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Introduction: This study tried to find out type of lobar features found in patients with progressive supranuclear palsy (PSP) and whether they differ from those of frontotemporal dementia (FTD) as both of these are tauopathies. Methods: We studied lobar functions of 45 patients with PSP. Results: Five (11.1%) patients had no lobar feature; 11 (24.4%) had PSP-like features like apathy, frontal release signs, impaired motor Luria written sequences, and fist-edge-palm test; and 29 (64.4%) patients had FTD-like lobar features like disinhibition, poor naming, and word finding difficulty. Among features resembling FTD, behavioural variant type occurred in 31.1%, primary progressive aphasia type occurred in 58.6%, 3.4% patients had semantic dementia type features, and 6.9% were unclassified. Conclusions: Hence, patients with PSP with lobar features may fall in the middle of PSP-FTD spectrum with frontal lobe features typical of PSP (PSP-frontal like) and those with frontal lobe features resembling FTD (PSP-FTD complex) in between.

BACKGROUND Headache is quite prevalent in general population. Few studies have been done on medical residents and comparison between headache prevalence and types in medical and non-medical student groups is quite lacking. This institute having medical residents as well as non-medical students, provides an opportunity to study and compare frequency and pattern of headache in these student groups. The study was aimed at finding out the type and frequency of headache, disability due to headache and treatment practices followed by these two student groups and the effect on the quality of life of our work force resulting from headache. MATERIALS AND METHODS Headache characteristics were studied in 200 medical residents and non-medical students who had at least one episode of headache of at least moderate intensity in the last 1 year using structured questionnaire. RESULTS Headache occurred in 81% students (79.9% of males and 83.9% of females), of whom, 81.82% were medical, 77.14% were non-medical, 79.65% were married and 82.76% were unmarried. Episodic tension-type headache (TTH) was most frequent headache type and migraine without aura was uncommon. More males had TTH than females (55.6% versus 39.3%) and migraine was more common in females (39.3% versus 20.1%). Common triggers for headache in medical students were stress, lack of sleep and in non-medical students were stress, sunshine and loud noise. Only 10.5% students were on prescription drugs while 69.8% were self-medicating. CONCLUSION Headache is almost as frequent in medical as in non-medical students and it affects the quality of life of our work force

'Locked-in syndrome (LIS)' is a neurological disorder, often missed initially and can have grave consequences. A rare case of LIS caused due to folic acid deficiency-induced hyperhomocysteinemia is being described here. A 16-year-old boy presented with complaints of sudden onset weakness of all the four limbs with loss of voice for one day. All the tendon reflexes were increased, bilateral planters were extensor and sensory system was intact. Patient was conscious and responded to verbal commands by ocular movements in vertical direction. Hence, a diagnosis of LIS was made. Magnetic resonance imaging of the head revealed an acute infarct in ventral pons. Serum homocysteine level was elevated (20.65 μmol/l) and folic acid level was severely low (1.7 nmol/ml). Cause of LIS was found to be hyperhomocysteinemia induced stroke in the pons, related to folic acid deficiency. The patient was managed with antiplatelet agents and folic acid supplementation and was discharged subsequently. Recognition of LIS is important as casual remarks at bedside can severely traumatize an already paralyzed but conscious and awake patient. Folic acid deficiency can lead to hyperhomocysteinemia, which can cause strokes and even LIS. Prevention of hyperhomocysteinemia may possibly prevent such neurological disasters.

We studied three patients with Unverricht–Lundborg disease for autistic features along with other clinical features associated with progressive myoclonus epilepsy. We diagnosed this disease based on noise and touch sensitive myoclonus, ataxia, cognitive decline, typical EEG features, normal MRI of the brain and applied Children's Global Assessment Scale and Childhood Autism Spectrum Test to these children. The CGAS score was 35 in two and 50 in one of them. CAST scores were above 15 in all of three of them. Autistic features may be an important clinical feature of this disease. History and physical examination for myoclonus should probably be taken in autistic children., Highlights • Unverricht–Lundborg disease can present with autistic features and hyperactivity. • Main autistic features are an absence of eye contact and avoidance of strangers and absence of attachment to the parents. • Children's Global Assessment Scale scores may be moderately to severely affected. • Childhood Autism Spectrum Test scores may be above the cutoff of 15.

Scrub typhus, a mite-borne zoonotic disease, is endemic in several parts of India. It may cause multisystemic disease involving lungs, heart, spleen, liver, hematological system, and nervous system. Neurological involvement may include meningoencephalitis, cerebellitis, cranial nerve palsies, plexopathy, transverse myelitis, muscle dysfunction, neuroleptic malignant syndrome, parkinsonian syndrome, and Guillain–Barre syndrome. Here, we report a rare patient of scrub typhus, who developed meningoencephalitis followed by long-segment myelitis and axonal polyneuropathy, with hepatic, renal, hematological, and pulmonary involvement, following acute febrile illness with associated neurocysticercosis. He gained consciousness with a resolution of almost all of his complaints, with the exception of muscular power, which showed partial improvement following treatment with doxycycline, azithromycin, and steroids. What needs to be explored is whether the existence of neurological scrub typhus with neurocysticercosis is the coincidental price paid for living in the tropics or there is something more to it as in case of Japanese encephalitis and neurocysticercosis co-infection.

N-hexane neuropathy is an occupational disease caused by exposure to n-hexane, which is used as a solvent in silk screen printing. Here, we describe a 35-year-old man, a silk screen printer by profession, who presented with dizziness, distal swelling of both lower limbs for 10 months and tingling and burning sensation in both feet for 9.5 months along with cold allodynia. The patient had normal results of a motor and sensory system examination, apart from an impaired temperature sense. Nerve conduction tests showed a conduction block in bilateral common peroneal nerves and absence of conduction in bilateral sural nerves. These symptoms resolved when further exposure to n-hexane was ceased but cold allodynia remained. Thus, cold allodynia and impaired temperature sense can be a manifestation of n-hexane neuropathy. Hence, abnormalities on nerve conduction studies can be detected in n-hexane neuropathy patients, even before clinical examination detects any such abnormalities. In the case of the patients presenting with sensory motor neuropathy, history of occupational exposure to n-hexane becomes important, as the sooner the disease is detected, the better the chances of recovery.

Objectives Autonomic dysfunction is often a late feature of multiple system atrophy (MSA). Based on early features, MSAp (Parkinsonian) and MSAc (cerebellar) variants are known. We studied the severity of autonomic dysfunction at first examination in MSA patient that may have relevance in its early diagnosis. Methods Clinical (including autonomic), radiological and lab features of 53 MSA patients were analyzed in the context of MSAp (16 patients) and MSAc (37 patients). Results Most frequent autonomic symptoms were erectile dysfunction in 30 out of 38 males (78.9%), bladder symptoms in 35 (66%), followed by blackouts/fainting attacks in 33 (62.3%). Autonomic abnormalities were detected in hand grip test (86.8%), deep breathing test (79.2%), cold pressor test (71.7%), Valsalva maneuver (75.5%), heart rate variability at 30:15 beats after standing (50.9%) and systolic BP on standing (41.5%). Six (16.2%) MSAp and 1 (6.3%) MSAc patients continued to have autonomic symptoms for several months (38.7 ± 26.11, median 36 months) before the appearance of cerebellar (1 patient) or Parkinsonian (6 patients) features. Conclusion Autonomic dysfunction may be the only presenting feature in some patients with MSA. Routine autonomic testing may help in the early diagnosis of MSA in patients presenting with Parkinsonian or cerebellar features.

Objectives Rarity of specific MRI features like ‘hot-cross bun’ sign and ‘hyperintense putamen rim’ reduce diagnostic utility of MRI in MSA. We therefore, studied some non-specific MRI features in addition to the specific ones, to find their diagnostic utility. Patients and methods Clinical and MRI features of 53 indoor and outdoor patients with MSA were analyzed in the context of its Parkinsonian (MSA-P) and cerebellar (MSA-C) variants. Results Of 53 cases (mean age: 59.53 ± 9.74 years), 16 (30.2%) had MSA-C and 37 (69.8%) had MSA-P. Midbrain atrophy was found in 37 (69.8%) MSA patients (70.3% of MSA-P and 68.8% of MSA-C), cerebellar atrophy in 45 (84.9%) MSA patients (81.1% of MSA-P and 93.8% of MSA-C), ‘hot-cross bun’ sign in 13 (24.5%) MSA patients (27% of MSA-P and 18.8% of MSA-C), hyperintense putamen rim in 19 (35.8%) MSA patients (37.8% of MSA-P and 31.3% of MSA-C) and corpus callosal atrophy in 39 (73.6%) MSA patients (75.7% of MSA-P and 68.8% MSA-C). The midbrain atrophy was mainly lateral tegmental and resembled a positive ‘Morning glory’ sign in 16 (30.2%). Conclusion “Hot cross bun” sign and “hyperintense putamen rim” sign were rarely seen in MSA. Combination of mid brain atrophy, corpus callosum atrophy and cerebellar atrophy was more commonly observed in both MSA-C and MSA-P and may be taken as of diagnostic significance.

Cannabis, an illicit recreational substance, is considered to be relatively safe by the public.1 However, potential health risks, particularly cardiovascular risks, are a cause of concern.2 Ischaemic and rarely haemorrhagic strokes may occur with cannabis use.2–4 Stroke usually ensues following chronic cannabis use or with concomitant use of tobacco and cannabis.2 3 A 23-year-old man, brought in an unconscious state with suspected poisoning had …

Objectives Cardinal extrapyramidal features of progressive supranuclear palsy (PSP) help in clinically differentiating this condition from Parkinson's disease and other Parkinsonian syndromes. However, not all extrapyramidal features may be initially present, thus posing a difficulty in early diagnosis. We studied their frequency at the time of first presentation. Methods Patients diagnosed clinically with PSP using the National Institute for Neurological Disorders and Society for PSP (NINDS/SPSP) criteria and seen between August 2010 and April 2013 were examined for the presence, ‘presence with deviation’ or absence of six extrapyramidal features: axial rigidity, symmetry, extended posture, backward falls, absence of tremors and lack of levodopa response. Results Twenty-eight patients (mean (SD) age 64.86 (9.72) years; 16 (57%) men) met the inclusion criteria. Of these, 14% had all six extrapyramidal features associated with PSP, 39% had five, 29% had four, 14% had three and 4% had two. The most frequent extrapyramidal sign was axial rigidity (68%). Axial plus peripheral rigidity was found in 18% of patients and peripheral rigidity alone in 14%. Extrapyramidal features were symmetrical in 29% and asymmetrical beyond 1 year in 29%. Body posture was extended in 46% and flexed in 21%. Backward falls were found in 50% and forward falls in 11%. Pill-rolling tremors were observed in 29%. Response to levodopa therapy was poor in 21% and good beyond 6 months in 39%. Conclusions Only 14% of PSP patients present with all six cardinal extrapyramidal features. Also, deviations from standard descriptions are common in the initial stages of disease.

Leptospirosis is a zoonosis prevalent worldwide and is endemic in many parts of India. In early leptospiremic as well as late immune phase of the disease kidney, liver, heart, and lungs are commonly involved. Neurological manifestations are rare but may occur during immune phase in the form of aseptic meningitis, meningoencephalitis, seizures, myelitis, polyradiculoneuritis, and myalgia. In this report, we describe a rare case of leptospirosis with combined involvement of nerve, muscle, and myoneural junction in generalized fashion along with pulmonary, renal, and hepatic dysfunction.