An Analysis of Clinico-radiological Features and Outcome in Patients with Longitudinally Extensive Transverse Myelitis.

Background: Longitudinally extensive transverse myelitis (LETM) is an immune-mediated neurological disorder affecting the spinal cord. It may be associated with the demyelination of the brain and optic nerves. Clinical features, radiological picture, and treatment outcomes vary depending on the etiology. Objectives: To assess different etiologies of LETM and analyze their differences in clinicoradiological features and treatment outcome. Materials and Methods: It is a single-center retrospective cross-sectional observational study. A total of 42 patients presented with LETM to our center for over 10 years (2010-2019) were included in this study. Their clinical, radiological, CSF findings, treatment, and neurological status (at nadir and 6 months) assessed by the EDMUS scoring system were compared and presented in this study. Results: In this study, 80% of patients were females, with the highest female predominance noted in NMOSD (87%). Among various etiologies, 16 patients had NMOSD, seven were idiopathic, five had connective tissue disease, and four were due to infective etiology. Bladder involvement was seen predominantly in patients with infective and systemic causes, whereas respiratory muscle involvement was seen predominantly with infective etiology. More than six-segment involvement was seen predominantly in idiopathic cases. All Ro-52 positive patients had relapses. NMOSD had a better neurological outcome than other etiology. Conclusions: NMOSD is the most common cause of LETM, with a good neurological outcome at 6 months, while infective etiology had a poor neurological recovery. NMOSD with Ro-52 antibody positivity had relapses despite being on immunosuppressant therapy.

Wasp sting - Causing a fatal menace.

Wasp stings are seen routinely in emergency setup, especially in developing countries. They result in varied manifestations, including both local and systemic reactions. Neurological complications, like stroke, are infrequent in the presentation. A 40-year-old healthy male presented with two episodes of generalized tonic-clonic seizures with left dense hemiplegia after 6 h of massive wasp stings. Local manifestations of urticaria, redness, and itching were present over the face, neck, and upper limbs. Magnetic resonance imaging showed massive infarct in the anterior and middle cerebral artery regions with right internal carotid artery thrombosis. An echocardiogram showed severe left ventricular dysfunction with no evidence of clot, and the carotid duplex study was normal. Systemic manifestations such as anaphylactic shock, stroke, and myocarditis are rare, fatal, and life-threatening. We must be aware of these most unusual and possible complications following a hymenopteran sting.

Prevalence of Non-motor Symptoms in Parkinson's Disease and Its Impact on Quality of Life in Tertiary Care Center in India.

CONTEXT: Parkinson's disease (PD) is a neurodegenerative disease characterized by traditional motor features. Non-motor symptoms (NMS) are also seen in PD, which inevitably emerge through the disease progression and are often under-recognized and untargeted. AIMS: We studied the prevalence of NMS in PD and their impact on health-related quality of life (HRQoL). MATERIALS AND METHODS: A cross-sectional observational study from January 2017 to July 2017 of PD patients (n = 100) was done. NMS and HRQoL are measured using NMS scoring scale; PD questionnaire-39 and Hoehn and Yahr scale, respectively. Motor symptoms were assessed using scales for outcome in Parkinson's disease (SCoPA) - motor scoring scale. STATISTICAL ANALYSIS: Descriptive statistics calculated for NMS' prevalence. Continuous variables were assessed by two-tailed t-test and discrete and categorical variables by chi-square test. Multiple linear regression analysis was done among scoring scales to identify the influence on 39-item Parkinson's disease questionnaire (PDQ-39) scoring scale. All statistical data collected are analyzed with SSPS software version- 20 for windows. RESULTS: In 100 study population, 66 were males and 34 females. The mean age was 68.35 years and median onset of duration of PD was 3.49 with 64.6% on treatment. Fatigue, pain, and lightheadedness were more prevalent NMS with 78%, 75%, and 69%, respectively. With regression analysis, strongest predictor was NMSS score (P = 0.000), with each unit increase, it is associated with nearly 0.65 increase in PDQ-39 score. CONCLUSION: Though motor symptoms define the disease, NMS have a larger impact on HRQoL in PD and on caregiver's life. Understanding the pattern and effect of NMS is needed for targeted treatment strategies.