Neurology India最新文献

Background: Vascular hypotheses was previously considered to play a major role in pathophysiology of migraine. Recently, neurological mechanisms have been proposed with implication of the trigemino-vascular pathway. Deciphering the pathophysiology of this disorder is extremely important for diagnosis, assessment of progression and to explore targeted treatment options.

Objectives: To assess white matter alterations in patients of migraine by using Diffusion Tensor Imaging.

Materials and methods: We performed Diffusion Tensor Imaging in migraine patients to assess changes in microstructural integrity of white matter tracts involved in pain processing to localize the tracts involved in migraine. This is a cross-sectional observational study involving 50 subjects (30 patients of migraine diagnosed as per ICHD-III and 20 age and sex matched controls). DTI was performed on 3T MRI and the mean diffusivity and fractional anisotropy values of the cases were compared with controls.

Results and conslusion: Significant changes were noted in the multiple white matter tracts implicated in pain processing compared to the controls. Significant association was also noted between the DTI parameters and the type and frequency of migraine. DTI can thus assist in the diagnosis, assessing the extent of neurological damage in patients of migraine and follow up post treatment.

Background and objectives: The electrophysiological process of emergence from general anesthesia (GA) commences from deeper structures of the brain rather than the cortex. The phylogenetically old parts of the brain (hippocampus) are the first to recover during emergence. Study objectives were to evaluate and predict the effect of preoperative hippocampal volume (HV) measured using MRI with emergence from GA and delayed extubation in patients undergoing elective neurosurgical procedures.

Methods: Patients aged 18-65 years of age scheduled for elective neurosurgical procedures under GA with GCS = 15 were recruited into the prospective cohort. Those who underwent excision of the hippocampus, amygdala, and temporal lobe pathology were excluded. Bilateral HVs and total brain volume were measured preoperatively using MRI brain. GA was induced by thiopentone, fentanyl, and vecuronium and maintained with sevoflurane. At the end of the surgery, sevoflurane was turned off, and a fresh gas flow of 6 L min-1 oxygen was set, allowing patients to wake up by "no contact technique." Time elapsed from turning off sevoflurane till the onset of different phases of emergence was measured. The patterns of emergence were assessed using GCS and Riker Sedation-Agitation Scale.

Results: The complete data of 125 patients of 1192 screened for recruitment were analyzed. The median time for extubation was 13 minutes (IQR 9-16). The average bilateral standardized HV had a statistically significant negative correlation with the time to extubation (r = -0.185; P = 0.039). Average of bilateral standardized HV <2097 mm3 predicts delayed extubation with a specificity: 70.7%, sensitivity: 51.2% and AUC: 0.672, CI 0.524-0.724. Standardized dominant HV <1925 mm3 also predicts delayed extubation with specificity: 78%, sensitivity: 46.4% and AUC: 0.635, CI 0.533-0.738.

Conclusion: Neurosurgical patients with larger average HV might lead to early extubation, vocalization, and faster gaining of orientation after GA.

Background: Efficacy data on nonpharmacotherapy-based interventions such as cognitive retraining and mindfulness meditation on improving neuropsychological functioning in early Alzheimer's disease (AD) are sparse in Indian literature.

Objective: The objective of the study was to quantify the effect of cognitive retraining (CR) versus mindfulness training (MT) on neuropsychological test performance in patients with early AD.

Methods and materials: We administered CR and MT strategies in two prospectively enrolled groups of individuals (N = 34) who met the criteria for mild cognitive impairment (MCI) due to AD. Inclusion was based on patient choice and informed consent. One group of 20 patients was imparted supervised CR, and the other group included 14 patients who opted for MT as open-labeled interventions, with group allocation based on participant choice.

Results: Paired t test was performed with assessment of baseline and postintervention neuropsychological scores of CR and MT groups. The CR group revealed significant improvement on scores at 3 months (P < 0.05) for Addenbrooke's Cognitive Examination (ACE) subcomponents, particularly total score, memory, visuospatial, and language subscores as well as on Clinical Dementia Rating (CDR) scale. The MT group showed no significant differences on these tests post-intervention with a trend toward improvement on recall scores, and none of the other test scores demonstrated a declining trend.

Conclusions: This proof-of-concept study demonstrated significant benefit of CR in improving neuropsychological test performance in patients with MCI due to AD and need to be studied in long-term, multicenter, randomized controlled trials in harmonized groups of patients with MCI and early AD.

Introduction: Gliosarcomas (GSM) are rare intracranial tumors composed of both glial and mesenchymal components. Given the rarity of the condition, there is limited literature on their clinical, radiological, pathological features, and treatment modalities.

Methods: Histopathologically confirmed cases of gliosarcomas were retrospectively analyzed. Based on the intraoperative macroscopic descriptions, patients were subdivided into two groups: tumors resembling meningioma and tumors resembling glioblastoma. Clinicoradiological presentations, characteristic pathological features, therapeutic modalities, and the survival of patients with gliosarcoma were analyzed.

Results: Twenty-five patients (17 males and 8 females) were retrospectively analyzed in this study. The mean age of presentation was 45.8 + 11.7 years, while the mean duration of symptoms was 2 months. The most common site of the tumor was frontal lobe. All the patients underwent maximal safe resections. Postoperative radiotherapy was received by all 25 patients. Sixteen patients received concurrent and adjuvant chemotherapy with temozolomide.The median survival was 11 months (range: 4-42 months). Patients with tumors mimicking a meningioma (intraoperatively) had better survival than patients with glioblastoma-like features (P < 0.01).

Conclusion: Our study supports the presence of two distinct types of GSM: one which is similar to glioblastoma multiforme and another which resembles more of meningioma. Good surgical excision is a favorable prognostic factor for the outcome of GSM. Gliosarcoma which resembles meningioma has got better survival outcome compared to the one that resembles glioblastoma.