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Byline: Arjimand. Yaqoob, Waseem. Dar, Adnan. Raina, Zubair. Khuja, Amit. Chandra, Immia. Bukhari, Hilal. Ganie, Maqbool. Wani, Ravouf. Asimi Cerebrotendinous xanthomatosis (CTX) is a treatable autosomal recessive disorder with varied [...]

Byline: Arjimand. Yaqoob, Waseem. Dar, Maqbool. Wani, Ravouf. Asimi, Adnan. Raina, Hilal. Ganie, Amit. Chandra Dear Editor Leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis is one of the subtypes of the [...]

Byline: Arjimand. Yaqoob, Waseem. Dar, Adnan. Raina, Amit. Chandra, Zubair. Khawaja, Immia. Bukhari, Hilal. Ganie, Maqbool. Wani, Ravouf. Asimi Moebius syndrome presents as congenital, nonprogressive unilateral or bilateral facial and [...]

Byline: Waseem. Dar, Maqbool. Wani, Arjimand. Yaqoob, Adnan. Raina, Hilal. Ganie, Zahoor. Parray, Amit. Chandra, Ravouf. Asimi Dear Sir, Here we present two cases of hearing loss secondary to neurobrucellosis [...]

Background and Aim: The World Health Organization estimated that 15 million people throughout the world suffer stroke every year. Only 5%-10% of all acute ischemic stroke (AIS) patients presenting to emergency departments (EDs) are eligible for and receive thrombolytic therapy. This study was conducted to assess and compare the efficacy and safety profile of thrombolysis with tenecteplase (TNK) with that of alteplase among patients with AIS who were eligible for thrombolysis. Materials and Methods: This was a hospital-based prospective observational study. All the patients who presented with AIS within the time window period of =4.5 h to ED of Sher-i-Kashmir Institute of Medical Sciences, Soura, from September 2018 to March 2021, were screened for eligibility of thrombolysis by TNK. A total of 76 patients were enrolled; among which 42 were thrombolysed with TNK and 34 patients were thrombolysed with alteplase. These data were compared with departmental data of patients thrombolysed by alteplase during July 2015-July 2017. Inclusion and exclusion criteria used in the study were as per the American Heart Association/American Stroke Association guidelines for thrombolysis. Efficacy and safety were assessed and compared of the two drugs. Results: After 24 h of thrombolysis, early neurological improvement occurred in 62% of TNK patients compared to only 35% of patients from alteplase group, which was significant statistically (P < 0.05). An excellent functional outcome, defined as the Modified Rankin Scale (mRS) of 0-1 at 3 months of discharge, was seen in 67.6% of TNK and 48.5% of alteplase group. A poor recovery, defined as the mRS of 4-6 at 3 months of follow-up, was seen in 16% and 21% in TNK and alteplase group patients, respectively. Conclusion: TNK appears to be characterized by a better safety and efficacy profile than alteplase; however, further multicenter studies and randomized controlled trials are required to confirm our preliminary findings. [ABSTRACT FROM AUTHOR]

Byline: Irfan. Shah, Ravouf. Asimi, Yuman. Kawoos, Mushtaq. Wani, Maqbool. Wani, Sheikh. Nawaz, Atif. Rasool, Adnan. Raina Sir, Meningitis retention syndrome (MRS) is a very rare syndrome mainly reported to [...]

Background: Trigeminal neuralgia is sudden unilateral severe, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve. Pulsed radiofrequency stimulation (PRF) has been recently introduced to alleviate neural, joint pain, and muscle pain. We tried to use PRF for pain relief in trigeminal neuralgia. The primary objective of our study was to observe the effectiveness and safety of pulsed radiofrequency in the patients of trigeminal neuralgia who are refractory to medical management. The secondary objective was to study the effect of pulsed radiofrequency on the duration of pain relief in these patients. Methodolgy: In this observational study, we enrolled all fresh patients with trigeminal neuralgia attending our pain clinic for the first time and those who had not responded to conservative medical treatment or interventional nerve blocks. All the patients were diagnosed on the basis of signs, symptoms and MRI (CISS sequence). Anatomical landmarks of ophthalamic nerve, maxillary nerve, mandibular nerve were identified and nerve stimulation was done by placing the probe in the affected nerve division. Each point was stimulated with the radiofrequency probe kept for 10 minutes, giving a current of 10 to 30 milli-amperes with a set frequency of 2 Hertz. A total of 10 settings were given on alternate days. Assessment of pain relief, improvement, or deterioration was done using Barrow Neurological Institute Pain Intensity Score and Brief Pain Inventory facial scale scoring. Results: There was a significant reduction in pain scores observed on Barrow neurological institute (BNI) and Brief Pain Inventory-(BPI) pain intensity score (p value of <0.05) before and after pulsed radiofrequency (PRF) application. The duration of pain relief after the application of PRF was up to 180 days in 15 patients, 181-300 days in 8 patients and 300 to 600 days in 7 patients. Only 2 patients had a prolonged pain relief lasting for 601-720 days. One patient had developed exposure keratitis after 4 sittings of pulsed radiofrequency application at the supraorbital foramen. Conclusion: PRF offers short term relief in a majority of patients for a period of 18 months to 24 months. However, it was found that the long term effects of PRF may not be seen in patients with TN. PRF may be used as a short term measure for alleviating severe pain of TN till neurolytic blocks or a definitive surgery is carried out. [ABSTRACT FROM AUTHOR]

Background: Till date, no data has been published about the use of intravenous (IV) thrombolysis in acute ischemic stroke (AIS) from Kashmir valley. Objective: The objective of the study is to assess and determine the pattern of use of IV thrombolysis for AIS in Kashmir, including its efficacy and the difficulties faced in providing this modality of treatment. Materials and Methods: This was a prospective cross-sectional observational study conducted from July 2016 to July 2018. All those patients who were admitted with a diagnosis of stroke and gave informed consent were included in this study. Results: A total of 2023 patients of stroke presented to our emergency department during the study period. Out of them, 1085 (53.6%) cases were found to have hemorrhagic stroke and 938 (46.3%) patients were having ischemic stroke. 9.2% patients of ischemic stroke presented within the window period of thrombolysis, but only 34 (3.6%) patients received IV alteplase. The mean onset to door time in those who received thrombolysis was 103.5 ± 51.17 min. Door-to-needle time (DNT) of ≤60 min was achieved in only 14 (41.2%) cases, whereas mean DNT was 82.7 ± 49.17. There was a statistically significant improvement in the National Institutes of Health Stroke Scale in those who received thrombolysis as compared to those who did not receive it. Conclusion: Hemorrhagic stroke occurs in majority of stroke patients (53.6%) in our community. 3.6% of ischemic stroke patients were thrombolyzed. Thrombolytic therapy presented positive outcomes in comparison to nonthrombolyzed patients which, however, was not statistically significant. [ABSTRACT FROM AUTHOR]

Byline: Irfan. Wani, Saleem. Sheikh, Zafar. Shah, Arshid. Pandith, Mushtaq. Wani, Ravouf. Asimi, Maqbool. Wani, Shahnawaz. Sheikh, Iqra. Mehraj Introduction: Migraine is a complex, recurrent headache disorder that is one [...]

Byline: Irfan. Wani, Sawan. Verma, Mushtaq. Wani, Ravouf. Asimi, Saleem. Sheikh, Maqbool. Wani, Nawaz. Sheikh, Irfan. Shah, Mudasir. Mushtaq Idiopathic intracranial hypertension (IIH) is a disorder defined by clinical criteria [...]

Miller Fisher syndrome (MFS), is an acute peripheral neuropathy, a variant of Guillain-Barre syndrome, that develops following exposure to different viral, bacterial, and fungal pathogens. Patients usually present with a triad of ophthalmoplegia, ataxia, and areflexia. During Covid pandemic MFS has been described associated with novel coronavirus disease 2019 (COVID-19). Here we describe the clinical course, Cerebrospinal fluid (CSF) findings, nerve conduction studies, treatment and outcome of the patient having MFS concurrent with COVID 19. [ABSTRACT FROM AUTHOR]

Byline: Mushtaq. Wani, Sheikh. Saleem, Sawan. Verma, Irfan. Yousuf, Maqbool. Wani, Ravouf. Asimi, Riyaz. Daga, Irfan. Shah, Aejaz. Wasp and bee sting are commonly encountered worldwide. Local reactions are more [...]

The article presents a case study of a 20-year-old, unmarried male presented to the emergency department with complaints of severe throbbing headache, neck stiffness, and vomiting for six days. He underwent a series of examinations and was diagnosed to have meningitis retention syndrome (MRS) that is associated with with herpes simplex virus type 2 (HSV-2) meningitis following the development of urinary retention that was administered by catheterization.

Objectives: The study was aimed to assess the epidemiological profile and patient characteristics, various morphological patterns of posterior reversible encephalopathy syndrome (PRES) on MRI and various pathophysiological mechanisms on MR perfusion. Methods: It was a prospective and observational study done over a total of 40 patients. Standard sequences included T1 and T2-weighted sequences, FLAIR, DWI, SWI and MR perfusion. Results: Females were affected predominantly with F:M ratio of 12:1. The commonest age group affected was between 20-40 years. The most common symptom was headache. The commonest etiology being pregnancy induced(37.5%). Hypertension was reported in 70%, out of which 37.5% included pregnancy induced hypertension. The commonest region involved was occipital lobe seen in 85% of patients. Atypical PRES was seen in 42.5% of patients in the form of involvement of atypical locations; basal ganglia 10%, thalami 2.5% and cerebellum 2.5%; diffusion restriction 12.5% and hemorrhage 22.5%, out of which 10% had subarachnoid hemorrhage, 10% has intraparenchymal hematoma and 2.5% had minute focal hemorrhage. rCBV and rCBF was decreased in 82.5% of patients and unchanged in 12.5% of the total number of patients supporting the hypoperfusion theory. Conclusion: PRES predominantly involves female, hypertension is seen in most of the patients. The commonest lobes involved are the occipital and parietal lobes; however the incidence of atypical PRES is also seen in a significant number of patients. The basic pathophysiological mechanism is hypoperfusion. [ABSTRACT FROM AUTHOR]

Background: Decompressive hemicraniectomy not only reduces the intracranial pressure but has been demonstrated to increase survival and decrease the morbidity in patients with supratentorial malignant brain infarcts (STMBI). The aim of this study was to assess the efficacy of surgical decompression to decrease the mortality and morbidity in patients with STMBI refractory to medical therapy and to compare the results with those of the medically managed patients. Methods: All the 24 consecutive patients with clinical and radiological diagnosis of STMBI, refractory to medical management in 2 years, were included. Option of surgical decompression after explaining the outcome, risk and benefits of the procedure was given to the attendants/relatives of all patients who were fulfilling the inclusion criteria. The patient group, whose attendants/relatives were not willing to undergo surgery, were subjected to the same medical therapy and they were taken as the "control group." Results: Supratentorial malignant infarcts were more common in the age group of 41-60 years. Mean age of presentation was 42.16 ± 16.2 years and the mean GCS on admission was 7.83 ± 2.1. Mortality was 16.7% in the surgically and 25.0% in the medically managed group. Patients operated early (<48 h), age ≤60 years, midline shift <5 mm and size of infarct less than 2/3rd of the vascular territory involved showed good prognosis. The functional outcome revealed by modified Rankin Score (mRS) and Glasgow Outcome Score (GOS) was better in surgically managed patients. Results of the Zung Self-Rating Depression Score were better in surgically managed patients at 1 year. Barthal Index in the surgically managed group showed statistically significant results. Conclusions: Decompressive hemicraniectomy with duroplasty if performed early in STMBI not only decreases the mortality but also increases the functional outcome when compared with patients who were managed conservatively with medical therapy only. [ABSTRACT FROM AUTHOR]

Wasp and bee sting are commonly encountered worldwide. Local reactions are more common, generally are self-limiting and settle within a few hours. Multiple stings can lead to various clinical manifestations like vomiting, diarrhea, dyspnea, generalized edema, hypotension, syncope, acute renal failure, and even death. Rarely, they can cause vasculitis, serum sickness, neuritis, and encephalitis. We are reporting a case of 40-year-old male who presented with stroke, right hemiparesis with severe multi?organ dysfunction due to multiple wasp stings. [ABSTRACT FROM AUTHOR]

3 Cerebellar ataxia occurring post Covid 19 infection has been rarely reported in literature further adding to gamut of neurological involvement of Covid 19 infection. 197 Neurology Asia 2021; 26(1): 197 - 198 Para-infectious cerebellar ataxia post Covid 19 infection A 65 year old non-smoker hypertensive and diabetic male on permanent pacemaker (for complete heart block 5 years back) was admitted to our hospital for severe covid pneumonia and RT-PCR was positive. 4,5 Since, in our patient, ataxia occurred after Covid 19 infection had resolved and CSF was normal, the cerebellar involvement was possibly immune mediated in nature. [Extracted from the article]

White matter disease refers to a set of diseases that affect the white matter of the brain and all of which have different consequences on brain function. Most of the studies have shown that it results from the defects during protein synthesis, with the gene defects in EIF2B 1-5, encoding the five subunits of eukaryotic translation initiation factor 2B (eIF2B) α, β, γ, δ and ε, respectively. eIF2B plays a crucial role in protein translation and its regulation under different conditions. The previous studies have shown that mutations in five subunits of eIF2B cause white matter disease of the brain and thus EIF2B is the main culprit in development of white matter disease. In this study, the mutational screening of EIF2B5 gene encoding eIF2Bε was performed for the first time in 12 Kashmiri patients, each having a unique white matter disease condition. We found two novel missense mutations in EIF2B5: c.580A>G, p.Thr194Ala and c.611C>T, p.Ala204Val among the patients with demyelinating disease (multiple sclerosis), but no mutation was found in other patients. In conclusion our study suggests involvement of the EIF2B5 gene in MS development, thus suggesting p.Thr194Ala to be a susceptibility factor for the development of multiple sclerosis.