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   2016| July-August  | Volume 64 | Issue 4  
    Online since July 5, 2016

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Endoscopic pituitary surgery: Techniques, tips and tricks, nuances, and complication avoidance
Bhawani Shanker Sharma, Dattaraj Paramanand Sawarkar, Ashish Suri
July-August 2016, 64(4):724-736
DOI:10.4103/0028-3886.185352  PMID:27381121
Endoscopic pituitary surgery is useful in all micro- and macro-pituitary adenomas including those with suprasellar and cavernous sinus extension. The endoscope provides a panoramic close-up, a multi-angled view with excellent illumination and magnification, permitting complete excision of the tumor with preservation of normal pituitary. However, surgeons need to learn altogether different skills unique to endoscopy and the learning curve is steep. The learning curve can be shortened by proper selection of cases, gradual transition from the microscopic to the endoscopic approach, adequate sphenoethmoidal recess widening, identification of important landmarks during each stage of surgery, and use of neuronavigation. Results and long term outcomes can be improved with bimanual dynamic dissection and sequential tumor excision, preservation of normal pituitary, avoidance of arachnoidal tear and use of extended approach for tumors with large suprasellar extension. The gradual transition from microscopic to endoscopic approach, adherence to step by step technique and learning 'tips and tricks' of the endoscopic pituitary surgery reduce complications.
  11,060 482 1
History and evolution of neurosurgery in Assam
Binoy Kumar Singh, Zakir Hussain, Basanta Kumar Baishya, Rajib Hazarika, Bijon Singh
July-August 2016, 64(4):751-757
DOI:10.4103/0028-3886.185411  PMID:27381124
Assam is a land of rich traditions and culture and advanced medical facilities that are comparable with facilities throughout the world. In this article, the history of development of Neurosciences in Assam is traced.
  10,612 93 -
Training neurologists in India: Past, present and future
M Gourie-Devi
July-August 2016, 64(4):602-603
DOI:10.4103/0028-3886.185391  PMID:27381098
  4,439 181 1
Consent taking in neurosurgery: Education and tips for safe practice
Daljit Singh, D Tanshi
July-August 2016, 64(4):742-750
DOI:10.4103/0028-3886.185373  PMID:27381123
Neurosurgery is the most difficult branch of surgery and interventions may occasionally lead to a poor prognosis. Most of the times, one would assume that the likely outcome of a surgery is going to be good; however, not so uncommonly, the results may be devastating. Poor outcomes are further compounded by litigations, which are rising. The safety for neurosurgeon is the consent signed by the patient that ensures some defense. There are no guidelines given by the society and the controlling authorities on what constitutes a real consent. Some judgments by Supreme Court have given us some lead; however, a large part of the complexities involved in the consent process remain unresolved. We, therefore, have to frame our own guidelines and standards that shall be uniformly adapted by all of us. We can even set a precedent for other disciplines of surgery to follow regarding consent-taking for neurosurgery. This shall also serve as a foundation for the wider benefit and safety of surgeons from other disciplines. This paper is an attempt to simplify the complexities of the consent taking process and aims to provide adequate education and information about the nuances of informed consent.
  4,300 165 -
Prenatal Blake pouch cyst with hydrocephalus
Udaya Bhaskarini Vakakmudi, Rajeswaran Rangasami, Varalakshmi N Gopinath
July-August 2016, 64(4):830-831
DOI:10.4103/0028-3886.185399  PMID:27381149
  4,104 55 -
Permanent spinal cord injury during lumbar spinal anesthesia: A report of two cases
Kamble Jayaprakash Harsha, K Parameswaran
July-August 2016, 64(4):808-811
DOI:10.4103/0028-3886.185349  PMID:27381139
  4,081 61 -
Ventriculoperitoneal shunt tube infection and changing pattern of antibiotic sensitivity in neurosurgery practice: Alarming trends
Vikas Kumar, Ankit S Shah, Daljit Singh, Poonam S Loomba, Hukum Singh, Anita Jagetia
July-August 2016, 64(4):671-676
DOI:10.4103/0028-3886.185408  PMID:27381112
Introduction: Infection associated with a ventriculoperitoneal shunt is a severe complication with a high morbidity and substantial mortality. There are no guidelines to choose antibiotics in case of shunt infection. Most surgeons use antibiotics of their choice whereas limited centres follow their own antibiotic policy. An alarming increase in antibiotic resistance has led to rising morbidity and mortality. Materials and Methods: This was a retrospective analysis of patients who underwent ventriculoperitoneal shunt surgery between January 2010 and December 2015 at our institution. Shunt tubes and cerebrospinal fluid were sent for culture and sensitivity in patients who were suspected clinically of having shunt tube infections. The processing of the samples was done by standard techniques, and the identification of the organism along with its sensitivity pattern was performed using Vitek 2 system. Results: A total of 1186 ventriculoperitoneal shunt surgeries were performed during this period at our institute in patients of all age groups. There were 757 (63.8%) male and 429 (36.2%) female patients. A total of 156 samples of patients were sent for culture and sensitivity during this period, out of which 79 (50.6%) samples had growth of an organism either in the cerebrospinal fluid [36 (23.1%)], shunt tubing [16 (10.2%)], or in both [27 (17.3%)]. The most common organisms grown in the cultures were Staphylococcus aureus [65 (82.3%)] or coagulase-negative Staphylococcus [22 (25.3%)] in the Gram-positive group and Escherichia coli [17 (21.5%)] in the Gram-negative group. Over the last 6 years, the sensitivity pattern of both Gram-negative and Gram-positive bacteria has shown alarming decreasing sensitivity for various commonly used antibiotics. Conclusion: Ventriculoperitoneal shunt infection has become an important concern in cases of hydrocephalus. Due to the development of a high proportion of antibiotic resistance, we recommend an empirical therapy of antibiotic therapy for prophylaxis and suspected infection in ventriculoperitoneal shunt surgery.
  3,938 148 3
Brain MRI findings in a patient with scrub typhus infection
Zafar Neyaz, Vishwaroop Bhattacharya, Nabeel Muzaffar, Mohan Gurjar
July-August 2016, 64(4):788-792
DOI:10.4103/0028-3886.185397  PMID:27381130
  3,671 182 1
Cell therapy for neurological disorders: The elusive goal
Prakash N Tandon, Pankaj Seth
July-August 2016, 64(4):612-623
DOI:10.4103/0028-3886.185418  PMID:27381103
The positive outcomes of the transplantation of fetal neural tissue in adult rat models of a variety of neurological disorders, particularly Parkinson's disease, in the 1970s, and its translation to humans in the 1980s, raised great hopes for patients suffering from these incurable disorders. This resulted in a frantic research globally to find more suitable, reliable, and ethically acceptable alternatives. The discovery of adult stem cells, embryonic stem cells, and more recently, the induced pluripotent cells further raised our expectations. The useful functional recovery in animal models using these cell transplantation techniques coupled with the desperate needs of such patients prompted many surgeons to “jump from the rat-to-man” without scientifically establishing a proof of their utility. Each new development claimed to overcome the limitations, shortcomings, safety, and other technical problems associated with the earlier technique, yet newer difficulties prevented evidence-based acceptance of their clinical use. However, thousands of patients across the globe have received these therapies without a scientifically acceptable proof of their reliability. The present review is an attempt to summarize the current status of cell therapy for neurological disorders.
  3,316 156 2
Radiosurgery for the management of refractory trigeminal neuralgia
Ajay Niranjan, L Dade Lunsford
July-August 2016, 64(4):624-629
DOI:10.4103/0028-3886.185393  PMID:27381104
Gamma Knife stereotactic radiosurgery (SRS) is a minimally invasive surgical approach for managing medically refractory trigeminal neuralgia (TN). The goal of trigeminal neuralgia SRS is to eliminate or reduce the facial pain in order to improve the quality of life. Over the past 28 years, 1250 patients have undergone gamma knife SRS for TN at our institution. In our retrospective review of 503 patients who underwent SRS for management of refractory TN, 449 patients (89%) experienced initial pain relief at a median latency of 1 month. At the one year mark, 73% patients were pain free (with or without medications) and 80% had pain control. Repeat radiosurgery was performed for 193 patients (43%). At the one year mark, 26% of these patients were completely pain free and 78% were pain free with or without medications. The role of gamma Knife SRS in the management of medically refractory trigeminal neuralgia has evolved over the past two decades. SRS is a minimally invasive procedure and is associated with 60-90% rate of pain relief in patents with medical refractory trigeminal neuralgia. Early intervention with SRS as the initial surgical procedure for management of refractory trigeminal neuralgia is associated with faster, better, and longer pain relief. As SRS is the least invasive procedure for TN, it is a good treatment option for patients with other high-risk medical conditions. SRS is an attractive alternative especially to those who do not want to accept the greater risk associated with other surgical procedures.
  2,646 89 -
A forgotten cause of bilateral wrist drop
Saumya H Mittal, Shivanand Pai, KC Rakshith, ZK Misri
July-August 2016, 64(4):800-802
DOI:10.4103/0028-3886.185407  PMID:27381136
  2,656 63 -
Highest cited papers published in Neurology India: An analysis for the years 1993–2014
Paritosh Pandey, V Subeikshanan, Venkatesh S Madhugiri
July-August 2016, 64(4):703-721
DOI:10.4103/0028-3886.185362  PMID:27381119
Context: The highest cited papers published in a journal provide a snapshot of the clinical practice and research in that specialty and/or region. Aims: The aim of this study was to determine the highest cited papers published in Neurology India and analyze their attributes. Setting and Design: This study was a citation analysis of all papers published in Neurology India since online archiving commenced in 1993. Methods: All papers published in Neurology India between the years 1993-2014 were listed. The number of times each paper had been cited up till the time of performing this study was determined by performing a Google Scholar search. Published papers were then ranked on the basis of total times cited since publication and the annual citation rate. Statistical Techniques: Simple counts and percentages were used to report most results. The mean citations received by papers in various categories were compared using the Student's t-test or a one-way analysis of variance, as appropriate. All analyses were carried out on SAS University Edition (SAS/STAT®, SAS Institute Inc, NC, USA) and graphs were generated on MS Excel 2016. Results: The top papers on the total citations and annual citation rate rank lists pertained to basic neuroscience research. The highest cited paper overall had received 139 citations. About a quarter of the papers published had never been cited at all. The major themes represented were vascular diseases and infections. Conclusions: The highest cited papers reflect the diseases that are of major concern in India. Certain domains such as trauma, allied neurosciences, and basic neuroscience research were underrepresented.
  2,301 153 -
Statin-associated ocular myopathy mimicking ocular myasthenia: Rare occurrence
Rohan Mahale, Anish Mehta, Madhusudhan B Kempegowda, Abhinandan K Shankar, Aju Abraham John, Mahendra Javali, Rangasetty Srinivasa
July-August 2016, 64(4):785-786
DOI:10.4103/0028-3886.185404  PMID:27381128
  2,352 57 1
Acute Physiology and Chronic Health Evaluation II score of ≥15: A risk factor for sepsis-induced critical illness polyneuropathy
Salil Gupta, Mayank Mishra
July-August 2016, 64(4):640-645
DOI:10.4103/0028-3886.185356  PMID:27381107
Background: Critical illness polyneuropathy (CIP) is a common complication of severe sepsis and systemic inflammatory response syndrome (SIRS). The risk factors for sepsis-induced CIP have not been well established. Aim: The aim of this study was to find out the risk factors of sepsis-induced CIP, especially its relationship with the severity of illness. Patients and Methods: A cohort of 100 patients with sepsis defined as SIRS of proven or presumed microbial etiology were followed up with nerve conduction studies (NCS) performed within the first 14 days of admission. If the assessment was normal then the study was repeated between day 21 and 28. The two groups (with and without neuropathy) were compared. The following risk factors were evaluated for the development of sepsis-related CIP: Duration of symptoms, stay in Intensive Care Unit, and mechanical ventilation; use of neuromuscular blocking agents (NMBAs), steroids, insulin infusion, and inotropes. The following laboratory parameters recorded in the first 24 h of admission were included: Hemoglobin (Hb), total leukocyte count, serum urea, creatinine, aminotransaminases (aspartate aminotransferase and alanine aminotransferase), total protein, albumin, potassium, creatinine kinase, plasma glucose, HbA1C, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score at admission or within 24 h. Results: Thirty-seven patients had features of neuropathy. Among these 37 patients, 30 patients (81%) developed it in the first 14 days. Multivariate analysis using linear regression showed the APACHE II score and use of NMBAs to be significant factors in its development. An APACHE II score of ≥15 was associated with a significant risk of developing CIP (relative risk: 11.6, 95% confidence interval: 4.9–27.2, P < 0.0001). Conclusion: Critically ill patients with sepsis and APACHE II score at admission or within 24 h of ≥15 are at risk for the development of CIP.
  2,282 81 -
Myasthenia gravis accompanied by Graves' disease, thyrotoxic hypokalemic periodic paralysis and thymic hyperplasia
Kun Huang, Yue-Bei Luo, Huan Yang, Xiao-Su Yang, Jing Li
July-August 2016, 64(4):783-785
DOI:10.4103/0028-3886.185401  PMID:27381127
  2,287 46 -
Clinical, radiological, and functional evaluation of surgical treatment in degenerative lumbar canal stenosis
B. C. M. Prasad, VV Ramesh Chandra, B Vijayalakshmi Devi, Siva Subrahmanyam Chivukula, K Pundarikakshaiah
July-August 2016, 64(4):677-683
DOI:10.4103/0028-3886.185378  PMID:27381113
Background: Lumbar spinal stenosis is a frequent indication for spinal surgery. The clinical symptoms may not be accurately reflected on radiological studies. Treatment is aimed at not only obtaining immediate pain relief but also in preventing its long-term disabling sequelae. The walking ability needs to be correlated with functional outcome measures in assessing patients with symptomatic lumbar canal stenosis (LCS). Aims and Objectives: To study and evaluate the outcome of surgery for degenerative LCS on a clinical, radiological, and functional basis, and to establish an association between various factors that may be influencing the development of LCS. Materials and Methods: A prospective study of 48 patients was carried out at the Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupathi, in whom the LCS was confirmed and measured on magnetic resonance imaging images by thecal sac cross-sectional area (CSA). Their functional assessment was done by motorized treadmill test for assessment of the time of appearance of first symptom and the maximum walking distance. The visual analog scale (VAS), Oswestry disability index (ODI), Japanese Orthopedic Association (JOA) score, and Short Form-36 (SF-36) score were also evaluated. Conclusions: The post-operative VAS, ODI, JOA, SF-36 scores showed a significant improvement from the preoperative ones. Postoperative thecal sac measurements showed a significant neural decompression substantiating the results of improvement in the functional assessment scores after surgery. The treadmill test is a quantifiable means of dynamic function. It may be considered as a useful tool for the assessment of functional impairment and for the correlation of thecal sac CSA with lumbar canal stenosis. A combination of functional scores, treadmill test, and thecal sac CSA may be included in the preoperative assessment of outcome in patients with LCS.
  2,177 120 -
A summary of some of the recently published, seminal papers in neuroscience
K Sridhar, Vimal Paliwal, Abhijeet Kumar Kohat, Aastha Takkar, Ravi Yadav, Mazda K Turel, Manjul Tripathi, Kuntal Kanti Das, Anant Mehrotra
July-August 2016, 64(4):758-781
DOI:10.4103/0028-3886.185387  PMID:27381125
  2,192 73 -
Cognitive function and activities of daily living in people affected by leprosy: A cross-sectional, population-based, case-control study
Kyung Wook Kang, Seong-Min Choi, Min-Ho Shin, Sun Seog Kweon, Hyung-Cheol Park, O Dong-Chan, Mi-Ja Choi, Myeong-Hee Lee, Dong-Eun Kim, Kang-Ho Choi, Soo-Ji Baek, Byeong C Kim
July-August 2016, 64(4):656-660
DOI:10.4103/0028-3886.185410  PMID:27381109
Objectives: There has been controversy regarding whether or not people affected by leprosy have more cognitive dysfunction than healthy individuals. The purpose of this study was to assess cognitive functions and activities of daily living (ADL) in people affected by leprosy relative to a control population living in rural areas. Materials and Methods: We assessed cognitive functions and ADL using the Korean Mini-Mental State Examination (K-MMSE), Korean Dementia Screening Questionnaire (KDSQ), and Seoul-Instrumental ADL (S-IADL). Higher scores of K-MMSE and lower scores of both KDSQ and S-IADL are indicative of better functioning. We assessed 224 persons living in Sorokdo who were affected by leprosy and 448 age- and gender-matched control subjects living in Namwon of the Chonbuk province. Results: After adjusting for age, gender, and educational status, the K-MMSE score was found to be significantly higher in people affected by leprosy than in control subjects (23.14 ± 4.89 vs. 22.25 ± 4.62, respectively, P = 0.022). Items related to memory in the KDSQ showed no differences between the groups, but people affected by leprosy had a better score in division for other cognitive functions than controls. On items related to ADL in the KDSQ and S-IADL, people affected by leprosy performed significantly worse compared with controls. Conclusions: Our results suggest that although people affected by leprosy have a lower capacity of ADL, they may have better cognitive functions than normal controls.
  2,186 72 -
NFU1 gene mutation and mitochondrial disorders
Yasemin G Kurt, Bulent Kurt, Ibrahim Aydin, Mehmet Agilli, Fevzi N Aydin
July-August 2016, 64(4):630-632
DOI:10.4103/0028-3886.185402  PMID:27381105
Mitochondrial respiratory chains consist of approximately 100 structural proteins. Thirteen of these structural proteins are encoded by mitochondrial DNA (mtDNA), and the others by nuclear DNA (nDNA). Mutation in any of the mitochondrial structural-protein related genes, regardless of whether they are in the nDNA or mtDNA, might cause mitochondrial disorders. In the recent past, new nuclear genes required for assembly, maintenance, and translation of respiratory chain proteins have been found. Mutation in these genes might also cause mitochondrial disorders (MD). NFU1 gene is one of such genes and has a role in the assembly of iron–sulfur cluster (ISC). ISCs are included in a variety of metalloproteins, such as the ferredoxins, as well as in enzymatic reactions and have been first identified in the oxidation-reduction reactions of mitochondrial electron transport. It is important to be aware of NFU1 gene mutations that may cause severe mitochondrial respiratory chain defects, mitochondrial encephalomyopathies and death, early in life.
  2,156 48 -
Endovascular treatment of A1 aneurysms of the anterior cerebral artery
Peng Liu, Xianli Lv, Youxiang Li, Ming Lv
July-August 2016, 64(4):694-700
DOI:10.4103/0028-3886.185405  PMID:27381117
Aim: The aim of this study was to present the clinical and angiographic outcomes of A1 aneurysms treated by coil embolization. Materials and Methods: We retrospectively evaluated 38 consecutive patients with A1 aneurysm (20 ruptured and 18 unruptured; mean age, 53.8 ± 11.9 years) from 2011 to 2014 treated by an endovascular approach in our hospital. Follow-up angiography was obtained in 30 patients. Clinical outcomes were evaluated by modified Rankin Scale (mRS) over telephone. Results: Among the 38 patients, 24 were treated with single-catheter technique, 8 with stent-assisted coiling (Enterprise 3; Solitaire 5), 5 with parent vessel obliteration, and 1 with balloon-assisted coiling. Initial angiographic results revealed that complete occlusion was achieved in 21 aneurysms (55.3%), near-complete occlusion in 16 (42.1%), and partial occlusion with contrast agent filling the aneurysm sac in 1 (2.6%). Procedure-related complications were observed in 6 patients (15.8%). Follow-up angiographic imaging evaluation after coil embolization was performed in 32 aneurysms (mean interval, 22.6 ± 6.7 months), which showed that 31 (96.9%) aneurysms remained stable or improved without regrowth, while minor recanalization was found in 1 aneurysm (3.1%), which was treated by parent vessel occlusion. Clinical follow-up evaluation was excellent in 37 of the 38 patients (mRS score 0 in 34, and mRS score 1 in 3) at a mean duration of 26.6 ± 7.7 months. Conclusions: Endovascular treatment is feasible and effective for A1 segment aneurysms. The current treatment selections, including single-catheter embolization, balloon-assisted coiling, stent-assisted coiling, and parent vessel occlusion, should be performed according to the characteristics and morphology of A1 aneurysms.
  2,123 52 -
Early neurological and cognitive impairments in subclinical cerebrovascular disease
Penka A Atanassova, Radka I Massaldjieva, Borislav D Dimitrov, Aleksandar S Aleksandrov, Maria A Semerdjieva, Silvia B Tsvetkova, Nedka T Chalakova, Kostadin A Chompalov
July-August 2016, 64(4):646-655
DOI:10.4103/0028-3886.185359  PMID:27381108
Background: The subclinical cerebrovascular disease (SCVD) is an important public health problem with demonstrated prognostic significance for stroke, future cognitive decline, and progression to dementia. The earliest possible detection of the silent presence of SCVD in adults at age at risk with normal functioning is very important for both clinical doctors and scientists. Materials and Methods: Seventy-seven adult volunteers, recruited during the years 2005–2007, with mean age 58.7 (standard deviation 5.9) years, were assessed by four subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB)-Eclipse cognitive assessment system. We used a questionnaire survey for the presence of cerebrovascular risk factors (CVRFs) such as arterial hypertension, smoking and dyslipidemia, among others, as well as instrumental (Doppler examination) and neurological magnetic resonance imaging (MRI) procedures. Descriptive statistics, comparison (t-test, Chi-square) and univariate methods were used as followed by multifactor logistic regression and receiver operating characteristics analyses. Results: The risk factor questionnaire revealed nonspecific symptoms in 44 (67.7%) of the subjects. In 42 (64.6%) of all 65 subjects, we found at least one of the conventional CVRFs. Abnormal findings from the extra- and trans-cranial Doppler examination were established in 38 (58.5%) of all studied volunteers. Thirty-four subjects had brain MRI (52.3%), and abnormal findings were found in 12 (35.3%) of them. Two of the four subtests of CANTAB tool appeared to be potentially promising predictors of the outcome, as found at the univariate analysis (spatial working memory 1 [SWM1] total errors; intra-extra dimensional set 1 [IED1] total errors [adjusted]; IED2 total trials [adjusted]). We established that the best accuracy of 82.5% was achieved by a multifactor interaction logistic regression model, with the role CVRF and combined CANTAB predictor “IED total ratio (errors/trials) × SWM1 total errors” (P = 0.006). Conclusions: Our results have contributed to the hypothesis that it is possible to identify, by noninvasive methods, subjects at age at risk who have mild degree of cognitive impairment and to establish the significant relationship of this impairment with existing CVRFs, nonspecific symptoms and subclinical abnormal brain Doppler/MRI findings. We created a combined neuropsychological predictor that was able to clearly distinguish between the presence and absence of abnormal Doppler/MRI findings. This pilot prognostic model showed a relatively high accuracy of >80%; therefore, the predictors may serve as biomarkers for SCVD in subjects at age at risk (51–65 years).
  2,088 66 -
Glioblastoma multiforme masquerading as a tumefactive demyelinating lesion: Lessons learned at autopsy
Kirti Gupta, Sahil Mehta, Chirag K Ahuja, Pravin Salunke, Navneet Sharma
July-August 2016, 64(4):737-741
DOI:10.4103/0028-3886.185351  PMID:27381122
Tumefactive demyelinating (TD) lesions are extremely challenging lesions to diagnose during their histopathological examination and are often misdiagnosed as tumors. On the contrary, a glioblastoma multiforme is rarely misdiagnosed as a TD unless the two coexist. We present a case of a 60-year old man who was diagnosed as having tumefactive demyelination on a stereotactic biopsy. At autopsy, however, the lesion revealed a grade IV glioblastoma. The myelin loss along the periphery of the lesion was erroneously interpreted as TD during the histopathological examination. We have described the imaging, the biopsy, and the autopsy findings of this instructive case. It is pertinent to recognize its histology to prevent a misdiagnosis.
  2,061 69 -
Risk factors responsible for the volume of hemorrhage in aneurysmal subarachnoid hemorrhage
Jianfeng Liu, Jian Song, Di Zhao, Hui Li, Yingying Lu, Guobiao Wu, Kai Hou, Xuan Gao
July-August 2016, 64(4):686-691
DOI:10.4103/0028-3886.185398  PMID:27381115
Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency with a high mortality and morbidity. There is a marked association of the ensuing neurological functional deficits following aSAH with the volume of hemorrhage. The volume of intracranial hemorrhage in aSAH is usually quantified by the revised Fisher grades. Materials and Methods: A total of 155 patients who suffered from aSAH were evaluated for risk factors that led to an increased volume of intracranial hemorrhage. These included various demographic factors, the medical history, the preadmission blood pressure, and the aneurysm characteristics. Results: The number of aneurysms was significantly related to poor revised Fisher grades (grade 3 or 4; P = 0.016). Thus, the presence of multiple aneurysms (2–4) was a significant risk factor responsible for a poor modified Fisher grade (odds ratio [OR] = 4.0, P = 0.004). Significantly higher risk of intracranial hemorrhage was also observed for aneurysms located on the the internal carotid artery (ICA), anterior communicating artery (ACOA), or middle cerebral artery (MCA) when compared with other sites (P < 0.001). Bleeding in ACOA was significantly associated with a poor Fisher's grade (OR = 4.3, P = 0.025). Additionally, the preadmission diastolic blood pressure (DBP) alone was significantly associated with a poor Fisher grade (P = 0.024). Conclusion: Preadmission DBP, multiple aneurysms, and aneurysms of the ACOA are associated with markedly increased volume of hemorrhage as evaluated by the revised Fisher grades. Thus, patients harboring an intracranial aneurysm having the above mentioned features should seek an early intervention in order to prevent the occurrence of aSAH.
  2,038 78 1
Correlation between qualitative balance indices, dynamic posturography and structural brain imaging in patients with progressive supranuclear palsy and its subtypes
Shaik Afsar Pasha, Ravi Yadav, Mohan Ganeshan, Jitender Saini, Anupam Gupta, M Sandhya, Pramod Kumar Pal
July-August 2016, 64(4):633-639
DOI:10.4103/0028-3886.185417  PMID:27381106
Objectives: To compare the clinical, balance, and radiological profile of progressive supranuclear palsy (PSP) of Richardson type (PSP-R) and Parkinsonian type (PSP-P). Materials and Methods: Twenty-nine patients with PSP (PSP-R: 17, PSP-P: 12) satisfying the probable/possible National Institute of Neurological Disorders and Stroke-PSP criteria were recruited and assessed with Unified Parkinson's Disease Rating Scale-III, PSP rating scale (PSPRS), Berg balance scale (BBS), Tinetti performance-oriented mobility assessment gait and total (TPG and TPT) score, dynamic posturography (DP), and magnetic resonance imaging. Data were compared with 30 age- and gender-matched healthy controls. Results: The mean ages of PSP-R, PSP-P, and controls were comparable (62.5 ± 6.6, 59 ± 8.9, and 59.8 ± 7.6 years). The PSP group had significantly poor DP scores and more radiological abnormalities than controls. The PSPRS, TPG, and TPT scores were significantly more impaired in PSP-R compared to PSP-P (P = 0.045, P = 0.031, and P = 0.037, respectively). In DP, the limits of overall stability were most significant (P < 0.001) and PSP-R had lower scores. PSP-R compared to PSP-P had more often “Humming Bird” sign (P < 0.001), “Morning Glory” sign (P < 0.008), and generalized cortical atrophy (P < 0.001). The area of midbrain (P < 0.002) and midbrain/pons ratio (P < 0.013) was significantly lower in PSP-R. In PSP-P, the overall balance index significantly correlated with BBS, TPG, and TPT (r = −0.79, P = 0.002; r = −0.772, P = 0.003; and r = −0.688, P = 0.013) and the midbrain axial anterior–posterior diameter significantly correlated with the TPG and TPT (r = 0.74, P = 0.01; r = 0.66, P = 0.018). Conclusions: While balance and radiological abnormalities were more severe in PSP-R, the qualitative and quantitative measurements of severity of balance in PSP-P rather than PSP-R was a better reflection of the pathology of the midbrain.
  2,030 77 2
The Cover Page

July-August 2016, 64(4):601-601
DOI:10.4103/0028-3886.185390  PMID:27381097
  1,960 78 -
Interpreting forest plots and funnel plots in meta-analysis
Sunil K Raina
July-August 2016, 64(4):840-840
DOI:10.4103/0028-3886.185366  PMID:27381156
  1,931 62 -
Stuck to the ventilator: The neuromyopathy of critical illness
Neetu Ramrakhiani
July-August 2016, 64(4):604-605
DOI:10.4103/0028-3886.185385  PMID:27381099
  1,898 83 -
Paroxysmal kinesigenic dyskinesia: A frequently misdiagnosed movement disorder
Shuchit Pandey, Vikram V Holla, Abdul Qavi, Rakesh Shukla
July-August 2016, 64(4):792-793
DOI:10.4103/0028-3886.185413  PMID:27381131
  1,896 61 -
Lumbar canal stenosis: Clinical, radiological and functional outcome
Hemant Bhartiya
July-August 2016, 64(4):684-685
DOI:10.4103/0028-3886.185384  PMID:27381114
  1,843 108 -
Professor Noshir Hormusjee Wadia: A Doyen of Indian Neurology
Prakash N Tandon
July-August 2016, 64(4):845-846
DOI:10.4103/0028-3886.185392  PMID:27381161
  1,800 72 -
“Pink pinna sign”: A harbinger of lamotrigene-induced serious drug rash
Sachin Sureshbabu, Dinesh Nayak, Sudhir Peter, Laxmi Khanna
July-August 2016, 64(4):782-783
DOI:10.4103/0028-3886.185369  PMID:27381126
  1,732 96 1
Idiopathic ventral herniation of the spinal cord
Suprava Naik, Alok K Udiya, Gurucharan S Shetty, Rajendra V Phadke, Vivek Singh, Sunil K Jain, Shweta Singhal
July-August 2016, 64(4):831-832
DOI:10.4103/0028-3886.185363  PMID:27381150
  1,742 59 -
Phenytoin-induced rhabdomyolysis: Timely recognition for safely remission
Paolo di Russo, Paolo Perrini, Nicola Benedetto, Gabriele Siciliano
July-August 2016, 64(4):793-794
DOI:10.4103/0028-3886.185415  PMID:27381132
  1,722 56 1
Clear cell sarcoma of the paraspinal ligament – A rare tumor at an unusual location: A review
Sharad Pandey, Anirudha Puntambekar, Vivek Sharma, Kulwant Singh, Deepa Santhosh, Amrita Ghosh, Abhijeet Kunwar
July-August 2016, 64(4):802-805
DOI:10.4103/0028-3886.185353  PMID:27381137
  1,730 39 -
ADAPT for emergent stroke treatment: Newer technique, Indian experience
Vikram Huded, Vikram Bohra, Romnesh deSouza, Ritesh Nair
July-August 2016, 64(4):796-798
DOI:10.4103/0028-3886.185364  PMID:27381134
  1,696 69 -
Churg–Strauss syndrome in a pediatric patient presenting with recurrent hemorrhagic stroke and mitral regurgitation due to a prolapsed mitral valve
Shri Ram Sharma, Hibu Habung, Masaraf Hussain
July-August 2016, 64(4):827-830
DOI:10.4103/0028-3886.185374  PMID:27381148
  1,697 38 -
Weakness in the critically ill: Can we predict and prevent?
Vinod Puri, Anu Gupta
July-August 2016, 64(4):606-607
DOI:10.4103/0028-3886.185395  PMID:27381100
  1,647 83 -
Traumatic bilateral atlantoaxial rotatory subluxation with hangman fracture in an adult
Kai Han, Shang-Bin Cui, Le Wang, Fu-Xin Wei, Shao-Yu Liu
July-August 2016, 64(4):811-814
DOI:10.4103/0028-3886.185412  PMID:27381140
  1,682 36 -
Third ventricular craniopharyngioma
Omekareswar Rambarki, Alugolu Rajesh
July-August 2016, 64(4):834-835
DOI:10.4103/0028-3886.185370  PMID:27381152
  1,662 41 -
Differential expression levels of collagen 1A2, tissue inhibitor of metalloproteinase 4, and cathepsin B in intracranial aneurysms
R Arun Babu, Pradip Paul, Meera Purushottam, Dwarakanath Srinivas, Sampath Somanna, Sanjeev Jain
July-August 2016, 64(4):663-670
DOI:10.4103/0028-3886.185350  PMID:27381111
Aims: Intracranial aneurysms (IAs) express a variety of differentially expressed genes when compared to the normal artery. The aim of this study was to evaluate the expression level of a few genes in the aneurysm wall and to correlate them with various clinicoradiological factors. Materials and Methods: The mRNA level of collagen 1A2 (COL1A2), tissue inhibitor of metalloproteinase 4 (TIMP4), and cathepsin B (CTSB) genes were studied in 23 aneurysmal walls and 19 superficial temporal arteries harvested from 23 patients undergoing clipping of IAs, by real-time polymerase chain reaction method. Results: The mean fold change of COL1A2 gene between the aneurysm sample and the superficial temporal artery (STA) sample was 2.46 ± 0.12, that of TIMP4 gene was 0.31 ± 0, and that of CTSB gene was 31.47 ± 39.01. There was a positive correlation of TIMP4 expression level with maximum diameter of aneurysm (P = 0.008) and fundus of aneurysm (P = 0.012). The mean fold change of CTSB of patients who had preoperative hydrocephalus in the computed tomogram (CT) scan of the head at admission was 56.16 and that of the patients who did not have hydrocephalus was 13.51 (P = 0.008). The mean fold change of CTSB of patients who developed fresh postoperative deficits or worsening of the preexisting deficits was 23.64 and that of the patients who did not develop was 42.22 (P = 0.039). Conclusions: COL1A2 gene and CTSB genes were overexpressed, and TIMP4 gene was underexpressed in the aneurysmal sac compared to STA and their expression levels were associated with a few clinicoradiological factors.
  1,640 62 -
Achalasia and amyotrophic lateral sclerosis as part of Allgrove syndrome
Gourav Jain, Aditya Choudhary, Manoj Goyal, Vivek Lal
July-August 2016, 64(4):841-842
DOI:10.4103/0028-3886.185368  PMID:27381157
  1,645 48 -
Cavernous malformation in the conus medullaris: A rare report
Ram Kumar Goyal, Biswaranjan Nayak, Rajiv Maharshi, Debabrata Biswal
July-August 2016, 64(4):821-823
DOI:10.4103/0028-3886.185416  PMID:27381145
  1,614 44 -
Leprosy and cognition
Vinay Goyal, Binod K Khaitan
July-August 2016, 64(4):661-662
DOI:10.4103/0028-3886.185389  PMID:27381110
  1,585 69 -
Becoming Dr. Q: My journey from migrant farm worker to brain surgeon
Manjul Tripathi
July-August 2016, 64(4):844-844
  1,564 72 -
The war against shunt infections – fighting with our backs to the wall!
R Girish Menon
July-August 2016, 64(4):608-609
DOI:10.4103/0028-3886.185388  PMID:27381101
  1,563 67 -
A case of subcortical heterotopia presenting with focal motor seizures and sensory loss
Permphan Dharmasaroja
July-August 2016, 64(4):787-788
DOI:10.4103/0028-3886.185396  PMID:27381129
  1,580 38 -
Pathologically proven peripheral neurolymphomatosis
Yingxin Yu, Ming Ren, Xiaokun Qi
July-August 2016, 64(4):805-807
DOI:10.4103/0028-3886.185354  PMID:27381138
  1,523 38 -
Integrated PET/MRI imaging of semantic dementia
Amarnath Jena, Sangeeta Taneja, Aashish Gambhir, Pushpendra N Renjen
July-August 2016, 64(4):826-827
DOI:10.4103/0028-3886.185365  PMID:27381147
  1,473 47 -
Is instability the nodal point of pathogenesis for both cervical spondylotic myelopathy and ossified posterior longitudinal ligament?
Atul Goel
July-August 2016, 64(4):837-838
DOI:10.4103/0028-3886.185379  PMID:27381154
  1,461 52 1
Recurrent myelopathy and optic neuritis associated with systemic lupus erythematosus
Rajesh Verma, Kamal K Nagar, Mannan Mehta
July-August 2016, 64(4):798-800
DOI:10.4103/0028-3886.185355  PMID:27381135
  1,451 44 1
Scientific publications and emerging Indian neuroscientists
Atul Goel
July-August 2016, 64(4):722-723
DOI:10.4103/0028-3886.185380  PMID:27381120
  1,403 88 -
Fresh frozen plasma for plasma exchange - How safe is it?
Smita Vimala, Nilima Rahael Muthachen, Karen Ruby Lionel
July-August 2016, 64(4):795-796
DOI:10.4103/0028-3886.185357  PMID:27381133
  1,440 48 1
Migration of a lateral ventricular choroid plexus papilloma: An uncommon occurrence
Abhidha Shah, Arjun Dhar, Atul Goel
July-August 2016, 64(4):817-818
DOI:10.4103/0028-3886.185361  PMID:27381143
  1,438 46 1
Giant arteriovenous malformation in the conus medullaris mimicking a tumor
Lu Jia, Hongming Ji, Shaohua Ren, Lirong Li, Guoping Li, Xuan Zhang, Xinming Ding
July-August 2016, 64(4):823-825
DOI:10.4103/0028-3886.185406  PMID:27381146
  1,406 35 -
Professor Peter Joseph Jannetta
Guru D Satyarthee, Shushil Kumar
July-August 2016, 64(4):847-848
DOI:10.4103/0028-3886.185375  PMID:27381162
  1,393 41 -
Endovascular treatment of A1 segment aneurysms
Vivek Singh, Rajendra V Phadke
July-August 2016, 64(4):701-702
DOI:10.4103/0028-3886.185383  PMID:27381118
  1,381 51 -
“Vices of my blood” — Risk factors of subarachnoid hemorrhage
Abrar Ahad Wani
July-August 2016, 64(4):692-693
DOI:10.4103/0028-3886.185403  PMID:27381116
  1,358 53 -
Wooden spinal model for teaching and training
Deepak Kumar Jha
July-August 2016, 64(4):814-815
DOI:10.4103/0028-3886.185367  PMID:27381141
  1,319 55 -
Turban-like transcalvarial destructive mass in a young child, with extensive extracranial and intracerebral involvement: A cytological diagnosis and review
Rakesh K Gupta, Kaushik Majumdar, Anita Jagetia, Ravindra K Saran
July-August 2016, 64(4):818-821
DOI:10.4103/0028-3886.185358  PMID:27381144
  1,311 48 -
The guilty microbes in shunt infection: Is there an emerging trend?
Sandip Chatterjee
July-August 2016, 64(4):610-611
DOI:10.4103/0028-3886.185386  PMID:27381102
  1,299 54 -
Spontaneous non-thrombotic regression of vein of Galen malformation in a child following shunt surgery
Pankaj Gupta, Manish Agrawal, Virendra Deo Sinha
July-August 2016, 64(4):815-817
DOI:10.4103/0028-3886.185409  PMID:27381142
  1,290 40 -
Postmyelitis pygalgia
Boby Varkey Maramattom, Jacob Eapen Mathew
July-August 2016, 64(4):832-833
DOI:10.4103/0028-3886.185360  PMID:27381151
  1,267 34 -
Bilateral cranio-orbital neurofibromas in a 16-year-old child with neurofibromatosis 1
Peng Li, Zhijun Yang, Zhenmin Wang, Pinan Liu
July-August 2016, 64(4):835-836
DOI:10.4103/0028-3886.185400  PMID:27381153
  1,262 36 -
Calcified worm in the brain
Krishnan Ganapathy
July-August 2016, 64(4):842-843
DOI:10.4103/0028-3886.185377  PMID:27381159
  1,226 36 -
Author's reply
Vedantam Rajshekhar
July-August 2016, 64(4):839-840
DOI:10.4103/0028-3886.185376  PMID:27381155
  1,165 54 -
Authors' reply
Rohan Mahale, Anish Mehta, Madhusudhan B Kempegowda, Mahendra Javali, Srinivasa Rangasetty
July-August 2016, 64(4):842-842
DOI:10.4103/0028-3886.185382  PMID:27381160
  1,127 42 -
Authors' reply
Patompong Ungprasert, Karn Wijarnpreecha, Charat Thongprayoon
July-August 2016, 64(4):841-841
DOI:10.4103/0028-3886.185381  PMID:27381158
  1,072 35 -
Online since 20th March '04
Published by Wolters Kluwer - Medknow