Journal of Neurosciences in Rural Practice


Issue 03 · Volume 13 · April 2022
DOI: 10.1055/s-011-52215
  • Sutar R. Epidemiological Risk Factors of Suicidal Behavior in Medical Students. Journal of Neurosciences in Rural Practice 2022; 13: (3) 357'
    Abstract
    None.


  • Mercuri V, Armocida D, Paglia F, Patrizia G, Santoro A, D'Angelo L. Giant Prolactinoma Embedded by Pseudoaneurysm of the Cavernous Carotid Artery Treated with a Tailored Therapeutic Scheme. Journal of Neurosciences in Rural Practice 2022; 13: (3) 358-69'
    Abstract
    The coexistence of intracranial aneurysm (IA) is generally thought to be highest in patients with pituitary adenomas (PAs). Different mechanisms may play a role in aneurysm formation, but whether the PA contributes to aneurysm formation is still unclear. In the literature, there are numerous reported cases of this association; however, the analyses of the characteristics of PAs, aneurysms, and treatment management are rare and limited to a restricted number of case reports. We report a rare case of an embedded aneurysm in a macroprolactinoma treated with therapeutic management tailored to the clinical, neurological, and radiological characteristics of the patient. To select the best treatment, we reviewed the literature and reported the only cases in which the radiological characteristics of aneurysms, PAs, therapeutic management, and patient outcome are described. We aimed to understand what are the variables that determine the best therapeutic management with the best possible outcome. The presence of a large pseudoaneurysm of the internal carotid artery completely embedded in a giant macroprolactinoma is rare and needs a tailored treatment strategy. The importance of the preoperative knowledge of asymptomatic IA coexisting with PA can avoid accidental rupture of the aneurysm during surgical resection and may lead to planning the best treatment. A high degree of suspicion for an associated aneurysm is needed, and if magnetic resonance imaging shows some atypical features, digital subtraction angiography must be performed prior to contemplating any intervention to avoid iatrogenic aneurysmal rupture. Our multimodal approach with the first-line therapy of low-dose cabergoline to obtain prolactin normalization with minimum risks of aneurysms rupture and subsequent endovascular treatment with flow diverter has not been described elsewhere to our knowledge. In the cases, we suggest adopting a tailored low-dose cabergoline therapy scheme to avoid rupture during cytoreduction and initiate a close neuroradiological follow-up program..


  • Azzam M, Fahmi A, Utomo B, Faris M, Parenrengi MA, Sudiana IK, et al.. The Effect of ACTH(4-10) PRO8-GLY9-PRO10 Administration on the Expression of IL-6 and IL-8 in Sprague Dawley Mice with Spinal Cord Injury. Journal of Neurosciences in Rural Practice 2022; 13: (3) 370-5'
    Abstract
    Background Spinal cord injury (SCI) is a significant cause of morbidity since it results in the inflammation process which leads to necrosis or apoptosis. Inflammatory response to the tissue damage increases IL-6 and IL-8 levels. ACTH4 - 10Pro8-Gly9-Pro10 is a peptide community that has been shown to have a beneficial effect on minimizing the morbidity and increasing the recovery time. Methods This study is a true experimental laboratory research with a totally randomized method. The subjects were animal models with light and extreme compression of spinal cord, respectively. Results The administration of ACTH 4-10 in mild SCI in the 3-hour observation group did not show a significant difference in IL-6 expression compared with the 6-hour observation group. The administration of ACTH 4-10 in severe SCI showed a significantly lower expression level of IL-6 in the 3-hour observation group compared with the 6-hour one. The administration of ACTH 4-10 in severe SCI led to a significantly lower IL-8 expression in the 3-hour observation group compared with the 6-hour one. However, there was no significant difference in IL-8 expression in the group receiving ACTH 4-10 in 3 hours observation compared with that in 6 hours observation. Conclusion The administration of ACTH4-10Pro8-Gly9-Pro10 can reduce the expression of IL-6 and IL-8 at 3-hour and 6-hour observation after mild and severe SCI in animal models. Future research works are recommended..


  • Ajayan N, Christudas J, Morris L, Hrishi AP. An Entropy-Based Prospective Randomized Controlled Trial to Evaluate the Analgesic and Hypnotic Effects of Equipotent Doses of Sevoflurane and Isoflurane in Patients Presenting for Spine Surgeries. Journal of Neurosciences in Rural Practice 2022; 13: (3) 376-81'
    Abstract
    Objectives Minimal alveolar concentration (MAC) of anesthetic agents has been considered a suitable measure of the potency of inhalational anesthetics. Furthermore, it is assumed that equi-MAC concentrations of different anesthetic agents have a similar potency in suppressing responses to painful stimuli. Isoflurane and sevoflurane are two commonly used volatile anesthetic agents in spine surgeries. Therefore, these agents' hypnotic and analgesic potencies should be distinguished and comprehended for the optimal administration of anesthesia. Consequently, we undertook this study to compare the analgesic and hypnotic potencies between these agents at equi-MAC concentrations, using the entropy monitor. Materials and Methods Forty patients undergoing lumbar spine surgery were randomly assigned to two groups receiving either isoflurane ( n = 20) or sevoflurane ( n = 20). After induction, maintenance of anesthesia was done with age-corrected 1.0 MAC of either isoflurane or sevoflurane. A standardized noxious stimulus was provided to all the patients after achieving a steady state of 1.0 MAC. The state entropy (SE), response entropy (RE), and RE-SE were recorded at baseline, prestimulus, and poststimulus time points in both groups. Statistical Analyses Data are presented as frequency and percentages for categorical variables and mean +/- standard deviation for continuous variables. The comparison of categorical variables between the two groups was made using the Fisher's exact test, and the Student's t -test was used for continuous variables. A p -value of < 0.05 was considered to be statistically significant. Results At age-corrected 1.0 MAC, there was no significant difference in the SE, RE, and RE-SE in both the groups at any time point. Conclusion Our study shows that during a steady state of age-corrected 1.0 MAC single-agent anesthesia, sevoflurane and isoflurane have comparable analgesic and hypnotic potencies as measured by entropy indices when a standardized nociceptive stimulus is provided..


  • Garg S, Chauhan A, Singh S, Bansal K. Epidemiological Risk Factors of Suicidal Behavior and Effects of the Components of Coping Strategies on Suicidal Behavior in Medical Students: A North-Indian Institution-Based Cross-Sectional Study. Journal of Neurosciences in Rural Practice 2022; 13: (3) 382-92'
    Abstract
    Background Mental stresses and adoption of poor coping strategies can be a cause of suicidal behavior in medical students. Objective The aim of this study is to evaluate the prevalence and risk factors of suicidal behavior, and effects of the components of coping strategies on suicidal behavior among medical students Methodology An institution-based cross-sectional study was conducted among medical students of a college located in North India for a period of 2 months from February to March 2021. A total of 531 study participants (calculated sample size) were selected, and then allocated proportionally to each academic year, both through stratified random sampling technique. Then, the participants were asked to complete a self-administered questionnaire consisting of sociodemographic characteristics, Patient Health Questionnaire-9, Suicidal Behaviors Questionnaire-Revised (SBQ-R), and coping inventory. A pretest was done to modify the coping inventory and then exploratory factor analysis was performed on it to classify the components of coping strategies. Chi-square test and multiple logistic regression analysis were used to determine the risk factors and their association with suicidal behavior. Results A total of 104 (19.6%) respondents had reported SBQ-R cutoff score > 7 and had suicidal behavior. The rate of lifetime suicidal ideation, plan, and attempt was 20.3, 10.3, and 2.3%, respectively, among medical students, with 1-year prevalence of suicidal ideation at 33%. The mean age of the participants was 21.26 years (standard deviation = 1.99). The identified risk factors significantly associated with higher suicidal behavior were depression (odds ratio [OR] = 9.6), dissatisfaction with academic performances (OR = 4.9), and coping with mental disengagement (OR = 4.6), while coping with supportive strategies (OR = 0.57) was investigated as a preventive factor for the suicidal behavior. Conclusion The prevalence of suicidal behavior is found to be highly alarming, revealing that depression and poor coping strategies are risk factors among medical students. The analysis recommends that quantification of the problems, treatment at an early stage, and proactive student counseling to help them embrace the appropriate coping strategies, should be the first steps in prevention of suicidal behavior..


  • Vranda MN, Kumar CN, Janardhana N. Developing a Screening Tool for Mental Health Professionals for Measuring Intimate Partner Violence among Women with Mental Illness at Tertiary Care Setting. Journal of Neurosciences in Rural Practice 2022; 13: (3) 393-7'
    Abstract
    Background Intimate partner violence (IPV) is the major public health issue seen in all cultures. Mental health professionals play a significant role in screening IPV and providing needed care and support to the survivors. There is a dearth of scale to measure comprehensively different dimensions of violence. The study aimed to develop a screening tool for measuring IPV among women with mental illness (WwMI) in India. Methods The newly developed IPV scale was administered to 200 WwMI at a tertiary care hospital. Results The factor analysis revealed four factors constituted 67.15% of the variance. The internal consistency Cronbach's alpha (0.92) and split-half reliability coefficient value (0.80) for the final 31-item IPV scale were found to be highly adequate and reliable. Conclusion Psychometric properties of scale found to be an effective tool for screening IPV among WwMI by mental health professionals and planning effective intervention strategies to prevent the IPV..


  • Ikwuegbuenyi CA, Patil SN, Nie JW, Bankole OB, Mehta AI. Effects of COVID-19 on Neurosurgical Service: Perspective from a Tertiary Medical Center in Nigeria. Journal of Neurosciences in Rural Practice 2022; 13: (3) 398-402'
    Abstract
    Background The outbreak of COVID-19 caused a significant impact on neurosurgical case volume in Nigeria due to the widespread recommendation to minimize elective procedures and redistribute healthcare resources to support COVID-19 patients. This study aims to analyze the effect of COVID-19 in one tertiary care Nigerian hospital on the demographic characteristics, diagnostic classes, and elective/non-elective procedure statuses. Methods A retrospective single-center chart review study was conducted to review all patients undergoing a neurosurgical procedure between March to June in 2019 and 2020. Descriptive data on patient age, gender, sex, diagnosis, surgical procedure, elective/non-elective surgery status, and month and year of admission were recorded. Diagnoses were categorized into one of seven types by author review. Pearson's Chi-Square and Fisher's Exact Tests were utilized to test for independence of the categorical variables to the year of patient admission, and a Welch two-sample t-test was used to test for a significant difference in mean age between the two cohorts. Results A total of 143 cases were reviewed. There was a 59.8% reduction in overall neurosurgical case volume with an 82% reduction in elective procedures (39 vs. 7, p = 0.017, 95% CI: 1.15 - 8.77) between 2019 and 2020. No significant differences were noted in patient cohorts when comparing demographic characteristics, diagnosis type, or month of admission between the two years. Conclusion There was a significant reduction in elective neurosurgical procedures during the early months of COVID-19 in Nigeria. Further studies should consider examining the effects of COVID-19 into 2021..


  • Gowda VK, Hiremath R, Gornale V, Shivappa SK, Benakappa N, Benakappa A. A Randomized Controlled Trial on the Study of Effectiveness and Safety of Hormonal (ACTH) Treatment Alone versus Hormonal (ACTH) with Levetiracetam for Epileptic Spasms. Journal of Neurosciences in Rural Practice 2022; 13: (3) 403-10'
    Abstract
    Background West's syndrome (WS) is a triad of epileptic spasms (ESs), psychomotor delay, and hypsarrhythmia. The treatment of ESs is still controversial. Hence, we designed a randomized controlled trial (RCT) to compare the outcomes in children with WS treated with adrenocorticotropic hormone (ACTH) alone versus ACTH and levetiracetam (LEV). Objectives To compare the treatment outcomes and side effects in children treated with ACTH alone versus ACTH and LEV. Methods This prospective randomized controlled trial was conducted from December 2017 to May 2019 in tertiary care center, Bangaluru. Children from 2 months to 5 years of age, diagnosed with WS were included. Fifty children in each group were analyzed for efficacy and side effects. Results There was no difference in the baseline characteristics in both groups. There was no difference in spasms response at the end of 2 weeks between the groups (88 vs. 82%) with p -value of 0.813. The relapse rates were less in ACTH and LEV group (20%) compared with ACTH alone (22%) but statistically not significant ( p > 0.1). There was no difference observed in subsequent epilepsy rates (18%) in ACTH versus 19% in ACTH with LEV group ( p > 0.1) and side effects. There was improvement in milestones 48% in ACTH with LEV group versus 37% in ACTH alone however statistically not significant ( p > 0.1). Conclusion There was no difference in children treated with ACTH alone versus ACTH and LEV in terms of control of spasms and subsequent epilepsy rates. The relapse rate is less, and developmental outcome is better in ACTH with LEV group but statistically not significant..


  • Bhat A, Biswas A. Cognitive Profile of Large-Vessel Vascular Dementia-An Observational Study from a Tertiary Care Center in Kolkata. Journal of Neurosciences in Rural Practice 2022; 13: (3) 411-6'
    Abstract
    Introduction Vascular dementia is the second leading cause of dementia worldwide. Its heterogenous presentation along with potential for reversibility at earlier stages makes it unique among all dementias. Objectives We aimed to study the cognitive dysfunction in large-vessel vascular dementia. Second, we tried to study the cognitive dysfunction in large-vessel vascular dementia as per the arterial territory involvement. Additionally, we also tried to study the contribution of hemispheric involvement to the dementia severity as evidenced by clinical dementia rating (CDR) scale. Materials and Methods We recruited 28 patients of large-vessel vascular dementia and categorized them on the basis of the arterial territories and hemisphere involved. The groups were later studied for the type of cognitive and behavioral dysfunctions as well as the dementia severity. Results Among 28 patients of large-vessel vascular dementia, attention (100%), executive function (100%), and behavior (100%) were more impaired in anterior cerebral artery territory infarcts ( p < 0.05). Language (53.8%) and memory (53.8%) were more impaired in middle cerebral artery territory infarcts, while visuoperceptual (33.3%) domains were more impaired in posterior cerebral artery territory infarcts ( p > 0.05). The mean CDR was lower in patients of right-sided lesions (1.292) than in those with left-sided (1.750) or bilateral lesions (2.000). Conclusion Different arterial territory lesions have different patterns of cognitive impairment in large-vessel vascular dementia. The dementia severity is less in right-sided lesions when compared with left-sided or bilateral lesions..


  • Kumar A, Mudassir S, Sinha N, Babanrao WB, Ranjan A. Stroke in Tuberculous Meningitis and Its correlation with Magnetic Resonance Angiography Manifestations. Journal of Neurosciences in Rural Practice 2022; 13: (3) 417-23'
    Abstract
    Objective The primary objective of the study was to assess the location of cerebral infarction and look for corresponding magnetic resonance angiography (MRA) changes in patients with tuberculous meningitis (TBM). We also evaluated the predictors of ischemic stroke in TBM and the impact of these infarctions on patient's outcome. Methods This was a single-center prospective study between September 2018 and September 2020. Demographic and laboratory parameters were noted. Cranial magnetic resonance imaging and MRA were performed at the time of admission to the hospital. Results Among 120 patients with TBM, 46 had stroke. Nineteen (15.8%) patients died, of which 12 (10%) suffered from stroke. The most common site of infarction was the basal ganglia (54.3%). The commonest site of MRA abnormalities was the middle cerebral artery (39.1%). British Medical Research Council (BMRC) stage 3, cerebrospinal fluid (CSF) sugar, CSF adenosine deaminase (ADA) level, basal exudates, hydrocephalus, and hyponatremia were found to be predictors of stroke in TBM, while BMRC stage 3, CSF cell count, CSF ADA level, and anemia were found to be significantly associated with mortality in TBM patients with stroke. Conclusion The basal ganglia were the most common site of ischemic stroke in TBM, and middle cerebral artery was the most often involved intracranial blood vessel. BMRC stage 3 was significantly associated with both stroke and mortality in TBM patients with stroke..


  • Pahwa PK, Mani S. Current Profile of Physical Impairments in Children with Cerebral Palsy in Inclusive Education Settings: A Cross-Sectional Study. Journal of Neurosciences in Rural Practice 2022; 13: (3) 424-30'
    Abstract
    Introduction Cerebral palsy (CP) excerpts a heterogeneous corral of neurological disorders occurring due to injury to the developing brain leading to motor dysfunctions. The CP children enjoy success and progress in normal school education and curriculum program. The principle of inclusive education has been acknowledged over recent decades in all countries supporting the schooling of children with disabilities into mainstream settings for constructing an inclusive society. Objective The objective of this study was to determine the current status of physical impairments in children with CP in inclusive education settings in district Mandi, Himachal Pradesh. Materials and Methods A survey using the physical examination of all CP children ( n = 20) between the age group of 6 and 12 years in inclusive education settings with an organized interview of special educators in school settings was conducted. Descriptive analysis was conducted by using SPSS IBM 22. Results A total of 20 CP children (11 boys and 9 girls, with the mean age of 9.8 +/- 1.69) were enrolled in the study. Mean and standard deviation of Visual Analog Scale (6.5 +/- 0.82), Pediatric Balance Scale (21.4 +/- 17.1), Gross Motor Function Classification System, Expanded and Revised (2.8 +/- 1.46), Manual Ability Classification System (2.5 +/- 1.1), Gross Motor Function Measurement-88 (36.40 +/- 22.94), and Goal Attainment Scale (35.9 +/- 0.40) with the total WeeFIM score (75.7 +/- 3.4) were analyzed as the score of all outcome measures. Conclusion Right to Education act promotes the compulsory education of such children, and limiting disability by knowing the current profile of impairments could help in improving physical and functional status in children..


  • Kachhara R, Nigam P, Nair S. Tuberculum Sella Meningioma: Surgical Management and Results with Emphasis on Visual Outcome. Journal of Neurosciences in Rural Practice 2022; 13: (3) 431-40'
    Abstract
    Background Tuberculum sella meningioma form a distinct surgical entity with significant morbidity for the patient due to early and profound visual involvement. Surgical treatment of tuberculum sella meningioma is challenging in view of the proximity of vital neuro-vasculature. These lesions may be approached via a high-route (trans-cranial) or a low-route (trans-sphenoidal). Materials and Methods The authors present a consecutive series of 36 patients, operated by the first author from 1996 onward, with an analysis of clinical presentation (emphasizing visual deterioration), imaging features, operative approaches, and outcome with postoperative visual status. Results There were 36 patients (72 eyes) in the series, 75% females and 25% males. The mean age of patients was 48.05 +/- 10.02 years. In all, 88.89% had visual diminution, 50% had headache, 5.56% had behavioral changes, and 2.78% had seizures. The mean tumor size was 4.01 +/- 1.01 cm. The frontotemporal approach was employed in 66.67% of patients, and all patients underwent a right-sided approach. There was no significant difference between improvement in the vision between the right eye and left eye, despite the fact that right-sided approach was employed in nearly cases. Conclusion While tuberculum sella meningioma have profound morbidity in terms of visual deterioration, timely surgical intervention may help patients gain serviceable vision postoperatively. We advocate the trans-cranial approach and find no difference in visual outcomes on employing right-sided approach, regardless of the side with worse vision..


  • Nattala P, Kishore MT, Murthy P, Christopher R, Veerabathini JS, Suresh S. Association between Parent-Reported Executive Functions and Self-Reported Emotional Problems among Adolescent Offspring of Fathers with Alcohol-Dependence. Journal of Neurosciences in Rural Practice 2022; 13: (3) 441-7'
    Abstract
    Objectives To compare the executive functions in adolescents of fathers with alcohol dependence (AOFADs) with a control group of adolescents without a paternal history of alcohol dependence and examine the association between executive functioning problems and behavioral and emotional problems. Materials and Methods The study included 39 AOFADs and 45 adolescent offspring of fathers without a history of alcohol-use disorders, who were matched for age and sex. They were assessed using standardized measures of executive functions and emotional and behavioral problems. Statistical Analysis A comparison was made between the two groups about the parental report of adolescents' executive functions and adolescents' self-reported emotional and behavioral problems. ANCOVA was performed to understand the covariance of educational and socio-economic status on executive functions. Correlation between executive functions, emotional and behavioral problems, and the duration of father's alcohol dependence was examined with Spearman's rho. Results AOFAD group showed significant impairment on all subdomains of executive functions and emotional and behavioral disturbances ( p < 0.01) but not on the prosocial behavioral dimension ( p < 0.01). The group differences were independent of child's education and family income. Executive functional impairments positively correlated with psychopathology ( p < 0.01). Problems with executive functions and psychopathology correlated with the duration of the father's alcohol dependence. Conclusions AOFADs are at risk for executive function impairments which in turn are strongly associated with emotional and behavioral problems. The association is independent of child's education and family economic status. The duration of alcohol dependence in fathers is associated with these problems. It has implications for targeted interventions for both adolescents and families..


  • Igwe WC, Umeadi EN, Echendu ST, Odita AO. Sociodemographic Factors Influencing Health Care-Seeking Behavior for Pediatric Epilepsy in Southeast Nigeria. Journal of Neurosciences in Rural Practice 2022; 13: (3) 448-52'
    Abstract
    Background Early presentation and initiation of appropriate anticonvulsants help in controlling epilepsy and reducing morbidity and mortality associated with epilepsy. Objectives This study aimed to assess the health-seeking behavior for pediatric epilepsy among caregivers in Southeast Nigeria and the associated sociodemographic factors. Methodology This study was a cross-sectional descriptive and questionnaire-based study. The participants were recruited consecutively. Results Majority of the caregivers were mothers, had some formal education, and were employed. While 50% of these caregivers did not seek any home treatment for seizures, the other half offered various types of unorthodox home treatments. Treatments in primary and secondary levels of care were the most common form of first point of care outside the home. The most common reasons for the choice of care outside the home were advice from relations and belief in the efficacy of care offered. About 45% of the caregivers presented to tertiary level of care within 6 months of seizure onset. The major motivators for seeking care in tertiary level of care were health workers and families of children with epilepsy. Conclusion There is a need to strengthen the primary and secondary levels of care through continuous medical education of health workers in these levels of care for effective management of epilepsy. This will help in making prompt and correct diagnosis, classification, and initiation of appropriate therapy in epilepsy..


  • Gupta S, Rozatkar AR, Chaudhary P, Kk A, Vullanki SS, Kachhawaha G. Profiles of the Patients and Their Referral Patterns Visiting the Psychiatry Clinic of a General Hospital Setting Located in a Mental Health Resource Deficient Region of India: A Retrospective Observational Study. Journal of Neurosciences in Rural Practice 2022; 13: (3) 453-61'
    Abstract
    Objectives Treatment for mental health problems is determined by cultural, health infrastructure, and illness-related factors. Literature is sparse from India, particularly from the mental health resources-deficient regions of the country such as central India. Therefore, the current study is aimed at assessing the profile of the patients visiting the psychiatry outpatient facility (OPF) of a tertiary-care general hospital setting (GHS), their referral patterns, and their determinants. Materials and Methods A retrospective chart review of the newly registered individuals (October 2019 to March 2020) in the psychiatry OPF of the GHS from Central India was used in the study. Data (sociodemographic profiles, illness characteristics, and referral patterns) were extracted as per the standard guidelines. Statistical Analysis Descriptive statistics were used to represent sociodemographic, illness-, and past treatment-related characteristics of the participants. Chi-squared test was used to compare the referral characteristics of the two groups (self-referred patients vs. those referred by others, dependent variable) with regard to characteristics of the patients (independent variables). Results A total of 418 individuals were registered in the clinic. Most individuals suffered from the neurotic, stress-related, and somatoform group of disorders ( n = 231, 39.5%). More than halves were self-referred; most were referred from the internal medicine and allied departments. Being male, having at least graduate degree (chi (2) df(1) = 4.25 to 6.79, p < 0.05), suffering from organic mental-, psychotic-, and recurrent affective-disorders, and positive family history (chi (2) df(1) = 4.91 to 21.76, p < 0.05 to <0.001) along with first treatment attempt or previous treatment from the traditional healers, and absence of co-occurring medical illness were associated with self-referral (vs. referred by others) (chi (2) df(1) = 4.64 to 17.6, p < 0.05 to <0.001). Conclusions GHS has a characteristic referral pattern. The referral patterns of the patients for various psychiatric problems are determined by their sociodemographic, illness, and cultural characteristics; particularly, poor mental health literacy (among the patients-caregivers), stigma related to mental disorders, and unavailability of the mental health services act as major determinants. Sensitizing the patients-caregivers and health-care professionals concerning this could facilitate an early engagement with the psychiatric treatment. Future research needs to explore this phenomenon in greater detail, maybe by qualitative methods..


  • Paul A, Sriganesh K, Chakrabarti D, Reddy KRM. Effect of Preanesthetic Fluid Loading on Postinduction Hypotension and Advanced Cardiac Parameters in Patients with Chronic Compressive Cervical Myelopathy: A Randomized Controlled Trial. Journal of Neurosciences in Rural Practice 2022; 13: (3) 462-70'
    Abstract
    Purpose Hypotension during the early intraoperative phase is common and can lead to adverse perioperative outcomes. Fluid preloading is one of the methods to limit its occurrence. Patients with chronic compressive cervical myelopathy may have autonomic dysfunction, which can aggravate hemodynamic alterations during anesthesia. This study compared the occurrence of postinduction hypotension and changes in cardiac dynamic indices in patients with and without crystalloid preloading undergoing decompressive cervical spine surgery. Methods This randomized controlled trial was conducted over 15 months after obtaining patient consent, approval of the institute ethics committee, and trial registration. We compared preanesthetic fluid loading with Ringer's lactate (20 mL/kg over 30 minutes) with no preloading (2 mL/kg/h maintenance) in 60 consecutive patients undergoing cervical spine surgery. The ANSiscope was used to determine baseline cardiac autonomic function. Noninvasive cardiac output monitor was used to assess changes in heart rate, mean arterial pressure, cardiac index (CI), stroke volume variation (SVV), and total peripheral resistance index during study intervention, anesthetic induction, tracheal intubation, and change in position from supine to prone. Results The incidences of postinduction hypotension were 26.7% (8/30) and 86.7% (26/30) and the median doses of mephentermine used were 0 and 6 mg, respectively, in patients with and without fluid preloading (both p < 0.001). Preloading resulted in improvement in CI, reduction in SVV, and lesser vasopressor use. Conclusion Preloading reduced the occurrence of postinduction hypotension and vasopressor use, improved CI, and reduced SVV during the early intraoperative period. Registration number of Clinical Trial The trial was registered with Clinical Trial Registry of India (CTRI/2018/07/014970 on 19/07/2018)..


  • Sarma P, Garg M, Prem P, Gupta R. Embolization of the Middle Meningeal Artery for the Treatment of Chronic Subdural Hematoma: A Path Less Travelled So Far. Journal of Neurosciences in Rural Practice 2022; 13: (3) 471-5'
    Abstract
    Introduction Chronic subdural hematoma (CSDH) is relatively common and usually encountered in elderly population. With steady increase in life expectancy, incidence of CSDH also is bound to increase proportionately. Though surgery is the treatment of choice and relatively a simpler procedure, recurrence is a cause of concern. Embolization of the middle meningeal artery (MMA) is a newly evolving treatment modality in CSDH and offers hope in some of the recently published case series. Materials and Methods Five cases of CSDH were subjected to embolization of MMA over a period from October 2019 to July 2020. Among them, it was employed for treatment in four cases after at least two recurrences following surgery, and in one case, it was done as the patient was not fit for surgery. All procedures were done under general anesthesia and polyvinyl alcohol (PVA) particles were used for embolization. Follow-up of the patients were done with computed tomography brain at 4 weeks and after 6 months of the procedure. Results There was no incidence of recurrence in our series. Furthermore, embolization per se did not cause any complication or side effect which could be directly attributable to the procedure itself. Conclusion In carefully selected patients based on clinical profile and angiographic findings, MMA embolization can be an effective modality for the treatment in CSDH..


  • Koul R, Maiwall R, Alam S, Pamecha V, Tevethia HV, Sarin SK. Ictal Blinking in Hepatic Encephalopathy Pre- and Post-Liver Transplant: Report of Eight Patients. Journal of Neurosciences in Rural Practice 2022; 13: (3) 476-82'
    Abstract
    Objective Seizures are reported in 20 to 30% of cases with chronic liver disease in association with hepatic encephalopathy. Majority of these are focal seizures. Ictal blinking is reported first time in these patients pre- and post-liver transplant. Methods From November 2018 to October 2021, retrospective data was analyzed in patients with end-stage liver disease and hepatic encephalopathy, both pre- and post-liver transplant. Results Eight patients had ictal blinking, four were pre-transplant and four post-transplant. Five patients (four after liver transplant and one pre-transplant) were seizure free, three died of liver disease and multiorgan dysfunction, and one did not follow-up. Conclusion Ictal blinking in relation to liver disease and hepatic encephalopathy is reported, often missed and requires short duration antiepileptic medications..


  • Chongtham V, Sharma N, Parashar K, Pandey C. Determinants and Characteristics of the Violent Incidents in a Tertiary-Level Mental Health Care Center. Journal of Neurosciences in Rural Practice 2022; 13: (3) 483-9'
    Abstract
    Background The Mental Health Care Act of India, 2017 has for the first time focused on violence management interventions, especially restraint and seclusion in psychiatric settings, and recommended important guidelines in this aspect. Objective This situation has created a strong need to review the prevalence of violence in inpatient settings, associated clinical and social correlates keeping a preventive model in context. Hence, this study was undertaken to fulfill this need. Methods: A retrospective matched case-control chart review design was employed. All patients who exhibited at least one violent incident during their ward stay were included. For each case, the control was selected by individual matching based on age +/- 2 years and gender from patients who were admitted during the study period but did not exhibit any violent incident. The information about the characteristics of violent incidents and management was also collected. Results 8.80% of patients exhibited at least one incident of violence and a total of 186 violent incidents were recorded during the study period. Variables including involuntary admission, history of the previous admission, history of violence, impulsivity, lack of insight, and irritability at the time of admission significantly predicted the likelihood of violent incidents. The use of chemical restraining was the most common method of management of violent incidents. Conclusion Violent incidents in psychiatric inpatient settings are still common. Efforts should be made to understand the risk as well as antecedent factors well in time. Verbal de-escalation should be employed and chemical and physical restraint should be used only as a last resort after exhausting the least restrictive interventions..


  • Dhikav V, Jadeja B, Gupta P. Community Screening of Probable Dementia at Primary Care Center in Western India: A Pilot Project. Journal of Neurosciences in Rural Practice 2022; 13: (3) 490-4'
    Abstract
    Introduction Timely detecting dementia is an important goal of clinicians and public health professionals alike for better management and prevention of complications. Community screening of dementia could be a powerful strategy. Facilities for dementia screening at primary care level are virtually nonexistent and are a prominent implementation gap. Hence, a study was done to assess the feasibility of dementia screening at primary care using General Practitioner Assessment of Cognition (GPCoG) scale among older adults with subjective memory complaints. It was further aimed to assess the frequency of cardiovascular risk factors in those who met screening criteria for cognitive impairment. Materials and Methods Older adults coming to three urban primary care centers in western India for screening of noncommunicable diseases such as diabetes and hypertension (opportunistic screening) with subjective memory complaints were enrolled and screened for dementia using GPCoG. A Mini-Mental State Examination (MMSE) was done in patients who came alone for referral purpose in case the score levels in GPCoG examination met cutoff limits for informant interview. Written medical records were examined to assess status of comorbid vascular risk factors such as diabetes, hypertension, coronary artery disease, and cerebrovascular accidents. Results A total of 350 older adults (M:F = 276: 74; mean age +/- 68 +/- 6.7 years) were screened out of 3,000 older adults who reported during the study period. There were 161 older adults with GPCoG score less than or equal to 5 (56.14%) and 149 subjects with MMSE less than or equal to 24 indicating significant cognitive impairment (42.5%). There were very few ( n = 11, 3.14%) out of 350 people who came with caregivers; hence, MMSE was done along with for referral to healthcare providers. A total of 142 had comorbid diabetes/and or hypertension (40.5%). A total of 86 had diabetes alone (24.5%) and a total of 128 had hypertension (36.5%). Conclusion Current study results indicate that using a simple screening tool such as GPCoG, community screening of probable dementia, is feasible in primary care settings, as is indicated by significant yield of probable dementia cases (42.5%). These cases can be referred to appropriate centers for further workup, confirmation of diagnosis, and treatment. Also, detection of comorbid cardiovascular conditions, for example, diabetes and hypertension, that can be managed along with cognitive impairment/dementia for potential prevention/further deterioration, which can strengthen noncommunicable disease screening..


  • Nagaraja CT, Ramalingaiah AH, Arimappamagan A, Mitra S, Shukla D, Srinivas D, et al.. Spectrum of Surgically Resected Lesions of the Cavernous Sinus: A Neuropathologic Audit. Journal of Neurosciences in Rural Practice 2022; 13: (3) 495-509'
    Abstract
    Background The cavernous sinus is a complex space composed of extradural venous plexus within dural folds. Several important structures like the carotid artery, cranial nerves, and sympathetic nerve fibers traverse through this space. Radiological diagnosis may not be definitive and in the context of discordance between clinical and neuroimaging diagnosis, histopathological evaluation becomes essential for diagnosis and management. Literature on the pathological spectrum of lesions is scarce as, with a shift in the treatment paradigm, most small lesions of cavernous sinus are treated with radiosurgery. However, surgical management still plays a role for larger lesions and in radiologically ambiguous cases for planning the definitive management. Materials and Methods We retrospectively reviewed all surgically resected lesions of the cavernous sinus over the last two decades (1998-2019). The clinical presentation, neuroimaging features, and histopathological findings were reviewed. Lesions extending from sella and other adjacent areas were excluded. Results Thirty-eight cases of isolated cavernous sinus mass lesions were diagnosed over the last two decades (1998-2019). Cavernous hemangiomas (19 cases, 50%) constituted the most frequent pathology, followed by aspergilloma, meningioma, schwannoma, metastatic adenocarcinoma, chondrosarcoma, and chordoma. Overall, 29.4% (10/34) could not be accurately diagnosed on neuroimaging. Of these, four cases of cavernous hemangiomas were mistaken for either meningioma (three cases) or schwannoma (one case). Neither chordoma nor chondrosarcoma was suspected. Conclusion This is the first study in literature, enumerating the pathological and imaging spectrum of surgically resected cavernous sinus lesions. Cavernous hemangiomas, metastases and chordomas, and chondrosarcoma posed the greatest difficulty in diagnosis on neuroimaging and the reasons for the same are analyzed. In the context of clinical and neuroimaging discordance in diagnosis, pathological characterization becomes essential for appropriate and timely management..


  • Patil S, Patil V, Tekkalaki B, Chate S, Patil NM. Public-Private Partnership (PPP) Model of Psychiatry Day Care Center in India: Its Challenges and Opportunities-A 2-Year Experience. Journal of Neurosciences in Rural Practice 2022; 13: (3) 510-4'
    Abstract
    Background Most patients admitted in day care center are suffering from schizophrenia who do not recover fully due to nagging negative symptoms and cognitive deficits which linger and persist making the patients unfit and unacceptable for employment. But regular employment can help in recovery. In this way, day care centers would help in recovery of patients and hence the need for these kinds of centers. In India, day care centers are in infancy stage and to a larger extent are inadequately used. There is no data available from psychiatry day care center run as public-private partnership (PPP) project in a tertiary care general hospital psychiatry unit (GHPU). This model is first of its kind in India. Here, we narrate experiences gained in last 2 years. Objectives This article narrates the challenges and opportunities in a psychiatry day care center in PPP model. Materials and Methodology It a cross-sectional study. Description of day care center: Day care center was started as PPP model called Manasadhara model in the state of Karnataka, first of its kind in India. Recruitment Patients currently asymptomatic are recruited into the center after initial interview/assessment of patients and family members from the in-charge psychiatrist after obtaining informed consent. Statistical Analysis Data are analyzed using mean and median mode. A p -value of < 0.05 was considered significant. Appropriate statistical methods were applied. Results Total number of patients recruited in the study were 33 ( n = 33). Mean age of the patients was 34.5 (7.4) years. Majority (51.52%) of patients were in the age group of between 26 and 35 years. Majority (51.52%) of patients' age of onset of illness fell between 21 and 30 years, and 63.64% of patients' duration of illness ranged between 11 and 15 years. Conclusion Running a day care center in PPP model that too in a GHPU set up is difficult. Skills in which patients need to be trained should be decided based on patients' profile and cultural basis of the place. Common problems faced were poor placements, transportation, financial difficulties, and poor funding..


  • Baquero-Herrera PE, Ardila-Martinez MA, Abdala-Vargas NJ, Racedo J, Ordonez-Rubiano EG. Treatment Limitations for Pediatric Diffuse Intrinsic Pontine Gliomas in a Middle-Income Country. Journal of Neurosciences in Rural Practice 2022; 13: (3) 515-20'
    Abstract
    Objectives To evaluate the surgical management outcomes in pediatric patients with diffuse intrinsic pontine gliomas (DIPGs) who underwent intended biopsies and partial resections in a middle-income country, highlighting the barriers and challenges of these procedures for further investigation. Methods A retrospective review of a prospective acquired series of patients who underwent biopsy or resection for DIPG between January 2012 and June 2018 at our institution was performed. Results A total of 43 patients with posterior fossa tumors were identified. From these, seven pediatric DIPG cases were enrolled. Five were males. The median age was 5 years (range: 1-12 years). Only one patient (14.3%) had a ganglioglioma, while the others presented pilocytic and diffuse astrocytomas. Two (28.6%) patients had an intentional biopsy, and the other five (71.4%) had a partial resection. In the three (28.6%) patients who presented with associated hydrocephalus, the endoscopic third ventriculostomy was performed in the same surgical time. The median preoperative Lansky play-performance scale (LPPS) was 80 (range: 60-100), while the median postoperative LPPS was 23 (range: 7-52). Conclusion A decrease in overall survival was noted compared with data reported in other series. Multifactorial barriers were discussed including the social, geographic, and economic features that may influence on final outcomes..


  • Singh PK, Chaurasia RN, Pratap S, Tiwari T, Mishra VN, Singh T. Effect of Emotional Valence on Working Memory of Psychogenic Non-Epileptic Seizures (PNES) Patients. Journal of Neurosciences in Rural Practice 2022; 13: (3) 521-4'
    Abstract
    Background The present study investigated how emotional valence influenced the working memory of patients with psychogenic non-epileptic seizures (PNES) as compared to healthy individuals. Methods Emotional-N-Back task (E-N-back task) was administered to 15 PNES patients and equal number of healthy individuals. A 2 x 3 one-way analysis of variance (ANOVA) was used. Correct detection (accuracy) and reaction (RT) time were recorded as behavioral performance measures. Results The ANOVA result of correct detection (accuracy) measure revealed significant difference in the performance of patients with PNES as compared with healthy individual, F (2, 48) = 17.08, p = 0.001. However, on the measure of reaction time (RT), both groups performed equally and there was no significant difference, F (2, 48) = 1.13, p = 0.33. Also the results of present study showed that patients with PNES are quicker in identifying unpleasant picture stimuli, which is evident from their mean comparison: unpleasant ( M = 65.55, SD = 15.66), pleasant ( M = 58.22, SD = 20.03), and neutral ( M = 45.11, SD = 23.13). Conclusion Conclusively, the finding of the present study shows a significant effect of emotional valence on working memory of patients with PNES on the measure of correct detection (accuracy), but not for second measure, i.e., reaction time this clearly reveals that patients with PNES are poor at emotional-cognitive integration, specifically at working memory level..


  • Rolle ML, Garba DL, Griswold DP, Fernandez LL, Sanchez DM, Clavijo A, et al.. Implementing a Neurotrauma Registry in Latin America and the Caribbean. Journal of Neurosciences in Rural Practice 2022; 13: (3) 525-8'
    Abstract
    Background Traumatic brain injury (TBI) has a disproportionately greater impact in low- and middle-income countries (LMICs). One strategy to reduce the burden of disease in LMICs is through the implementation of a trauma registry that standardizes the assessment of each patient's management of care. Objective This study aims to ascertain the interest of Latin America and the Caribbean (LAC) nations in establishing a shared neurotrauma registry in the regional block, based on an existing framework for collaboration. Methods A descriptive review was performed regarding the interests of LAC nations in implementing a shared neurotrauma registry in their region. We convened a meeting with seven Caribbean and five Latin American nations. Results One hundred percent ( n = 12) of the LAC representatives including neurosurgeons, neurointensivists, ministers of health, and chief medical officers/emergency medical technicians (EMTs) agreed to adopt the registry for tracking the burden of TBI and associated pathologies within the region. Conclusion The implementation of a neurotrauma registry can benefit the region through a shared database to track disease, improve outcomes, build research, and ultimately influence policy..


  • Naik S, Bhoi SK, Deep N, Mohakud S, Mishra B, Dey A, et al.. Vascular Manifestations of Tuberculous Meningitis: MR Angiography and Venography Study. Journal of Neurosciences in Rural Practice 2022; 13: (3) 529-36'
    Abstract
    Purpose The purpose of this study is to evaluate magnetic resonance (MR) angiography (MRA) and venography (MRV) findings in tuberculous meningitis (TBM). Methods Thirty consecutive patients of clinically diagnosed TBM were enrolled. Apart from T2-weighted imaging, T1-weighted imaging (T1WI), diffusion-weighted imaging, susceptibility-weighted imaging, fluid-attenuated inversion recovery, and postcontrast T1WI, time-of-flight (TOF) MRA and postcontrast MRV were done in all the patients. MRV was done after intravenous administration of gadolinium-based contrast agent followed by postcontrast T1WI. MRA and MRV findings were analyzed. Results Mean age of the patients was 33.13 +/- 14.93 years. Duration of symptom was 34.90 +/- 33.82 (range: 10-150) days. Out of 30 patients, 11 were categorized as definite TBM and 19 probable TBM. Eighteen (60%) were grade I, 7 (23%) grade II, and 5 (16%) grade III TBM based on severity. MR abnormalities were in varying combinations of leptomeningeal enhancement in 24 (80%), pachymeningeal in 2, both in 3, tuberculomas in 13 (43.3%), ventriculitis in 1, hydrocephalus in 16 (53.3%), and infarcts in 10 (33.3%) patients out of which the tubercular zone infarct in 9 patients. TOF MRA showed arterial abnormality in 13 patients. Anterior cerebral artery and middle cerebral artery have commonly involved vessels. Dural sinus thrombosis was noted in two patients. Both were female. One patient had subacute thrombus in the posterior part of superior sagittal sinus, left transverse sinus, and proximal right transverse sinus. The second patient had a filling defect in the transverse sinus. Conclusion In TBM, there is predominant arterial involvement causing infarcts which are usually seen in the tubercular zone. However, occasionally, there may be venous involvement causing cerebral venous sinus thrombosis..


  • Rahmathulla G, Lara-Velazquez M, Pafford R, Hoefnagel A, Rao D. Upper Extremity Monoplegia following Prone Surrender Position for Spinal Surgery. Journal of Neurosciences in Rural Practice 2022; 13: (3) 537-40'
    Abstract
    Background Secondary peripheral nerve injuries remain a significant perioperative problem due to patient positioning and contribute to reduced patient quality of life and exacerbated professional liability. Comorbidities and concomitant lesions can further elicit these injuries in patients undergoing spinal surgeries. Case Presentation We report a case of a 70-year-old male polytrauma patient presenting with a left first-rib fracture and an adjacent hematoma around the brachial plexus without preoperative deficits. Subsequent to a lumbar spinal fusion in the prone position, he developed a postoperative left upper extremity monoplegia. The postoperative magnetic resonance imaging revealed an enhanced asymmetric signal in the trunks and cords of the left brachial plexus. He progressively improved with rehabilitation, a year after the initial presentation, with a residual wrist drop. Conclusions Pan brachial plexus monoplegia, following spine surgery, is rare and under-reported pathology. To minimize the occurrence of this rare morbidity, appropriate considerations in preoperative evaluation and counseling, patient positioning, intraoperative anesthetic, and electrophysiological monitoring should be performed. We emphasize an unreported risk factor in polytrauma patients, predisposing this rare injury that is associated with prone spinal surgery positioning, SEPs being an extremely sensitive test intraoperatively and highlight the importance of counseling patients and families to the possibility of this rare occurrence..


  • Apetse K, Kouassi K, Anayo NK, Waklatsi KP, Guinhouya MK, Agba L, et al.. Neuromyelitis Optica Spectrum Disorders in Black African: Experience of Togo (2015-2020). Journal of Neurosciences in Rural Practice 2022; 13: (3) 541-5'
    Abstract
    Introduction Neuromyelitis optica spectrum disorders (NMOSD) would disproportionately affect blacks within mixed populations. However, they are rarely reported in black African. The objective of this work was to report the experience of Togo, a West African country in terms of NMOSD. Methods This is a series of six cases diagnosed between 2015 and 2020 in the only three neurology departments in Togo. The diagnosis of NMOSD was made according to the criteria of the International Panel for NMO Diagnosis (2015) and the patients had a minimum clinical follow-up of 6 months after the diagnosis. The search for anti-aquaporin 4 (AQP4) antibodies was performed by immunofluorescence on transfected cells. Results The mean age was 25.33 years and the sex ratio female/male was 5/1. The average time between the first attack and the diagnosis was 122.83 days. Clinically, there was isolated medullary involvement (2/6), simultaneous opticomedullary involvement (3/6), and area postrema syndrome (1/6). Five patients were anti-AQP4 positive. All six patients had extensive longitudinal myelitis. At 6 months of follow-up, there was one case of death and one case of blindness. Conclusion The rarity of NMOSD cases in Togo could be linked to an underestimation. To better characterize the NMOSDs of the black African population, multicenter and multidisciplinary studies are necessary..


  • Shivaram S, Tallapalli AVR, Gupta M, Nashi S, Kulkarni GB, Alladi S. Spontaneous Downbeat Nystagmus in Anti-GAD-Antibody-Associated Paraneoplastic Syndrome. Journal of Neurosciences in Rural Practice 2022; 13: (3) 546-9'
    Abstract
    Spontaneous downbeat nystagmus and ocular flutter are rare clinical signs. Such findings are commonly related to cerebellar pathology, predominantly ischemia. In a significant percentage of patients, the cause may not be found. If these signs are associated with ataxia, cognitive decline, and seizure, anti-glutamic acid decarboxylase-associated neurological syndrome must be suspected. Background history of tumor has to be enquired. Treatment with immune modulation helps in partial recovery of such cases..


  • Bishwas S, Islam MS, Shiplu MH, Rana MS, Ashfaq M, Rashid M, et al.. Arteriovenous Malformation of Conus Medullaris Fed by the Artery of Desproges-Gotteron. Journal of Neurosciences in Rural Practice 2022; 13: (3) 550-3'
    Abstract
    Presence of the artery of Desproges-Gotteron is extremely rare. It has seldom been mentioned in the literature as well. The authors have dealt with a case of a dural arteriovenous malformation (AVM ) of conus medullaris fed by the artery of Desproges-Gotteron in a young female of 19 years. The patient presented with a tingling sensation of lower limbs, progressive difficulty walking, and incontinence of the bladder. There was weakness in all groups of muscle of both lower limbs and definite sensory level on examination. Magnetic resonance imaging revealed multiple flow voids at the level of conus medullaris. Spinal digital subtraction angiography (DSA) revealed dural AVM at the level of conus. The patient underwent transarterial embolization with 30% Endocryl( n -butyl cyanoacrylate) in two stages, and repeated spinal DSA revealed no evidence of residual AVM. Patient's neurology gradually improved. Almost 2 years down the line, the follow-up revealed gradual but complete motor and sensory deficits recovery except for occasional burning pain in lower limbs. Spinal AVM supplied by the artery of Desproges-Gotteron is a unique variation. Moreover, the authors believe that it is the first reported case in Bangladesh..


  • Khosama H, Girsang R, Natadidjaja S, Mawuntu AHP, Tumewah R. Belly Dancer's Dyskinesia Responsive to Oral Medication Treatment. Journal of Neurosciences in Rural Practice 2022; 13: (3) 554-7'
    Abstract
    Belly dancer's dyskinesia is a rare disease characterized mostly by the uncontrolled and rhythmic movements of the abdominal wall. No exact etiology has been identified yet and the treatment is mostly symptomatic. From most available case reports, oral medication therapy often provides disappointing result in term of reducing the symptom. Here, we report a patient who has satisfactory improvement after treated with oral medication only..


  • Ibrahim S, Reddy V, Menon G. Intra-Parenchymal Cerebellar Metastasis-A Rare Presentation of Castration-Resistant Prostate Cancer. Journal of Neurosciences in Rural Practice 2022; 13: (3) 558-60'
    Abstract
    Intracranial metastases from prostate carcinoma are uncommon and usually manifest as dural secondaries in the supratentorial compartment. We present an unusual case of intra-parenchymal posterior fossa prostatic metastasis in a 61-year-old gentleman and discuss the diagnostic and management challenges involved. A 61-year-old hypertensive, diabetic man presented with gait unsteadiness for 1-month duration and no other neurological deficits. He had previously undergone bilateral orchiectomy for prostate carcinoma with multiple osseous metastases. Magnetic resonance imaging showed a well-defined lobulated, intraventricular, peripherally enhancing lesion in the fourth ventricle with obstructive hydrocephalus. He underwent sub-occipital craniectomy and decompression, and histological examination was consistent with metastatic prostate adenocarcinoma. Although cerebellar secondaries are atypical, a suspicion of metastasis should be upheld in all patients with the history of prostate carcinoma, regardless of their location and radiological characteristics of the intracranial lesion..


  • Singh AS, Sidhu AS. Orthostatic Myoclonic Jerks in a Case of Hashimoto's Encephalopathy. Journal of Neurosciences in Rural Practice 2022; 13: (3) 561-2'
    Abstract
    Hashimoto's encephalopathy (HE) is an uncommon syndrome with the characteristic triad of positive antithyroid antibodies (most commonly antibodies to thyroid peroxidase), response to steroids, and clinical picture presenting either as stroke-like pattern of focal neurological deficit or slowly progressive cognitive impairment. Myoclonus or tremors, seizures, and psychosis are other associated features which can be seen in HE. Herein, we report a girl with an uncommon presentation of orthostatic axial and myoclonic jerks in bilateral lower limbs in a case of HE..


  • Suresh S, Hrishi AP, Divakar G, Sethuraman M. At the Eye of the Hurricane! Perioperative Management of an Unoptimized Metastatic Pheochromocytoma Presenting for Emergency Neurosurgery. Journal of Neurosciences in Rural Practice 2022; 13: (3) 563-7'
    Abstract
    Metastatic pheochromocytoma (PCC) is a rare entity arising from extra-adrenal tissue. We report the perioperative management of a young woman presenting with metastatic PCC to the vertebral body resulting in vertebral collapse and spinal cord compression necessitating emergency surgery. There are no reports of anesthetic management of a patient with unoptimized metastatic PCC presenting for emergency neurosurgery under general anesthesia. Our anesthetic goals were to maintain a deep anesthetic plane with stable hemodynamics, facilitate intraoperative neuromonitoring, manage catecholamine surges during anesthetic induction, tumor resection, and manage perioperative massive blood loss. The successful perioperative management of metastatic PCC has become possible with the vast armamentarium of anesthetic drugs and intraoperative advanced monitoring techniques. In addition, our role in understanding the pathophysiology and course of the disease is essential to ensure low morbidity and mortality of such cases in their most vulnerable perioperative period..


  • Singla M, Singh B, Midha V, Paul BS. An Uncommon Case of Celiac Disease and Deep Cerebral Venous Sinus Thrombosis. Journal of Neurosciences in Rural Practice 2022; 13: (3) 568-70'
    Abstract
    Celiac disease is an enteropathy characterized by malabsorption related with gluten intolerance and immune-mediated pathogenesis. It may manifest with gastrointestinal features like diarrhea, abdominal pain, weight loss, and anemia. Besides, it can manifest with various extraintestinal features like ataxia, neuropathy, stroke, or sometimes venous sinus thrombosis. Being of autoimmune origin, relation with systemic lupus erythematosus has also been reported. Herein, we present a rare case of a young patient with celiac disease who presented with fever, headache, and altered sensorium and was found to have meningitis with deep cerebral venous sinus thrombosis..


  • Murali SH, Gohil J, Easwer HV. A Sporadic Cisternal Cystic Oculomotor Schwannoma-Case Report and Review of Literature. Journal of Neurosciences in Rural Practice 2022; 13: (3) 571-5'
    Abstract
    Schwannoma arising from a pure motor cranial nerve in sporadic cases is a rare finding. We report adult female patient presented with a seizure without oculomotor palsy. On evaluation, she was diagnosed with cystic oculomotor schwannoma and underwent surgery. She developed oculomotor palsy postoperatively. Here, we describe a rare sporadic cystic oculomotor schwannoma..


  • Baykoca-Arslan B, Belirgen M. Cranial Screw Migration along the Subdural Peritoneal Shunt Catheter in a Pediatric Patient. Journal of Neurosciences in Rural Practice 2022; 13: (3) 576-7'
    Abstract
    Craniotomy is a common surgery used to expose the brain by removing a part of the bone from the skull. During surgery, bone flaps can be fixed by using variety of materials that can migrate in the long term. A 7-year-old boy presented several years after the craniotomy and subdural peritoneal (SP) shunt surgeries. It was decided to remove the shunt catheter, and during the diagnostic tests, we saw that a loosened titanium screw has migrated along the SP shunt catheter from the skull into the abdominal wall. To the best of our knowledge, this is the first case in the reported electronic literature for a pediatric patient with a subcutaneous migration of a screw along the shunt catheter..


  • Verma R, Chakraborty R. A Case of Dopa Responsive Dystonia Presenting as Isolated Foot Dystonia. Journal of Neurosciences in Rural Practice 2022; 13: (3) 578-9'
    Abstract
    None.


  • Yadav N, Kumar GM. A Rare Case of Complete Absence of Mammillary Bodies on Imaging. Journal of Neurosciences in Rural Practice 2022; 13: (3) 580-2'
    Abstract
    None.