Neurology India最新文献

Background: Non-motor symptoms have a more significant impact on the quality of life in Parkinson's disease than motor symptoms.

Objectives: To evaluate the frequency of non-motor symptoms in Parkinson's disease and study their impact on quality of life.

Methods: A cross-sectional study was conducted on 100 patients with idiopathic Parkinson's disease. All patients underwent a detailed history and neurological examination, Hoehn and Yahr staging, MDS UPDRS scoring, NMSS scoring, and PDQ-39 scoring to assess their quality of life.

Results: All patients presented with at least one non-motor symptom. The most frequently affected non-motor symptom was sleep/fatigue (95%), followed by urinary (79%) and gastrointestinal dysfunction (76%). The total NMSS score significantly correlated with disease severity and quality of life.

Conclusion: Non-motor symptoms are quite prevalent in patients with Parkinson's disease and significantly impact their quality of life.

Objective: This study was conducted to analyze the association of serum biomarkers (S-100 B protein [S-100β], glial fibrillary acidic protein [GFAP], neuron-specific enolase [NSE], and phosphorylated form of neurofilament protein heavy subunit [pNF-H]) with injury severity at presentation and functional outcome at 6 months across the American Spinal Injury Association Impairment Scale (AIS) classifications, in acute traumatic spinal cord injury (SCI) patients.

Methodology: A total of 26 adult acute traumatic-SCI patients with spinal-column fracture (presenting within 24 hours of injury) were recruited. The enzyme-linked immunosorbent assay technique was utilized to quantitatively assess the serum biomarkers at admission, 2 days, and 7 days after injury.

Results: Day 2 GFAP serum levels >0.34 ng/ml demonstrated an association with non-functional status (AIS A-C) at admission (AUC 0.77, 95% CI 0.56-0.98; sensitivity 73.3%; specificity 80%; P = 0.07) and complete SCI (AIS A) at admission (AUC 0.76, 95% CI 0.55-0.97; sensitivity 76.9%; specificity 71.4%; P = 0.05). Day 7 GFAP serum levels >0.32 ng/ml demonstrated an association with complete SCI (AIS A) at admission (AUC 0.78, 95% CI 0.53-1.00; sensitivity 76.9%; specificity 80%; P = 0.07). Day 7 S-100β serum levels >100 pg/ml predicted the non-functional status (AIS A-C) at 6-months (AUC 0.86, 95% CI = 0.58-1.00; sensitivity 66.7%; specificity 100%; P = 0.09) and complete SCI (AIS A) at 6-months (AUC 1.00, 95% CI 1.00-1.00; sensitivity 100%; specificity 100%; P = 0.04).

Conclusions: Serial monitoring of serum GFAP and S-100β levels may provide useful insights into the objective assessment of injury severity and prognostication of acute traumatic SCI patients.

Background: There are cerebrospinal fluid (CSF)-filled spaces on either side in the cerebello-mesencephalic fissure in relation to superior cerebellar peduncle, middle cerebellar peduncle, and anterior cerebellum, seen as triangular spaces on axial sections of magnetic resonance imaging (MRI) at the level of upper pons and on axial sections of brain stem on gross anatomy.

Objective: To conduct an anatomical and radiological study of this triangular space and correlate with MRI findings of normal brain and of lesions surrounding the cerebello-mesencephalic fissure.

Methods and material: Five formalin-preserved posterior fossa cadaver specimens were studied for gross anatomy, MRI, and computed tomogram imaging using gelatin to delineate the CSF space of cerebello-mesencephalic fissure. MRIs of brain from patients with normal findings and with posterior fossa lesions were also studied, and the results were correlated.

Results: There are well-defined CSF spaces symmetrical and triangular in shape seen on either side on routine axial sections of MRI brain at the level of upper pons. They are bounded by superior cerebellar peduncle anteromedially, middle cerebellar peduncle anterolaterally, and the anterior lobe of cerebellum postero-laterally forming the base. The interpeduncular sulcus forms the apex. These spaces are distorted or displaced by lesions surrounding the cerebello-mesencephalic fissure.

Conclusions: The knowledge of gross and radiological anatomy of this triangular space as seen on axial MRI brain (which we humbly propose to be called as Chandy's space) is helpful in understanding the relations and surgical approaches to lesions in the cerebello-mesencephalic region.

Background: Rabies is transmitted to humans through the saliva of an infected animal.

Case: We report a rare case of rabies encephalitis presenting with subarachnoid hemorrhage. An elderly gentleman presented with behavioral disturbances and rapid worsening in sensorium. Neuroimaging showed diffuse subarachnoid hemorrhage, hydrocephalus, and right vertebral dissecting aneurysm requiring extraventricular drainage. He had history of dog bite 4 months prior with incomplete immunization. Despite adequate management, his condition deteriorated further and succumbed to death. Autopsy confirmed the diagnosis of rabies.

Conclusions: Rabies encephalitis can pose a diagnostic challenge requiring an extensive diagnostic evaluation because of its variable and uncommon clinical and radiological presentations.

Background: Autoimmune encephalitis (AE) is now emerging as an important cause of reversible cognitive impairment.

Aims: We aimed to study cognitive domains affected in various subtypes of AE, assess the changes in cognitive profile, and factors that predict residual cognitive impairment.

Methods: Cognitive assessment was conducted based on their age at presentation (≤12 years: Vineland Social Maturity Scale, 13-18 years: Montreal Cognitive Assessment and >18 years: Addenbrooke's Cognitive Examination-III). They were screened for psychiatric manifestations by Neuropsychiatric Inventory questionnaire. The assessment was repeated after 6 months.

Results: Mean age was 21.8 (21.8 ± 17.0) years. Among 74 (M:F: 29:45) patients, 38 (51%) were less than 18 years of age, 22 (37%) adults and 9 (12%) patients belonged to late onset (more than 45 years). Cognitive impairment was seen in 100% of late onset, 85% adults and 58% children. At follow-up, Cognitive impairment was present in 27 out of 45 (60%) patients. Cognitive impairment was common in patients with late-onset AE and in patients with anti-Leucine-rich glioma inactivated-1 (LGI-1) positivity. Age more than 45 years, mutism, hallucinations, incontinence, altered consciousness, psychiatric manifestations, and modified Rankin Scale (mRS) scores more than three, abnormal EEG were shown to be significantly associated with poor cognitive scores. The cognitive domains affected were attention, fluency, memory as residual deficits. The pattern of cognitive recovery during follow-up showed significant improvement in all domains except for new learning, memory, and fluency.

Conclusions: Cognitive Impairment is common in autoimmune encephalitis with new learning, memory and fluency domains severely affected. Late-onset, abnormal EEG, high mRS scores and coexistent psychiatric disturbances predict poor cognitive outcomes.