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Tropical ataxic neuropathy, which is prevalent in the tropics causes significant disability as well as increased mortality and remains an enigmatic disease with no effective treatment or cure, even a century after its identification. The syndrome, first described in Jamaica in 1897 and christened as tropical ataxic neuropathy in 1959, is a constellation of bilateral optic atrophy, bilateral sensory neural deafness, predominant posterior column involvement and pyramidal tract myelopathy, with ataxic polyneuropathy. The exact etiopathogenesis remains unresolved, and several factors have been proposed including malnutrition, vitamin B deficiencies, malabsorption, poor protein consumption, chronic cyanide, and nitrile toxicity, with a strong geospatial endemic prevalence in areas of cassava cultivation. In this review, we summarize the history, epidemiology, clinical features, and controversies regarding the pathogenesis and differential diagnosis of the disease and identify the potential areas for further research concerning this debilitating disorder that is common in the tropics. Its multifactorial etiopathogenesis provides potential opportunities for research and international collaboration to identify novel avenues for treatment. [ABSTRACT FROM AUTHOR]

Context: Serum Alkaline phosphatase (ALP) & phosphate are considered to be indicators of vascular calcification. Link between bone metabolism, vascular calcification, cardiovascular events have been well studied in chronic kidney disease and ischemic heart disease. Aims: To determine that increased serum phosphate and alkaline phosphatase are predictors of mortality rates and recurrent vascular events in stroke. Materials and Methods: Sixty patients admitted with acute stroke (ischemic & haemorrhagic) were included in the study. Their baseline clinical characteristics and biochemical parameters including serum ALP and phosphate were noted. All patients were followed up for a period of one year. The all- cause mortality, the mortality due to cardiovascular events and recurrent vascular events without death were noted during the follow up. Statistical analyses were done to look for any correlation between mortality and baseline levels of serum ALP and phosphate. Results: Of the 60 patients, 8 (13.3%) patients were lost for follow up. Fourteen (26.9%) patients died; of which 12 deaths were due to vascular causes and 2 deaths were due to non vascular causes. Increasing levels of serum ALP and phosphate correlated with all cause mortality and recurrent vascular events without death Conclusion: Serum ALP and phosphate prove to be cost effective prognostic indicator of mortality and recurrent vascular events in stroke. This finding has to be confirmed with studies including larger population. Further research on ALP inhibitors, Vitamin D analogues and phosphate binders to improve mortality in stroke population can be encouraged. [ABSTRACT FROM AUTHOR]

Cryptococcus neoformans is a rarely reported cause for osteomyelitis. We report an extremely unusual case of calvarial cryptococcal osteomyelitis in a 42-year-old sub-optimally immunocompetent male. This case discusses the atypical presentations of cryptococcosis in HIV-negative patients and its importance of early diagnosis. [ABSTRACT FROM AUTHOR]

Muscle involvement in leprosy is rare, but not unknown. We report an interesting case of a 59 year old gentleman who presented with icthyosis, arthralgias, fever and peripheral neuropathy, mimicking a collagen vascular disease. Histological evaluation of superficial peroneal nerve and peroneus brevis revealed unusual dual involvement by Hansen's disease, with numerous lepra bacilli in both. Involvement of skeletal muscle by Mycobacterium is very rare. The clinical presentation and treatment details of the case with a brief review of literature, is presented. [ABSTRACT FROM AUTHOR]

Background: Peripheral nerve involvement in systemic vasculitis can occur in 60% to 70% of cases. Sural nerve is commonly biopsied for diagnosis but yield is found to be low (20%). Reports in literature suggest diagnostic yield is enhanced by combined superficial peroneal nerve (SPN) and Peroneus Brevis (PB) muscle. SPN/PB biopsy has the advantage of a single incision to obtain a sample of nerve and muscle. Objective: To determine the usefulness of SPN/PB biopsy in diagnosis of vasculitic neuropathy diagnosed in accordance with established criteria with Clinicopathological correlation. Materials and Methods: 27 cases of suspected vasculitic neuropathy seen in a Govt Medical College between 1998-2008 were reviewed (age range:22-76yrs, M:F 14:13). Clinically mononeuritis multiplex was common (58%), while distal symmetric polyneuropathy was rare (8%). Serological evidence of systemic vasculitis was seen in five (2-Churg Strauss, 2-Rheumatoid arthritis and 1 mixed connective tissue disease) and the remaining 22 were considered nonsystemic vasculitis (NSVN). Twenty five underwent combined SPN/PB biopsy, and two sural nerve biopsy. Clinical spectrum and biopsy findings were analysed. Results: Definitive evidence of necrotizing vasculitis was observed in 2/27 cases, both of whom had systemic vasculitis. In the remaining 25 cases features suggestive of vasculitis was found. Inflammation was more frequent in SPN (15/25) compared to PB muscle (8/25). Vasculitis was seen in both muscle and nerve in systemic vaculitis but was infrequent in PB biopsies in NSVN (6/20). Denervation was most frequent in muscle biopsy (88%). Conclusion: Overall diagnostic yield of SPN was higher compared to PB muscle (65% versus 30%) in NSVN compared to systemic vasculitis. [ABSTRACT FROM AUTHOR]

Background: Olfactory dysfunction is a predominant non - motor symptom in patients with Parkinson's disease. Indian studies on olfactory loss using standardized kits are lacking., Objective: 1) To assess the olfactory impairment in patients with Parkinson's disease 2) To verify the applicability of UPSIT to Indian subjects 3) To assess the correlation between olfactory dysfunction and duration, stage and severity of the illness., Materials and Methods: Patients with Parkinson's disease attending Neurology outpatient and inpatient departments were taken for the study. The details of demographic data and illness were collected. Patients with other risk factors for hyposmia were excluded from the study. Detailed neurological examination and smell test were done using University of Pennsylvania Smell Identification Test (UPSIT) kit. 40 healthy individuals without any pre-morbid illness or risk factors for hyposmia were studied for the applicability of the British version of UPSIT to the Indian population, 20 of whom were age and sex matched with the Parkinson's disease patients. Statistical analysis was done using Wilcoxon matched-pair signed-ranks test (WSRT)) and Pearson correlation test., Results: Parkinson's disease patients had a mean age 58.2 years and a mean duration of illness of 5.5 years. Parkinson's disease patients had a low score on UPSIT compared to controls which was statistically significant (p 0.000) and the loss spanned a variety of odorants in UPSIT. There was no correlation with the age, staging or duration of the illness., Conclusions: Olfactory loss is a significant non motor symptom in Parkinson's disease patients and is probably not related to the disease duration, stage or severity of motor symptoms.

We studied olfactory function in a cohort of 25 temporal lobe epilepsy (TLE) patients and 25 healthy controls. Our objectives were to measure olfactory acuity in patients with right, left or bilateral TLE and compare them with age and sex matched controls, and to correlate olfactory acuity with duration of seizure, baseline seizure control and the number of drugs used. Olfactory impairment is common in neurological disorders and dysfunction of the temporo-limbic neural substrates involved in olfactory perception is noted in TLE. We measured olfactory acuity in 25 patients with TLE, nine with right, 10 with left and six with bilateral temporal lobe seizure activity, and compared them to the controls. Odor identification was assessed using the University of Pennsylvania Smell Identification Test (UPSIT) which is a 40 item olfactory test used to diagnose olfactory deficits. Our results showed that patients with TLE exhibited significant impairment in UPSIT performance compared to the controls. There was no significant difference in scores between the right and left TLE patients. The severity of olfactory impairment did not correlate with the duration of seizures, baseline seizure control and number of drugs used. We concluded that significant olfactory impairment is seen in both right and left TLE patients, unrelated to the duration and baseline frequency of seizures or drugs used., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Sensitivity, specificity, and diagnostic yield of the superficial peroneal nerve (SPN)/peroneus brevis muscle (PBM) biopsy in 43 patients with clinically suspected vasculitic neuropathy was studied. Biopsies were classified as "definite", "suspicious" or "possible" in accordance with established criteria. Vasculitis was detected in 27 patients (21 with non-systemic vasculitis, and six with systemic vasculitis). In patients with "definite" vasculitis (n=13), the sensitivity of SPN/PBM biopsy was 76.4% with 100% specificity. By including patients suspicious for vasculitis (n=10), sensitivity increased to 85.1% but the specificity dropped to 87.5%. The overall diagnostic yield of SPN biopsy in those patients with definite vasculitis was 76.9% (10/13), and 53.8% (7/13) for muscle biopsy. The addition of muscle biopsy increased the diagnostic yield by 23%. Asymmetric nerve fiber loss, Wallerian degeneration and presence of hemosiderin were statistically significant markers of probable vasculitis. Muscle tissue was more likely to show hemosiderin (85.7%) than a nerve biopsy (71%). A combined SPN/PBM biopsy offers excellent diagnostic yield in the diagnosis of vasculitic neuropathy., (Copyright © 2012 Elsevier Ltd. All rights reserved.)