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.

Role of serotonin transporter and receptor gene polymorphisms in treatment response to selective serotonin reuptake inhibitors in major depressive disorder.

OBJECTIVE: Significant challenges in the management of major depressive disorder include the lag period from treatment initiation to an evident response, low response rates and unpredictable disparities in outcome between patients. As a large part of these has been linked to genetic mechanisms, we tried to establish a relationship between genes associated with serotonin neurotransmission and outcome to selective serotonin reuptake inhibitor (SSRI) treatment. METHODS: One hundred and twenty-five patients with moderate to severe depression [at least 15 on the Hamilton Depression (HAM-D) Rating Scale] being started on SSRI were recruited. Those with a reduction of at least 50% from baseline or an absolute score of 7 or less after 8 weeks of treatment were considered as responders. The serotonin transporter linked polymorphic region 5HTTLPR, serotonin transporter intron 2 (STin2) polymorphism and the 5-HT receptor 1A rs6295 polymorphisms were studied in association with outcome. RESULTS: The l/l genotype of the 5HTTLPR was associated with greater likelihood of response (OR: 4.65, CI: 1.74-12.38, p = 0.003). Patients with the 12/12 repeat variant of the STin2 VNTR polymorphism showed a greater reduction in HAM-D score, compared to patients with the 10/10 genotype (OR: 0.12, CI: 0.03-0.44, p = 0.001). We found no association of the 5HTR1Ars6295 polymorphism with response. CONCLUSIONS: The 5HTTLPR polymorphism and the SLC6A4 intron 2 polymorphism were associated with treatment response, with the l/l genotype and 12-copy allele showing a tendency towards better outcomes, respectively.

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.

Carotid Stump Syndrome: An Uncommon Cause of Recurrent Ipsilateral Strokes.

Carotid stump syndrome is a rare cause of recurrent cerebrovascular accidents. Carotid stump is the patent proximal remnant below the completely occluded internal carotid artery (ICA). Cerebral and retinal ischemic symptoms seen after complete occlusion of ipsilateral ICA is known as carotid stump syndrome. Known for causing recurrent ipsilateral cerebrovascular accidents, it is a potentially treatable entity. The therapeutic goal is medical management with a statin, dual anti-platelet therapy along with surgical intervention either with an endovascular repair or carotid endarterectomy. Herein, we present a case of carotid stump syndrome managed medically.

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.

'Enemy within': an interesting cause for anemia during warfarin therapy for atrial fibrillation.

The oral anticoagulant warfarin is a vitamin K antagonist and is considered the first line anticoagulant in valvular atrial fibrillation. However prothrombin time should be closely monitored, drug interactions checked and compliance regarding diet ensured when the patient is on warfarin therapy. Anaemia should be looked for, evaluated for the cause and corrected since it is an independent predictor of bleeding and thrombotic episodes during warfarin therapy for atrial fibrillation We present an interesting case of anaemia which developed during warfarin therapy for atrial fibrillation. The patient was on amiodarone and was consuming leafy vegetables resulting in frequent raise in prothrombin time during which time she developed bleeding into the right femoral pseudoaneurysm which had developed following catheterisation for thrombectomy. Surgical correction of pseudoaneurysm was done, comedication was changed and diet compliance ensured which resulted in the subsequent maintenance of prothrombin time in the therapeutic range and steady haemoglobin levels.

EEG Database of Seizure Disorders for Experts and Application Developers.

This article presents an online accessible electroencephalogram (EEG) database, where the EEG recordings comprise abnormal patterns such as spikes, poly spikes, slow waves, and sharp waves to help diagnose related disorders. The data, as of now, are a collection of EEGs from a diagnostic center in Coimbatore, Tamil Nadu, India, and the data samples pertain to an age-group ranging from 1 to 107 years. Eventually, the EEG data concerning other disorders as well as those from other institutions will be included. The present database provides information under the following categories: major classification of the disorder, patient's record, digitized EEG, and specific diagnosis; in addition, a search facility is incorporated into the database. The mode of access by the domain experts, application developers, and researchers, along with a few classical applications are explained in this article. With the advance of clinical neuroscience, this database will be helpful in developing software for applications such as diagnosis and treatment.