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Objective We study the clinical relevance of classifying traumatic brain injury (TBI) into moderate and mild categories based on the Glasgow Coma Scale (GCS) score at admission with respect to the treatment intensity and 6-month mortality and morbidity rates. Methods Analysis of patients from a prospectively maintained database admitted at a level I trauma center from 2013 to 2019 with an admission GCS score between 9 and 15 and a minimum follow-up of 6 months post-TBI was done to study the treatment intensity and 6-month morbidity and mortality rates for each GCS score from 9 to 15. Results In all, 2,060 patients met the study criteria, of which 1,684 were males (81.7%). Road traffic accident was the most common cause of TBI (83.7%). There was a significant linear increase in the proportion of patients who had good outcomes with increasing GCS scores from 9 to 15 (p ≤ 0.001). When the variables in each GCS score were compared with a GCS score of 15, there was an increase in the odds ratio of mortality and poor outcome with decreasing GCS scores (p ≤ 0.001). Patients with a lower admission GCS score required more intense treatment in the form of surgery and ventilation (p ≤ 0.00001). There was a higher incidence of pupillary asymmetry in patients with lower GCS scores (p ≤ 0.00001). Conclusions The classification of TBI patients into moderate and mild based on the GCS score at admission is not of any practical value, and TBI patients may be more usefully classified based on the admission GCS score into severe and not severe groups. [ABSTRACT FROM AUTHOR]

The most common presenting form of neurocysticercosis in the Indian subcontinent is a solitary cysticercus granuloma (SCG). Patients with typical SCGs almost never require any form of surgical intervention. Herein, we report an extremely rare case of bacterial superinfection of a left frontal SCG in a 23-year-old female, resulting in severe perilesional edema and mass effect. The patient had to undergo an emergency left decompressive hemicraniectomy and excision of the infected granuloma. Serum enzyme-linked immunoelectrotransfer blot (EITB) for cysticercal antibodies was positive and histopathological examination of the lesion revealed a cysticercus. The culture of the pus from within the lesion grew vancomycin-resistant Enterococcus spp. for which she was treated with linezolid for 6 weeks. At 6 months follow-up, she had residual motor dysphasia, right homonymous hemianopia, and right hemiparesis but was steadily improving. Secondary bacterial infection of an SCG is very uncommon and can be devastating. A high index of suspicion is therefore required when there is disproportionate perilesional edema and mass effect. [ABSTRACT FROM AUTHOR]

Aim: We aimed to estimate the prevalence of physiological anisocoria and also evaluate the accuracy of clinical assessment of anisocoria employed in routine bedside examination.Materials and Methods: A total of 708 voluntary subjects between the ages of 20-69 years who had no history of ophthalmologic or neurological disease other than refractive error were included in the study. In a closed room with uniform ambient lighting, the subjects' pupils were examined clinically and the presence or absence of anisocoria was recorded. This was followed by photography of the subjects' pupils using a digital camera secured on a tripod at a fixed distance from the subject's face. A difference in pupillary size of 0.4 mm or more was considered anisocoria.Results: Of the 708 subjects, 361 (51%) were males. The average pupillary diameter of the subjects was 4.99 mm. Ninety-seven (13.7%) had measured anisocoria on photography. Ninety-seven subjects (13.7%) also had anisocoria on clinical examination, however, only 45 of them had measured anisocoria. The clinical measurement of anisocoria, therefore, showed a specificity of 0.91 and a sensitivity of 0.46. With a prevalence of anisocoria of 13.7%, the positive predictive value was 0.46, and the negative predictive value was 0.91.Conclusions: The prevalence of physiological anisocoria was 13.7%, which is less than what has previously been reported. The sensitivity of clinical examination in detecting early anisocoria is poor. Patients at risk of developing uncal herniation may, therefore, benefit from routine bedside pupillary assessment with a portable device such as a pupillometer. [ABSTRACT FROM AUTHOR]

Background: Surface electromyography (EMG) is a noninvasive, accurate method to measure electrical activity produced in muscles.Aim: To assess the improvement of spasticity after decompressive surgery for compressive myelopathy using surface EMG.Setting and Design: Neurophysiology laboratory of a tertiary care center. Before-after trial. Both EMG and Modified Modified Ashworth Scale (MMAS) were utilized.Materials and Methods: Thirty-one nonconsecutive patients (28 males; age 25-72 years) with compressive cervical myelopathy and spasticity (MMAS score ≥1) were recruited. Patients with lower motor neuron findings, Nurick grade 5, and those with joint deformities, contractures, or thrombophlebitis of the upper limbs were excluded. EMG activity was measured from the pronator teres and biceps brachii for 31 age-related controls (25 males) as well as for the patients both pre- and post-operatively.Statistical Analysis: Student's t-test for comparison of continuous variables and Pearson correlation co-efficient for assessing the significance of associations.Results: EMG recording done 1-week postoperatively showed a reduction in baseline activity in the pronators and supinators by 21% and 36%, respectively. There was a decrease in co-activation of the pronators during active supination by almost 62% and of the supinators during active pronation by around 33% (P < 0.05). On passive movement, there was a decrease in co-activation of the pronators during supination by approximately 23%, and the supinators during pronation by 35% (P < 0.05). EMG activity was significantly reduced in the pronators during supination in all patients, including those in whom the MMAS scores remained the same postoperatively.Conclusion: Surface EMG is an objective tool to detect improvement in spasticity following decompressive surgery for compressive cervical myelopathy even in those patients who showed no improvement on the MMAS. [ABSTRACT FROM AUTHOR]

Background: We observed that in patients with traumatic brain injury (TBI) who did not improve as expected, serum levels of phenytoin were in the toxic range and that their sensorium improved with modification of the dose. This led us to study the usage of phenytoin in patients with TBI. Aims: To determine the prevalence of phenytoin toxicity in TBI patients and to study the suitability of using ideal body weight (IBW) to guide phenytoin dosing. Setting and Design: Neurotrauma unit of a tertiary care centre in India. Prospective data collection from an already established protocol of drug level monitoring. Materials and Methods: The study cohort included 100 consecutive adult patients with mild or moderate TBI who were administered phenytoin based on IBW. Trough serum phenytoin and albumin levels were measured on day 4 after administration of the loading dose and actual body weight obtained when it was possible. Statistical Analysis: Chi-square was used for comparing categorical variables, student's f-test for continuous variables and multivariate regression analysis to obtain independent risk factors. Results: Clinical toxicity was observed in 15% of patients and biochemical toxicity in 36%, with a significant association between the two (P < 0.01). Using multivariate analysis, abdominal girth <≤75 cm (P = 0.07), neck circumference ≤34 cm (P = 0.025) and IV dose proportion ≥80% (P = 0.003) were independent risk factors for biochemical toxicity. The plot between actual weight and IBW showed that toxicity occurred when IBW was higher than actual weight. Conclusion: The prevalence of biochemical phenytoin toxicity was high, with independent risk factors being a higher proportion of IV administration and overestimation of weight by IBW. Clinical suspicion of phenytoin toxicity was a good predictor of biochemical toxicity. [ABSTRACT FROM AUTHOR]

The article presents a case study of 35‑year old woman presented with headache and vomiting followed by gait ataxia. It reports the diagnosis of giant tentorial bicompartmental cystic schwannoma unrelated to the cranial nerves from histopathology evaluation; and mentions about Schwannomas which is considered in the differential diagnoses of tentorial tumor.