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Background: Cortical venous thrombosis (CVT) is a rare condition, compared to arterial stroke and often occurs in young individuals presenting with varying clinical features., Aim: The aim is to study clinical profile and assess the outcome and prognostic factors of CVT patients., Methodology: A case series study was done for 2 years. CVT cases confirmed by magnetic resonance imaging were included in this study. Clinical presentation and risk factors were noted then patients were assessed at the time of discharge for their physical and mental status. Modified Rankin scale was used to group patients, accordingly scores 0-2 were considered as good and 3-6 as poor outcome, respectively. Data were analyzed using Chi-square test to know the association between prognostic factors and outcome., Results: Out of 81 patients, more than half of the patients were in the age group of <35 years (55.6%), and majority of patients were females (79%). Most common symptom was headache (82.7%) and least was fever (14.8%). Superior sagittal sinus was most commonly involved (74.1%). Nearly half of the patients were in puerperal period (44.1%). Patients aged more than 35 years (odds ratio [OR]: 9.1, confidence interval [CI]: 4.463-19.750) presenting with symptoms such as fever (OR: 3.442, CI: 1.088-12.140), impaired consciousness (OR: 5.467, CI: 2.064-15.330) and having clinical signs such as coma (OR: 23.99, CI, 3.844-544.1), papilledema (OR: 25.15, CI: 7.565-101.5), and with focal neurological deficit (OR: 9.366, CI: 2.693-3.41) had statistically significant poor outcome., Conclusion: Females formed a major bulk of patients. Higher number patients showed poor outcome. Study showed association between age, headache, impaired consciousness, coma, papilledema, and neurological deficit to poor outcome., Competing Interests: There are no conflicts of interest.

Tumefactive multiple sclerosis (MS) is a rare variant of MS characterized by the presence of large demyelinating plaques of more than 2 cm, identified with magnetic resonance imaging (MRI). Distinguishing tumefactive lesions from other etiologies of intracranial space occupying lesions is necessary to avoid the inadvertent intervention. We had a 14-year-old girl who presented to us with two episodes of subacute hemiparesis over a span of 6 months. Her MRI brain showed large lesions, which were hyperintense on T2-weighted/flair images with incomplete ring enhancement open towards the gray matter in postgadolinium images with minimal surrounding edema and mass effect. We treated her as a case of tumefactive demyelination (TD) with steroids after which patient recovered with minimal deficits. TD occurs more commonly in women and young adults and is reported rarely. TD in a young girl with recurrence in such short span causing bilateral hemiparesis has never been reported.

Background: Focused studies on cranial neuropathy in Guillain-Barré syndrome (GBS) and its prognostic implication are not done previously., Aim: To study the clinical profile of GBS patients with special reference to cranial neuropathy and its prognostic implication., Materials and Methods: The study included 61 patients with GB syndrome, fulfilling Asbury Cornblath's criteria for GB syndrome. A pre-designed semi-structured questionnaire was used to obtain data regarding demographic profile and clinical profile. All patients underwent detailed neurological examination, investigations including nerve conduction studies and CSF examination and treated according to the severity of the illness. Patients were followed up for 6 months. During analysis two groups were made depending on cranial nerve involvement, and compared with respect to various parameters., Results: Out of 61 patients 38 (62.3%) patients had cranial nerve palsies, in that 25 had multiple cranial nerve palsies, and 13 had single isolated nerve palsy. A majority of 30 (49.2%) had bulbar palsy, 28 (46%) had facial nerve palsy, and all had bilateral involvement except 3 patients who had unilateral palsy. Hypoglossal nerve involvement was seen in six (10%) patients and four (6.5%) patients had ophthalmoplegia. Only one had bilateral vestibulocochlear nerve palsy. On comparing various clinico-electrophysiological parameters among patients of GB syndrome with and without cranial nerve involvement, the presence of respiratory paralysis, IVIg and ventilatory support requirement had significant association with cranial nerve involvement in GBS., Conclusion: Our study found a correlation between cranial nerve palsies and severity of the illness. Cranial nerve innervated muscles recover earlier as compared to distal limb muscles. No association was found between outcome at 6 months and cranial nerve involvement.

Introduction: Cluster headache (CH) is uncommon and most painful of all primary headaches, and continues to be managed suboptimally because of wrong diagnosis. It needs to be diagnosed correctly and specifically treated. There are few studies and none from this region on CH., Materials and Methods: To study the detailed clinical profile of CH patients and to compare them among both the genders. Study was conducted at Mahatma Gandhi hospital, Jodhpur (from January 2011to December 2013). Study comprises 30 CH patients diagnosed according to International Headache Society guidelines (ICHD-II). Routine investigations and MRI brain was done in all patients. All measurements were reported as mean ± SD. Categorical variables were compared using the Chi-square test, and continuous variables were compared using Student's t-test. SPSS for Windows, Version 16.0, was used for statistical analyses with the significance level set at P = 0.05., Results: M: F ratio was 9:1. Age at presentation was from 22-60 years (mean - 38 years). Latency before diagnosis was 3 months-12 years (mean - 3.5 years). All suffered from episodic CH and aura was found in none. Pain was strictly unilateral (right-19, left-11), predominantly over temporal region-18 (60%). Pain intensity was severe in 27 (90%) and moderate in 3 (10%). Pain quality was throbbing in 12 (40%). Peak intensity was reached in 5 minutes-30 minutes and attack duration varied from 30 minutes to 3 hours (mean - 2.45 hours). Among autonomic features, conjunctival injection-23 (76.6%) and lacrimation-25 (83.3%) were most common. Restlessness during episode was found in 80%. CH duration varied from 10 days to 12 weeks. Circadian periodicity for attacks was noted in 24 (80%)., Conclusion: Results are consistent with other studies on many accounts, but is different from Western studies with respect to low frequency of family history, chronic CH, restlessness and aura preceeding the attack. Detailed elicitation of history is paramount as misdiagnosis is common.

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity commonly associated with eclampsia, septicemia, chemotherapeutic drugs etc. Concurrent occurrence of Guillain-Barre syndrome (GBS) with PRES is a rare entity. Dysautonomia is a proposed mechanism for such occurrence. Here we present a non-diabetic, non-hypertensive 63-year-old male patient, who came with acute onset flaccid quadriparesis, developing generalized seizures, altered sensorium and raised blood pressure on fifth day of illness. Magnetic resonance imaging (MRI) of brain showed altered signal intensities involving the parieto-occipital areas suggestive of posterior reversible encephalopathy. Cerebrospinal fluid analysis showed albuminocytological dissociation, nerve conduction studies revealed demyelinating type of polyneuropathy. The patient was treated with antihypertensives and antiepileptics. After resolution of the encephalopathy, intravenous immunoglobulin (IVIg) was given. The patient recovered gradually over few months. Our case concludes GBS as independent risk factor, for PRES may be secondary to dysautonomia and physicians should be aware of such rare coexistence so that early treatment can be done to reduce the mortality and morbidity.