Neurology India最新文献

Background: The classical cascade sign describes the mesodiencephalic coronal hyperintense signal changes described in neuro-Behcet's disease (NBD).

Material and methods: This case series included consecutive cases having a cascade sign in brain imaging, and its aetiology with outcome were determined.

Result: This case series describes the involvement of similar lesions in demyelinating disorders (multiple sclerosis, myelin oligodendrocyte glycoprotein antibody-associated disease, clinically isolated syndrome), NBD, and glioma, thereby extending the spectrum. The clinical presentation can be varied with focal neurological deficit, tremors, ataxia, seizure, dysphagia, dysarthria, and behavioural abnormality.

Conclusion: The cascade sign could be a phenomenon beyond NBD.

Background: Ethmoidal dural arteriovenous fistulas (dAVF) may demonstrate aggressive clinical behavior due to retrograde cortical venous reflux and venous hypertension and require treatment in such instances. Microsurgical treatment remains the preferred modality due to technical challenges with endovascular treatment and importantly, the risk of blindness with transarterial embolization.

Objective: This video presents a step-by-step demonstration of the pterional approach for a Cognard type 4 ethmoidal dAVF with a comparative summary of pros and cons across different treatment modalities.

Surgical procedure: Pterional craniotomy was performed on the side of the dominant venous drainage. The principal draining vein was identified via the sub-frontal corridor and disconnected. Dura at the site of the fistula was coagulated. Postoperative angiogram showed complete fistula occlusion.

Results: Patient recovered well with resolution of symptoms at two-week follow-up.

Conclusion: Microsurgical treatment via pterional approach remains a safe and effective modality for occlusion of ethmoidal dAVFs.

Background: The trochlear nerve is unique in its origin, course, and function, being the longest and thinnest among all cranial nerves, underscores the nerve's vulnerability during surgical procedures.

Material and methods: Thirty-two trochlear nerves from sixteen formalin preserved brains of human cadavers were examined. The course of the trochlear until it reaches the lateral wall of the cavernous sinus. Measurements made from the tentorial entry point to anterior clinoid process and posterior clinoid process, origin of the nerve until tentorium entry point, total tentorial length of the nerve noted.

Results: We describe segment under the tent as "Subtentorial" segment, being separate from the tentorial segment. Mean distance between trochlear nerve and dural entrance on right and left sides was 28.08 mm and 27.95 mm, respectively. The mean length of tentorial segment was found to be 7.81 mm on the right side and 8.11 mm on the left side. The mean distance from the anterior clinoid process (ACP) to the dural entrance of the trochlear nerve on right side was 17.63 mm and the left side was 18.00 mm. The mean distance from the posterior clinoid process (PCP) to the dural entrance of the trochlear nerve was 12.97 mm on the right side and was 12.50 mm on the left side.

Conclusion: The study provides valuable prescience into the cadaveric anatomy of the trochlear nerve's entry into the tentorium emphasizing its application in various skull base surgeries.

Nocardiosis has a predilection for affecting the lungs or occurs as a disseminated disease. Cerebral involvement resulting in multiple brain abscesses is rarely reported in 2% of cases. A 30-year-old woman diagnosed with immunocompromised state six months back presented with headache, multiple episodes of seizures, and progressive right hemiparesis for the past three months. She was initially treated with antibiotics, but in view of non-improvement, an early burr-hole aspiration of the abscess resulted in the correct diagnosis. She was then subsequently treated with antimicrobial therapy and surgical excision of the abscess, resulting in significant improvement. Follow-up at four-month duration showed significant improvement with complete resolution of all clinical features. Patients with multiple cerebral nocardial abscesses may require combined treatment with antimicrobial therapy and surgical excision to improve the mortality and prognosis. An early burr-hole-guided aspiration results in faster etiological diagnosis and prompt targeted approach.

Background: The conventional methods have their limitations in containing CSF leaks after infratentorial neurosurgery.

Objective: To test the utility of a novel method Extra-Axial ETV (EAETV), for containing persistent CSF leaks after infratentorial neurosurgery.

Methods and material: This prospective pilot study was conducted between April 2022 and September 2024 and included all patients who underwent intradural infratentorial neurosurgery. The recurrent cases, patients with VP shunts, patients requiring CSF diversion before the onset of CSF leak, patients requiring postoperative EVD for >48 hours, and patients who died of causes other than CSF leak were excluded.

Results and conclusion: The incisional CSF leak occurred in 41/274 (14.96%) cases. Patients with persistent ventriculomegaly/hydrocephalus had a significantly higher incidence of CSF leak (p-0.02). The conservative methods contained CSF leaks in 23/41 (56.1%) patients. Of 18 patients with persistent CSF leaks, ten underwent EAETV and a lumbar drain was placed in eight. The lumbar drain contained CSF leaks in six (75%) while EAETV contained CSF leaks in all cases. The EAETV diverts CSF to the supratentorial compartment and thereby reduces CSF circulation to the infratentorial compartment. This helps in containing persistent CSF leaks after infratentorial surgery. It also addresses the associated hydrocephalus.

Background: Mild traumatic brain injury (mTBI) can result in persistent neurological symptoms and signs and may contribute to late life cognitive decline. Yet, recognition of post-mTBI symptoms in older populations, especially in low-middle-income countries such as India, remains inadequate. Hence, there is a critical need to develop a screening tool to assess lifetime post-mTBI symptoms in India, which has a disproportionately high rate of TBI.

Objective: To develop the Kerala Brain Injury Questionnaire (KBIQ) to assess post-mTBI (postconcussive) symptomatology.

Methods: We examined the feasibility, reliability, and validity of the KBIQ, which assessed clinical symptoms possibly related to mTBI over the previous month in the Kerala Einstein Study (KES), based in Kerala state, India.

Results: 682 KES participants (mean age 68.5 ± 5.7 years, 40.5% women, and 14.9% reported mTBI) without dementia completed the KBIQ. The KBIQ had high acceptability and response rates with no concerns raised during administration raised by participants or interviewers. The KBIQ demonstrated high internal consistency and good validity, as assessed by comparison to mTBI history. We used principal component analysis to determine that the KBIQ has a six-component structure.

Conclusions: The KBIQ is a reliable and valid assessment of chronic postconcussive symptoms in older Indian adults. The KBIQ can be used by nonclinicians, making it suitable for widespread case detection in community settings and for prescreening individuals prior to clinic visits, helping clinicians identify potential undiagnosed health issues.

Background: In head injury patients, it is crucial to maintain normal carbon dioxide levels, improve synchrony, and keep airway pressures and dead space ventilation to a minimum during mechanical ventilation. Adaptive support ventilation (ASV) decreases airway pressure and work of breathing by providing minute ventilation at an optimal frequency and tidal volume based on the patient's lung compliance and airway resistance.

Objective: To compare respiratory mechanics during ASV mode with that during synchronized intermittent mandatory ventilation (SIMV) mode in head injury patients.

Methods and material: Forty-six adult patients of 18-50 years of age, either sex, having sustained a head injury, being tracheostomized, and receiving mechanical ventilation, were enrolled. All the patients received both modes of ventilation in a cross-over manner: SIMV and ASV for 4 hours each; half of the patients (n = 23) initially received the former, followed by the latter, and vice versa in the remaining half (n = 23). A comparison of hemodynamics, respiratory mechanics, and arterial blood gas during both modes was done.

Results: Airway pressures (peak, plateau, and mean) were higher during SIMV mode, while compliance (both dynamic and static) was better (higher) during ASV mode at almost all time points (P < 0.05). Dead space ventilation was higher during SIMV mode (P < 0.05).

Conclusions: In head injury patients, owing to better patient-ventilator synchrony with ASV mode as compared to SIMV mode, similar values of oxygenation and carbon dioxide levels were maintained at lower airway pressures, leading to better compliance.