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Background: Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by autonomic and inflammatory features. There is paucity of data regarding sustained benefits of any treatment modality. We aimed to document the effect of steroids in CRPS on long-term basis.Materials and Methods: We came across five patients of CRPS in Out Patient clinics of super-speciality Institutes in North India. All five cases fulfilled the Budapest criteria for the diagnosis of CRPS. All of them received prednisolone and were prospectively followed up for 2 years. Treatment outcome was carefully recorded in all affected modalities.Results: All five cases were found to have excruciating neuropathic pain in defined regions along with cutaneous manifestations. Osseous changes in the form of surface erosion of underlying bones in four cases and marked marrow edema leading to considerable increase in bone thickness in one case were noted. All these features improved considerably following steroid therapy. Bone marrow edema and bone resorption showed improvement on serial imaging.Conclusion: Apart from pain relief, steroids therapy is capable of reversing the osteo-cutaneous autonomic changes of CRPS type I. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recurrent strokes cause greater complications and worse outcomes by adding to the existing neurological deficit. There is the paucity of data on serum markers of inflammation as predictors of recurrent stroke. This study was planned to analyze the clinico-etiological profile of recurrent noncardioembolic ischemic stroke, estimate aspirin resistance among regular aspirin users and evaluate blood biomarkers high-sensitivity C-reactive protein (hsCRP), Tumor necrosis factor-alpha (TNF-a), Lipoprotein-associated phospholipase A2 (Lp-PLA2) as probable predictors of stroke recurrence. METHODS: Patients of recurrent noncardioembolic ischemic stroke fulfilling the inclusion criteria were enrolled. Detailed history, clinical examination, and investigations were obtained as per protocol. Aspirin resistance was determined by light transmission aggregometry. Serum hsCRP, TNF-a, and Lp-PLA2 levels were estimated. RESULTS: This study included 34 males and 16 females. Majority of the patients were > 60 years (n = 30, 60%). Thirty (60%) cases had a repeat stroke after 1 year of primary event. Thirty-nine (78%) study participants had hypertension, while 15 (30%) had diabetes. Middle cerebral artery (n = 40, 80%) was the most common vascular territory. Thirty-one (62%) cases belonged to TOAST subtype 1 (large artery atherosclerosis). Seventy two percent cases were prescribed aspirin after index stroke, but only 36% were compliant. Median (range) hsCRP level was 7.5 (0.3-155) mg/L with 72% of patients having high hsCRP level (>3 mg/L). Median (range) serum PLA2 level was 11.98 (3.31-87.24) ng/ml in patients and 6.96 (0.15-61.42) ng/ml in controls (P = 0.029). Median (range) serum TNF-a level in patients was significantly higher than controls (68.22 [1.3-287] pg/ml versus 0.098 [0.002-36.31] pg/ml, P < 0.001). Aspirin resistance was found in 41.7% patients while 16.7% were semi-resistant. Mean % platelet aggregation was 34.75 ± 21.58 in patients and 64.75 ± 16.98 for controls (P < 0.001). CONCLUSIONS: Majority of patients with recurrent stroke were elderly (>60 years), hypertensive, and non-compliant with aspirin. Aspirin resistance was an important factor in patients with antiplatelet compliance. Inflammatory biomarkers hsCRP, PLA2, and TNF-a were found to be significantly elevated in patients compared to controls. [ABSTRACT FROM AUTHOR]

Intracerebral pneumocephalus is commonly associated with head and facial trauma, ear infection, tumors and surgical interventions. Osteomas are relatively common, benign tumors that occur mainly in the paranasal sinuses, the frontal sinus in particular. Pneumocephalus has been commonly reported with frontal osteoma but isolated presentation as frontotemporal dementia is uncommon. Patient was admitted with complaints of change of behavior and forgetfulness for the last one year. He had progressively become more apathetic and presented with behavioral abnormalities. General physical examinations were within normal limits including the motor and sensory system although neuropsychiatry assessments were below the average level, with features of dementia. Further, MRI brain revealed pneumocephalus in bilateral frontal lobe. CT cisternography revealed a well defined lobulated densely sclerotic lesion of approximate size 20 × 17 × 27mm transverse and cranio-caudal axis respectively arising from right ethmoid sinus. Clinically, the association of pneumocephalus and isolated presentation as frontotemporal dementia has not been described to the best of our knowledge. A single case has been described with ethmoid osteoma. Radiological features were suggestive of osteoid osteoma. The uniqueness of the case is the development of dementia with frontotemporal involvement and resemblance with Frontotemporal Dementia. This is the only case with dementia and pneumocephalus (secondary to osteoid osteoma) to best of our knowledge. [ABSTRACT FROM AUTHOR]

Psychogenic non-epileptic seizures (PNES) are epilepsy like episodes which have an emotional rather than organic origin. PNES is thought as result of tension/distress which piles up in an individuals and show physical symptoms in form of seizures. Individuals with PNES can neither process, perceive or communicate their emotional problem nor modulate their emotional state. However, the psychopathology of PNES is poorly understood. Research on etiology of PNES suggests the role of multiple psychiatric and neurological factors. Present study aimed at examining alexithymia and emotional regulation in epilepsy and PNES patient group. For this purpose thirty participants out of which PNES (n = 15) and epilepsy (n = 15) were selected from Sir Sunder Lal Hospital, BHU. Participants were administered with Toronto Alexithymia Scale which measure emotional identification/recognition problem in patients and Difficulties in Emotional Regulation Scale (DERS) to measure emotion regulation difficulties and responses were obtained on two separate administration. Mean score, standard deviation and t-test was calculated which was significant which shows that PNES patient were more alexithymic and emotionally dysregulated than epileptic group. [ABSTRACT FROM AUTHOR]

Objective: The aim is to compare the retinal nerve fiber layer (RNFL) thickness of longitudinally extensive transverse myelitis (LETM) eyes without previous optic neuritis with that of healthy control subjects. Methods: Over 20 LETM eyes and 20 normal control eyes were included in the study and subjected to optical coherence tomography to evaluate and compare the RNFL thickness. Result: Significant RNFL thinning was observed at 8 o’clock position in LETM eyes as compared to the control eyes (P = 0.038). No significant differences were seen in other RNFL measurements. Conclusion: Even in the absence of previous optic neuritis LETM can lead to subclinical axonal damage leading to focal RNFL thinning. [ABSTRACT FROM AUTHOR]

Psychogenic non-epileptic seizures (PNES) are episodes of altered movement, sensation or experience which are similar to epilepsy but caused by psychological process and not associated with abnormal discharges in the brain. Because of its somatic and psychiatric manifestation it neither falls in medical nor in mental health domain. Mostly, PNES are frequently misdiagnosed as epileptic seizures which risks patient's life. The global prevalence of PNES is estimated to about 2-33%/100,000 per year. Moreover, patient referred to epilepsy care unit of which 5 to 33% are PNES, 10 to 40% (PNES) of refractory seizures, among which mostly are women (75%) with age range of 20 to 30 years. Diagnosis of PNES is complicated by possible co-morbidity with epilepsy and other somatic co-morbidities like chronic pain, headache, sleep disturbances, asthma, obesity and other psychiatric disorders. The gold standard to diagnose patient of PNES is video-encephalography (V-EEG) although it has pitfalls. No single mechanism of event or contributing factor has been identified to be necessary to explain PNES, usually it is assumed as an unintentional manifestation of emotional distress which can be explained on the basis of neurophysiological, psychological and social base. Till now no accepted protocol for the treatment of PNES exists because of varied underlying mechanism that have triggered PNES and which do exist is not for long period and differs individually. The future suggested treatment intervention should include these three arms i.e. neurological, cognitivebehavioural and psychopharmacological intervention. [ABSTRACT FROM AUTHOR]

An isolated and unilateral foot drop due to intracranial lesion is quite rare. Presenting herein a case of a 14-year-old female who complained of inability to wear and hold slipper in her left foot. Detailed neurological examination revealed left foot dorsiflexion which had 1/5 muscle power along with brisk left ankle reflex. Magnetic resonance imaging of the brain revealed multiple conglomerate inflammatory granulomas in cerebrum and cerebellum, larger one in right parasagittal region with perifocal oedema. Magnetic resonance spectrum was suggestive of tuberculoma. Her chest X-ray chest revealed milliary shadowing. She was put on antitubercular drugs, steroid and a prophylactic anti-epileptic drug. The dorsiflexion improved to grade 4/5 after three weeks of treatment. The motor homunculus for foot is located in parasagittal area. Therefore, in patients with foot drop, we must keep high index of suspicion for parasagittal lesions, so that prompt diagnosis and early management can be done to prevent complications and improve the quality of life of patient. [ABSTRACT FROM AUTHOR]

Dolichoectatic arteries are elongated tortuous aneurysms of intracranial arteries most commonly of vertebrobasilar tree presenting with ischaemic, haemorrhagic, thromboembolic lesions or with cranial nerve compression. The clinical presentation includes tic douloureux, neuralgia, tinnitus, vertigo, motor or sensory deficits, ataxia, dementia, Parkinsonism, hydrocephalus, headache, migraine, aneurysm, neoplasm, stroke/ transient ischaemic attacks, leukoencephalopathy, central sleep apnoea and cerebellar dysfunctions. We present a case of recurrent facial nerve palsy secondary to vertebrobasilar dolichoectasia, an interesting and rare condition. [ABSTRACT FROM AUTHOR]

The article highlights entrapment neuropathy secondary tubercular nerve abscess, which is unlike entrapment neuropathy secondary to Hansen's disease that is common in Southeast Asia and Indian subcontinent.