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Objective: Multiple ring-enhancing lesions of the brain are enigmatic neuroimaging abnormality. In this systematic review, we evaluated the etiological spectrum of these lesions. Methods: This systematic review adhered to the PRISMA guidelines. We searched PubMed, Embase, Scopus, and Google Scholar up until 15 June 2023. We included case reports and case series. Quality evaluation of each case was based on selection, ascertainment, causality, and reporting. The extracted information included demographic characteristics, clinical features, type and number of multiple enhancing brain lesions, diagnostic procedures, final diagnoses, treatments, and patient outcomes. Protocol Registration: PROSPERO CRD42023437081. Results: We analyzed 156 records representing 161 patients, 60 of whom were immunocompromised. The mean age was 42.6 years, and 67% of patients experienced symptoms for up to 1 month. A higher proportion of immunocompromised patients (42% vs. 30%) exhibited encephalopathy. Chest or CT thorax abnormalities were reported in 27.3% of patients, while CSF abnormalities were found in 31.7%, more frequently among the immunocompromised. Definitive diagnoses were established via brain biopsy, aspiration, or autopsy in 60% of cases, and through CSF examination or other ancillary tests in 40% of cases. Immunocompromised patients had a higher incidence of Toxoplasma gondii infection and CNS lymphoma, while immunocompetent patients had a higher incidence of Mycobacterium tuberculosis infection and immune-mediated and demyelinating disorders. The improvement rate was 74% in immunocompetent patients compared to 52% in the immunocompromised group. Conclusion: Multiple ring-enhancing lesions of the brain in immunocompromised patients are more frequently caused by Toxoplasma gondii infections and CNS lymphoma. Conversely, among immunocompetent patients, Mycobacterium tuberculosis infection and immune-related demyelinating conditions are common. [ABSTRACT FROM AUTHOR]

We report an interesting case of visual loss and visual hallucinations in a 37-year-old man. He presented with decreased vision in both eyes and visual hallucinations for the last one and a half months. He also had multiple focal to bilateral tonic-clonic seizures. On examination, there was no perception of light rays in both eyes. Fundus examination revealed disc oedema with peripapillary small haemorrhages in both eyes. Initially, the discs were hyperaemic, which turned pale in the subsequent examination at 1 month. Magnetic resonance imaging (MRI) of the brain revealed T2 hyperintensities in periventricular white matter and right fronto-parietal-occipital gray matter. His electroencephalogram showed intermittent slowing. His cerebrospinal fluid (CSF) examination showed five cells (all lymphocytes), protein 50 mg/dl, sugar 76 mg/dl (corresponding blood sugar 90 mg/dl). His CSF specimen was positive for anti-measles IgG antibodies. In conclusion, acute vision loss can rarely be the presenting symptom and, therefore, SSPE should also be considered in differential diagnoses of acute vision loss in measles-endemic regions. [ABSTRACT FROM AUTHOR]

Background: Subacute sclerosing panencephalitis (SSPE) is a devastating brain disease caused by persistent infection by the measles virus. Several cases of SSPE in pregnant ladies have been described. This systematic review is focused on maternal and foetal outcomes among pregnant women with SSPE. Methods: We searched four databases (PubMed, Embase, Scopus, and Google Scholar). We reviewed all relevant cases, published until 14 August 2022. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was registered with PROSPERO (CRD42022348630). The search items that we used were "((Pregnancy) OR (delivery)) AND (Subacute sclerosing panencephalitis (SSPE))". Dyken's criteria were used for the diagnosis of SSPE in pregnant women. The extracted data was recorded in an Excel sheet. The Joanna Briggs Institute Critical Appraisal tool for case reports was used to assess the quality of published cases. Results: We came across 19 reports describing details of 21 cases. The age of SSPE-affected women varied from 14 to 34 years (mean 23 years). In the majority (n=14), clinical manifestations were started in the antepartum period. Nine pregnant SSPE women presented with vision loss. After delivery, 13 SSPE-affected women died. On the contrary, 15 foetuses, though the majority were preterm, were alive. Five foetuses either died soon after birth or were still-born. Conclusion: In conclusion, SSPE in pregnancy is often missed, as it mimics eclampsia. SSPE in pregnancy usually has a devastating course. Universal early childhood measles vaccination is the only way to fight this menace. [ABSTRACT FROM AUTHOR]

Keywords: jaw; myoclonus; EEG; SSPE EN jaw myoclonus EEG SSPE S63 S65 3 08/28/23 20230802 NES 230802 Subacute sclerosing panencephalitis (SSPE) or Dawson's encephalitis is a chronic debilitating disorder of the central nervous system characterized by progressive cognitive impairment, myoclonic jerks, extra-pyramidal symptoms and classical high-amplitude generalized periodic slow-wave discharges also known as Rademecker complexes in electroencephalogram (EEG). Here we present two cases with progressive cognitive impairment, jaw-myoclonus and characteristic EEG findings diagnosed with SSPE. Second video shows involuntary jaw-opening myoclonus accompanied by eye-widening, giving a surprised look, followed by head and truncal-negative myoclonus. [Extracted from the article]

Indian data regarding serious neurological and psychiatric adverse events, following coronavirus disease 2019 (COVID‑19) vaccination, are lacking. We, therefore, systematically evaluated cases of post‑vaccinal serious neurological and psychiatric adverse reactions published from India. A systematic review of cases published from India, which were archived in PubMed, Scopus, and Google Scholar databases, was performed; pre‑print databases along with ahead‑of‑print contents were searched in addition. Retrieved articles, as on June 27, 2022, were evaluated following PRISMA guidelines. EndNote 20 web tool was used to make a PRISMA flow chart. Individual patients’ data were compiled in a tabular form. The protocol of the systematic review was registered with PROSPERO (CRD42022324183). A total of 64 records describing 136 instances of serious neurological and psychiatric adverse events were identified. More than 50% (36/64) reports were from the following four states, namely, Kerala, Uttar Pradesh, New Delhi, and West Bengal. The mean age of persons developing these complications was 44.89 ± 15.77 years. In the majority, adverse events occurred within 2 weeks of administration of the first dose of COVISHIELD vaccine. Immune‑mediated central nervous system (CNS) disorders were identified in 54 instances. Guillain‑Barre syndrome and other immune‑mediated peripheral neuropathies were reported in 21 cases. Post‑vaccinal herpes zoster was recorded in 31 vaccine recipients. Psychiatric adverse events were recorded in six patients. In Indian recipients of COVID‑19 vaccine, a variety of serious neurological complications were reported. The overall risk appears minuscule. Immune‑mediated central and peripheral neuronal demyelinations were the most frequently reported post‑vaccinal adverse events. A large number of cases of herpes zoster have also been reported. Immune‑mediated disorders responded well to immunotherapy. [ABSTRACT FROM AUTHOR]

Background: Prospective studies regarding tuberculous myelitis are lacking. We aimed to prospectively evaluate patients with tuberculous myelitis to identify the features that distinguish tuberculous myelitis from other myelitis. Methods: This was a prospective study. Patients presenting with paraparesis/quadriparesis, and MRI showing myelitis were included. All patients were subjected to clinical, neuroimaging, and laboratory evaluation. Diagnosis of definite tuberculous myelitis was made if GeneXpert test in CSF was positive. Probable tuberculous myelitis was diagnosed if there was evidence of tuberculosis elsewhere in the body. Patients were treated with methylprednisolone and antituberculosis treatment. Patients were followed for 6 months. We compared the clinical, laboratory, and neuroimaging parameters and response to treatment of tuberculous myelitis with other myelitis. P values were adjusted using the Benjamini-Hochberg (BH) procedure to control false discovery rate. Results: We enrolled 52 patients. Eighteen (34.6%) patients had tuberculous myelitis. Headache (P = 0.018) was significantly more common in tuberculous myelitis. The CSF protein (P < 0.001), and CSF cell count (P < 0.001) were significantly higher in tuberculous myelitis. On neuroimaging, a LETM was common in tuberculous myelitis. Spinal meningeal enhancement (14; 77.8%), extra-axial collection, and CSF loculation (6; 33.4%), arachnoiditis (3;16.7%), and concomitant spinal tuberculoma (2;11.1%) were other common imaging features of tuberculous myelitis. Tuberculous myelitis patients showed a better response (P = 0.025) to treatment. Conclusion: Tuberculous myelitis was seen in approximately 35% of all myelitis cases, in a high tuberculosis endemic zone. Headache, markedly elevated CSF protein and spinal meningeal enhancement were distinguishing features. Tuberculous myelitis patients responded well to corticosteroids. [ABSTRACT FROM AUTHOR]

COVID-19 vaccines have brought us a ray of hope to effectively fight against deadly pandemic of COVID-19 and hope to save lives. Many vaccines have been granted emergency use authorizations by many countries. Post-authorization, a wide spectrum of neurological complications is continuously being reported following COVID-19 vaccination. Neurological adverse events following vaccination are generally mild and transient, like fever and chills, headache, fatigue, myalgia and arthralgia, or local injection site effects like swelling, redness, or pain. The most devastating neurological post-vaccination complication is cerebral venous sinus thrombosis. Cerebral venous sinus is frequently reported in females of childbearing age, generally following adenovector-based vaccination. Another major neurological complication of concern is Bell's palsy that was reported dominantly following mRNA vaccine administration. Acute transverse myelitis, acute disseminated encephalomyelitis, and acute demyelinating polyneuropathy are other unexpected neurological adverse events that occur as result of phenomenon of molecular mimicry. Reactivation of herpes zoster in many persons, following administration of mRNA vaccines, has been also recorded. Considering the enormity of recent COVID-19-vaccinated population, the number of serious neurological events is miniscule. Large collaborative prospective studies are needed to prove or disprove causal association between vaccine and neurological adverse events occurring vaccination. [ABSTRACT FROM AUTHOR]

Measles inclusion-body encephalitis (MIBE) is rare, with insights largely from case studies. We systematically analyzed subacute Sclerosing Panencephalitis (SSPE) cases in immunocompromised patients, identifying distinctive clinical and neuroimaging features. These findings could facilitate MIBE diagnosis without the need for brain biopsies. Our systematic review on MIBE and HIV-related SSPE adhered to PRISMA guidelines and was registered with PROSPERO. We searched multiple databases and followed a detailed inclusion process with independent reviews and quality assessment. Data on patient demographics, clinical features, and outcomes were compiled. A review of 39 studies on 49 MIBE patients and 8 reports on HIV-positive SSPE patients was conducted. Acute lymphoblastic leukemia, HIV, organ transplants, and malignancies were common precursors to MIBE. Perinatal HIV was prevalent among SSPE cases. Seizures were the primary symptom in MIBE, often drug-resistant and progressing to status epilepticus or epilepsia partialis continua, whereas periodic myoclonus was universal in SSPE. Neuroimaging showed distinct patterns for each group, and histopathology confirmed measles virus presence in 39% of MIBE cases. MIBE patients typically progressed to coma and death. In conclusion, MIBE and SSPE in HIV-infected patients present with distinct clinical pictures but identical brain pathological abnormalities. [ABSTRACT FROM AUTHOR]

COVID-19 is caused by the coronavirus SARS-CoV-2 that has an affinity for neural tissue. There are reports of encephalitis, encephalopathy, cranial neuropathy, Guillain-Barrè syndrome, and myositis/rhabdomyolysis in patients with COVID-19. In this review, we focused on the neuromuscular manifestations of SARS-CoV-2 infection. We analyzed all published reports on SARS-CoV-2-related peripheral nerve, neuromuscular junction, muscle, and cranial nerve disorders. Olfactory and gustatory dysfunction is now accepted as an early manifestation of COVID-19 infection. Inflammation, edema, and axonal damage of olfactory bulb have been shown in autopsy of patients who died of COVID-19. Olfactory pathway is suggested as a portal of entry of SARS-CoV-2 in the brain. Similar to involvement of olfactory bulb, isolated oculomotor, trochlear and facial nerve has been described. Increasing reports Guillain-Barrè syndrome secondary to COVID-19 are being published. Unlike typical GBS, most of COVID-19-related GBS were elderly, had concomitant pneumonia or ARDS, more prevalent demyelinating neuropathy, and relatively poor outcome. Myalgia is described among the common symptoms of COVID-19 after fever, cough, and sore throat. Duration of myalgia may be related to the severity of COVID-19 disease. Few patients had muscle weakness and elevated creatine kinase along with elevated levels of acute-phase reactants. All these patients with myositis/rhabdomyolysis had severe respiratory complications related to COVID-19. A handful of patients with myasthenia gravis showed exacerbation of their disease after acquiring COVID-19 disease. Most of these patients recovered with either intravenous immunoglobulins or steroids. [ABSTRACT FROM AUTHOR]

Background: Gall bladder cancer (GBC) is associated with abdominal pain, lump, nausea, vomiting, and jaundice due to either gall bladder mass or the involved adjacent peritoneal structures. Gall bladder cancer presenting as refractory epilepsy is rare. Here we report a young female GBC patient who presented with an atypical and refractory frontal lobe seizures as the first manifestation of gall bladder cancer.Case Presentation: A 46 years young female presented first time to the hospital with uncontrolled seizures and headache in 5 months duration. Seizures were very atypical in semiology with ptosis and mydriasis to either side along with ipsilateral ocular deviation. The episodes were bilateral but right eyelid ptosis, mydriasis and right horizontal conjugate deviation were frequent. MRI brain showed encephalomalacia in the left frontal region on axial T2 and coronal T1 weighted images without any enhancement on gadolinium contrast. CECT abdomen revealed a heterogeneously enhancing gall bladder mass with the evidence of lung metastasis from chest CT scan. CSF for malignant cytology was negative. Seizures were refractory to the treatment.Conclusion: Though CNS involvement is uncommon but it can be the only presentation in gall bladder cancer. [ABSTRACT FROM AUTHOR]

Abstract Objective Computed tomography (CT) of the thorax is the imaging modality of choice to detect or demonstrate lesions suggestive of active pulmonary tuberculosis. We aimed to evaluate the imaging abnormalities detected on CT of the thorax in patients with tuberculous meningitis (TBM). Methods In this prospective study, we enrolled consecutive newly-diagnosed patients with TBM. Patients were subjected to detailed clinical evaluation and laboratory investigations including MRI of brain and thoracic CT. Patients were administered WHO recommended treatment and followed-up for 6 months. At 6 months, disability assessment was done. Results We included 81 patients. Fifty-six patients (69.1%) had abnormalities in CT of thorax. Miliary tuberculosis was seen in 10 (18%) patients. Centrilobular nodules were the commonest parenchymal abnormality seen in 23 (41%) patients. Pleural abnormalities and mediastinal lymphadenopathy were seen in 8 (14%) and 47 (84%) patients, respectively. On multivariate analysis, meningeal enhancement (OR = 3.5, 95%CI 1.2–9.8, P = 0.017) and CBNAAT positivity (OR = 8.7, 95%CI 1.0–73.0, P = 0.045) were independently associated with an abnormal CT of thorax. The sensitivity and specificity of CT thorax in identifying definite cases (CB-NAAT positive) of TBM were found to be 93.33% and 36.36%, respectively. Positive predictive value and negative predictive value of abnormal CT thorax in predicting definite TBM were 25% and 96%, respectively. Conclusion CT thorax abnormalities were noted in approximately two-thirds of TBM patients, and were more frequent in definite TBM cases. CT thorax abnormalities helped in upgrading the diagnostic certainty level, in many patients with tuberculous meningitis, from possible to probable. Highlights • CT thorax abnormalities were noted in two-thirds of TBM patients. • On multivariate analysis, meningeal enhancement and GeneXpert MTB/RIF positivity were associated with abnormal CT thorax. • CT thorax abnormalities helped in upgrading diagnostic certainty level from possible to probable. [ABSTRACT FROM AUTHOR]

Abstract Background This study evaluated the prevalence and predictors of venographic abnormalities in tuberculous meningitis. Material and methods Consecutive patients of tuberculous meningitis were included in the study. Clinical evaluation, cerebrospinal fluid examination and contrast-enhanced MRI of brain were done. Every participant was subjected to time of flight magnetic resonance venography (MRV). Presence of filling defects at superior sagittal sinus, dominant transverse or sigmoid sinus, and non-visualization of deep venous system was considered suggestive of thrombosis. The presence of filling defects at non-dominant transverse or sigmoid sinus was considered suggestive of thrombosis only in the presence of corresponding changes in T1, T2, and GRE sequences, parenchymal changes or presence of collaterals. The patients were followed up for 6 months. A modified Barthel index ≤12 at 6 months was taken as poor outcome. Results Out of 107 patients, MRV was found to be abnormal in 12 patients (11.2%). The superior sagittal sinus was the most commonly involved sinus. On univariate analysis, the presence of vomiting (P = 0.004), altered sensorium (P = 0.004), seizures (P < 0.001), vision impairment (P = 0.038), papilledema (P < 0.001), diplopia, oculomotor palsies, basal exudates (P = 0.004) and MBI ≤12 at baseline (P = 0.004) were significantly associated with an abnormal MRV. On multivariate analysis, none of the above factors were found to be significant. No association was found between an abnormal MRV and poor outcome. Conclusion MRV abnormalities suggestive of venous sinus thrombosis can occur in about 11% patients. Superior sagittal sinus is the most commonly involved sinus. An abnormal MRV may not predict a poor outcome in patients with tuberculous meningitis. Highlights • Venous involvement and venous thrombosis in tuberculous meningitis is not known. • Out of 107 patients, MRV was found abnormal in 12 (11.2%) patients. • The superior sagittal sinus was the most commonly involved sinus. • Vomiting, coma, seizures, vision impairment, papilledema, diplopia, oculomotor palsies and basal exudates were associated with abnormal MRV. • No association was found between poor outcome and abnormal MRV. [ABSTRACT FROM AUTHOR]

An editorial is presented which discusses opsoclonus myoclonus syndrome in children, which is a kind of ocular motility disorder characterized by spontaneous, multidirectional, arrhythmic conjugate saccades. It mentions use of adrenocorticotropic hormone therapy, corticosteroids and intravenous immunoglobulins for treatment of opsoclonus myoclonus syndrome. It states that virus like Chikungunya, Dengue, Japanese encephalitis and West‑Nile Virus are responsible for opsoclonus myoclonus syndrome.

Background The factors responsible for seizure recurrence in patients with Solitary calcified neurocysticercosis (NCC) are not well understood. Blood brain barrier (BBB) breach may be associated with seizure recurrence. Dynamic contrast enhanced (DCE) MRI derived indices k ep, k trans and v e are useful in quantifying BBB permeability. In this study, we assessed the possible role of DCE-MRI and matrix metalloproteinases (MMP)-9 levels in predicting seizure recurrence. Methods In this prospective-observational study, patients with new-onset seizures and a solitary calcified NCC were included. DCE-MRI was done to quantify BBB integrity. DCE-MRI parameters were measured as k ep , k trans and v e . MMP-9 levels were estimated. Patients were followed for 1 year, when DCE-MRI and MMP-9 levels were repeated. Patients were classified into two groups on the basis of seizure recurrence, which was defined as the recurrence of an episode of seizure at least 1 week after the initiation of the anti-epileptic drugs. Logistic regression analysis was done. Results At 1-year of follow up, 8 out of 32 patients had seizure recurrence. Baseline DCE-MRI derived k ep (p = 0.015) and MMP-9 levels (p = 0.019) were significantly higher in the seizure “recurrence” group compared with the “no recurrence” group. On within-group analysis, a significant increase in k ep (p = 0.012), v e (p = 0.012), and MMP-9 levels (p = 0.017) was observed in the seizure “recurrence” group while a decrease was seen in v e and MMP-9 levels in the “no recurrence” group. Conclusion Higher values of DCE-MRI indices and MMP-9 levels, with a corresponding trend in the follow-up, can be useful in predicting lesions with a higher propensity for seizure recurrence. [ABSTRACT FROM AUTHOR]

Background Solitary calcified neurocysticercosis is a common cause of seizures in the developing countries. Factors responsible for seizure recurrence in patients with solitary calcified neurocysticercosis are not known. We evaluated the clinical, neuroimaging and biochemical predictors of seizure recurrence. Methods This was a prospective observational study. Patients with new-onset seizures and a solitary calcified neurocysticercosis were included. Patients were evaluated clinically; baseline electroencephalography and magnetic resonance imaging of brain were done for all patients.. The patients were followed for 1 year. Seizure recurrence was defined as the recurrence of an episode of seizure at least 1 week after the initiation of the anti-epileptic drugs. Results Fifty-four patients with a mean age of 20.43 ± 7.34 years were included. Thirteen patients developed seizure recurrence during the follow-up period. On univariate analysis, status epilepticus at presentation (p = 0.025), size of the lesion >10 mm (p = 0.015), presence of perilesional edema (p < 0.001) and scolex (p = 0.033) were significantly associated with seizure recurrence. On multivariate analysis, only presence of perilesional edema (p = 0.018, odds ratio = 12.122, 95% confidence interval 1.521–96.639) was an independent predictor of seizure recurrence. Conclusion Status epilepticus at presentation is associated with an increased risk of seizure recurrence. Neuroimaging features like presence of perilesional edema and scolex can similarly predict seizure recurrence. These neuroimaging features can serve as potential surrogate markers to define therapy in these patients. The findings of our study might be helpful in stratifying patients with a higher risk of seizure recurrence, especially those who may require a more aggressive management. [ABSTRACT FROM AUTHOR]

The article discusses the physiological effects of the element manganese, where excessive exposure to it can cause the disorder called manganism or other neurodegenerative disorders. Topics discussed include the presence of the element in the human body, the activities which can cause manganese exposure like manganese mining, welding and fossil fuel combustion and discussions on the research study regarding manganese neurotoxicity.

Background: Dengue encephalitis is a rare neurological manifestation of dengue fever. Its clinical presentation is similar to other viral encephalitides and encephalopathy. No single specific finding on magnetic resonance imaging of dengue encephalitis has yet been documented. They are highly variable and atypical.Case Presentation: A 15-year boy presented with fever, the headache and altered sensorium of 12-day duration. On neurological examination, his Glasgow Coma Scale score was 10 (E3M4V3). There was no focal neurological deficit. Laboratory evaluation revealed leukopenia and marked thrombocytopenia. Dengue virus IgM antibody was positive both in serum and cerebrospinal fluid. Magnetic resonance imaging of the brain revealed signal changes in bilateral parietooccipital and left frontal regions (left hemisphere more involved than the right hemisphere). There was gyriform enhancement bilateral parietooccipital regions consistent with cortical laminar necrosis. Bilaterally diffuse subcortical white matter was also involved and subtle T2 hyperintensity involving both basal ganglia was noted. Gradient echo sequence revealed presence of hemorrhage in the subcortical white matter. Patient was treated conservatively and received platelet transfusion. Patient became fully conscious after 7 days.Conclusion: In a patient with highly suggestive dengue e\ephalitis, we describe an unusual magnetic resonance imaging finding. This report is possibly the first instance of cortical laminar necrosis in such a setting. [ABSTRACT FROM AUTHOR]

Vision loss is a disabling complication of tuberculous meningitis. Approximately, 15% of survivors are either completely or partially blind. All structures of the visual pathway may be affected in tuberculous meningitis. Optic nerve and optic chiasma are most frequently and dominantly affected. Thick-gelatinous exudates lying over the base of brain, are the pathological hallmark of tuberculous meningitis and are responsible for almost all of its major complications, including vision loss. Strangulation of optic nerves and optic chiasma by the exudates, compression over optic chiasma by the dilated third ventricle, raised intracranial pressure, endarteritis, shunt failure, bacterial invasion of optic nerves and drug-induced optic nerve damage are important reasons that are considered responsible for vision loss. Prompt antituberculosis treatment is the best management option available. Immunomodulatory drugs and cerebrospinal fluid diversion procedures are of limited help. Early recognition and treatment of tuberculous meningitis is the only way forward to tackle this problem. [ABSTRACT FROM AUTHOR]

Background Ventriculo-peritoneal shunt surgery is one of the most commonly performed surgery for the management of tuberculous hydrocephalus. There is decreased clarity on issues regarding the indication as well as timing of cerebrospinal fluid diversion procedures in tuberculous meningitis. We systematically analysed published literature on this subject with an objective to assess the value of cerebrospinal fluid diversion procedures in tuberculous meningitis. Methods A systematic search of literature was performed using PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) for articles published till August 2016. All original studies, irrespective of their design, enrolling at least 10 patients with tuberculous meningitis and hydrocephalus, and in whom the outcome following ventriculo-peritoneal shunt was described, were included in this review. Data was extracted on a pre-formed data extraction sheet. Primary outcome was defined using Glasgow outcome scale (GOS). Results Nineteen studies, comprising of 1038 patients, were included in the review. A majority of patients were children. Good outcome (GOS 5 and 4), following ventriculo-peritoneal shunt, was observed in 58.26% of patients; 78.57% of patients in grade I, 65.35% in grade II and 67.97% in grade III achieved a good outcome while only 31.51% in grade IV could achieve a good outcome. On subgroup analysis, 61.08% of HIV-negative patients achieved a good outcome as compared to only 25% of HIV-positive patients. There were 18.03% deaths in the HIV-negative group as compared to 66.67% deaths in the HIV-positive group after shunt surgery. The rate of complications following ventriculo-peritoneal shunt was 22.11%; shunt blockage, leading to shunt revision, was the most common complication. Majority of included studies were clinically and methodologically heterogeneous. Conclusion Outcome, following ventriculo-peritoneal shunt, depends on the clinical severity of tuberculous meningitis. HIV-infected patients have a worse prognosis when compared with HIV uninfected patients. Compared to children, corresponding data is sparse for adult patients with tuberculous meningitis. [ABSTRACT FROM AUTHOR]

Background: Acute vision loss in the post-partum period can occur due to many reasons. Eclampsia, posterior reversible encephalopathy syndrome (PRES), pituitary apoplexy, and central serous retinopathy are some of the important causes. Cryptococcal meningitis as a cause of acute vision loss in the post-partum period has not been mentioned in literature. Case presentation: A 25-year-old female presented to us with acute bilateral complete vision loss in the post-partum period. Her serum was tested positive for HIV antibodies. Cerebrospinal fluid (CSF) examination revealed cryptococcal meningitis. She was started on amphotericin B, antiretroviral drugs, and steroids. Though symptoms of meningitis resolved after treatment no significant improvement in vision was observed at 3 months. Conclusions: Cryptococcal meningitis may be considered as one of the causes of acute vision loss in pregnant/ post-partum females with human immunodeficiency virus (HIV) positivity. [ABSTRACT FROM AUTHOR]

An editorial is presented which discusses Guillain–Barré syndrome caused by Zika virus. It mentions that Zika virus is a mosquito‑borne flavivirus that is associated with a variety of neurological complications like Guillain–Barré syndrome, myelitis, and meningoencephalitis. It states that Zika‑associated Guillain–Barré syndrome can be treated with plasmapheresis and intravenous immunoglobulins.

Myeloneuropathy is a frequently encountered condition and often poses a diagnostic challenge. A variety of nutritional, toxic, metabolic, infective, inflammatory, and paraneoplastic disorders can present with myeloneuropathy. Deficiencies of vitamin B12, folic acid, copper, and vitamin E may lead to myeloneuropathy with a clinical picture of subacute combined degeneration of the spinal cord. Among infective causes, chikungunya virus has been shown to produce a syndrome similar to myeloneuropathy. Vacuolar myelopathy seen in human immunodeficiency virus (HIV) infection is clinically very similar to subacute combined degeneration. A paraneoplastic myeloneuropathy, an immune-mediated disorder associated with an underlying malignancy, may rarely be seen with breast cancer. Tropical myeloneuropathies are classified into two overlapping clinical entities — tropical ataxic neuropathy and tropical spastic paraparesis. Tropical spastic paraparesis, a chronic noncompressive myelopathy, has frequently been reported from South India. Establishing the correct diagnosis of myeloneuropathy is important because compressive myelopathies may pose diagnostic confusion. Magnetic resonance imaging (MRI) in subacute combined degeneration of the spinal cord typically reveals characteristic signal changes on T2-weighted images of the cervical spinal cord. Once the presence of myeloneuropathy is established, all these patients should be subjected to a battery of tests. Blood levels of vitamin B12, folic acid, vitamins A, D, E, and K, along with levels of iron, methylmalonic acid, homocysteine, and calcium should be assessed. The pattern of neurologic involvement and results obtained from a battery of biochemical tests often help in establishing the correct diagnosis. [ABSTRACT FROM AUTHOR]

Introduction Japanese encephalitis (JE) is one of the most lethal mosquito-borne viral encephalitis seen in India. Toll-like receptors (TLRs) play a critical role in host defence mechanism against flaviviruses causing encephalitis. We assessed whether abnormalities in toll-like receptor (TLR3) increase the susceptibly for JE. Method A total of 103 JE patients (all from an endemic area) and 103 healthy control subjects were examined for TLR3 Leu412Phe polymorphism with the help of polymerase chain reaction (PCR) and genetic sequencing method. Results A significantly higher frequency of Leu412Phe polymorphism was noted in JE patients as compared with healthy controls [mutant (TT) genotype, P-value = 0.019; mutant (TT) + heterozygous (CT) genotype, P-value = 0.013]. Furthermore, frequency of 412Phe allele (T) of TLR3 gene was significantly higher in patients with JE than in controls (P-value = 0.001). There was no significant difference in the distribution of any of the TLR3 Leu412Phe (L412F) polymorphism genotype with death within 1 month. Conclusion TLR3 gene polymorphism might confer host genetic susceptibility to JE in Indian population. TLR3 polymorphism did not affect the mortality. [ABSTRACT FROM AUTHOR]

Background Solitary cysticercus granuloma (SCG) of the brain is the most common type of neurocysticercosis in India. In this study, we evaluated TLR4 polymorphisms in patients with SCG. Methods One-hundred-forty-three patients with SCG and 134 controls were enrolled. Assessment for TLR4 Asp299Gly and Thr399Ile polymorphism was done. TLR4 genotype was determined by PCR-sequencing chain termination method. The patients were followed for 6 months. Results Asp/Gly (P = 0.024) and Thr/Ile (P = 0.004) genotypes were significantly associated with the SCG. The Gly (Asp/Gly plus Gly/Gly) genotype (P = 0.025) and Ile (Thr/Ile plus Ile/Ile) genotype (P = 0.008) were significantly associated with the SCG. Gly/Gly and Ile/Ile genotypes were not significantly associated with SCG (P = 0.767 for Gly/Gly, P = 0.936 for Ile/Ile). At 6 months, TLR4 299Asp/Gly (P = 0.02) and 399Ile/Thr (P = 0.023) polymorphisms were significantly associated with the calcification or persistence of SCG. Conclusions TLR4 polymorphisms are associated with the susceptibility to infection with SCG. [ABSTRACT FROM AUTHOR]

Dengue is associated with many neurological dysfunctions. Up to 4% of dengue patients may develop neuromuscular complications. Muscle involvement can manifest with myalgias, myositis, rhabdomyolysis and hypokalemic paralysis. Diffuse myalgia is the most characteristic neurological symptom of dengue fever. Dengue-associated myositis can be of varying severity ranging from self-limiting muscle involvement to severe dengue myositis. Dengue-associated hypokalemic paralysis often has a rapidly evolving course; benign nature; excellent response to potassium; and, often leads to diagnostic confusion with other dengue-associated neuromuscular disorders. Rhabdomyolysis is the most severe form of muscle involvement and may be life-threatening. Guillain-Barré syndrome is another frequent neuromuscular dengue-associated complication. Dengue-associated Guillain-Barré syndrome responds very well to intravenous immunoglobulins. Predominant spinal gray matter involvement has been reported in a patient presenting with areflexic paraparesis. Mononeuropathies often manifest with paralysis of the diaphragm due to phrenic nerve dysfunction. Brachial plexopathy, in the form of neuralgic amyotrophy, has been described much more frequently than lumbo-sacral plexopathy. Early recognition of these neuromuscular complications is needed for successful treatment and to prevent further disabilities. [ABSTRACT FROM AUTHOR]

Objectives: Corticosteroids have been used in the treatment of Bell's palsy and several other postinfectious neurological conditions. We hypothesized that administration of a single dose of intravenous (IV) methylprednisolone might be an effective alternative to oral prednisolone. Materials and Methods: In this open label, randomized trial, patients with acute Bell's palsy were randomized into two groups. One group received single dose (500 mg) of IV methylprednisolone while the other group received 10 days of oral prednisone. Outcome was assessed at 1 and 3 months with House-Brackmann scale. Results: At 3 months, 93 (79.48%) patients had completely recovered. IV methylprednisolone and oral prednisolone groups had similar recovery rates (80% vs. 78.33%, P > 0.05). Patients with Grade 2 and 3 recovered completely. In patients with Grade 6, the recovery rate was 20%. A better outcome was observed if corticosteroids were administered within 3 days of onset of palsy. Conclusion: Intravenous methylprednisolone and oral prednisolone showed equivalent benefit in patients with acute Bell's palsy. [ABSTRACT FROM AUTHOR]

Objectives: In patients with neurocysticercosis, perilesional inflammatory activity is thought to be responsible for seizures. This study was designed to evaluate the serum and cerebrospinal luid (CSF) concentrations of cytokines as well as matrix metalloproteinase (MMP)-2 and MMP-9 in patients with a solitary cysticercus granuloma. Materials and Methods: The study included 47 patients suffering from seizures in whom a solitary cysticercus granuloma was detected on a computed tomography (CT) scan. The study also included 47 control subjects. Their serum and cerebrospinal luid (CSF) was analysed for cytokines and MMP levels. A follow-up CT was performed after 6 months. Results: The median levels of cytokines, interleukin (IL)-1β, IL-5, IL-6, IL-10 and tissue necrosis factor (TNF)-α, MMP-2 and MMP-9 were significantly elevated, both in the serum and CSF of patients having an intracerebral solitary cysticercus granuloma, in comparison to that of controls. The follow-up CT revealed that in 27 patients, the lesions were calcified and in 5 patients, there was complete resolution of the lesions. In 15 patients, the lesions remained unchanged. Higher baseline CSF MMP-2 and TNF- α level were seen in patients with persisting lesions. Higher serum baseline MMP-2, IL-6 and a low CSF IL-10 level were seen in patients with complete resolution of the granuloma. A high baseline IL-1β level was associated with a calcified lesion. Fourteen patients had recurrence of seizures. A high baseline serum TNF-α level was independently associated with seizure recurrence (P = 0.021, OR = 1.041, CI = 1.006 to 1.078). Conclusion: In patients with a solitary cysticercus granuloma, cytokines and matrix metalloproteinases in the CSF and serum are elevated. Different patterns of immunological changes were observed in patients following resolution or calcification of the lesion. [ABSTRACT FROM AUTHOR]

The article presents summaries of several neuroscience-related papers published in various journals. One paper in the March 2015 issue of the "Journal of Neurosurgery" describes an augmented reality system developed for image-guided neurosurgery. An editorial in Volume 76 of "Neurosurgery" focuses on the role of early endovascular intervention in acute stroke patients.

Purpose: Cerebral hemiatrophy is a common childhood disease. It clinically manifests with seizures, hemiparesis and mental retardation. Materials and Methods: In this prospective study, previously untreated patients with seizures and cerebral hemiatrophy were recruited. Cerebral hemiatrophy was diagnosed on the basis of hemispheric ratio. Patients with acquired hemiconvulsion, hemiplegia, and epilepsy (HHE) syndrome were included in group A. Group B included patients with congenital HHE syndrome. Patients were followed up for 6 months for seizure recurrence. Results: Out of 42 patients 26 were in group A and 16 were in group B. After 6 months, there was significant reduction in seizure frequency (P < 0.0001) in both the groups. At least 50% reduction in seizure frequency was noted in all the patients. Complete seizure freedom was observed in 15 (35.7%) patients. Seizure recurrences were significantly higher (P = 0.008) in group A. On univariate analysis, predictors of seizure recurrences were history of febrile seizures (P = 0.013), hippocampal sclerosis (P = 0.001), thalamic atrophy (P = 0.001), basal ganglia atrophy (P = 0.001), cerebellar atrophy (P = 0.01), ventricular dilatation (P = 0.001), epileptiform discharges at presentation (P = 0.023), complex partial seizures (P = 0.006) and status epilepticus (P = 0.02). On multivariate analysis, hemispheric ratio was the only significant factor for seizure recurrence. Conclusion: Patients with congenital hemiatrophy had better seizure control than that in patients with HHE syndrome. [ABSTRACT FROM AUTHOR]

Objectives: Lennox-Gastaut syndrome is a catastrophic epileptic encephalopathy. In Lennox-Gastaut syndrome, seizures are resistant to pharmacological treatment. In this prospective study, we evaluated the clinical features, neuroimaging, and response to treatment. Materials and Methods: Forty-three consecutive newly diagnosed patients of Lennox-Gastaut syndrome were enrolled in the study. Baseline clinical assessment included seizure semiology, seizure frequency, electroencephalography, and neuroimaging. Patients were treated with combinations of preferred antiepileptic drugs (sodium valproate [VPA], clobazam [CLB], levetiracetam [LVT], lamotrigine [LMT], and topiramate [TPM]). Patients were followed for 6 months. The outcome was assessed using modified Barthel index. Results: Tonic and generalized tonic-clonic forms were the most common seizures types. Features suggestive of hypoxic-ischemic encephalopathy (37.2%) were most frequent neuroimaging abnormality. Neuroimaging was normal in 32.6% of patients. With a combination valproic acid (VPA), CLB, and LVT, in 81.4% of patients, we were able to achieve >50% reduction in seizure frequency. Eleven (25.58%) patients showed an improvement in the baseline disability status. Conclusions: A combination of VPA, CLB, and LVT is an appropriate treatment regimen for patients with Lennox-Gastaut syndrome. [ABSTRACT FROM AUTHOR]

Abstract: This review focusses on paradoxical reactions occurring during the treatment of tuberculous meningitis (TBM) in human immunodeficiency virus-negative cases. A paradoxical reaction is defined as the worsening of a pre-existing lesion or the appearance of new lesion in a patient whose clinical symptoms initially improved with anti-tuberculosis treatment. A number of different paradoxical reactions have been reported in patients with TBM including expansion of existing cerebral tuberculomas, and appearance of new tuberculomas, hydrocephalus, and optochiasmatic and spinal arachnoiditis. While the exact mechanism of paradoxical reactions is uncertain, an exaggerated immune reaction against Mycobacterium tuberculosis-associated antigens is currently the most accepted theory for tuberculous paradoxical reaction. Corticosteroids are considered to have a beneficial effect in the management of paradoxical reactions. Immuno-modulatory drugs, including tumor necrosis factor-α antagonists, thalidomide and interferon-γ have been used in isolated cases with more severe forms of paradoxical reactions. [Copyright &y& Elsevier]

Abstract: Dengue-associated hypokalemic paralysis is considered an important but under-emphasized neuromuscular complication of dengue virus infection. Review of the published literature reveals that 35 instances of hypokalemic paralysis associated with dengue have been recorded from the Indian subcontinent and all but two, were males. The median age of presentation is 29years and moderate to severe grade pure motor quadriparesis is precipitated during the phase of defervescence of moderate to high-grade fever. Recovery starts within 12h of potassium supplementation and is usually complete in a couple of days. Redistribution or increased loss of potassium from the body is speculated as the pathophysiological mechanism involved in the causation of hypokalemia. It is not possible to derive the exact etiopathological correlation from the published literature either due to a lack of comprehensive reporting or inadequate work-up of the patients. Curious is the fact that only 35 patients had manifest-paralysis when more than two-thirds affected with the dengue virus exhibit hypokalemia; whether this indicates a genetically mediated channel disorder or an incidental association remains to be seen. [Copyright &y& Elsevier]

Background: Some important clinical differences exist between human immunodeficiency virus (HIV)-seropositive and HIV-seronegative patients. Alterations in the cerebrospinal fluid (CSF) cytokines and matrix metalloproteinase have been noted in tuberculous meningitis. In HIV-infected patients, the immunopathogenesis is expected to be different. Materials and Methods: In this study, 64 patients of tuberculous meningitis (28 HIV seropositive and 36 seronegative) were included. The patients were followed up for six months. Cerebrospinal fluid (CSF) samples of tuberculous meningitis patients and 20 controls were subjected to tissue necrosis factor (TNF)-α, interleukin (IL)-1β, interferon (IFN)-γ, IL-1β, matrix metalloproteinase (MMP)-2, and MMP-9 estimations. The levels were correlated with the patients’ baseline clinical characteristics, CSF parameters, neuroimaging findings, and the outcome. The outcome was assessed and modified with the Barthel index. Results: The CSF cytokines and MMP levels were significantly elevated in tuberculous meningitis when compared with the controls. There was no significant difference seen between HIV seropositive and seronegative tuberculous meningitis, except for the IL-1β level, which was significantly lower in the HIV-infected patients. The cytokine and MMP levels did not correlate with the baseline clinical characteristics, disease severity, cerebrospinal fluid characteristics, neuroimaging findings, and outcome. Conclusion: In conclusion, HIV infection did not affect a majority of the CSF cytokines and MMP levels in tuberculous meningitis except for IL-1β level. None of the estimated inflammatory parameters correlated with the outcome. [ABSTRACT FROM AUTHOR]

Background: Some important clinical differences exist between human immunodeficiency virus (HIV)-seropositive and HIV-seronegative patients. Alterations in the cerebrospinal fluid (CSF) cytokines and matrix metalloproteinase have been noted in tuberculous meningitis. In HIV-infected patients, the immunopathogenesis is expected to be different. Materials and Methods: In this study, 64 patients of tuberculous meningitis (28 HIV seropositive and 36 seronegative) were included. The patients were followed up for six months. Cerebrospinal fluid (CSF) samples of tuberculous meningitis patients and 20 controls were subjected to tissue necrosis factor (TNF)-α, interleukin (IL)-1β, interferon (IFN)-γ, IL-1β, matrix metalloproteinase (MMP)-2, and MMP-9 estimations. The levels were correlated with the patients’ baseline clinical characteristics, CSF parameters, neuroimaging findings, and the outcome. The outcome was assessed and modified with the Barthel index. Results: The CSF cytokines and MMP levels were significantly elevated in tuberculous meningitis when compared with the controls. There was no significant difference seen between HIV seropositive and seronegative tuberculous meningitis, except for the IL-1β level, which was significantly lower in the HIV-infected patients. The cytokine and MMP levels did not correlate with the baseline clinical characteristics, disease severity, cerebrospinal fluid characteristics, neuroimaging findings, and outcome. Conclusion: In conclusion, HIV infection did not affect a majority of the CSF cytokines and MMP levels in tuberculous meningitis except for IL-1β level. None of the estimated inflammatory parameters correlated with the outcome. [ABSTRACT FROM AUTHOR]

Introduction: Acute confusional state/delirium is a frequent cause of hospital admission, in the elderly. It is characterized by an acute fluctuating impairment of cognitive functions and inattention. Recognition and prompt treatment is crucial to decrease the morbidity and mortality associated with it. Materials and Methods: In this retrospective study, we determined the etiology and prognostic factors of an acute confusional state. A total of 52 patients of acute confusional state were clinically evaluated. All patients were also subjected to a battery blood biochemical examination, cerebrospinal fluid analysis and neuroimaging. Disability was assessed by using modified Barthel index (MBI). Patients were followed-up for 3 months. Results: The mean age of our cohort was 65.04 ± 10.6 years. 32 (61.5%) patients were male. In 33 patients, we were able to identify possible precipitating cause of an acute confusional state. In the rest of the patients results of all the tests were normal. Leukocytosis and hyponatremia were frequent factors associated with delirium. The mean duration of the hospital stay was 10.73 ± 3.6 days (range 5-21 days). Patients with an abnormal work-up (possible precipitating cause) had significantly lower mortality, less duration of hospital stay and less severe disability after 3 months. Age, underlying illness, serum creatinine, abnormal neuroimaging and MBI were identified as a significant prognostic indicator. 18 (34.6%) of our patients died, of these in 10 patients we could not find a precipitating cause. Conclusion: Patients, in whom a cause was found out, had better prognosis in terms of lesser mortality and the duration of hospital stay. [ABSTRACT FROM AUTHOR]

Introduction: Acute confusional state/delirium is a frequent cause of hospital admission, in the elderly. It is characterized by an acute fluctuating impairment of cognitive functions and inattention. Recognition and prompt treatment is crucial to decrease the morbidity and mortality associated with it. Materials and Methods: In this retrospective study, we determined the etiology and prognostic factors of an acute confusional state. A total of 52 patients of acute confusional state were clinically evaluated. All patients were also subjected to a battery blood biochemical examination, cerebrospinal fluid analysis and neuroimaging. Disability was assessed by using modified Barthel index (MBI). Patients were followed-up for 3 months. Results: The mean age of our cohort was 65.04 ± 10.6 years. 32 (61.5%) patients were male. In 33 patients, we were able to identify possible precipitating cause of an acute confusional state. In the rest of the patients results of all the tests were normal. Leukocytosis and hyponatremia were frequent factors associated with delirium. The mean duration of the hospital stay was 10.73 ± 3.6 days (range 5-21 days). Patients with an abnormal work-up (possible precipitating cause) had significantly lower mortality, less duration of hospital stay and less severe disability after 3 months. Age, underlying illness, serum creatinine, abnormal neuroimaging and MBI were identified as a significant prognostic indicator. 18 (34.6%) of our patients died, of these in 10 patients we could not find a precipitating cause. Conclusion: Patients, in whom a cause was found out, had better prognosis in terms of lesser mortality and the duration of hospital stay. [ABSTRACT FROM AUTHOR]

This study was aimed to determine the prognostic factors in medically treated patients of spinal tuberculosis. In this longitudinal observational study, from July 2010 to December 2011, 70 consecutive patients (40 males and 30 females) spinal tuberculosis were enrolled. Diagnosis of spinal tuberculosis was based on characteristic clinical and neuroimaging features. Diagnosis was histopathologically and/or bacteriologically verified. Patients received antituberculous treatment as per World Health Organization guidelines and were followed for 6 months. Disability was evaluated with modified Barthel index (MBI). Outcome was defined as good (MBI > 12) and poor (MBI ≤ 12). Various clinical and neuroimaging parameters, likely to affect the outcome, were analyzed using univariate and multivariate analysis. After 6 months, 45 patients had a good outcome, while 25 patients had a poor outcome. On univariate analysis, duration of illness >6 months (OR 0.062, CI 0.018–0.212), bladder involvement (OR 0.102, CI 0.033–0.317), spinal deformity (OR 0.050, CI 0.013–0.196), spastic paraparesis (OR 0.572, CI 0.190–1.723), and flexor spasms (OR 0.077, CI 0.021–0.280) were found as important clinical predictors of poor outcome. Involvement of more than 2 vertebrae (OR 0.095, CI 0.028–0.328), complete collapse (OR 0.072, CI 0.022–0.241), cord compression (OR 0.025, CI 0.003–0.204), spinal extension of the abscess (OR 0.044, CI 0.005–0.350), and thick/septate abscess wall (OR 0.062, CI 0.016–0.240) were the neuroimaging parameters associated with poor prognosis. However, on multivariate analysis, duration of illness >6 months (Exp-b 0.086, CI 0.019–0.378), cord compression (Exp-b 0.035, CI 0.003–0348), and spinal extension of the abscess (Exp-b 0.109, CI 0.017–0.91) were significant. Medical management results in clinical improvement in a majority of the patients of spinal tuberculosis. Duration of illness >6 months, cord compression, and spinal extension of abscess are associated with poor outcome. [ABSTRACT FROM AUTHOR]

Highlights: [•] Patients with refractory seizures were assessed with diffusion tensor tractography. [•] We evaluated 33 patients of, lesional and non-lesional, refractory epilepsy. [•] Diffusion changes were detected both ipsilateral and contralateral to the lesion. [•] Microstructural changes were also observed in patients with normal imaging. [•] Our findings may help in epilepsy surgery planning and prognostication. [ABSTRACT FROM AUTHOR]

Abstract: Background: Micturitional disturbances in tuberculous meningitis have been reported infrequently and that too without urodynamic studies. Bladder dysfunction in tuberculous meningitis is often considered secondary to tuberculous radiculomyelopathy. We, in this study, evaluated the incidence and pattern of bladder dysfunction in tuberculous meningitis. Materials and method: In this prospective study, 51 patients were included. In addition to clinical evaluation, patients were subjected to a urodynamic study along with magnetic resonance imaging (MRI) of brain and spine. Patients were followed up for 6months. A follow-up urodynamic study was performed after 6months. Results: Out of 51 patients, urinary symptoms were present in one-third of the patients. Approximately, 70% (36) of the patients had urodynamic abnormalities. The commonest (22/51) urodynamic abnormality was detrusor hyporeflexia/areflexia. Other urodynamic abnormalities were neurogenic detrusor overactivity in 10, detrusor sphincter dyssynergia in 6, normal detrusor activity in 19, reduced bladder sensation in 12, raised cystometric capacity in 9, and larger volumes of post-void residual urine in 12 patients. Six patients were unable to void on command. Three patients with neurogenic detrusor overactivity had leak during study. MRI showed spinal meningeal enhancement in 37, lumbosacral arachnoiditis in 25, myelitis in 12 patients, CSF loculations in 6, and cord atrophy in 5 patients. Spinal arachnoiditis and urinary symptoms showed significant association with urodynamic abnormalities. Follow-up urodynamic study showed resolution of urodynamic abnormalities in 72.6% of the patients with treatment. Seven (28%) patients, with normal baseline urodynamic findings, paradoxically developed new abnormalities. Conclusion: Bladder dysfunctions, in tuberculous meningitis, are frequently encountered. A significant association exists between urodynamic abnormalities and tuberculous lumbosacral arachnoiditis and myeloradiculopathy. [Copyright &y& Elsevier]

Abstract: Impairment of vision is a devastating complication of tuberculous meningitis which may occur as a result of increased intracranial pressure, compression over the visual pathways or vasculitis. We herein present occurrence of neuroretinitis in a 35-year-old lady presenting with low grade fever and headache for one month, and associated with diminution of vision from 3weeks. She was diagnosed as a case of definite tuberculous meningitis and initiated on anti-tuberculous treatment as per WHO guidelines with supplemental corticosteroids. Marked improvement in vision was observed and at 3months of follow-up the patient was asymptomatic. Direct ophthalmoscopy, visual field analysis, fluorescein angiography, optical coherence tomography and magnetic resonance imaging of the brain were done to document the ophthalmological findings. Neuroretinitis, being an unusual cause of visual impairment in tuberculous meningitis, must be considered in patients without any evidence of raised intracranial pressure or compression, and with normal fluorescein angiography. We suggest that neuroretinitis may be added to list of causes of visual impairment in patients with tuberculous meningitis. [Copyright &y& Elsevier]

Transient signal abnormality in the splenium of corpus callosum on magnetic resonance imaging (MRI) is occasionally encountered in clinical practice. It has been reported in various clinical conditions apart from patients with epilepsy. We describe 4 patients with different etiologies presenting with signal changes in the splenium of corpus callosum. They were diagnosed as having progressive myoclonic epilepsy (case 1), localization-related epilepsy (case 2), hemicrania continua (case 3), and postinfectious parkinsonism (case 4). While three patients had complete involvement of the splenium on diffusion-weighted image ("boomerang sign"), the patient having hemicrania continua showed semilunar involvement ("mini-boomerang") on T2-weighted and FLAIR image. All the cases had noncontiguous involvement of the splenium. We herein, discuss these cases with transient splenial involvement and stress that such patients do not need aggressive diagnostic and therapeutic interventions. An attempt has been made to review the literature regarding the pathophysiology, etiology, and outcome of such lesions. [ABSTRACT FROM AUTHOR]

Abstract: Background: Albendazole therapy has been found effective in solitary cysticercus granuloma. An optimal duration of albendazole therapy is not exactly known. Even 3-day therapy has been found effective. Methods: We included 105 patients of new-onset seizures and solitary cysticercus granuloma. We compared 3-day albendazole therapy and 15-day therapy with a control group. Each group had 35 patients. This was an open-label randomized trial. Patients were followed for 6months. MRI was done after 6months. Seizure recurrences during follow-up were noted. Results: After 6months, albendazole group, in comparison to placebo group, had significantly higher proportion (43/70 versus 13/35) of patients in whom lesion had disappeared. Albendazole treatment for 15days was insignificantly better in comparison to 3-day treatment regimen. In 15-day albendazole group lesser number of lesions (2.8%) was calcified than 3-day albendazole group (8.57%) or no treatment group (20%). After 6months of follow-up, seizure recurrence was seen in 20 (19%) patients. The majority (15/20) of patients, experiencing seizure recurrence, had an abnormal follow-up MRI. Five patients had seizures despite normal MRI. Conclusion: In conclusion, albendazole was significantly better in producing lesion resolution. A 15-day treatment with albendazole was better than 3-day treatment. Albendazole, possibly, led to less number of lesions got calcified and possibly, there was less risk of seizure recurrence. [Copyright &y& Elsevier]

Abstract: Background: Cranial nerve involvement is commonly observed in patients with tuberculous meningitis. The present study evaluated the incidence, predictors and prognostic significance of cranial nerve involvement in tuberculous meningitis. Materials and method: One hundred-fifty-eight adult patients with tuberculous meningitis were retrospectively evaluated and followed up for 9months. A detailed clinical evaluation and cranial magnetic resonance imaging were done in every patient. Result: At inclusion, 60 (38%) patients had cranial neuropathy. Sixteen patients were having involvement of two or more cranial nerves. Abducent nerve was the most frequently (32.3%) affected cranial nerve. Predictors of cranial nerve involvement were age >25years, history of vomiting, altered sensorium, hemiparesis, diplopia, papilledema, signs of meningeal irritation, severe functional disability, cerebrospinal fluid protein >2.5g/L and cerebrospinal fluid cell count >100/mm3. The presence of optochiasmatic arachnoiditis and hydrocephalus was also a significant predictor of cranial neuropathy. Presence of cranial neuropathy was significantly associated with poor outcome. Conclusion: Cranial nerve involvement occurred in more than one third of patients with tuberculous meningitis. The presence of cranial neuropathy was associated with poor outcome. [Copyright &y& Elsevier]

Abstract: Background: Solitary cysticercus granuloma – a benign form of parenchymal neurocysticercosis – is considered as the most common cause of partial seizures. This study comparatively evaluated the seizure-related prognosis in patients with new-onset seizure having solitary cysticercus granuloma and in patients with normal neuroimaging. We also assessed the factors of seizure recurrence. Material and method: Seventy-four patients of new-onset partial seizure with solitary cysticercus granuloma and 45 patients of new-onset partial seizure with normal neuroimaging were followed up for 6months. A follow-up neuroimaging was carried out after 3months. Result: Thirteen patients (17.6%) in solitary cysticercus granuloma group and 15 patients (33.3%) in normal neuroimaging group had seizure recurrences (P =0.049). In solitary cysticercus granuloma group, family history of seizure disorder (P =0.004), headache (P =0.029), and serial seizures (at onset) (P =0.001) were significantly associated with the seizure recurrence. Granuloma remained unresolved in all patients. In patients with normal neuroimaging, abnormal EEG (P =0.043), at inclusion, was only a significant factor of the seizure recurrence. Conclusion: The patients with solitary cysticercus granuloma had favorable seizure-related prognosis when compared with patients having normal neuroimaging. Serial seizures and headache predicted seizure recurrence in patients with solitary cysticercus granuloma. The presence of electroencephalographic abnormality predicted seizure recurrence in patients with normal neuroimaging. [ABSTRACT FROM AUTHOR]

Abstract: Background: Acute dengue myositis is characterized by fever and myalgia (with or without muscle weakness). Method: The 7 cases of acute dengue myositis were retrospectively evaluated in the present study. Dengue myositis was diagnosed on the basis of a clinical picture consistent with the infection, elevated creatine phosphokinase, normal CSF, positive serum IgM for dengue virus, and the exclusion of other causes. Results: The mean age of patients was 19.4 (range 3–40) years. Majority (5) of the patients were male. In our series 3 of the cases suffered from fulminant myositis. They were characterized by generalized weaknesses which included the respiratory muscles. All the 3 patients had markedly elevated creatine phosphokinase levels (ranging from 16,590 to 117,200IU/L). Two patients suffering from fulminant myositis required mechanical ventilation. However, they succumbed to their illnesses. The third patient showed signs of improvement. One case had paraparesis and an elevated creatine phosphokinase level. However, a spontaneous complete recovery was observed. The remaining 3 cases had quadriparesis with trunk and neck weaknesses, sparing of respiratory muscles, creatine phosphokinase levels up to 3000U/L. However, a complete recovery was observed in these patients within 4weeks. Conclusion: To conclude, early respiratory involvement, high creatine phosphokinase values, and severe myalgia suggest a severe form of dengue myositis. [ABSTRACT FROM AUTHOR]

Tuberculosis is the most common opportunistic infection in human immunodeficiency virus (HIV) infected persons. HIV-infected patients have a high incidence of tuberculous meningitis as well. The exact incidence and prevalence of tuberculous meningitis in HIV-infected patients are not known. HIV infection does not significantly alter the clinical manifestations, laboratory, radiographic findings, or the response to therapy. Still, some differences have been noted. For example, the histopathological examination of exudates in HIV-infected patients shows fewer lymphocytes, epithelioid cells, and Langhan's type of giant cells. Larger numbers of acid-fast bacilli may be seen in the cerebral parenchyma and meninges. The chest radiograph is abnormal in up to 46% of patients with tuberculous meningitis. Tuberculous meningitis is likely to present with cerebral infarcts and mass lesions. Cryptococcal meningitis is important in differential diagnosis. The recommended duration of treatment in HIV-infected patients is 9-12 months. The benefit of adjunctive corticosteroids is uncertain. Antiretroviral therapy and antituberculosis treatment should be initiated at the same time, regardless of CD4 cell counts. Tuberculous meningitis may be a manifestation of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. Some studies have demonstrated a significant impact of HIV co-infection on mortality from tuberculous meningitis. HIV-infected patients with multidrug-resistant tuberculous meningitis have significantly higher mortality. The best way to prevent HIV-associated tuberculous meningitis is to diagnose and isolate infectious cases of tuberculosis promptly and administer appropriate treatment. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The symptomatic central nervous system involvement is often seen in patients with miliary tuberculosis. Materials and methods: In this study, we evaluated 60 consecutive miliary tuberculosis patients, who presented with some neurological manifestations. Evaluation included neurological examination, a battery of blood tests, HIV serology, sputum examination, cerebrospinal fluid (CSF) examination along with imaging of the brain and spinal cord. The patients were followed up after completion of 6 months of antituberculous treatment. Results: Patients ranged between 14 and 53 years in age. Three patients tested HIV positive. Forty-eight (80%) patients had tuberculous meningitis. In 12 (20%) patients, the CSF examination was normal. In 27 patients with tuberculous meningitis, neuroimaging revealed intracerebral tuberculoma. Fourteen patients showed multiple tuberculomas, while 7 had a solitary tuberculoma. In six patients, the tuberculomas were small and numerous. In two patients, neuroimaging revealed a spinal tuberculoma. For three patients with tuberculous brain masses, the CSF was normal. Nine (15%) patients presented with myelopathy. Three patients exhibited Pott''s paraplegia. Three patients had transverse myelitis (with normal neuroimaging). In three patients, the spinal MRI revealed an intramedullary tuberculoma. On follow-up, 15 (25%) patients expired. Thirty-one (52%) patients showed significant improvement. Eight patients (13%) showed nil or partial recovery. Six of the patients with no improvement developed vision loss. Six (10%) patients were lost to follow up. Conclusion: A variety of neurological complications were noted in military tuberculosis patients, tuberculous meningitis and cerebral tuberculomas being the most frequent complications. However, a majority of patients improved following antituberculous treatment. [Copyright &y& Elsevier]