Neurology India最新文献

Background and objectives: Limited data are available regarding symptomatic intracerebral hemorrhage (sICH) after intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) from India. We analyzed the incidence, predictors, and functional outcome following sICH in the South Indian population.

Methods: We retrospectively analyzed all patients with AIS who were treated with IVT between January 2012 and December 2022. The potential predictors of sICH and functional outcome at 3 months were investigated using univariate and multivariate analysis.

Results: Of the 348 patients (71.55% men), 24 (6.92%) developed sICH. The patients with sICH had more severe stroke (National Institute of Health Stroke Scale [NIHSS] on admission 15.16 ± 5.07 versus 11.14 ± 5.48, P = 0.006), high blood glucose (BG) on admission (P = 0.001), high creatinine levels (P = <0.002), poor Alberta Stroke Program Early CT Score (ASPECTS ≤5, P = 0.01) and had cardioembolic etiology (CE) (P = <0.001). The multiple logistic regression model showed that sICH was independently associated with high admission BG levels (odds ratio [OR] = 3.85;95%CI [1.55-9.58]; P = 0.004) and CE (OR = 4.63; 95%CI [1.72-11.00]; P = 0.002). At 3 months, 33% had a poor functional outcome. Stroke severity with an NIHSS > 15 (OR = 3.58; 95%CI [1.96-6.35]; P = <0.001), high admission BG (OR = 2.60; 95%CI [1.50-4.48]; P = 0.001), and large vessel occlusion (OR = 2.49; 95%CI [1.41-4.38]; P = 0.002) independently predicted poor functional outcome.

Conclusion: The presence of hyperglycemia at stroke onset and cardioembolic stroke etiology predicted sICH after IVT.

Objectives: To evaluate whether the outcome of IV-tPA Administration (ITA) time differs for each occluded vessel in acute ischemic stroke and to find prognostic predictors following ITA without endovascular treatment.

Methods: We chose a cohort of only IV-tPA administered patients whose occluded vessel segments were confirmed by neuroimaging. ITA time, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Score (mRS), Early Neurological Improvement (ENI), Alberta Stroke Program Early CT (ASPECT) scores, infarct volumes, and collateral status were recorded.

Results: Sixty-seven patients were included with 47 MCA (14 M1, 33 M2), 7 ACA, and 13 PCA occlusions. ROC analysis where time to ITA is the predictor showed poor discrimination (AUC values < 0.7) for prognosis. In PCA infarcts, ENI1 (NIHSS score improvement ≥ 4 points from baseline at 2 hours) was significantly associated (P = 0.045) with ITA time. Higher infarct volume was significantly associated with lower odds of good mRS (1 and 3 months)/ENI4 (≥20% improvement from baseline NIHSS score at 24 hours), good collateral status had a significantly favorable outcome in the MCA, M2 and PCA segments. For each unit increase in ASPECT, the odds of good mRS (0-2 vs. 3-6) in 3 months increased by 2.01 (95% CI = 1.09 to 3.94, P = 0.031).

Conclusions: Although the small sample size of PCA and ACA segment occlusion precluded the cut-off values of ITA time, other factors such as age, collateral status, infarct volume, and ASPECT score remain crucial alongside ITA timing. Limitations in this study include the small and imbalanced sample size and the single-center retrospective design, which may limit the generalizability of the results.

Background: Most contemporary clinical trials of mechanical thrombectomy (MT) have often excluded patients over the age of 80 years. Thus, evidence regarding efficacy of endovascular treatment in the octogenarians is still scanty. The present study assesses the efficacy of MT in octogenarians.

Materials and methods: Between January 2015 to December 2020, clinical records of 27 patients (age ≥80 years), who underwent MT for stroke were queried from our database.

Results: Out of total 229 patients, who underwent mechanical thrombectomy during the study period, 29 patients were of age ≥80 years, with a baseline disability (mRS score 0-3). We excluded two patients, who showed recanalization following iv-tPA. Recanalization through MT was achieved in 25 (93%) patients, without any event of symptomatic intracranial hemorrhage. Three had mortality and three patients required a decompressive craniectomy. Eighteen (66%) patients received intravenous thrombolysis prior to MT and nine underwent direct MT. Out of the latter group, three presented beyond the window period for thrombolysis, five were on anticoagulants, and one was in immediate post-surgical period. Baseline National Institutes of Health Stroke Scale (NIHSS) was 17 (range 8-22) and ASPECT score was six (range 3-9). Mean post-procedure NIHSS was three (range 1-10). 90-day mRS of 0-2 was achieved in 21/27 (78%) patients.

Conclusion: Contrary to the prevalent apprehensions of poor outcomes in elderly stroke patients treated with MT, our study showed favorable radiological and clinical results. Accordingly, more optimistic pre-procedural counselling before MT is probably advisable even in this age group of patients.

Background: Spontaneous intracranial hypotension (SIH) results from cerebrospinal fluid loss, mostly due to a spinal dural tear. Patients with SIH are treated with an autologous epidural blood patch (EBP) if conservative treatment fails. There is a paucity of studies from India regarding the symptom relief and long-term outcomes of patients with SIH. In this study, we present our institutional experience regarding the clinical-epidemiological profile, imaging findings, and long-term outcomes of patients after treatment of SIH who have presented to our hospital since 2012.

Methods: We retrospectively examined the medical records of all patients with a diagnosis of SIH from 2012 to date. We collected data regarding the clinical presentation, imaging findings, and treatment received. Subsequently, we performed telephonic follow-ups to enquire about their headache severity at 3 months and 6 months (using a numeric rating scale) after treatment, current quality of life by using the EuroQOL-5D questionnaire, and sleep quality.

Results: Since 2012, 37 SIH patients have been treated at our institution. The predominant symptom was headache (97%), and 86% had postural headache. Pachymeningeal enhancement, engorged venous sinuses, subdural collection, and spinal longitudinal epidural collection were the most common findings on magnetic resonance imaging (MRI), with a median Bern score of 9. Twenty-five (68%) patients received EBP, most commonly at the C6-C7 level, mostly with fluoroscopic assistance. About 71% of patients achieved complete symptom relief. Post-EBP MRI (n = 12) showed partial resolution of SIH features. On telephonic follow-up, the median headache score at 3 and 6 months was 3. The median QOL scores were 1 for mobility, self-care, usual activity, pain, and anxiety/depression, implying no problems in these dimensions. The median sleep score was 100, indicating excellent sleep.

Conclusion: Patients have good symptom relief following treatment of SIH, leading to a good quality of life, even years after the initial presentation.

Background: Many neurological diseases show seasonal incidence variations, and transient global amnesia (TGA) is one of them. Arterial hypertension is the most common clinical symptom accompanying TGA in the acute phase. Blood pressure is subject to physiological variability depending on the season.

Objectives: The aim of the study was to analyze the seasonal variability in the incidence and blood pressure values of patients with TGA and the potential association between these variables.

Materials and methods: Retrospective, cross-sectional, single center analysis of 70 medical records of patients with TGA. All the patients underwent 24-hour automatic blood pressure monitoring during hospitalization. Analysis of the seasonal incidence and variability of blood pressure depending on the season and a month has been performed.

Results: The highest incidence of TGA have been observed at the turn of winter and spring (March) and in autumn (November). No significant relationship between the seasonality of TGA occurrence and the seasonal variability of blood pressure has been found.

Conclusions: Our study showed a reversal of the physiological seasonal variability of blood pressure (BP) in patients with TGA, which may indicate impaired autonomic control of blood pressure in these patients. As arterial hypertension often co-occurs with TGA, the obtained results may be one of the aspects useful for planning antihypertensive treatment in these patients.

Abstract: Cerebral infarction secondary to ECMO is a commonly reported complication in the pediatric population; but acute stroke management with IV Tissue plasminogen activator (tPA) is not well studied or reported. We present a case of a 14-year-old female who developed a right middle cerebral artery (MCA) acute ischemic stroke (AIS) 12 days after veno-arterial ECMO (VA-ECMO) decannulation with successful thrombolysis using tPA with an excellent neurologic outcome. This case highlights the need for further studies related to both the use of thrombolysis in children, as well as the causes and optimal approach of ECMO related cerebral ischemic infarcts and other neurologic injury in the pediatric population.

Background and aim: The etiological profile of acute febrile encephalopathy (AFE) varies across different geographic areas and in different seasons across the world. Limited literature in children suggests central nervous system (CNS) infections to be the most common cause of AFE in India and developing countries. Most of these studies have been done in the plains of India, and no study has been done in the Himalayan region of northwestern India, where most of the vectors causing AFE in other parts of India, like mosquitoes, are not found. Therefore, this leads to a lacuna in available data on the etiological profile in this region with an elevation of 1000-21,000 ft from the sea level. Our aim was to study the clinical and etiological profile of pediatric AFE and the risk factors associated with mortality in AFE in Himachal Pradesh, a hilly Himalayan state of India located in northwestern Himalayas.

Materials and methods: This was a prospective, descriptive, observational study conducted in the pediatric intensive care unit (PICU) of Indira Gandhi Medical College Shimla, for a period of 1 year, in which all children aged from 1 to 18 years with clinical evidence of AFE and meeting the inclusion criteria were enrolled and studied for the clinical features, etiology, and risk factors for mortality. Chi-square test was used to find the significance of study parameters on a categorical scale between two or more groups. A P value of 0.05 or less was considered as statistically significant.

Results: Sixty-nine patients were enrolled in the study. Fever, altered sensorium, vomiting, seizures, and headache were the most common symptoms. The most common clinical sign was raised ICT, followed by low Glasgow coma scale (GCS). The most common etiology was CNS infections. Among these, scrub encephalitis was the most common cause that was seen in 15.8%, followed by viral and tubercular meningitis in 14.4% and 11.1%, respectively. Eighteen patients out of 69 with AFE died, giving a case fatality rate of 26%. Shock, GCS <8, ventilatory support, MODS, DIC, and delayed presentation were significant risk factors associated with mortality.

Conclusions: Infectious causes attributed maximum to the etiology of AFE, and among them, scrub encephalitis was the most common cause of AFE.

Objectives: To evaluate the outcomes of intracranial arteriovenous malformations (AVMs) after single-session treatment with gamma knife radiosurgery (GKRS) and factors influencing the outcomes.

Methods and material: Single-center retrospective study, including patients undergoing GKRS for intracranial AVMs. Demography, treatment profiles, and follow-ups were collected from the medical records. Obliteration rates, adverse radiation events (AREs), and clinical outcomes were noted, and factors influencing the same were evaluated.

Results: A total of 313 patients with a mean age of 27 years (8-66 years) were included in the study. While Spetzler-Martin (SM) grade 2 (46.3%) or SM grade 3 (37.4%) AVMs were common, SM grade 1 and SM grade 4 accounted for 10.9% and 5.4% of cases. The mean modified Pollock-Flickinger (PF) score was 1.02 (0.18-2.23), whereas the mean AVM volume was 3.75 cc (0.04-16 cc). The mean marginal dose was 23 Gy with 95% coverage. A total of 253 (80%) patients came for follow-up, but only 196 (62.6%) patients had adequate follow-up, out of which 148 (75.5%) had complete obliteration. AVM volume was the single most significant factor influencing the obliteration rates in AVM. Clinical outcomes were dependent on the AVM volume and modified PF score. Of 107 patients with seizures, 69% (75) were seizure-free. Twenty-two (8.7%) had complications, of which only seven had permanent neurological deficits (five hemiparesis and three visual field defects). The rebleed rate was 5.5% (14 patients).

Conclusion: GKRS remains a safe and effective treatment modality for intracranial AVMs. The AVM volume was the most important factor affecting the obliteration rates and AREs. The AVM volume and modified PF scores were significant factors affecting the clinical outcomes.

Background: Stroke, a debilitating condition often leading to long-term disability, poses a substantial global concern and formidable challenge.

Aims and objectives: The association of klotho with stroke was inconclusive, and we aimed to clarify the role of klotho in stroke.

Materials and methods: The data of 10,737 samples and 16 variables were collected from National Health and Nutrition Examination Surveys 2009-2016. Logistic regression analyses were performed to explore the association between klotho and stroke, followed by an importance evaluation of klotho. Then the association between klotho and other variables was explored by logistic regression and Spearman analyses, and important variables correlated with klotho were determined. Furthermore, mediation analyses based on population and mendelian randomization (MR) were performed to assess the mediating effect of klotho involved in stroke.

Results: The level of klotho was lower in the stroke group than in the nonstroke group (P < 0.001). Regression analysis showed that klotho significantly correlated with the stroke risk (OR = 0.253, P < 0.001). After adjusting for different variables, their independent association was still significant (all P < 0.05). Among all the variables, the importance of klotho involved in stroke ranked first. In addition, smoking status, age, alcohol use, and hypertension significantly correlated with klotho level (all P < 0.05), suggesting the mediating role of klotho on the association between these variables and stroke. The population study only indicated the mediating effects of klotho on the association of smoking/age and stroke (all P < 0.05). However, the mediation MR did not support its mediating effect.

Conclusion: Klotho was significantly associated with stroke, but their causal relationship needed further investigation.