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   2019| March-April  | Volume 67 | Issue 2  
    Online since May 13, 2019

 
 
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REVIEW ARTICLE
A review of transcranial electrical stimulation methods in stroke rehabilitation
Cassandra D Solomons, Vivekanandan Shanmugasundaram
March-April 2019, 67(2):417-423
DOI:10.4103/0028-3886.258057  PMID:31085852
Transcranial electrical stimulation (TES) uses direct or alternating current to non-invasively stimulate the brain. Neuronal activity in the brain is modulated by the electrical field according to the polarity of the current being applied. TES includes transcranial direct current stimulation (tDCS), transcranial random noise stimulation, and transcranial alternating current stimulation (tACS). tDCS and tACS are the two non-invasive brain stimulation techniques that have been used alone or in combination with other rehabilitative therapies for the improvement of motor control in hemiparesis. Increasing research in these methods is being carried out to improvise on the existing technology because they have proven to exhibit a lasting effect, thereby contributing to brain plasticity and motor re-learning. Artificial stimulation of the lesioned or non-lesioned hemisphere induces participation of its cells when a movement is being performed. The devices are portable, stimulation is easy to deliver, and they are not known to cause any major side effects which are the foremost reasons for their trials in stroke rehabilitation. Recent research is focused on maximizing the outcome of stroke rehabilitation by combining them with other modalities. This review focuses on stimulation protocols, parameters, and the results obtained by these techniques and their combinations.
  887 34 -
ORIGINAL ARTICLES
Comparative evaluation of intraoperative use of normal saline, Ringer's lactate, and combination of normal saline and Ringer's lactate in neurosurgical patients – A preliminary randomized clinical trial
Hemant Bhagat, Vasudha Singhal, Hari H Dash, Shalvi Mahajan, Nitasha Mishra, Mihir P Pandia
March-April 2019, 67(2):452-458
DOI:10.4103/0028-3886.258047  PMID:31085860
Background: Fluid management during intracranial surgery is an important concern. The type of fluid used can have biochemical and metabolic effects during intraoperative management. However, it is yet to be known whether biochemical and metabolic effects have an influence on the clinical outcome of a patient. Objective: A prospective evaluation of the effects of normal saline (NS), Ringer's lactate (RL), and a combination of NS and RL on the biochemical, metabolic, and clinical outcomes in patients undergoing intracranial tumor surgery was carried out. Materials and Methods: Ninety patients undergoing elective intracranial tumor surgery were randomized to receive NS, RL, or a combination of NS and RL. The biochemical and metabolic parameters were studied at different time points in the intraoperative and postoperative period. The hemodynamic parameters, brain relaxation score at the time of bone flap elevation, postoperative complications, and the duration of hospital stay were the clinical outcome variables of our study. Results: The use of NS was associated with hyperchloremic metabolic acidosis and ionic hypocalcemia. RL caused significant hyponatremia and increase in serum lactate levels. The combination of NS and RL has least influence on biochemical and metabolic parameters. The effects of three fluids were similar on the hemodynamics, brain relaxation score, as well as on postoperative complications and the duration of postoperative hospital stay. Conclusion: There are variable effects of NS, RL, or its combination on the biochemical and metabolic parameters in patients undergoing intracranial tumor surgery. However, the clinical outcome of the patients remains similar.
  688 34 -
The efficacy of gamma knife radiosurgery in patients with trigeminal neuralgia: The initial experience of the Bezmialem Vakif University
Halil Akdag, Didem Comert, Kerime Akdur, Ayten Sakarcan, Hakan Seyithanoglu, Mustafa Aziz Hatiboglu
March-April 2019, 67(2):476-480
DOI:10.4103/0028-3886.258009  PMID:31085863
Background: Gamma knife stereotactic radiosurgery is, compared with surgical treatment, a less invasive treatment option for patients with trigeminal neuralgia (TN). Aim: In this report, we analyzed the effect and safety of gamma knife radiosurgery performed in patients with TN. Materials and Methods: We retrospectively reviewed patients who underwent gamma knife radiosurgery for TN between June 2014 and January 2017. All patients were treated with Leksell Gamma Knife Model C (Elekta, Stockholm, Sweden) with a prescription dose of 40 Gy with a 50% isodose line. The follow-up of the patients was performed 1 week after the procedure and after every 3 months. The pain score of the patients was recorded using the visual analog scale (VAS). Complications were also reviewed. Statistical Analysis: Statistical analysis was performed using the Statistical Package for the Social Sciences software for Windows, version 23.0. Results: Twenty-four patients (10 males, 14 females) were included in the study. The median age of the patients was 62.5 years (range, 34–91 years). The pre-gamma knife median VAS was 10 (range, 5–10), and the median VAS was 1 (range, 0–10) during the last follow-up. The pain decreased in 16 (76%) patients. Two patients (9%) had treatment-related complications. One patient developed hypoesthesia along the dermatome of the maxillary branch of the fifth cranial nerve and another patient developed facial paresis, which recovered after the usage of steroids for 3 months. Conclusion: Gamma knife radiosurgery is an effective and safe treatment for patients with TN with an acceptable pain control rate.
  694 9 -
NI FEATURE: PATHOLOGY PANORAMA - ORIGINAL ARTICLE
Primary pineal tumors – Unraveling histological challenges and certain clinical myths
Anuj Verma, Sridhar Epari, David Bakiratharajan, Ayushi Sahay, Naina Goel, Girish Chinnaswamy, Prakash Shetty, Aliasgar Moiyadi, Atul Goel, Tejpal Gupta, Rakesh Jalali
March-April 2019, 67(2):491-502
DOI:10.4103/0028-3886.258045  PMID:31085866
Background: Pineal gland tumors range from the well-differentiated “pineocytoma” [World Health Organization (WHO) grade I], which have a very good prognosis, to the aggressive and poorly differentiated “pineoblastoma” (WHO grade IV) with “pineal parenchymal tumor of intermediate differentiation” (PPTID; WHO grades II and III) occupying intermediary differentiation and prognosis. Papillary tumor of the pineal region (PTPR; WHO grades II and III) is a distinct entity with propensity for recurrence and spinal dissemination. However, the diagnostic criteria to differentiate these entities, especially between WHO grades II and III of both PPTID and PTPR, remain nebulous. Objective: To evaluate the relative frequency of the individual entities and histomorphological (including the proliferation indices) features across the spectrum of pineal parenchymal tumors (PPTs) [including PTPRs] along their course. Design: All cases of PPTs were retrieved, reviewed, and graded based on the histological criteria defined in the literature. Results: PPTID, more commonly seen in young adults, was the most common subtype of PPT. This was followed by pineoblastoma which was more commonly seen in children. Clinical progression was seen in both grades II and III of PPTID; however, it was more commonly seen in cases with a MIB1 labeling index of >10%. PTPRs (both grades II and III) showed an aggressive histological transformation and also intraparenchymal metastasis. Conclusion: PPTIDs are the most common adult primary PPTs and have the potential to progress and disseminate in both grades II and III. Both grades of PTPRs have a metastatic potential. These findings suggest the need for postoperative adjuvant therapy in both grades of PPTID and PTPR.
  639 28 -
ORIGINAL ARTICLES
Predictors of dementia-free survival after bilateral subthalamic deep brain stimulation for Parkinson's disease
Syam Krishnan, Krishnakumar Kesava Pisharady, Roopa Rajan, Sankaran Gangadhara Sarma, Prabhakaran Sankara Sarma, Asha Kishore
March-April 2019, 67(2):459-466
DOI:10.4103/0028-3886.258056  PMID:31085861
Objective: Bilateral subthalamic nucleus deep brain stimulation (STN DBS) improves motor complications and quality of life (QOL) in patients with Parkinson's disease (PD). However, it does not delay or prevent the occurrence of dementia. The deleterious effects of dementia on QOL and activities of daily living (ADL) underscore the importance of identifying predictors of dementia-free survival in PD patients considered for STN DBS. Aims and Methods: The baseline clinical and neuropsychological data and the occurrence of dementia recorded during the longitudinal follow-up of a cohort of patients with PD with at least 2 years follow-up after bilateral STN DBS, were reviewed. Results: One hundred and sixteen patients operated between 1999 to 2014 satisfied the inclusion criteria. Their mean age was 56.5 (±10) years and the mean duration of PD at surgery was 11.2 (±4.2) years. During the 542 person–years of follow-up, 30 patients developed dementia. The mean dementia-free survival after surgery was 8.7 [95% confidence interval (CI): 7.8–9.6] years. In univariate analysis, the baseline factors of older age, longer disease duration, past history of depression or psychosis, freezing of gait in OFF phase, worse ADL scores in ON phase, lower levodopa response of the Unified Parkinson's Disease Rating Scale (UPDRS) III axial sub-scores, and poor performances in the Addenbrooke's Cognitive Examination and Wisconsin Card Sorting Test (WCST) were associated with a shorter dementia-free survival. Among these, only freezing of gait and poor performance in WCST were independent predictors. Conclusion: Presence of freezing of gait in the drug OFF state and executive dysfunction predict the occurrence of earlier dementia in PD patients who otherwise qualify for bilateral STN DBS.
  622 19 -
NI FEATURE: CITADELS SCULPTING FUTURE - COMMENTARY
Forty years of clinical excellence at the Dr A Lakshmipathi Neurosurgical Centre and Post-Graduate Institute of Neurological Surgery, Voluntary Health Services (VHS) Hospital
K Sridhar, MC Vasudevan, Shyam Sundar Krishnan, Anil Pande, Pradeep Kumar Jain
March-April 2019, 67(2):516-529
DOI:10.4103/0028-3886.257984  PMID:31085870
The Achanta Lakshmipathi Neurosurgical Center (ALNC) and Post Graduate Institute of Neurological Surgery is a private teaching neurosurgical institution located in the VHS (Voluntary Health Services) Hospital Chennai. It has been a leader and trendsetter among the private academic neurosurgical training institutions, and because of its unique legacy, has influenced the progress of Neurosurgery in India. The center was the second neurosurgical Institute to be created by Prof. B Ramamurthi and has trained neurosurgeons in the unique ALNC school of Neurosurgery. The Institute has grown to become a centre of excellence in microsurgery, and spinal surgery and has become a training centre for neurosurgery since 1985. The unique humanitarian aspects of the Voluntary Health Services Hospital helped in bringing the best of Neurosurgery to all strata of society. Forty years after its inception, the ALNC continues its delivery of excellence in clinical neurosurgery and academics.
  613 14 -
GUEST COMMENTARY
Should neurosurgeons retire?
Krishnan Ganapathy
March-April 2019, 67(2):370-374
DOI:10.4103/0028-3886.258036  PMID:31085838
Being a neurosurgeon is a protracted, time-consuming, and labor-intensive occupation. It presupposes excellent, continuing physical and mental competence, and a passion to always do better than the best. During the last two decades, the exponential deployment of operative technology has resulted in a radical transformation, making a neurosurgeon trained four decades ago, run the risk of being outdated. Expectations from patients have reached an all time high level. Socioeconomic and medicolegal aspects cannot be brushed aside. It is universally accepted that in spite of increasing longevity in the educated upper middle class, the process of ageing per se continues relentlessly. When is enough enough? Is there a risk that a “senior, experienced” neurosurgeon may even become a liability to his patients some day? Should there be a mandatory time point at which a neurosurgeon should necessarily stop operating. The author reviews the published literature and opines that after the age of 65 years, all seniors should agree to their operating privileges being formally reviewed regularly every 2 years.
  562 22 -
LETTERS TO EDITOR
Subacute combined degeneration of spinal cord – Never forget this reversible myelopathy
Pooja Gupta, Geetanjali Gupta
March-April 2019, 67(2):590-591
DOI:10.4103/0028-3886.258010  PMID:31085888
  565 16 -
BOOK REVIEWS
Emerging legal issues in medicine and health-care
Harsh Deora
March-April 2019, 67(2):626-627
DOI:10.4103/0028-3886.257997  
  512 18 -
ORIGINAL ARTICLES
Frontal assessment battery in Parkinson's disease: A study on 170 patients
Arup K Datta, Dhiman Das, Kalyan B Bhattacharyya, Paramita Bose, Amar K Mishra, Shyamal K Das
March-April 2019, 67(2):433-438
DOI:10.4103/0028-3886.258052  PMID:31085855
Background: Frontal assessment battery (FAB) was devised as a specific study design to assess frontal lobe dysfunction. Since Parkinson's disease (PD) is often associated with cognitive and other higher mental function complications, FAB test has been carried out by a number of workers to assess the integrity of the frontal lobe. On the other hand, the other frequently conducted test, performed in order to evaluate the mental status, is the Mini Mental State examination of Folstein (MMSE), but its reliability has been questioned in PD, since it does not assess the functions of the frontal lobe alone. Material and Methods: The present study was undertaken in order to assess the suitability of application of the FAB test in Indian patients and to perform its comparative analysis with the MMSE scale. Results and Conclusions: It was observed that the FAB test correlated with the age and the level of education of the patient. The results also correlated with that of the MMSE study, in spite of the fact that the latter is not considered to be a test which can assess exclusively the status of the frontal lobe. To the best of our knowledge, this is first study undertaken in India in this regard.
  492 23 -
Acute cholecystitis in patients with stroke
Yasuhiro Kuroi, Daisuke Imazato, Kei Yamazaki, Hidetoshi Kasuya
March-April 2019, 67(2):439-441
DOI:10.4103/0028-3886.258055  PMID:31085856
Background: Although acute cholecystitis after stroke is rare, an immediate diagnosis and treatment is required. Material and Methods: In the past five years, we observed six patients with acute cholecystitis during the initial hospitalization for stroke. Results: Three patients had cardiac embolism, two had subarachnoid hemorrhage, and one had intra-cerebral hemorrhage. Four had calculous cholecystitis and two had acalculous cholecystitis. One of the patients with acalculous cholecystitis had hemorrhagic cholecystitis. The most commonly presented symptom was fever (50%), whereas only one patient (17%) had abdominal pain. Three patients (50%) were completely asymptomatic. Conclusions: Acute cholecystitis and stroke are closely associated, and anti-thromboembolic drugs may cause hemorrhagic cholecystitis. Stroke patients tend to have atherosclerotic risk factors resulting in ischemic injury of the gallbladder. Furthermore, severe hemiparesis, a fasting state, dehydration, or bacteremia, which are occasionally exhibited by stroke patients, are known risk factors for acalculous cholecystitis. Stroke patients, especially patients with aphasia and consciousness disturbance, require immediate abdominal examination, if acute cholecystitis is suspected.
  485 17 -
NI FEATURE: THE EDITORIAL DEBATE V-- PROS AND CONS
Trigeminal neuralgia: An orphan with many fathers
Manjul Tripathi
March-April 2019, 67(2):414-416
DOI:10.4103/0028-3886.258020  PMID:31085851
  428 39 -
GUEST COMMENTARY
The neurovascular syndromes: A review of pathophysiology – Lessons learnt from Prof. Chandy's paper published in 1989
Harjinder S Bhatoe
March-April 2019, 67(2):377-388
DOI:10.4103/0028-3886.258002  PMID:31085840
  429 37 -
NI FEATURE: JOURNEY THROUGH THE EONS - COMMENTARY
Dr. Sriramachari, founder neuropathologist of India
S Sandhyamani, Prakash N Tandon
March-April 2019, 67(2):356-363
DOI:10.4103/0028-3886.257995  PMID:31085836
  440 21 -
NI FEATURE: TIMELESS REVERBERATIONS - COMMENTARY
Neurological Society of India Annual Conference at Pune, December 1977
Madakasira Bheemarao Pranesh
March-April 2019, 67(2):353-355
DOI:10.4103/0028-3886.257996  PMID:31085835
  420 20 -
CASE REPORTS
Brachial plexus neuropathy by hibernoma compression: An unusual presentation of peripheral non-neural sheath nerve tumor and a systematic review of literature
Luis Henrique A Sousa, Jennyfer P G Chaves, Robinson Antonio M Marques, Larissa L G Silva
March-April 2019, 67(2):481-484
DOI:10.4103/0028-3886.258049  PMID:31085864
Brachial plexus neuropathies are uncommon and are rarely caused by a tumor. The clinical presentation of a brachial plexus neuropathy caused by a tumor depends on the degree of malignancy of the tumor and its localization. We report an illustrative case of a 27-year old female subject with a progressively increasing mass lesion causing brachial plexus compression, ipsilateral shoulder pain, C8 dermatomal paresthesia, and impairment of motor power. The patient underwent surgical resection of the mass and neurolysis of the nerves in the vicinity. Following the surgical procedure, the patient had improvement in the pain and paresthesia that he was suffering from. The histopathological diagnosis revealed a hibernoma, an extremely rare tumor described only once previously in this location. A systematic review of the literature was performed utilizing the PubMed database to access articles published before March 2018, using: A – the term 'hibernoma' in the title/abstract associated with the following MeSH terms: brachial plexus neuropathies OR brachial plexus neuropathy OR nerve compression syndrome, OR brachial plexus; B – the MeSH term 'brachial plexus' associated with the term 'non neural sheath nerve tumor' or 'peripheral non-neural sheath nerve tumor'. The origin of the hibernoma, as well as its metabolic influence, pathology, and treatment have been discussed.
  422 16 -
LETTERS TO EDITOR
Acute stroke thrombolysis following dabigatran reversal using idarucizumab
Kamble J Harsha, Sibi Thirunavukkarasu, Kenneth Butcher
March-April 2019, 67(2):568-570
DOI:10.4103/0028-3886.258032  PMID:31085880
  420 18 -
NI FEATURE: THE QUEST - ORIGINAL ARTICLE
Neurosurgery videos on online video sharing sites: The next best teacher?
P Krishna Kumar, Biju Bhadran, G Harrison
March-April 2019, 67(2):505-509
DOI:10.4103/0028-3886.258028  PMID:31085868
Background: E-learning platforms, especially the online neurosurgical video sharing sites, are playing a key role in the dissemination of knowledge related to the essential steps of operative neurosurgery. Aim: A national survey was undertaken to assess the utility of neurosurgical operative videos exhibited on the online video-sharing sites. Materials and Methods: Resident trainees in neurosurgery, as well as junior and senior consultant neurosurgeons practicing in India were provided, on the Google platform, a questionnaire consisting of nine multiple-choice questions and a space for remarks. 520 people were contacted using e mail and/or whattsapp modalities, out which 98 responses were considered valid. Results: Majority (n = 87, 88.8%) of the responders voted that internet videos have helped them in improving their surgical skills. There was no statistically significant difference between people working in rural and urban areas in this regard (P = 0.517). Both senior and junior neurosurgeons were utilizing these online videos for enhancing their surgical skills, and there was no statistically significant difference regarding the perception of the usefulness of these online video channels between the two groups (P = 0.660). However, the response rate to the questionnaires sent was only 18.84%. Conclusions: Online video-sharing platforms are useful, especially in a country like India with diverse neurosurgical infrastructure. The need for the development and maintenance of a dedicated, high-quality, structured video bank through collaboration and cooperation of high volume centers and institutes of repute in India is strongly advocated.
  416 12 -
CASE REPORTS
Extracranial–intracranial high-flow bypass for post-traumatic cavernous carotid pseudo-aneurysm presenting with epistaxis: Case report
Vivek K Kankane, Abhijeet G Warade, Basant K Misra
March-April 2019, 67(2):485-490
DOI:10.4103/0028-3886.257994  PMID:31085865
We present a case of posttraumatic cavernous carotid pseudo-aneurysm presenting with epistaxis, in which microsurgical treatment was the treatment of choice as endovascular treatment was perceived to be too risky because of a bone fragment impinging on the wall of the aneurysm. The patient was successfully managed by a high-flow, radial artery, external carotid artery-middle cerebral artery bypass and trapping of the internal carotid artery. The patient was discharged one week later without any further episode of hemorrhage.
  388 18 -
NI FEATURE: THE FIRST IMPRESSION - COMMENTARY
The cover page

March-April 2019, 67(2):351-352
DOI:10.4103/0028-3886.258005  
  365 35 -
GUEST COMMENTARY
Imprecise eponyms in stroke medicine – A growing need for uniform terminologies/definitions across the globe
Kamble J Harsha
March-April 2019, 67(2):364-369
DOI:10.4103/0028-3886.258048  PMID:31085837
Background: Remarkable advancements in the understanding of etiological risk factors and pathophysiology of cerebrovascular diseases have led to the refining of definitions and terminologies in stroke medicine periodically. We aim to analyze the utility and meaning of different eponyms in the stroke medicine literature during the last 20 years. Materials and Methods: A systematic search was performed in Google Scholar for the words “stroke,” “TIA,” “cerebrovascular accident (CVA),” “cerebrovascular insult,” “cerebrovascular event,” “cerebral ischemia,” and “cerebrovascular disease.” Each of the words were searched yearwise from 1996 to 2015, and the numbers of articles using these words were collected and analyzed. Results: “ Stroke” has been the most common terminology used in literature, which showed a progressive increase in its usage until 2010, after which its use drastically reduced. “Cerebrovascular events” and “cerebral ischemia” are the second most commonly used terminologies with variable definitions; there was a steep increase in the use of these words until 2012. Conclusions: The most imprecise term that continues to be used is “CVA”. The precisely defined entity like “cerebrovascular disease,” which is a group of diseases, continues to be used inappropriately. All the terms are not defined uniformly across the globe, whereas most continue to use the World Health Organisation definition of stroke, defined in the 1970s. It is essential to condemn the use of imprecise terminologies and promote the use of recently defined precise terms “stroke” and “transient ischemic attack (TIA)”. Unless the same terms with precise definitions are used in clinical practice or literature, the progress of stroke medicine will continue to be hampered.
  374 23 -
ORIGINAL ARTICLES
Prevalence and clinical characteristics of malformations of cortical development and incomplete hippocampal inversion with medically intractable seizures in Chennai – A prospective study
RM Bhoopathy, B Arthy, SS Vignesh, AV Srinivasan
March-April 2019, 67(2):442-447
DOI:10.4103/0028-3886.258046  PMID:31085857
Objective: To study the prevalence and clinical characteristics of malformation of cortical development (MCD) and incomplete hippocampal inversion (IHI) in adults with intractable seizures. Materials and Methods: In this prospective study of 3220 epileptic patients in our epilepsy clinic between 2012 and 2014, 416 had intractable seizures. In all patients, a detailed clinical history, neurological examination, electroencephalography (EEG), computed tomography (CT) scan, magnetic resonance imaging (MRI) brain, and neuropsychological assessment was conducted to identify MCD and IHI. Results: Out of 416 patients with intractable seizures, MCD and IHI were confirmed in 85 patients (48 males, 37 females). MCD was observed in 46 (11.05%) patients and IHI were observed in 39 (9.37%) patients. Chi square test revealed no signi cant difference between the MCD and IHI groups across the patients in different age groups, gender, type of seizure, duration and onset of seizure, seizure frequency, clustering, status epilepticus, EEG, febrile seizures, and family history. Statistically significant differences (P < 0.05) were observed between the MCD and IHI groups for change in seizure semiology and in intelligence quotient (IQ) and memory quotient (MQ) scores obtained using Wechsler's adult intelligence scale III and Wechsler's memory scale. The IHI group showed higher IQ and MQ scores when compared to the MCD group. Furthermore, IHI occurred along with MCD in 6.52% (N = 3) of the population. Conclusion: MCD and IHI patients are often associated with intractable complex partial seizures. Intractable epilepsy patients with normal intelligence and normal MRI should be investigated with hippocampal volumetric studies to identify the presence of IHI. Isolated IHI can be considered as a form of MCD because it mimics the clinical features of MCDs.
  377 12 -
LETTERS TO EDITOR
Management of postoperative vasospasm following endoscopic endonasal surgery for craniopharyngioma: Report and review of literature
Varun Aggarwal, Prakash Nair, Pankaj Shivhare, K Santhosh Kumar, ER Jayadevan, Suresh Nair
March-April 2019, 67(2):606-609
DOI:10.4103/0028-3886.258043  PMID:31085895
  358 19 -
NEUROIMAGES
Acute necrotizing encephalopathy of childhood
Madhurima Sharma, Dinesh Sood, Narvir Singh Chauhan, Padam Negi
March-April 2019, 67(2):610-611
DOI:10.4103/0028-3886.257990  PMID:31085896
  357 20 -
LETTERS TO EDITOR
Isolated bilateral triceps muscle weakness as a presenting complaint in myasthenia gravis: A review
MR Thilak, Arvind N Prabhu, Sai S Rao K, Mangroliya J Vasantbhai
March-April 2019, 67(2):566-568
DOI:10.4103/0028-3886.258004  PMID:31085879
  349 13 -
COMMENTARY
Non-invasive brain stimulation in stroke: Do the electrical currents have the potential to enhance neuroplasticity?
Kamal N Arya
March-April 2019, 67(2):424-426
DOI:10.4103/0028-3886.258019  PMID:31085853
  343 15 -
LETTERS TO EDITOR
Shapiro syndrome presenting with catatonia and thrombocytopenia
Jasmin Garg, Priti Arun, Nishit Sawal
March-April 2019, 67(2):576-580
DOI:10.4103/0028-3886.258035  PMID:31085884
  342 16 -
Thrombolysis of acute ischemic stroke in a HIV-positive patient: Report and review of literature
Kalpesh Sanariya, Arun Garg, Biplab Das, Atma Ram Bansal
March-April 2019, 67(2):580-582
DOI:10.4103/0028-3886.258007  PMID:31085885
  335 23 -
NI FEATURE: THE EDITORIAL DEBATE IV-- PROS AND CONS
Shifting goal posts and paradigm shifts: Trends in outcome evaluation in glioma management
A Arivazhagan
March-April 2019, 67(2):410-411
DOI:10.4103/0028-3886.258012  PMID:31085849
  343 15 -
GUEST COMMENTARY
Proxy war against head injury: Myriads of conflicting laws and gender-based discrimination
Nishant S Yagnick, Manjul Tripathi, Sandeep Mohindra
March-April 2019, 67(2):375-376
DOI:10.4103/0028-3886.258042  PMID:31085839
This article is the culmination of two axioms. The first is the authors' belief that the practice of medicine is, if anything, a social profession. The second is the glaring realization that conscience is the worst motivator. When we combine the two, we understand why a war needs to be waged for a stronger legislation making the wearing of helmets compulsory, and why doctors need to be at the forefront of this war.
  346 10 -
NI FEATURE: THE EDITORIAL DEBATE I-- PROS AND CONS
Cholecysto-cardiac link: The heart of the matter
Madhu Nagappa, Arun B Taly
March-April 2019, 67(2):391-392
DOI:10.4103/0028-3886.258015  PMID:31085842
  334 15 -
NEUROIMAGES
Imaging in diffuse leptomeningeal glioneuronal tumor
Raj Ghoniya, Amol Raheja
March-April 2019, 67(2):615-616
DOI:10.4103/0028-3886.258051  PMID:31085900
  331 14 -
ORIGINAL ARTICLES
Health-related quality of life after surgery in supratentorial gliomas
Deepak Khatri, Awadhesh Jaiswal, Kuntal K Das, Satyadeo Pandey, Kamlesh Bhaisora, Raj Kumar
March-April 2019, 67(2):467-475
DOI:10.4103/0028-3886.257998  PMID:31085862
Introduction: With improvements in overall and progression-free survival in gliomas, current focus in neurosurgical oncology has largely shifted to the issue of quality of life (QOL) after treatment. There are not too many prospective studies evaluating QOL in these patients. We prospectively analyzed the health related quality of life (HRQOL) using the short form (SF) 36 questionnaire among patients harbouring a supratentorial glioma who underwent surgery at a tertiary care center in India. Methods: HRQOL was evaluated prospectively in 103 patients, between May 2016 and November 2017, at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. Score improvements were evaluated in terms of the smallest difference that a patient perceived to be clinically beneficial. The responsiveness of scores was assessed as minimum clinically important difference (MCID), effect size (ES) and relative efficiency. Cronbach's alpha co-efficient was used to assess the reliability of the result obtained. Results: The mean pre-operative score was the highest in the mental health domain (50.21±21.45) and significantly lower in patients with raised intracranial pressure (ICP), pre-operative deficits, a poor Karnofsky performance scale (KPS) score, in large tumors (>4cm) located in an eloquent location and in deep-seated tumors. A significant improvement was noted across all domains except the physical role (P-value 0.20). Overall, the general health domain was most responsive to change with the largest t-value (6.56) and 55.7% patients achieved their target MCID in general health (GH) domain. Among all the factors studied, only a low baseline SF-36 score was significantly associated with a change in QOL after surgery. Conclusion: Most parameters of HRQOL improved following surgery. Only small-to-moderate improvements occured in the early follow-up period. Large improving trends were noted on a long-term basis, irrespective of the histo-pathological grade. Similar improvements were also noted in patients who subsequently underwent re-surgery despite the development of post-operative complications or new deficits. Also, a low baseline QOL score heralded a poor survival.
  336 9 -
NI FEATURE: THE EDITORIAL DEBATE IV-- PROS AND CONS
Role of neuropsychology in continuum of health care in neurological conditions
Ashima Nehra
March-April 2019, 67(2):404-409
DOI:10.4103/0028-3886.258013  PMID:31085848
  326 16 -
NI FEATURE: THE EDITORIAL DEBATE I-- PROS AND CONS
The infamous story of incident stroke and inflamed gall bladder!
M V Padma Srivastava, VY Vishnu
March-April 2019, 67(2):389-390
DOI:10.4103/0028-3886.258025  PMID:31085841
  309 25 -
LETTERS TO EDITOR
Novel GRIN2B mutation: A rare cause of severe epileptic encephalopathy
Indar Kumar Sharawat, Jaivinder Yadav, Lokesh Saini
March-April 2019, 67(2):562-563
DOI:10.4103/0028-3886.257986  PMID:31085877
  316 17 -
NI FEATURE: THE EDITORIAL DEBATE V-- PROS AND CONS
Radiosurgery for the management of intractable trigeminal neuralgia
Ajay Niranjan
March-April 2019, 67(2):412-413
DOI:10.4103/0028-3886.258017  PMID:31085850
  319 10 -
REVIEW ARTICLE
Perioperative significance and management of electrocardiographic abnormalities in patients undergoing cerebral aneurysm surgeries
Indira Malik, Pragati Ganjoo
March-April 2019, 67(2):427-432
DOI:10.4103/0028-3886.258038  PMID:31085854
Morphological electrocardiological changes and arrhythmias are commonly encountered in patients with aneurysmal subarachnoid hemorrhage. These, if undetected and unaddressed, can cause cardiovascular ailments, postsurgical poor neurological outcomes and long term medical complications.
  301 28 -
NI FEATURE: CENTS (CONCEPTS, ERGONOMICS, NUANCES, THERBLIGS, SHORTCOMINGS) - COMMENTARY
Endoscopic single stage trans-oral decompression and anterior C1 lateral mass and C2 pedicle stabilization for atlanto-axial dislocation
Yad R Yadav, Vijay S Parihar, Shailendra Ratre, Amitesh Dubey, Sonpal Jindel, Mashoo N Dubey
March-April 2019, 67(2):510-515
DOI:10.4103/0028-3886.257989  PMID:31085869
Although most of the cases of atlanto-axial dislocation (AAD) and basilar invasion can be managed by posterior approaches in the recent times, anterior decompression with stabilization is required in selected patients who persist with irreducible AAD even after manipulation of the C1-C2 facet joint under general anesthesia. A single stage endoscopic trans-oral decompression and stabilization can be used in such patients. It has not been described so far to the best of authors' knowledge. This is indicated in irreducible AAD with the mandibular angle lying below the C2-C3 disc space. It is not a proper choice when the mandibular angle is above the C2-C3 disc space, there is involvement of the facet joint by trauma or any other pathologies, and if a posterior compression at the cervicomedullary junction persists. All patients should undergo pre-operative radiographs, computed tomography (CT) scan and magnetic resonance imaging with angiogram of the cranio-vertebral region. Utilizing this technique, an intra-operative satisfactory reduction of the dislocation with C1-C2 stabilization could be achieved in 3 patients, and 7 required an additional odontoid excision. Post- operative plain radiographs should be performed to assess for C1- C2 alignment and fusion at 3 and 12 months after surgery. All 10 patients of our series had an irreducible AAD and two had an additional basilar invasion. All patients improved from the pre-operative Ranawat grade 3A (n = 8) and 3B (n = 2) to post-operative grade 1 (n = 9) and 2 (n = 1) at a 3–12- month follow-up assessment. The average duration of the procedure and blood loss was 145 minutes and 75 ml, respectively. Endoscopic trans-oral single stage decompression and stabilization seems to be an effective and safe alternative in selected patients with AAD and basilar invasion.
  309 17 -
NI FEATURE: THE FOURTH DIMENSION - COMMENTARY
A summary of some of the recently published, seminal papers in neuroscience
Mazda K Turel, Manjul Tripathi, Ashish Aggarwal, Navneet Singla, Chirag K Ahuja, Aastha Takkar, Sahil Mehta, Kanwaljeet Garg, Ravi Yadav, Anant Mehrotra, Kuntal K Das
March-April 2019, 67(2):542-561
DOI:10.4103/0028-3886.258003  
  296 24 -
LETTERS TO EDITOR
A ruptured isolated orbitofrontal artery aneurysm
Niu Xiaodong, Hu Zhihong, Mao Qing, Li Jin
March-April 2019, 67(2):598-599
DOI:10.4103/0028-3886.258044  PMID:31085891
  302 10 -
COMMENTARY
Pineal tumors: Rare but challenging entity
Sujata Chaturvedi, Vaishali Suri
March-April 2019, 67(2):503-504
DOI:10.4103/0028-3886.258023  PMID:31085867
  295 11 -
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTERS TO EDITOR
A report of quadriparesis in dengue fever due to hematomyelia
M Senthil Kumar, KR Srinanthini, S Gopal
March-April 2019, 67(2):530-531
DOI:10.4103/0028-3886.258054  PMID:31085871
  288 16 -
LETTERS TO EDITOR
Meningioma associated with Gorlin–Goltz syndrome and a short review of literature
Pritinanda Mishra, Mounabati Mahapatra, Mamita Nayak, Bhagabati P Dash, Susama Patra
March-April 2019, 67(2):595-598
DOI:10.4103/0028-3886.257991  PMID:31085890
  293 9 -
Chronic meningitis with persistent hypoglycorrhachia: An unusual presentation of Lyme's disease
Rajni Farmania, Prashant Jauhari, Biswaroop Chakrabarty, Sheffali Gulati
March-April 2019, 67(2):563-565
DOI:10.4103/0028-3886.258039  PMID:31085878
  283 9 -
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTERS TO EDITOR
Intracranial migrating bone dust: Innocuous or evil?
Palak A Jaiswal, George C Vilanilam, P Rajalakshmi, Krishna K Kumar, Mathew Abraham
March-April 2019, 67(2):534-536
DOI:10.4103/0028-3886.258041  PMID:31085873
  265 23 -
LETTERS TO EDITOR
Globus pallidus internum targeted deep brain stimulation placement using optic tract stimulated visual evoked potentials and corticospinal tract stimulation in a case of severe dystonia
Nitin Manohar, Keta Thakkar, Anandh Balasubramaniam, Astha Palan
March-April 2019, 67(2):600-601
DOI:10.4103/0028-3886.258040  PMID:31085892
  266 20 -
Intrathecal synthesis of immunoglobulin G antibodies to Taenia solium scolex antigens in neurocysticercosis
Lisandra A Suzuki, Cláudio L Rossi
March-April 2019, 67(2):574-575
DOI:10.4103/0028-3886.257988  PMID:31085883
  282 3 -
Diagnostically useful MRI artifact – India ink artifact
Venkatraman Indiran, V Sivakumar
March-April 2019, 67(2):573-574
DOI:10.4103/0028-3886.258027  PMID:31085882
  271 13 -
Late changes on magnetic resonance imaging in posterior spinal artery syndrome: A report and literature review
Yuya Kobayashi, Shunichi Sato, Ryota Takamatsu, Rie Watanabe, Kenichi Hoshi, Wataru Ishii, Hiroyuki Yahikozawa
March-April 2019, 67(2):571-573
DOI:10.4103/0028-3886.258006  PMID:31085881
  277 6 -
NI FEATURE: THE EDITORIAL DEBATE III-- PROS AND CONS
Neurosurgery videos on online video sharing sites: The next best teacher?
Rajesh Chhabra, Sunil Kumar Gupta
March-April 2019, 67(2):402-403
DOI:10.4103/0028-3886.258021  PMID:31085847
  263 19 -
Neurosurgery videos on online video sharing sites
Mayank Kaushal, Saman Shabani, Shekar N Kurpad
March-April 2019, 67(2):397-398
DOI:10.4103/0028-3886.258022  PMID:31085845
  265 17 -
NI FEATURE: THE EDITORIAL DEBATE II-- PROS AND CONS
Dementia in Parkinson's disease after subthalamic deep brain stimulation - Is it inevitable and predictable?
Dwarakanath Srinivas
March-April 2019, 67(2):395-396
DOI:10.4103/0028-3886.258018  PMID:31085844
  268 9 -
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTERS TO EDITOR
A drip in time worked just fine: Thrombolysis in stroke with recent myocardial infarction
Sachin A Adukia, Gopal K Dash, Amit H Patanvadiya
March-April 2019, 67(2):540-541
DOI:10.4103/0028-3886.258026  PMID:31085875
  257 19 -
LETTERS TO EDITOR
Magnetic resonance vessel wall imaging in intracranial atherosclerotic disease simulating vasculitis
K Arun, Chinmay Nagesh, C Kesavadas, Sapna E Sreedharan, PN Sylaja
March-April 2019, 67(2):588-589
DOI:10.4103/0028-3886.258031  PMID:31085887
  255 20 -
An intracranial developmental venous anomaly presenting with seizure
Necati Ucler
March-April 2019, 67(2):604-605
DOI:10.4103/0028-3886.258034  PMID:31085894
  264 7 -
NI FEATURE: THE EDITORIAL DEBATE III-- PROS AND CONS
E Learning- Educative practical and clinical videos online - A new way of learning
Suresh Dugani
March-April 2019, 67(2):399-401
DOI:10.4103/0028-3886.258024  PMID:31085846
  258 9 -
NEUROIMAGES
Eight-and-a-half syndrome: A rare neuro-ophthalmologic syndrome of pontine infarction
Jaslovleen Kaur, Birinder S Paul, Gagandeep Singh
March-April 2019, 67(2):611-612
DOI:10.4103/0028-3886.257993  PMID:31085897
  246 20 -
LETTERS TO EDITOR
Genetic analysis of a family from India with Machado–Joseph disease
Ram M Anjanappa, Sanjeev Jain, Gurusidheshwar M Wali, Meera Purushottam
March-April 2019, 67(2):582-588
DOI:10.4103/0028-3886.258030  PMID:31085886
  255 9 -
NI FEATURE: THE EDITORIAL DEBATE II-- PROS AND CONS
Can cognitive decline be the nemesis of motor improvement secondary to deep brain stimulation?
Milind Deogaonkar
March-April 2019, 67(2):393-394
DOI:10.4103/0028-3886.258016  PMID:31085843
  251 11 -
CORRESPONDENCE
Have we been neglecting an intraoperative indicator of intact cerebral autoregulation in patients with aneurysmal subarachnoid hemorrhage?
Summit Dev Bloria, Ankur Luthra, Pallavi Bloria, Abhijeet Anand, Tanvi Khera, Richa Panghal, Anjuman Chander
March-April 2019, 67(2):619-620
DOI:10.4103/0028-3886.257992  PMID:31085903
  244 13 -
COMMENTARY
Malformations of cortical development and incomplete hippocampal inversion
Bhaskara Rao Malla
March-April 2019, 67(2):448-449
DOI:10.4103/0028-3886.258014  PMID:31085858
  250 5 -
LETTERS TO EDITOR
Conus melanocytoma: A rare spinal tumor
Vikas Sharma, S Bhaskar, Abhishek Kumar, Minakshi Bhardwaj
March-April 2019, 67(2):591-595
DOI:10.4103/0028-3886.258008  PMID:31085889
  246 9 -
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTERS TO EDITOR
Cerebral arteriotomy to retrieve an entrapped microcatheter after a partial cerebral arteriovenous malformation embolization
Fei Wang, Xiao-yan Yao, Yi Gong, Dong Yuan, Huan-Zhi Wang, Tao Sun
March-April 2019, 67(2):536-539
DOI:10.4103/0028-3886.258029  PMID:31085874
  244 7 -
COMMENTARY
Malformations of cortical development and inverted hippocampal inversion: The questions raised
Manjari Tripathi, Divyani Garg
March-April 2019, 67(2):450-451
DOI:10.4103/0028-3886.258037  PMID:31085859
  230 14 -
NEUROIMAGES
Cerebral hemiatrophy: A delayed sequalae of multidrug-resistant tuberculous meningitis
Ravindra K Garg, Imran Rizvi, Amita Jain, Hardeep S Malhotra, Neeraj Kumar, Shweta Pandey
March-April 2019, 67(2):614-615
DOI:10.4103/0028-3886.257985  PMID:31085899
  231 11 -
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTERS TO EDITOR
Migrating pseudomeningocele: A rare complication of posterior fossa surgery
Manoj K Kapanigowda, Anita Nagadi, Sriram Patwari, Vineetha Raghu, Harsha Chadaga
March-April 2019, 67(2):532-533
DOI:10.4103/0028-3886.258050  PMID:31085872
  228 9 -
LETTERS TO EDITOR
Intramuscular hemangioma of the medial rectus as a rare cause of extraocular muscle enlargement: Report and review of literature
Prashant Sakharam Gade, Harish Naik, Laxmikant Bhople, Vernon Velho
March-April 2019, 67(2):601-604
DOI:10.4103/0028-3886.258033  PMID:31085893
  231 5 -
NEUROIMAGES
Isolated astasia with anterior corpus callosum stroke
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
March-April 2019, 67(2):613-613
DOI:10.4103/0028-3886.258011  PMID:31085898
  222 7 -
Fatal transorbital penetrating injury to brain by the clutch lever of a bike
Ashish Aggarwal, Aman Batish, Pravin Salunke
March-April 2019, 67(2):617-617
DOI:10.4103/0028-3886.258053  PMID:31085901
  221 8 -
BOOK REVIEWS
Tenets of craniosynostosis. Surgical principles and advanced multidisciplinary care
Maneet Singh Gill
March-April 2019, 67(2):628-629
DOI:10.4103/0028-3886.258000  
  203 13 -
CORRESPONDENCE
Campus placements for neurosurgical jobs: An idea whose time has come?
George C Vilanilam, Pankaj Shivhare
March-April 2019, 67(2):618-619
DOI:10.4103/0028-3886.257987  PMID:31085902
  199 13 -
NI FEATURE - BOOKS FROM MY SHELF - COMMENTARY
Oliver Sacks: An anthropologist on Mars. Seven paradoxical tales
Sunil Pandya
March-April 2019, 67(2):621-623
DOI:10.4103/0028-3886.258001  PMID:31085904
  208 4 -
BOOK REVIEWS
Missile injuries of the brain, spine and peripheral nerves
Deepak Gupta
March-April 2019, 67(2):624-625
DOI:10.4103/0028-3886.257999  
  185 8 -
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