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Introduction: Recently, neutrophil-to-lymphocyte ratio (NLR) has been proven to be useful in predicting severity, mortality, and morbidity of stroke. NLR is low cost and yet not used widely as a biomarker to predict prognosis.Aims: We evaluated the association of NLR in severity of stroke and ischemic stroke subtypes.Methodology: A total of 69 subjects with ischemic stroke onset within 24 h were included in the study and categorized according to TOAST classification. National Institutes of Health Stroke Scale was used to determine stroke severity at admission. Samples were obtained within 24 h of stroke onset and NLR measured which was later correlated with severity and subtypes of stroke.Results: NLR and severity of stroke showed statistically significant association (P< .05). Median (interquartile range [IQR]) of NLR was significantly high in severe cases (7.1 [4.03-7.698]), as compared to others. The area under the receiver operating characteristic curve for NLR to predict the stroke severity was 6.07 [area under the curve 0.764; 95% confidence interval: 0.647 to 0.858). When NLR was more than 6.07, there was 90.90% chances of moderate-to-severe stroke and with milder stroke, 93.10% had NLR of less than equal to 6.07. NLR and stroke subtypes also showed statistically significant association (P< .05). Median (IQR) of NLR in embolic stroke was significantly high (4.75 [2.95-8.2]), as compared to other stroke subtypes.Conclusion: NLR, at a cut-off 6, has moderate sensitivity and higher specificity in predicting stroke severity and NLR was high in embolic stroke among other stroke subtypes.

Neuromyelitis optica (NMO) is a central nervous system inflammatory demyelinating autoimmune disease. It can be an isolated entity or can coexist other autoimmune diseases like systemic lupus erythematous. We report a 33-year-old female who presented with symptoms of bulbar myelitis. On evaluation, she was found to have leukopenia, positivity for antinuclear factor, anti-double-stranded DNA, Ro-52, and SS-A/SS-B antibodies. She did not respond to methylprednisolone, but improved after IVIg and cyclophosphamide. NMO antibody was also positive. There is a debate about the relationship of NMO with autoimmune disorders. In patients with uncharacterized lupus myelitis, doing NMO antibodies routinely will help in detecting more of NMO and increase our familiarity of the disorder and hence its association with lupus.

Cerebral venous thrombosis (CVT) represents less than 5% of all strokes. Isolated cerebral deep venous thrombosis is very rare. Most patients present with rapid neurological deterioration. Early diagnosis and treatment may avoid potentially devastating consequences. Thrombosis of the cerebral deep venous system presenting with bilateral thalamic and basal ganglia infarction or oedema is not uncommon. We present a case of CVT with extensive involvement of basal ganglia, thalami and corpus callosum.

Spinocerebellar ataxia 12 (SCA12) is an autosomal dominant cerebellar ataxia (ADCA) described in a single family with a CAG repeat expansion in the PPP2R2B gene. We screened 247 index cases, including 145 families with ADCA, for this expansion. An expanded repeat ranging from 55 to 61 triplets was detected in 6 affected and 3 unaffected individuals at risk in a single family from India. The association of the PPP2R2B CAG repeat expansion with disease in this new family provides additional evidence that the mutation is causative. Ann Neurol 2001;49:117–121

Essential thrombocythemia (ET) is a rare myeloproliferative disorder occurring predominantly in the elderly population. Its occurence in the pediatric age group is even more rare. We report a 13-year-old girl who presented with isolated cerebral venous thrombosis and was diagnosed with essential thrombocythemia. Family screening for any thrombocytosis was 20 negative. With no secondary cause apparent for persistent thrombocytosis, we looked for the JAK2 mutation, but the result was negative. In contrast to linkage of JAK2 mutation positivity with increased thrombotic risk, our case showed that thrombosis can occur in the absence of JAK2 mutation in a case of essential thrombocythaemia. The indications for treatment and the best treatment of children with ET are currently not known, and guidelines for the management of children with ET are needed. Adult patients have near-normal life expectancy because of the low rate of leukemic conversion, but no child has been monitored long enough to assess prognosis.