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1. Acute Hemichorea-Hemiballismus in Patients with Tuberculous Meningitis: An Atypical Manifestation of Stroke

Author

Garg, Ravindra Kumar, Rizvi, Imran, Kumar, Neeraj, Gupta, Priyanka, Tripathi, Pooja, Arjun Bal, KP, Parihar, Anit, Malhotra, Hardeep Singh, Pandey, Shweta, and Uniyal, Ravi

Subjects
Care and treatment, Complications and side effects, Development and progression, Case studies, Movement disorders -- Case studies -- Development and progression -- Care and treatment, Central nervous system diseases -- Case studies -- Complications and side effects -- Care and treatment, Tuberculosis -- Case studies -- Complications and side effects -- Care and treatment
Abstract

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

Published
2025
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9. List of contributors

Author

Achur, Rajeshwar, primary, Adhikary, Krishnendu, additional, Ahire, Eknath D., additional, Akhila, A., additional, Alekhya, Kella, additional, Anousakis, Ch., additional, Ansar, Waliza, additional, Aranha, Ivan, additional, Aravind, Vulli, additional, Arora, Naina, additional, Badgaiyan, Rajendra D., additional, Bagchi, Debasis, additional, Bahekar, Triveni Nilkanth, additional, Balekundri, Amruta, additional, Banerjee, Priyanka, additional, Banerjee, Ritam, additional, Banerjee, Pradipta, additional, Banik, Samudra P., additional, Bansal, Suraj, additional, Baral, Tejaswini, additional, Barh, Debmayla, additional, Baron, David, additional, Batabyal, Nandita, additional, Benson, Ruby, additional, Bhattacharya, Subhrajit, additional, Bhattacharyya, Jhimli, additional, Biswas, Ayan, additional, Biswas, Pallabi, additional, Blanco, Tracey, additional, Blum, Kenneth, additional, Bowirrat, Abdalla, additional, Braverman, Eric R., additional, Chatterjee, Ananya, additional, Chaudhry, Anubha, additional, Chaurasia, Rameshwar Nath, additional, Chowdhury, Sumana Roy, additional, Dakshayini, P.N., additional, Damarasingu, Prasanth, additional, Darshan, J.C., additional, Das, Siddhartha, additional, Das, Arpita, additional, Dasari, Rajasekhar, additional, De, Shaoli, additional, Debnath, Anirban, additional, Dennen, Catherine, additional, Dharmamoorthy, G., additional, Dhavale, Raiu K., additional, Dhingra, Sameer, additional, Downs, B. William, additional, Ejaz, Laila, additional, Ejaz, Haris, additional, Elman, Igor, additional, Evangelou, E., additional, Favas, T.T., additional, Garg, Ravindra K., additional, Giordano, John, additional, Gogoi, Maya, additional, Gold, Mark S., additional, Gupta, Munesh Kumar, additional, Gupta, Ashim, additional, Gupta, Abhishek Amod, additional, Han, David, additional, Hanumegowda, Sujatha M., additional, Hati, Subrota, additional, Helan, K.P., additional, Hemachudha, Pasin, additional, Hemachudha, Thiravat, additional, Hossain, Ashfaque, additional, Hostert, Alyssa, additional, Iorio, E.L., additional, Jain, Pushpendra Kumar, additional, Jana, Sudipta, additional, Jawed, Junaid Jibran, additional, Johnson, Aieshel Serafin, additional, Kachave, Ramanlal N., additional, Karati, Dipanjan, additional, Keceli, T.M., additional, Keservani, Raj K., additional, Kesharwani, Rajesh K., additional, Kesharwani, Anuradha, additional, Keshri, Anand Kumar, additional, Khalsa, Jag, additional, Khona, Dolly K., additional, Kiritsakis, Apostolos, additional, Krishnamani, Madhu, additional, Kumar, Anand, additional, Kumar, Podilapu Manoj, additional, Kumar, Neeraj, additional, Kumar, Shivam, additional, Kumar, Nitesh, additional, Kumari, Reena, additional, Kurian, Shilia Jacob, additional, Lall, Neha, additional, Llanos, Luis Gomez, additional, Mahajan, Sunil K., additional, Majumder, Rajib, additional, Makwana, Mitali, additional, Malhotra, Hardeep Singh, additional, Malhotra, Kiran Preet, additional, Mandal, Supriya, additional, McLaughlin, Thomas, additional, Meenakshi, Sarasa, additional, Mehra, Parul, additional, Mendes, Odete, additional, Metkus, Jarred D., additional, Mitra, Mousumi, additional, Mitra, Sudeep, additional, Mohan, Aishvaryaa, additional, Muili, Fatima, additional, Mukherjee, Swarupananda, additional, Mukherjee, Priyanka, additional, Murti, Krishna, additional, Nandi, Dilip Kumar, additional, Narapaka, Pavan Kumar, additional, Njie Mbye, Ya Fatou, additional, Oh, Angela, additional, Ohia, Sunny E., additional, Okolie, Anthonia, additional, Opere, Catherine A., additional, Paliwal, Vimal Kumar, additional, Panda, Satyajit, additional, Parihar, Vipan Kumar, additional, Patil, Dhananjay M., additional, Patil, Sharangouda J., additional, Pattanayak, Sudeepta, additional, Prabhu, Vikas Vittal, additional, Prasad, P. Dharani, additional, Prasad, Amit, additional, Preethi, Pakala, additional, Premalatha, S.J., additional, Raina, Hansika Sanjay, additional, Ramírez, Yael Quiles, additional, Rawat, Suraj Singh, additional, Renuka Jyothi, S., additional, Robinson, Conrad, additional, Roy, Uddappanda Bopaiah, additional, Rupreo, Vibeizonuo, additional, S., Theertha, additional, S.S., Kiron, additional, Saha, Rudra P., additional, Saifeddine, Mohamad, additional, Saini, Ankit Kumar, additional, Samanta, Saptadip, additional, Sannaningaiah, Devaraja, additional, Sanyal, Saptarshi, additional, Saranya, K., additional, Sarkar, Riya, additional, Sen, Amartya, additional, Sengar, Pratishtha, additional, Shahidi, F., additional, Sharma, Swati, additional, Shelke, Akshay, additional, Sheth, Meet, additional, Shibu, Shalmy M., additional, Shivaprasad, H.N., additional, Shukla, Kuldeep, additional, Simpatico, Thomas A., additional, Singh, Abhilasha, additional, Singh, Anshul, additional, Singh, Varun Kumar, additional, Singh, Abhishek Kumar, additional, Singh, Manoj Kumar, additional, Singh, Meghna, additional, Soman, Sauparnika, additional, Sonal Sekhar, M., additional, Sonawane, Deepak D., additional, Sonawane, Vijayraj N., additional, Soni, Gaurav, additional, Sravani, T., additional, Srivastava, Nimish, additional, Srivastava, Chhitij, additional, Surana, Khemchand R., additional, Tejan, Nidhi, additional, Thanos, Panayotis K., additional, Tom, Annmaria, additional, Tsitsipas, Ch., additional, Udaya Kumar, V., additional, Uniyal, Ravi, additional, Urs, Vijeth L., additional, Veeranna, S., additional, Venkatappa, Manjula M., additional, Ward, D. Isum, additional, Wozniak, Lucyna A., additional, Yadav, Latika, additional, and Manasa, Goudicherla, additional

Published
2024
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17. Treatment outcome in patients with spinal neurocysticercosis: a systematic review of published cases and case series

Author

Garg, Ravindra Kumar, Rizvi, Imran, Nigam, Harish, Pandey, Shweta, and Uniyal, Ravi

Abstract

ABSTRACTAimsSpinal neurocysticercosis is a rare central nervous system infection caused by the larval form of the Taenia solium. Due to its rarity, most knowledge is derived from isolated case reports. This review aims to evaluate existing case reports and observational studies to provide a comprehensive overview of the disease’s clinical presentation and treatment outcomes.MethodsFollowing PRISMA guidelines, a comprehensive search was performed across various databases. The review included case reports, case series, and observational studies, and it is registered with PROSPERO (CRD42024496957).ResultsThis review analyzed 206 spinal neurocysticercosis cases (from 171 published reports). Symptoms persisted for one week to six months in 49% of cases, and common presentations included paraparesis/quadriparesis (61.7%) and neck/limb/back pain (40.8%). CSF abnormalities were observed in 23.8%. Thoracic involvement was most frequent (39.3%), followed by cervical (27.2%). Neurocysticercosis lesions in other regions, primarily the brain, were found in 18.9%. Differential diagnoses included spinal cord tumors (13.1%). Treatment often involved surgery alone (32%) or with cysticidal drugs (45.6%), with a 91.3% improvement rate, indicating favorable outcomes.ConclusionsSpinal neurocysticercosis primarily affects the thoracic and cervical regions. Most patients respond well to medical therapy; surgery is mainly for progressive neurological deficits.

Published
2025
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18. Tumor necrosis factor-a, CD1A and CD1E genetic polymorphisms in Guillain-Barre syndrome: A study from India

Author

Chakraborty, Rajarshi, Verma, Rajesh, Jain, Amita, Garg, Ravindra, Atam, Virendra, Malhotra, Hardeep, Sharma, Praveen, Prakash, Shantanu, Kumar, Neeraj, Pandey, Shweta, Uniyal, Ravi, and Rizvi, Imran

Subjects
Testing, Care and treatment, Analysis, Development and progression, Genetic aspects, Polymerase chain reaction -- Testing, Tumor necrosis factor -- Analysis, Disease susceptibility -- Analysis, Single nucleotide polymorphisms -- Analysis, Guillain-Barre syndrome -- Development and progression -- Care and treatment -- Genetic aspects
Published
2023

19. Predictors of cerebrospinal fluid GeneXpert MTB/RIF positivity in patients with tuberculous meningitis: A prospective cohort study.

Author

Gupta, Priyanka, Kumar, Neeraj, Garg, Ravindra Kumar, Malhotra, Hardeep Singh, Rizvi, Imran, Verma, Rajesh, Sharma, Praveen Kumar, Uniyal, Ravi, Pandey, Shweta, Jain, Amita, and Jain, Parul

Abstract

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]

Published
2024
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28. Accelerated hypertension and intracerebral haemorrhage following first dose of ChAdOx1-nCOV-19 vaccination

Author

Pandey, Shweta, Garg, Ravindra, Malhotra, Hardeep, Kumar, Neeraj, and Uniyal, Ravi

Subjects
Covishield (Vaccine) -- Complications and side effects -- Case studies, Complications and side effects, Case studies, Risk factors, Causes of, Intracerebral hemorrhage -- Case studies -- Risk factors -- Causes of, Hypertension -- Case studies -- Risk factors -- Causes of, COVID-19 vaccines -- Case studies -- Complications and side effects
Published
2022

29. An Unusual Patient with Acute Multiple Cranial Palsy, Tongue Fasciculations, and Proximal Weakness

Author

Garg, Ravindra, Gupta, Sorabh, Rizvi, Imran, Malhotra, Hardeep, Kumar, Neeraj, and Uniyal, Ravi

Subjects
Diagnosis, Complications and side effects, Case studies, Causes of, Botulism -- Case studies -- Diagnosis -- Complications and side effects, Food contamination -- Case studies, Neurologic manifestations -- Case studies -- Causes of, Neurologic manifestations of general diseases -- Case studies -- Causes of
Published
2022

39. The spectrum of central nervous system manifestations in leprosy: a systematic review of published case reports and case series.

Author

Garg, Ravindra Kumar, Uniyal, Ravi, Pandey, Shweta, Tejan, Nidhi, Rizvi, Imran, Sharma, Praveen Kumar, Kumar, Neeraj, and Malhotra, Hardeep Singh

Subjects
CENTRAL nervous system, HANSEN'S disease, MYCOBACTERIUM leprae, CERVICAL cord, SPINAL cord
Abstract

Background This systematic review aimed to investigate central nervous system (CNS) involvement in leprosy by analysing multiple cohort studies, individual cases and case series. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PubMed, Scopus and Embase databases were searched up to 8 July 2023, using a predefined search strategy. Inclusion criteria included patients diagnosed with leprosy with evidence of CNS involvement. The quality of the included cases was evaluated using the Joanna Briggs Institute checklist. Results A total of 34 records were identified, including 18 cohort studies and 16 reports describing 27 isolated cases. Autopsies revealed macroscopic changes in the spinal cord, neurofibrillary tangles and senile plaques. Mycobacterium leprae was detected in neurons of the medulla oblongata and spinal cord using PCR and phenolic glycolipid 1 staining. Cerebrospinal fluid (CSF) analysis showed inflammatory changes, increased gamma globulins and detection of Mycobacterium leprae antigens and antibodies. In 21 patients (78%), spinal cord/brachial plexus abnormities were detected. In the majority, MRI revealed T2/fluid-attenuated inversion recovery (FLAIR) hyperintensity in the cervical cord. In patients with brainstem involvement, T2/FLAIR hyperintensity was noted in the cerebellar peduncles, facial nerve nuclei and/or other cranial nerve nuclei. Brain parenchymal involvement was noted in three patients. Conclusions This systematic review provides evidence of CNS involvement in leprosy, based on autopsy findings, neuroimaging, CSF analysis and neurophysiological studies. [ABSTRACT FROM AUTHOR]

Published
2024
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40. A Case of Subacute Sclerosing Panencephalitis: Some Unusual Clinico-Radiological Manifestations

Author

Uniyal, Ravi, Garg, Ravindra, Malhotra, Hardeep, Tejan, Nidhi, Kumar, Neeraj, Pandey, Shweta, and Shekhar, Ravi

Subjects
Diagnosis, Complications and side effects, Case studies, Causes of, Pediatric research, Bruxism -- Case studies -- Causes of, Subacute sclerosing panencephalitis -- Case studies -- Diagnosis -- Complications and side effects, Seizures (Medicine) -- Case studies -- Causes of, Dystonia -- Case studies -- Causes of
Published
2021

42. Paroxysmal Hemicrania: An Update

Author

Paliwal, Vimal and Uniyal, Ravi

Subjects
Diagnosis, Care and treatment, Paroxysmal hemicrania -- Diagnosis -- Care and treatment
Published
2021

43. The spectrum of psychiatric manifestations in subacute sclerosing panencephalitis: A systematic review of published case reports and case series

Author

Garg, Ravindra K., Kar, Sujita K., Malhotra, Hardeep S., Pandey, Shweta, Jain, Amita, Rizvi, Imran, Uniyal, Ravi, and Kumar, Neeraj

Abstract

AbstractData related to psychiatric manifestations in subacute sclerosing panencephalitis (SSPE) is currently available only in the form of isolated case reports. In this systematic review, we evaluated the spectrum of psychiatric manifestations and their impact on the course and outcome of SSPE. Data were obtained from 4 databases (PubMed, Embase, Scopus, and Google Scholar), with the most recent search conducted on March 27, 2023. The PRISMA guidelines were followed, and the PROSPERO registration number for the protocol is CRD42023408227. SSPE was diagnosed using Dyken’s criteria. Extracted data were recorded in an Excel spreadsheet. To evaluate the quality of the data, the Joanna Briggs Institute Critical Appraisal tool was employed. Our search resulted in 30 published reports of 32 patients. The mean age was 17.9 years. Schizophrenia, catatonia, and poorly characterized psychotic illnesses were the 3 most common psychiatric presentations that were seen in 63% (20/32) of cases. Catatonia was seen in 4 patients. Affective disorders, mania, and depression were reported among 22% (7/32) cases. In approximately 81% (26/32) cases, the course of SSPE was acute fulminant. Treatment with antipsychotic drugs had poor or no response. Out of 17 patients, who received antipsychotic drugs, 6 patients noted severe extrapyramidal adverse effects. SSPE often masquerades as a psychiatric disorder. Unresponsive psychiatric symptoms, early extrapyramidal signs, and progressive encephalopathy indicate SSPE.

Published
2024
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