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Author(s): Ravindra Kumar Garg (corresponding author) [1]; Imran Rizvi [1]; Neeraj Kumar [1]; Priyanka Gupta [1]; Pooja Tripathi [1]; KP Arjun Bal [1]; Anit Parihar [2]; Hardeep Singh Malhotra [1]; [...], We report two cases of tuberculosis meningitis patients developing hemichorea-hemiballismus during antituberculosis treatment. First, a 56-year-old woman experienced right-sided hemichorea-hemiballismus 3 months into treatment. MRI scans revealed a left thalamus and subthalamic infarct. After 10 days of continued treatment and corticosteroids, her movements subsided. Second, a 17-year-old female developed hemichorea-hemiballismus while on antituberculosis drugs and corticosteroids. MRI scans displayed ischemic lesions, optochiasmatic arachnoiditis, gyral enhancement, and a small tuberculoma. After shunt surgery and tetrabenazine treatment, she significantly improved and resumed daily activities. In conclusion, hemichorea-hemiballismus may paradoxically occur in tuberculosis meningitis patients, potentially linked to ischemic lesions in the thalamus and subthalamus. Keywords: Antituberculosis drugs, central nervous system tuberculosis, disseminated tuberculosis, paradoxical reaction

Objective: To identify the clinical, laboratory, and radiological markers that could predict a positive GeneXpert result in patients suspected of tuberculous meningitis. Methods: In this prospective, observational study, patients with tuberculous meningitis were systematically evaluated. Various clinical, laboratory [including cerebrospinal fluid (CSF) microscopy, culture, and GeneXpert], and neuroimaging factors were examined. All participants were administered anti-tuberculous treatment and corticosteroids. A six-month follow-up was done to evaluate the outcome. Results: Of the 116 patients studied, 54 (46.6%) tested positive for GeneXpert, while 62 (53.4%) were negative. Third cranial nerve involvement (OR 3.71, 95% CI 1.052-13.09, P =0.04) and the presence of basal exudates on neuroimaging (OR 5.22, 95% CI 2.03-13.42, P =0.001) emerged as independent predictive factors for a positive GeneXpert result. A positive CSF GeneXpert result (P =0.002) and drug resistance (P =0.004) were significantly linked to adverse outcomes. Additionally, a high score on the Medical Research Council stage III (OR 5.64, 95% CI 1.18-26.87, P =0.03) and elevated CSF cell counts (OR 1.002, 95% CI 1.00-1.001, P =0.03) were identified as independent predictors of poor prognosis. Conclusions: Third cranial nerve involvement and the presence of basal exudates were significant indicators of a positive GeneXpert result. MRC stage III disability and elevated CSF cell counts predicted poor outcomes. [ABSTRACT FROM AUTHOR]

Objectives: There is a bidirectional and complex interplay between psychiatric comorbidities and migraine. Migraine has been observed in 50-60% of patients with psychogenic non-epileptic seizures (PNES). Studies describe migraine as a medical comorbidity in PNES. However, there are limited studies on impact of PNES on migraine. We aim to see the impact of PNES on migraine. Materials and Methods: This cross-sectional and observational study was conducted at a tertiary-care center from June 2017 to May 2019. Fifty-two patients with migraine with PNES and 48 patients with migraine without PNES were included on the study. Migraine and PNES were diagnosed based on International Classification of Headache Disorders-3 (ICHD-3) and International League Against Epilepsy (ILAE) criteria, respectively. Headache intensity was assessed using visual analog scale. Comorbid depression, anxiety, and somatoform-symptom-disease were assessed using the Generalized Anxiety Disorder-7 Scale, Patient Health Questionnaire-9, and DSM-5 criteria, respectively. Results: Females were common in both groups and the difference was statistically insignificant. Headache frequency was significantly more in patients with migraine with PNES (P < 0.05). However, headache intensity was similar in both groups. Patients with headaches and PNES identified triggers less commonly except for stress. Depression and somatoform symptom disorder were significantly more common in patients with migraine with PNES. Abnormal neurocircuitry involving frontal, limbic, and thalamic regions due to comorbid PNES may cause central sensitization, resulting in frequent migraine headaches which is further augmented by coexisting depression and somatoform-symptom-disease. Conclusion: Migraine with PNES patients suffers more frequent headaches than patients with migraine without PNES. They differ in various headache triggers, with mental stress being the predominant trigger. [ABSTRACT FROM AUTHOR]

Background: In approximately 25% of peripheral neuropathy cases, diagnosis remains obscure. In India, leprosy continues to remain one of the most frequent causes of peripheral neuropathy. We, in this prospective evaluation, performed nerve biopsies in patients with peripheral neuropathy for early confirmation of the diagnosis. Materials and Methods: A total of 55 consecutive cases of peripheral neuropathy were included in this study. All patients were subjected to clinical and electrophysiological evaluation. Sural nerve biopsies were performed in all the patients. Result: After a nerve biopsy in 29 cases, we were able to identify the underlying cause of peripheral neuropathy. In 26 cases, the diagnosis remained obscure. The most frequent histopathological diagnosis was leprosy, which was seen in 20 cases. Other diagnoses were chronic demyelinating neuropathy (four cases), vasculitis (two cases), and amyloidosis in one case. In two biopsies, the findings were consistent with hereditary neuropathies. The demonstration of lepra bacilli was the most distinctive feature. In addition, foamy macrophages (100%) and granuloma (100%) formation, epineurial (83.3%) and endoneurial infiltration (69%) along with epineurial (87.5%) and perineurial thickening (77.3%) were also noted more frequently in leprosy-associated neuropathy. Conclusion: The nerve biopsies revealed that leprosy was the most common etiology in patients with peripheral neuropathy. In approximately 47% of the cases, even nerve biopsies failed to establish a confirmed diagnosis. [ABSTRACT FROM AUTHOR]