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Background: Large core acute ischemic strokes have predominantly been excluded from endovascular therapy (EVT) studies due to perceived higher risks of hemorrhage and poorer functional outcomes. However, recent randomized controlled trials (RCTs) indicate that EVT for large vessel occlusion (LVO) strokes improves functional outcomes compared to medical management alone, despite higher hemorrhagic transformation rates, with no corresponding increase in symptomatic intracerebral hemorrhage (sICH) rates. The real-world outcomes of this intervention in Indian patients remain underexplored. Objectives: To evaluate the real-world outcomes of EVT for large core acute ischemic strokes with LVO in an Indian population. Methods: We conducted a single-center, retrospective observational study using a 7 years prospective database of EVT in anterior circulation stroke patients. Patients with Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 3-5 were included. Clinical and radiologic data were analyzed, with the primary endpoint being 90-day modified Rankin scale (mRS) scores. Safety outcomes included rates of sICH and mortality. Descriptive statistical analysis was done using Microsoft Excel. Results: The study included 25 patients who met the inclusion criteria. Mean age of patients was 52.9 ± 14.3 years, and there were 13 (52%) males. Median ASPECTS was 5 (interquartile range 4-5). Successful recanalization, classified by modified Thrombolysis in Cerebral Infarction score, was 92%. Good functional recovery, that is, 90-day mRS 0-3, was achieved in nine (36%) patients. Safety outcomes: sICH was seen in four (16%) and mortality was reported in nine (36%) patients. Conclusions: Our results reaffirm findings from RCTs, provide updated real-world evidence, and suggest that EVT is a viable option to be considered in selected patients with large core ischemic infarcts. [ABSTRACT FROM AUTHOR]

Byline: Divyani. Garg, Rajinder. Dhamija, Aditya. Choudhary, Ritu. Shree, Sujit. Kumar, Priyanka. Samal, Abhishek. Pathak, Pamidimukkala. Vijaya, Yareeda. Sireesha, Sruthi. Nair, Sanjay. Sharma, Soaham. Desai, Human. Sinha, Ayush. Agarwal, Ashish. [...]

Background: Cerebral venous sinus thrombosis (CVST) is a rare, treatable cause of stroke. Even though CVST has an established medical treatment, 15% of patients remain refractory to treatment. These patients may be candidates for endovascular treatment (EVT), yet the selection of patients remains a challenge. The study aims to understand the profile and outcome of patients treated with EVT and the type of procedure associated with good outcomes. Methods: This is a single-center, retrospective analysis of CVST patients who underwent EVT from 2009 till 2022. Patients who received only medical management were excluded. Modified Rankin Scale (mRS) ≤2 at 3 months was taken as the primary outcome. Secondary outcomes assessed were hospital stay, death, recurrence, mRS ≤ 2 at discharge, and angiographic recanalization. Results: Fifty-two patients were included. Twenty-eight (53.8%) were males; the mean age was 33.3 ± 12.3 years. Headache (n = 44, 84.6%) predominated among the symptoms. The common risk factors were anemia (n = 13, 25.5%) and hyperhomocysteinemia (n = 13, 25.5%). Worsening of sensorium (n = 21, 40.3%) and non-improvement of symptoms (n = 15, 28.8%) were the common indications for the procedure. Twenty-five (48.1%) people underwent in situ thrombolysis (IST). Death occurred in eight (15.3%) patients. Thirty-six (73.5%; 36/49) patients had a good outcome at 3 months. IST had a significantly better outcome (mRS ≤ 2, n = 20, 80%) compared to other procedures (P = 0.04). Hospital stay was lesser in the IST subgroup, but without statistical significance. Midline shift >5 mm (odds ratio [OR] 6.8 [1.5--30.9], P = 0.01) and Glasgow Coma Scale <9 before the procedure (OR 27.2 [3.1--236.4], P = 0.002) predicted bad outcomes at 3 months. Female gender (OR 4.5 [1.07--8.8], P = 0.03), presence of altered sensorium (OR 10.2 [1.2--87.5], P = 0.01), encephalopathic syndrome (P = 0.02), presence of parenchymal bleed (OR 3.7 [0.9--4.5], P = 0.04), and midline shift (OR 4.8 [1.1--20.2], P = 0.03) were associated with poor outcome at discharge. Conclusion: EVT yielded good outcomes in carefully selected, medically refractory patients of CVST. IST performed well compared to other procedures. [ABSTRACT FROM AUTHOR]

LGI1 (Leucine-rich glioma inactivated protein-1)antibody disease is one of the major causes of limbic encephalitis encountered in clinical practice manifesting with clinical seizures, behavioural disturbances and movement disorders. Here we discuss the varied presentations of this disease through three cases encountered at our center emphasizing the cardinal clinical, imaging and laboratory diagnostic features. Recognition of these characteristics would lead to early diagnosis and prompt management of this eminently treatable condition. [ABSTRACT FROM AUTHOR]

Byline: Rohit. Bhatia, M. Padma Srivastava, P. Sylaja, Snigdha. Komakula, Ashish. Upadhyay, Vibhor. Pardasani, Thomas. Iype, Rajsrinivas. Parthasarathy, Rajshekhar. Reddy, Suman. Kushwaha, Jayanta. Roy, P. Satish, Anjan. Trikha, Naveet. Wig, [...]

Byline: V. Soumya, Dileep. Ramachandran, Sabarish. Sekar, Sapna. Sreedharan, P. Sylaja Sir, A 2-year-old girl born of nonconsanguinous parentage, detected in the antenatal period to have right cerebellar hypoplasia with [...]

Measuring the mechanical properties of weld Heat Affected Zone (HAZ) remains one of the main challenges in the failure analysis of spot-welded components. Due to the small size of the HAZ and variation in the temperature history, different peak temperatures and cooling rates impose a range of phase transformations across the resistance spot weld. Among the HAZ sub-regions, the sub-critical HAZ (SCHAZ), which experiences temperatures below AC1 (350–650 °C), usually shows a reduction in the hardness in most of the modern AHSS grades due to the martensite tempering phenomenon. SCHAZ softening may lead to strain localization during loading. Therefore, it is important to characterize the local properties of the SCHAZ region to accurately predict RSW failure. However, it is not feasible to extract standard mechanical test specimens out of the SCHAZ of the spot-welded structure due to its small size. In this work, the SCHAZ of the spot weld for two AHSS, 3G-980 and PHS-1500, was simulated using a Gleeble® (Dynamic Systems Inc., 323 NY-355, Poestenkill, NY 12140, USA) 3500 thermo-mechanical simulator. An in-situ high-speed IR thermal camera was used to measure the entire temperature field during the Gleeble heat-treatment process, which allowed for the visualization of the temperature distribution in the gauge area. The temperature and hardness data were fit to a Hollomon-Jaffe (HJ) model, which enables hardness prediction in the SCHAZ at any given temperature and time. Using the HJ model, a heat treatment schedule for each material was chosen to produce samples with hardness and microstructure matching the SCHAZ within actual spot weld coupons. Tensile specimens were machined from the coupons heat treated using simulated heat treatment schedules, and mechanical testing was performed. The results showed that the 3G-980 SCHAZ has a slight increase in yield strength and tensile strength, compared to the base metal, due to the formation of fine carbides within the microstructure. In contrast, the SCHAZ of PHS-1500 showed a significant reduction in the yield and tensile strength with yield point elongation behavior due to the reduction of the martensite phase and an increase in carbide formation due to the tempering process. [ABSTRACT FROM AUTHOR]

Byline: Bhagya. Shaji, B. Srikumar, Dileep. Ramachandran Cerebrotendinous xanthomatosis is an autosomal recessive inborn error of metabolism that is an often missed but treatable cause of hereditary ataxia. We report [...]

Introduction/Aims: Studies conducted during the coronavirus disease 2019 (COVID 19) pandemic have reported varied data regarding the incidence of Guillain--Barre syndrome (GBS). The present study investigated demographic and clinical features, management, and outcomes of patients with GBS during a specified period of the COVID 19 pandemic, and compared these features to those of GBS in the previous year. Methods: A multicenter, ambispective cohort study including 26 centers across India was conducted. Data from a pre COVID 19 period (March 1 to August 31, 2019) were collected retrospectively and collected ambispectively for a specified COVID 19 period (March 1 to August 31, 2020). The study was registered with the Clinical Trial Registry India (CTRI/2020/11/029143). Results: Data from 555 patients were included for analysis: pre COVID 19 (n = 334) and COVID 19 (n = 221). Males were more commonly affected during both periods (male:female, 2:1). Gastroenteritis was the most frequent antecedent event in 2019 (17.4%), whereas fever was the most common event in 2020 (10.7%). Paraparesis (21.3% versus [vs.] 9.3%, P = 0.001) and sensory involvement (51.1% vs. 41.3%; P = 0.023) were more common during COVID 19 in 2020, whereas back pain (26.3% vs. 18.4%; P = 0.032) and bowel symptoms (20.7% vs. 13.7%; P = 0.024) were more frequent in the pre COVID period. There was no difference in clinical outcomes between the two groups in terms of GBS disability score at discharge and 3 months after discharge. Independent predictors of disability in the pre COVID period included areflexia/hyporeflexia, the requirementfor intubation, and time to bulbar weakness; in the COVID 19 period, independent predictors included time from onset to admission, intubation, and intubation requirement. The mortality rate was 2.3% during the entire study period (13/555 cases). Discussion: Results of this study revealed an overall reduction in the frequency of GBS during the pandemic. The lockdown likely reduced the risk for antecedent infections due to social distancing and improved hygiene, which may have resulted in the reduction of the frequency of GBS. [ABSTRACT FROM AUTHOR]

Introduction: The unprecedented challenges during the COVID pandemic and the subsequent lockdown had resulted in a delay in treatment metrics for acute stroke. There is a rising concern that COVID-19 co-infection can adversely affect stroke outcome. We aim to investigate the impact of COVID-19 in the management of stroke patients. We also compared the differences in stroke manifestations, etiological pattern, treatment course, and outcome of acute stroke patients in COVID-19 confirmed cases. Methodology: A single-center retrospective study was done at the Stroke Unit, Government Medical College, Thiruvananthapuram. Consecutive patients of acute stroke confirmed by imaging, presenting within 24 hours of the onset of symptoms in May to July 2020 and May to July 2019, were included. The primary data variables included baseline demographics, risk factors, admission NIHSS, stroke timings, thrombolysis rate, TOAST etiology, mRS at discharge, and in-hospital mortality. Results: Strokes with higher NIHSS, arrival blood sugar and blood pressure, and delays in door-to-CT and door-to-needle time were more during the pandemic. Intravenous thrombolysis was less and mortality was higher in COVID-19 strokes during the pandemic. COVID-19-positive stroke patients had more hemorrhagic strokes, more severe strokes with low CT ASPECTS, more hemorrhagic transformation, high in-hospital mortality, and poor functional outcome at discharge and 3 months. Conclusion: Our study was a hypothesis-generating study with a limited number of patients. This study has reconfirmed the higher severity of the stroke, with a higher mRS score and mortality during the pandemic, especially among COVID-19-positive stroke patients. [ABSTRACT FROM AUTHOR]