Journal of Neurosciences in Rural Practice
 
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January-March 2017
Volume 8 | Issue 1
Page Nos. 1-160

Online since Thursday, November 10, 2016

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EDITORIALS  

Coercion and admission in psychiatric facilities p. 1
Avinash De Sousa
DOI:10.4103/0976-3147.193546  PMID:28149072
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Neurovascular conflict of abducent nerve p. 3
Nishanth Sadashiva, Dhaval Shukla
DOI:10.4103/0976-3147.193564  PMID:28149073
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The clinical variability of midbrain lesions p. 5
Pacei Federico
DOI:10.4103/0976-3147.193562  PMID:28149074
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ORIGINAL ARTICLES Top

Epileptic patients are at risk of cardiac arrhythmias: A novel approach using QT-nomogram, tachogram, and cardiac restitution plots p. 7
Marwan S Al-Nimer, Sura A Al-Mahdawi, Namir M Abdullah, Akram Al-Mahdawi
DOI:10.4103/0976-3147.193553  PMID:28149075
Background: Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias. Objectives: This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz), and cardiac restitution plots. Methods: A total number of 71 healthy subjects (Group I) and 64 newly diagnosed epileptic patients (Group II) were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG) was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias. Results: Significant prolonged corrected QT corrected (QTc) and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years) in Group II compared with Group I. Conclusion: Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias.
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Knock and drill technique: A simple tips for the instrumentation in complex craniovertebral junction anomalies without using fluoroscopy p. 14
Arun Srivastava, Jayesh Sardhara, Sanjay Behari, Sindgikar Pavaman, Jeena Joseph, Kuntal Das, Anant Mehrotra, Awadhesh K Jaiswal, Kamlesh Bhaishora
DOI:10.4103/0976-3147.193555  PMID:28149076
Context: Existence of complex variable bony and vertebral artery (VA) anomalies at craniovertebral junction (CVJ) in subset of complex CVJ anomalies demands individualized instrumentation policy and placing screws in each bone requires strategic preoperative planning and intraoperative skills. Aim: To evaluate the clinical accuracy of knock and drill (K and D) technique for the screw placement in complex CVJ anomalies. Settings and Design: Prospective study and operative technical note. Materials and Methods: Totally 36 consecutive patients (16 - pediatrics, 20 - adult patients) of complex CVJ: Complete/partial occipitalized C1 vertebra; at least one hypoplastic (C1/C2) articular mass, rotational component, and variations in the third part of VA were included in this study. Preoperative detail computed tomography (CT) CT CVJ with three-dimensional reconstruction was done for the assessment of CVJ anatomy and facet joint orientation. The accuracy of novel technique was assessed with postoperative CT to evaluate cortical breach in between 5th and 7th postoperative day in all the patients. All patients were underwent clinico-radiological evaluation at 6-month follow-up. Results: Totally 144 screws were placed using K and D technique (pediatric group - 64 screws, adult patients - 80 screws). Total of 12 screws were placed in C1 lateral mass in both age group without any bony cortical breach and complication. Sixteen C2 pedicle screws and 12 C2 pars screw in pediatrics and 18 C2 pedicle screws in adult patients were placed without any bony breach or VA injury. Out of thirty subaxial lateral mass screws in pediatric group, the bony breach was encountered with one screw (3.3%). Total of 38 C2 pars screws was placed in adult group in which bony breach along with VA injury was encounter with 1screw (2.6%). Conclusion: A simple technique of K and D for placing a screw increases the accuracy and spectrum of bony purchase and has the potential to reduce the complication in patients with complex CVJ anomalies.
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Outcome prediction after traumatic brain injury: Comparison of the performance of routinely used severity scores and multivariable prognostic models p. 20
Marek Majdan, Alexandra Brazinova, Martin Rusnak, Johannes Leitgeb
DOI:10.4103/0976-3147.193543  PMID:28149077
Objectives: Prognosis of outcome after traumatic brain injury (TBI) is important in the assessment of quality of care and can help improve treatment and outcome. The aim of this study was to compare the prognostic value of relatively simple injury severity scores between each other and against a gold standard model – the IMPACT-extended (IMP-E) multivariable prognostic model. Materials and Methods: For this study, 866 patients with moderate/severe TBI from Austria were analyzed. The prognostic performances of the Glasgow coma scale (GCS), GCS motor (GCSM) score, abbreviated injury scale for the head region, Marshall computed tomographic (CT) classification, and Rotterdam CT score were compared side-by-side and against the IMP-E score. The area under the receiver operating characteristics curve (AUC) and Nagelkerke's R2 were used to assess the prognostic performance. Outcomes at the Intensive Care Unit, at hospital discharge, and at 6 months (mortality and unfavorable outcome) were used as end-points. Results: Comparing AUCs and R2s of the same model across four outcomes, only little variation was apparent. A similar pattern is observed when comparing the models between each other: Variation of AUCs <±0.09 and R2s by up to ±0.17 points suggest that all scores perform similarly in predicting outcomes at various points (AUCs: 0.65–0.77; R2s: 0.09–0.27). All scores performed significantly worse than the IMP-E model (with AUC > 0.83 and R2 > 0.42 for all outcomes): AUCs were worse by 0.10–0.22 (P < 0.05) and R2s were worse by 0.22–0.39 points. Conclusions: All tested simple scores can provide reasonably valid prognosis. However, it is confirmed that well-developed multivariable prognostic models outperform these scores significantly and should be used for prognosis in patients after TBI wherever possible.
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Toxic effect of khat (Catha edulis) on memory: Systematic review and meta-analysis p. 30
Birhane Alem Berihu, Gebrekidan Gebregzabher Asfeha, Abadi Leul Welderufael, Yared Godefa Debeb, Yibrah Berhe Zelelow, Hafte Assefa Beyene
DOI:10.4103/0976-3147.193524  PMID:28149078
Background: People use khat (Catha edulis) for its pleasant stimulant effect of physical activity, consciousness, motor, and mental functions. Although there are reports assessing the effect of khat on memory, there was no study based on formal systematic review and meta-analysis. Objective: We have therefore conducted this meta-analysis to determine the level of evidence for the effect of khat (C. edulis Forsk) on memory discrepancy. Methods: MEDLINE, Cochrane Library, PubMed, Academic Search Complete, SPORTDiscus, ScienceDirect, Scopus, Web of Science, and Google Scholar were searched to retrieve the papers for this review. Keywords utilized across database search were khat, cat, chat, long-term memory, short-term memory, memory deficit, randomized control trial, and cross-sectional survey. The search was limited to studies in humans and rodents; published in English language. Result: Finding of various studies included in our meta-analysis showed that the effect of acute, and subchronic exposure to khat showed that short-term memory appears to be affected depending on the duration of exposure. However, does not have any effect on long-term memory. Conclusion: Although a number of studies regarding the current topic are limited, the evidenced showed that khat (C. edulis) induced memory discrepancy.
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Intravenous thrombolysis for acute ischemic stroke: Review of 97 patients p. 38
Anish Mehta, Rohan Mahale, Kiran Buddaraju, Anas Majeed, Suryanarayana Sharma, Mahendra Javali, Purushottam Acharya, Rangasetty Srinivasa
DOI:10.4103/0976-3147.193558  PMID:28149079
Background: Intravenous thrombolysis (IVT) has now become a standard treatment in eligible patients with acute ischemic stroke (AIS) who present within 4.5 h of symptom onset. Objective: To determine the usefulness of IVT and the subset of patients who will benefit from IVT in AIS within 4.5 h. Materials and Methods: Patients with AIS within 4.5 h of symptom onset who underwent IVT were studied prospectively. The study period was from October 2011 to October 2015. Results: A total of 97 patients were thrombolysed intravenously. The mean onset to needle time in all patients was 177.2 ± 62 min (range: 60–360). At 3 months follow-up, favorable outcome was seen in 65 patients (67.1%) and poor outcome including death in the remaining 32 patients (32.9%). Factors predicting favorable outcome was age <65 years (P = 0.02), the National Institute of Health Stroke Scale (NIHSS) <15 (P < 0.001), small vessel occlusion (P = 0.006), cardioembolism (P = 0.006), and random blood sugar (RBS) <250 mg/dl (P < 0.001). Factors predicting poor outcome was diabetes mellitus (P = 0.01), dyslipidemia (P = 0.01), NIHSS at admission >15 (P = 0.03), RBS >250 mg/dl (P = 0.01), Dense cerebral artery sign, age, glucose level on admission, onset-to-treatment time, NIHSS on admission score >5 (P = 0.03), and occlusion of large artery (P = 0.02). Conclusion: Milder baseline stroke severity, blood glucose <250 mg/dL, younger patients (<65 years), cardioembolic stroke, and small vessel occlusion benefit from recombinant tissue plasminogen activator.
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Urodynamic profile in acute transverse myelitis patients: Its correlation with neurological outcome p. 44
Anupam Gupta, Sushruth Nagesh Kumar, Arun B Taly
DOI:10.4103/0976-3147.193547  PMID:28149080
Objective: The objective of this study was to observe urodynamic profile of acute transverse myelitis (ATM) patients and its correlation with neurological outcome. Patients and Methods: This prospective study was conducted in the neurorehabilitation unit of a tertiary university research hospital from July 2012 to June 2014. Forty-three patients (19 men) with ATM with bladder dysfunction, admitted in the rehabilitation unit, were included in this study. Urodynamic study (UDS) was performed in all the patients. Their neurological status was assessed using ASIA impairment scale and functional status was assessed using spinal cord independence measure. Bladder management was based on UDS findings. Results: In total, 17 patients had tetraplegia and 26 had paraplegia. Thirty-six patients (83.7%) had complaints of increased frequency and urgency of urine with 26 patients reported at least one episode of urge incontinence. Seven patients reported obstructive urinary complaints in the form of straining to void with 13 patients reported both urgency and straining to void and 3 also had stress incontinence. Thirty-seven (86.1%) patients had neurogenic overactive detrusor with or without sphincter dyssynergia and five patients had acontractile detrusor on UDS. No definitive pattern was observed between neurological status and bladder characteristics. All patients showed significant neurological and functional recovery with inpatient rehabilitation (P < 0.05 and P< 0.001, respectively). Conclusions: The problem of neurogenic bladder dysfunction is integral to ATM. Bladder management in these patients should be based on UDS findings. Bladder characteristics have no definitive pattern consistent with the neurological status.
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Not only the sugar, early infarct sign, hyperDense middle cerebral artery, age, neurologic deficit score but also atrial fibrillation is predictive for symptomatic intracranial hemorrhage after intravenous recombinant tissue plasminogen activator p. 49
Sombat Muengtaweepongsa, Pornpoj Prapa-Anantachai, Pornpat A Dharmasaroja
DOI:10.4103/0976-3147.193548  PMID:28149081
Background: Symptomatic intracranial hemorrhage (sICH) is the most unwanted adverse event in patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (i.v. rt-PA). Many tool scores are available to predict the probability of sICH. Among those scores, the Sugar, Early infarct sign, hyperDense middle cerebral artery, Age, Neurologic deficit (SEDAN) gives the highest area under the curve-receiver operating characteristic value. Objective: We aimed to examine any factors other than the SEDAN score to predict the probability of sICH. Methods: Patients with acute ischemic stroke treated with i.v. rt-PA within 4.5 h time window from January 2010 to July 2012 were evaluated. Compiling demographic data, risk factors, and comorbidity (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation (AF), ischemic heart disease, valvular heart disease, previous stroke, gout, smoking cigarette, drinking alcoholic beverage, family history of stroke, and family history of ischemic heart disease), computed tomography scan of patients prior to treatment with rt-PA, and assessing the National Institutes of Health Stroke Scale (NIHSS) score for the purpose of calculating SEDAN score were analyzed. Results: Of 314 patients treated with i.v. rt-PA, there were 46 ICH cases (14.6%) with 14 sICH (4.4%) and 32 asymptomatic intracranial hemorrhage cases (10.2%). The rate of sICH occurrence was increased in accordance with the increase in the SEDAN score and AF. Age over 75 years, early infarction, hyperdense cerebral artery, baseline blood sugar more than 12 mmol/l, NIHSS as 10 or more, and AF were the risk factors to develop sICH after treated with rt-PA at 1.535, 2.501, 1.093, 1.276, 1.253, and 2.492 times, respectively. Conclusions: Rather than the SEDAN score, AF should be a predictor of sICH in patients with acute ischemic stroke after i.v. rt-PA treatment in Thai population.
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Epidural tramadol via intraoperatively placed catheter as a standalone analgesic after spinal fusion procedure: An analysis of efficacy and cost p. 55
Vijaysundar Ilangovan, Thanga Tirupathi Rajan Vivakaran, D Gunasekaran, D Devikala
DOI:10.4103/0976-3147.193535  PMID:28149082
Objective: This was a prospective analysis of epidural tramadol as a single analgesic agent delivered through intraoperatively placed epidural catheter for postoperative pain relief after spinal fusion procedures in terms of efficacy and cost. Materials and Methods: Twenty patients who underwent spinal fusion procedures were included in the study. After completion of the procedure, an epidural catheter was placed at the highest level of exposed dura and brought out through a separate tract. Postoperatively, tramadol was infused into the epidural space via the catheter at a dose of 1 mg/kg diluted in 10 ml of saline. The dosage frequency was arbitrarily fixed at every 6 h during the first 2 days and thereafter reduced to every 8 h after the first 2 days till day 5. Conventional intravenous analgesics were used only if additional analgesia was required as assessed by visual analog scale (VAS). Results: Patients' VAS score was assessed every 4 h from the day of surgery. Patients with a VAS score of 6 or more were given additional analgesia in the form of intravenous paracetamol. Of the twenty patients, eight patients needed additional analgesia during the first 24 h and none required additional analgesia after the first 24 h. The median VAS score was 7 within the first 24 h and progressively declined thereafter. Epidural tramadol was noted to be many times cheaper than conventional parenteral analgesics. Conclusion: Epidural tramadol infusion is safe and effective as a standalone analgesic after open spinal fusion surgery, especially after the 1st postoperative day. Intraoperative placement of the epidural catheter is a simple way of delivering tramadol to the epidural space. The cost of analgesia after spinal fusion surgery can be reduced significantly using epidural tramadol alone.
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Cerebrovascular hemodynamics during pranayama techniques p. 60
L Nivethitha, A Mooventhan, NK Manjunath, Lokesh Bathala, Vijay K Sharma
DOI:10.4103/0976-3147.193532  PMID:28149083
Background: Pranayama techniques are known to produce variable physiological effects on the body. We evaluated the effect of the two commonly practiced Pranayama techniques on cerebral hemodynamics. Materials and Methods: Fifteen healthy male volunteers, trained in Yoga and Pranayama, were included in the study. Mean age was 24 years (range 22–32 years). Study participants performed 2 Pranayamas in 2 different orders. Order 1 (n = 7) performed Bhastrika (bellows breaths) followed by Kumbhaka (breath retention) while order 2 (n = 8) performed Kumbhaka followed by Bhastrika. Both breathing techniques were performed for 1 min each. Continuous transcranial Doppler (TCD) monitoring was performed during the breathing techniques. TCD parameters that were recorded included peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MFV), and pulsatility index (PI) of the right middle cerebral artery at baseline, 15, 30, 45, and 60 s. Results: Significant reductions in EDV (3.67 ± 6.48; P< 0.001) and MFV (22.00 ± 7.30; P< 0.001) with a significant increase in PI (2.43 ± 0.76; P< 0.001) were observed during Bhastrika. On the contrary, a significant increase in PSV (65.27 ± 13.75; P< 0.001), EDV (28.67 ± 12.03; P< 0.001), and MFV (43.67 ± 12.85; P< 0.001) with a significant reduction in PI (0.89 ± 0.28; P< 0.01) was observed only during Kumbhaka. Conclusion: Bhastrika and Kumbhaka practices of Pranayama produce considerable and opposing effects on cerebral hemodynamic parameters. Our findings may play a potential role in designing the Pranayama techniques according to patients' requirements.
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Clinical predictors of abnormal head computed tomography scan in patients who are conscious after head injury p. 64
Rakesh Kumar Mishra, Ashok Munivenkatappa, Vasuki Prathyusha, Dhaval P Shukla, Bhagavatula Indira Devi
DOI:10.4103/0976-3147.193538  PMID:28149084
Background: Indication of a head computed tomography (CT) scan in a patient who remains conscious after head injury is controversial. We aimed to determine the clinical features that are most likely to be associated with abnormal CT scan in patients with a history of head injury, and who are conscious at the time of presentation to casualty. Materials and Methods: This is a prospective observation study of patients presented to casualty with history of head injury, and who were conscious, i.e., Glasgow Coma Scale (GCS) 15 at the time of evaluation. All patients underwent head CT scan. The CT scan was reported as abnormal if it showed any pathology ascribed to trauma. The following variables were used: age, gender, mode of injury (road traffic accident, fall, assault, and others), duration since injury, and history of transient loss of consciousness, headache, vomiting, ear/nose bleeding, and seizures. Logistic regression analysis was used to identify the clinical features that predicted an abnormal CT scan. Results: During the observation period, a total of 1629 patients with head injury were evaluated, out of which 453 were in GCS 15. Abnormal CT scan was present in 195 (43%) patients. Among all the variables, the following were found significantly associated with abnormal CT scan: duration since injury (>12 h) P< 0.001; vomiting odds, ratio (OR) 1.89 (1.23, 2.80), P< 0.001; and presence of any symptom, OR 2.36 (1.52, 3.71), P< 0.001. Conclusion: A patient with GCS 15 presenting after 12 hours of injury with vomiting or combination of symptoms has a significant risk of abnormal head CT scan.
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Complications in mechanically ventilated patients of Guillain–Barre syndrome and their prognostic value p. 68
Archana Becket Netto, Arun B Taly, Girish B Kulkarni, GS Uma Maheshwara Rao, Shivaji Rao
DOI:10.4103/0976-3147.193542  PMID:28149085
Introduction: The spectrum of various complications in critically ill Guillain–Barre syndrome (GBS) and its effect on the prognosis is lacking in literature. This study aimed at enumerating the complications in such a cohort and their significance in the prognosis and mortality. Materials and Methods: Retrospective case record analysis of all consecutive mechanically ventilated patients of GBS in neurology Intensive Care Unit (ICU) of a tertiary care institute for 10 years was done. Demographic, laboratory, and treatment details and outcome parameters were recorded. Results: Among the 173 patients were 118 men and 55 women (2.1:1), aged 1–84 years. The average number of ICU complications per patient was 6.8 ± 1.8 (median = 7, range = 1–12). The most common complication was tracheobronchitis (128). Other pulmonary complications were found in 36 patients. The next was metabolic hyponatremia (115) hypokalemia (67), hypocalcemia (13), stress hyperglycemia (10), hyperkalemia (8), hypernatremia (9). Sepsis (40), UTI (47), dysautonomia (27), hypoalbuminemia (76), anemia (75), seizures (8), paralytic ileus (5), bleeding (4), anoxic encephalopathy (3), organ failures (12), deep vein thrombosis (7), and drug rashes (1) were also noted. The complications, considered significant in causing death, Hughes scale ≤ 3 at discharge, prolonged mechanical ventilation (>21 days) and hospitalization (>36 days) were pneumonia, hyponatremia, hypokalemia, urinary infection, tracheobronchial infections, hypoalbuminemia, sepsis, anemia dysautonomia. Conclusion: Active monitoring and appropriate and early intervention by the clinician will improve the quality of life of these patients and reduce the cost of prolonged mechanical ventilation and ICU stay.
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Clinical impression and western aphasia battery classification of aphasia in acute ischemic stroke: Is there a discrepancy? p. 74
Aju Abraham John, Mahendra Javali, Rohan Mahale, Anish Mehta, PT Acharya, R Srinivasa
DOI:10.4103/0976-3147.193531  PMID:28149086
Background: Language disturbance is a common symptom of stroke, a prompt identifier of the event, and can cause devastating cognitive impairments. There are many inconsistencies and discrepancies between the different methods used for its evaluation. The relationship between Western Aphasia Battery (WAB) and a simple bedside clinical examination is not clear. Aim: The aim of this study is to determine if bedside clinical impression of aphasia type can reliably predict WAB classification of aphasia and to describe the discrepancies between them. Materials and Methods: Eighty-two consecutive cases of acute ischemic stroke and aphasia were evaluated with bedside aphasia assessment, handedness by Edinburgh Handedness Inventory and WAB scoring was done. Kappa statistics was used to find the overall agreement of clinical impression and WAB. Results: Disagreement was seen predominantly for the nonfluent aphasias when the clinical impression was compared with WAB classification. WAB also had diagnosed three cases as having anomic aphasia using taxonomic classification, but same cases had normal language by aphasia quotient scoring of WAB. There was an overall agreement of 63.4% between patient's bedside clinical impression and WAB classification of aphasia, with a P< 0.001. Conclusion: Clinical impression was fairly reliable, as compared to WAB in assessing the type of aphasia. Clinical impression was appropriate in an acute setting, but WAB was required to quantify the severity of deficit, which may help in accessing prognosis, monitoring progression, and rehabilitation planning. Along with WAB, a bedside clinical impression should be done for all the patients to strengthen the description of aphasic deficit.
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Motor cognitive processing speed estimation among the primary schoolchildren by deriving prediction formula: A cross-sectional study p. 79
Vencita Priyanka Aranha, Monika Moitra, Shikha Saxena, Kanimozhi Narkeesh, Narkeesh Arumugam, Asir John Samuel
DOI:10.4103/0976-3147.193544  PMID:28149087
Objectives: Motor cognitive processing speed (MCPS) is often reported in terms of reaction time. In spite of being a significant indicator of function, behavior, and performance, MCPS is rarely used in clinics and schools to identify kids with slowed motor cognitive processing. The reason behind this is the lack of availability of convenient formula to estimate MCPS. Thereby, the aim of this study is to estimate the MCPS in the primary schoolchildren. Materials and Methods: Two hundred and four primary schoolchildren, aged 6–12 years, were recruited by the cluster sampling method for this cross-sectional study. MCPS was estimated by the ruler drop method (RDM). By this method, a metallic stainless steel ruler was suspended vertically such that 5 cm graduation of the lower was aligned between the web space of the child's hand, and the child was asked to catch the moving ruler as quickly as possible, once released from the examiner's hand. Distance the ruler traveled was recorded and converted into time, which is the MCPS. Multiple regression analysis of variables was performed to determine the influence of independent variables on MCPS. Results: Mean MCPS of the entire sample of 204 primary schoolchildren is 230.01 ms ± 26.5 standard deviation (95% confidence interval; 226.4–233.7 ms) that ranged from 162.9 to 321.6 ms. By stepwise regression analysis, we derived the regression equation, MCPS (ms) = 279.625–5.495 × age, with 41.3% (R = 0.413) predictability and 17.1% (R2 = 0.171 and adjusted R2 = 0.166) variability. Conclusion: MCPS prediction formula through RDM in the primary schoolchildren has been established.
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Autonomic dysfunction: A comparative study of patients with Alzheimer's and frontotemporal dementia – A pilot study p. 84
Thomas Gregor Issac, Sadanandavalli Retnaswami Chandra, Neelesh Gupta, Malligurki Raghurama Rukmani, S Deepika, TN Sathyaprabha
DOI:10.4103/0976-3147.193545  PMID:28149088
Introduction: In frontotemporal dementia (FTD) and Alzheimer's disease (AD), central autonomic structures get affected early. An insight into autonomic functions in these patients is likely to be of diagnostic importance and thus help in prognosticating and also probably explain unexplained sudden death in some of these patients. Objectives: The objective of this study is to identify autonomic dysfunction prevailing in patients. Then, if there is dysfunction, is the pattern same or different in these two conditions. And if different it will serve as an additional biomarker for specific diagnosis. Patients and Methods: There were 25 patients and 25 controls and six patients and three controls in AD and FTD groups, respectively. The participants who were recruited were assessed for heart rate variability and conventional cardiac autonomic function testing. The parameters were analyzed using LabChart version 7 software and compared with control population using appropriate statistical methods using SPSS version 22 software. Results: The mean overall total power was low in the FTD group (P < 0.001), and there was significant reduction in the standard deviation of normal-to-normal intervals and root mean square of successive differences (P < 0.001) with elevated sympathovagal balance in the FTD group (P = 0.04). Patients with AD also showed sympathetic dominance, but there was in addition parasympathetic suppression unlike in the FTD group. Conclusion: This study reveals autonomic dysfunction in patients with FTD and AD. Both conditions show sympathetic dominance, probably consecutive to the involvement of central autonomic regulatory structures as a shared domain. It remains to be confirmed if these findings are the cause or effect of neurodegeneration and might open up newer territories of research based on the causal role of neurotransmitters in these regions and thus lead to novel therapeutic options such as yoga. The presence of parasympathetic suppression in AD in addition helps differentiate these two conditions.
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Admission experiences of psychiatric patients in tertiary care: An implication toward Mental Health Care Bill, 2013 p. 89
Ramachandra , Vijayalakshmi Poreddi, Rajalakshmi Ramu, Sugavana Selvi, Sailaxmi Gandhi, Lalitha Krishnasamy, BM Suresh
DOI:10.4103/0976-3147.193527  PMID:28149089
Background: Coercion is not uncommon phenomenon among mental health service users during their admission into psychiatric hospital. Research on perceived coercion of psychiatric patients is limited from India. Aim: To investigate perceived coercion of psychiatric patients during admission into a tertiary care psychiatric hospital. Materials and Methods: This was a cross-sectional descriptive survey carried out among randomly selected psychiatric patients (n = 205) at a tertiary care center. Data were collected through face-to-face interviews using structured questionnaire. Results: Our findings revealed that participants experienced low levels of coercion during their admission process. However, a majority of the participants were threatened with commitment (71.7%) as well as they were sad (67.8%), unpleased (69.7%), confused (73.2%), and frightened (71.2%) with regard to hospitalization into a psychiatric hospital. In addition, the participants expressed higher levels of negative pressures (mean ± standard deviation, 3.76 ± 2.12). Participants those were admitted involuntarily (P > 0.001), diagnosed to be having psychotic disorders (P > 0.003), and unmarried (P > 0.04) perceived higher levels of coercion. Conclusion: The present study showed that more formal coercion was experienced by the patients those got admitted involuntarily. On the contrary, participants with voluntary admission encountered informal coercion (negative pressures). There is an urgent need to modify the Mental Health Care (MHC) Bill so that treatment of persons with mental illness is facilitated. Family member plays an important role in providing MHC; hence, they need to be empowered.
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The self-stigma of depression scale: Translation and validation of the Arabic version p. 96
Hussain Ahmed Darraj, Mohamed Salih Mahfouz, Rashad Mohamed Al Sanosi, Mohammed Badedi, Abdullah Sabai
DOI:10.4103/0976-3147.193552  PMID:28149090
Background: Self-stigma may feature strongly and be detrimental for people with depression, but the understanding of its nature and prevalence is limited by the lack of psychometrically validated measures. This study is aimed to validate the Arabic version self-stigma of depression scale (SSDS) among adolescents. Materials and Methods: A cross-sectional study involved 100 adolescents randomly selected. The analyses include face validation, factor analysis, and reliability testing. A test–retest was conducted within a 2-week interval. Results: The mean score for self-stigma of depression among study participants was 68.9 (Standard deviation = 8.76) median equal to 71 and range was 47. Descriptive analysis showed that the percentage of those who scored below the mean score (41.7%) is shown less than those who scored above the mean score (58.3%). Preliminary construct validation analysis confirmed that factor analysis was appropriate for the Arabic-translated version of the SSDS. Furthermore, the factor analysis showed similar factor loadings to the original English version. The total internal consistency of the translated version, which was measured by Cronbach's alphas ranged from 0.70 to 0.77 for the four subscales and 0.84 for the total scale. Test–retest reliability was assessed in 65 respondents after 2 weeks. Cronbach's alphas ranged from 0.70 to 0.77 for the four subscales and 0.84 for the total scale. Conclusions: Face validity, construct validity, and reliability analysis were found satisfactory for the Arabic-translated version of the SSDS. The Arabic-translated version of the SSDS was found valid and reliable to be used in future studies, with comparable properties to the original version and to previous studies.
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REVIEW ARTICLE Top

Corpus callosum and neglect syndrome: Clinical findings after meningioma removal and anatomical review p. 101
David Gomes, Madalena Fonseca, Maria Garrotes, Maria Rita Lima, Marta Mendonça, Mariana Pereira, Miguel Lourenço, Edson Oliveira, José Pedro Lavrador
DOI:10.4103/0976-3147.193549  PMID:28149091
Two types of neglect are described: hemispatial and motivational neglect syndromes. Neglect syndrome is a neurophysiologic condition characterized by a malfunction in one hemisphere of the brain, resulting in contralateral hemispatial neglect in the absence of sensory loss and the right parietal lobe lesion being the most common anatomical site leading to it. In motivational neglect, the less emotional input is considered from the neglected side where anterior cingulate cortex harbors the most frequent lesions. Nevertheless, there are reports of injuries in the corpus callosum (CC) causing hemispatial neglect syndrome, particularly located in the splenium. It is essential for a neurosurgeon to recognize this clinical syndrome as it can be either a primary manifestation of neurosurgical pathology (tumor, vascular lesion) or as a postoperative iatrogenic clinical finding. The authors report a postoperative hemispatial neglect syndrome after a falcotentorial meningioma removal that recovered 10 months after surgery and performs a clinical, anatomical, and histological review centered in CC as key agent in neglect syndrome.
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CASE SERIES Top

Isolated sphenoid sinus lesions: Experience with a few rare pathologies p. 107
Nishanth Sadashiva, BN Nandeesh, Dhaval Shukla, Dhananjaya Bhat, Sampath Somanna, Bhagavatula Indira Devi
DOI:10.4103/0976-3147.193540  PMID:28149092
Introduction: The sphenoid sinus is often neglected because of its difficult access. The deep position of the sphenoid sinus hinders early diagnosis of pathologies in that location. Delayed diagnosis can cause serious complications due to proximity to many important structures. Objectives: The aim of this study is to demonstrate different pathologies which can affect the sphenoid sinus and elucidate the findings. Methods: Cases of isolated sphenoid sinus lesions encountered in the neurosurgical setting which had rare pathologies are discussed. Pathologies such as Langerhans cell histiocytosis, solitary plasmacytoma, chordoma, pituitary adenoma, leiomyosarcoma, fungal infection, and mucocele which appeared primarily in sphenoid sinus are discussed along with their imaging features and pathological findings. Conclusion: Multitude of different pathologies can occur in sphenoid sinus. Detailed preoperative imaging is very helpful, but transnasal biopsy and histological study are required often for definitive diagnosis. The possible advantages of early diagnosis before spread of pathology for prognosis cannot be overemphasized.
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POINT OF VIEW Top

Are counseling services necessary for the surgical patients and their family members during hospitalization? p. 114
Birudu Raju, Krishna Reddy
DOI:10.4103/0976-3147.193551  PMID:28149093
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IMAGES IN NEUROSCIENCES Top

Epidural pneumorrhachis consequent to Hamman syndrome p. 118
Prasad Krishnan, Sayan Das, Chandramouli Bhattacharyya
DOI:10.4103/0976-3147.193525  PMID:28149094
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Cockayne syndrome with intracranial calcification, hypomyelination, and cerebral atrophy p. 120
Joe James, James Jose
DOI:10.4103/0976-3147.185511  PMID:28149095
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CASE REPORTS Top

Risperidone-induced enuresis in a 12-year-old child p. 122
Reetika Dikshit, Sagar Karia, Avinash De Sousa
DOI:10.4103/0976-3147.193530  PMID:28149096
Risperidone has been documented to be effective in the management of behavior problems, aggression, and conduct disorder in children. While metabolic side effects like weight gain and obesity have been attributed to Risperidone use in children, side effects of the drug related to the urinary bladder are rare. We present a case of Risperidone-induced enuresis in a 12-year-old boy with conduct disorder that resolved completely after stopping the medication.
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Magnetic resonance imaging findings of isolated abducent nerve palsy induced by vascular compression of vertebrobasilar dolichoectasia p. 124
Hidetaka Arishima, Ken-ichiro Kikuta
DOI:10.4103/0976-3147.193529  PMID:28149097
If the origin of isolated abducent nerve palsy cannot be found on neuroradiological examinations, diabetes mellitus is known as a probable cause; however, some cases show no potential causes of isolated abducent nerve palsy. Here, we report a 74-year-old male who suffered from diplopia due to isolated left abducent nerve palsy. Magnetic resonance angiography and fast imaging employing steady-state acquisition imaging clearly showed a dolichoectasic vertebrobasilar artery compressing the left abducent nerve upward and outward. There were no abnormal lesions in the brain stem, cavernous sinus, or orbital cavity. Laboratory data showed no abnormal findings. We concluded that neurovascular compression of the left abducent nerve might cause isolated left abducent nerve palsy. We observed him without surgical treatment considering his general condition with angina pectoris and old age. His symptom due to the left abducent nerve palsy persisted. From previous reports, conservative treatment could not improve abducent nerve palsy. Microvascular decompression should be considered for abducent nerve palsy due to vascular compression if patients are young, and their general condition is good. We also discuss interesting characteristics with a review of the literature.
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COMMENTARY Top

Commentary p. 127
Andre C Felicio
DOI:10.4103/0976-3147.193566  PMID:28149098
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CASE REPORT Top

Bilateral ptosis without upward gaze palsy: Unusual presentation of midbrain tuberculoma p. 129
Shatanik Sarkar, Chaitali Patra, Malay Kumar Dasgupta
DOI:10.4103/0976-3147.193526  PMID:28149099
Central nervous system tuberculoma can have variable presentations depending on the site and number of tuberculomas. We are reporting a rare case of an 11-year-old male child presenting with ptosis and ataxia. Clinical examination revealed bilateral partial 3rd cranial nerve palsy (ptosis without any upward gaze palsy) associated with dysdiadochokinesia and ataxia on the right side. Magnetic resonance imaging of the brain revealed a single ring-enhancing lesion in the dorsal midbrain with perifocal edema. Magnetic resonance spectroscopy provided the etiological information as tuberculoma.
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COMMENTARY Top

Commentary p. 132
Adomas Bunevicius
DOI:10.4103/0976-3147.193563  PMID:28149100
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Commentary p. 133
A Arboix, M José Sánchez
DOI:10.4103/0976-3147.193557  PMID:28149101
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CASE REPORT Top

Magnetic resonance imaging brain findings in a case of aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder, presenting with intractable vomiting and hiccups p. 135
Prerna Garg, Muthusubramanian Rajasekaran, Salil Pandey, Gnanashanmugam Gurusamy, Devanand Balalakshmoji, Rajakumar Rathinasamy
DOI:10.4103/0976-3147.193533  PMID:28149102
Neuromyelitisoptica (NMO) and multiple sclerosis (MS) were once considered to be differing manifestation of same auto immune disease, NMO predominantly involving the optic nerve and cord. Now with discovery of NMO antibody the concept has changed and a spectrum of disorders with lesions in brain has been identified. Occasionally, brain may be the first or the only site of involvement in these disorders hence it is essential to be aware of this spectrum. The brain lesions in NMO/NMOSD may be located in characteristic regions and present with symptoms mimicking non neurological disease. We herein present a case of an adult female who was admitted with intractable vomiting and hiccups; subsequently on MRI brain found to have very tiny demyelinating foci in Area Postrema.
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COMMENTARY Top

Commentary p. 138
Adnan A Awada
DOI:10.4103/0976-3147.193554  PMID:28149103
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CASE REPORT Top

Lipomatous meningioma: A rare subtype of benign metaplastic meningiomas p. 140
Mehmet Onur YŁksel, Mehmet Sabri Gürbüz, Osman Tanrıverdi, Sevilay Akalp Özmen
Lipomatous meningiomas are extremely rare subtypes of benign meningiomas and are classified as metaplastic meningioma in the World Health Organization classification. We present a 77-year-old man presented with the history of a gradually intensifying headache for the last 3 months. A right frontoparietal mass was detected on his cranial magnetic resonance imaging. The patient was operated on via a right frontoparietal craniotomy, and histopathological diagnosis was lipomatous meningioma. Distinctive characteristics of lipomatous meningiomas were discussed with special emphasis to importance of immunohistochemical examinations, particularly for its differentiation from the tumors showing similar histology though having more aggressive character.
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COMMENTARY Top

Commentary p. 143
Dilip Kumar Das
DOI:10.4103/0976-3147.193559  PMID:28149105
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LETTERS TO THE EDITOR Top

Combined transchoroidal and subchoroidal approach for resection of a large hemorrhagic epithelial cyst: Expanding the operative corridor to the third ventricle p. 145
Dale Ding, Christopher E Furneaux
DOI:10.4103/0976-3147.193536  PMID:28149106
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COMMENTARY Top

Commentary p. 147
Athanasios K Petridis
DOI:10.4103/0976-3147.193598  PMID:28149107
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LETTERS TO THE EDITOR Top

A single center study of epidemiology of neural tube defects p. 147
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/0976-3147.193599  PMID:28149108
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Developing cerebral venous infarct presenting with seizure occurring after lumbar drain placement following trans-sphenoidal surgery of cushing's disease: Review of literature p. 148
Dattaraj Sawarkar, Guru Dutta Satyarthee, Pankaj Singh, Hitesh Gurjar, MM Singh, BS Sharma
DOI:10.4103/0976-3147.193567  PMID:28149109
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Visual disturbance in patients with cryptococcal meningitis: The road ahead p. 151
Cijoy K Kuriakose, Ajay Kumar Mishra, Harshad Arvind Vanjare, Ancy Raju, OC Abraham
DOI:10.4103/0976-3147.193560  PMID:28149110
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Acute subdural hematoma from a ruptured aneurysm of the distal middle cerebral artery p. 152
Dale Ding, Arnold P Bok
DOI:10.4103/0976-3147.193541  PMID:28149111
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COMMENTARY Top

Commentary p. 155
Amey R Savardekar, Dhaval Shukla
DOI:10.4103/0976-3147.193565  PMID:28149112
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LETTER TO THE EDITOR Top

Subdural hematoma and mycotic aneurysm bleed p. 156
Atul Goel
DOI:10.4103/0976-3147.193556  PMID:28149113
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COMMENTARY Top

Commentary p. 156
Girish Menon
DOI:10.4103/0976-3147.193561  PMID:28149114
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LETTERS TO THE EDITOR Top

Multicystic encephalomalacia secondary to head trauma p. 158
RV Phadke, Vivek Agarwal, Suprava Naik
DOI:10.4103/0976-3147.193528  PMID:28149115
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Cryptococcal meningitis presenting as acute onset bilateral cerebellar infarct p. 159
Ajay Kumar Mishra, Harshad Arvind Vanjare, Promila Mohan Raj
DOI:10.4103/0976-3147.193537  PMID:28149116
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