculoperitoneal shunting: A comprehensive review of literature p. 85
LS Harischandra, Anurag Sharma, Sandip Chatterjee
DOI:10.4103/0028-3886.253968  PMID:30860103
Ventriculoperitoneal shunts are one of the commonest surgical procedures performed in neurosurgery. Complications of this procedure include mechanical complications and nonmechanical ones. The most distressing mechanical complication is shunt migration, and often when this occurs, it becomes difficult to work out the mechanism and the management protocol. This review is designed to answer questions regarding management details of this unfortunate complication, and also seeks to identify the causes
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ORIGINAL ARTICLES Top

Prevalence of autism spectrum disorder in Indian children: A systematic review and meta-analysis Highly accessed article p. 100
Anil Chauhan, Jitendra K Sahu, Nishant Jaiswal, Kiran Kumar, Amit Agarwal, Jasleen Kaur, Sukhmanjeet Singh, Meenu Singh
DOI:10.4103/0028-3886.253970  PMID:30860104
Background: Autism spectrum disorder (ASD) is a developmental disability and is of public health importance. It affects not only the child and the family. It also has direct and indirect cost implications on the nation that are incurred in providing health care, support for education, and rehabilitative services. There is a lack of evidence-based estimate of the population prevalence of ASD in India. Therefore, this systematic review was aimed at determining the prevalence of ASD in the Indian population. Materials and Methods: We conducted a systematic review and meta-analysis of the published studies evaluating the prevalence of ASD in the community setting. A search within the published literature was conducted from different databases (PubMed, OvidSP, and EMBASE). The analysis of data was done using STATA MP12 (StataCorp, College Station, TX, USA). Results: Four studies were included in this systematic review. Of the four included studies, one had studied both urban and rural populations, and the other three had studied the urban populations only. The study from the rural setting showed a pooled percentage prevalence of 0.11 [95% confidence interval (CI) 0.01–0.20] in children aged 1-18 years; and, four studies conducted in the urban setting showed a pooled percentage prevalence of 0.09 (95% CI 0.02–0.16) in children aged 0-15 years. Conclusion: The scarcity of high-quality population-based epidemiological studies on ASD in India highlights an urgent need to study the burden of ASD in India. The proper acquisition of data related to the prevailing burden of ASD in India would lead to a better development of rehabilitative services in our country.
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Primary angiitis of the central nervous system: Clinical profiles and outcomes of 45 patients p. 105
Soumya Sundaram, Deepak Menon, Pooja Khatri, Sapna Erat Sreedharan, ER Jayadevan, Prabhakaran Sarma, Christian Pagnoux, PN Sylaja
DOI:10.4103/0028-3886.253578  PMID:30860105
Objective: To describe the clinical profile, treatment response and predictors of outcome in patients with primary angiitis of the central nervous system (PACNS) from a single tertiary care center. Methodology: Retrospective analysis of consecutive patients diagnosed with PACNS from January 2000 to December 2015. Outcome was defined as poor when the 6-month modified Rankin scale (mRS) was ≥3. Results: The median age of the 45 patients included in this study was 36 (range 19-70) years at disease onset and 31 (68.9%) were males. The initial presentation was ischemic stroke in 15 (33.3%), hemorrhagic stroke in 4 (8.9%), headache in 11 (24.4%), seizures in 8 (17.8%) and cognitive dysfunction in 5 (11.1%) patients. Diagnosis was confirmed by a four vessel cerebral digital subtraction angiogram (DSA), biopsy and by both biopsy and DSA in 26 (57.8%), 15 (33.3%) and 4 (8.9%) patients, respectively. All patients received glucocorticoids and 14 patients received in addition either cyclophosphamide or azathioprine as their first treatment. The median duration of follow-up was 33.1 (0.7-356) months. A poor 6-month outcome was observed in 12 (26.7%) patients. Relapse occurred in 25 (55.6%) patients and 7 (15.6%) died. Predictors of a poor outcome consisted of cognitive dysfunction at diagnosis (80% vs 20%; P = 0.014) and NIHSS ≥5 (62.5% vs 37.5%; P <.0005). None of the patients with a normal EEG had a poor outcome (P = 0.046). Predictors of relapse were a higher NIHSS at admission (P =.032) and a normal DSA (P = 0.002). Conclusion: In this cohort, severe deficits and cognitive symptoms at onset and an abnormal EEG were associated with a poor 6-month outcome.
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COMMENTARY Top

Primary angiitis of the central nervous system – An Indian experience p. 113
Achal Kumar Srivastava, Pradeep K Reddy Sura
DOI:10.4103/0028-3886.253599  PMID:30860106
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Primary central nervous system vasculitis in India – need for a multicenter prospective cohort study p. 115
Ramana Appireddy, Garima Shukla
DOI:10.4103/0028-3886.253600  PMID:30860107
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ORIGINAL ARTICLES Top

Usefulness of a modified questionnaire as a screening tool for swallowing disorders in Parkinson disease: A pilot study p. 118
Sureshkumar Radhakrishnan, Unnikrishnan K Menon, KR Sundaram
DOI:10.4103/0028-3886.253586  PMID:30860108
Aims: To determine the correlation between our questionnaire scores and two standard Parkinson's disease (PD) disability scores [Unified Parkinsons' Disease Rating Scale (UPDRS) and Hoehn and Yahr (H and Y)], and to study the correlation between the various subgroups of our dysphagia screening questionnaire. Settings and Design: This study was conducted at a movement disorder clinic in a tertiary care hospital in Kochi, Kerala. This was a cross-sectional observational study. Materials and Methods: A questionnaire was developed comprising 11 items, keeping in mind the most relevant swallowing issues in PD patients. The questions were subdivided into four groups representing the different stages of swallowing. Reliability and validity studies were conducted for the questionnaire. Corresponding UPDRS and H and Y scores were documented on the same day. Statistical Analysis Used: Mean and standard deviation (SD) values of the scores in each group and the correlation between scores (Pearson correlation coefficient) were done. Results: Responses were obtained from 106 PD patients (67 males, 39 females), with a mean age of 66.9 years (SD, 8.62). Our questionnaire score showed a high coefficient of variation (145%) compared to the UPDRS and H and Y scores. There was also moderate correlation between our questionnaire score and the two standard scores with a significant P value. Finally, the highest mean scores were for questions from group A and the least for questions from group D. Conclusions: The association between worsening motor symptoms and swallowing difficulties has been documented in this study. The oral stage of swallowing remains the most affected in PD, which can be recognized early using our questionnaire.
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Assessment of visual misperceptions in patients with Parkinson's disease using single and bistable percepts as testing tools p. 123
Ankur Wadhwa, Bhupender K Bajaj, Shweta Pandey
DOI:10.4103/0028-3886.253587  PMID:30860109
Background: Visual misperceptions (VMs) and hallucinations (VHs) often go unreported in patients with Parkinson's disease (PD). We assessed the utility of single and bistable visual percepts as testing tools for visual perceptual abnormalities in PD. Aim: To assess VM in patients with PD using single and bistable percepts as testing tools. Settings and Design: This was a case-control study conducted at a movement disorders clinic. Materials and Methods: Thirty patients with PD and 30 age and sex-matched controls were assessed for motor severity and stage using Unified Parkinson's Disease Rating Scale-III (UPDRS-III) and modified Hoehn and Yahr scale. Higher mental functions were assessed by Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Trail making tests (TMT-A and B) scores. The participants were presented with monochromatic images representing either “single” or “bistable percepts” and the misperceptions were recorded. VM scores of patients and controls were compared. The correlation between disease duration, treatment period, motor severity, frontal executive functions, and VMs were determined. Results: Twenty-six patients had mild-to-moderate PD. Patients with PD had higher mean VM scores (P < 0.0005). None of the patients reported VHs. TMT-A, TMT-B, TMT-B − A scores were significantly lower in the control group (P < 0.0005). Cases showed significant positive correlation of VM with disease duration, treatment duration, UPDRS-III score, H and Y stage, and TMT A and B and an inverse correlation with MMSE and FAB scores. The patients with VM score greater than the upper limit of normal (Mean + 1.5 standard deviation [SD]), calculated from the control group, showed similar correlation of VM with motor and cognitive parameters. Conclusions: VMs are frequent in patients with PD when assessed using single and bistable visual percepts. VM correlates with frontal executive dysfunction, disease duration, and severity.
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Stroke-related education to emergency department staff: An acute stroke care quality improvement initiative p. 129
Inder Puri, Rohit Bhatia, Deepti Vibha, MB Singh, MV Padma, Praveen Aggarwal, Kameshwar Prasad
DOI:10.4103/0028-3886.253636  PMID:30860110
Background: Acute ischemic stroke therapy is time sensitive, and optimum treatment is missed due to pre-hospital and/or in-hospital delay. Materials and Methods: A prospective observational (before and after) study was conducted for 1 year.The study period was defined as phase-I or pre-education phase, phase-II or immediate post-education phase, and phase-III or delayed post-education phase, with each phase lasting for 4months. All consecutive stroke patients presenting within 12 hours of stroke onset were enrolled. Baseline and outcome data including acute stroke care quality matrices and functional outcomes were collected. Results: A total of 264 patients were enrolled. All acute stroke care quality matrices improved significantly (P ≤ 0.01) with a median door to imaging time (DTI) of 114, 35, and 47 minutes in the three phases consecutively. In phase-II, proportions of patients imaged within 25 minutes of arrival increased by 35%. Mean door to needle (DTN) time were 142 ± 49.7,63.7 ± 25.1, and 83.9 ± 38.1 minutes in the three consecutive phases. Patients with DTN < 60 minutes of arrival increased by 63%. Modified Rankin score (mRS) at 3 months improved significantly in all ischemic stroke patients (P = 0.04) and patients with mRS of 0–2 increased by 22%. Conclusions: Stroke education to emergency department (ED) staff is an effective method to improve acute stroke care.
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COMMENTARY Top

Stroke-related education to emergency department staff p. 134
Man Mohan Mehndiratta, Natasha Singh Gulati, Prachi Mehndiratta
DOI:10.4103/0028-3886.253598  PMID:30860111
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ORIGINAL ARTICLES Top

3D-Double-Inversion recovery detects perilesional gliosis better than 3D-FLAIR and postcontrast T1 imaging in calcified neurocysticercosis p. 136
Jitender Saini, Pradeep Kumar Gupta, Praveen Gupta, Ravi Yadav, Nishtha Yadav, Rakesh Kumar Gupta
DOI:10.4103/0028-3886.253614  PMID:30860112
Background: Perilesional gliosis is an important substrate for seizures in patients harboring a calcified neurocysticercosis (NCC) lesion and magnetic resonance imaging (MRI) is useful for evaluating gliosis. Aims: The purpose of this study was to evaluate the usefulness of double-inversion recovery (DIR) sequence for identifying perilesional gliosis. Settings and Design: Hospital-based cross-sectional study. Methods and Materials: Forty-five patients with seizures were included in this study and a total of 88 calcified lesions identified on susceptibility weighted imaging (SWI) were evaluated on 3D-fluid attenuating inversion recovery (FLAIR), 3D-DIR, and 3D-postcontrast T1-weighted imaging on a 3T MRI for the presence of perilesional signal changes/enhancement. Perilesional signal was rated on a semiquantitative scale from grade 0 to 2 by independent raters. Statistical Analysis Used: Friedman, Wilcoxon signed rank, and Kappa tests were used. Results: 3D-DIR sequence performed better than both 3D-FLAIR and postcontrast 3D-T1W sequences as more number of lesions showed perilesional signal change on DIR sequence. DIR sequence showed perilesional signal abnormality in 24 lesions in which 3D-FLAIR was normal, whereas in another 18 lesions, it demonstrated perilesional signal changes better than 3D-FLAIR. In only three lesions, FLAIR was found to be superior to DIR sequence, whereas postcontrast T1W images showed rim enhancement in five cases where no perilesional signal change was seen on FLAIR/DIR sequences. Conclusions: Combining 3D-DIR with 3D-FLAIR, and postcontrast 3D-T1W sequences is beneficial for evaluation of calcified NCC lesions and 3D-DIR sequence is better than other two sequences for perilesional signal abnormalities.
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”Tailored” far lateral approach to anterior foramen magnum meningiomas – The importance of condylar preservation p. 142
Dwarakanath Srinivas, Pragyan Sarma, Harsh Deora, Manish Beniwal, V Vikas, K V L N Rao, BA Chandramouli, Sampath Somanna
DOI:10.4103/0028-3886.253609  PMID:30860113
Introduction: Anterior and anterolaterally situated foramen magnum meningiomas are a technically complex subgroup of meningiomas. The need for an extensive exposure and bone work and their complex anatomy make them a difficult and challenging group of tumors to resect. The bone work has ranged from an extensive condylar resection to condylar preserving exposures. In this paper, we present our experience with condylar preserving or minimal condylar resection based approaches to these tumors. Materials and Methods: All patients who underwent surgical resection of anterior and anterolaterally situated foramen magnum meningiomas were included in the analysis. The study period was more than 10 years from 2005 to 2015 at our institute; a tertiary referral centre in India. The records along with demographic profile, clinico-radiological features, surgical strategies, outcomes as well as mortality and morbidity were analysed. Results: There were a total of 20 patients (9 males and 11 females) who were operated during the study period. The average age was 36.7 years. In 16 patients, gross-total or near-total resection could be achieved, four patients underwent subtotal resection. Eight patients had fresh morbidity in the form of new motor deficits, pseudomeningocele formation, worsening of the lower cranial nerve functions or post-operative adhesions leading to syrinx formation. The follow-up ranged from 6 months to 140 months. Conclusion: Foramen magnum meningiomas are an eminently treatable group of tumors. Condylar preservation provides a good visualization, while helping to preserve joint stability and in avoiding instrumental stabilization.
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Effectiveness of preoperative facial nerve diffusion tensor imaging tractography for preservation of facial nerve function in surgery for large vestibular schwannomas: Results of a prospective randomized study p. 149
Raghu Samala, Sachin A Borkar, Ravi Sharma, Ajay Garg, Ashish Suri, Deepak Gupta, Shashank Sharad Kale
DOI:10.4103/0028-3886.253631  PMID:30860114
Background: The goal of surgery in case of a large vestibular schwannoma is complete excision of tumor and preservation of facial nerve function. The identification and preservation of facial nerve is very difficult during surgery, particularly in case of large tumors. This prospective randomized study was conducted to find out the effectiveness of preoperative facial nerve diffusion tensor imaging tractography (DTI) to predict location of the nerve and preservation of facial nerve function in surgery for large vestibular schwannomas. Materials and Methods: In this prospective randomized study, we recruited 100 patients with a large vestibular schwannoma(> 3cm). After initial scrutiny, 94 patients were randomized based on a computer generated chart. In group I, preoperative DTI was done and the operating surgeon was informed about the position of facial nerve preoperatively. In group II, DTI was not done. The facial nerve preservation rates and clinical outcome at follow up was compared between the two groups. Results: Out of 94 patients, there were 47 patients in group I (DTI group) and 47 patients in group II (Non DTI group). In DTI group, 40 patients were left for comparison after the exclusion criteria was applied. Preoperative DTI predicted that the facial nerve position was concordant with its intraoperative position in 39 patients (97.5% concordance). Facial nerve preservation rates were statistically significant in group I (DTI group) (P value = 0.002). Conclusion: The study establishes the role of preoperative DTI tractography for better facial nerve preservation in surgery for large vestibular schwannomas (>3 cm).
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Crescent durotomy for midline posterior fossa lesions p. 155
Manas Panigrahi, Shaikh Mohammad Samiruddin, Sudhindra Vooturi
DOI:10.4103/0028-3886.253637  PMID:30860115
Objective: The conventional midline suboccipital craniectomy, the standard approach for posterior fossa lesions, involves ligation of the occipital sinus. Postoperative sequelae that could occur from ligation of the occipital sinus include hydrocephalus, cerebrospinal fluid (CSF) leak, and pseudomeningiocoele formation. The standard of practice of venous pathway preservation, as practiced elsewhere in the cranium, should also be attempted in the posterior fossa. In the current study, we compared postsurgical complications between conventional “Y” durotomy with the proposed crescent durotomy in patients with posterior fossa lesions who underwent midline suboccipital craniectomy. Materials and Methods: The prospective data of 104 patients who underwent a midline suboccipital craniotomy for posterior fossa tumors between January 2011 and December 2015 was performed. Comparison of study variables was done between the durotomy techniques used. Results: Of the 104 patients who formed the study population, 39 (37.5%) were women. While 75 patients underwent crescent durotomy, the remaining underwent the conventional “Y” durotomy. Among the postsurgical complications, there were no differences between groups in terms of their surgical site hematoma (2.7% vs 3.4%; P = 1.000) and edema (1.3% vs 0.0%; P = 1.000). The groups were also similar in terms of the incidence of postsurgical CSF leak (1.3% vs 6.9%; P = 0.187) and cranial nerve deficits (4.0% vs 6.9%; P = 0.617). However, more number of patients who underwent the “Y” durotomy had postoperative pseudomeningiocoele (2.7% vs 17.2%; P = 0.017). Conclusion: The “crescent” durotomy is a novel dural opening technique which attempts to preserve the normal venous flow physiology. The crescent durotomy reduces the need for a duroplasty, facilitates a comfortable primary closure, thus reducing the risk of developing a postoperative pseudomeningiocoele.
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COMMENTARY Top

Cresentic durotomy for midline posterior fossa lesions p. 159
Ashwani Chaudhary
DOI:10.4103/0028-3886.253605  PMID:30860116
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ORIGINAL ARTICLE Top

Neuroprotective role of dexmedetomidine in epilepsy surgery: A preliminary study p. 163
Ashish Bindra, Ashutosh Kaushal, Hemanshu Prabhakar, Arvind Chaturvedi, Poodepedi Sarat Chandra, Manjari Tripathi, Vivekanandan Subbiah, Sandeep Sathianathan, Jyotirmoy Banerjee, Chander Prakash
DOI:10.4103/0028-3886.253616  PMID:30860117
Purpose: Long standing temporal lobe epilepsy (TLE) causes cerebral insult and results in elevated brain injury biomarkers, S100b and neuron specific enolase (NSE). Surgery for TLE, has the potential to cause additional cerebral insult. Dexmedetomidine is postulated to have neuroprotective effects. The aim of this study was to assess the effect of intraoperative dexmedetomidine on S100b and NSE during TLE surgery. Materials and Methods: 19 consenting adult patients with TLE undergoing anteromedial temporal lobectomy were enrolled and divided into two groups. Patients in Group D (n = 9) received dexmedetomidine whereas patients in Group C (n = 10) received saline as placebo in addition to the standard anaesthesia technique. Blood samples of these patients were drawn, before induction of anaesthesia, at the end of surgery, as well at 24 hours and 48 hours postoperatively, and analysed for serum S100b and NSE. Results: The demographic and clinical profile was comparable in both the groups. The baseline S100b in group C and group D was 66.7 ± 26.5 pg/ml and 34.3 ± 21.7 pg/ml (P = 0.013) respectively. After adjustment for the baseline, the overall value of S100b was 71.0 ± 39.8 pg/ml and 40.5 ± 22.5 pg/ml (P = 0.002) in the control and study group, respectively. The values of S100b (79.3 ± 53.6 pg/ml) [P = 0.017] were highest at 24 hours postoperatively. The mean value of NSE in the control and study group was 32.8 ± 43.4 ng/ml (log 3.0 ± 0.1) and 13.51 ± 9.12 ng/ml (log 2.42 ± 0.60), respectively. The value of NSE in both the groups was comparable at different time points. Conclusions: Lower perioperative values of S100b were observed in patients who received intraoperative dexmedetomidine. Dexmedetomidine may play a role in cerebroprotection during epilepsy surgery.
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CASE REPORT Top

Ictal FDGPET and SPECT in hemifacial seizures due to cerebellar epilepsy—Case report p. 169
Swapan Gupta, Sita Jayalakshmi, Lokesh Lingappa, Ramesh Konanki, Sudhindra Vooturi, Pushpalatha Sudhakar, Manas Panigrahi
DOI:10.4103/0028-3886.253622  PMID:30860118
The role of cerebellum in seizure generation is debatable. Semiology and electroencephalography (EEG) findings are non-specific and sometimes misleading, posing further difficulty in proving the epileptogenicity in pre-surgical workup. We report two cases of cerebellar lesions who presented with hemifacial seizures since the neonatal period and were refractory to antiepileptic drugs (AEDs). Both inter-ictal and ictal EEGs were non-contributory. Magnetic resonance imaging (MRI) showed a lesion in the cerebellum, in proximity to cerebellar peduncle in both the patients. (18) F-fluorodeoxyglucose–positron emission tomography (FDG-PET) and ictal single photon emission computed tomography (SPECT) showed focal hypermetabolism and hyperperfusion respectively, corresponding to the lesion on MRI in both the cases. Intraoperative electrocorticography showed rhythmic spikes confirming the epileptogenic nature of the lesion. Both patients were operated with a favorable surgical outcome. Histopathology was suggestive of a ganglioglioma in one child and a low-grade glioma in the other. Both cases illustrate that FDG-PET and SPECT can act as surrogate markers for invasive recordings to prove the epileptogenicity of cerebellar lesions, especially in resource limited settings.
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NI FEATURE: PATHOLOGY PANORAMA - COMMENTARY Top

ISNO consensus guidelines for practical adaptation of the WHO 2016 classification of adult diffuse gliomas p. 173
Vani Santosh, Palavalasa Sravya, Tejpal Gupta, Dattatraya Muzumdar, Geeta Chacko, Vaishali Suri, Sridhar Epari, Anandh Balasubramaniam, Bishan Dass Radotra, Sandip Chatterjee, Chitra Sarkar, Rakesh Jalali
DOI:10.4103/0028-3886.253572  PMID:30860119
Introduction: Recent advances in the molecular biology of adult diffuse gliomas have brought about a paradigm shift in their diagnostic criteria, as witnessed in the World Health Organization (WHO) 2016 guidelines for central nervous system tumors. It is now mandatory to perform several molecular tests to reach a definitive integrated diagnosis in most of the cases. This comes with additional cost and higher turnaround time, which is not always affordable in developing countries like India. In addition, the non-uniform distribution of advanced research and diagnostic testing centers adds to the difficulty. Methods: The Indian Society of Neuro-oncology (ISNO) multidisciplinary expert panel consisting of neuropathologists, neurosurgeons, and radiation/medical oncologists convened to prepare the national consensus guidelines for approach to diagnosis of adult diffuse gliomas. Results: Algorithms for arriving at an integrated diagnosis of adult diffuse gliomas predominantly using immunohistochemistry and with minimum possible additional molecular testing were agreed upon, thus addressing the problems of cost, accessibility, and turnaround time. Mandatory and optional tests were proposed for each case scenario. Conclusion: This document represents the consensus of the various neuro-oncology disciplines involved in diagnosis and management of patients with adult diffuse gliomas. The article reflects a practical adaptation of the WHO recommendations to suit a resource constrained setup.
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The Indian Society of Neuro-oncology guidelines: A “personalized” approach to treating adult diffuse gliomas p. 183
Sujit S Prabhu
DOI:10.4103/0028-3886.253602  PMID:30860120
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NI FEATURE: THE QUEST - COMMENTARY Top

Cerebral vasospasm and delayed cerebral ischemia: Review of literature and the management approach Highly accessed article p. 185
Chandril Chugh, Himanshu Agarwal
DOI:10.4103/0028-3886.253627  PMID:30860121
This article highlights the pathogenesis and management of cerebral vasospasm. It discusses the various pharmacological, endovascular, and neurosurgical approaches available for the treatment of cerebral vasospasm. Numerous drugs and procedures have been tried and tested in the management of cerebral vasospasm. We try to highlight the pros and cons of various pharmacological agents and case-based use of other not so popular and investigational techniques.
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NI FEATURE: CENTS (CONCEPTS, ERGONOMICS, NUANCES, THERBLIGS, SHORTCOMINGS) - ORIGINAL ARTICLE Top

Cerebrospinal fluid rhinorrhea from the lateral recess of sphenoid sinus: More to it than meets the eye p. 201
Gopikrishnan Rajasekar, Prakash Nair, Mathew Abraham, Vinod Felix, Arunkumar Karthikayan
DOI:10.4103/0028-3886.253634  PMID:30860122
Background: Cerebrospinal fluid (CSF) leak from the lateral recess of the sphenoid sinus is rare when compared to leaks from other sites. The extended endonasal approach along with a transpterygoid extension provides adequate exposure for repair of these defects. Materials and Methods: We retrospectively analyzed a series of seven patients who underwent eight transpterygoid approaches for repair of the CSF leak from the lateral recess of the sphenoid sinus. We analyzed the patient characteristics, site of leaks, type of repair done, and presence of increased intracranial pressure (ICP) in these individuals. Results: Seven patients underwent eight transpterygoid approaches for CSF leaks from the lateral recess of the sphenoid sinus. The leak was bilateral in one patient. The materials used for repair consisted of fat, fascia lata, free mucosal flap or a vascularised nasoseptal flap, and fibrin glue. Evidence of increased ICP was found in five of the seven patients. CSF diversion was needed in three of the seven patients (two ventriculoperitoneal shunt and one thecoperitoneal shunt). Conclusion: Endoscopic endonasal transpterygoid approach provides an excellent visualization of the skull-base defect and facilitates adequate instrument manipulation within the corridor, allowing successful repair of the defect with low rates of recurrence. Increased ICP can have a role in causing spontaneous CSF rhinorrhea from this location.
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NI FEATURE: CITADELS SCULPTING FUTURE - COMMENTARY Top

History of Neurosurgery at Sri Venkateswara Institute of Medical Sciences, Tirupati p. 207
Ramesh Chandra Vemula, Gautam Hanu
DOI:10.4103/0028-3886.253574  PMID:30860123
The history of the Department of Neurosurgery, at Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, a leading tertiary care center in Andhra Pradesh, is presented. The inception of this department and its growth to its present stature is documented. The Department of Neurosurgery was started in 1993, and the residency program in 2003. It caters to a huge population from Andhra Pradesh, Tamil Nadu, and parts of Karnataka. The Tirumala Tirupati Devasthanams (TTD), the caretaker of the Tirumala Venkateswara Swamy temple is a major stakeholder in SVIMS. The hospital provides quality health care without resulting in any financial burden to the patient.
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The Department of Neurosurgery, Grant Medical College and Sir J.J Group of Hospitals, Mumbai p. 218
Harish Naik, Vernon Velho, Deepak A Palande, Sunil Pandya
DOI:10.4103/0028-3886.253575  PMID:30860124
The Department of Neurosurgery was founded in the Grant Medical College, Mumbai, in the year 1958, and is celebrating its 60th anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was one of the first government medical colleges to start a Neurosurgery Department within the state. The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centers throughout Maharasthra and in several other parts of the country. The patients opt for this institution to get a standard of care that may be comparable with the highest standards prevalent, and the students achieve their goal of getting excellent education in Neurosurgery at par with the best institutes of the world. The department has, therefore, over the years, established its place in the country as a premier training facility and an epitome of medical excellence. This article traces the illustrious history of the Department of Neurosurgery, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, and also of the eminent faculty members and residents, who helped in advancing the standards of Neurosurgery in the region as well as the rest of India.
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NI FEATURE: NORMATIVE DATA - ORIGINAL ARTICLE Top

Construction of Indian human brain atlas p. 229
Jayanthi Sivaswamy, Alphin J Thottupattu, Raghav Mehta, R Sheelakumari, Chandrasekharan Kesavadas
DOI:10.4103/0028-3886.253639  PMID:30860125
Context: A brain magnetic resonanace imaging (MRI) atlas plays an important role in many neuroimage analysis tasks as it provides an atlas with a standard coordinate system which is needed for spatial normalization of a brain MRI. Ideally, this atlas should be as near to the average brain of the population being studied as possible. Aims: The aim of this study is to construct and validate the Indian brain MRI atlas of young Indian population and the corresponding structure probability maps. Settings and Design: This was a population-specific atlas generation and validation process. Materials and Methods: 100 young healthy adults (M/F = 50/50), aged 21–30 years, were recruited for the study. Three different 1.5-T scanners were used for image acquisition. The atlas and structure maps were created using nonrigid groupwise registration and label-transfer techniques. Comparison and Validation: The generated atlas was compared against other atlases to study the population-specific trends. Results: The atlas-based comparison indicated a signifi cant difference between the global size of Indian and Caucasian brains. This difference was noteworthy for all three global measures, namely, length, width, and height. Such a comparison with the Chinese and Korean brain templates indicate all 3 to be comparable in length but signifi cantly different (smaller) in terms of height and width. Conclusions: The findings confirm that there is significant difference in brain morphology between Indian, Chinese, and Caucasian populations.
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NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - ORIGINAL ARTICLE Top

Variations in electroencephalography with mobile phone usage in medical students p. 235
Kanak Parmar, Ruchika Tandon, Neeraj Kumar, Ravindra Kumar Garg
DOI:10.4103/0028-3886.253610  PMID:30860126
Background: Electromagnetic fields (EMFs) emitted by cellular telephones may cause neurological ill effects like cognitive dysfunction, emotional instability, and even brain tumors. Slowing of brain activity on electroencephalography (EEG) has been shown. However, these findings need further validation. Aims: EEG changes and adverse effects experienced following cell-phone use were studied. Settings and Design: The study was conducted in the Department of Neurology of a tertiary care university hospital in India on North Indian students of the University, from August 2017 to October 2017. Materials and Methods: Twenty-one students underwent video-EEG recording before and after application of Samsung GT-56312 dual SIM smart phone in switched off, switched on, and switched on mode with conversation. Statistical Analysis Used: Average EEG frequencies and amplitudes were calculated for different brain regions. Chi-square tests and t-tests were used for comparison between variables. Results: The mean age of 7 (33.3%) male and 14 (66.7%) female subjects was 20.76 ± 1.48 years. The average EEG frequencies following mobile phone application with conversation were higher and the amplitudes lower than the baseline values. Frequencies were greater on the right side. Slow waves were detected in the frontal region in 38.1%, in the parietal region in 33.3%, in the occipital and temporal region in 19.1%; and, generalized slow waves were seen in 9.5% students. During the experiment, 23.8% experienced headache, 19% experienced irritation, and 9.5% felt drowsy. Headache and loss of concentration (33.3%), sleep disturbances (28.6%), and fatigue (19%) were frequent in daily life. Conclusions: Experimental application of mobile phones may lead to some EEG changes and certain ill effects on the well-being. Hence, prolonged use of these gadgets warrants caution.
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NI FEATURE: THE FOURTH DIMENSION - COMMENTARY Top

A summary of some of the recently published, seminal papers in neuroscience p. 242
Mazda K Turel, Manjul Tripathi, Ashish Aggarwal, Navneet Singla, Chirag K Ahuja, Aastha Takkar, Sahil Mehta, Kanwaljeet Garg, Anant Mehrotra, Kuntal K Das
DOI:10.4103/0028-3886.253576  PMID:30860127
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LETTERS TO EDITOR Top

Complex heterozygous polymerase gamma mutation and cerebral folate deficiency in a child with refractory partial status p. 259
Debopam Samanta, Raghu Ramakrishnaiah, Richard E Frye
DOI:10.4103/0028-3886.253623  PMID:30860128
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Knowing the unknown – CD8 encephalitis: A novel form of HIV-associated neurocognitive disorder p. 261
Sumeet P Mirgh, Vikas A Mishra, Rishit K Harbada, Jehangir S Sorabjee
DOI:10.4103/0028-3886.253630  PMID:30860129
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Novel genotype–electroclinical phenotype correlations in sporadic early-onset childhood myoclonic–atonic epilepsy p. 264
Suresh P Babu, Ramshekhar N Menon, Ajay Asranna, Sheela Nampoothiri, Ashalatha Radhakrishnan, Ajith Cherian, Sanjeev V Thomas
DOI:10.4103/0028-3886.253628  PMID:30860130
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Spontaneous spinal epidural hematoma and septic encephalopathy secondary to postpartum septicemia p. 268
Sucharita Anand, Vimal K Paliwal, Zafar Neyaz, Arun K Srivastava
DOI:10.4103/0028-3886.253608  PMID:30860131
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Neuromuscular abnormalities in serotonin syndrome may be mistaken as seizure: A report and literature review p. 269
Sanjay Prakash, Bansi Adroja, Chaturbhuj Rathore
DOI:10.4103/0028-3886.253624  PMID:30860132
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A case of herpes zoster infection mimicking carpal tunnel syndrome p. 272
Yavuz Samanci, Bedia Samanci
DOI:10.4103/0028-3886.253607  PMID:30860133
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Transient splenial hyperintensity in a rare case of chikungunya encephalitis p. 273
Rupinder Singh, Ramanjeet Kaur, Pawan Pokhariyal, Rajul Aggarwal
DOI:10.4103/0028-3886.253649  PMID:30860134
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A case of trigeminal neuralgia caused by both duplicated superior cerebellar arteries p. 276
Kazuma Doi, Satoru Takeuchi, Terushige Toyooka, Naoki Otani, Kojiro Wada, Kentaro Mori
DOI:10.4103/0028-3886.253640  PMID:30860135
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Microsurgical treatment of interhemispheric epidermoid: An institutional series p. 278
Sumit Bansal, Rabi N Sahu, Ashis Patnaik
DOI:10.4103/0028-3886.253650  PMID:30860136
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Tumorigenic aneurysmal bleed: Cause of sinister bleed in intracranial metastases p. 281
Manish Kumar, Ravi Bharatbhai Chauhan, Manjul Tripathi, Chirag K Ahuja, Sandeep Mohindra
DOI:10.4103/0028-3886.253651  PMID:30860137
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Gray variant of acute disseminated encephalomyelitis and its response to immunomodulatory drugs p. 284
Sunil Pradhan, Animesh Das
DOI:10.4103/0028-3886.253652  PMID:30860138
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Hemiplegic cluster headache: A case report and review of the literature p. 287
Ankit Dave, Sanjay Prakash
DOI:10.4103/0028-3886.253626  PMID:30860139
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A Takayasu tale that tells it all: Diagnostic and therapeutic discussions on an interesting case p. 288
Sachin Sureshbabu, Amit A Khan, Raghunath Babu, Gaurav Mittal, Sudhir Peter, C Sobhana, Amit Garg, Laxmi Khanna
DOI:10.4103/0028-3886.253645  PMID:30860140
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Diffusion tensor imaging and tractography in diffuse intrinsic pontine glioma – A major determinant of resectability and description of a new subtype p. 292
Krishnamurthy Sridhar, K Srinivasan
DOI:10.4103/0028-3886.253625  PMID:30860141
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A rare extrapyramidal manifestation in a patient with primary central nervous system lymphoma p. 297
Tze Yuan Tee, Ching Soong Khoo, Norlinah Mohamed Ibrahim, Syazarina Sharis Osman
DOI:10.4103/0028-3886.253620  PMID:30860142
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Recurrent atypical meningioma of the lumbosacral spine p. 300
N Sadiya, Anil Pande, S Salapathi, Siddhartha Ghosh
DOI:10.4103/0028-3886.253643  PMID:30860143
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Giant cell tumor of the spine with pulmonary metastasis p. 303
Somshankar Pandey, Usha Jaipal
DOI:10.4103/0028-3886.253582  PMID:30860144
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Tapping the temporal horn – An alternative to Paine's point for intraoperative ventricular puncture p. 305
Girish Menon, Ajay Hegde
DOI:10.4103/0028-3886.253632  PMID:30860145
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Benign fibrous histiocytoma of the cervical vertebra: A rare case p. 306
Mehmet C Ezgu, Ali F Cicek, Soner Yasar
DOI:10.4103/0028-3886.253644  PMID:30860146
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Pontomedullary germinoma with suprasellar and spinal metastasis: A report and comprehensive review of literature p. 308
Kanwaljeet Garg, Ravi Sharma, Hitesh K Gurjar, Shashank S Kale
DOI:10.4103/0028-3886.253629  PMID:30860147
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A case of delayed-onset hereditary hemorrhagic telangiectasia with a frameshift ENG mutation p. 312
Hiroyuki Akagawa, Hideaki Onda, Shunsuke Nomura, Toyoaki Shinohara, Hidetoshi Kasuya
DOI:10.4103/0028-3886.253633  PMID:30860148
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Left persistent primitive trigeminal artery with a large wide-neck aneurysm presenting as opercular syndrome p. 315
Nancy Carolina Duarte-Valdivieso, Ho-Fai Wong, Luis Rafael Moscote-Salazar, Samer S Hoz, Willem Guillermo Calderon-Miranda, Angel Lee, Amit Agrawal
DOI:10.4103/0028-3886.253635  PMID:30860149
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Technical nuances of performing a neurosurgical procedure in a patient with cardiac pacemaker: Winter on fire! p. 316
Harsh Deora, Kuntal Kanti Das, Sanjog Gajbhiye, Awadhesh Jaiswal, Sanjay Behari
DOI:10.4103/0028-3886.253638  PMID:30860150
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Absence of axis (C2) posterior elements leading to C2–C3 instability and myelopathy in young adults p. 318
Rajesh K Meena, Hitesh K Gurjar, Seema Singh, Deepak Aggarwal
DOI:10.4103/0028-3886.253646  PMID:30860151
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MR imaging in the diagnosis of Marchiafava–Bignami syndrome p. 321
Raina A Tembey, Alpana Karnik, Sanjeev A Mani
DOI:10.4103/0028-3886.253648  PMID:30860152
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NEUROIMAGES Top

Vein of Labbe territory hemorrhagic infarction- a distinct neurosurgical entity Highly accessed article p. 324
Sunil Munakomi
DOI:10.4103/0028-3886.253580  PMID:30860153
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Congenital unilateral peri-Sylvian syndrome in a patient with recurrent seizures, left hemiparesis, and cognitive impairment p. 325
Chinky Chatur, Ankit Balani, Mallapragada Gopalakrishna Murthy, Rammohan Vadapalli
DOI:10.4103/0028-3886.253642  PMID:30860154
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Isolated infarction of the tonsil in the cerebellum p. 326
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
DOI:10.4103/0028-3886.253573  PMID:30860155
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Dilated Virchow–Robin spaces on MRI: Differential diagnosis ranging from benign to pathological entities p. 329
Maria Maddalenas Sirufo, Lia Ginaldi, Massimo De Martinis
DOI:10.4103/0028-3886.253585  PMID:30860156
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Ocular ipsipulsion elicited by closing eyes in lateral medullary infarction p. 331
Shi-Lin Yang, Tao Yang, Xiang Han, Qiang Dong
DOI:10.4103/0028-3886.253618  PMID:30860157
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Is it status epilepticus? No, it is infantile tremor syndrome p. 332
Suresh Kumar Angurana, Shivani Randev, Vishal Guglani
DOI:10.4103/0028-3886.253615  PMID:30860158
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Bilateral carotid hypoplasia with multiple posterior circulation aneurysms p. 333
Himanshu Agarwal, Rajashekar Reddi, Bipin Walia, Chandril Chugh
DOI:10.4103/0028-3886.253613  PMID:30860159
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CORRESPONDENCE Top

Antibodies to dengue, Zika, Campylobacter jejuni and gangliosides in Guillain-Barre syndrome p. 335
Pathum Sookaromdee, Viroj Wiwanitkit
DOI:10.4103/0028-3886.253641  PMID:30860160
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NI FEATURE - BOOKS FROM MY SHELF - COMMENTARY Top

Ramon Y Cajal: Precepts and counsels in scientific investigation. Stimulants of the spirit p. 336
Sunil Pandya
DOI:10.4103/0028-3886.253577  PMID:30860161
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BOOK REVIEWS Top

A history of medicine p. 339
Sunil Pandya
DOI:10.4103/0028-3886.253579  
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Neuro-rehabilitation - a multidisciplinary approach Highly accessed article p. 343
Harsh Deora
DOI:10.4103/0028-3886.253611  
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OBITUARY Top

IN MEMORIUM: Prof. Jagjit S Chopra, DCH, FRCP, PhD, FAMS, FIAN(15 June 1935 – 18 January 2019) p. 346
Vijay K Kak, Inder M S Sawhney
DOI:10.4103/0259-1162.253606  PMID:30860162
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Online since 20th March '04
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