Neurology India最新文献

Pediatric intracranial aneurysms (PIAs) are highly uncommon, with an incidence of <5% (0.17 to 4.6%) and <2% of PIA complicates into an aneurysmal hemorrhage. Pediatric aneurysms are usually treated by clipping, coiling, or more recently with flow diversion. Herein, we describe a 3-year male, whose ruptured vertebrobasilar junction aneurysm was successfully treated with a flow diverter and coiling.

Anti γ aminobutyric acid B(GABA B) receptor encephalitis is a rare form of autoimmune encephalitis. Our aim is to study the clinical characteristics and treatment outcomes of anti GABA B receptor encephalitis. This is a retrospective case series from the Neuroimmunology laboratory of Amrita Institute of Medical Sciences, Kochi, Kerala, India from 2016 to 2021. A total of four cases (two males, two females, age range: 13-80 years) tested positive for GABA B antibody during the study period. The clinical manifestations of anti GABA B receptor encephalitis found in our patients consisted of seizures, cognitive function decline (especially recent memory), and behavioral abnormalities. No malignancies were encountered. Patients were treated with steroids and immunoglobulins and showed an improvement in behavioral and cognitive function. However, one patient succumbed to illness while being treated with plasma exchange, and two other patients died at a later date due to other causes.

Various neurological complications have been linked with vaccines ranging from encephalitis, stroke, ADEM to GBS and many more. Although both viral as well as bacterial vaccines have been reported to cause neurological adverse events, brachial plexitis following vaccination is very uncommon. Vaccination drive against COVID-19 was started on 16th Jan 2021 in India. Various adverse events have been reported following vaccination since then. We observed two cases of brachial plexitis following the first dose of the Covishield vaccine. Although the risk-benefit ratio is very low for the COVID-19 vaccine, it is of vital importance for every clinician to be aware of such a rare adverse event.

Infantile dural arteriovenous fistula (IDAVF) is a rare complex dural arteriovenous fistulas. This study is to provide a comprehensive understanding of the angioarchitecture of arteriovenous shunts in IDAVFs and planning endovascular treatment. Five cases of IDAVF and a literature review were analyzed to characterize the shunt patterns of IDAVFs in terms of anatomic relations to the arterial feeder, sinuses, and cortical veins. Treatment characteristics and outcomes were evaluated. A total of 37 cases of IDAVF were identified, including 32 cases from the 15 literature studies and five cases from our center. The patients' age is 11 weeks to 27 years, with an average of 6 ± 7.8 years. Fourteen patients were female, and 23 patients were male. IDAVFs were characterized by multiple high-flow fistulas fed by arterial feeders from six vessels converging to enlarged dural sinuses, most of which were torcular, transverse-sigmoid, or superior sagittal sinuses (94.6%). In 31 cases treated endovascularly, only 9 (29%) IDAVFs resulted in complete occlusion. Clinical outcomes were reported in 28 cases treated endovascularly with a 64.3% of morbidity (mRS ≥ 2) and mortality. There were no differences in complete occlusion rate (25% vs 33.3%, P > 0.999) and death rate (21.4% vs 21.4%, P > 0.999) between transarterial and transvenous approaches. IDAVFs were characterized by multiple high-flow fistulas fed by arterial feeders from six vessels converging to enlarged dural sinuses, most of which were torcular, transverse-sigmoid, or superior sagittal sinuses. Considering these multiple suppliers and high-flow shunts, transarterial or transvenous embolization is still insufficient and unsatisfactory.

Background: Cerebral vascular malformations are rare but important causes of epilepsy in young women. The risk of bleed during pregnancy and delivery as well as the fetal outcomes are important concerns for women with epilepsy (WWE) due to cerebral vascular malformations (EVM).

Objectives: We compared the maternal and fetal outcomes of a cohort of EVM with women with focal epilepsy due to other causes (ENVM).

Methods and material: We identified all EVMs in the Kerala Registry of Epilepsy and Pregnancy and compared their characteristics with that of a set of randomly selected ENVM in the same registry. The clinical characteristics, pregnancy outcome, and seizure risk during pregnancy from the vascular malformations were compared between the two groups with Chi-square test and multivariate logistic regression after adjustment for age, epilepsy classification, and AED usage.

Results: There were 45 women with EVM (arteriovenous malformations: 25, cavernoma: 20) in this registry between 1998 and 2018. The EVM and ENVM groups (n = 96) had similar rates of seizure relapse during pregnancy (37.1% vs. 55.1%), fetal loss (11.4% vs. 13.5%), and fetal malformations (9.4% vs. 9%). The rate of delivery by cesarean section, adjusted for maternal age, was higher for the EVM group (61.2% vs. 39%, odds ratio = 2.79, 95% CI: 0.99-7.9, P = 0.05). AVM bled during pregnancy for three women (none of the cavernoma had bled during pregnancy).

Conclusions: Maternal and fetal outcomes were comparable for the EVM and ENVM groups, but the former had a higher rate of cesarean section. AVM bled during pregnancy for 15% of women.

Stents are increasingly used for coiling difficult aneurysms, to reduce the risk of recurrences, or to modify blood flow. Currently, available bifurcation aneurysm models are ill-suited to assess stent performance before clinical use. We designed a new animal model of wide-neck canine Y-type bifurcation aneurysm (such as middle cerebral artery (MCA) bifurcation) and previously reported one of T-type (such as basilar bifurcation). Its potential value as a training tool as well as in the evaluation of new techniques or stent or embolic agents was assessed. Seven canine aneurysms were created (three: Y-type, four: T-type). Aneurysms were followed by transfemoral cerebral angiography (TFCA) and computed tomography angiography (CTA). We performed TFCA and self-expandable stent placement for the parent artery adjoined to the aneurysmal neck in one month's follow-up. We assessed the long-term patency of the parent artery with CTA and euthanasia and got a specimen for pathologic study at six months' follow-up. In six models except one (T-type), a wide-neck bifurcation aneurysm was created successfully and they showed good long-term patency at six months' follow-up. Stent placement was technically difficult in these cases, but did not lead to aneurysm thrombosis in CTA or neointimal closure of the aneurysm neck in pathologic finding at postoperative six months later. This model may be suitable for studying the effects of endovascular treatment on aneurysm and branch occlusion rates, for preclinical testing of stents and other intravascular devices, and for training students in endovascular technique.