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Background: Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) within 4.5 hours of symptom onset is currently approved for treatment of acute ischemic stroke. It improves the rate of favourable outcomes despite the risk of hemorrhagic transformation. Aim: To study the outcomes of IV thrombolysis. Materials and methods: All patients who came to the emergency with in window period with signs and symptoms suggestive of acute ischmeic stoke were included in the study. CT brain plain was done to rule out ICH. Base line glucose and BP was recorded. NIHSS was calculated. Patients whose score was between 5-25 were given IV thrombolysis with rTPA or tenecteplase. Drug was given according to availability and it was free of cost Results: Total of 41 patients was given thrombolysis. 28 were given alteplase and 13 were given tenecteplase. Improvement in NIHSS was 3.34 points at the time of discharge. Almost 40% improved significantly improved in follow up mRS scores Conclusion: Our study concluded that thrombolysis for ischemic stroke provides early functional ability and decreased morbidity without any significant risk of bleeding
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Background: IIH is defined as an elevated intracranial pressure but no clinical, laboratory or radiological evidence of hydrocephalus, infection, tumor or vascular abnormality. Aim: To study the clinical and radiological profile of Idiopathic Intracranial Hypertension (IIH). Materials and methods: Total 31 IIH cases were studied. Patients were subjected to Fundoscopy, CT/MRI brain and CSF analysis. Results: Females were predominant and Headache was the most common presenting symptom. All patients had papilledema. Mean CSF pressure was 318.1 mm of H2O. MRI findings included prominent subarachnoid space, vertical tortuosity of optic nerves, flattening of posterior sclera. Conclusion: IIH predominantly affects women with headache being the most common symptom. Medical management and Life style medication is mostly useful. Surgical management is imperative in patients with impending vision loss.
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Background: Idiopathic epilepsy is defined as disorder in which there is no underlying cause or structural pathology other than a possible hereditary predisposition for generating seizures which can be generalized or focal in nature. Objective: To study the occurrence of executive dysfunction in patients with idiopathic epilepsy and its association with age, gender, seizure type, duration of epilepsy, age at seizure onset, antiepileptic drug therapy and seizure control &the association of the interictal EEG pattern. Materials and methods: 100 cases of epileptic patients with normal CT scan brain / MRI brain were studied. Frontal Assessment Battery &The Executive Interview (EXIT) were used to assess the executive functions. Results: The FAB score were normal in 46% and abnormal in 54% of the cases. Executive dysfunction as per the FAB score was mild in 32% and moderately severe in 22% of the cases. Impairment in Executive function as per EXIT score was mild in 84% and moderate in 16 % of the cases. Executive Dysfunction was more in cases with either primary or secondarily generalized seizures, cases with a higher seizure frequency, longer duration of epilepsy, uncontrolled epilepsy and seen in 17.5% with normal and 10% cases with an abnormal EEG. Conclusion: Our study found a significant proportion of patients with idiopathic epilepsy have Executive Dysfunction, which adds to the seizure burden by reducing the capacity of an individual to successfully engage in self-care, social, academic and occupational pursuits.
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Background: Human Immunodeficiency Virus (HIV) infection is a global pandemic, India has second largest burden of HIV illness. Nervous system is most frequent and serious target of HIV infection. Aim: The main aim of our study was to evaluate the occurrence of various neurological manifestations in HIV positive patients and to correlate them with CD4 count at the time of presentation. Materials and methods: This prospective study was carried out for a period of 2 years from January 2014 to December 2016 in the Department of Neurology, Gandhi Hospital, Hyderabad, India. Those patients, who satisfied the inclusion criteria (>18 year of age; HIV positive; any gender) were included in our study. Patients who were HIV positive but having non neurological medical conditions were excluded. Those with various neurological symptoms were subjected to thorough neurological examination, whenever indicated neuroimaging, CSF analysis, NCS, Toxoplasma serology were done. CD4 count was done in all patients. KameraSateesh Kumar, VeenaNarisetty, P. Chandra Shekar, Changala Praveen, AlluriNeeraja. A clinical study of neurological manifestations in HIV positive patients in a tertiary care hospital of Telangana, India. IAIM, 2018; 5(1): 42-49. Page 43 Results: Our study enrolled a total of 1011 HIV positive patients, out of them 354(35%) patients had neurological manifestations. Among them, 239 (67.51%) were male and115 (32.48%) were female. We analyzed patients presented with various neurological symptoms, 187(52%) patients presented with parasthesias. CD4 count was done to all patients. Out of 354 patients, 188 (39.4%) patients had low CD4 count (<200μL). NCS was abnormal in 182 (51.4%) patients. Axonal sensory neuropathy was the most common abnormality found in 82 (45.0%) patients. The most common neurological manifestation was peripheral neuropathy, seen in 166 (46.8%) patients. Conclusion: HIV infection can affect all levels of the neuronal axis. Neurological manifestations are common in 4th decade of life and males affect more than females. Peripheral neuropathy was the most common neurological manifestation and Tuberculosis was the prominent infectious etiology. Neurological manifestations are seen with low CD4 count and there is a significant correlation between them hence can be stated that, these are the manifestations of the late stage of the disease.
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Background: Posterior reversible encephalopathy syndrome (PRES) is a clinic-radiological syndrome comprising of seizures, disturbed vision, altered mental function and headache in various combinations developing over hours. The most common risk factor being abrupt or accelerated hypertension, renal failure, immunosuppressive therapy, eclampsia, autoimmune disease and infections. MRI Brain is the gold standard for diagnosis PRES generally has a favorable prognosis, but neurological sequale and even fatalities can occur in some cases. Aim: The Aim of the study was to Review the clinical and neuroimaging findings in patients diagnosed with Posterior reversible encephalopathy syndrome (PRES). Material and methods: This was a Prospective study done for duration of 2 years from December 2014 to November 2016 in the Department of Neurology, Gandhi Medical College, Hyderabad, Telangana, a tertiary care teaching hospital in south India. The study group patients were selected from pool of inpatients and out patients from various specialities and subspecialities as neurology, internal medicine, obstetrics and gynecology, pediatrics and nephrology. Results: A total of 60 PRES patients included in the study. In the present study age group varied from 15 years to 65 years. Majority of cases 50% (30/60) were among 26-35 years age group. This was in accordance with majority of pregnant population in our series. Female to male ratio was 4:1. Highest incidence of cases i.e., 40% (24 /60) was with eclampsia, followed by autoimmune disease in 20% cases (12/60). 90% patients had predominant parieto-occipital hyper intense lesions on MRI. M Manjusha, Veena Narisetty, Sateesh Kumar Kamera, Dhairyawan Pokalkar. To study clinical and neuroimaging findings in posterior reversible encephalopathy syndrome (PRES). IAIM, 2017; 4(11): 137-143. Page 138 Conclusion: In the present study the mean age of presentation was 32 years and higher prevalence (85 %) was seen in females. Eclampsia is the commonest cause of PRES. Majority of patients are hypertensive with mean BP being 182/112 mm hg while normotensive PRES seen in sepsis