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Introduction: Postural instability and gait difficulty are the major contributors to disability in patients with Parkinson's disease (PD) and are least responsive to dopaminergic therapies. Transcranial direct current stimulation (tDCS) of the brain is reported to improve locomotor function in patients with PD. Aims and Objectives: (1) To determine the effect of bilateral anodal tDCS on locomotor function by measuring the change in timed up and go (TUG) test scores in patients with PD immediately after tDCS. (2) To estimate the association of the effect of bilateral anodal tDCS on executive function and that on locomotor function by measuring the relation between the Stroop test scores and the TUG test scores. Study Design: Randomized triple-blind sham-controlled crossover study. Methods: A total of 30 patients with PD diagnosed using the Movement Disorder Society clinical diagnostic criteria for PD, belonging to H&Y stages 2--4, fulfilling the inclusion and exclusion terms were included in the study. Patients were randomized to receive the "real" or the "sham" tDCS stimulation in the first session and a week later the other type of stimulation, i.e., sham or real, was given. The gait of all the patients was assessed using the TUG test performed immediately before and after the "real" as well as the "sham" sessions. The Stroop test was also performed before and after each stimulation session. Results: The mean age [±standard deviation (SD)] of the study participants was 61.1 (±10.9) years, with two-thirds of them being males and one-third being females. Patients showed statistically significant improvement in the averaged TUG tests scores post the "real" stimulation compared to the "sham" stimulation session (p < 0.05). Statistically significant improvement in Stroop test scores (incongruent) was observed after the "real" stimulation. Conclusions: Locomotor function of patients with PD improves immediately following bilateral anodal tDCS, and the improvement in locomotor function has a positive correlation with improvement in executive function. Area of Research: Clinical aspects [ABSTRACT FROM AUTHOR]

A 42 year old male patient presented with sudden onset painless drooping of right shoulder while lifting himself up with his right arm from squatting position. He was diagnosed to have fracture of spine of right scapula. Neurological examination of the patient revealed patient's inability to abduct the right arm and mild weakness of handgrip without associated wasting or fasciculations. Impairment of pain sensation in right half of face, right cervical and upper thoracic dermatomes (T1-T4), and absence of deep tendon reflexes in right upper limb with brisk deep tendon reflexes in lower limbs were discovered on examination. The patient's cervico-dorsal Magnetic Resonance Imaging confirmed a syrinx extending from cervico-medullary junction to the upper thoracic segments. The patient did not have any obvious features suggestive of charcot's arthropathy on clinical and radiological examination. The case highlights the importance of detailed neurological examination and unusual presentation of fracture of spine of scapula in a patient harbouring cervico-dorsal syrinx. [ABSTRACT FROM AUTHOR]

The French physician Augustine Marie Morvan first used the term 'la choriotae fibrillare' to describe a syndrome characterized by peripheral nerve hyperexcitability, dysautonomia, insomnia and fluctuating delirium. There are no published reports of the condition from the Indian subcontinent. We report the first such case from the region. Our patient, a 24-year-old male, presented with easy fatigability and stiffness in both the calves for 18 months; continuous twitching of muscles of all four limbs and jaw for two months; hyperhydrosis, palpitations, urinary symptoms, burning dysesthesia in hands, insomnia and abnormal sleep behavior for about a month. Patient had bilateral hyper-reflexia with extensor plantar on the right and equivocal response on the left. Electromyography revealed continuous muscle fiber activity. Thyroid function test, electroencephalography, computerized tomography scan (head) and routine cerebrospinal fluid analysis were normal. The patient showed marked clinical and electrophysiological improvement on prednisolone along with symptomatic therapy over the next two months. [ABSTRACT FROM AUTHOR]

Patients with vitamin B12 deficiency are known to present with neuropsychiatric manifestations. Autoimmune origin of vitamin B12 deficiency due to pernicious anemia is relatively less common in Asians compared to certain western populations. Other autoimmune disorders including autoimmune thyroiditis may be associated with pernicious anemia. The coexistent hypovitaminosis B12 and hypothyroidism presenting with multiple level neuraxis involvement is relatively rare. Our patient, a 50 year old previously healthy male started becoming impulsive, irrational, and socially indiscreet around 4 months prior to presentation. He started talking to 'ghosts' and insisted that his house is haunted by 'spirits'. He was started on antipstchotics for his abnormal behaviour by psychiatrist only to worsen further. He was noted to have ataxic gait more prominent in the dark. He could hardly walk or feed himself without assistance. He had difficulty writing with his hand and had troublesome paraesthesias in extremities. When he presented to Neurology, he had MMSE score of 14/28. He had marked sensory ataxia, pseudoathetosis, normal motor power with exaggerated deep tendon reflexes and extensor plantars. Investigations revealed macrocytic hypochromic anemia with severely low vitamin B12 levels and hypothyroidism. Patient had positive antinuclear antibody, thyroid peroxidase and antiparietal cell antibodies. Elisa for HIV and routine blood tests including LFT, KFT were within normal limits. There was subclinical evidence of peripheral neuropathy. MRI Brain revealed cerebral atrophy and EEG showed background beta activity. Patient was started on 1000 microgam / d of parenteral vit B12 alongwith gradually escalating dose of I thyroxin. Patient showed significant signs of cognitive improvement within one week of treatment and reached MMSE score of 28/30 after 2 weeks. [ABSTRACT FROM AUTHOR]

Background: Herpes simplex virus (HSV) has rarely been reported as a cause of acute polyneuritis cranialis. Aim: To report the clinical features and outcome in a case of polyneuritis cranialis following reactivation of HSV 1 infection. Case: A 21 year old female, presented with acute onset difficulty in closing her left eye, deafness in left ear, electric shock like pain in her left face and left sided loss of taste sensation without hyperacusis, tinnitus, vertigo or ear discharge. Two weeks back, she had fever with vesicular eruptions in the oral cavity, which improved over one week. Patient had history of vesicular eruptions in her oral cavity two years back also. On examination, no vesicular rash was evident in oral cavity, external ear and tympanic membrane. Patient had left 7th infranuclear palsy and sensorineural deafness. There was no facial sensory loss. Left corneal reflex, with contralateral consensual response, was absent. Serum IgM and IgG for HSV1 antibodies were positive. CSF showed 16 lymphocytes/cmm, sugar 49 mg % (blood sugar: 99 mg %), protein 11 mg%, and positive PCR for HSV1 DNA. MRI brain showed enlargement of left cranial nerve V, VII and VIII complex with contrast enhancement. Audiometry and BAER were unrecordable from left ear. Left facial nerve conduction study showed decreased CMAP amplitude. Patient received intravenous acyclovir 30mg/kg/day for 10 days. Pain improved within 3 days and by 4 months, she made complete recovery with normal responses on repeat BAER and facial nerve conduction study. Conclusion: Reactivation of HSV 1 infection can present as polyneuritis cranialis. High index of suspicion and early treatment results in satisfactory outcome. [ABSTRACT FROM AUTHOR]