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Background and Objectives  The loss of swallow tail sign (STS) has been studied for the diagnosis of Parkinson's disease (PD). The study aims to establish the role of STS on high-resolution 3D susceptibility-weighted images (SWI) on 3T MRI in clinically diagnosed cases of PD and compare with control population. Methods and Materials  Forty-five patients with clinically diagnosed PD and Parkinson plus syndrome (PPS) formed the study group and were compared with 45 controls without any neurological disease and normal brain magnetic resonance imaging (MRI). Presence or absence of STS was studied on 1-mm thick axial 3D SWI images in bilateral substantia nigra by two radiologists independently, followed by consensus reading. Bilateral absent, unilateral absent, and faintly present STS were considered as absent STS and predicted PD or PPS, and bilateral presence was considered as a positive STS, and was assessed keeping the clinical diagnosis as the gold standard. Results  The sensitivity of the absent STS was 75.55%, specificity 97.77%, positive predictive value 97.14%, negative predictive value 80% and accuracy 86.66%, in the diagnosis of PD or PPS, with odd ratio of 132 (confidence interval 15.97–1098.75). Kappa coefficient was 0.80 (p  < 0.001) for both inter- and intrarater agreement, suggesting high reproducibility for the detection of STS. Conclusions  Absence of the STS is a good predictor of degeneration of the nigrosome 1 in the substantia nigra in the PD or PPS patients; hence, it can act as a useful marker of these diseases. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) has been gold standard investigation for diagnosing anterior cruciate ligament (ACL) tear. Availability and cost are two main factors limiting the universal use of MRI in all those patients in whom ligament injury is suspected. We compared the outcome of functional USG with gold standard MRI scan in this prospective study. Materials and Methods: In this study, we included the patients coming to orthopedics outpatient department with sign and symptoms of ACL injury. We performed functional USG of the injured and uninjured knee and noted the difference in translation, measured by USG. More than 1 mm of difference in translation of tibia on the affected side as compared to uninjured side is taken as significant. We compared our result with the findings of MRI. The study result of 130 patients revealed high sensitivity (81.65%) and high specificity (89%) in diagnosing ACL injury. The positive predictive value of the test was 97.8%, and the negative predictive value was 44%. The P value of the difference of translation as 0.0001 was also statistically significant. Conclusions: We can safely conclude from the study that the functional USG can be used as a primary tool to diagnose ACL tears. USG's ubiquitous availability and simple technique of the procedure can bring a revolution in the future for diagnosing and managing ACL injury. [ABSTRACT FROM AUTHOR]

Inclusion body myositis (IBM) is the most common inflammatory myopathy above the age of 50 years and three times more common in males than females. It presents as a distal more than proximal myopathy and has an indolent progressive course. Despite the latest advancements, it is challenging to diagnose this disease as it may resemble amyotrophic lateral sclerosis (ALS) clinically and polymyositis histopathologically. What sets it apart from the other myopathies is the fact that it has a very poor response to standard therapies of steroids and immunosuppressants. We present a case of a 30-year-old female patient presenting with relatively rapid onset of quadriparesis and dysphagia which was ultimately diagnosed with IBM. This case report attempts to highlight the difficulties in diagnosing this rare disease and the limited modalities of treatment. [ABSTRACT FROM AUTHOR]

Cervical ribs rarely become symptomatic. Cerebral ischemia or infarct due to cervical rib is extremely rare and, invariably, these patients have a history of upper limb symptoms before presenting with stroke. We report a young boy with cervical rib who presented with stroke. A right sided cervical rib was noted during angiogram, causing mild stenosis and post stenotic dilatation of right subclavian artery distal to the rib. An abduction angiogram showed complete occlusion of the right subclavian artery and visualization of collaterals. Right carotid angiogram also showed evidence of thromboembolic episodes in the right middle cerebral artery territory. [ABSTRACT FROM AUTHOR]