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Papers by Madhavi Karri

Journal of Stroke Medicine

Background: Decompressive craniectomy (DC) is a life-saving treatment modality for acute malignan... more Background: Decompressive craniectomy (DC) is a life-saving treatment modality for acute malignant strokes. We aimed to identify the risk factors and assess the long-term functional outcome in patients with malignant stroke undergoing DC. Methods: We conducted an ambispective study on patients (>18 years) undergoing DC between January 2016 and January 2019. Demographic data, stroke risk factors, clinical characteristics, and serial imaging findings were collected. We measured the functional outcomes using the National Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), modified Ranking Scale (mRS), and Barthel index (BI) at 3, 6, and 12 months postoperatively. We did univariate and multivariate regression analyses for the independent variables and outcomes. Results: On admission, the 93 patients (70 males) had a mean GCS of 11.77 (standard deviation [SD]: 2.90) and a mean NIHSS score of 13.65 (SD: 4.41). Diabetes (odds ratio [OR]: 1.76; 0.67-4.46, 95% confidence interval [CI])...

Romanian Journal of Neurology

Myasthenia gravis is an autoimmune neuromuscular junction disorder affecting skeletal muscles. It... more Myasthenia gravis is an autoimmune neuromuscular junction disorder affecting skeletal muscles. It is characterized by muscle fatigability with fluctuating weakness and diurnal variations. Here, we present an elderly female presented with subacute onset dysphagia predominantly to solids with weight loss for one month. Upper gastrointestinal endoscopy showed a crico-esophageal spasm. Manometric studies showed distal esophageal spasm with normal pressures. Clinically, she had proximal muscle weakness of all four limbs with bulbar weakness. Nerve conduction studies done were suggestive of postsynaptic neuromuscular junction disorder. Serum acetylcholinesterase receptor antibodies were elevated. We started her on pyridostigmine and low dose steroids, following which her symptoms improved. Here smooth muscle involvement was considered secondary to myasthenia gravis, which recovered after treatment. Treating physicians should even think of neurological causes in patients presenting with dy...

Journal of Stroke Medicine

Background: Stroke has been a growing concern with increasing morbidity and mortality worldwide. ... more Background: Stroke has been a growing concern with increasing morbidity and mortality worldwide. Tenecteplase has been approved in India as a newer thrombolytic, in acute ischemic stroke, since 2016. Very few studies have been reported to know the efficacy of Tenecteplase in AIS compared to alteplase. Aim: This study was done to understand the efficacy and related complications of Tenecteplase in AIS. Methods: In this prospective study, we took 112 people with AIS who received Tenecteplase, admitted between August 2018 and August 2020. After obtaining ethical approval, we tabulated patients’ data and did the statistical analysis using an unpaired t test, Analysis of Variance, and chi-square test. A P value of <.05 using a 2-tailed test was considered significant for all statistical analyses. Results: Out of 112 patients, 67.9% were male and 32.1% were female, with a mean age of 60.7 years. We classified stroke by using the TOAST classification. About 62.5% are classified as large...

IP Indian Journal of Neurosciences

A novel coronavirus (COVID-19) pandemic is caused by severe acute respiratory syndrome coronaviru... more A novel coronavirus (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2). This pandemic has been globally alarming in the current period. Several neurological manifestations are reported occurring with the infection. Guillain barre syndrome (GBS) or acute onset inflammatory polyradiculoneuropathy has been among the frequent manifestations observed among them. To know the pattern and outcome of GBS in COVID-19 affected individuals. We have taken six individuals admitted with flaccid quadriparesis in the last two months. All were affected recently by COVID 19 infection, which RT PCR of the nasopharyngeal swab confirmed. The study participants have undergone nerve conduction studies and have been diagnosed with Guillain Barre syndrome using Brighton criteria. We did cerebrospinal fluid (CSF) analysis after admission. We initiated all patients on Intravenous immunoglobulin according to body weight (2g/kg divided over five days). We used the Barth...

Libyan Journal of Medical Sciences, 2021

Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition with chara... more Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition with characteristic clinical and radiological features. PRES occurring as a complication post blood transfusion is reported to be rare, irrespective of the presence of an underlying hematological disorder. Here, we describe a case of a 37-year old female known case of chronic anemia secondary to menorrhagia, who received three units of packed red blood cells transfusion and there was raise in hemoglobin from 6 gm/dl to 11 gm/dl. Four hours after the last transfusion, she developed occipital headache with neck pain and presented to us with two episodes of generalized tonic-clonic seizures after four days of symptoms onset. With this clinical picture in correlation with magnetic rsonance imaging findings, features were consistent with PRES. PRES is contemplated as one of the acute transfusion reactions but a rare entity, which is often preventable.

Brain Circulation, 2021

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

Context: Posterior cerebral artery (PCA) derives its blood supply from the vertebrobasilar system... more Context: Posterior cerebral artery (PCA) derives its blood supply from the vertebrobasilar system. However, in 10% of the population, they get blood supply from the internal carotid artery via a posterior communicating artery. This variant is called as fetal type of PCA (fPCA). Whether fPCA is an anatomical variant or a predisposing factor for a cerebrovascular event remains an enigma. Aims: The aim is to assess if fPCA is associated with increased risk of ischaemic stroke or other vascular anomalies. Settings and Design: It is a retrospective cross-sectional observational study. Subjects and Methods: Patients who underwent MR or CT angiography, over 5 years for various neurological illnesses were screened for fPCA. Those patients were assessed for vascular anomalies and ischaemic stroke. Statistical Analysis Used: Chi-square in the Statistical Package for the Social Sciences v23. Results: On analysis of 250 patients, five had aneurysms; three had AV malformation, one with Fenestrat...

Journal of the Royal College of Physicians of Edinburgh

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Introduction The occurrence of both Guillain-Barré syndrome(GBS) and myasthenia gravis (MG) in th... more Introduction The occurrence of both Guillain-Barré syndrome(GBS) and myasthenia gravis (MG) in the same individual is rare. The underlying pathophysiology was assumed to be autoimmune humoral mechanisms and molecular mimicry with a cross-reaction between autoantibodies and myelin sheath of peripheral nerves and acetylcholine receptors of the neuromuscular junction (NMJ). Case description A 68-year-old male known diabetic and hypertensive with good drug compliance presented with acute onset quadriparesis with bulbar involvement for 1 day. On examination, he had mild neck flexion weakness and bulbar weakness. He had flaccid quadriparesis with absent deep tendon reflexes and negative Babinski. The rest of the neurological examination was normal. Discussion and evaluation Blood and electrophysiological studies showed evidence of demyelinating polyradiculoneuropathy with temporal dispersion suggestive of Guillain-Barré syndrome. He was treated with intravenous immunoglobin and complete r...

Journal of Stroke Medicine

Background: Ischemic stroke in young adults is becoming a rising concern with the increase in vul... more Background: Ischemic stroke in young adults is becoming a rising concern with the increase in vulnerability to traditional risk factors and changing lifestyles. Aim: An overview of risk factors, classification, and clinical outcome of ischemic stroke in young adults (19 to 45 years) has been presented. Methods: Data fulfilling the study criteria from the stroke registry between June 2014 and June 2017 were collected, and a detailed proforma was taken that included history, clinical examination, and routine investigations. Selective investigations such as prothrombotic workup and 24-hour Holter monitoring were performed. Stroke was subclassified using the Trial of Org 10172 in Acute Stroke Treatment criteria. National Institute of Health Stroke Scale (NIHSS) scores at baseline and the modified Rankin score (mRS) scoring after 3 months of patients’ admission were calculated. Results: Out of 223 identified cases of ischemic stroke in young adults, 186 (83.4%) were taken for analysis, c...

Postgraduate Medical Journal

An 11-year-old boy diagnosed as acute postinfectious glomerulonephritis presented with cluster se... more An 11-year-old boy diagnosed as acute postinfectious glomerulonephritis presented with cluster seizures with features of posterior reversible encephalopathy syndrome by MRI of brain. His blood pressure was 190/110 mm Hg with Glasgow Coma Scale of 7/15 (E2M4V1) with no meningeal signs. During third day of admission, he was noticed to have unilaterally dilated non-reacting right pupil (horizontally oval) (figure 1A) lasting for 2 min and resolved spontaneously (figure 1C) with normal left eye pupil simultaneously (figure 1B,D). He showed no clinical and …

International Journal of Research in Medical Sciences

Background: Primary headache disorders are among the most ubiquitous disorders affecting people w... more Background: Primary headache disorders are among the most ubiquitous disorders affecting people worldwide. Migraine headache is one of the commonest syndromes of primary headache. There are few studies regarding clinical profile of migraine and migraine triggers in India. The objective this study was to study the gender, age distribution, frequency, severity of migraine attacks and other associated symptoms in patients presenting with migraine. To study in detail about triggers of migraine in present study population.Methods: About 222 patients who presented with history suggestive of migraine with or without aura defined according to International classification of headache disorders 2, fulfilling the study criteria were included. The study duration was fifteen months from March 2017 to May 2018. Details were collected using a proforma.Results: In this study, incidence of Migraine is higher in females (169,76%) than males (53, 24%). Majority of migraine patients were between age gr...

Annals of Indian Academy of Neurology

242 Sir, Guillain–Barre syndrome (GBS) is the most common cause of acute flaccid paraparesis or q... more 242 Sir, Guillain–Barre syndrome (GBS) is the most common cause of acute flaccid paraparesis or quadriparesis after eradication of polio with an incidence of 1–2 cases per 100,000 per year throughout the world.[1] Nerve conduction studies (NCSs), cerebrospinal fluid (CSF) analysis, and magnetic resonance imaging (MRI) add supportive evidence for the diagnosis. In the early stages, clinical evidence is diagnostic whereas electrophysiological studies may be normal or may have only absent H reflex throughout the course.[2] Recent infections and vaccinations are the most common triggers whereas pregnancy and parturition, bariatric surgery, renal transplantation, and trauma are also reported.

Annals of Indian Academy of Neurology

Annals of Indian Academy of Neurology ¦ Volume 22 ¦ Issue 3 ¦ July-September 2019 333 to low-CSF ... more Annals of Indian Academy of Neurology ¦ Volume 22 ¦ Issue 3 ¦ July-September 2019 333 to low-CSF pressure. Previous reports have suggested that the mechanism of frontal lobe dysfunction due to low-CSF pressure could be explained by brain sagging and anatomic distortion.[4,5] In this case, we did not find any clue of intracranial hypotension on the patient’s brain MRI, such as pachymeningeal thickening and sagging brainstem. However, considering the symptom onset, the course of recovery, and the result of the neuropsychological test, we assume that her symptom of psychomotor slowing suggesting frontal lobe dysfunction was closely related to the choroid plexus infarction. Further studies with more cases are needed to understand its underlying mechanism. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

West African Journal of Radiology

Dengue encephalitis is caused by a nonneurotropic virus of Flaviviridae group. It is a very rare ... more Dengue encephalitis is caused by a nonneurotropic virus of Flaviviridae group. It is a very rare manifestation of dengue fever caused by direct invasion of neural tissue into brain parenchyma. It causes a spectrum of neurologic manifestations such as meningitis, encephalitis, myelitis, and stroke. Here, we discuss a 20-year-old antenatal woman who presented with acute-onset fever and altered sensorium for 1 day. Blood investigations showed mild thrombocytopenia. Magnetic resonance imaging showed characteristic hemorrhagic encephalitis involving bilateral thalami and pons with diffusion restriction. Cerebrospinal fluid for the meningoencephalitic panel was negative. Serology for dengue NS1 antigen and immunoglobulin M antibody were positive. Although considered as a nonneurotropic virus, acute clinical presentation of fever, and altered sensorium apart from herpes and Japanese encephalitis, dengue encephalitis should also be regarded as one of the differentials.

International Journal of Neurology and Neurosurgery

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Introduction Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired auto... more Introduction Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired autoimmune disease of the peripheral nervous system. Its clinical presentation and excellent response to steroids is a hallmark to the disease entity. It is usually a straight forward diagnosis in typical cases. Atypical CIDP often is of diagnostic concern and has been a challenge for practising neurologists. Case description Here, we present a 56-year old female presented with isolated left palatal palsy preceded by a short febrile illness. Clinically consistent with post-infectious bulbar palsy, she was treated with intravenous pulse steroids and antibiotics. She had progressive disease and later developed quadriparesis with neck flexor weakness with progressive bulbar weakness and hypercapnic respiratory failure. Discussion and evaluation MRI whole spine with contrast showed nerve root enhancement. Nerve conduction studies of all four limbs and LP and CSF analysis were consistent with CID...

Journal of Stroke Medicine

Background: Decompressive craniectomy (DC) is a life-saving treatment modality for acute malignan... more Background: Decompressive craniectomy (DC) is a life-saving treatment modality for acute malignant strokes. We aimed to identify the risk factors and assess the long-term functional outcome in patients with malignant stroke undergoing DC. Methods: We conducted an ambispective study on patients (>18 years) undergoing DC between January 2016 and January 2019. Demographic data, stroke risk factors, clinical characteristics, and serial imaging findings were collected. We measured the functional outcomes using the National Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), modified Ranking Scale (mRS), and Barthel index (BI) at 3, 6, and 12 months postoperatively. We did univariate and multivariate regression analyses for the independent variables and outcomes. Results: On admission, the 93 patients (70 males) had a mean GCS of 11.77 (standard deviation [SD]: 2.90) and a mean NIHSS score of 13.65 (SD: 4.41). Diabetes (odds ratio [OR]: 1.76; 0.67-4.46, 95% confidence interval [CI])...

Romanian Journal of Neurology

Myasthenia gravis is an autoimmune neuromuscular junction disorder affecting skeletal muscles. It... more Myasthenia gravis is an autoimmune neuromuscular junction disorder affecting skeletal muscles. It is characterized by muscle fatigability with fluctuating weakness and diurnal variations. Here, we present an elderly female presented with subacute onset dysphagia predominantly to solids with weight loss for one month. Upper gastrointestinal endoscopy showed a crico-esophageal spasm. Manometric studies showed distal esophageal spasm with normal pressures. Clinically, she had proximal muscle weakness of all four limbs with bulbar weakness. Nerve conduction studies done were suggestive of postsynaptic neuromuscular junction disorder. Serum acetylcholinesterase receptor antibodies were elevated. We started her on pyridostigmine and low dose steroids, following which her symptoms improved. Here smooth muscle involvement was considered secondary to myasthenia gravis, which recovered after treatment. Treating physicians should even think of neurological causes in patients presenting with dy...

Journal of Stroke Medicine

Background: Stroke has been a growing concern with increasing morbidity and mortality worldwide. ... more Background: Stroke has been a growing concern with increasing morbidity and mortality worldwide. Tenecteplase has been approved in India as a newer thrombolytic, in acute ischemic stroke, since 2016. Very few studies have been reported to know the efficacy of Tenecteplase in AIS compared to alteplase. Aim: This study was done to understand the efficacy and related complications of Tenecteplase in AIS. Methods: In this prospective study, we took 112 people with AIS who received Tenecteplase, admitted between August 2018 and August 2020. After obtaining ethical approval, we tabulated patients’ data and did the statistical analysis using an unpaired t test, Analysis of Variance, and chi-square test. A P value of <.05 using a 2-tailed test was considered significant for all statistical analyses. Results: Out of 112 patients, 67.9% were male and 32.1% were female, with a mean age of 60.7 years. We classified stroke by using the TOAST classification. About 62.5% are classified as large...

IP Indian Journal of Neurosciences

A novel coronavirus (COVID-19) pandemic is caused by severe acute respiratory syndrome coronaviru... more A novel coronavirus (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2). This pandemic has been globally alarming in the current period. Several neurological manifestations are reported occurring with the infection. Guillain barre syndrome (GBS) or acute onset inflammatory polyradiculoneuropathy has been among the frequent manifestations observed among them. To know the pattern and outcome of GBS in COVID-19 affected individuals. We have taken six individuals admitted with flaccid quadriparesis in the last two months. All were affected recently by COVID 19 infection, which RT PCR of the nasopharyngeal swab confirmed. The study participants have undergone nerve conduction studies and have been diagnosed with Guillain Barre syndrome using Brighton criteria. We did cerebrospinal fluid (CSF) analysis after admission. We initiated all patients on Intravenous immunoglobulin according to body weight (2g/kg divided over five days). We used the Barth...

Libyan Journal of Medical Sciences, 2021

Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition with chara... more Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition with characteristic clinical and radiological features. PRES occurring as a complication post blood transfusion is reported to be rare, irrespective of the presence of an underlying hematological disorder. Here, we describe a case of a 37-year old female known case of chronic anemia secondary to menorrhagia, who received three units of packed red blood cells transfusion and there was raise in hemoglobin from 6 gm/dl to 11 gm/dl. Four hours after the last transfusion, she developed occipital headache with neck pain and presented to us with two episodes of generalized tonic-clonic seizures after four days of symptoms onset. With this clinical picture in correlation with magnetic rsonance imaging findings, features were consistent with PRES. PRES is contemplated as one of the acute transfusion reactions but a rare entity, which is often preventable.

Brain Circulation, 2021

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

Context: Posterior cerebral artery (PCA) derives its blood supply from the vertebrobasilar system... more Context: Posterior cerebral artery (PCA) derives its blood supply from the vertebrobasilar system. However, in 10% of the population, they get blood supply from the internal carotid artery via a posterior communicating artery. This variant is called as fetal type of PCA (fPCA). Whether fPCA is an anatomical variant or a predisposing factor for a cerebrovascular event remains an enigma. Aims: The aim is to assess if fPCA is associated with increased risk of ischaemic stroke or other vascular anomalies. Settings and Design: It is a retrospective cross-sectional observational study. Subjects and Methods: Patients who underwent MR or CT angiography, over 5 years for various neurological illnesses were screened for fPCA. Those patients were assessed for vascular anomalies and ischaemic stroke. Statistical Analysis Used: Chi-square in the Statistical Package for the Social Sciences v23. Results: On analysis of 250 patients, five had aneurysms; three had AV malformation, one with Fenestrat...

Journal of the Royal College of Physicians of Edinburgh

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Introduction The occurrence of both Guillain-Barré syndrome(GBS) and myasthenia gravis (MG) in th... more Introduction The occurrence of both Guillain-Barré syndrome(GBS) and myasthenia gravis (MG) in the same individual is rare. The underlying pathophysiology was assumed to be autoimmune humoral mechanisms and molecular mimicry with a cross-reaction between autoantibodies and myelin sheath of peripheral nerves and acetylcholine receptors of the neuromuscular junction (NMJ). Case description A 68-year-old male known diabetic and hypertensive with good drug compliance presented with acute onset quadriparesis with bulbar involvement for 1 day. On examination, he had mild neck flexion weakness and bulbar weakness. He had flaccid quadriparesis with absent deep tendon reflexes and negative Babinski. The rest of the neurological examination was normal. Discussion and evaluation Blood and electrophysiological studies showed evidence of demyelinating polyradiculoneuropathy with temporal dispersion suggestive of Guillain-Barré syndrome. He was treated with intravenous immunoglobin and complete r...

Journal of Stroke Medicine

Background: Ischemic stroke in young adults is becoming a rising concern with the increase in vul... more Background: Ischemic stroke in young adults is becoming a rising concern with the increase in vulnerability to traditional risk factors and changing lifestyles. Aim: An overview of risk factors, classification, and clinical outcome of ischemic stroke in young adults (19 to 45 years) has been presented. Methods: Data fulfilling the study criteria from the stroke registry between June 2014 and June 2017 were collected, and a detailed proforma was taken that included history, clinical examination, and routine investigations. Selective investigations such as prothrombotic workup and 24-hour Holter monitoring were performed. Stroke was subclassified using the Trial of Org 10172 in Acute Stroke Treatment criteria. National Institute of Health Stroke Scale (NIHSS) scores at baseline and the modified Rankin score (mRS) scoring after 3 months of patients’ admission were calculated. Results: Out of 223 identified cases of ischemic stroke in young adults, 186 (83.4%) were taken for analysis, c...

Postgraduate Medical Journal

An 11-year-old boy diagnosed as acute postinfectious glomerulonephritis presented with cluster se... more An 11-year-old boy diagnosed as acute postinfectious glomerulonephritis presented with cluster seizures with features of posterior reversible encephalopathy syndrome by MRI of brain. His blood pressure was 190/110 mm Hg with Glasgow Coma Scale of 7/15 (E2M4V1) with no meningeal signs. During third day of admission, he was noticed to have unilaterally dilated non-reacting right pupil (horizontally oval) (figure 1A) lasting for 2 min and resolved spontaneously (figure 1C) with normal left eye pupil simultaneously (figure 1B,D). He showed no clinical and …

International Journal of Research in Medical Sciences

Background: Primary headache disorders are among the most ubiquitous disorders affecting people w... more Background: Primary headache disorders are among the most ubiquitous disorders affecting people worldwide. Migraine headache is one of the commonest syndromes of primary headache. There are few studies regarding clinical profile of migraine and migraine triggers in India. The objective this study was to study the gender, age distribution, frequency, severity of migraine attacks and other associated symptoms in patients presenting with migraine. To study in detail about triggers of migraine in present study population.Methods: About 222 patients who presented with history suggestive of migraine with or without aura defined according to International classification of headache disorders 2, fulfilling the study criteria were included. The study duration was fifteen months from March 2017 to May 2018. Details were collected using a proforma.Results: In this study, incidence of Migraine is higher in females (169,76%) than males (53, 24%). Majority of migraine patients were between age gr...

Annals of Indian Academy of Neurology

242 Sir, Guillain–Barre syndrome (GBS) is the most common cause of acute flaccid paraparesis or q... more 242 Sir, Guillain–Barre syndrome (GBS) is the most common cause of acute flaccid paraparesis or quadriparesis after eradication of polio with an incidence of 1–2 cases per 100,000 per year throughout the world.[1] Nerve conduction studies (NCSs), cerebrospinal fluid (CSF) analysis, and magnetic resonance imaging (MRI) add supportive evidence for the diagnosis. In the early stages, clinical evidence is diagnostic whereas electrophysiological studies may be normal or may have only absent H reflex throughout the course.[2] Recent infections and vaccinations are the most common triggers whereas pregnancy and parturition, bariatric surgery, renal transplantation, and trauma are also reported.

Annals of Indian Academy of Neurology

Annals of Indian Academy of Neurology ¦ Volume 22 ¦ Issue 3 ¦ July-September 2019 333 to low-CSF ... more Annals of Indian Academy of Neurology ¦ Volume 22 ¦ Issue 3 ¦ July-September 2019 333 to low-CSF pressure. Previous reports have suggested that the mechanism of frontal lobe dysfunction due to low-CSF pressure could be explained by brain sagging and anatomic distortion.[4,5] In this case, we did not find any clue of intracranial hypotension on the patient’s brain MRI, such as pachymeningeal thickening and sagging brainstem. However, considering the symptom onset, the course of recovery, and the result of the neuropsychological test, we assume that her symptom of psychomotor slowing suggesting frontal lobe dysfunction was closely related to the choroid plexus infarction. Further studies with more cases are needed to understand its underlying mechanism. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

West African Journal of Radiology

Dengue encephalitis is caused by a nonneurotropic virus of Flaviviridae group. It is a very rare ... more Dengue encephalitis is caused by a nonneurotropic virus of Flaviviridae group. It is a very rare manifestation of dengue fever caused by direct invasion of neural tissue into brain parenchyma. It causes a spectrum of neurologic manifestations such as meningitis, encephalitis, myelitis, and stroke. Here, we discuss a 20-year-old antenatal woman who presented with acute-onset fever and altered sensorium for 1 day. Blood investigations showed mild thrombocytopenia. Magnetic resonance imaging showed characteristic hemorrhagic encephalitis involving bilateral thalami and pons with diffusion restriction. Cerebrospinal fluid for the meningoencephalitic panel was negative. Serology for dengue NS1 antigen and immunoglobulin M antibody were positive. Although considered as a nonneurotropic virus, acute clinical presentation of fever, and altered sensorium apart from herpes and Japanese encephalitis, dengue encephalitis should also be regarded as one of the differentials.

International Journal of Neurology and Neurosurgery

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Introduction Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired auto... more Introduction Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired autoimmune disease of the peripheral nervous system. Its clinical presentation and excellent response to steroids is a hallmark to the disease entity. It is usually a straight forward diagnosis in typical cases. Atypical CIDP often is of diagnostic concern and has been a challenge for practising neurologists. Case description Here, we present a 56-year old female presented with isolated left palatal palsy preceded by a short febrile illness. Clinically consistent with post-infectious bulbar palsy, she was treated with intravenous pulse steroids and antibiotics. She had progressive disease and later developed quadriparesis with neck flexor weakness with progressive bulbar weakness and hypercapnic respiratory failure. Discussion and evaluation MRI whole spine with contrast showed nerve root enhancement. Nerve conduction studies of all four limbs and LP and CSF analysis were consistent with CID...