Neurology India最新文献

Abstract: Phosphoglycerate dehydrogenase deficiency is a rare neurometabolic disorder with clinical features of congenital microcephaly, psychomotor retardation, intractable seizures, and spasticity. We report a 2.5-year-old boy presenting with speech delay, seizures, microcephaly, and hyperactive behavior. Genetic testing detected a likely pathogenic homozygous variant c.1129G>A in the PHGDH gene. Parents were carrier for the detected variant. Biochemical analysis showed low serine and treatment with oral serine and glycine resulted in seizure control, followed by catchup of developmental milestones. This case illustrates the need for evaluating underlying neurometabolic causes, particularly treatable entities, in clinical presentations similar to cerebral palsy.

Abstract: Anterior odontoid screw fixation is a simple and safe surgical technique. It is performed routinely for adult patients, resulting in an abundance of literature on the subject. On the other hand, the use of an anterior odontoid screw in pediatric patients for the management of type 2 odontoid fractures is scarcely reported. Although the surgical strategy is the same as in adult patients, it is essential to be aware of a few distinct perioperative nuances in pediatric patients. These nuances have been highlighted. In order to prevent irreversible loss of head rotatory motion for pediatric type II odontoid fractures, anterior screw fixation should be attempted whenever feasible. This provides adequate fixation while maintaining the range of cervical rotatory motion.

Background: The quality of recovery following neurosurgery is of utmost significance, and the type of anesthesia used directly impacts it. Previous research on total intravenous anesthesia (TIVA) and inhalation anesthesia yielded mixed results. We used the Quality of Recovery-40 questionnaire (QoR-40) to prove equivalence in quality of recovery between TIVA and balanced anesthesia in patients undergoing elective supratentorial tumor resection.

Methods: After Institutional Review Board approval, this prospective, single-blinded, single-center, randomized equivalence trial was conducted at a tertiary care hospital in southern India. 93 adults undergoing elective supratentorial craniotomy were randomly allocated into Group A (n = 48) and Group B (n = 45). Group A received TIVA with propofol, while Group B received balanced anesthesia with Sevoflurane. The primary outcome was a QoR-40 score on postoperative days 1, 2, and 3. Secondary endpoints were intraoperative hemodynamics, brain relaxation score, recovery profile, and postoperative analgesia.

Results: The global QoR-40 score, measured on the preoperative day, POD1, and POD2 were comparable between Group A (TIVA) and Group B (Sevoflurane Balanced). The POD3 QoR-40 was lower (P = 0.015 95% CL; 18.9-0.8) for Group A (111.8 ± 8.9) versus Group B (116.6 ± 9.7). However, the mean difference in the score between TIVA and the balanced group on the POD1, POD2, and POD3 (-1.8, -2.8, -4.8) was lesser than the minimal clinically significant difference of 6.3. No significant difference was found in secondary outcomes.

Conclusions: TIVA and balanced anesthesia provide comparable quality of recovery as assessed with the QoR-40 score in adults undergoing elective supratentorial craniotomy and tumor excision.

Background: The quantitative insulin-sensitivity check index (QUICKI) has an excellent linear correlation with the glucose clamp index of insulin sensitivity (SIClamp).

Objective: It is important to investigate whether QUICKI would be useful index of insulin resistance (IR) to predict clinical outcome in ischemic stroke (IS) patients without type 2 diabetes mellitus (T2DM).

Methods and material: Prospective cohort patients who were diagnosed with IS and without a history of T2DM in the ACROSS-China registry were included from May 2008 to December 2009. And, QUICKI was calculated by the formula: 1/[log (fasting insulin, μU/mL) + log (fasting blood glucose, mg/dL)] and split into four quartiles.

Results: Of 1149 study participants, recurrent IS, all-cause death, and poor outcome occurred in 169 (14.71%), 72 (6.53%), and 261 (22.72%) cases, respectively in 1-year follow-up. Multivariable Cox proportional hazards analyses showed that the risk of incident primary endpoints was associated with a lower QUICKI quartile. In the Cox proportional hazard model, patients with the first QUICKI had an association with IS recurrence (adjusted hazard ratio, 2.90; 95% CI, 1.26-6.67; P = 0.001) and poor outcome (adjusted hazard ratio, 2.53; 95% CI, 1.06-5.99; P = 0.035), compared with those in the fourth quartile. Furthermore, the Kaplan-Meier survival analysis shown non-diabetic IS patients with a lower QUICKI had a higher mortality.

Conclusions: QUICKI as an insulin sensitivity index might be a potential predictor of clinical outcomes for acute IS patients without T2DM.

Abstract: Prehospital delay during a stroke is a global concern that affects the treatment modality and outcome of stroke victims. Understanding the underlying reasons for prehospital delays is essential to implement interventions to reduce the delay effectively. The review aims to study the recent evidence from various Indian regions to understand the underlying reasons for prehospital delays. The protocol of the review is registered under PROSPERO (ID: CRD42023476369). A qualitative approach was employed due to the lack of evidence from most Indian regions for comparison. Coding of each document followed by theme building was employed. Critical evaluations and comments were made on each theme while writing the content. Major reasons for prehospital delay include poor awareness regarding stroke symptoms, distance from the stroke center and location of the victim, income, and so on. Evidence from most of the Indian regions is not available on this topic. Nationwide studies are required to understand regional differences and major factors resulting in prehospital delay.

Introduction: Cerebral hemorrhage is highly disabling and lethal and is poorly treated. Previous studies have shown that edaravone dexborneol has effectively treated ischemic strokes. However, its use in treating cerebral hemorrhage has not been reported.

Materials and methods: 128 SD rats were randomly divided into the sham-operated group, cerebral hemorrhage group, edaravone intervention group (6 mg/kg), and edaravone dexborneol intervention group (7.5 mg/kg). All were administered by intraperitoneal injection two times until execution. Rats in each group were scored for neurological function at each time point after modeling and drug administration according to the Garcia scale.

Results: Compared with the cerebral hemorrhage group, the brain tissue damage around the hematoma was significantly reduced in the edaravone intervention group. The edaravone dexborneol intervention group at each time point and the expression of Fpn-1 protein were significantly higher (P < 0.05, P < 0.01), and the expression of ROS content, TfR, and IRP-2 was significantly lower (P < 0.05, P < 0.01); the changes in the edaravone dexborneol intervention group than the edaravone intervention group were more significant (P < 0.01).

Conclusion: Edaravone dexborneol may play a cerebral protective role by regulating the expression of iron metabolism-related proteins in rats with cerebral hemorrhage and inhibiting iron death in neuronal cells.

Background: Prediction of etiology of acute large vessel occlusion (LVO) will help to tailor mechanical thrombectomy (MT) approach.

Objective: ICAD-related LVO is focal and likely to have a short clot length, which can be measured on susceptibility-weighted imaging (SWI).

Materials and methods: This is a single-center study based on a retrospective analysis of acute LVO stroke treated by MT between April 2018 and June 2021. ICAD- related LVO was diagnosed if the final angiography showed fixed focal stenosis or re-occlusion after MT. Demographic and clinical characteristics, imaging features, SWI clot sign, SWI clot length and morphology of retrieved clots were compared between the ICAD-related LVO and Thromboembolic LVO.

Results: Ninety-eight patients underwent MT for acute LVO stroke. Eighty-two patients were included in the analysis among which 26 were grouped under ICAD-related LVO, and 56 were grouped under thromboembolic etiology based on the final angiogram. SWI clot length >9.1 mm with a branching pattern of occlusion was seen in thromboembolic LVO whereas a clot length < 9.1 mm with a truncal pattern of occlusion was seen in ICAD LVO (p<0.05). SWI Clot length cut off of 9.17 mm predicted the etiology of occlusion with a sensitivity of 62.5% (95% CI, 35.4-84.8) and specificity of 93.2% (95% CI, 81.3-98.6).

Conclusion: A short clot length (<9.1 mm) predicts ICAD related LVO as probable etiology. Along with other validated imaging parameters for predicting etiology, it helps to tailor mechanical thrombectomy.