Neurology India最新文献

Background and objectives: With improving life expectancy, the proportion of geriatric patients is steadily increasing in the population and traumatic brain injury (TBI) in the elderly is becoming a problem demanding increasing attention from the health community. We attempted to identify factors that correlate with the outcome (as measured by the Glasgow Outcome Scale [GOS]) in elderly patients with TBI and make a prognostic model.

Materials and methods: A prospective analysis of 220 consecutive TBI patients aged ≥60 years admitted at our hospital was performed. Data about demography, comorbidities, mode of injury, clinico-radiological features, associated injuries, medical/surgical complications, and outcome was analyzed. Patients without imaging findings of TBI and patients with chronic subdural hematoma (SDH) and lesional intracranial hemorrhage were excluded.

Results: The mean age of patients was 69.17 years, with 70.9% being males. Motor vehicle accidents (44%) and ground-level falls (43.7%) were the most common modes of injury. Antiplatelets and anticoagulants were being taken by 14.6% and 1.8% of patients, respectively. Out of 220 patients, 124 patients had mild, 48 had moderate, and 48 had severe head injuries. Median Rotterdam score (RS) was 2. Forty-one patients underwent surgery. The outcome was favorable (GOS 4-5) in 54.1% and unfavorable (GOS 1-3) in 45.9% of patients, with the overall mortality at the end of 1 month being 30.9%. On multivariate regression analysis, Glasgow Coma Scale (GCS), RS, and coagulation abnormality were found to be independent prognostic factors; these three variables were then used to design a nomogram.

Conclusion: In the absence of specific geriatric TBI prognostic models, a nomogram using GCS, RS, and coagulation abnormality can be used as a prognostic model.

There is somatotopic organization of body in motor and sensory cortex of brain. Distal parts of a limb have a much larger area of presentation as compared to proximal parts. So, isolated distal hand muscle weakness as a manifestation of stroke is not so uncommon, but isolated shoulder muscle weakness as a manifestation of stroke is very rare. Here, we are presenting a case who presented as isolated shoulder muscle weakness as manifestation of stroke, which if one will not look carefully, can be easily mistaken as upper brachial plexopathy. But, on taking proper history and after doing proper neurological examination, it has given impression of stroke which got confirmed by doing MRI Brain. So this case shows rare presentation of ischemic stroke as isolated shoulder muscle weakness and also shows importance of proper history and examination in neurology to make correct diagnosis and do timely management.

Background and aim: Despite the sustained progress in the realm of intraoperative neurophysiologic monitoring of the nervous system, little progress has been achieved in monitoring the olfactory pathway. Loss of olfactory function due to retraction-induced physical damage during operations has ill-appreciated negative consequences for the patients and is often underreported. Improvements in this area of neuromonitoring require a revisit of the technical challenges. We aim to describe the method to construct flexible, bipolar silver ball electrodes to stimulate the olfactory mucosa during cranial neurosurgery and suggest ways to overcome the challenges in eliciting olfactory evoked potentials.

Materials and methods: We analyze the potential difficulties in routinely eliciting olfactory evoked potential in neurosurgical operations and summarize ways to overcome them. We also describe the construction of a simple electrical stimulator electrode for the olfactory mucosa, its application, and potential recording sites in an effort to detect the potential during cranial neurosurgery.

Results: We created flexible, insulated bipolar silver electrodes and placed them atraumatically on the olfactory mucosa under endoscopic guidance, bilaterally, in 22 patients. We obtained an optimal position in less than 10 minutes in most cases. We also summarize the challenges faced and potential paths to overcome them.

Conclusions: Though electrical stimulation of the olfactory mucosa using custom-made silver electrodes is possible and takes little time to place them as part of an intraoperative neurophysiologic monitoring setup, detecting the minute potential remains elusive.

Alzheimer's disease (AD) is a major neurodegenerative disease, affecting more than two-third cases of dementia in the world. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used anti-inflammatory analgesic agents, representing 7.7% of worldwide prescriptions, of which 90% are in patients over 65 years old. Based on mixed findings by different randomized clinical trials (RCTs), a systematic review and meta-analysis were conducted to develop a better understanding of the protective role of NSAIDs in AD. Database search was Pubmed, WebScience, and Embase. RCTs investigating the effect of NSAIDs on AD or test scores assessing cognitive function in people without AD at baseline were included. Two indicators were the Mini-Mental State Examination (MMSE) Score and Hazard Ratio. 09 studies were included in the present Meta-analysis. For the MMSE score difference, the pooled effect size was - 0.06 (-0.22, 0.10) which was not statistically significant (P value = 0.47). For the MMSE score, the pooled effect size was - 0.0036(-0.0320, 0.0248), which was also not statistically significant (P value = 0.87). For Hazard Ratio (HR), the pooled HR calculated using the random effect model was 1.20 (95% CI: 0.95, 1.51), which was not statistically significant (P value = 0.15). Present meta-analysis shows that NSAIDs, in general, are not effective in the treatment of AD. They also have no protective effect against the development of AD on their sustained use.