Bilateral medial medullary syndrome secondary to Takayasu arteritis.

Medial medullary syndrome (MMS) is a rare type of stroke which results due to occlusion of the anterior spinal artery or vertebral artery or its branches. In this case report we present a patient who developed MMS secondary to Takayasu arteritis (TA). TA is a chronic inflammatory arteritis primarily involving the arch of aorta and its branches, which in our patient resulted in occlusion of subclavian arteries as well as infarction of the medial medulla bilaterally. To our knowledge this is the first time that MMS has been found to occur secondary to TA.

Calcified embolism: a rare cause of cerebral infarction.

Calcified cerebral emboli (CCE) are a rare cause of stroke and these emboli can be identified on a CT scan of the brain performed for the initial evaluation of stroke. In this report we present a patient who developed a CCE following cardiac catheterisation that lodged in the left middle cerebral artery with resultant right hemiparesis and aphasia. The calcified embolus was seen on CT but could not be identified on MRI. Predisposing factors for CCE include angiography and valve or vessel wall calcification. The natural history and response to standard therapy in patients with CCE as compared with stroke of other aetiologies have not been studied until now. Increased awareness and ability to identify calcified emboli will help us to have an improved understanding of strokes resulting from CCE.

Global aphasia without hemiparesis: A case series.

BACKGROUND: Global aphasia without hemiparesis (GAWH) is a rare stroke syndrome characterized by the unusual dissociation of motor and language functions. Issues regarding its etio-pathogenesis, lesion sites, and recovery patterns are extensively being debated in contemporary neuroscience literature. MATERIALS AND METHODS: Four patients admitted in our hospital between 2005 and 2009 with GAWH caused by ischemic stroke were studied retrospectively with emphasis on number and site of lesions, etiology, and recovery patterns. RESULTS: The clinical findings from our subjects showed that GAWH could result from either single/multiple lesions including subcortical lesions. The recovery was rapid, although not complete. One case evolved into Wernicke's aphasia as seen in earlier studies. Two subjects revealed evolution to transcortical sensory aphasia and one to Broca's aphasia which is distinct from previous proposals. Two cases showed lack of clinico-anatomic correlation during recovery. CONCLUSIONS: GAWH could result from both embolic and large vessel strokes and single or multiple lesions. The recovery pattern may be variable and may show lack of clinico-anatomical correlation indicating anomalous cerebral functional reorganization, questioning the conventional teaching of language representation in the brain.

Evaluation of knowledge of and attitudes toward epilepsy among the health science students of Manipal University.

This study was carried out to assess the knowledge, attitudes, and practices with respect to epilepsy among health science students of Manipal University. The study was conducted among first-year health science students of Kasturba Medical College on the Manipal and Mangalore campuses of Manipal University. All students willing to participate (n=587) were asked to answer a standardized questionnaire on epilepsy. Our study group included educated urban people from various ethnic backgrounds of various countries who chose health science as a career, which makes the study different from others. Even though most of the students had heard about epilepsy, very few knew about the underlying cause. Most of the students were ignorant about the drugs and ways to deal with epileptic seizures. Questions related to community and religion were deliberately avoided as some subjects found such questions offensive, which may have resulted in a difference in response as compared with previously published studies. It was observed that a large number of students were not aware of the nuances of epilepsy. However, we expect the knowledge, attitudes and awareness to improve considerably with time and increased exposure. These findings support a need to promote epilepsy awareness programs as a means of increasing public knowledge of epilepsy.

Estimation of salivary protein thiols and total antioxidant power of saliva in brain tumor patients.

BACKGROUND: The role of oxidative stress in the genesis of various types of cancers is well established. Several chemical, cell culture and animal studies also indicate that antioxidants may slow or even prevent the development of cancer. Brain is considered abnormally sensitive to oxidative damage as brain tissue has high rate of oxygen consumption, high lipid content and relatively low antioxidant defenses, compared to other tissues. MATERIALS AND METHODS: The study design chosen for the present study was cross sectional. The biochemical parameters that were estimated in saliva manually using spectrophotometric methods were ferric reducing antioxidant power (FRAP) assay--a direct measure of total antioxidant activity of biological fluids and protein thiols. The physical parameters of saliva that were also assessed were salivary flow rate, pH of the saliva and the osmolality of the saliva. RESULTS: The mean values of salivary flow rate and pH were significantly decreased among malignant and benign tumor patients whereas the salivary osmolality was significantly increased in both the groups of patients. The mean values of salivary FRAP were significantly reduced among malignant and benign tumor patients. However, the salivary protein thiols were significantly increased in these patients. CONCLUSION: Hence with these observations it can be concluded that in saliva, besides the physical characteristics, salivary FRAP and protein thiol levels are appropriate indicators of the antioxidant status in brain tumor patients.

Sporadic Creutzfeldt-Jakob disease--a review.

The objective is to study a patient with sporadic Creutzfeldt-Jakob disease (CJD). The patient, a 70-year-old woman with a history spanning over 1 month, with acute onset, progressive abnormal behavior, and cognitive decline with generalized asymmetrical myoclonic jerking, startle phenomenon, and cortical blindness, was referred to the hospital. On observation of clinical symptoms, metabolic and hematological investigations, MRI (magnetic resonance imaging), and EEG (electroencephalogram) were done. The clinical symptoms, MRI, and diagnostic EEG were suggestive of sporadic CJD. Other metabolic encephalopathies were ruled out. With sodium valproate and clonezepam, her myoclonic jerks improved slightly. As CJD is an incurable disease, no definitive treatment could be given.

Plasma protein oxidation in patients with brain tumors.

OBJECTIVE: Proteins can undergo numerous covalent changes on exposure to oxidants. Oxidative modification of protein in vivo may affect a variety of cellular functions. Protein oxidation in vivo is a natural consequence of aerobic life. Oxygen radicals and other activated oxygen species generated as byproducts of cellular metabolism or from environmental sources cause modifications to the amino acids of proteins that generally result in loss of protein function/enzymatic activity. It is now well known that reactive oxygen species (ROS) play a key role in human cancer development. Moreover, the brain is especially vulnerable to ROS mediated injury. METHOD: Therefore, in the present study, protein oxidation was assessed in the plasma of 17 patients with brain tumors and 16 age and gender-matched controls by measuring protein thiols and protein carbonyls spectrophotometrically. RESULTS: There was a significant decrease in protein thiols and carbonyls in malignant cases of brain tumors when compared with the control group. No significant change in protein thiols was noted in benign cases compared to controls. A comparison of levels in benign and malignant cases for both the parameters also showed no significant difference. DISCUSSION: Thus, free radical toxicity does lead to protein oxidation in patients with brain tumors.

Lipid peroxidation, hemolysis and antioxidant enzymes of erythrocytes in stroke.

Erythrocyte membrane lipid peroxidation and consequent percentage hemolysis and related antioxidant enzymes viz., superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase were determined in 16 cases of hemorrhagic stroke and 30 cases of thrombotic stroke. The results obtained were compared with 50 age and sex matched controls. 12 thrombotic stroke patients who showed symptomatic recovery after medication were considered for follow up. Lipid peroxidation and percentage hemolysis in patients with thrombotic stroke and hemorrhagic stroke was significantly elevated when compared to controls. Glutathione reductase and superoxide dismutase levels were found to be significantly reduced in thrombotic stroke and hemorrhagic stroke respectively, when compared to healthy subjects. There was no significant difference in the other parameters when compared to controls. In post treatment thrombotic stoke, catalase and glutathione reductase levels increased significantly and oxidative hemolysis decreased compared to their pretreatment values. Thus, our results indicate considerable oxidative stress in stroke.

Free radical toxicity and antioxidants in Guillain-Barre syndrome, a preliminary study.

BACKGROUND: The generation of reactive oxygen species (ROS) has been implicated in the pathogenesis of a vast array of disease processes including some neurological disorders. METHOD: Ten patients with Guillain-Barre syndrome (GBS) and 10 age and sex-matched controls were included in this study. The erythrocyte glutathione (GSH), superoxide dismutase (SOD) and malondialdehyde (MDA) levels, as well as plasma antioxidant vitamins C and E and serum glutathione-S-transferase (GST) levels were estimated spectrophotometrically. RESULTS: The plasma vitamin E and the serum total glutathione-S-transferase levels were markedly increased in both pre- and post-treated cases of GBS when compared to controls. The erythrocyte glutathione and malondialdehyde levels were significantly reduced in GBS cases when compared to normals. However, plasma vitamin C and erythrocyte superoxide dismutase were not altered when compared to controls. CONCLUSION: Free radical toxicity may have an influence in patients suffering from GBS.