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ABSTRACT
Year : 2014  |  Volume : 17  |  Issue : 6  |  Page : 160-244
 

Selected Abstracts of IANCON 2014



Date of Web Publication30-Oct-2014

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How to cite this article:
. Selected Abstracts of IANCON 2014. Ann Indian Acad Neurol 2014;17, Suppl S2:160-244

How to cite this URL:
. Selected Abstracts of IANCON 2014. Ann Indian Acad Neurol [serial online] 2014 [cited 2019 Sep 15];17, Suppl S2:160-244. Available from: http://www.annalsofian.org/text.asp?2014/17/6/160/143466


266

Session: Eposter clinical 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

A prospective study on visual impairment

B. Shankar, A. Thaseen, T. Surendramohan, R. Rajarajan, R. Ramya, Cheran Elangovan, V. Kannan, R. Lakshmi Narasimhan, K. Bhanu,

Institute Of Neurology Madras Medical College Ch, Chennai.

Aim: To identify the neuroanatomical co-relation of visual pathway defects and visual impairment. Material and Method: Patient admitted over a period of 6 months from jan 2014 to June 2014 with complaints of monocular binocular complete incomplete transient permanent recurrent visual impairment were studied in detailed. Clinically assessed for pupillary reaction fundus examination visual field defects colour vision visual acuity. Cases were worked out with VEP (flash/pattern) optical coherence/ tomography (OCT) Goldmann perimeter Electroretinogram (ERG) MRI with orbital cuts and other investigation appropriate to the content of the case. Finally patients categorised on basis of onset aetiology and severity of vision loss. Study: Among 58 cases patient with monocular transient include vision loss optic neuritis (5) ADEM (3) CRAO (2) Retinal detachment due to eclampsia (4). Patients with monocular permanent vision loss includes orbital cellulitis (5) HIV associated vision loss (3) neuroretinitis (2). Patient with recurrent monocular vision loss include recurrent optic neuritis (3) Neuromyletis optica (3) multiple sclerosis (3). Patient with transient binocular vision loss were due to cerebral venous thrombosis (6) PRES (5). Patient with binocular permanent vision loss includes CVA (11) Retinitis pigmentosa (2) pituitary apoplexy (1) were analysed. Results: Among field defects 68% showed congruous hemianopia 31% had incongruous hemianopia 1% had junctional scotoma. Visual impairment due to CVA & optic neuritis were common. In this study 76% of causes were treatable cause and in our study 31% had their vision back completely. 49% had partial recovery of vision and 20% had permanent loss of vision. Conclusion: This on-going study is an effort to identify the pattern of visual impairment due to neurological cause there anatomical correlation common types of visual impairment and common etiologies

25

Session: Eposter clinical 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Hand on head sign in cervical radiculopathies

Dr. Shaji CV, Dr. Roopchand PS, Dr. Shyma MM, Dr. Prasanth SR, Dr. Parvathy G

Professor and Head Department of Neurology Gove, Alappuzha.

Background: Cervical radiculopathy is a common case in Neurology op department. It is often difficult to clinically detect manage radicular pain in a busy op department. Hand on head symptom/sign can be used in such situations to identify cervical radiculopathy. Objectives: To analyze features of cervical radiculopathy with hand on head sign. Methods: We analysed patients having cervical radiculopathy with positive hand on head sign/ symptom in a prospective study in the Neurology department of a tertiary care centre. Clinical and magnetic resonance imaging profile of patients were analysed with charts and bar diagrams. Result: We analysed data of 21 patients who presented with cervical radiculopathy and Hand on head sign/symptom over a period of 6 months. In the study group 85.7% of the study population comprised of males of which 90.47% were in the age group between 30 to 45 years. Left side was affected in 85.7% with 52.4% having some amount of motor weakness. All had sensory signs and symptoms and reflex abnormalities. C6 C7 disc involvement was seen in 61.9% of the study group. Management wise 95.24% received medical management and among them 85.71% had a paucity of response to standard therapeutic regime. Discussion: Hand on head symptom/sign was more in young males. Most commonly affected side was left. A C6/C7 disc prolapse with Predominant C7 root involvement was seen in our study. All patients were severely symptomatic with relative paucity of response to standard treatment. Conclusion: Hand on head symptom/sign is an easy and reliable clinical tool to detect cervical radiculopathies especially C7 root involvement. These patients are severely symptomatic with poor response to medical management.

73

Session: Eposter clinical 1.3

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

An interesting case of myelopathy

Dr. Kumar N. M, Dr. Praveen Kumar S, Dr. Agadi J. B,

Dr. Archana B. Netto, Dr.karthik N.

Bangalore Medical College and Research Institute, Bangalore.


We report a 39 year old patient from south India presenting with progressive asymmetric spastic weakness affecting both lower limbs with sensory deficits & bladder symptoms. Workup for spastic paraparesis (hemogram vitamin B12 levels serum copper levels) were normal except mild eosinophilia. Serum VDRL HIV I and II ANA profile were negative. MRI spine showed posteriorly placed T2 hyperintense lesion (D3 - D5 level). MRI Brain was normal. CSF analysis was normal (OCB negative). NCS of all limbs and bilateral VEP were normal. Tracking eosinophilia we did absolute eosinophil count & serum total IgE levels which were elevated (IgE - 1136 IU/ml). Allergen test (skin prick test) was positive for several antigens including house dust mite. A diagnosis of atopic myelitis was made. He showed partial response to corticosteroids. There has been no clinical / radiological dissemination for two years. Earlier thought to be peculiarly Japanese phenomenon this case probably represents the first case of atopic myelitis to be described in India. It fulfills the recently proposed diagnostic criteria for the same. It is possible that the incidence of atopic myelitis may be underestimated where it is not a standard practice to measure serum IgE levels in patients with idiopathic myelopathy.

108

Session: Eposter clinical 1.4

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Experience with plasmapheresis in neurological disorders in the tertiary care hospital in Central India

Dr. Shailesh Mohan Badole, Dr. Syed Ghouse Rabbani,

Dr. Ateeq Ur Rehman, Dr. Hari Radhakrishna

Care Hospitalsnampally Hyderabad Telangana State, Hyderabad.

Background: Plasmapheresis is established as effective in severe acute inflammatory demyelinating polyneuropathy (AIDP)/Guillain-Barre syndrome (GBS) acute fulminant demyelinating CNS disease like NMO & myasthenia gravis. Objective: To assess role of plasmapheresis in treatment of neurologic disorders. Methods: We analyzed our experience with plasmapharesis in neurologic disorders. There were two patients with Myasthenic crisis one with NMO & 8 patients with GBS. Abstract: One patient of myasthenic crisis was on non-invasive ventilation(NIV). She was treated with plasmapheresis steroids azathioprine pyridostigmine & gradually weaned off from NIV. Second patient of myasthenia gravis initially presented with pneumonia also found to have thrombocytopenia treated with antibiotics & azathioprine was withheld in view of thrombocytopenia. Subsequently she went into myasthenic crisis required readmission & mechanical ventilation. After 3 cycles of plasmapharesis patient was gradually weaned off from ventilator. One patient of longitudinally extensive transverse myelitis ? NMO was bedridden. She underwent 6 cyles of plasmapharesis. Subsequently on follow up her power improved to grade V in all limbs. There were total 8 patients of Guillain-Barre Syndrome (GBS) who were treated with plasmapharesis. After plasmapharesis the patients with Huges grade IV improved to grade III & those with grade II & III were improved to grade I. During procedure intervention related reversible hypotension occurred in 2 patients. One patient developed hypersensitivity reaction to transfusion of FFP after procedure. Infection & mortality rates due to plasmapharesis were zero. Conclusion: Treatment with plasmapharesis is very effective method of immunomodulation & without any complications in proper settings.

221

Session: Eposter clinical 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Role of mechanical ventilation in Tuberculous meningitis

U K Misra, Jayantee Kalita, Sanjeev Kumar Bhoi, Betai Sagar

Sanjay Gandhi Post Graduate Institute of Medical S, Lucknow.

Background: TB meningitis is an unpredictable area and has high mortality and morbidity which is mainly due to raised intracranial pressure stroke and granuloma. Some of these patients have respiratory failure and may be required to be given mechanical ventilation. In view of paucity of studies of ventilated patients with TBM we report our experience of consecutive patients with TBM undergoing mechanical ventilation and their outcome. Methods : Diagnosis of TBM was based on clinical MRI and CSF findings and were grouped into stage I II and III. The patients withTBM were also grouped as definite and probable. Those who were unable to maintained saturation CO2 > 50 mm Hg or acidosis pH <7.3 were mechanically ventilated. Ventilators related complications pneumonia pneumothorax sepsis pulmonary embolism and infections were noted. Drug induced hepatitis occurrence of seizures and focal deficit were noted. Outcome was defined as death or discharge. Result: There were 38 patients with TBM out of 74 who need artificial ventilation. The age ranged 5 to66 year (36.47 +/-14.5). The admission stage of meningitis was I in 2(2.7%) II in 33 (44.6%) III in 39 (52.7%). The duration of illness was 79.59 +/- 102.9 (2 730days). The complications included aspiration pneumonia in 5(6.8%) pneumothorax in 1(1.4%) DVT in 1(1.4%) Pulmonary embolism in 1(1.4%) seizures in 35 (47.3%) ventriculo-paritoneal shunt/External ventricular drainage done in 20(27%). Drug induced hepatitis necessitating withdrawal of anti-tubercular drugs was seen in 37 (50%). 27patients (36.5%) died and 37 (63.5%) were discharged. Death was related to presence of seizures and not related to GCS stage of meningitis and presence of stroke. Conclusion: In TB meningitis patients 36.5% died but 63.5% could be salvaged and the ventilation need is related to presence of seizures (p=0.004) cranial nerves involvement (p=0.011) and not related to MRI abnormality.

243

Session: Eposter clinical 1.7

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Outcome of patients with encephalitis on mechanical ventilation

Jayantee Kalita, Vinita Elizabeth Mani, Sanjeev Kumar Bhoi, Usha Kant Misra

Sanjay Gandhi Post Graduate Institute of Medical S, Lucknow.

Background: Encephalitis is common in India with mortality rates of 30-50%. Deaths due to respiratory failure may be prevented by mechanical ventilation. There is a paucity of literature on mechanical ventilation in encephalitis patients. Objective: To describe the clinical characteristics etiology and outcome of encephalitis patients needing mechanical ventilation. Materials and Methods: Consecutive patients with encephalitis on mechanical ventilation between 2012 and 2014 were included. Their clinical features blood investigations etiology CSF and MRI findings were noted. Complications during hospital stay including ventilator associated complications were noted. Outcome was defined as discharge or death. Results: Among 160 patients with encephalitis 41 patients needed ventilation. Their median age was 38 years (2-75) 20 (49%) were females and median duration of illness was 10 days (2-30). Median Glasgow coma score was 7 (3-15). 33 patients (81%) had focal deficit and 14 had MRI abnormalities. 16 patients had thrombocytopenia. 16 and 24 patients had renal impairment and hepatitis respectively. Median duration of mechanical ventilation was 4 days (1 -140). Underlying etiology included Japanese encephalitis in 4 herpes simplex in 2 scrub typhus in 4 dengue in 5 falciparum malaria in 1 pyogenic meningitis in 1 and rabies in 2 patients. 13 patients (32%) had ventilator acquired pneumonia. 24 patients expired and death was related with focal deficits (p 0.05) hypotension (p 0.003) bleeding (p 0.04) and low hemoglobin at admission (p 0.04). Conclusion: 26% patients with encephalitis needed mechanical ventilation of which 42% survived. Patients with treatable etiologies survived.

251

Session: Eposter clinical 1.8

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

The clinical and radiological characteristics of tuberculous meningitis (TBM) patients with pulmonary miliary tuberculosis

Dr. Swapan Gupta, Dr. Sanjay Pandey, Dr. Vinod Puri,

Dr. Neera Chaudhry.

GB Pant Hospital, Delhi

Introduction: Pulmonary miliary tuberculosis (micronodular mottling on chest imaging) is reported to occur in 12-31% cases of tubercular meningitis (TBM) in different studies. Aims and Objectives: This study aims at evaluating the clinical and radiological characteristics of tuberculous meningitis (TBM) patients with pulmonary miliary tuberculosis. Material and Methods: Diagnosis of TBM was based on consensus tuberculosis meningitis criteria (Lancet 2010) and that of miliary tuberculosis on chest imaging. Detailed clinical evaluation was done. Severity of meningitis was graded into medical research council (MRC) Grades I II and III. All patients were also subjected to TB-PCR. Results: 9 out of 55 (16.4%) patients with TBM had pulmonary miliary tuberculosis. Their mean age was 35.3 years and 5 patients were females. Mean duration of symptom was forty five days. Seven patients were in MRC stage II and one each was in stage I and III.. Brain imaging revealed hydrocephalus (2) tuberculoma (5) basal meningeal enhancement (2) and infarction (2). MRI was normal in 2 patients. Seizures were present in 2 patients. TB-PCR was positive in only 1 out of 9 patients. At follow-up 6 patients had improvement 1 expired and 2 lost to follow-up. Conclusion: The association of TBM with pulmonary miliary tuberculosis is common even without HIV. Brain tuberculomas are very common though they may not always correlate with seizure occurrence. High incidence of tuberculomas in tuberculous meningitis with pulmonary miliary tuberculosis suggests a possible pathogenetic role as well.. Prognosis is generally good with treatment.

252

Session: Eposter clinical 1.9

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Evaluation of orbital cellulitis and results of treatment

R. Rajarajan, R. Lakshminarasimhan, V. Kannan, K. Bhanu

Institute of Neurology Madras Medical College, Chennai.

Introduction: Orbital cellulitis involves structures posterior to the orbital septum. It is usually associated with severe sight and life threatening complications. Despite significant antimicrobial advances and diagnostic techniques the management of orbital cellulitis remains challenging. Results: 4 patients with diagnosis of orbital cellulitis were identified. All patients had painful ophthalmoplegia proptosis ptosis visual loss conjuctival chemosis and radiologic evidence of orbital cellulitis with cavernous sinus thrombosis. Sinus/nasal smear stains positive for mucorales in 2 patients. All patients were immunocompromised with diabetes and renal dysfunction. 2patients developed hemiparesis. All patients received antibiotics antifungals and 1patient received low molecular weight heparin and 3patients received steroids. 3patient underwent orbital decompression. Visual acuity improved in 2patients 1patient died and no improvement in vision in 1patient. Conclusion: It is very important to differentiate preseptal from orbital cellulitis as it has therapeutic and prognostic implications. High degree of suspicion of mucormycosis is required especially in immunocompromised individual. There is no need for dose reduction of amphotericin b since it is a cumulative toxicity and renal monitoring is required in these patients. The role of heparin in septic cavernous sinus thrombosis is still unclear.

282

Session: Eposter dementia 2.1

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Analysis of Gait parameter in Ataxia patients using electronic walkway: with and without cognitive load

Hrishikesh Kumar, Banashree Mondal, Payel Chatterjee, Supriyo Choudhury, Sidharth Shankar Anand, Swagata Sen, Titas Chakraborty, Marium Umme Kulsum, Dipak Naskar, Richeek Pradhan

Institute of Neurosciences Kolkata, Kolkata.

Background: Ataxia is a neurodegenerative disorder characterized by progressive gait abnormality abnormal eye movements and poor coordination of limb movements. The gait parameters of ataxia patients might be significantly affected by dual tasking. To understand the effect of cognitive load on gait we have evaluated the walking parameters of ataxia patients of various etiologies with or without cognitive tasks. Methods: In this cross sectional study the gait parameters of thirty one Ataxia patients were assessed through electronic walkway (GAITRite). The severity and pattern of ataxia in these patients were evaluated by International Co-Operative Ataxia Rating Scale (ICARS). Differences between gait parameters with or without cognitive load (100-7 test reverse counting mental calculations) were assessed using Wilcoxon Sign Rank test. Results: Mean age of 31 ataxia patients was 45.13 (SD 11.82) and 54.8% were male. The mean ICARS score (International Co-Operative Ataxia Rating Scale) was 38 (SD 17.7). The gait parameters significantly changed during performing cognitive task. The gait velocity and cadence reduced significantly after providing cognitive load to the ataxic patients. {velocity= 72.03 (26.5) Vs 46.75 (17.2) cm/sec p value 0.0001. cadence= 98.56 (22.9) Vs 82.21 (24.37) p value=0.0001}. However few gait parameters (base width Toe in/Toe out Heel off/On and Heel %) has not shown significant change. Conclusion: We present objective gait parameters of ataxia patients using validated instrument (GAITRite). The gait of ataxia patients are attention demanding and hence dual tasking while walking can lead to slowness interruption or even fall among ataxia patients.

143

Session: Eposter dementia 2.2

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Neurobehavioral abnormalities in patients with Normal Pressure Hydrocephalus

Robert Mathew, Sauda, Selvi, Remya Prakash

Pushpagiri Institute for Medical Sciences SK Hospi, Trivandrum.

Aim: To study the neurobehavioral abnormalities in patients with Normal Pressure Hydrocephalus. Methods and setting: Prospective cross sectional descriptive study. Patients diagnosed as having possible or probable NPH as per the consensus criteria were included. Patients availing dementia care service during the period 2007 to 2013 from three centres were selected. All the patients underwent detailed neurologic evaluationneuropsychology evaluation and neuroimaging in addition to biochemical evaluation possible for treatable causes. Abridged version of the Cambridge behavior inventory (CBI) was used. Patients with atleast one behavioral abnormality as per the CBI were included in the study. Results: Of the 531 demented patients seen during this period neuropsychologist evaluation could be done in 207 patients. Of this 28 patients with NPH were selected for the analysis. Mean age was 74.44( SD 7.69) 52% males and duration of illness 3years(SD2.45). Mean education was 6.47 (4.05) years. Mean ACE score was 30.57 (SD 15.72) there by ibdicating advanced cognitive impairment. The mean of the total CBI score was 21.5 (maximum score 180). The most impaired was everyday skills and the least impaired was eating habbits. Good correlation was seen among most of the CBI parameters. Memory score in ACE was found to correlate well with impairment of everyday skills (p=0.047) and abnormalities in belief (0.029). No correlation between CBI and ACE total score (p=0.966 Pearson's correlation). Conclusions: Neurobehavioral abnormalities are sparse in patients with NPH even at a stage of advanced cognitive impairment. No correlation was seen between cognitive impairment and neurobehavioral abnormalities.

246

Session: Eposter dementia 2.3

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

HIMAL is a common but underdiagnosed radiologicalentity

N. Thamilpavai, Dr. Prof. K. Bhanu, B. Shankar

Institute of Neurology Madras Medical College, Chennai.


During normal foetal life failure of hippocampus to rotate itself results in hippocampal malrotation. 13 year old girl born of non consanguineous union term delivered cried immediately after birth with birth weight of 2.7kg had dysmorphic facial features. Presented with history of seizures since 2 months of agestarted on multiple antiepleptic drugs worsened even with good compliance. H/o poor scholastic performance. Hyperactivity and poor attention hard of hearing present since childhood more on right sidewith speech and articulation difficulty. H/o aggressive behaviour developmental delay for language and socio personal mile stones. Nervous system examination was normal except forleft eye esotropia right sided conductive hearing loss. Cardiovascular examination revealedsystolic murmur grade 3/6. Routine investigations normal. Echo: Small VSD + Audiogram: Bilateral hearing loss conductive Right > left. Mri revealed vertical orientation of left hippocampus no evidence for hippocampal sclerosis. Our patient fits in with 22Q11.2 deletion. Hippocampal malrotation is a malformation that should be considered in the differential diagnosis of patients with temporal lobe epilepsy. There is increased prevalence of HIMAL in patient with 22q11.2 deletion. Patient with HIMAL does not necessarily develop hippocampal sclerosis.

260

Session: Eposter dementia 2.4

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

A study of verbal fluency test in normal individuals

Dr. N. Praveen Chander, Dr. Philo Hazeena, Dr. Muthu,

Dr. S. Balasubramanian

Madras Institute of Neurology Madras Medical Coll, Chennai.

Introduction: Verbal fluency refers to the ability to produce speech fluently without undue word finding pauses.The literature quotes that the values for semantic verbal fluency test varies from 18 to 22 animals / minute. We undertook the study to assess the normative data in our population. AIMThe study is done to assess the verbal fluency in normal individuals of different educational status in our population. Methodology: The study was conducted in 75 normal individuals who were divided into three groups as school going children literate and illiterate based on their educational status. The participants were asked to name as many animals as possible in their local language in one minute and the results were analysed. Results: The study showed that the semantic verbal fluency test values in all the three groups were within 15 animals / minute. The results in the three groups are as 9 to 15 range in literate group 8 to 14 range in illiterate group and 11 to 16 in school going children. Discussion: Our study reveals that in all the three groups the verbal fluency test value is well below the normal standards (18-22). This may be due to varying socio economic reasons literacy or other reasons which has to be analysed. Conclusion: Our study reveal that results of the fluency test in our population is well below the standard value as mentioned in the literature. A larger study to standardise word fluency test based on demographics education and socio economic status in our population has to be done.

264

Session: Eposter dementia 2.5

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Rapidly Progressive Dementia: What all to think?

Suman Kushwaha, Manmeet Kaur, Lomesh Bhirud, Aldrin Anthony

Institute of Human Behavior & Allied Sciences, Delhi.

Introduction: Rapidly progressive dementias are conditions that typically cause dementia over weeks or months. The differential diagnosis has varied etiologies. The importance lies in early and accurate diagnosis as most of them can be treated. This study presents a comprehensive approach to aid in diagnosis and management based on our experience. Material & Method: "Duration" 1 Year Fifteen patients were evaluated in detail in accordance with clinical history and presentation. Routine investigations and Neuroimaging was done in all patients & PET scan in selected patients. The special tests included CSF studies TPO antibodies autoimmune Para neoplastic & vasculitic profile serum homocysteine and methylmalonate levels CSF Enolase measles antibodies and VDRL. Brain biopsy was done in three patients. Results: The different etiologies of RPD were categorized as prion diseases (2 patients) infective etiology 4 patients (racemose neurocysticercosis multiple NCC subacute sclerosing panencephalitis progressive multifocal leukoencephalopathy) autoimmune nutritional and malignancy 3 patients. This spectrum of etiologies highlights the need for high degree of suspicion for treatable causes. Cognitive deficits were seen in all the lobes with prominent behaviour abnormality. Symptomatic and specific treatment was given to the patients. The patients with infective autoimmune and nutritional etiology improved. Conclusion: Rapidly progressive dementias presents with wide variety of differential diagnosis. It is a challenge to a neurologist. The clinical profile and the examinations and investigations should aid in early and accurate diagnosis and defining for treatable etiology. Timely Symptomatic and specific management will help in ensuring a better quality of life for the patient.

285

Session: Eposter dementia 2.6

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Cognition in advanced dementia

Baiju, Robert Mathew, Sauda, Remya Prakash

Pushpagiri Institute for Medical Sciences SK Hospi, Trivandrum.

Aim: To study the pattern of cognitive impairment in advanced dementia. Method: Prospective cross sectional descriptive study. Patients availing dementia care service during the period 2007 to 2013 from three centres were selected. All the patients underwent detailed neurologic evaluationneuropsychology evaluation and neuroimaging in addition to biochemical evaluation possible for treatable causes. All patients were administered neuropsychology test battery consisting of Addenbrook's Cogitive Examination-Revised version (ACE)HADSADLTrail ATrail BRAVLT and (IQCODE). Results: Of 207 patients diagnosed as having dementiaproper syndromic diagnosis could be made in 58. Mean age was 70.27(SD 10.68)male 56%mean education 8.4(SD 4.5). Mean duration of illness 3.49(SD 2.3) years. Mean ACE score was 36.35(SD 20.22)there by indicating advanced dementia. For ease of comparison the total scores and subscores were converted to percentage of maximum score(PMS). The most involved domain was memory mean PMS(MPMS) 25.4 and least involved was language MPMS 47.34. Significant difference was seen among MPMS (t test p<.005). When cortical and subcortical dementias were considered separatelythe domain maximum involved in AD as well as NPH was memory and the least involved was language. However no significant difference was seen between ACE total score or subscore across AD and NPH (p>0.05). No correlation was seen between age or duration of illness and any of the cognitive parameters (p>0.05 Pearson correlation). Conclusion: In this cohort of patients with advanced dementia no difference was seen in cognitive functions impairment between cortical and sub cortical dementias. Even at advanced stage cognitive domains appeared differentially involved.

15

Session: Eposter epilepsy 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Seizures - A Clinical Study

Anas Abdul Majeed, Dr. R. Srinivasa, Dr. P. T. Acharya,

Dr. Mahendra J. V, Dr. Rohan Mahale, Dr. Sudhindra Aroor, Dr. Suryanarayana Sharma, Dr. Madhusudhan, Dr. Anish Mehta, Dr. Aju John

M S Ramaiah Medical College, Bengaluru.


We retrospectively studied 90 patients with postinfarction seizures to determine the clinical features (onset number type) prognosis and electroencephalographic and computed tomographic/ MRI findings; we included infarctions of all etiologies. 37 ( 41%)of the 90 seizuresappeared early (within 2 weeks after the infarction).53 (59%) of the 90 seizures occurred late( after 2 weeks of the infarction). 44 ( 49%) of the 90 seizures were single and status epilepticus was seen in 9 patients. Early-onset seizures were more likely to be generalized (62% of 37); late-onset seizures were also more likely to be generalized (68% of 53). 51 percent (46) of the 90 initial seizures became multiple recurrent seizures and we could identify a precipitating factor in 2 of the 46 recurrent seizures. The most common electroencephalographic abnormality in the 81 patients so examined was Focal slowing with or without diffuse slowing. An attempt was made to look at the predilection of seizures based on the location. Deep infarctions on computed tomograms (cortical infarctions extending to subcortical structures) tended to cause recurrent seizures (Chi Square value = 12.310 p value = 0.00045 (significant).

294

Session: Eposter epilepsy 1.10

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Levetiracetam monotherapy for partial seizures with or without secondary generalization: An open label non-comparative non-randomized prospective study

Debashish Chowdhury, Dr. K. Venkateswarlu, Dr. Meena Gupta, Dr. Geeta A. Khwaja

Professor Department of Neurology Gb Pant Hospit, New Delhi.

Background: Few studies from West have evaluated Levetiracetam (LEV) monotherapy in the treatment of partial seizures. So far none exists from India to the best of our knowledge. Aim: To assess the efficacy and safety of LEV monotherapy in the treatment of partial seizures with or without secondary generalization in Indian Patients. Methods: An open label non-comparative non-randomized prospective study of 1 year duration. Six months and one year seizure free rates as primary outcome and the seizure free period from the day of starting LEV retention rate QOL safety and tolerability as the secondary outcomes were evaluated. Starting with 250 mg bid orally for a period of 2 weeks the dose was up titrated to 500 mg bid (Dose level 1). The dose was further increased to 2000 mg/day (Dose level 2) or 3000 mg/day (Dose level 3) for patients experiencing seizures at previous dose levels. Results: Forty five subjects were enrolled and 37 completed the study. 86% of the subjects were stabilized at dose level 1 & 2. The 6 months and 1 year seizure free rates were 93.3% and 62.2% respectively with all treatment levels. Retention rate was 82.2%. LEV was well tolerated. 46% subjects reported only mild type of adverse events. Compliance was substantiated by matching serum levels of LEV in the randomly selected ten subjects. LEV treatment lead to improvement in QOL of 73.9% subjects. Conclusion: Current study supports the safety and effectiveness of LEV monotherapy in the treatment of partial seizures with or without secondary generalization.

84

Session: Eposter epilepsy 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Refractory epilepsy in neurocysticercosis: A prospective study

Biplab Das, Manoj Kumar Goyal, Manish Modi, Pratap Chand, Parampreet K Singh, Vivek Lal

Pgimer Chandigarh, Chandigarh.

Introduction: Refractory epilepsy due to neurocysticercosis (NCC) especially in endemic areas is significant. However studies of this topic are lacking. We carried out this study to determine the prevalence of medically refractory epilepsy (MRE) in patients with epilepsy secondary to NCC. Aims and Objectives: 1. Determining prevalence of medically refractory epilepsy in patients with NCC 2. To determine risk factors predisposing to MRE in patients with NCC. Patients and Methods: This observational; prospective and retrospective study of 200 NCC patients (diagnosed as per del Brutto criteria) with epilepsy were studied for two years to determine prevalence of MRE in NCC. Results: 200 patients of seizures diagnosed as definite [(n=59 (29.5%)] or probable [(n=141(70.5%)] NCC were enrolled in the study both in a prospective [(n=51 (25.5%)] and a retrospective manner [(n=149 (74.5%)] and were followed for a minimal period of one year. Prevalence of MRE was found to be 65/1000 NCC patients with epilepsy. The risk factors associated with high risk of MRE were male sex (p=0.035) higher age (p=0.016) pig raising practices (p=0.003) and pork eating (p=0.04) presence of multiple (> 2) (p=0.0001) or mixed stage lesions (p=0.007) on neuroimaging. Conclusions: NCC is rarely associated with refractory epilepsy. The common risk factors associated with increased chance of refractory epilepsy include pig raising practices pork eating male sex increased age and presence of multiple or mixed type of lesions on neuroimaging.

117

Session: Eposter epilepsy 1.4

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Clinical and eeg profile of subacute sclerosing panencephalitis (SSPE) patients in a neurology tertiary care centre in eastern india

Saurabh Rai, Dr. A. Pandit, Dr. A. Biswas, Prof. A. Senapathi, Prof. K. B. Bhattacharyya, Prof. G. Ganguly

Bangur Institute of Neurosciences Kolkata, Kolkata.

Introduction: SSPE is a disease of the CNS caused by persistent infection of immune resistant Measles virus usually affecting children fatal in most. Although a rare consequence of Measles its incidence in India is still high. A study regarding the clinical and EEG profile of SSPE patients has not been done in Eastern India and this ongoing study attempts to address the same. Aims and objectives: Evaluate the clinical and EEG profile of SSPE patients. Materials and Methods: This descriptive cross sectional study included patients of SSPE attending the Neurology OPD and admitted to BIN from February 2013 onwards who fulfilled Dyken's criteria of probable SSPE. Results: This ongoing study had 24 cases of probable SSPE as per Dyken's criteria (17 males 7 females). Mean age of presentation was 9.2years(youngest seven oldest 20years) presenting on an average of 5 months from symptom onset(range 2 to 12months). Of these 18 had prior history of measles(5were females) having measles at an average age of 2 years 5 had been vaccinated and developing SSPE on an average of 7.7 years after measles. Initial complaint was cognitive decline in 12 frequent falls in 10 seizures in two. All had Myoclonus cognitive decline CSF antimeasles IgG antibodies and typical pseudoperiodic discharges on EEG- pattern being Delta waves in 15 multiple spikes in 8 and spike and slow wave in one. Conclusion: Some aspects of our results were comparable to studies done before although a conclusive comparison would be possible only on completion of this study.

186

Session: Eposter epilepsy 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

A study on the etiological factor for new onset seizure in tropics at tertlary care centre

Moses P. Moorthy, Shunmuga Sundaram K, Bala Subramanian S, Kamaraj V, Bhanu K

Madras Institute of Neurology MMC Chennai, Erode.

Purpose: The aim of the study is to know the common etiological factor for new onset seizures in tropics. Materials & Methods: This prospective study was conducted at Rajiv Gandhi Govt. General Hospital Madras Medical College from January 2014 to April 2014. Patients who are admitted with new onset seizure were included. Patient with known seizure disorder were excluded. Demographic Details: New onset seizures are more common in males especially in 3rd and 4th decades from different areas of state with different occupation. Results: In this study 100 patients were included. The analysis of etiological factor revealed the following result. CNS Infections (32%) Vascular causes (25%) Craniocerebral trauma (13%) Space occupying lesions (12%) Metabolic causes (10%) Alcohol related seizure (6%) OPC poisoning (2%). Discussion: This study reveals similar results as the study done by JMK Murthy et al. Conclusion: This study reveals that CNS infections vascular causes craniocerebral trauma are the common etiology for new onset seizures in tropics. Appropriate measures to control these factors will help in reducing the morbidity and mortality

201

Session: Eposter epilepsy 1.6

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Spontaneous fetal loss in women with epilepsy

Sanjeev V. Thomas, J. Jitha, S. Sreevidya

Sree Chitra Tirunal Institute for Medical Sciences, Trivandrum.

Objective: To characterize the patterns of spontaneous fetal loss in women with epilepsy. Methods: The outcome of all completed pregnancies notified under this registry was categorized as fetal loss or live birth. Fetal loss is categorised as spontaneous fetal loss (spontaneous abortions intrauterine death and stillbirth) induced abortion on fetal or maternal indication. The maternal epilepsy characteristics AED usage and fetal characteristics of the those with fetal loss were compared with those with live births. Results: During the period 1998 to 2013 there were 2266 registration in this registry out of which 1711 were completed analysable pregnancies. There were 1557 live birth (91%) and 154 fetal loss (103 spontaneous fetal loss (5.9%) 51 induced abortion (3%) - maternal indication 40 and fetal indication 11). There was no significant difference in the spontaneous FL rates according to the maternal education maternal occupation or maternal epilepsy syndrome. There was significant association between spontaneous fetal loss and exposure to clonazepam (13.3% p=.047) clobazam (9.7% p=.23) topiramate (17.4% 0.44) and levetiracetam (13.3% p=.47). Discussion: About nine percent of pregnancies ended up as fetal loss under this registry. The spontaneous fetal loss observed in this study is lower than that reported for community at large and for other hospital based studies on pregnancy outcome. There is excess risk of spontaneous fetal loss associated with exposure to certain AEDs. Conclusion: Fetal loss is a potential outcome of pregnancy in less than ten percent of pregnancies in women with epilepsy. The risk of fetal loss associated with certain AEDs deserve further attention.

214

Session: Eposter epilepsy 1.7

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Cognitive evaluation of patients with Parkinson's disease using the Malayalam version of Montreal Cognitive Assessment (MoCA-M)- results of a pilot study from Kerala

Dr. Radhamani M. M, Dr. Syam Krishnan, Sunitha Justus, Dr. Ramsekhar Menon, Sankara Sarma, Dr. Asha Kishore

Senior Residentneurology, Trivandrum.


Cognitive evaluation of patients with Parkinson's disease using the Malayalam version of Montreal Cognitive Assessment (MoCA-M)- results of a pilot study from Kerala. Radhamani M Syam Krishnan Sunitha Justus Ramsekhar Menon Sankara Sarma P Asha Kishore. Background: Montreal Cognitive assessment (MoCA) was designed as a brief and easily administered cognitive screening tool for Mild Cognitive Impairment (MCI). The usefulness of MoCA as a suitable accurate and brief test for screening all levels of cognition in Parkinson's disease (PD) has been demonstrated; it is more sensitive than Mini Mental Status Examination (MMSE). We have done a cross-cultural adaptation of MoCA translating it into Malayalam (MoCA-M) and this has shown good internal consistency and test- retest reliability comparable to the original version. Objective: Cognitive evaluation of patients with PD using MoCA-M and comparison of the results with previously validated Malayalam versions of Mini Mental Status Examination (MMSE) and Addenbrooke Cognitive Examination (ACE). Methods: MoCA-M and the Malayalam versions of MMSE and ACE were applied to 100 consecutive patients with PD attending the movement disorders clinic. Results: Mean age of patients was 57.8(Β΁ 9.07) years; 71% of the patients were men. Mean duration of disease was 7.1(Β΁ 4.2) years. The mean Hoehn and Yahr stage was 2.69(Β΁0.88). MoCA-M was easy to administer and took only around 10 minutes per patient. The mean MoCA M scores was 24.6 (Β΁4.1). The MoCA-M scorescorrelated significantly with the MMSE ( R=0.70; p<0.001) and ACE (R=0.8; p <0.001)scores. Conclusions: MoCA-M is a quick and useful screening test for cognitive dysfunction in Malayalam speaking patients with PD and the results correlate well with other established tests.

279

Session: Eposter epilepsy 1.8

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Reproductive harmone profile in women with epilepsy on aeds: A case control study

Dr. Hima Bindu Bolla, Dr. S. A. Jabeen, Dr. Shiva Laxmi,

Dr. Priscilla Chandran, Dr. Rukmini Mridula, Dr. Meena A. K,

Dr. Rupam Borgohain

Nizams Institute of Medical Sciences.

Background: It is well known that epilepsy antiepileptic drugs (AEDs) and the reproductive system have complex interactions. Objectives: To study sex hormone levels in women of reproductive age with epilepsy on antiepileptic drugs (AEDs) Material & Methods: This is a cross sectional case control study. Sex hormone profile which included Follicular Stimulating Hormone (FSH) Prolactin (PRL) Luteinizing Hormone( LH) DehydroEpiandosteroneSulphate (DHEAS)Total Testosterone (TT)Sex Hormone Binding Globulin(SHBG) Progesterone Estradiol (E2)and Serum Albumin were estimated in 26 consecutive women with epilepsy. Control group were age matched healthy volunteers on the corresponding day of menstrual cycle. Results: Our study group comprised of 26 women with a mean age of 26 Β΁ 7.2 yrs ( 18-47 yrs). Of these 10 (38.5%)were having focal epilepsy and 16(61.5%) were having generalized epilepsy. Average duration of illness was 9 yr. Of them 10 (38.5 %) are unmarried and 16 (61.5% )are married. Four (25%) of married women suffered from infertility. Harmone levels were analysed separately for women in follicular phase and luteal phase. Progesterone and FEI were low and LH/FSH SHBG were higher in patient group in both follicular & luteal phases (p value < 0.05). There was no significant difference in FSHE2& Albumin levels between the 2 groups.. Total testosterone DHEAS levels were low in the patient group during the follicular phase but not in luteal phase. In the luteal phase prolactin levels were significanly high in patient group. Conclusion: This study shows the significant alteration of sex hormone levels in women with epilepsy leading to reproductive dysfunction.

280

Session: Eposter epilepsy 1.9

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Levitirecetam induced Psychogenic non epileptic seizures: A case series

Shaik Jabeen, Shaik Afshan Jabeen, Padmaja, Arun, Rukmini Mridula, Srilatha, Meena Ak, Rupam Borgohain

Associate Professor of Neurology, Hyderabad.

Background: Approximately 25-30% of epilepsy patients referred to tertiary epilepsy centers or specialized hospitals have psychogenic non epileptic seizure (PNES). In randomized controlled trials 13.3% of levetiracetam-treated patients reported behavioral symptoms including agitation hostility anxiety apathy emotional labiality depersonalization and depression. There are only two few case reports of PNES induced with levetiracetam. Methods: We report a case series of patients with epilepsy who also were found to be suffering with concomitant PNES ( documented by VEEG). There were five patients with a mean age of 18 yrs ( range 13-22 yrs). There were 3 females and 2 males. Patients who had history of psychiatric disease were excluded. In all these patients there was a strong correlation of PNES commencing after addition of levetiracetam therapy. Moreover all the patients improved after withdrawal of levetiracetam in addition to psychiatric management. Conclusion: Levetiracetam can induce PNES in susceptible population. Awareness of this adverse effect may help in patient management.

74

Session: Eposter epilepsy 2.1

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

A profile of Epilepsy in tertiary care hospital in central India

Dinesh Chouksey, O. P. Lekhra, S. Athale, Amit Maheshwari

SAIMS Medical College and PG Institute., Indore.

Introduction: In India 10 million people are suffering from epilepsy. The etiology of epilepsy is complex and heterogeneous amongst various studies. The distribution of subtypes of epilepsy is variable in different parts of our country. There is dearth of data on epilepsy from central India. Aims and objective: To determine subtypes of epilepsy and to generate demographic data from central India. Material and Methods: This is an observational study of 120 patients of epilepsy done during a period of one year conducted in the department of Neurology. All patients underwent detailed clinical EEG and neuroimaging as per ILAE guidelines. Results: Median age of the patients was 39.5years. Male to female ratio was 2:1. Majority (60%) of patients belonged to the second to fourth decade of life. Seventy one percent patients had generalized seizures while 29% patients had partial seizures. Generalized tonic clonic seizure was the commonest subtype. Specific etiology was found in 41.67% patients. Interictal EEG was abnormal in 35.8% patients. Neuroimaging abnormality was found in 40% patients. Neurocysticercosis was diagnosed in 9.16% tuberculoma was found in 5% cases while a vascular cause was identified in 10% patients. Conclusion: The age of onset of epilepsy was most commonly in second decade. Predominant seizure semiology was generalized tonic clonic and predominant epilepsy type was idiopathic generalized. Infective granuloma was found to be the commonest etiology in our study. Majority of patients responded to monotherapy. Findings of our study are similar to that from other observers in different parts of the country.

293

Session: Eposter epilepsy 2.10

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Clinical profile of auto immune encephalitis

E. Uma Maheswari

Tamiilnadu Govt. Multisuperspeciality Hospital Ch, Chennai.


Clinical profile of autoimmune encephalites. Uma Maheswari. E Yomesh u.v Jawahar. M Bhoopathy. R. MTamil Nadu Govt. Multi Super Speciality Hospital Chennai. Introduction: Encephalitis presents with a variety of symptoms which may vary depending on the etiology of the encephalitis or the region affected. Particular clustering of symptoms should lead the clinician to consider one etiology over another. We present 2 cases auto immune encephalitis Anti NMDA R encephalitis and hashimotos encephalopathy which presented with protean symptoms and signs. Key words: Anti NMDA R- N- Methyl D-Asparate Receptor. Abstract Case 1 Ms. A 13 year oldpreviously healthy girl presented with prodromal symptoms of 2 weeks duration followed by subtle psychiatric symptoms which progressed to develop seizures and alteration in the level of sensorium and autonomic instability. Anti NMDA encephalitis and was subsequently confirmed by detecting the antibodies to NMDA receptors in the serum. Case 2 Ms B17 year oldpreviously healthy girl presented with subtle psychiatric symptoms which progressed to develop seizures with signal changes in the medial temporal lobe with detection of CSF thyroperoxidase antibodies and the patient showed a excellent response to steroid and confirming our diagnosis of Hashimotos encephalopathy.

118

Session: Eposter epilepsy 2.2

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Evaluation follow up and responsiveness of antiepileptic drugs in patients of refractory epilepsy of tertiary care center

Dr. Arti Waskel, Dr. Arti Waskel, Dr. Alak Pandit, Prof. G. Ganguly, Dr. A. Biswas

Ipgmer Bangur Institute of Neurosciences Kolkat, Kolkata.


Evaluation follow up and responsiveness of antiepileptic drugs in patients of refractory epilepsy of tertiary care center name- dr arti waskel dr. A. Pandit dr a. Biswasprof. G. Ganguly bangur institute of neurosciences kolkata. Drug resistant epilepsy defined as failure of adequate trials of two tolerated and appropriately chosen and used antiepileptic drugs to achieve sustained seizure freedom. Aims and Objectives: To determine the factors associated with poor response to therapy responsiveness to the multidrug therapy and to evaluate the effects of newer antiepileptics in refractory epilepsy. Material and Methods: this is a ongoing prospective observational study in Neuromedicine department of BIN Kolkata. All epilepsy patients on two or more antiepileptic drugs were taken and evaluated periodically. Results: 117 epilepsy patients on AED were chosen. 32 were aged 2-12years 26were aged 13-20years remaining were above 20years. Patients were classified according to seizure type-18were idiopathic and 49 were localization related symptomatic epilepsy 50had syndromic epilepsy 8 had JME 4JAE 6BRE 7LGS4LKS 7TS2PME5West syndrome. In localization related epilepsy 9had structural lesions in Frontal lobe 7MTS 6occipital and6 prietal lobe epilepsy 23had HIE. 59were On AEDs 74were taking one first line AED with adjunctive drugs 32 patients were on second line AED 11on newer AEDs. 33had uncontrolled seizures on drugs 17had satisfactory control 19had poor drug response 48 patients had average response. Conclusion: Patients of symptomatic epilepsy continued to have seizure on treatment than idiopathic epilepsy. Very poor drug response noted in patients of multiple seizure type TS LGS cortical malformation MTS and patients with HIE.

158

Session: Eposter epilepsy 2.3

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area



A rare association of down syndrome with tuberous sclerosis: a rare case report


Arun Prakash T., Arun Prakash T., U. Meenakshisundaram,

C. U. Velmurugendran, V. Shankar, P. R. Prabash

Department of Neurology Sri Ramachandra University, Chennai.

Background: Isolated Down Syndrome and Tuberous Sclerosis with their complications and presentations have been reported widely but a combination of Down syndrome with Tuberous Sclerosis is rarely reported. We are reporting a case of rare association of Down syndrome with tuberous sclerosis. IntroductionThis Paper reports the clinical features of a patient with Down syndrome associated with Tuberous SclerosisCase ReportA thirty year old female born to non consanguineous parents with the history of global developmental delay and was operated for VSD presented to us. Clinically she had features of down syndrome with tuberous sclerosis. Discussion: This Patient was clinically examined and upon examining her she fulfilled the two major criteria of Revised Diagnostic criteria for Tuberous sclerosis complex: Such as facial angiofibromas and Shagreen pathch. At the same time she also had clinical features of Down Syndrome such as low set ears: Mental retardation Stunted growth Low muscle tone Palmarcrease she has been subjected to karyotypingwhich genetically proved the presence of an additional chromosome 21 The genetic testing for tuberous sclerosis gene has not been done due to logistic issues. Conclusion: Combination of two genetic disorder in a single patient is extremely rare.

161

Session: Eposter epilepsy 2.4

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

A case series of joubert syndrome

Nanda Kumar V, Bhanu K, Leemapauline

Madras Medical College, Chennai.

Introduction: Joubert syndrome (JS) is a rare autosomal recessive brain malformation disorder with the key finding of cerebellar vermis hypoplasia with a complex brainstem malformation that comprises the molar tooth sign (MTS) on MRI. The clinical elements that supports the diagnosis of JS are hypotonia mental retardation cerebellar ataxia. The other clinical features that define subtypes of JS termed Joubert syndrome and related disorders (JSRD) include encephalocele polymicrogyria retinal dystrophy cystic kidney diseasehepatic fibrosis. Case vignette: In our case series of four patients with JS case one and two are siblings of age five[girl] and two[boy] years respectively. Both presented with developmental delay. On examination they had hypotonia and ataxia. MRI revealed MTS. Case three is a six year old girl presented with developmental delay and difficulty in walking. Clinical examination revealed oculomotor apraxiahypotoniaataxia. MRI showed MTS. Case four is a two month old boy presented with abdominal distentionabnormal eye movements. Clinical examination revealed absent social smilenystagmushypotoniahepatomegaly. USG abdomen showed polycystic kidneyshepatic fibrosis. MRI showed MTS. Conclusion: Congenital malformations of CNS is a important cause of global developmental delay[GDD]. Any child presenting with GDD and cerebellar signs with uneventful perinatal period should be evaluated for Joubert syndrome.

162

Session: Eposter epilepsy 2.5

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Clinical electroencephalographic and radiological profile of patients with alcohol related seizures

Pawan Soni, L. J. Basumatary, M. Das, M. Goswami, A. K. Kayal

Senior Resident Department of Neurology Gauhati, Guwahati.

Objective: To study clinical electroencephalographic and radiological profile of patients with alcohol related seizures. Methods: 58 consecutive male patients presenting with alcohol related seizures were analyzed by the detailed history related to alcohol consumption detailed neurological examination EEG routine blood investigation and radio imaging of brain. Results: Mean age of presentation was 36.37 years mean duration of alcohol consumption was 11.69 years; mean duration between last binge of alcohol and seizure was 34.9 hours. Among 58 patients 54 had GTCS while 4 patients had focal seizures. Out of 54 patients with GTCS 40 patients had withdrawal symptoms at presentation compared to none with focal seizures. 36 patients had AUDIT score of 20 or more and 13 patients had previous history of seizures following abstinence. 21 patients had evidence cerebral atrophy on CT scan 3 patients had evidence of ringed lesions and 1 patient had evidence calcified nodules on MRI. Only 5 patients had seizures within 6 hours of alcohol intake among these 1 patient had evidence of IGE on EEG low AUDIT score and no withdrawal symptoms at presentation. Conclusion: Cortical atrophy is related to the duration of alcohol intake. Partial seizures can be seen in the setting of ARS and those patients may benefit from MRI to identify underlying cause. IGE is more likely in patients presenting with ARS within first 6 hours especially if they have low AUDIT score and no alcohol withdrawal symptoms.

182

Session: Eposter epilepsy 2.6

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Study of sleep spindles in pediatric epilepsy patients

Dr. Atri Chatterjee, Dr. Atri Chatterjee, Dr. Bhavesh Solanki,

Dr. Arun Koul, Dr. Anirban Ghoshal, Dr. Sidharth Anand,

Dr. Goutam Das, Dr. Joydeep Mukherjee, Dr. Durga Prasad Chakraborty, Prof. Shankar Prasad Saha

Nil Ratan Sircar Medical College, Kolkata.

Background: Sleep spindles are rhythmic oscillations usually in 12-14 Hz range. During the first two years of life sleep spindles undergo maturation. [1] Abnormalities of sleep spindles are associated with mental retardation as well as schizophrenia. [1,2] A reduction in sleep spindles has been found to precede focal seizures. [3] This study aims to compare characteristics of sleep spindles between pediatric patients of epilepsy with normal controls. Materials and Methods: 30 consecutive patients with epilepsy aged 0-5 years were selected from the institutional epilepsy clinic. 30 consecutive controls were selected from referrals to the outpatient department. Sleep electroencephalography (EEG) was performed after sleep induction with triclofos. For each patient frequency of sleep spindles (per minute) spindle frequency (Hz) and mean duration of sleep spindles (milliseconds) were calculated. Results: Frequency of sleep spindles spindle frequency and mean duration of spindles were significantly lower (P>0.05) in the patients (mean Β΁ s.d. 1.5 Β΁ 2.7 3.17 Β΁ 5.7 439.4 Β΁ 752.7 respectively) in comparison with the control population (mean Β΁ s.d. 2.71 Β΁ 1.7 11.6 Β΁ 1.9 1581.6 Β΁ 190.7 respectively). Conclusion: Sleep spindles in pediatric patients with epilepsy are lower in frequency in comparison to normal controls and significantly shorter in duration as well.

References

1. Spinosa MJ Garzon E. Sleep spindles: validated concepts and breakthroughs. J epilepsy clin neurophysiol 2007;13:179-82.

2. Luthi A. Sleep Spindles: Where They Come From What They Do. The Neuroscientist 2013;20:243-56.

3. Tezer FI Remi J Erbil N Noachtar S Saygi S. A reduction of sleep spindles heralds seizures in focal epilepsy. Clin Neurophysiol 2014.

235

Session: Eposter epilepsy 2.7

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Magnetic resonance spectroscopy in drug naive juvenile myoclonic epilepsy

Vinod Puri, Vinod Puri, Sajan PM, Neera Chaudhry, Veena Chowdhury, Anjali Prakash

GB Pant Hospital, New Delhi - 110 002, New Delhi, India.

Purpose: To evaluate the cerebral metabolic differences between drug naΓͿve juvenile myoclonic epilepsy (JME) patients and healthy controls and amongst sexes and also to study whether these metabolic alterations reflect involvement of a specific network dysfunction. Methods: Thirty drug-naive patients with JME and 10 age- and sex-matched healthy volunteers were studied with multi-voxel proton spectroscopy (1H-MRS) at 1.5 T over medial prefrontal cortex (MPC) primary motor cortex (PMC) thalamus (TH) striatum( STR) posterior cingulate gyrus (PCG) and insular(INS) parietal and occipital cortices. The ratios for integral values of N-acetyl-aspartate (NAA) over creatinephosphocreatine (Cr) were determined. Results: The NAA/Cr ratio was reduced bilaterally in all the areas studied except in left PCG and left parietal region in patients of JME as compared to controls andthe lower NAA/Cr ratio was statistically significant in bilateralMPC (right p= 0.001; left p= 0.014) and PMC (rightp= 0.006;left p=0.030). Multiple regression analysis revealed correlation between thalamus PMC andstriatum but the left thalamus also correlated with PCG and insula in patients. Conclusion: The study concludes thatthereexists neurochemical dysfunction indrug Naive JME patients. It also suggests diverse involvement of the thalamocortical circuitry with existence ofpreferential involvement of some networksover others within this thatplay a role in the pathophysiology of JME. Furthermore the cortical hyperexcitability in JME is perhaps not diffuse.

258

Session: Eposter epilepsy 2.8

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Mapping and volumetry of heschl's gyrus by voxel based morphometry(vbm) in planning temporal lobe resection in patients with “tle with auditory aura

Dr. Ashalatha Radhakrishnan, Jija. S. James, Anu Sundar, Bejoy Thomas, Chandrashekharan Kesavadas, Ramshekhar Menon, George Vilanilam, Mathew Abraham, Sanjeev V Thomas

SCTIMST, Trivandrum.

Purpose: TLE with auditory aura (TLE-AA) form a specific subgroup of patients where the ictal onset zone extends to Heschl's gyrus (HG). After anterior temporal lobectomy (ATL) TLE-AA patients seldom become seizure-free. Through VBM of HG we analyzed the reasons for surgical failure in them. Methods: Of 456 consecutive patients operated for TLE from 2000-2010 we identified TLE-AA patients. Their HG was mapped by VBM pre-and post-surgically. Automated anatomical labeling using T1 image normalized to customized template was then segmented into GM WM and CSF using probability maps. Modulation and smoothing with a 12-mm isotropic Gausian Kernel was done. The volume of the HG (cm3) was computed by multiplying and summing voxel-by-voxel volume. Bivariate followed by multivariate logistic regression model analysis was performed comparing TLE-AA from patients with other auras. Pre-and-post-surgical VBM of HG was compared by ANOVA. Results: Of 456 patients who underwent ATL 344 (75.4 %) had aura; 19 (5.5%) were TLE-AA. 11/19 (57.8%) with TLE-AA had prior encephalitis (p=0.006)10/19 (52.6%) had normal MRI and 8/19 (42.1%) had normal histopathology (p = 0.000). 10/19 had persistent seizures after surgery versus 86/325 with other auras (p=0.01). 7/10 (70%) patients underwent left ATL (p =0.01). HG was intact in 9/10 patients (90 %) who had seizures postoperatively. In 9 patients without seizures the HG was disrupted completely by more than two-third its volume (mean pre-versus post-surgery volume 3.02cm3 versus 0.41cm3 p = 0.001). Conclusions: Volumetric mapping of HG pre and post-surgically in patients with TLE-AA confirmed that major disruption or removal of HG will only make the patient seizure-free. A presurgical VBM-HG mapping to incorporate it in resection should be attempted by anatomic landmarks or by neuronavigation

262

Session: Eposter epilepsy 2.9

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Clinical radiological outcome profile in cerebral venous thrombosis

Dr. P. Asir Julin

Institute of NeurologyMadras Medical College, Chennai.

Introduction: Cerebral venous sinus thrombosis (CVT) is an uncommon challenging condition with its variability of clinical symptoms and signs which over the past few years has been diagnosed more frequently due to greater awareness and the availability of better non-invasive diagnostic techniques. Objective: The purpose of this study is to analyse the clinical featuresinvestigation profiletreatment and outcome of CVT in our institution. Materials and Methods: The study was conducted in Madras Institute of Neurology between August 2012 to July 2014. Patients of all age group and both sexes with features of CVT were included in the study. Results and Discussion: The study analysed 91 patients. The overall incidence of CVT in our Institute is 7.5%. Among this males were 45% and females were 55%. Postpartum cases constituted more than half of the female casespresenting commonly around 10-15 days postpartum. Mean age of presentation in males 35-40yr and in females 20-25 years Most common presenting complaint being headache (81.8%)followed by seizures (42.4%) hemiparesis (36.3%) papilledema (33.3%). Isolated Benign intracranial hypertension was present in 5 cases. Coagulation profile was done which shows hyperhomocystienemia in 8 patientProtein C deficiency in 2 patients and APLA in one patient. Radiologicallyhemoraghic infarct seen in 45.4% of casesdelta sign in CT was detected in 3%. MRI analysis showed superior sagittal sinus involvement in 60.6% transverse sinus in 39.3%cortical vein in 15% deep venous system in 3%.. Death was reported in 4.35%. The overall outcome was fairly good. Conclusion: Sinus thrombosis remains a diagnostic challenge but improved diagnosis and treatment now result in an excellent outcome for most patients.

28

Session: Eposter inflamm 2.1

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Clinical profile of patients presenting with longitudinally extensive transverse myelitis (LETM) in Western Rajasthan

Gaurav M. Kasundra, Gaurav M. Kasundra, Amita N. Bhargava, Bharat Bhushan, Shubhakaran Khichar, Isha Sood, MD. Yasin, Janardan

Dr. S. N. Medical College Jodhpur, Jodhpur.

Objective: Underlying etiology of longitudinally extensive transverse myelitis (LETM) in India is different from West where most studies have been done. Methods: Patients presenting with acute myelitis involving three or more spinal segments were included. Specific investigations were individualized as per clinical scenario. Results: 42 patients of LETM were included. Neuromyelitis Optica (NMO) was diagnosed in 4(9.5%) postinfectious Acute Transverse Myelitis (ATM) in 16(38%) and subacute combined degeneration (SACD) and acute disseminated encephalomyelitis (ADEM) in 5 patients each (11.9%). Two patients (4.8%) each had zoster tuberculous (TB) multiple sclerosis (MS) and radiation myelitis. One patient (2.4%) each had lupus Human Immunodeficiency Virus (HIV) malignancy and paraneoplastic myelopathy. Lesions extending 11-15 segments were seen in TB HIV lupus ADEM and ATM. SACD NMO radiation malignant zoster paraneoplastic and MS (one patient with 3 segments and one with 11 segments) lesions involved 4-8 segments on an average. Preferential involvement was central cord (NMO MS ATM malignancy) complete cord (ADEM lupus HIV paraneoplastic) dorsal cord (SACD) central/dorsal (radiation) central/complete (TB) and central/peripheral (zoster). ADEM ATM HIV radiation malignant lupus and paraneoplastic myelopathy affect cervical cord while SACD MS and NMO affected dorsal cord. TB ATM ADEM and SACD affect either. Lupus myelitis had 2 lesions discretely involving cervical and dorsal cord. ATM ADEM HIV TB lupus and zoster had lesions upto conus. One patient of ADEM 4 of NMO and one of MS had optic neuritis. Recurrent myelitis was seen in some NMO and MS patients. Conclusion: Infectious causes predominate in Indian LETM.

142

Session: Eposter inflamm 2.10

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Primary MDR CNS TB not a rarerity

Dr Mona Thakre

Aditya Birla Memorial Hospital, Pune.


Primary MDR CNS TB not a rarerity. Background: Multi-drug-resistance tuberculosis (MDR-TB) defined resistance to at least to isoniazid and rifampicin. Globally MDR-TB accounts for 3.4% of new cases and 20% re-treatment cases. In India MDR-TB accounts for 2.1% new cases and 15% (CI 13-17) of re-treatment cases. Objective: Case presentation of a severe CNS with Pulmonary Primary MDR TB which was fatal. Case History- 25 years old lady presented with fever and cough of 2 weeks duration. She was diagnosed to have pleural effusion and aspiration was suggestive of TB. She was put on 4 drug first line AKT but did not show any response to fever and became progressively drowsy. CT brain showed hydrocephalus and EVD was done. Patient further developed bilateral basal ganglia infarcts and became GCS 3/5 in 3weeks and later succumbed. She was put on 2nd line AKT on clinical suspicion. Sputum done showed AFB and CSF culture which came later showed MTB which was resistant to all 4 first line drugs. Discussion: Primary CNS MDR is not a rarity and we need to suspect it whenever patient is not responding to 4 drug AKT. Our case demonstrates a very rapidly progressing MDR CNS TB with Pulmonary TB which did not respond to 2nd line drugs which could be given for 1week only as patient succumbed. Rapid diagnosis of MDR TB is the only way to pick up these cases. Conclusion: High degree of suspicion should be kept for MDR TB when patient is not responding to first line AKT.

164

Session: Eposter inflamm 2.2

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Spectrum of clinical and radiological features in 11 patients with autoimmune synaptic encephalitis

Netravathi M, Kamble N, Satishchandra P, Pal PK

National institute of mental health and neuroscien, Bangalore.

Background: Autoimmune encephalitis (AIE) encompasses a heterogenous group of disorders characterized by immune-mediated neuronal cell destruction. Aims: To report the clinical immunological imaging profile and treatment outcome of patients with AIE. Methodology: A chart review of 11 patients (M: F-5:6) with AIE from 2011 to 2014 is presented. All patients were admitted and evaluated with antibody markers and MRI. Results: Among the 11 patients 3 each were positive for anti-NMDA anti-VGKC and anti-TPO and 2 for anti-GAD antibodies. Psychiatric disturbances was the predominant abnormality in 9 (81.8%) followed by movement disorders (45.5%) seizures (36.4%) speech disturbances (36.4%) stiffness of the limbs (18.2%) and visual hallucinations (9.1%). MRI brain was normal in patients with anti-GAD and anti-TPO antibodies; while all patients with anti-NMDA and anti-VGKC antibodies showed abnormalities. Four (66.7%) had changes affecting medial temporal lobe; followed by basal ganglia (33.3%) insula (16.7%) thalamus (16.7%) and hippocampus (16.7%). Patients with anti-NMDA antibody were children and presented with seizures behavioural changes and mutism. Patients with anti-GAD antibody presented with limb stiffness. All showed gradual improvement with immunomodulation except one (9.1%) patient with anti-GAD antibody who succumbed to the illness. Conclusion: All patients with anti-VGKC anti-NMDA and anti-TPO presented with triad of behavioural changes impaired cognition and seizures; while limb stiffness was more commonly observed in patients with anti-GAD antibody. Mutism was present in all patients with anti-NMDA antibody which may help in early identification of the disorder. MRI brain showed changes restricted to limbic structures in anti-NMDA and anti-VGKC. Early diagnosis and treatment of autoimmune encephalitis is essential for better outcome and prevent long-term sequelae.

83

Session: Eposter inflamm 2.3

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Neuromyelitis optica clinico-demographic profile from a tertiary care center in north india

Dr. Aastha Takkar, Dr. Dheeraj Khurana, Dr. Vivek Lal, Dr. Sudesh Prabhakar

Department of Neurology Postgraduate Institute of, Chandigarh.

Background: Neuromyelitis optica (NMO) as a disease entity distinct from multiple sclerosis has been well recognized after the discovery of pathogenic IgG-NMO autoantibody. Limited data on clinical and investigative profile of NMO is available from India. We carried out the following study to define clinical characteristics in patients of NMO in North India and to find the seropositivity of NMO-IgG antibody. Objectives: To study clinical characteristics of NMO in North Indian population. Methods: 25 patients fulfilling the Wingerchuk criteria for NMO were enrolled retrospectively and prospectively from our MS registry from June 2012 to June 2014. Detailed clinical and investigative profile was collected and analyzed. Results: Of 25 patients enrolled in our cohort 88% were females and 12% were males. The mean age was 31.16 Β΁ 10.72 years. 72% patients had a relapsing course and 28% had a monophasic illness. The first event was myelitis in 52% patients optic neuritis in 28% patients and remaining 20% patients had contiguous optic neuritis and myelitis at presentation. 56% patients in our cohort tested positive for the NMO-IgG antibody. Discussion: Limited data on the spectrum of NMO is available from India. NMO-IgG antibody positivity may help in early and accurate diagnosis of this entity. With the expansion in the therapeutic armamentarium for the neuro-immunological diseases early diagnosis and prompt treatment may alter the course of NMO. Most patients in our series who were diagnosed early in the course of illness responded well to treatment (in the terms of EDSS).

120

Session: Eposter inflamm 2.4

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Profile of guillain -barre syndrome patients admitted in a tertiary care centre with respect to response to various modalities of treatment

Dr. Chafale Vishal Annaji, Dr. Chafale Vishal Annaji,

Dr. T. N. Kundu, Dr. Alak Pandit, Dr. Lahoti Satish

DM Neurology Resident Bangur Institute of Neurosc, Kolkata.

Aims: To evaluate clinical and electrophysiological profile of Gullain-Barre Syndrome to explore factors associated with outcome and to see the response to various modalities of treatment. Materials and Methods: This is an ongoing prospective study of 120 patients started in December 2012. History and clinical findings were noted and patients were subjected to electrodiagnostic studies. Ptients with GBS disability score β‰͵3 were treated with IVIg Plasmapharesis or IV methylprednisolone. Others were managed conservatively. We compared response to different modalities of treatment. Results: Most common subtype was AIDP 73(60.83%) followed by AMAN 34(28.33%)MFS 9(7.5%) and AMSAN 3(2.5%). 1 patient presented with Pandysautonomia. Mean time for onset to maximum weakness was 6.8(SDΒ΁4.87)days. Most common antecedent illness was URTI. 22(18.33%) patients had respiratory involvement and 13(10.83%) required ventilatory support 43(35.83%) had autonomic involvement. 69(57.5%) had cranial nerve involvement7th be the commonest. Electrodiagnostic testing revealed abnormal H reflex and F wave to be the commonest and earliest abnormality. While 27(22.5%) received IVIg 26(21.67%) received plasmapheresis 16(13.33%) IV methylprednisolone and 51(42.5%) were managed conservatively. Patients were followed up for 6 months. Strength improved by grade β‰͵1 in 57% of patients treated with plasmapheresis 56% in IVIG group and 33% in IV Methylprednisolone group. We found mortality rate of 7(5.83%) and most of patients were older than 60years. Conclusion: Increasing age delay in starting treatment early peak disability autonomic dysfunction bulbar weakness reduced CMAP was associated with poorer outcome. Group of patients treated with IVIG and plasmapheresis showed more improvement than IV Methylprednisolone group.

188

Session: Eposter inflamm 2.6

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Autoimmune mimickers of atypical Parkinson syndromes: A case series

Sudheeran K, Anand Kumar A, Annamma Mathai, Anuja NS,

Vivek Nambiar

Department of Neurolgy Amrita Institute of Medical, Kochi.


Atypical  Parkinsonism More Details/Parkinson plus syndrome is a heterogenous group of neurological disorders characterized by parkinsonian features-bradykinesia rigidity tremor postural imbalance poor response to levodopa and additional clinical features. Current practice utilizes the clinical criteria for diagnosis of these disorders. We present a series of ten cases of atypical parkinsonism (9 male age range 49-75 years) of 2 months to 156 months duration [Probable multiple system atrophy (MSA)-2 Possible progressive supranuclear palsy (PSP)-1 Probable PSP-3]. New uncharacterized neuronal antibodies were seen in eight patients leucine rich glioma associated protein (LGI) 1 antibody was seen in one and one patient had an uncharacterized neuronal antibody along with LGI1 antibody. Four patients had abnormal CSF (elevated protein in CSF/pleocytosis with normal glucose). All patients were treated with intravenous methyl prednisolone 1gm for five days followed by azathioprine/mycophenylate mofetil. There wasgood clinical improvement in terms of Unified Parkinson Disease Rating Scale (UPDRS) motor scale and or modified Rankin Scale (m RS). There was improvement in eye movement postural instability and associated cerebellar /autonomic symptoms. Two patients had reappearance of symptoms on stopping the steroid and improvement on restarting steroid. One patient died of infection though there was good recovery. Follow up period ranges from 1month to 6months. Presence of neuronal specific antibodies abnormal CSF significant and immediate response to steroids and reappearance of signs and symptoms on early steroid withdrawal points towards an underlying autoimmune aetiology. Our series emphasizes the need for a thorough evaluation of potential treatable causes including autoimmune etiology in atypical parkinsonism.

49

Session: Eposter inflamm 2.7

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Brainstem demyelination presenting as eight-and-a-half syndrome with hemiataxia: a probable nine syndrome: A new dimension

Rohan R. Mahale, Anish Mehta, Mahendra JV, Madhusudhan BK, Suryanarayana Sharma, R Srinivasa

Department of Neurology M. S. Ramaiah Medical Col, Bangalore.


One-and-a-half syndrome represents ipsilateral conjugate horizontal gaze palsy (one) due to a lesion in the abducens nucleus or horizontal gaze center in the paramedian pontine reticular formation (PPRF) and an ipsilateral internuclear ophthalmoplegia (half) due to a lesion in the medial longitudinal fasciculus (MLF). Additional involvement of intraaxial fasciculus of the facial nerve results in palsy of cranial nerve VII and this along with one-and-a-half syndrome constitute the eight-and-a-half syndrome. There are new variants of this syndrome caused by extension of lesion to involve new adjacent structures in pontine tegmentum. We report an elderly patient who presented with eight and a half syndrome associated with ipsilateral hemi-ataxia due to demyelination involving lower pons with extension into rostal dorso-lateral medulla. The present case represents probable Nine syndrome which adds new dimension to eight-and-a-half syndrome.

52

Session: Eposter inflamm 2.8

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Family with  Ehlers-Danlos syndrome More Details (Combined Classic and vascular type) with rare presentation of muscle weakness including severe facial and trigeminal motor weakness

Shantanu Shubham, Shantanu Shubham, A. Nalini, N. Devraddi, N. Gayathri, Chandrajit Prasad

NIMHANS, Bangalore.


S. Shantanu1A. Nalini1N. Devraddi1N. Gayathri 2Chandrajit Prasad3Departments of Neurology Neuropathology NeuroImaging and Interventional Radiology NationalInstitute of Mental Health and Neuro Sciences Bengaluru India Background: Two reports exist on neuromuscular involvement in Ehlers-Danlos Syndrome(EDS). Hypotonia is known but muscle weakness is hardly recognized. Objectives: To report clinical radiological and pathological features of a mother and daughter with EDS and unusual muscle weakness. Materials and Methods: A mother and daughter with combined EDS seen two months ago. Results: 35 year old lady reported generalized myalgiaeasy fatigabilitygluteal and thigh pain aggravated on exertionprogressive weakness of pelvic followed by pectoral girdles and thighs for 3 years. Neck flexor and trunkal weaknessshoulder girdle wasting 6 months. Recurrent jaw dislocationeasy bruising with dark pigmentationhyperextensibility of joints many years. Has transluscent skin with prominent veinspapyraceous scarssevere myopia. Wasting of temporalis and masseterssevere bifacial weakness sternocleidoidstrapezius pectoral girdle atrophy. MRC grade 4 power at shoulders and armsgrade 3+ at pelvis and thighs. DTRs: Normal. Lactate-29 mg/dl;Homocyteine-24CK-275IU.2DECHO Myxomatous degeneration of mitral valves. High myopia with astigmatism. NCS-normal. EMG-myopathic. Muscle MRI-severe fatty infiltration of paraspinal musclesgluteus maximus and mediusquadriceps more affected than hamstrings. Histopathology-increased subsarcolemmal reaction productsfew COX deficient fiberspreserved COL6Ξ΁1and Ξ΁2Laminin. Daughter15years has exertional myalgiatall statureright hemifacial hypoplasiamyopiahyperextensible jointshyperelastic skinneck flexor weakness. Poorly responsive microcytic hypochromic anaemia(Hb6.4). CK2D ECHO-normal. Conclusions: Our patients had the rare combination of Classic and Vascular type of EDS with unusual facial and trigeminal muscle weakness which are not reported earlier.

66

Session: Eposter inflamm 2.9

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

To assess the serum level of vitamin D in patients with acute multiple sclerosis

saraswathi, Dr. Saraswathi. S, Prof. Dhanaraj. M, Dr. Danalakshmi S

Apolo main hospitals, Chennai.

Introduction: Vitamin D defeciency is one of the risk factors for Multiple Sclerosis. Recently more number of Multiple sclerosis patients are reported from India inspite of it being a tropical country. The aim of the present study is to find out the serum level of vitamin D among patients with acute Multiple sclerosis. Materials and Methods: Patients with definite MS following acute relapse within 10 days of attack or clinically isolated syndrome following the first attack were included. The diagnosis of MS was done based on Mcdonald criteria. Those patients with duration of illness more than 10 days and those who had steroid therapy or Vitamin D or calcium supplements earlier were excluded. Equal number of age and gender matched controls were also chosen. Serum vitamin D level was done using electro chemiluminescence immune assay method. The results were collected and compared. Statistical analysis was done using independent T test. Results: The study group included 22 patients with 18 definite MS and 4 CIS patients; Mean age 37.36; 12 females and 10 males. The control group included 17 patients with Mean age 34.18; 12 females and 5 males. The serum Vitamin D level in study group ranged between 3.3 ng/dl to 30 ng/dl with a Mean level of 9.9 ng/dl where as it was between 3 ng/dl and 30.8 ng/dl with a Mean level of 19.3 ng/dl in control group. It was significantly low in patients with Multiple Sclerosis with a P value of < 0.0005 and confidence interval of 95%. Conclusion: In patients with Acute Multiple Sclerosis Serum Vitamin D level was found to be significantly low. A larger study involving more number of patients need to be done to explore its therapeutic role.

104

Session: Eposter MD 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

To study cause of death in patients of neurological Wilson's disease

Niraj Kumar, Dr. Deepika Joshi

Asstt. Professor Neurology IGIMS Patna, Patna.

Objectives: To study cause of death in patients of neurological Wilson's disease. Background: Wilson's disease (WD) is a treatable autosomal recessive disorder of copper metabolism and is characterised by protean manifestations due to accumulation of copper in liver brain cornea and other tissues. Although treatable but still deaths in patients of WD are not rare. Methods: We studied cause of death in 44 patients who were diagnosed WD based on detailed clinical evaluation Kayser- Fleischer ring in cornea and biochemical studies (decreased serum ceruloplasmin and serum copper and increased urinary copper) and neuroimaging. Results: A total of 6 patients (13.6%)died during the observation period. The main cause of death was the delay in diagnosis. The mean delay in diagnosis for all patients was 18.9 months while it was 25.4 months for those who died. Of the 6 patients who died5 patients had dystonic presentation while one had parkinsonian presentation. Five of the 6 patients were juveniles (age below 18 years) and one was adult. Four of the 6 patients showed poor compliance for the treatment (zinc and penicillamine) as well as for the regular follow up. Conclusion: Early and correct diagnosis institution of proper treatment and lifelong continuation can prevent devastating consequences as WD is a treatable disorder.

194

Session: Eposter MD 1.10

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

The spectrum of clinical profile of patients with ataxia telengiectasia: A case series from nims

Dr. Sireesha Yareeda, Dr. Rupam B, Dr. Rukmini M, Dr. A. K. Meena, Dr. S. A. Jabeen

NIMS, Hyderabad.

Objective: To evaluate the clinical profile of children with ataxia telangiectasia and identify atypical manifestations. Methods: Twelve children with ataxia telangiectasia diagnosed consecutively in the Neurology out patient department of NIMS were studied for clinical manifestations and duration of illness. The ataxia severity was rated by the ICARSSARA and BARS. Results: Seven were female(59%) while 5 were male(41%). The average age of presentation was 8.25 years (4-13 years) while age of first symptom was 5.25 years (3-9 years). Seven (59%) had ataxia as their initial complaint while 3(25%)had telangiectasia 1 (0.08%) had seizure and 1 (0.08%) had recurrent respiratory infections. Cafe au lait spots were seen in 25 %. High parental consanguinity (75%) was noted. The most common infection was respiratory in 7(58 %) followed by gastrointestinal in 3(25%). The atypical manifestations were peripheral neuropathy in 1 muscular dystrophy in 1two with refractory seizures and 1 with hypothyroidism. Respiratory tract infections were more common in patients with oculomotor apraxia (p=0.02). On comparison of patients with an early onset (<5 years) Vs late onset(>5 years) disease clinical features were similar except that speech disturbances were common with late onset. Conclusions: Patients had a wide spectrum of manifestations including refractory seizuresfoot drop and muscular dystrophy. High prevalence of recurrent infections in patients with oculomotor apraxia highlights the need for aggressive infection prophylaxis andimmunisation in these children.

284

Session: Eposter MD 1.11

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Fragile X-associated Tremor /Ataxia Syndrome (FXTAS): first case report from India

Achal Kumar Srivastava, Mohd Faruq, Deepak Kumar, Ajay Garg, Garima Shukla, Vinay Goyal, Madhuri Behari

Professor Department of Neurology All India Inst, New Delhi.

Background and Objectives: Fragile-X associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder caused by expansion of CGG repeats in 5' untranslated region of the FMR1 gene at Xq27.3. It primarily affects males and its clinical features resemble diseases like Spinocerebellar ataxia type-12 Parkinson's Disease and Essential tremor. In this study we report the first case of FXTAS from India. Case: A 66-year-old male presented to Ataxia clinic of AIIMS with progressive asymmetrical onset upper-limb (left >>right) tremor that started 10 years ago. Two years after onset he also developed head tremor and mild gait ataxia. No other member of his family had similar complaints except one second degree cousin. He had head tremor resting tremors and postural tremor. He had asymmetric intention tremor with dysmetria (Left >right) with impaired tandem walking. Deep tendon reflexes were reduced with flexor plantar responses. MR imaging of brain showed cerebro-cerebellar atrophy with diffuse white matter hyperintensities on T2W and FLAIR images in the fronto-parietal area and periventricular region. Patient's DNA was tested negative common SCAs 1 2 3 and 12. Further testing showed that the patient was a carrier of FXTAS mutation with 96-CGG repeats in FMR 1gene which confirmed the diagnosis of Probable-FXTAS based on Jacquemont's criteria. Conclusions: To the best of our knowledge this case is the first diagnosed and reported case of FXTAS from India. We suggest that FXTAS diagnosis should be considered in all late onset cases of progressive Tremor disorder with or without ataxia or parkinsonian features.

88

Session: Eposter MD 1.12

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Neuropsychiatric manifestations in Parkinson's disease

Dr. Kamesh Arun. R, Kamesh Arun. R, Shanmugasundharam N, Bhanu K

Institute of Neurology, Madras Medical College & R, Chennai.

Background: Neuropsychiatric symptoms are common in Parkinson's disease. The Neuropsychiatric inventory is a valid and reliable tool to assess the psychiatric symptoms.OBJECTIVE: To determine the prevalence of neuropsychiatric disorders in Parkinson's disease and its relation to severity of Parkinson's disease. Methods: This was an observational cross sectional study. The neuropsychiatry inventory and Hoehn and Yahr staging were used to assess the prevalence of psychiatric symptoms and disease severity in 50 Parkinson's patients. Result: 70% of patients had at least one psychiatric symptom whereas 50% of patients had two or more symptoms. The frequency of the symptoms were depression(36%) sleep disorder(32%) anxiety(30%) appetite change(16%) irritablity(12%) apathy(10%) agitation(10%) hallucination(8%) delusion(6%) aberrant motor behaviour(2%) disinhibition(2%) and Euphoria(0%). There was no relation between the neuropsychiatric symptoms and the severity of Parkinson's disease. There were two sets of clustering of symptoms one among delusion hallucinationagitation and irritability and the other among depression anxiety and sleep disorder. Conclusion: This study shows high prevalence of psychiatric symptoms in Parkinson's disease and the need to address them.

128

Session: Eposter MD 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Study on Parkinsonism in young patients in a tertiary care hospital

Debjani Roy Chowdhury, Dr. Atanu Biswas, Dr. K. B. Bhattacharyya, Dr. Arijit Roy

DMPDT (Neuromedicine) Bangur Institute of Neurosci, Kolkata.


Study on parkinsonism in young patients in a tertiary care hospitaldr. Debjani Roychowdhury Dr. Atanu Biswas Dr. K B Bhattacharyya Dr. Arijit Roy. Background: Parkinsonism in young patients comprises early onset Parkinson disease (EOPD) and secondary parkinsonism (SP). Objectives: Classify young patients (<40yrs) with parkinsonism into possible clinical syndromes and studying clinical profile of EOPD. Method: The study is going on in Bangur Institute of Neurosciences from June 2013 to be continued to August 2014. History and clinical examinations were done in pre-structured proforma following movement disorder clinic of the institute. Relevant biochemical tests and MRI were done. EOPD were studied following Unified Parkinson's Disease Rating Scale Modified Hoehn and Yahr Staging (H&Y) Schwab and England Activities of Daily Living Scale. Results: Out of 35 patients 20(57.14%) have EOPD (2 juvenile Parkinson disease 18 young onset Parkinson disease) 5 Wilson's disease 2 post encephalitic sequel 2 Extra pontine myelinolysis 3 Drug induced parkinsonism 1 congenital hypothyroidism 1 multi infarction state 1 undiagnosed. Five (33.33%) SP had asymmetric presentation. Four (20%) EOPD have family h/o either tremor or PD in 1st degree relatives. Tremor {17(85%)} gait abnormality {18(90%)} postural instability {13(65%)} are common in EOPD. Twelve (60%) EOPD have dystonia compared to 8(53.33%) SP. Drug induced dyskinesia present in 6. Eight (40%) are in H&Y stage-2.5. Conclusion : Asymmetric Parkinsonism does not rule out SP. Tremor gait abnormality postural instability are common in EOPD contradicting other study. Positive family history frequent presence of dystonia early levodopa-induced dyskinesias are characteristic in EOPD.

181

Session: Eposter MD 1.4

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Unilateral and bilateral mirror dystonia in adult-onset primary Writer's cramp

Sunitha Raj Robert, Sunitha Raj Robert, Syam K, Asha Kishore

CCC for Movement Disorders SCTIMST, Thiruvananthapuram.

Aim: To examine the frequency of unilateral and bilateral mirror dystonia in simple and complex writer's cramp (WC). Background: Mirror dystonia (MD) in WC refers to the abnormal postures in the symptomatic hand during writing with the asymptomatic hand. Lack of interhemispheric inhibition (IHI) due to impairment of local inhibitory circuits in the dystonic hemisphere causes MD. Bilateral MD is considered rare in WC. Methods: Thirty patients with primary adult-onset WC participated. WC was classified as simple or complex depending on the presence or absence of task specificity. Severity of WC was measured using Writers Cramp Rating Scale (WCRS). The presence laterality and pattern of MD were recorded. Results: All patients (27 males 3 females) were right-handed. The mean age of the patients was 35 years and the mean duration of symptoms was 8 years. The type of WC was simple in 22 patients (73%) and complex in 8 (27%). MD was seen in 26 patients (87%). MD was unilateral in 20 patients (77%) and bilateral in 6 (23%). Complex WC patients had more bilateral MD (25%) than simple WC (18%). MD was of extension pattern in 20 (77%) and flexion pattern in 6 patients (23%). Writing Movement Score (p=0.012) Writing Speed Score (p=0.008) finger score (p=0.003) postural tremor (p=0.002) and mean Botulinum toxin dose used (p=0.01) were higher in complex WC. Conclusion: Bilateral mirror dystonia indicating bihemispheric loss of IHI is not rare (20%) in patients with writer's cramp and is more frequent in those with complex writer's cramp.

245

Session: Eposter MD 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

To evaluate the prevalence of urinary and sexual dysfunction in Idiopathic Parkinson's disease as compared to healthy controls at a tertiary care hospital in India: A questionnaire based case con

Dr. Rima M Chaudhari, Dr. Vinay Goyal, Dr. Madhuri Behari, Dr. Garima Shukla, Dr. Achal Srivastava

Senior Resident Neurolgy AIIMS, New Delhi.

Background: Urinary and sexual dysfunction are common non motor symptoms in idiopathic Parkinson's disease. The aim of this study was to use specific questionnaires for each domain for females and males and healthy controls. Methods: There were 199 patients recruited at the Movement disorders clinic over 2 years and 192 healthy controls. Clinical assessment was done by overactive bladder (OAB) questionnaire for urinary functions and sexual dysfunction by International erectile function index (IIEF ) for males and by the arousal and desire domains of the female sexual function index (FSFI) for females. Results: The mean age of patients was 57.7 Β΁10 years and 49.5Β΁ 11 years in control group. In the control group 34 % had an overactive bladder while 62 % patients had symptoms (p value<0.001). 80 % of female patients had severe symptoms while only 52 % of controls had severe symptoms. (p = 0.012). For males 30 out of the 118 males (25.4% ) had severe dysfunction as against 4 out of 118 controls (0.02%) p value <0.001. After stratified analysis for age age groups (20-40 40-60 >60) OAB was more common in patients than controls in both first and third set of age groups. Sexual dysfunction was more severe in the middle age groups in both genders after stratifying for age. Conclusion: Urinary and sexual dysfunction is prevalent in patients more than controls even after stratifying for age.

281

Session: Eposter MD 1.6

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Mirror movement among patients with Parkinson's disease- an under-appreciated clinical sign

Hrishikesh Kumar, Payel Chatterjee, Banashree Mondal, Supriyo Choudhury, Swagata Sen, Richeek Pradhan, Sidharth Shankar Anand, Titas Chakraborty, Dipak Naskar, Shounak Biswas

Institute of Neurosciences Kolkata, Kolkata.

Background: Mirror movement (MM) is hitherto underappreciated phenomenon see in Parkinson's Disease (PD). We intended to clinically evaluate MM in PD patients and also estimate change in this phenomenon upon intake of levodopa (L-dopa). Methods: In this analytical cross-sectional study fifty patients with PD were evaluated using a clinical scale for evaluation of MM and Unified Parkinson's Disease Rating Scale (UPDRS) in OFF and ON phase. Five different tasks (finger tapping hand movement pronation supination foot dangling and spiral movements) were instructed for assessments of different objective parameters of MM. Video recording of the evaluation were performed in all patients. The changes in MM rating scores of same patients from OFF to ON phase were compared using Wilcoxon Sign Rank test.25 age and gender matched control (healthy volunteers) has been evaluated for MM. Results: The mean age of 50 PD patients was 63.78 (SD 9.4) years and 76% of them were male. Among them 92% patients demonstrated MM. A significant improvement were noted in the total mean UPDRS score (mean change in score from OFF to ON=6.33 p value 0.0001). Individual tasks to demonstrate MM has not shown significant change from OFF to ON phase of PD. None of the control has demonstrated MM in our study. Conclusion: MM was found to be a common symptom among PD patients and it can be an important clinical guide for diagnosis of PD. No significant change of MM from OFF to ON phase was seen in spite of improvement of PD symptoms.

283

Session: eposter MD 1.7

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Objective Gait analysis in Parkinson's disease reflecting the effect of levodopa

Hrishikesh Kumar, Banashree Mondal, Swagata Sen, Payel Chatterjee, Supriyo Choudhury, Sidharth Shankar Anand, Mariam Umme Kulsum, Titas Chakraborty, Richeek Pradhan

Institute of Neurosciences Kolkata, Kolkata.

Background: One of the hallmark symptoms of Parkinson's disease (PD) is gait instability. As an overall clinical outcome the gait stability improve following levodopa (L-dopa) therapy. Often this improvement is inconsistent. Hence we have undertaken this study for a precise gait analysis among PD patients in ON and OFF phase. We also tried to identify gait variables which respond and those which do not respond to L-dopa therapy. Methods: In this observational cross sectional study we evaluated the gait parameters of seventy consecutive PD patients using automated electronic walkway (GAITRite) and Unified Parkinson's Disease Rating Scale (UPDRS) in OFF phase and ON phase following administration of L-Dopa. The gait parameters and rating scores between OFF and ON phases were compared using Wilcoxon Sign Rank Test. Results: The mean age of 70 patients was 64.56 (SD 8.81) years and 75.7% were male. There were significant increase in mean cadence {∆ cadence= 1.76 steps/ second (p value 0.013)} and velocity {∆ velocity= 11.64 cm/sec (p value 0.0001)} following L-Dopa administration. Most of the symmetrical and asymmetrical gait parameters have shown a significant improvement with an exception of swing time or single support time. Conclusion: L-Dopa therapy can improve most of the gait parameters among PD patients. Swing time was regarded as a speed-independent marker of steadiness and fall risk in previous research. Hence suggested non-improvement of swing time or single support time may reflect the incomplete resolution of gait instability and persistent fall-risk in ON phase among most PD patients.

183

Session: Eposter MD 1.8

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Neuroleptic malignant syndrome: A case series of 10 patients in a tertiary care centre

S. Selvin, S. Selvin, U. Meenakshisundaram, C. U. Velmurugendran, V. Shankar, P. R. Prabash

Department of Neurology Sri Ramachandra University, Chennai

Background: Neuroleptic Malignant Syndrome is a life-threatening condition caused by dopaminergic hypoactivity due to neuroleptics and sudden reduction in dosage or withdrawal of dopamine agonists. Aim: To analyse the clinical presentation treatment and prognosis of patients presenting with NMS. Materials and Methods: This is a prospective study of the presentation treatment and prognosis of 10 patients diagnosed to have NMS in Sri Ramachandra University Chennai from August 2012 to June 2014. Results: 9 patients were male and 1 female. Mean age was 60 years. One patient was below 40 years of age. 4 patients developed symptoms within 3 weeks of starting antipsychotics (40%).3 were started on Olanzapine Clozapine Risperidone and one with Haloperidol. 2 patients(33%) developed NMS following non-compliance with Levodopaone following Amantidine withdrawalone following Pramipexole Selegiline Trihexyphenydyl withdrawal and two following Pramipexole and Amantidine withdrawal. All six patients (60%) presented to ER within one week following withdrawal. Schizophrenia (40%)and Parkinsonism (60%) were two main disorders for which patients were prescribed these drugs. The most common symptom was fever with altered sensorium(50%). 20% of them presented with muscle rigidity postural instability and tremors. Leucocytosis and elevated CPK was noted in all patients. Acute Respiratory failure was observed in two patients (20%) for which tracheostomy was done. Metabolic acidosis was observed in three patients(30%). Dantrolene and Bromocriptine were used as treatment. Recovery was complete in all patients. Mean interval for recovery was between 7 to 12 days.4 patients were restarted on low dose low potency neuroleptics at discharge. Rest of them was restarted on dopaminergic agents. Conclusion: Given the widespread prescription of neuroleptics by physicians in a variety of fields all physicians need to be able to properly and timely recognize and appropriately manage NMS.

193

Session: Eposter MD 1.9

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Neuropsychiatric co morbidity and quality of life in oromandibular dystonia: A Case Control Study

Dr. Neha Rai, Prof. Vinay Goyal, Dr. Nand Kumar, Prof. Garima Shukla, Prof. Madhuri Behari

All India Institute of Medical Sciences Delhi, Delhi.

Objective: The aim is to access the prevalence depression anxiety obsessive compulsive disorder (OCD) and psychosis along with quality of life (QOL) in idiopathic primary OMD. Methods: Total 71 cases of OMD and 71 healthy age and gender matched controls were enrolled. Patients below 14 yrs or with history of substance abuse prior psychiatric disorder dementia or other significant comorbidity were excluded. All subjects were screened for major neuropsychiatric disorders using Mini International Neuropsychiatric Interview (MINI) and accordingly for depression anxiety psychosis and OCD with individual rating scales. Dystonia severity was scored by Fahn-Marsden (BFM) Scale & OMD Questionnaire25. WHO QOL-BREF was used for QOL. Results: The prevalence of depression anxiety OCD and psychosis was 28%(n=20) 35%(n=25) 4.2%(n=3) 0% in OMD and 9.9%(n=7) 7%(n=5) 1.4%(n=1) 0% in controls respectively. Depression(p=0.005) and anxiety (p<0.001) were more common in OMD than in healthy controls. 70%(n=14) patients with depression and 84%(n=21) with anxiety had associated blepharospasm (p<0.001). Both depression and anxiety showed strong association with blepharospasm severity but not with severity of OMD age gender age of onset or duration of disease. Patient with depression and anxiety had significant (p<0.001) lower scores in WHOQOL-BREF physical health and psychological domains. Conclusions: This study showed that depression and anxiety disorders are highly prevalent in OMD and more among those who have associated belpharospasm. Both depression and anxiety negatively affect QOL and hence their recognition and treatment can enhance the QOL in OMD patients.

270

Session: 124Eposter Neuropathy 2.1

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Vasculitic neuropathy in elderly: A clinical electrophysiological and histopathological study from a university hospital

Anish L, Taly AB, Mahadevan A, Nagappa M

Nimhans, Trivandrum.

Background: Vasculitis is a rare and important treatable cause of neuropathy particularly in the elderly population. Objective: To describe clinical electrophysiological and histopathological profile of vasculitic neuropathy in elderly. Patients & Methods: One-hundred patients aged 65 and above underwent nerve biopsy between January 2002 and December 2011. Forty-six patients [M: F 2.8: 1] were diagnosed vasculitic neuropathy: definite-12 probable-10 and possible-24 [Collins et al 2000]. Results: Mean age at evaluation was 69.85Β΁4.9 years and mean duration of symptoms was 21.54Β΁33.53 months. Onset was varied: chronic- 38 sub-acute- 4 and acute-4. Three patients had a relapsing-remitting course. Seventeen patients had systemic vasculitis. Key symptoms were: paresthesias (89%) weakness (80%). sensory loss (70%) wasting (63%). Clinico-electrophysiological patterns of neuropathy included: Distal symmetrical sensorimotor polyneuropathy-18 multiple mononeuropathy- 9 asymmetric sensorimotor neuropathy- 10 symmetrical sensory neuropathy-4 asymmetric sensory neuropathy- 1 and others- 4. It is noteworthy that in 31 patients diagnosis of vasculitis was not suspected prior to biopsy. Immunomodulators were instituted in 31 patients and included Steroids alone (10) other Immunosuppresants with or without Steroids (15) IVIg with Immunosuppresants (2) and Plasmapharesis (4). Others received symptomatic medications (14). Twenty seven patients were followed up for a mean duration of 6.5 months. Fifteen (55%) improved 8 (30%) remained unchanged and four (15%) deteriorated despite treatment. Conclusion: This study describes one of the largest cohorts of elderly subjects with vasculitic neuropathy. Nerve biopsy plays a critical role in establishing the diagnosis and thereby instituting appropriate treatment for this disabling cause of neuropathy.

127

Session: Eposter Neuropathy 2.2

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Study on clinical etiological evaluation of polyneuritis cranialis in tertiary care hospital in odisha

Srikanta Kumar Sahoo, Dr. Maheswar Samanta,

Dr. Nihar Ranjan Biswal, Dr. Biswajyoti Ratha, Dr. Kali Prasanna Swain, Prof. Dr. Ashok Kumar Mallik,

Prof. Dr. Gita Mohanty

DM (neurology) Student, Cuttack.


There are 12 pairs of cranial nerves that innervate most of the structures of the head and neck. The afferent and efferent connections of these 12 cranial nerves traverse the meninges subarachnoid space bony structures of the skull and superficial soft tissues. Dysfunction of these nerves may occur at any of these sites along their course. We have studied 127 cases of multiple cranial nerve palsies admitted to SCB Medical college and Hospital Cuttack. Most common age of presentation was between 40-50 yrs age(35%). Males are more affected than females(72%). Most common cause found to be involvement of Brain parenchyma (26%) followed by processes within Nerves (22%) meningeal involvent (21.8%) skull base lesion(18.1%) disorders of NMJ(6.2%) and Idiopathic (9.3%) causes. Etiologically most common cause was found to be Infectious(30%) most commonly Tubercular infection CSOM HIV Herpes CMV infection followed by Tumours (19%) Acoustic neuroma Brain stem glioma Chlesteatoma schwannoma metastatic diposits nasopharyngeal tumors followed by Craniovertebral Anomaly(12.7%) Multiple sclerosis and other demyelinating causes(11.7%) GBS(11.7%)Vascular causes(posterior circulation strokes 7.8%) trauma(7%) and idiopathic (9.44%) causes. Most common cranial nerve involved was VII cranial nerve followed by VIII nerve IX X XI followed by VI III and II cranial nerve. 58% cases improved after treatment of primary causes.

192

Session: Eposter Neuropathy 2.3

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Electrophysiological follow-up in carpal tunnel syndrome

Dr. Sanjeev Kumar Bhoi, Dr. Sanjeev Kumar Bhoi, Prof. J. Kalita, Prof. U. K. Misra

Sanjay Gandhi PGI Lucknow UP, Lucknow.

Objective: The aim of our study was to characterize the neurophysiologic outcomes in patients of a carpal tunnel syndrome (CTS) undergoing local corticosteroid injection. Methods: Clinical and neurophysiologic assessments for CTS were done at baseline 1 and 3 months after treatment. The parameters evaluated in the nerve conduction study (NCS) were lumbrical interossi (LI) for motor and palm wrist (PW) difference for sensory evaluation between median and ulnar nerves. Results: Thirty four patients whose median age was 46 (range 29-74) years and 27 (79.4%) were female were included in the study. 22 patients were from rural area. Carpal tunnel syndrome was bilateral in 24 (70.6%) right hand in 6 (17.6%) and left hand in 4 (11.8%) patients. The median duration of CTS symptoms was 24 (range 3-120) months. There was a significant improvement at 1 and 3 months interval from baseline in clinical parameters; severity score for pain (p=0.0001) numbness (p=0.0001) paresthesia (p=0.0001) burning (p=0.0001) nocturnal awakening (p=0.0001) and allodynia (p=0.0001). Nerve conduction studies in 58 affected hands showed mean palm wrist difference at baseline was 1.08Β΁0.77 ms at 1 months 0.79Β΁0.66 ms (p=0.0001) and at 3 month 0.72Β΁0.55 ms (p=0.0001). The lumbrical interossi conduction at base line was 2.05Β΁1.69 1 month 1.62Β΁1.35 (p=0.03) and at 3 month 1.43Β΁1.26 (p=0.003). The nerve conduction parameters showed worsening in 30.9% and 23.5% for PW conduction and 35.3% and 27.9% hands for LI conduction at 1 and 3 months respectively. Conclusions: Local corticosteroid injection is clinically effective in reducing symptoms of carpal tunnel syndrome but one-third of patients showed worsening of NCS at follow-up. Significance: Nerve conduction studies should be used for diagnosis of CTS but not for monitoring in local steroid treatment.

288

Session: Eposter Neuropathy 2.4

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Study of peripheral neuropathy in chronic kidney disease stage 5 and its outcome after kidney transplantation

Dr. R. Ramya, Cheran Elangovan, S. Balamurugan, R. Laxmi Narasimhan, V. Kannan, N. Gopala Krishnan, K. Bhanu

Institute of Neurology Madras Medical College, Chennai.

Introduction: Neurological complications occur in approximately 60% of patients suffering from severe kidney disease affecting the nervous system at all levels. Among the many most common is uremic neuropathy and it depends on GFR duration of CKD and dialysis therapy. Aim: To evaluate the prevalence of peripheral neuropathy both overt and subclinical in CKD stage 5 patients on HD through nerve conduction studies and to assess the outcome of neuropathy after renal transplantation by follow up nerve conduction studies at the end of 1st and 3rd month. Materials and Methods: Study included 30 CKD stage 5 patients on HD who were on kidney transplant programme (live related) in nephrology department. All patients were assessed by detailed history physical examination neurological examination and blood routine investigations. Patients were subjected to nerve conduction study immediately after HD and were divided into 2groups such as with and without clinical and neurophysiological evidence of neuropathy. Those who had clinical and neurophysiological evidence of neuropathy underwent follow up nerve conduction studies in post renal transplant period at the end of 1st and 3rd months and the results compared. Results: Neurophysiological parameters improved between the 2 nerve conduction studies done in post transplant period. Conclusion: In Post renal transplant patients there is improvement in neurophysiological parameters due to segmental remyelination.

166

Session: Eposter Neuropathy 2.5

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Episodic neurological dysfunction in hereditary peripheralneuropathy a rare cause for a common presentation

Pawan Raj P. I, Pawan Raj P. I, Kulkarni Girish Baburao, Pooja M, Chakradhar N, Kulkarni Advaith Prakash, Mustare Veerendrakumar

NIMHANS (National Institute of Mental Health and N, Bangalore.

Introduction: Episodic transient neurological symptoms (ETNS) are important set of problems presenting to a neurologist in his practice. Objective: To report a patient of ETNS who on evaluation was diagnosed to have X linked dominant hereditary motor sensory neuropathy(CMTX). Material and Methods: Details of history examination and investigations including genetic studies. Results: A 19 year old student was admitted with 4 episodes of transient motor weakness (20 minutes to few hours) on right side improving completely from 8 years of his age last episode 1 month prior to presentation. On examination he had pes cavus impaired vibration in lower limbs and absent reflexes. On enquiry family history suggestive of CMTX and similar episodes in mother and brother was reported. Routine blood investigations Echo MRA and EEG were normal. Serial MRI's showed resolving white matter changes in corpus callosum and centrum semiovale. Nerve conductions showed demyelinating axonal sensory motor neuropathy. Genetic testing was positive for c.425G>A; p. R142Q mutation (hemizygous) in GJB1 gene. This is known mutation in CMTX but not been reported with ETNS. Compared to patients reported previously our patient was not a known case of CMTX no predisposing factors and other family members had similar episodes. The identification of this presentation is important to avoid extensive investigations and using steroids / antiplatelets and to prognosticate. Conclusions: Probably the first reported case of CMTX with transient neurological dysfunction from India highlighting the importance of clinical and laboratory evaluation to identify common presentation of uncommon entity

209

Session: Eposter Neuropathy 2.6

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Neurolymphomatosis- rare presentation of lymphoma with peripheral neuropathy

Shruthi Kamath, Dr. Manoj Goyal, Dr. Manish Modi, Dr. Vivek Lal

PGIMER Chandigarh, Chandigarh.


Neurolymphomatosis- rare presentation of lymphoma with peripheral neuropathy. Introduction: Peripheral nervous system (PNS) involvement can occur in various forms of lymphoma and at any stage of the illness. Though traditionally thought to be immune-mediated with recent advances in technology especially PET scan more and more patients are being seen with PNS involvement secondary to direct invasion (neurolymphomatosis). We report 3 cases with direct PNS involvement by lymphoma cells. Case reports: First case was a 69 years old gentleman with asymmetric painful sensorimotor polyneuropathy. NCS showed sensory-motor axonal and demyelinating neuropathy. PET-CT revealed FDG avid bilateral adrenal masses sacral nerve roots and brachial plexus. FNAC from adrenal mass revealed diffuse large B-cell lymphoma. He succumbed to his illness. Autopsy revealed diffuse large B cell lymphoma involving adrenals brachial and lumbosacral plexuses. The second patient a diagnosed case of pre-B cell lymphoma presented with painless distal predominant LMN quadriparesis. NCS showed demyelinating neuropathy with conduction blocks. Nerve biopsy revealed infiltration by B-cell lymphoma cells. The third patient presented with asymmetric sensorimotor neuropathy affecting upper limbs and right side of face. PET scan showed evidence of lymphoma. CSF showed malignant lymphomatous cells and nerve biopsy showed evidence of neurolymphomatosis. Discussion: Neurolymphomatosis is a rare condition which occurs secondary to direct invasion of peripheral nerves by lymphoma cells. Early clinical suspicion and diagnosis by appropriate investigations helps in proper management and avoidance of unnecessary therapeutic measures such as immunomodulation.

216

Session: Eposter Neuropathy 2.7

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Noninflammatory toxic myopathy in stone hair dye poisioning

Dr. Arvind Kankane, Dr. Arvind Kankane, Dr. M. Zaki Siddiqui, Dr. Ashish Sharma, Dr. Kshitiz Nath

M L B Medical College Jhansi, Jhansi


Noninflammatory toxic myopathy in stone hair dye poisioningStone hair dye is commonly used suicidal agent in Bundelkhand region. Chemically it is Paraphenylene di-amine(PPD). It has high morbidity and mortality and its incidence has increased dramatically in past few years. Clinical profile of PPD poisoning is characterized by angiodema myocarditis hepatotoxicity renal failure and myopathy. We hereby evaluate clinical and histological pattern of muscle involvement caused by PPD. Material and Methods: The material comprised of 20 cases admitted in MLB Medical College Jhansi U. P. from February 2014 to august 2014.. Diagnosis was made on basis of the history of dye ingestion and symptoms of neck swelling black coloured urine and muscular pain. The cases were thoroughly evaluated for evidence of myopathy in form of muscle cramps swelling and weakness of extremities. Diagnosis of myopathy was confirmed by elevated creatine kinase electromyography and muscle biopsy. Results: Mean age of presentation was 30 years majority of them were male(55%). Mean duration from dye ingestion to presentation was 1 day. Muscle involvement was manifested by cramps and weakness of all four limbs(45%). Mean serum CPK was 15000. Electromyography revealed low amplitude polyphasic MUAP with early and complete interference pattern. Muscle biopsy was done in 10 patients which revealedevidences of non inflammatory myopathy on H&E staining. Conclusion: Stone hair dye (PPD) may be considered as a cause of toxic myopathy. Muscle biopsy revealed non inflammatory myopathy which may be due to direct toxic effects of PPD ingestion. However further studies are required to determine exact mechanism of muscle injury.

13

Session: Eposter NM 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

A study on treatment pattern for refractory myasthenia gravis and myasthenia gravis in crisis in a super speciality hospital with particular reference to rituximab

K. Vijayan, JSK Chaitanya, S jaffar vali, P. R. Ambika, K T Manisenthil

Neurologistkovai Medical Center and Hospital, Coimbatore.


This study was done in population having refractive myasthenia gravis (MG) and patients in crisis. This is a retrospective analysis about clinical data diagnosis and the course of treatment of 10 refractory MG patients and 3 patients in MG crisis (11 AChR +; 1 MuSK +; 1 seronegative) who were hospitalised in past 4 years. They were treated with RTX a monoclonal antibody against CD20+ cells that causes prolonged B cell depletion. Patients are assessed according tomyasthenia gravis foundation of America and modified ZAS (Zaheer Ahmed Sayyed )classification before and after rituximab. All 13 patients received RTX 2X500 mg at an interval of 2 weeks (1 cycle). On RTX administration sustained clinical improvement was observed in all patients along with a reduction of conventional immunotherapies. Further RTX also helped in weaning 3 patients who were in crisis off the ventilator. Mean follow up has been 13 months and the longest follow up has been for 28 months. Further RTX administration decreased the prednisolone dose administered to the above patients with a mean of 69.23% after one cycle of RTX therapy. Ach receptor antibody titers were found to be decreased by 17.2%. Similarly the doses of Azathioprine was reduced to 66.6% and Pyridostigmine frequency was decreased to a mean of 15.38% after cycle 1 and it was further reduced to 53.84%. 23.07% were completely tapered off during the follow-up period. This is the largest and first report of RTX in MG patients from India. Furthermore this is the first case series to report a long term follow up of the low dose RTX followed by Mycophenolate mofetil which is a novel therapeutic regimen. Only 1 patient required a second dose of RTX. Our results support the hypothesis that rituximab is beneficial and well tolerated in managing refractory MG and MG in crisis. We found that modified ZAS classification is still relevant and very useful during follow up of these patients.

42

Session: Eposter NM 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Myosinopathies: A new group of disorders - Description of MYH2 MYH3 MYH7 and MYH8 types by clinical MR Imaging histopathological and Electron microscopic studies

A. Nalini, Dr. A. Nalini, Dr. N. Gayathri, Dr. Chandrajit Prasad

National Institute of Mental Health and Neuroscien, Bangalore.

Background: Hereditary myosin myopathies are a new group of diseases with onset at birth childhood or adult life. They are generally benign disorders. Aims and Objectives: To describe clinical muscle MRI histopathological and EM findings of these recently diagnosed cases at our Neuromuscular Disorders clinic. Materials and Methods: Six cases from 4 families. Results: Family1:32 years lady had progressive asymmetrical foot drop for 6years weakness of pelvic girdle for 4years left hand extensors and hand grip for 2years. CK-178IU/L. Her six year old son born with contractures has prominent muscles no weakness. CK-2712IU. Biopsies: Rimmed vacuoles with fibre size variation irregular dabbled eosinophilic masses in many fibers intensely green on MGT and unstained on SDH NADH-Tr. Family2: 50 year old lady was born with clenched fists weak as a child. By 19 years developed pelvic girdle weakness. Father had severe talipes equinovarus and clenched fists since birth. Died at 72years. Elder brother and sister have clenched fists. Son aged 29 years was a floppy child. Since childhood has nuchal contracture motor disabilities hypermobile joints. Case5:23 year lady born with distal arthrogryposis had delayed acquisition of milestones. Walks from 7 years of age. Has trismus from infancy. Seizures for 6 months. Has low set ears micrognathia malocclusion of teeth jaw trismus hand and foot pseudocamptodactyly ulnar deviation of wrists right foot equinovalgus deformity. Contractures at all major joints. Grade 4 muscle weakness. Case6:28 years old thin lady with foot deformities and gait abnormality from infancy. Neck flexors distal limb weak interphalangeal joints hyperextensible. CK-63IU. Case7:22 years boy with foot deformity and weakness from 12 years of age. Pelvic girdle weakness for last 4 years. CK-91IU. Conclusion: First report on Myosin myopathies from India. Important to recognize and prognosticate these rare and relatively benign disorders.

45

Session: Eposter NM 1.3

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Monomelic amyotrophy (Hirayama disease) and bibrachial amyotrophy: phenotypically distinct but identical by MR imaging

V. Preethish-Kumar, A. Nalini, Jitender Saini, Shriram Varadharajan, Kiran Polavarapu

Department of Clinical Neuro Sciences National Inst, Bangalore.

Background: Cervical MRI in Monomelic Amyotrophy(MMA) demonstrates classical finding of posterior dural detachment and/ or cord atrophy with signal changes. Only one report exists on clinical and MRI description of bilateral symmetrical MMA/Bibrachial Amyotrophy (BBA). Aims and Objectives: To characterise MRI features in 23 cases of BBA seen over last decade. Materials and Methods: All patients were clinically and electrophysiologically defined to have BBA and underwent cervical contrast MRI including flexion studies. Results : All had symmetrical distal onset with moderate to severe involvement of muscles of hands and forearms with relative/total sparing of Brachioradialis. Mean age of illness onset-20.7Β΁6.5 years mean duration-70.6Β΁75.3 months. MRI: In neutral position prominent posterior epidural space(PES) seen in 27.1%. Flexion studies done in 19 cases and in 16(84.2%) showed forward displacement of posterior dura crescent shaped epidural enhancement in 17/21(81%). Bilateral T2 signal hyperintensities (eye of snake appearance) in cord seen in 14(60.9%); symmetrical- 12(85.7%). Maximum hyperintensity noted at C5-C6 C6-C7 (combined-64.3%) levels. Cord atrophy seen in 21 (91.3%) variably extended from C2 to D2[most affected segments: C5-C6 C6-C7(together-66.7%)]; symmetrical atrophy-18(85.7%). Cord diameter of <5mm-66.7%. Straightening of spine-18(78.3%). Disc osteophyte complexes in 10 cases(43.5%). Conclusion: This study confirms that MMA and BBA are phenotypically distinct but pathophysiologically similar on MRI. Classical flexion induced myelopathy with posterior epidural enhancement and/or cord atrophy with signal changes were detected in all cases. It is important to differentiate these disorders from ALS. It was interesting that many had disc osteophyte disease at an early age. Although the pathology seems to be degenerative in these disorders they occur secondary to dynamic alterations causing mechanical induced ischemic damage to anterior horn cells.

106

Session: Eposter NM 1.4

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Glia in amyotrophic lateral sclerosis pathogenesis: Protectors or aggravators?

Phalguni Anand Alladi, Phalguni Anand Alladi, Poojashri Mishra, Dinesh Dhull, Anu Mary Varghese, Vijayalakshmi K,

T. N. Sathyaprabha, A. Nalini, T. R. Raju

Department of Neurophysiology National Institute, Bengaluru - 560 029, India.

Background: Glial cells play a considerably important role in the pathophysiology of neurodegenerative diseases. However whether they protect the neurons or otherwise in Amyotrophic Lateral Sclerosis (ALS) remains to be elucidated. Previous studies conducted in our lab demonstrated reactive astrogliosis by concurrent increase in expression of GFAP and S100Ξ΂ and reduced expression of glutamate transporter-1 in the animal and cellular models of Sporadic ALS (SALS). Proteomic analysis of the ALS-CSF revealed more than 10 fold up-regulation of chitotriosidase a protein of microglial origin. Therefore investigating the glial responses in ALS is physiologically and therapeutically relevant. Purpose: To determine the role of astrocytes and microglia in SALS by investigating the expression patterns of trophic factors inflammatory mediators and activation markers. Methods: Expression of Vascular endothelial growth factor (VEGF) glial cell line derived growth factor (GDNF) interleukin-6 (IL-6) tumor necrosis factor alpha (TNFΞ΁) prostaglandin E2 (PGE2) and cyclooxygenase2 (COX2) was studied using double labeling immunocytochemistry with confocal microscopy in primary astroglial and microglial cultures exposed to 10% v/v ALS-CSF. Results: An increase in TNF-Ξ΁ and IL6 expression was observed after astroglial cultures were exposed to ALS-CSF as compared to the controls indicating inflammatory responses. Up-regulation of PGE2 and COX2 levels in both astroglial and microglial cultures further confirms the phenomenon. Down regulated expression of growth factors VEGF and GDNF suggests loss of trophic support. Conclusion: The loss of trophic support from glia may cause exacerbation of the disease pathology. Simultaneously activation of astroglia and microglia marked by the release of inflammatory markers like PGE2 and cytokines emphasize the role of glia as aggravators of neuronal degeneration and disease progression specifically mediated via neuroinflammation.

159

Session: Eposter NM 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Brand related adverse effects with immunoglobulins

Rahul Namburi, Rahul Namburi, U. Meenakshisundaram,

C. U. Velmurugendran, V. Shankar, P. R. Prabash

Department of Neurology Sri Ramachandra Universit, Chennai

Background: Therapy with intravenous immunoglobulin preparations has been used effectively in a wide range of conditions. Although generally well tolerated intravenous immunoglobulin preparations may be associated with transient hypotension in some patients. Results from the hemodynamic studies(Kroez M etal 2003) indicated that immunoglobulin G dimers in polyclonal immunoglobulin G are responsible for the hypotensive events associated with some immunoglobulin preparations. Aim: To study the adverse effects like hypotension caused by different intravenous immunoglobulin preparations. Materials and methods: A retrospective analysis of 53 patients admitted at Sri Ramachandra Hospital in neurology department with symptoms of weakness of limbs preceded by fever diarrhoea were evaluated by thorough history clinical examination and by doing nerve conduction studies and patients who did not have hypotension and cardiac diseases earlier were included. Results: Out of 53 patients who were diagnosed as AIDP from 2011 to 2014with an age group of 11-75yrs 34 of them received intravenous immunoglobulin therapy. 22 of them received Brand A drug out of which 17 were Male and 5 were Female12 Patients received Brand B drug. Out of 22 patients who received brand A drug 8 patients had hypotension(36.3%) within 5 Days of immunoglobulin administration and patients who received Brand B drug did not have hypotension. Conclusion: The clinician should be aware of different intravenous immunoglobulin preparations available containing G dimers as this can produce a fall in blood pressure which may endanger life.

219

Session: Eposter NM 1.6

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Spinal cord and radicular involvement in patients of tuberculous meningitis predictors and prognostic factors

Rahul Gupta, Dr. R. K. Garg Dm Neurlogy,

Dr. H. S. Malhotra DM Neurology, Dr. R. Verma DM Neurology, Dr. P. K. Sharma DM Neurology, Dr. Ragini Singh MD Radiology

Senior Resident Department of Neurology, Lucknow.

Background: Spinal cord and nerve root involvement secondary to tuberculous meningitis (TBM) is inadequately studied so far. Objective: To study the myeloradicular involvement predictors and prognostic factors in patients with TBM. Material and Methods: In this prospective study 71 consecutive patients of newly diagnosed TBM were evaluated. MRI of the brain and spine with contrast were done in all patients. Anti- tuberculous treatment was given for 9 months with supplemental corticosteroid in the initial phase. Patients were followed for a minimum of 6 months. Results: Out of 71 patients 33 (46.5%) patients had clinical symptoms of myeloradiculopathy while 41 (57.7%) patients had radiological findings of myeloradiculopathy (excluding vertebral tuberculosis). The most common site of involvement was lumbosacral region (32.4%) followed by thoraco-lumbar (9.9%) thoracic (8.5%) cervical (4.2%) cervico-thoracic (1.4%) and cervico-thoraco-lumabar region (1.4%). Spinal meningeal enhancement was present in 40 (56.3%) patients lumbosacral arachnoiditis in 32.4% myelitis in 22.5% tuberculoma in 5.6% CSF loculaton in 5.6% cord atrophy in 4.2% and syrinx in 2.8% patients. The most common pattern in lumbosacral arahnoiditis was peripheral clumping of nerve roots. Univariate analysis showed raised CSF protein as a significant predictor of myeloradiculopathy (p=.028) which in turn had significant impact over the outcome (p=.046). On multivariate analysis hemiparesis was found to be significantly associated with poor outcome (p=.025). Conclusion: Myeloradiculopathy is frequently observed in patients of TBM. Raised CSF protein is an important predictor of its development. The patients of TBM who develop myeloradiculopathy have poor outcome.

17

Session: Eposter NM 2.1

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Audit of referrals of 701 patients of nerve conduction and electromyographic studies in a tertiary care teaching centre

O. P. Lekhra

Sri Aurobindo Medical College & PG Institute, Indore.

Background: Unlike other medical investigations nerve conduction and electromyographic studies are an extension of the neurological clinical examination. Aim: Audit of referrals of nerve conduction and electromyographic studies with regard to the appropriateness of the referral diagnosis. Methods: Retrospective data of 701 patients (2007-2010) was obtained from referral slips and the reports generated in the computerised data base of the neurophysiology laboratory of a tertiary care teaching hospital situated in semi urban setup in Central India. The data was entered in the excel sheet on certain predefined criteria's. After the electrodiagnosis the patients were grouped as confirmed classified or changed according to the contribution of the electrodiagnosis toward the diagnosis. Results: A total of 701 patients underwent the nerve conduction studies. The average duration presentation of patients was 8.5 months. The referral request came mostly from neurologist (65%). Brief clinical notes were not present in 47% of referral slips. No referral diagnosis or query was mentioned in 46% cases. Neuropathy was the commonest diagnosis after electrodiagnosis in 61% cases. Electromyographic studies were done in 194 cases but were normal in 72 cases. Overall electrophysiological tests were normal in 225 and abnormal in 476. Electrodiagnosis overall changed the initial diagnosis in 236 reclassified in 333 cases and confirmed in 132 cases. Conclusion: We found inappropriate practices in referral of patients for electro diagnosis. A proper referral slip should have a brief history and the mention query to be answered by the electrodiagnosis. This will lead to more meaningful use of NCS/EMG studies.

27

Session: Eposter NM 2.2

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

A case series of patients with bulbar onset ALS

Dr. Prasanth. S. R, Dr. Shaji. C. V, Dr. Ram Mohan, Dr. Roopchand, Dr. Shyma, Dr. Parvathy

Senior Resident Neurologytd Medical College Alap, Alappuzha.

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with a high degree of prognostic variablity in its subtypes. Bulbar-onset ALS patients have a shorter survival and higher morbidity than others. The clinical profile of 12 patients with bulbar onset ALS is reported here. Methods: All patients presenting with bulbar onset of ALS during the period September 2012 April 2014 were included. Data including age and gender distributionplace of dwellingpresenting symptomstime to onset of limb weakness and complications were collected. Needle EMG and nerve conduction studies were done in all patients. MR Imaging of cervical cordbrain and base of skull was also done. Results: Out of 15 patients with ALS 12 (80%)had bulbar onset ALS.66.6%(8/12) of subjects were males 41%(5/12) were in age group 60-70yrs. The mean age at symptom onset was 62 years. Presenting symptom was dysarthria in all patients and 4 had choking spells. The time interval to symptomatic progression beyond the bulbar region ranged from 3 months to 9 months. The median interval from onset to anarthria(which occurred in 5 patients) was 11 months. Seven patients (58.3%) had home in coastal areas with high background radiation. Two patients died during the study period due to aspiration pneumonia. Conclusions: The proportion of bulbar onset ALS was higher(80%)in our series. The role of specific geographical characteristics including high background radiation in the coastal regions in the causation needs to be investigated.

39

Session: Eposter NM 2.3

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Congenital myesthenia gravis: A case report of three siblings affected in a family

Dr. Nilesh Babasaheb Nagargoje, Dr. Sangeeta H. Ravat,

Dr. Ashvinikumar Patil, Dr. Neeraj Jain

Resident 2ND Year DM Neurology Seth GS Medical, Latur.

Background and Objectives: Congenital myesthenic syndromes are a group of heterogenous disorders affecting the neuromuscular transmission. They are classified on the basis of electrophysiological and ultrastructural analysis of neuromuscular junction. No reliable information about prevalence of congenital myesthenic syndromes in India is available. The incidence in European countries is 1 in 500000 live births. Patients are symptomatic at birth or present at adolescence or adulthood. Appropriate diagnosis is important as many of these syndromes are treatable with drugs. Our objective is to present a case report of three siblings affected with congenital myesthenic syndrome in a family and to briefly review the literature. Case: An 18 year female born of non-consanguineous marriage presented with fluctuating drooping of both eyelids and proximal weakness in both upper and lower limbs since 2 years of age. She had 6 other siblings. 2 of them were also affected similarly. Parents were unaffected. The inheritance was consistent with autosomal recessive pattern. All of them had fatiguable ptosisophthalmoparesishypertelorism and fatiguable limb weakness. The Repetitive nerve stimulation test showed decremental response in all. Acetylcholine receptor antibodies were absent. CT chest was not showing thymoma. They noted significant improvement after starting oral pyridostigmine. Conclusion: After searching the literature no such case reports of congenital myesthenic syndrome with siblings affected and normal parents were found in India. These cases are presented for their rarity and difficulty encountered in its diagnosis

65

Session: Eposter NM 2.4

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Hereditary inclusion body myopathy (HIBM)

Dr. Vinny Wilson, Dr. Vivek Lal, Dr. Manoj Goyal,

Dr. Dheeraj Khurana, Dr. Parampreet, Dr. Manish Modi,

Dr. Sahil Mehta

Postgraduate Institute of Medical Education and Re, Chandigarh.

Background: Hereditary inclusion body myopathy (HIBM) continues to be under-recognized clinically despite a characteristic topography of weakness where quadriceps muscles are totally spared even though patient is wheelchair bound. We for the first time report six patients of HIBM from three families in North India who were diagnosed only when they were wheelchair bound. Methods and Results: Three patients from three different families were diagnosed to be suffering from HIBM in our institute. There was no history of consanguinity in any of the families. While one patient has two affected siblings one has one affected sibling and in one patient family history is non contributory. Two of the siblings were examined personally and confirmed clinically to be suffering from HIBM. All the cases were misdiagnosed elsewhere and had received steroids. Among the three index cases two were more than fifteen years into their illness and already wheelchair bound while the third one still ambulatory and symptomatic only for two years. Discussion: This is the first case report of occurrence of HIBM in North Indian population. Despite its unique clinical presentation HIBM is frequently misdiagnosed resulting in unnecessary diagnostic and therapeutic interventions. A high index of suspicion of this rare myopathy along with proper clinical examination may go a long way in management of these patients.

68

Session: Eposter NM 2.5

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Four cases of classical Hirayama disease with different stages of evolution

Dr. Rajesh Venkat Indala, Dr. Venkatesan Nagarajan, Dr. K. Muthuraj, Dr. S. Sundar, Dr. Kamaksi shanbhogue

SRM University Kattankulathur Chennai, Chennai.


Hirayama disease is characterized by progressive muscle wasting and weakness of the distal upper limb especially small muscles of hand(s) predominantly in young males followed by spontaneous arrest within several years. It was thought to be due to short dura (compared to bony vertebrae) which detaches from its posterior attachment and compresses the cord during every neck flexion leading to minor ischemic damage to anterior horn cells. During progressive stage of the disease application of a cervical collar to restrict neck flexion may minimize the ischemic insult and arrest progression of the disease. Four young male patients presented with painless unilateral wasting and weakness of hand and forearm without involvement of other limbs. MRI shows focal atrophy of cervical cord and extended flexion study reveals detached posterior dura compressing the cord with an enhancing posterior epidural mass confirming the diagnosis of Hirayama's disease. Nerve conduction studies shows predominant ulnar motor involvement compared to median nerve and electromyography showing denervation of lower cervical segment supplementing the diagnosis. Cervical collar is given to arrest the progression if there is any. Key words: Hirayama disease Oblique amyotrophy Monomelic Amyotrophy cold paresis Benign focal amyotrophy flexion myelopathy

180

Session: Eposter NM 2.6

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Case report on immunological association of neuromyotonia abstract

Karthikeyan, Karthikeyan, U. Meenakshisundaram,

C. U. Velmurugendran, V. Shankar, P. R. Prabash

Department of Neurology Sri Ramachandra University, Chennai.

Background: Neuromyotonia is a syndrome of spontaneously occurring muscle activity of peripheral nerve origin which can be triggered by voluntary or induced muscle contraction. It is one among several causes of visible myokymia. The abnormal activity is characterised electromyographically by doublet triplet continuous muscle fiber activity. Clinical evidence suggesting of possible autoimmune etiology. It is often associated with antibodies to voltage gated potassium channels. We report four patient meeting this criteria. Materials and Methods: This is a case series where the causes clinical features blood investigations CPK EMG anti voltage gated potassium channels. Antibody and treatment given has been documented. Results: All the four patients were male. Our cases includes age group of twenty to fifty two years. Stiffness cramps and undulating myokymia were the presenting features. One patient had insomnia and significant weight loss. EMG showed continuous muscle fiber activity. Anti voltage gated potassium channels antibody positive in all four patients. Curiously three patients have taken ayurveda treatment for various complaints. We treated with high dose of methyl prednisolone with significant amelioration of complaints. Conclusion: we observed four patient were positive to anti voltage gated potassium channel antibody suggestive of auto immune etiology and they improved with steroid therapy.

253

Session: Eposter NM 2.7

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Deep tendon reflexes as a clinical clue in lower motor neuron disorders: A study of 125 patients

Dr. Sachin S Bangar, Dr. Sachin S Bangar, Dr. Rakhil Yadav,

Dr. Satish V. Khadilkar

Grant Medical College and Sir J J Group of hospita, Mumbai.

Background: Deep tendon reflexes form an integral part of evaluation of the lower motor neuron diseases. The widely held belief that reflexes are preserved in myogenic disorders and lost out of proportion in neurogenic conditions has not been systematically studied. Aims and Objectives: To study the patterns of reflex changes in hereditary and acquired disorder of muscles nerves and anterior horn cells. Material and Methods: Five groups of 25 patients each [Duchene muscular dystrophy acquired myopathies spinal muscular atrophy acquired neuropathies and hereditary motor sensory neuropathies] were studied for reflex changes in relation to severity of muscle weakness in segments sub serving the reflexes. Results and Conclusions: Contrary to the conventional belief patients with inherited myopathies had upper limb areflexia in strong muscles while ankle reflex was maintained till advanced stages. Reflexes were much better preserved in acquired myopathies. Amongst neurogenic conditions reflex changes in patients with hereditary and acquired neuropathies were lost out of proportion to weakness while this is not true for anterior horn cell diseases.

70

Session: Eposter others 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Clinical profile evaluation management and visual outcome of idiopathic intracranial hypertension

Dr. Rajesh A, Dr. Agadi J. B., Dr. Praveen Kumar S,

Dr. Archana B. Netto, Dr. Karthik N

Bangalore Medical College and Research Institute, Bangalore.

Aim: To discuss the clinical features and management of patients who presented with optic disc edema and had features of idiopathic intracranial hypertension (IIH). Materials and Methods: 15 patients diagnosed to have IIH (who fulfilled modified Dandy's criteria) from January 2013 to June 2014 were clinically analyzed and followed up. Results: Most (13) of the patients were females and the mean age of presentation was 34.2 Years in adults & 13 years (1 case) in pediatric age group. Chief complaints were headache in 14 patients7 patients had transient visual obscuration 2 patients had reduced vision 2 patients had nausea vomiting and one patient had pulsatile tinnitus. Bilateral disc edema was seen in 15 patients (100%) & had enlarged blind spot as the common visual field defect. Neuroimaging revealed empty sella in three patients tortuous optic nerves in one patient. CSF opening pressure ranged between 270 to 530 mm H2O. Medical treatment was started for all patients and responded well. Follow up of these patients showed excellent recovery & normalization of field defect. None of them required surgical intervention. Conclusion: Majority of patients of IIH have bilateral papilloedema and enlarged blind spot. If detected early and treated promptly most of them show excellent recovery and surgical treatment could be avoided.

96

Session: Eposter others 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Delayed post-hypoxic encephalopathy: A prognostic dilemma

Meenakshi-Sundaram S, Meenakshi-Sundaram S, Karthik SN, Suresh P, Muthukani S, Thavamurugan R, Bharathi Sundar

Department of Neurosciences Apollo Speciality Hos, Madurai.

Background: Patients who improve from a hypoxic brain insult may deteriorate subsequently due to a rare but clinically important event described as delayed post-hypoxic encephalopathy. Aim: To describe the clinical profile of delayed post-hypoxic encephalopathy. Methods: Three patients with hypoxic brain insult and who subsequently had delayed deterioration due to this syndrome were studied at this center in south India. Results: All three patients had several similar features viz. a clinically definite hypoxic cerebral insult an initial encephalopathy characterized by altered sensorium attributable to the hypoxic event improvement in sensorium thereafter but followed by worsening in the level of sensorium with this deterioration being attributable to no other cause. The reasons for hypoxic insults were (a) intravenous self-administration of succinyl-choline in an attempt to commit suicide (b) anesthetic drug accident and (c) status epilepticus. These patients experienced the 2nd deterioration within 24 to 48 hours which was contrary to existing reports of such deterioration occurring after 7 to 21 days. The leucoencephalopathy otherwise known to occur were conspicuously absent in our patients; rather basal ganglionic and cortical laminar necrosis were the changes seen on cranial MRI. Further these patients had long-term motor and cognitive deficits. In all three patients a good prognosis was predicted by the treating team when the patients initially improved followed by an embarrassment when the patients deteriorated when the prognostic prediction had to be altered. Conclusions: Reporting of such occurrence may expand the existing spectra of delayed post-hypoxic leucoencephalopathy. Delayed post-hypoxic encephalopathy can often create significant prognostic dilemma in the ICU.

220

Session: Eposter others 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Definite tuberculous meningitis incidence predictors and prognostic impact

Dr. Sneh Kumar Jha, Dr. R. K. Garg DM Neurology,

Dr. H. S. Malhotra DM Neurology, Dr. R. Verma DM Neurology, Dr. P. K. Sharma DM Neurology, Dr. Amita Jain MD Microbiology

Senior Resident Department of Neurology, Lucknow.

Background: Tuberculous meningitis (TBM) is one of the most common causes of chronic meningitis in India. Present study was done to evaluate the incidence predictors and prognostic impact of definite TBM. Aim and Objectives: This study was done to see the predictors of definite TBM and its impact on outcome. Material and Methods: In this prospective observational study 118 cases of TBM were analyzed in detail by clinical laboratory (cerebrospinal fluid microscopy culture and polymerase chain reaction) and radiological parameters. Antituberculous drugs as per World Health Organization guidelines and supplemental dexamethasone formed the treatment protocol. The patients were followed for a minimum of 6 months. Results: Among 118 patients 43(36%) were in definite group. PCR was positive in 42 ZN staining in 3 and culture in 1 patient. On univariate analysis significant predictors of definite TBM were modified barthel index (MBI) score <12 at presentation (p=0.008) CSF total cell count >100 pcmm(p=0.010) and basal exudates on imaging (p=0.015). Mortality and disability was significantly greater in definite TBM on univariate analysis (p=0.001). Multivariate analysis done by binary logistic regression showed CSF protein >2.5 gm/L CSF total cells >100pcmm baseline MBI <12 positive TB PCR and altered sensorium on presentation were independently associated with poor outcome in all cases of TBM. Conclusion: The incidence of definite TBM was 36% among all cases of TBM. Severe disability at presentation CSF cells >100 pcmm and basal exudates on imaging were significant predictors of definite TBM and had adverse impact on prognosis.

5

Session: Eposter others 1.3

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

The clinical and radiological spectrum of posterior reversible encephalopathy syndrome (PRES): Case series of 20 patients from a tertiary hospital.

E. Prasanna Venkatesan, Dr. K. Ramadoss, Dr. Anish Ninan,

Dr. R. Balakrishnan, Dr. G. Gnanashanmugham

PSG IMSR, Salem.

Background and Purpose: PRES is an acute neuroradiological diagnosis due to breakdown in cerebrovascular regulation. The purpose of this study is to review the clinical and neuroimaging findings in patients diagnosed with PRES and with a special reference to its atypical features. Methods: We included all patients admitted in department of neurology with PRES from January 2013 to April 2014 in PSG IMSR hospital Coimbatore. All cases were evaluated with MRI. Results: 20 patients were included with a mean age of 28.5. The clinical presentation included headache (80%) generalized seizures (75%) altered sensorium (70%) cortical blindness (30%) and focal neurological deficit (10%). Among 20 cases 11 had postpartum eclampsia and 2 had pre eclampsia (65%). 5 patients had renal failure related causes like uremia acute glomerulonephritis and chronic kidney disease. There was 1 case with SLE on cyclosporine and 1 case of HIV on indigenous medicines. Acute BP elevation was seen in 80% of cases. Interestingly 92% of eclampsia had elevated BP whereas only 56% of PRES due other cause like renal failure had elevated BP. Complete reversibility was seen in 80% of cases. But SLE patient and 3 renal failure patients did not recover completely. MRI showed bilateral occipitoparietal involvement in 100% bifrontal involvement in 50% cerebellar involvement in 35% and basal ganglia involvement in 10%. Atypical MRI features like bifrontal involvement and diffusion restriction was seen in nearly half the cases. Conclusion: Triad of headache GTCS and altered sensorium is seen in >75% of cases. Acute BP elevation is not seen in all cases and is more likely to be associated with eclampsia than other causes. Atypical MRI features like frontal and cerebellar involvement can be seen in nearly half the cases.

100

Session: Eposter others 1.4

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Influence of hydrotherapy on Clinical and Cardiac autonomic function in migraine patients

TN Sathyaprabha, Sujan M. U, Abhishek H. A, Raghavendra Rao M, Ravikiran Kisan, Nalini A, T. R. Raju

National Institute of Mental Health & Neuroscience, Bangalore.

Background: Migraine is associated with varied clinical manifestations including autonomic symptoms due to increased vascular tone and vasogenic constriction. The growing body of literature suggests that dysfunctional autonomic nervous system may play pivotal role in the pathogenesis of migraine. Thermal therapies have been hypothesized to modulate these changes and alleviate pain. However data regarding the efficacy of hydrotherapy in migraine remains scant. We evaluated the effect of a hydrotherapy procedure (a hot arm and foot bath with ice massage to head) as an add on therapy in management of migraine. Methods: Forty chronic migraine patients fulfilling the International Classification of Headache Disorders (ICHD) II criteria were recruited from the neurology outpatient clinic. Patients were randomized to receive either hydrotherapy plus conventional pharmacological care (n=20) or conventional medication only (n=20). Hydrotherapy group received treatment with hot arm and foot bath (103oF to 110oF) and ice massage to head daily for 20 minutes for 45days. Patients were assessed using headache impact test (HIT) visual analogue scale (VAS) for pain and cardiac autonomic function by heart rate variability (HRV) before and after intervention period. Results: There was a significant decrease in HIT score headache frequency and intensity of headaches following treatment in both the groups. However it was more evident in add on hydrotherapy group compared to pharmacological treatment alone group. There was also significant improvement in HRV parameters. In particular there was significant decrease in heart rate (p<0.017) significant increase in High frequency (HF) (p<0.014) significant difference in Low frequency/high frequency ratio (LF/HF)(p = 0.004) in add on hydrotherapy group. Conclusion: Our study shows that hydrotherapy as an add on treatment enhanced the vagal tone in addition to reducing the frequency and intensity of headaches.

107

Session: Eposter others 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Clinical electrophysiological and radiological evaluation of monomelic amyotrophy attending tertiary care center of odisha

Dr. Maheswar Samanta, Prof. A. K. Mallick, Prof. Geeta Mohanty, Dr. K. P. Swain, Dr. Biswajyoti Ratha, Dr. S. Sahu, Dr. N. Biswal

DM Student Neurology, Cuttack.

Aim of Study: To study age of onset family h/o pattern of involvement progression associated Tremor or autonomic symptoms Fasciculation EMG of muscles MRI Spine in monomelic Amyotrophy. Key words: Monomelic amyotrophy (MMA)NCS(Nerve conduction study)U/L (unilateral)Material&Methods:70 cases ofMMAattending O. P. Dor admitted from January 2011- Aug.2013 are enrolled. Inclusion: Adolescents or adults with progressive atrophy involving unilateral/ asymmetrical limbs for at least 6month duration without sensory/ bladder/structural lesion on MRI spine. Exclusion: History of poliomyelitis significant trauma to spine or extremities toxins exposure vaccination in past six months signs of pyramidal/extra pyramidal/sensory involvement/abnormal NCS other than reduced amplitude or abnormal spine MRI. Statistical Analysis done by percentage& chi square test with P-value. Result: Out of 70 cases analysed Mean age of onset was 22.56 yrs (14-39yrs) 100% are males. UL involvement -64pts(~91%)(U/L UL - ~72% B/L UL asymmetrical involvement -18.46%.) LL (always U/L) - 6pts. (~9%) with 3 cases (~4%) familial. Affected limb areflexia 48 pt(68%) &contralateral 22(~31%) with exaggerated reflex in 6cases(~9%). Tremor(minipolymyoclonus)present in 43pts.(~61%) in affected hand & 28(~40%) contralateral. Fasciculationseen inaffected limb 8cases(~11% ). Average duration of progression in MMA found to be 1-3yrs. All affected muscles showed reduced CMAP with normal sensory NCS. EMG shows chronic neurogenic changes in all affected limb&12 cases(17%) contralateral. spinal cord MRI In all patients shows no changes. Conclusion: MMA should be considered in any case of one Limb or asymmetrical Homologous limb atrophy in young adults with areflexia.

144

Session: Eposter others 1.6

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Electromyography during thyroid surgery: techniques and value of recurrent laryngeal nerve monitoring using a dynamic mapping approach

Parthasarathy D Thirumala, Cheran Elangovan MBBS, Supriya Palwinder Singh MBBS, Paul Gardner MD,

Carl Snyderman MD, Elizabeth Tyler-Kabara MD,

Miguel Habeych MDMPH, Donald Crammond PhD,

Jeffrey Balzer PhD, Parthasarathy D. Thirumala MD MS

Department of Neurological Surgery University of, Pittsburgh.

Objective: Thyroid resection is a common procedure used to treat a variety of pathologies in and around the gland. Iatrogenic injury to recurrent laryngeal nerve(RLN) during thyroid resection has been reported to be as high as 6%. RLN injury has been a major reason for malpractice litigations involving thyroid surgeries. We investigated the usefulness of an algorithmic approach to RLNmapping to reduce the incidence of palsy and the usefulness of free-run electromyography(f-EMG) as an additional measure. Methods: Data from 250 patients undergoing free-runEMG (f-EMG) and stimulus-triggered-EMG(t-EMG) monitoring of the RLN during thyroid surgery were retrospectively reviewed. EMG was recorded in all cases using a two-channel DragonflyΒ; stick-on electrode adhered to the endotracheal tube prior to intubation. Stimulation was achieved using a hand-held monopolar stimulator. Results: 245 patients had no change in their RLN function after surgery nor did they show a significant change in pre and post-resection stimulation intensities. RLN was identified before during and after resection in all 245 patients. In the remaining 5 patients all awoke with clinical deficits 3 were temporary and 2 were permanent (both transections - 1 intentional 1 unintentional). Conclusions: When RLN EMG monitoring is implemented as a mapping technique as is performed in acoustic neuroma surgery for identification of the facial nerve rather than a passive wait and see procedure utilizing only or primarily free-run EMG there appears to be a significant reduction in permanent RLN palsies. Moreover relying only or primarily on free-run or spontaneous EMG discharges can lead to false-negative results.

151

Session: Eposter others 1.7

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Clinical spectrum and predictors of quality of life in chronic daily headache at a tertiary care center

Dr. Kiran Bala, Dr. Vachan Mehta, Dr. Hardeep Malhotra

Pt BD Sharma Pgims Rohtak, Delhi.

Aim: The study was done to assess the types of primary headaches culminating into chronic daily headache (CDH) and to find the predictors of QOL in these patients. Introduction: Primary headaches culminating into CDH afflict 4% to 5% of the general population and significantly affect QOL. Methodology: 100 adult patients with primary headache and 100 controls were studied. Disability was assessed using MIDAS and HIT -6 Hindi versions psychiatric and behavioral abnormalities by BDI (Beck Depression Inventory) and NPI-Q (Neuropsychiatric Inventory Questionnaire). Quality of life was assessed using SF-36 v2 health survey. Results: Most common type of primary chronic daily headache was Chronic migraine CM (57%) followed by chronic tension type headache (CTTH) (39%) and new daily persistent headache (4% ) Most common age group affected was 18-40 years (71%) with Female: male ratio 8.3:1.7. Significant impairment of all QOL scales of SF-36 v2 Health survey was noted.(P <.001). Worst affected was Role emotional (RE) mean 27.75 and least affected was vitality (VT) with mean of 40.42. No significant difference noted in Quality of life of CM vs. CTTH subjects. HIT-6 scoring showed severe disability (77% had score of 59-78) and 78.9% patients of Chronic migraine had severe disability on MIDAS. Psychiatric co-morbidity noted were: moderate depression(47%)mild to moderate anxiety(49%) mild irritability (53%) mild aggression (17%)mild to moderate apathy(33%)appetite and eating disorder (28%). Conclusion: 1. CM and CTTH are common types of CDH affecting females> males (8.3:1.7) in age group of 18-40yrs.2. QOL is significantly affected in patients with CDH (p<.001) both in CM and CTTH 3. Psychiatric co- morbidity is common in patients with CDH.

211

Session: Eposter others 1.8

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Headache in tuberculous meningitis: Predictors and outcome

Dr. Sanjeev Kimar, Prof. Rajesh Verma, Prof. Ravindra Kumar Garg, Dr. Hardeep Singh Malhotra

Senior Resident, Lucknow.

Background: Headache is one of the commonest symptoms of tuberculous meningitis (TBM). In this study we evaluated the severity of headache its predictive factors and impact on outcome. Material and Methods: In this prospective observational study 95 patients of TBM underwent detailed clinical laboratory and neuroimaging evaluation. Severity of headache was based on numeric rating scale. Headache was reassessed at 13 and 6 month follow up. Patients treated with world health organization antituberculous regimen. Results: Out of 95 patients of TBM we found that headache was mild moderate severe and intolerable in 22(23.16%) 22 (23.16%)35(36.84%) and 16(16.84%) patients respectively. On univariate analysis holocranial throbbing type headache (p=0.002) modified barthel index <12 (p=0.000) diplopia (p=0.055) seizures (p=0.000) visual impairment (p=0.024) cranial nerve palsy (p=0.002) meningeal signs (p=0.016) definite cases of TBM (p=0.001) and CSF protein > 2.5 g/l (p=0.000) were associated with severity of headache. Neuroradiological features significantly associated with severity of headache were meningeal enhancement (p=0.015) basal exudates (p=0.000) and hydrocephalus (p=0.003). On binary logistic regression analysis seizure chest x-ray CSF protein >2.5g/L and basal exudates were significant predictors of headache severity. Out of 15 patients who died 11(68.75%) had intolerable headache at admission. Conclusion: CSF protein >2.5g/L cranial nerve palsy paraparesis and infarct were significant predictors of poor outcome in-patient of severe and intolerable headache.

8

Session: eposter others 2.1

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Clinical laboratory findings and complications of scrub typhus- meningoencephalitis: Case series

E. Prasanna Venkatesan, E. Prasanna Venkatesan, S. K. C. Eswaradass

Appusami Hospital, Salem.

Background: Scrub typhus is an acute febrile illness caused by  Orientia tsutsugamushi Scientific Name Search shi a gram negative cocco bacillus transmitted by larval mites. The aim of this study is to analyze the clinical manifestations laboratory data and complications of scrub typhus meningoencephalitis. Patients and Methods: We included 15 patients who were admitted in Appusami Hospital Salem between September to December 2013. The WeilFelix test of >1:80 titer was taken as positive after ruling out malaria dengue leptospirosis bacterial viral and TB meningitis. Results: The mean age of study group was 42. There were 8 male and 7 female patients. A triad of fever altered sensorium and meningeal signs were present in 100% of cases. Headache and myalgia and seizures were seen in 86% 93% and 66.6% respectively. 2 patients had hemiparesis and eschar was seen in only 3 cases. The most common lab abnormalities were elevated liver enzymes (46%) renal failure (26%) and thrombocytopenia (13%). CSF was abnormal in all cases with protein elevation (66.6%) lymphocytic pleocytosis (100%) and hypoglycorrhachia (40%). WeilFelix test was strongly positive with >160 in 86% of cases. 4 patients developed ARDS and required ventilator support for 1 week. All cases showed excellent response to doxycycline and recovered without any deficits. Conclusion: Scrub typhus is often underdiagnosed in India due to non-specific clinical features and lack of diagnostic facilities. Meningoencephalitis with altered LFT should rise suspicion for scrub typhus especially after ruling out TBM. Eschar may give a clue to diagnosis but it is present in only 20-30% and usually goes unnoticed in dark skinned people. It can mimic TB meningitis and starting ATT can worsen liver function. Early diagnosis and treatment with tetracycline is necessary to prevent life threatening complications.

33

Session: Eposter others 2.2

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Scrub typhus meningitis: A retrospective study from South India

Ashraf V. V, Praveen Kumar R, Girija A. S, Saifudheen K, Sreekala C, Sohanlal T

Department of Neurology Malabar Institute of Medi, Kozhikode.


Scrub typhus is prevalent in India although definite statistics are not available. Central nervous system involvement in the form of meningitis or meningoencephalitis is common in scrub typhus. As specific laboratory tests remain inadequate or inaccessible prompt diagnosis is often difficult. Aim: To identify the clinical and laboratory parameters that may help in differentiating scrub typhus meningitis from other meningitis. Methods: A retrospective analysis of clinical and laboratory features of patients admitted in our center with scrub typhus meningitis over a period of 2 years was done. Diagnosis was by a positive scrub typhus IgM ELISA and abnormal cerebro spinal fluid (CSF) analysis in a patient with febrile illness. Results: Ninety three patients with scrub typhus were admitted during the study period and 21 had meningitis. There were 11 males and 10 females. Median age was 37 years (range 5 to 79 years). All patients had fever headache with mean duration of 10 days. Eschar was seen only in 3 patients. Seizures and transient encephalopathy was seen in 7 patients and papilledema was detected in 4. Mean CSF protein CSF glucose/blood glucose CSF cell count lymphocyte percentage were 105 mg/dl 0.65 144 cells/cmm 95 % lymphocytes respectively. Neuroimaging was unremarkable in 20 patients and one had a parieto occipital signal changes. All patients had elevated liver enzymes. All had received doxycycline and all recovered without any sequelae. Conclusions: Meningitis in scrub typhus is mild with quick complete recovery. Clinical features and CSF findings can mimic tuberculous meningitis except for almost normal CSF sugar and elevated liver enzymes. In the Indian context where both scrub typhus and tuberculosis are endemic scrub typhus serology may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.

46

Session: Eposter others 2.3

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Is Lathyrus staivus still an important pulse for some?

Vijaya Nath Mishra

Banaras Hindu University, Varanasi.


Lathyrus sativus have been recognized as neurotoxin containing pulse whose ingestion have been linked to result in spastic paresis. In the present study author have studied 20 districts of Uttar Pradesh and Bihar of which 1200 subjects were enquired to find out the knowledge about the L.sativus related neurotoxicity and to find out its current use as pulses in the meal.83% population knew that L.sativus is neurotoxic however we came to know 98 subjects from 18 families who are almost dependent on L.sativus for their pulse intake. These individuals have their own choice and reasons to use L. Sativus as primary pulse apart from poverty. Some interesting observations were also reported in the study. It was concluded that not only the L.sativus intake is responsible for Spastic paraparesis but other factors may also be present.

60

Session: Eposter others 2.4

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Etiological profile of cavernous sinus syndrome (CSS) in a tertiary care centre in India

Sanat Ramchandra Bhatkar, Dr. Manoj Goyal, Dr. Manish Modi, Professor K. K. Mukherjee, Prof. Paramjeet Singh, Pro. Vivek Lal

Postgraduate Institute of Medical Education and Re, Chandigarh.

Introduction: CSS is one the commonest causes of painful ophthalmoplegia worldwide common causes of which include bacterial or fungal infections non-infectious inflammation vascular lesions and neoplasms. There is paucity of data regarding the etiologic profile of CSS in Indian population which is supposed to be different from Western world due to high prevalence of infections in Indian population. Objective: To analyse the etiololgy of CSS in a North Indian tertiary care hospital. Materials & Methods: In an observational study all patients with CSS were included. Inclusion Criteria were involvement of 2 or more of the third fourth fifth (V1 V2) or sixth cranial nerves or involvement of only 1 of them + neuroimaging-confirmed cavernous sinus lesion. All patients were subjected to routine and specific investigations (CSF CEMRI Brain and biopsy etc.). The patients were accordingly subjected to medical or surgical treatment. Results: 24 patients have been enrolled in the study till now. 18 of these are males and 6 are females. Amongst causes the commonest aetiology was Tolosa Hunt Syndrome (THS) (26%) & Neoplasms (25%) mucormycosis (12.5%) and Hypertrophic Pachymeningitis (8.3%) Carcinomatous Meningitis Sarcoidosis and Bacterial causes (25%). Discussion and Conclusions: THS continues to be the commonest cause of CSS. Among the various aetiologies easily treatable ones constituted about 60%. Final results will be analysed and revealed in IAN.

86

Session: Eposter others 2.5

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Abnormal proximal MR Neurography in Hansen's neuritis Diabetic lumbosacral plexopathy and steroid responsive inflammatory brachial and lumbosacral plexopathy

Dr. Veeranna Gadad, Dr. A. Nalini, Dr. Chandrajit Prasad,

Dr. Jitender Saini

Departments of Neurology NIMHANS Karnataka, Bangalore.

Background: MR-neurography helps in understanding compressive / intrinsic neuropathies. Aims and Objectives: To describe the clinical and neurography features in proximal nerves in Hansen's neuritis Diabetic lumbosacral(LS) plexopathy and inflammatory brachial and LS plexopathy. Material and Methods: Contrast neurography was performed on 3Twith T2 STIR sequences of brachial and lumbosacral plexus. Results: Case1:28 year old man had progressive weakness patchy sensory loss and severe atrophy of right hand-4 mo asymmetrical foot drop-3mo hypoesthetic patches-3mo. Had MRC grade 1 power of right hand wrist. Grade 0 left foot drop. DTR's brisk. MRI(brachial plexus): Bilateral irregular thickening with STIR hyperintensity(HI) of roots trunks divisions cords left lumbosacral trunk L34 roots femoral nerve right L4L5 roots right ulnar nerve(UN) at elbow. STIR HI of left radial/UN. Enlarged left median nerve with abscess. Thenar hypothenar muscles had inflammation. Nerve biopsy-BT-TT. Case2: 23 years man noticed acute onset progressive severe right pectoral girdle(PecG) weakness after sleep 2.5months(mo) ago of arm-1.5mo. Acute and progressive left PecG weakness 1.5mo ago pelvic girdle(PelG)-1 month. Mild atrophy of scapular muscles and deltoid. MRC grade 2 at shoulders and arms. DTR's hypoactive in upper and hyperactive in lower limbs. MRI: Bilateral brachial plexus-diffusely thickened with hyperintensity. CSF protein 61gs Oligiclonal bands-positive. Case3:56 year diabetic man had progressive PelG and thigh weakness of 12 mo with severe pain and wheel chair bound state-6 mo. MRI-STIR-enhancement of cauda equina and enhancement of thickened lumbar plexus. Conclusions: High-resolution nerve imaging with extended anatomical coverage is feasible and improves the topographic description of lesion dispersion and is relevant for discrimination between focal/non-focal neuropathies.

146

Session: Eposter others 2.6

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Rare cause of occipital-temporal lobe seizures form-fruste of NF2 ?

Cheran Elangovan, Cheran Elangovan MBBS, Kathy Gardner MD, Amy Goldstein MD, Mandeep S. Tamber MD Phd

Pittsburgh.

Background: Neurofibromatosis type 2(NF2) is a rare genetic disorder(birth incidence 1/33000) characterized by the development of multiple benign tumors of the nervous system with wide variety of mutations in NF2 exons. The hallmark of NF2 is the development of bilateral vestibular schwannomas and possible additional meningiomas schwannomas ependymomas. The most common presentation is tinnitus and deafness(Evans et al1992; Parry et al1994). Report: We present a 14 year old girl who presented with increasing frequency of stereotypical seizure aura and headaches which started with seeing brightly coloured wheel followed by right homonymous hemianopia right leg numbness and blackouts. EEG showed multifocal spikes and amplitude suppression over left occipital region. Her audiology ophthalmology and skin exam were normal. Her MRI's showed 4.4X1.9x 2.7 cm cortically based enhancing tumor with multiple calcifications and internal septations in left occipital-parietal region and possible spinal root tumors at C6-C7 and C7-T1. There was no evidence for vestibular schwannomas. Surgical resection with electrocorticography monitoring was done and pathology report was consistent with meningiomatosis. Genome analysis showed a rare DNA variant in exon 2 of NF2 gene (c.215T>c; p. Val72Ala). MRI brain of asymptomatic mother at age 51 also showed evidence of enhancing meningioma 10.9x 9.4 x 13.9 cm lateral to the right inferior orbital fissure without vestibular schwannoma. Mother had normal eye exam including visual fields. To our knowledge NF2 presenting with meningiomatosis/meningioma in the absence other intracranial tumors has not been described in literature so far and could be a form-fruste versus atypical presentation of NF2.

156

Session: Eposter others 2.7

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Frontal lobe functions in Amyotrophic lateral sclerosis and its correlation with disease severity

Kuljeet Singh Anand, Prashant Kumar, Jyoti Garg

Department of Neurology PGIMER and Dr. RML Hospit, New Delhi.

Background: Assessment of frontal lobe function is important in ALS because of its overlap with the behavioral variant of frontotemporal dementia (FTD). FTD may develop in 10% of ALS suggesting similar neurodegenerative spectrum. Recent studies have shown frontal lobe dysfunction in 50% of ALS. AimTo assess frontal lobe function in ALS patients and it's correlation with disease severity. Material and Methods: Ten consecutive patients fulfilling Revised El-Escorial criteria for definite ALS were recruited for study. After recording demographic data and disease duration frontal assessment battery (FAB) was administered. For assessment of severity of the disease ALS Functional Rating Scale - Revised (ALSFRS-R) was used. After collection of data percentage of patients with poor FAB score calculated. FAB score was correlated with disease duration and severity. Results: Of ten patients (age 46-65 yrs; mean 54.8 yrs M: F ; 1:1) three (30%) cases were unable to complete FAB because of disability. All 3 also had difficulty in performing at least one additional FAB item. Of 7 who completed the FAB all had difficulty in performing at least one FAB item. Two (20%) had bulbar onset and eight (80%) had limb onset ALS. Duration of illness was 12-36 months (mean 17.6 months) at the time of assessment. In ALSFRS-R score five patients were illiterate without formal education so item adjusted score was calculated for all. As per ALSFRS-R score 3 patients had mild disability 5 moderate disability and 2 severe disability. On Pearson correlation no statistical significant direct correlation was found between severity of illness and FAB score. Conclusion: Present series showed frontal lobe dysfunction in all the cases and there was no correlation between FAB score and severity of illness.

93

Session: Eposter stroke 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Prevalence of patent foramen ovale in cryptogenic strokes of North Indian population

Dr. Gayathri, Dr. Dheeraj Khurana, Dr. Prabhakar, Dr. Ajay Bahl

Postgraduate Insttitute of Medical Education and r, Chandigarh.

Background: Cryptogenic strokes account for 30-40% of ischemic strokes paradoxical embolism secondary to patent foramen ovale(PFO) as a cause of cryptogenic stroke is important. Transcranial Doppler(TCD) with bubble contrast is a noninvasive bedside tool in the diagnosis of PFO with a high sensitivity and specificity. Data on the prevalence of PFO in cryptogenic stroke in India is lacking. Aims and Hypothesis: To determine the prevalence of Right to left shunt(RLS) with PFO in Cryptogenic Strokes of North Indian population by TCD with bubble contrastMethodsIn this hospital based prospective case control study TCD with bubble contrast with valsalva challenge was performed in 57 young cryptogenic strokes and 50 healthy controls who met the inclusion criteria for detection of PFO. Presence of HITS (High intensity transient signas) was considered as a positive test. Risk of Paradoxical embolism score (ROPE) score was applied to the population. Results: Right to left shunt was detected in 31% cryptogenic strokes vs 6% controls (p 0.001). Among cases 50% had mild 38.9% had moderate and 11.1% had severe grade of RLS. All patients with TCD positive for PFO showed superficial cortical infarcts. Minimum ROPE score of our population was 7 with no difference in the score between the two subgroups. Conclusions: TCD with bubble contrast is an excellent tool for the diagnosis of RLS in cryptogenic young strokes. North Indian cryptogenic strokes have a high prevalence of PFO as indicated by a RLS. This is the first report on prevalence of PFO in Indian population

232

Session: Eposter stroke 1.10

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Clinico-radiological profiles of lateral medullary (Wallenberg's) (LMS) syndrome patients from stroke unit of NIMHANS a tertiary care neurological hospital from Bangalore

Chakradhar N, Kulkarni Girish Baburao, Pawan Raj PI,

Kulkarni Advaith Prakash, Chandrajit Prasad, Mustare Veerendrakumar

NIMHANS, Banglore.

Introduction: Among the brainstem strokes lateral medullary syndrome (LMS) is the best recognized syndrome. There is paucity of literature from India regarding single center experience of this group of patients. Objective: To describe the Clinico-radiological profile of LMS patients. Materials and Methods: Retrospective study of 21 patients of LMS admitted to stroke ward of NIMHANS from 2006-14.. Results: There were 21 patients (M: F:: 19:2) mean age 39.1Β΁3.5 years onset to presentation being 3 days (median). Alcohol consumption (47.6%) smoking (38.1%) hypertension (23.8%) diabetes (23.8%) neck trauma/manipulation (9.5%) were the risk factors. Historically they presented with ataxia (95.2%) dysarthria (61.9%) dysphagia (57.1%) diplopia and hiccups (23.8%). Examination showed Horner's syndrome (85.7%) facial sensory loss (76.2%) absent gag (66.7%) contralateral sensory loss (66.7%). Elevated homocysteine and abnormal lipid profile were seen in 38.1% and 23.8% patients. CT scan was available in 68.2% and was normal in 55% showed cerebellar hypodensities in 45%. MRI brain showed medullary involvement in all cerebellar involvement (66.7 %.) thalamic involvement (9.5%). MR/CT Angio showed vertebral artery involvement in 81% (47% dissection 53% thrombosis) PICA -19 %(all thrombosed). They were treated with anticoagulants/anti platelets supportive measures. The out come was improvement in 17 patients (81%) no improvement in 3 patients (14.3%) and death in 1 patient (4.8%) (Myocardial infarction). Mean mRs at admission was 3.9Β΁1.1; at follow up (5.7Β΁6.2 months) was 1.9Β΁0.8. Conclusions: LMS affects predominantly young males vertebral artery being involved predominantly. MRI is better than CT for evaluation with majority improving with conservative treatment.

239

Session: Eposter stroke 1.11

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Neurologic manifestations in Hematological malignancies: A case series

Subramanian R, Gokula Krishnan H, Rama Krishnan V, Sarala G, Usha T, Bhanu K

Madras Institute of Neurology MMC Chennai, Chennai.

Introduction: Leukemias and Lymphomas represent a heterogenous group of Hematological malignancies that affect both Central nervous system and Peripheral nervous system. Neurologic manifestations may be due to (1) direct leukemic infiltration over (a) meninges as neoplastic meningitis (b)parenchyma as tumours (c) cranial nerve as palsies (2) coagulopathy and leukostasis (3) immune compromise either by disease per se or anti-leukemic treatment (4) paraneoplastic rarely. It may be the initial presentation. Case Presentation: we present a series of 9 cases with variety of neurologic manifestations viz. Pneumococcal meningitis as an initial manifestation of chronic lymphoid leukemia two cases of multiple cranial nerve palsies associated with numb chin syndrome in (a) plasma cell leukemia and (b) Non-Hodgkin's lymphoma 6 cases of acute myeloid leukemia of various types in FAB system with neurologic manifestations as Intracerebral hemorrhage thrombotic stroke myeloid sarcoma with compressive myelopathy polyradiculopathy peripheral neuropathy and cortical venous thrombosis. Conclusion: The neurological complications of Leukemias and Lymphomas are multifold. The Neurologist must be familiar in these aspect to optimize patient care.

297

Session: Eposter stroke 1.12

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

CVT in young adults

Dr. Manjesh Rathi, Dr. Suresh Kumar, Dr. Ch Preetham Reddy, Dr. Stephen Abraham Suresh, Dr. Deepak Arjun Das

Sree Balaji Medical College and Hospital, Chennai.


A retrospective study from Tertiary care teaching hospital in Chennai IndiaManjeshRathi* Stephen. S*ChennaReddy. P * Deepak Arjundas** SSK Ayyar**Suresh Kumar****Dept of neurology SriBalaji Medical College & Hospital Chrompet Chennai.**Dept of neurology Vijaya health centre VadapalaniChennai. Background and Purpose: We undertook this study to determine the frequency clinical patterns and etiologies of cerebral venous thrombosis in Tertiary care teaching hospital. Methods: Records of all adult patients admitted with an documented diagnosis of cerebral venous thrombosis from Jan 2011 through July2014 in hospital. Results: A total of 284(188 males and 96 females) cases of stroke in young were admitted to the Department of Neurology between Jan 2011 to July 2014. Cerebral venous thrombosis accounted for 15.49 % (44/284) Ischemic stroke 67.25 % (191/284) and 17.25 %(49/284) had spontaneous intracerebral haemorrhage (ICH). Among CVT patients (20 men 24 women) aged 15 to 45 years were identified. Nineteen cases (43.8%) had a clinical picture of headache. Protein C and S deficiencywas present in 8 (18.88%) BehΓͷet's disease in 4 cases 9.09%)antiphospholipid antibodies in 4(9.09%) oral contraceptives pills(OCP) in 4 (9.09%) postpartum in 3(6.81%) systemic lupus erythematosus in 2 (4.54%) and PCOD(Polycystic ovarian disease) in 2 (4.54%). Alcohol intake in 15 (34.09%) and smoking in 12 (27.27%). Conclusions: Cerebral venous thrombosis in young adults is not uncommon. Alcoholismcoagulation disorderOCP postpartumBehΓͷet's disease are common aetiologies of CVT. All patients with a headache/stroke should undergo MRI/MRV/MRA of brain as a routine protocol before being labelled idiopathic. Key Words: CVT vasculitis bahcets disease

22

Session: Eposter stroke 1.13

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Impact of anticoagulation on recanalization and outcome in puerperal and nonpuerperal cerebral venous sinus thrombosis subjects.

Bharat Bhushan, Bharat Bhushan, Amita Bhargava, Gaurav Kasundra M, Khichar Shubhakaran, Banakar Basavaraj, Pujar Guruprasad, Yasin Mohamad, Janardan Sharma

Dr. S. N. Medical College Jodhpur RajasthanIndia, Jodhpur


Background: Prospective data are lacking for recanalization in cerebral venous sinus thrombosis (CVST) in Indian context. Aims: To study the recanalization and outcome after CVST in puerperal and nonpuerperal subjects. Method: Prospective observational cohort study (September 2012 to March 2014) of 79 patients of CVST (46 female 33 male; mean age 35Β΁7 years). All were treated according to institutional protocol and oral anticoagulation for 12 months. Follow up MR brain with venogram was performed on 3 6 and 12 months. Complete (CR) partial (PR) or no recanalization (NR) were categorized on vessels status. NIHSS for deficit and modified Rankin Scale (mRS) for functional outcome were used. Results: Only 77 cases (31 puerperal 46 nonpuerperal) were evaluated till 1 year follow up due to mortality (2/79). At one year 22 (28.57%) achieved CR 23 (30%) PR and 32 (41.6%) had NR. Maximum CR (22/77) achieved at three month but insignificant later. Highest recanalization rate was in superior saggital sinus followed by transverse internal cerebral veins straight sinus and lowest in sigmoid sinus. Overall recanalization rate (CR+PR) was significant (p <0.027) in thrombophilic cases than nonthrombophilic but insignificant (p=0.26) in puerperal versus nonpuerperal group. Correlation for involvement of sinuses with Initial NIHHS and mRS was significant (Pearson correlation coefficient- 0.48 0.35 respectively; p <0.01). Correlation for recanalization with mRS age and hemoglobin was insignificant at 1 year. Conclusion: On long term anticoagulation overall recanalization rate was 58.44% tended to achieve peak within 3 month and unexpectedly significantly higher in thrombophilic cases.

134

Session: Eposter stroke 1.14

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Comparison between medical management and carotid intervention in patients withsymptomatic carotid artery stenosis

Pavankumar Cherukuri, G. Sivaram Naik, Deepika S, Bimal Prasad P, Suryaprabha T, Suvarna Alladi, Subhash Kaul

Nizam's Institution of Medical Sciences, Hyderabad.

Introduction: Based on the current guidelines interventional (surgical or endovascular) revascularization of carotid artery stenosis (CAS) is considered superior to medical therapy for secondary prevention of stroke. However these guidelines are based on the studies done before the era of aggressive medical management. Aim & objective: To investigate whether interventional (surgical or endovascular) revascularization is superior to the aggressive medical management. Material and Methods: Patients of ischemic stroke and transient ischemic attacks (TIA) due to significant CAS were given the option of medical or interventional treatment in the first 3 months following the stroke. Patients were followed up at 3-month 6-month and 1-year after stroke. Results: Out of 53 symptomatic patients 40 preferred medical management and 13 opted for interventional management. Among these 7 patients presented with TIA (13.3%) and 46 patients (86.7%) with ischemic stroke. The most common presenting symptom was left hemiplegia in 20 (37.7%) followed by right hemiplegia in 15 (28.3%) patients. Retinal symptoms were noted in 4 (7.5%) patients. Recurrence within one year was noted in 5 patients (12.5 %) in medical management group and 2 (15.4%) patients of interventional group. One patient with recurrence in medical group and one patient with recurrence in surgical group had poor compliance to drugs. Conclusion: There was no statistically significant difference in recurrence rate in medically or surgically managed group upto one year.

175

Session: Eposter stroke 1.15

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Sexual function among young male stroke survivors

M. Abid, K. Bhanu, G. Sarala, N. Ramakrishnan

Madras Institute of Neurology, Chennai.


Sexual Function Among Young Male Stroke survivorsM. Abid K. Bhanu G. Sarala N. Ramakrishnan Background Despite this high prevalence of Cerebrovascular diseases little information is available on sexual functions and sexual satisfaction in stroke patients. Aim: To assess the effects of stroke on sexual functions of young male stroke survivors. Methods: 50 young male stroke patients between a 20 to 45 yrs who were completely recovered after initial event were reviewed after 6 months. They were asked to complete a self-administered questionnaire by Monga et al with minor modifications concerning their pre stroke and post stroke sexual functions and habits. Results and Discussions: Among 50 patients studied 6 refused to answer and 4 aphasic patients didn't understand the questionnaire Among the stroke patients who had sexual dysfunction 42.5% were having of MCA territory infarct20.1% were having PCA territory infract10% were having ACA territory infract7.5% were havingmulti infract and 5% were having both dominant non dominant and brainstem haemorrhage and 2.5% were having cerebellar and subarachnoid haemorrhage.47.5% experienced decreased libido50% experienced decreased coital function47.5% have reduced sexual arousal65% have reduced sexual satisfaction 75% have reduced erectile function compared to pre stroke sexual life.70% were showing increased scores of depression on HDRS and GDS scale. Those patients having problem with sexual functioning were given self explanatory pamphlets on sexual positions and sex advice. Conclusions: Sexual dysfunction and dissatisfaction with sexual life are common in young male stroke patients. This is quite under reported. It is important for us to address this problem. The attitudes toward intimate sexual questions among professionals may reduce burden of this topic for stroke patients and their spouses.

208

Session: Eposter stroke 1.16

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Autonomic dysfunction in first ever ischemic stroke: Predictors & short term outcome-a prospective study

Sandeep N, Sapna Erat Sreedharan, P. Sankara Sarma, P. N Sylaja

SCTIMST Trivandrum, Trivandrum.

Background: Autonomic dysfunction is common in acute Ischemic stroke. Very few studies have looked at its impact on post-stroke outcome. Aim: We sought to study the prevalence of autonomic dysfunction in patients with first ever acute ischemic stroke clinical and imaging predictors of autonomic dysfunction in hemispheric strokes and its impact on discharge outcome. Methods: Consecutive patients with ischemic stroke who presented between 2 weeks to 3 months post stroke were recruited. The patients underwent clinical autonomic function testing and 24 hour Holter analysis. Clinical autonomic testing included both parasympathetic and sympathetic tests as per standard protocol. Holter parameters indicating autonomic dysfunction included both time domain(SDNN and rMSSD) and frequency domain measures(LFHFLF/HF ratio). Autonomic dysfunction was correlated with demographicclinical parameters and outcome measures. Results: Of 101 patients of mean age 63yrs72% were men. Majority had moderate to severe strokes at onset (Mean NIHSS-9 mRS-4 ). Clinical bedside autonomic testing criteria was comparable to Holter detected dysautonomia in our study population(p value 0.3). Among the analyzed parameters clinical autonomic dysfunction had a positive association with male gender and onset stroke disability. Insular involvement was associated with significantly higher incidence of autonomic dysfunction on holter testing. Those with autonomic dysfunction had more stroke severity at discharge which was independent of onset severity measured by NIHSS. Increasing age hemispheric laterality or presence of comorbidities had no impact on post-stroke dysautonomia. Conclusions: Male gender insular involvement and higher MRS at onset are associated with greater incidence of autonomic dysfunction post-stroke. Those with dysautonomia had more severe strokes at discharge independent of onset NIHSS.

241

Session: Eposter stroke 1.17

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

A study of gradient echo MRI sequence in patients with primary intracerebral hemorrahage

Lalitha Pidaparthi, Shaik Afshan Jabeen, Rukmini Mridula, Meena Ak, I

Senior Resident In Neurology, Hyderabad.

Introduction: In patients with primary intracerebral haemorrhage (PICH) the reported frequency of microbleeds on GE-MRI ranges from 17% to 80%. PICH with microbleeds was more common in elderly patients with prominent ischemic changes and frequent use of antithrombotics or anticoagulants. Objective: To study gradient echo MRI sequence to diagnose microbleeds in patients with primary intracerebral bleed and its correlation with outcome. Methods: This is ongoing prospective observational study. Patients presented with PICH who underwent CT scans and GRE MRI sequences were divided into two groups depending upon microbleeds on GRE imaging. Demographic data risk factors neurological findings imaging findings on CT and GRE were noted. The total duration of hospital stay mortality and mRS at 3 months were analysed. Results: Of 18 patients with PICH 6 (33.33%) patients had microbleeds on GRE imaging. Patients of PICH with microbleeds were older (>60 years) compared to patients without microbleeds (50% vs 25%).Most common symptomatic bleed location is thalamus and capsuloganglionic region in patients with and without microbleeds respectively. ICHS scores at admission were low in PICH with microbleeds group compared to PICH without microbleeds group. Hypertension diabetes and previous strokes were commonly seen in PICH with microbleeds compared to PICH without microbleeds. The duration of hospital stay was more in patients without microbleeds (16 days vs 12 days). There is no difference in mortality between these groups. Conclusion: Microbleeds are more common in elderly with multiple vascular risk factors. Microbleeds do not appear to increase the morbidity or mortality.

122

Session: Eposter stroke 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Clinico-radiological profile of posterior circulation strokes with a 6 month follow-up study from a tertiary care centre in Eastern India

Lahoti Satish Arun, Lahoti Satish Arun, Biman Kanti Roy, Bhaskar Bhattacharya, Rajesh Pramanick, Chafale Vishal Annaji

Bangur Institute of Neurosciences IPGMER Kolkata, Kolkata.

Introduction: Very limited hospital statistics are available for posterior circulation strokes in India. Aims: To evaluate cases of posterior circulation strokes by analyzing history conventional risk factors clinical laboratory and radiological profile. Material & Methods: 100 cases of posterior circulation strokes visiting Bangur Institute of Neurosciences IPGMER Kolkata from Jan 2013 to Dec 2013 were evaluated for clinical and laboratory profile and neuroimaging (CT/MRI/DSA). Results: Of the total 100 cases64(64%) were males (mean age 48.7yrs) while 36(36%) were females (mean age 44.4yrs); 68(68%) were ischemic while 32(32%) were hemorrhagic. Among ischemic strokes30% had TIAs (18% had only posterior circulation TIAs). Large artery (hemodynamic)(36%) and embolism(36%) (26%cardiembolism 10% artery-to-artery embolism) were the most common stroke mechanisms. Distal posterior circulation territory infarcts(44%) were much common than the proximal(26%) or middle territory(30%) infarcts. For hemorrhagic strokes uncontrolled hypertension was the commonest mechanism while cerebellum and thalamus were the commonest sites. Commonest predisposing factors for ischemic stroke were tobacco addiction followed by hypertension while for hemorrhagic strokes it was hypertension. Out of 100 14 died(14% mortality) 10 of hemorrhagic strokes and 4 of ischemic stroke commonest causes being septic and metabolic complications. Moderate disability (MRS score 3) was the most common outcome at 6 months. Conclusion: Clinical profile of posterior and anterior circulation strokes are similar. Embolic stroke mechanism distal territory location low GCS and high NIHSS at presentation conveyed the worst prognosis. Higher the NIHSS score at presentation greater was the mortality and greater was the disability at 6 months among survivors.

136

Session: Eposter stroke 1.3

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Sleep dysfunction in Parkinson's disease

Vinothkanna. S, K. Bhanu

Saveetha Medical College, Chennai.

Introduction: Sleep dysfunction a common non-motor components of Parkinson's disease often predate the motor manifestations of PD. Non-Motor symptoms are recently recognized as a major cause of disability in PD contributing significantly to the decreased quality of life. Aims & Objectives:1: To evaluate the frequency and the nature of the sleep abnormalities in Idiopathic parkinson's disease.2)To analyse the sleep architecture in Parkinson's disease using polysomnography. Materials & Methods: A Cross sectional study was carried out among fifty patients of Idiopathic Parkinson's disease who were recruited based on UKPDS brain bank Criteria for sleep study. Clinical staging was scored using Hoehn and Yahr staging system and severity was assessed using UPDRS part III. Objective assessment of sleep was done by polysomnography. Results: Disturbed sleep was reported by 35 patients and out of them 30 had difficultyin falling asleep and 24 had difficulty in maintaining sleep. There was a significant increase in the N1N2 stages of NREM sleep associated with a decrease in the slow wave sleep(N3) in 80%. The sleep efficiency ranges between55% to 94%. The overall duration of REM sleep was reduced and REM sleep onset latency was prolonged. Periodic limb movements in sleep restless leg syndrome and obstructive sleep apnoea also contribute to their sleep fragmentation resulting in defective day time functioning. Conclusion: Sleep architecture is markedly affected in patients with Parkinson's disease. It is essential that all the patients with Parkinson's disease should be evaluated for sleep disorders so that appropriate intervention can be taken to improve their quality of life.

150

Session: Eposter stroke 1.4

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Clinical demographic and socioeconomic factors influencing outcome in patients with acute ischemic stroke

R. Lalitha, Sundarachary N. V, Veeramma U, Sridhar A, Srinivasulu A

Guntur Medical College, Guntur.

Introduction: The available evidence worldwide suggests that 10% of stroke survivors are without any significant disability and able to function independently. Another 10% are so severely affected that they must remain institutionalized forsevere disability; the remaining 80% can return home with appropriate therapy trainingsupport and care. However data on the factors which influence the outcome in patients with Ischemic stroke are lacking in India. Objective: To identify the clinical demographic and socioeconomic factors influencing the outcome in patients with acute ischemic stroke. Methods: Clinical demographic and socioeconomic status data were collected from 185 adult patients with acute ischemic stroke addressing major questions on the underlying determinants of outcome. Individual data collection included medical history lifestyle behaviors nutrition and dietary profilepsychosocial/socioeconomic factors anthropometric measures were performed on all patients. Outcome at three months was measured using the mRS - 9 Q and documented. Multivariate regression analysis was used to determine which variables were associated with poor outcome at three months. Results: Mean age of the patients 57.6 (SD 14.2 ) years ;58.5 % were Male32.6 5 had some high school education78.8 % were unemployedOverall 62.8 % had anterior circulation stroke 26.4 % had posterior circulation stroke and 10.8 % had Watershed infarcts;12. 5 % Had mRS 9 Q scores of < 5 63.3 % had scores between 5 and 8 and 25.2 % had scores of > 8. The mRS 9 Q all subcomponent scores correlated strongly with outcome. Conclusion: Although clinical factors such as the severity of stroke underlying comorbidities and age of the patient influence outcome significantly socioeconomic factors are found to be important determinants of outcome in our study. Use of indigenous medicine was the single most important factor found to be associated with poorer outcome.

152

Session: Eposter stroke 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Evaluation of serum homocysteine level as a risk factor for ischemic stroke and it's association with various ischemic stroke subtypes in a South Indian population

MD Shafiqur Rehman, Dr. Subash Kaul, Dr. A. Suvarna, Dr. Suryaprabha, Dr. AK Kohat, Arun Kumar

Nizam's Institute of Medical Sciences, Hyderabad.


Evaluation of serum homocysteine level as a risk factor for ischemic stroke and it's association with various ischemic stroke subtypes in a South Indian population. Dr. MD Shafiqur Rehman Arun kumar Dr. Abhijit Dr. Suryaprabha Dr. A. Suvarna Dr. Subash KaulNizam's Institute of Medical Sciences Hyderabad Telangana. Background: Hyperhomocysteinemia (hHcy) is an independent risk factor for stroke but it's association with various ischemic stroke subtypes is still not clear. Because the conclusions of various previous studies were contradictory we aimed to investigate the association of hHcy with various stroke subtypes. Methods: This is a retrospective analysis of data from our institutional stroke registry. 357 ischemic stroke patients aged over 16 years were recruited from August 2012 to June 2014. Ischemic stroke subtypes were identified according to modified TOAST criteria. Demographic data and traditional risk factors for stroke were identified and fasting serum homocysteine (Hcy) level was measured. Statistical analysis was done using SPSS version 12. P value < 0.05 was taken as significant. Results: Of the total 357 patients we had 155 large vessel disease(LVD) 57 small vessel disease(SVD) 62 cardioembolic stroke(CE)and in 83 patients mechanism of stroke was unknown. The mean Hcy level was elevated in all subtypes ( LVD 20 Β΁ 12.9P: SVD 22.3 Β΁12.1: CE 26.5 Β΁17.6: Unknown - 25Β΁15.3). On univariate analysis hHcy was associated with LVD (p< 0.05) and SVD (p<0.05) stroke subtypes. After adjusting for other risk factors hHcy was independently associated with LVD (OR-1.8:95%CI1.1-2.8:p<0.01) and SVD (OR-0.50:95%CI 0.26-0.98 p = 0.04). Conclusion: Our data showed that hHcy is an independant risk factor for ischemic stroke specially LVD and SVD subtypes. Key words: hyperhomocyteinemia risk factors TOAST stroke subtypes.

171

Session: Eposter stroke 1.6

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Analysis of neurological disorders in early postpartum period

Subramanian R, Rama Krishnan V, Sarala G, Bhanu K

Madras Institute of Neurology, Chennai, India.

Introduction: Pregnancylabour and puerperium though considered as physiological processes many disorders complicate these processes. As per various studies the incidence of neurological disorders during pregnancy range from 326 to 584 per 100000 deliveries. No studies yet defined the incidence exclusively during early postpartum period. Objective: To study the etiological profile of patients presenting with neurological symptoms during early postpartum period. Materials and Methods: This prospective study was conducted at Madras Institute of Neurology between August 2013 to July 2014. All patients in early postpartum period i.e. within one week of delivery requiring neurologic consultation were included. Results and Discussion: There were 97 patients included. The incidence of neurological symptoms in postpartum period was 156 out of 13596 deliveries(1.14%). The common symptoms observed were convulsions headachefocal deficits blurring of visionaltered sensorium.55% of these symptoms occurred during initial 48 hours of delivery. The patients were categorized into 2 groups 1) Neurological disorders unrelated to pregnancy 2) Neurological disorders developed as a consequence of pregnancy and delivery. The former(n=32 i.e 33%) included Epilepsy-37.5% migraine-3% meningoencephalitis-12.5% encephalopathy-9.4% stroke-9.4% Dystonia-3% recovering Acute Inflammatory Demyelinating Polyneuropathy-3% Neuroleptic malignant syndrome due to Antipsychotics-3% paraplegia due to anesthesia induced spinal cord injury-3% and post dural puncture headache-15.6%. The latter (n=65 i.e 67%) included Cortical venous thrombosis-18.5% Eclampsia-60% HELLP-3% psychosis-4.6% depression-3% PRES-9.2% Lumbosacral plexopathy-1.5%. Death occurred in 2 cases of Eclampsia with status epilepticus. Conclusion: The incidence of neurological disorders in early postpartum period are fairly high. Opportunities to identify neurological emergencies should be vigorously pursued to optimize patient outcome

191

Session: Eposter stroke 1.7

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Transradial approach for intracranial interventions

Dr. Sudhir V. Shah, Dr. Chirayu Vyas, Dr. Sanjay Shah,

Dr. Shalin Shah, Dr. Tejas Patel

Head of Department of Neurology NHL Medical Colle, Ahmedabad.


Transradial approach for intracranial interventions has gained popularity in some interventional centres. We present our data of safety & feasibility for intracranial catheterisation & interventions through transradial approach. 415 patients underwent diagnostic four vessel angiogram through transradial route in last 6 years. Out of these patients 58 patients underwent carotid stenting65 patients underwent vertebral stenting & 8 patients underwent basilar stenting. Procedure was successful in 99% diagnostic procedures & 96% interventions. 7 patients suffered transient ischemic attack. One patient died due to intracranial haemorrhage 24 hours after procedure. 3 patients developed forearm haematoma. 2 patients developed pseudoaneurysm at radial puncture site for which surgical treatment was required. In conclusion transradial approach for intracranial interventions is feasible & safe with better patient comfort.

199

Session: Eposter stroke 1.8

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Correlation of level of consciousness on admission with subsequent prognosis in stroke population a study from Eastern India

Dr. Anirban Ghosal, Prokash Chandra Bagchi, Arun Koul, Atri Chatterjee, Bhabesh Solanki, Dr. D. P. Chakraborty, Prof. S. P. Saha

Dm Post Doctoral Trainee in Neurology, N. R. S. Medi, Kolkata.

Introduction: To improve stroke outcome it is important to identify predictors of outcome so that need for aggressive intervention can be planned. Any method to predict outcome should be simple accurate and reproducible. This is more important in developing countries where stroke management is largely conservative and without any stroke unit. Aims and Objectives: (1) To correlate between initial total GCS score and stroke outcome at 1 month and 3 months. (2) To investigate the relationship between components of GCS and outcome of stroke patients. Materials and Methods: In this prospective observational study 100 ischaemic and haemorrhagic stroke patients above 12 years of age admitted in General Medicine ward of N. R. S. Medical College Kolkata who reached this institute within 24 hours of symptom onset were studied for GCS at presentation and outcome was measured with modified Rankin Scale (mRS) at 1 and 3 months. Results & conclusion: In this study 29% of all patients expired. 37% of all patients (52.1% among survivors) had favourable outcome and 34% of all patients (47.89% among survivors) had unfavourable outcome as per mRS. Stroke patients with GCS more than 9 had high positive predictive value for survival. GCS 15 and 14 had extremely high positive predictive value for survival as well as excellent outcome. Patients with GCS score 8 or less even if survived had unfavourable outcome and with GCS 7 or less 90% expired. This study also demonstrated a strong relationship between verbal and eye component of GCS and subsequent outcome in acute stroke patients.

210

Session: Eposter stroke 1.9

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Interesting case series of parkinson plus syndrome

Harisudan S, Bhanu K, Shanmugasundaram K, Kamaraj V

Madras Medical College, Chennai.

Introduction: Parkinson plus syndromes are group of disorders which includes multi system atrophy (MSA) progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). PSP is a relatively rare disorder characterised by gaze restriction frequent falls axial rigidity& dementia with tremors relatively rare at onset. Objective: The purpose of this study is to highlight the increased prevalence of tremors among patients with PSP. Methods: This prospective study was conducted in Madras Institute of Neurology between January 2014 to July 2014. Patients of all age groups and sexes fulfilling the diagnostic criteria of PSP were included in this study. Results And Discussion: The study included 10 persons; 7 males and 3 females with ages between 58 to 77 years fulfilling the criteria for PSP. 6 had probable while 4 had possible PSP. All 10 had slowness of movements early falls and axial rigidity as their initial presentation. 7 had gaze restriction with slow vertical saccades and only 5 had vertical gaze restriction. 9 had unilateral resting tremors at presentation. 6 had emotional outbursts. 1 had features of PSP and CBD. 6 had MRI evidence of PSP. Conclusion: Presence of early tremors was considered to be much rarer in PSP. However in our study ninety percent of the individuals presented initially with tremors. Tremors at onset doesn't exclude PSP. Awareness of this helps in distinguishing PSP from parkinson's disease as the response to treatment and prognosis varies between the two conditions.

255

Session: Eposter stroke 2.1

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Development and implementation of acute stroke care pathway- A comparison cohort study in a Delhi tertiary care hospital

Dr. Neha Rai, Prof. Kameshwar Prasad, Prof. M. V. Padma,

Prof. Manjari Tripathi, Dr. Rohit Bhatia, Dr. Mamta B. Singh,

Dr. Deepti Vibha

All India Institute of Medical Sciences Delhi I, Delhi.

Objective: To develop and implement evidence based pathway for acute stroke management and to compare it with current conventional care among patients with acute stroke admitted in AIIMS Neurology department. Methods: A total 162 acute stroke patients (excluding SAH) above 18 years of age were enrolled in two groups-care pathway arm(n=77) and conventional care arm(n=85) within first 72 hours of the symptoms onset. Primary outcome was incidence of aspiration pneumonia. Secondary outcomes were control of clinical parameters like Blood Pressure(BP) blood sugar and body temperature; change in NIH Stroke Scale(NIHSS) at discharge; complication during the hospital stay - pressure sores seizures; patient and carer satisfaction; death or dependency at discharge and at 90 days accesses by Barthel Index(BI) and modified Rankin Scale(mRS). Results: Care pathway arm showed clinically important (p=.062) decrease in incidence of aspiration pneumonia on comparison with conventional care arm. Other secondary outcomes- control of BP blood sugar body temperature; change in NIHSS at discharge; incidence of pressure sores & seizures; patient and carer satisfaction; death; change in BI & mRS at 90 days all showed statistically nonsignificant (p>.05) difference among two arms. Pathway implementation was difficult due to resistance among staff because of increase in work load. Conclusion: Stroke care pathways appear to reduce the incidence of aspiration pneumonia. Whether such pathway actually influences functional outcomes needs further study with dedicated stroke staff in different care settings.

223

Session: Eposter stroke 2.10

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Stroke subtype classification according to TOAST criteria

Srilatha Siripuram, Dr. Dhairyawanp, Dr. Veena. N, Dr. Sateeshk, Dr. Sowjanya Poosarla, Dr. Santhosh Kumar, Dr. Amareshwer K

Gandhi Medical College Hyderabad, Secunderabad.


Stroke is a heterogeneous neurologic disorder. The etiology of ischemic stroke affects prognosis outcome and management. We have done a study to determine age- and sex-specific incidence rates risk factors and etiology for stroke. Objective: To Stroke subtype classification according to TOAST criteria.TOAST Diagnostic Classification - Diagnostic Group modified1. Atherosclerosis 2. Cardioembolic3. Lacunar 4. Other determined etiology 5. Undetermined etiologyMaterial and MethodsThe study was done in the Department of Neurology Gandhi Medical College over a period of 1 year from April 2013 to June 2014.History clinical examination blood & imaging investigations were taken for analysis. Results: Among 421 cases 141 females 280 males(sex ratio 1:2).Age of patients 18- 90 years(mean age 54).among these above 50 years are 243 (58%) below 50 years were 176 pts (42%) deaths occurred in 54(13%). Symptomotology 130 (31%) presented with left hemiplegia 151(36%) with right hemiplegia 143 (34 %) aphasia 71 (17 %) with loss of consciousness 9(2%) had seizures 8 (2%)with altered sensorium.Regarding risk factors 50(12%) were diabetics 205 (49%) were hypertensives alcoholics were 33(8%) smokers 11(2.5 %) both 84(20%) 46(11%) had previous stroke.Among 421 stroke cases 169(40%) were hemorrhagic strokes remaining 252 (60%) were ischemic strokes.Among ischemic strokes 10(4%) cardioembolic 68(27%) large artery 68 (27%) small vessel100 (40%) undetermined. Conclusion: Definition of stroke subtypes in clinical and epidemiological Studies is necessary for precise analysis of stroke populations treatment decisions and prognosis.

227

Session: Eposter stroke 2.11

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Predictors of gait recovery in post stroke gait disorder: A prospective observational study

Dr. Anoop Gupta, Dr. R. Verma DM Neurlogy,

Dr. R. K. Garg DM Neurology, Dr. H. S. Malhotra DM Neurology, Dr. P. K. Sharma DM Neurology

Senior Resident Department of Neurology, Lucknow.

Background and purpose: Gait dysfunction occurs commonly following stroke with varying degree of recovery. The objective of this study was to determine predictors of long term recovery of gait in stroke patients. Materials and Methods: This was prospective observational study conducted in dept. of neurology KGMU Lucknow. We prospectively evaluated assessed and followed 53 ischemic stroke patients at 3 and 6 months after incident stroke for gait recovery and independent walking. Outcome measures were changes in score on Functional Ambulation Catagories (FAC) on initial assessment and follow up. Results: After six months of onset of stroke 93% (n=63) of subjects regained independent gait and reached desired outcome (FAC β‰͵ 4). Cases with lower age and without risk factors showed better improvement in mean scores on outcome measures and on Rivermead Visual Gait Assessment Scale(RVGA) on follow-up in comparison to cases of higher age and with risk factors. However statistically significant differences were observed in changes between groups on follow up for Modified Barthel Scale(MBS) Modified Rankin Scale(MRS) FAC RVGA Walking Speed Step Length and Stride Length among non hyperlipidemic cases as compared to hyperlipidemic cases. There was significant improvement in step length in non-alcoholic's and in cases with right side involvement. Conclusion: In post stroke patients who were non ambulatory initially age and presence of risk factors were significant variables for prediction of recovery of gate dysfunction and independent walking at six months.

242

Session: Eposter stroke 2.12

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

A study of gradient Echo MRI sequence in patients with primary intracerebral hemorrahage

Lalitha Pidaparthi, Shaik Afshan Jabeen, Rukmini Mridula, Meena AK, Rupam Borgohain

Senior Resident in Neurology, Hyderabad.

Introduction: In patients with primary intracerebral haemorrhage (PICH) the reported frequency of microbleeds on GE-MRI ranges from 17% to 80%. PICH with microbleeds was more common in elderly patients with prominent ischemic changes and frequent use of antithrombotics or anticoagulants. Objective: To study gradient echo MRI sequence to diagnose microbleeds in patients with primary intracerebral bleed and its correlation with outcome. Methods: This is ongoing prospective observational study. Patients presented with PICH who underwent CT scans and GRE MRI sequences were divided into two groups depending upon microbleeds on GRE imaging. Demographic data risk factors neurological findings imaging findings on CT and GRE were noted. The total duration of hospital stay mortality and mRS at 3 months were analysed. Results: Of 18 patients with PICH 6 (33.33%) patients had microbleeds on GRE imaging. Patients of PICH with microbleeds were older ( >60 years) compared to patients without microbleeds (50% vs 25%).Most common symptomatic bleed location is thalamus and capsuloganglionic region in patients with and without microbleeds respectively. ICHS scores at admission were low in PICH with microbleeds group compared to PICH without microbleeds group. Hypertension diabetes and previous strokes were commonly seen in PICH with microbleeds compared to PICH without microbleeds. The duration of hospital stay was more in patients without microbleeds ( 16 days vs 12 days). There is no difference in mortality between these groups. Conclusion: Microbleeds are more common in elderly with multiple vascular risk factors. Microbleeds do not appear to increase the morbidity or mortality.

256

Session: Eposter stroke 2.13

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Study of clinical profile Etiologyrisk factors and radiological co-relation of posterior circulation ischemic stroke in a tertiary care centre

Madhusudhan B. K., Madhusudhan B. K., Mahendra J. V., Rohan M., Suryanarayan Sharma, Anish Mehta, Aju Abraham John, Sandya, Srinivasa R

Department of Neurology M. S. Ramaiah Institute of, Bangalore.

Background: Posterior circulation strokes account for 10 to 15% of all strokes. The area includes brainstem cerebellum occipital lobes and thalamus. Here we have studied the clinical profileetiology risk factors and radiological co-relation of posterior circulation stroke as there are very few studies available in literature. Materials and Methods: This is a retrospective and prospective study of consecutive cases of Post circulation stroke from January 2010 to March 2014. CT Scans/MRI scans of brain and CV Doppler/MRA/CTA/DSA of all patients was done. Inclusion Criteria; All posterior circulation strokes were included during the study period and Age more than 18years. Exclusion Criteria; If CT/MRI scan showed recent infarction in the anterior circulation any intracranial haemorrhage and other non-vascular lesions traumatic brain injury. Results: The incidence of posterior circulation stroke was 12 % in our study. There was a male predominance noted in our study and most common risk factor was hypertension and tobacco abuse. The common manifestations were giddinessfocal motor deficit altered sensorium headache. Posterior cerebral artery was most commonly involved as in other studies. Topographically distal (rostral basilar artery; superior cerebellar artery; posterior cerebral artery) intracranial involvement was most frequent as in other studies. Conclusions: Our study demonstrated the occurrence of posterior circulation stroke in relatively younger age group compared to the Western literature. In our study of south Indian population we found higher percentage of large artery disease and distal territory involvement frequently as a cause of posterior circulation ischemic stroke.

259

Session: Eposter stroke 2.14

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

The correlation of blood pressure on admission and outcome measure at 90 days in cases of spontaneous hypertensive intracerebral hemorrhage (sICH)

Dr. Srinath R, Dr. S. P. Gorthi, Dr. Y. S. Sirohi, Dr. P. Dhull, Dr. C. S. Narayanan

Army Hospital Research & Referral, New Delhi.

Background: Hematoma expansion after sICH secondary to uncontrolled hypertensioncontributes to the morbidity and mortality. However the association between elevated BP and functional outcomes after ICH remains unclear and forms the basis of this study. Methods: All consecutive subjects of hypertensive intracerebral hemorrhage meeting the inclusion and exclusion criteria admitted in a tertiary care hospital from 01 Apr 2012 to 30 Apr 2014 constituted the study subjects. The mean arterial pressure (MAP) as ascertained by three consecutive readings five minutes apart was kept at or below 130 mm Hg with appropriate treatment. The hematoma volume and an ICH score were calculated. Funtional outcome was assessed after 3 months with modified Rankin Scale. A correlation of MAP with functional outcome was studied. Results: A total of fifty (50) patients were studied. Functional outcome at 90 days poorly correlated with the MAP at onset but was significantly associated with a higher MAP at 72hrs. The ICH score reflecting Hematoma volume mass effect or presence of infra-tentorial hemorrhage had a statistically significant inverse effect on the outcome at 90 days. Intervention of raised ICP with Mannitol Hypertonic saline or EVD made no difference for functional outcome. Conclusions: Thisstudy demonstrates that the factors which has a significant bearing on the functional outcome at 90 days were MAP at 72 hrs and ICH score.

261

Session: Eposter stroke 2.15

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Superficial siderosis in a patient with basilar migraine

Dr. S. Ravindran, Dr. P. R. Somini, Dr. Malcolm jeyaraj, Dr. S. Sakthi Velayutham, Dr. S. Gobinathan

Government Stanley Medical College, Chennai.


Superficial siderosis of the central nervous system is a very rare disorder characterized by free iron and hemosiderin deposition along the pial and subpial structures of central nervous system caused by chronic bleeding into the subarachnoid space. Basilar type migraine is characterized by headache associated withsymptoms suggestive of brainstem involvement. A22 year old male presented with episodic occipital headache moderate to severe in intensity and associated with vertigo diplopia nausea vomiting transient quadriparesis and loss of consciousness(6-8hours). Each episode lasted for a period of one to five days and he had at least one to two episodes per week over the past 12 years.Neurological examination including fundus was normal. MRI Brain (Plain & Contrast) with whole spine screening showed features suggestive of Superficial siderosis. CSF analysis was normal. CT Angiogram of brain was normal. Our patient presented with typical features of Basilar type Migraine and MRI Brain incidentally showed features suggestive of Superficial siderosis. The patient did not have any clinical features of Superficial siderosis. Detailed investigations did not reveal any etiology for sub arachnoid haemorrhage. Only few anecdotal reports of associated Migraine in patients with Superficial siderosis of central nervous system could be found and the exact etiopathological mechanisms for the same are not known. The patient was treated with Propranolol Amitryptyline Flunarizine and symptomatically improved. The incidental radiological finding of Superficial siderosis of central nervous system in patient presenting with Basilar type Migraine is a very rare feature and does an association really exist?

303

Session: Eposter stroke 2.16

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Awareness about stroke symptoms and treatment options amongst Stroke patients admitted to tertiary care stroke centre

Dr. Sankalp Mohan, Dr. Vijay Sardana, Dr. Sankalp Mohan, Dr. Parag Moon, Dr. Dilip Maheshwari

Kota.

Introduction: Stroke is a leading cause of death and disability. The awareness of stroke symptoms remains far from satisfactory amongst the general population. There is a significant delay in patients reaching first medical care inspite of thrombolysis therapy approved for last 18 years. Knowledge of this option is far from desirable amongst patients and their relatives. The study was conducted to know about awareness of stroke ,its symptoms and treatment options amongst patients admitted in stroke unit of tertiary care centre. Method: 100 consecutive patients admittted to government medical college kota were selected and asked questions about awareness of stroke, delay in arriving medical consultation , reasons thereof and therapeutic options available including thrombolysis by a preformed questionnare proforma. Result: 76 were males 24 females. Seventy one were ischemic stroke and 29 were hemorrhagic. Thirty six percent patients gave history themselves while sixty four percent attendants reported about the disease. Only 34 patients or informants perceived or came to know that patient had stroke/paralysis. There was a delay of mean 10.6 hrs (range 1 hr to 4 days) in attending first medical care. Lack of awareness about the symptoms of stroke was the reason for delay in 49 %. In 22 percent there was delay due to lack of timely referral by primary care physicans and in 29 percent due to lack of timely transport facilities. Two percent knew about the meaning of brain stroke and its difference from heart attack. Only 6 % knew about the option of thrombolytic therapy. Forty one percent believed that they will recover while 59% did not know about the recovery or thought it is not treatable. Ninety percent had access to either print or electronic media. Conclusion: Stroke awareness and awareness about treatment options is very poor amongst patients attending tertiary care centre. Study highlights need to involve electronic and print media and non government organisations(NGOs) for increasing stroke awareness. Primary care physician and general practioners also need training regarding thrombolytic therapy and need for early referral of such patients to stroke centres.

4

Session: Eposter stroke 2.2

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

The 10000 fold effect of retrograde neurotransmission a new concept for stroke revival: use of intracarotid sodium nitroprusside

Dr. Vinod Kumar Tewari, Prof. Mazhar Husain, Prof. H. K. Das Gupta, Dr. Ravi Singhvie

Neuro Center Lucknow, Lucknow.


rTPA showed level-1 benefit in AIS. Intracarotid-sodium-nitroprusside(ICSNP)studied here for wide-treatment-window and fast-recovery.a) RETROGRADE-NEUROTRANSMISSION-RNT(acute): 1) Normal-impulse: At synaptic-level glutamate-activates NMDA-receptors having nitric-oxide-synthetase(NOS)on postsynaptic-neuron for further propagation by calcium-calmodulin-complex. Nitric-oxide(NO-produced-by-NOS)travels-backward across chemical-synapse(CS) binds NO-receptor/sGC of presynaptic-neuron regulating anterograde-neurotransmission(ANT). Heme(ligand-binding-site)exhibits >10000-fold higher affinity for NO than for oxygen(10000-fold-effect).2) Stroke: Normal synaptic-activity ANT and RNT are absent. NO-donor(SNP)releases NO from NOS. NO travels backward across CS to bind heme of NO-receptor/sGC generates ELECTRICAL-IMPULSE as in normal-ANT.b) VASOSPASM(acute): Juxtra-penumbra-perforators show vasospastic activity. NO vasodilates the perforators via the NO-cAMP-pathway.c) LONG-TERM POTENTIATION(LTP)chronic: Via NOcGMP-pathway. AIMS/STUDY DESIGN: to treat acute by RNT and vasodilatation and chronic-stroke by LTP. Case-control-prospective-study. MATERIALS AND METHODS: 82 cases(10-control without superfusion/with 5% dextrose superfusion and 72-patients-ICSNP group). Mean time was 9.5 days post-stroke. Pre/&/post- status was monitored by NIHSS MRI and TCD. RESULTS: After 90-sec in ICSNP-group mean NIHSS score decrease 1.44-points/6.55%; after 2-hr decrease 1.16-points; after 24-h increase 0.66-points/2.25% in control-group increase 0.7-points/3.53%; at 7-day decrease 8.61-point/44.58% in control-group decrease 2.55-points/22.37%; at 2-months decrease 6.94-points/62.80% in control-group decrease 2.77-points/8.78%. TCD improvements noted. CONCLUSIONS: ICSNP is swift-acting-drug(decrease of 1.44-points/6.55% NIHSS)in the treatment of stroke acting-within 90-seconds on average 9.5-post-stroke-day with a small decrease after 24-hours recovers-quickly.

34

Session: Eposter stroke 2.3

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Association of Vitamin D3 deficiency in ischemic stroke: A study form tertiary care center

Jaydip Ray Chaudhuri, VCS Srinivasarao Bandaru, Rukmini Mridula K, Banda Balaraju

Yashoda hospital, Hyderabad.

Background: Several studies have found Vitamin D3 deficiency causing to cardiovascualr diseases Recent Vitamin D3 deficiency studies have established serum 25-hydroxyvitamin D deficiency causing ischemic stroke. Aim: To investigate the relationship between Vitamin D3 deficiency and ischemic stroke at tertiary care center. Methods: We selected 350 patients with ischemic stroke admitted in stroke unit and 280 age and sex matched healthy subjects at Yashoda hospital Hyderabad India Study period from January 2011 to December 2013. All ischemic stroke patients underwent stroke subtyping and risk factors evolution. In both groups we estimated serum calcium phosphorus alkaline phosphatase CRP and Vitamin D3. Results: Out of 350 stroke patients 259 (74%) were men and mean age was 55.4Β΁12.1years control subjected 201 (72%) were men and (age range-25-89 years) in both groups. Serum Vitamin D3 deficiency was found in 159(45.4%) stroke patients and 85(30.3%) in controls (p=0.002). In ischemic stroke patients serum 25-hydroxyvitamin D deficiency was found in 55.6% (69/124) of patients with large artery atherosclerosis 20.3%(20/66) in stroke of un-determined etiology 54.7% (29/53) in cardioembolic stroke 41.6% (25/60) in small artery diseases and 34%(16/47) in stroke of other determined etiology. After regression analysis showed an independent association of Vitamin D3 deficiency with ischemic stroke (odds ratio: 1.5; 95%CI 1.1-2.5). The association was strongest with large artery atherosclerosis (odds ratio: 2.3; 95%CI 1.7-3.4) and cardioembolic stroke (odds ratio: 1.9; 95%CI 1.2-2.9). Conclusions: We found Vitamin D3 deficiency had an independent association with ischemic stroke and established in large artery arthrosclerosis and cardioembolic stroke.

62

Session: Eposter stroke 2.4

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Cortical blindness following indian tree green viper bite with angiographic evidence of posterior cerebral arteries vasospasm: A rare occurence

Anish Mehta, Rohan Mahale, Mahendra Javali, Madhusudhan BK, Suryanarayana Sharma, AJU Abraham John, R. Srinivasa

Department of Neurology MS Ramaiah Medical College, Bangalore.


The leading cause of fatal snake bite in India belongs to Viperidae species consisting of Russell's viper (Daboia russelli) and saw scaled viper (Echis carinatus). Local cellulitis renal failure and systemic hemorrhagic manifestation are the common clinical characteristics of viper bite. Neurological sequelae due to cerebral infarction following viper bite are rare. Anterior circulation infarction following viper bite is commonly reported. Posterior circulation ischemic infarction is rare and there are few reports on the same. Indian tree green viper (Trimeresurus gramineus) is a venomous pit viper species found only in southern India. Herein we report a normotensive patient who presented with dimunition of vision in both eyes following Indian tree viper bite without systemic envenomation. MRI brain revealed infarct in bilateral medial occipital lobe. MR angiogram showed vasospasm of bilateral posterior cerebral arteries and distal basilar artery. Repeat angiogram after 3 months showed normalisation of caliber of bilateral posterior cerebral arteries and distal basilar artery. This is the first case report of angiographic demonstration of toxin induced vasospasm involving posterior cerebral circulation.

71

Session: Eposter stroke 2.5

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Vit B 12 as a prognostic factor in cerebro vascular stroke

Venu Gopal Basam, Venu Gopal Basam, Sampath Kumar N. S

Narayana Medical College, Nellorea P., Nellore.

Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. Serum vit B12 is one of the modifiable risk factor for stroke. There are few studies regardingrole of vit B12 as a prognostic factor in Stroke. OBJECTIVESIn this study we investigated the risk factors for the stroke and role of vit B12 as a prognostic factor in Stroke. Material and Methods: A total of 350 patients with whose cerebro vascular stroke diagnosis was confirmed by CTand MRI were evaluated prognosis by NIHSS score at the time of admission as well as discharge and 3 &6 months after discharge and serum vit B12 was measured in all plotted the prognosis against the controls. Results: Out of total 350 patients of stroke 281 had intracerebral infarct & 69 had intracerebral hemorrhage. In stroke patients 266 had serum vit B12 levels >1500 pico grams per ml 84 had serum vit B12 levels <1500 pico grams per ml among 17 had serum vit B12 levels between 800-1500pico grams per ml 15 had serum vit B12 levels between 400-800pico grams per ml17 had serum vit B12 levels between 200-400pico grams per ml35 had serum vit B12 levels <200pico grams per ml However all patients who had serum vit B12 levels <200pico grams per ml werehad ischemic stroke.risk. There were no significant relationships of low level serum vit B12 wih prognosis of stroke. Conclussion: The present study concluded that low level serum vit B12 seems to be a risk factor for ischemic stroke in addition to conventional risk factors.. There were no significant relationships of low level serum vit B12 wih prognosis of stroke.

155

Session: Eposter stroke 2.6

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Ischemic stroke in young patients: study of risk factors and subtypes in a tertiary care government hospital

Dr. Krunal C. Padhiyar, Dr. Shailesh H. Darji, Dr. Heli S. Shah, Dr. Pranav B. Joshi, Dr. Shalin D. Shah, Dr. Sudhir V. Shah

D. M. Neurology Resident NHL Medical College, Ahmedabad.

Background: Ischemic stroke in young patients differs compared to older patients with regards to risk factors and etiology. The present study was conducted in a tertiary care government hospital in Gujarat in young patients with ischemic stroke in our regional population. Material and Methods: The study was done prospectively in young patients (15-45 years) with ischemic stroke who presented to our hospital during September 2012 to June 2014. All patients were evaluated for conventional risk factors. Vascular imaging (CTA/MRA or both) was done in 92% patients. TTE was done in all patients while TEE was done in 41% patients. The etiology was classified using TOAST classification system. Results: There were 57 patients with M: F ratio of 2.56:1 and the median age was 34 years (range-15 to 45 years). The types of stroke according to location were: anterior circulation: 87.71% posterior circulation: 8.77% and both: 3.5%. We found other determined etiologies (29.82% cases) as the most common subtype of ischemic stroke with non-atherosclerotic vasculopathies accounting for 17.54% cases. Atherosclerotic vascular disease and undetermined etiology accounted for 21.08% each. Cardioembolic strokes and small vessel disease accounted for 19.30% and 8.77% cases respectively. Extracranial and intracranial large artery disease in 24.56% and 19.59% respectively. Major risk factors were DM hypertension dyslipidemia and smoking. Multiple risk factors were present in 21% patients. Conclusion: The most common etiology in our study was other determined etiology with higher incidence of non-atherosclerotic vasculopathies. This study suggests importance of vascular imaging in young patient with ischemic stroke.

187

Session: Eposter stroke 2.7

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Hemorrhagic posterior reversable encephalopathy syndrome

Methil Pradeep, Dr. Ramakrishnan

KG Hospital & Post Graduate Institutecoimbator, Palakkad.


Posterior reversible encephalopathy(PRES)is a syndrome characterised by head ache seizure confusion visual impairment& MRI findings of cotical & subcortical vasogenic edema. It is usually reversible. We report one case of PRES who delevoped intra parenchymal bleed during the course of their illness. Methods: case report & review of literature. Results: The patient was a 60 year old male with visual loss & partial seizures. The patient had a renal transplant & was on cyclosporine. His BP was 210/110 mm Hg. MRI of the brain showed hyper intense lesions in the FLAIR in the posterior head regions consistent with PRES.shortly after wards the patient deteriorated & CT scan brain showed parieo occipital intra parenchymal hemmorhage. She under went decompressive surgery. Conclusion: Hemorrhage in posterior reversible encephalopathy is very rare& one cannot exclude the possibility of hemorrhage being part of the msot severe end of the spectrum of PRES.

215

Session: Eposter stroke 2.8

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Vertebral artery dissection: A case series of 10 patients in a tertiary care centre

Tripthi Sugumar, Tripthi Sugumar, U. Meenakshisundaram, C. U. Velmurugendran, V. Shankar, P. R. Prabash

Department of Neurology Sri Ramachandra University, Chennai.

Background: Vertebral artery dissection (VAD) has increasingly become a common entity. It has a wide spectrum of presentations. We report a comprehensive study analyses of ten cases of VAD. Methods: This was an observational study where clinical profile presentation imaging findings and management of 10 patients diagnosed to have VAD over 3 years in a tertiary care centre in south India were analysed. Results: Of ten patients observed 7 were male and 3 female. 7 were below age 40 and 3 between age 40-60 yrs. 7 developed spontaneous VAD of which 4 had preceding history of minor neck trauma and 1 had basilar artery aneurysm prior. One patient had major neck trauma. Most common presenting symptom was neck pain in 7/10 patients followed by giddinessvomiting in 5 and headache in 4. 7 had no clinical signs on presentation 3 had signs of stroke 1 had a TIA. DSA/ CT Angiogram was done in all confirming VAD. 7/10 cases had extracranial VAD. Treatment involved antiplatelets in 5 patients anticoagulants in addition in 5 and endovascular stenting in one. One patient who presented with giddiness later developed posterior circulation stroke followed by recurrent stroke of spinal cord. All showed improvement on followup. There was no mortality. Conclusion: Early diagnosis of VAD can be made with astute recognition of predisposing factors and presentation especially in young adults. This study showed that clinical profile plus MRI findings can point early towards VAD and antiplatelet therapy is sufficient in most cases.

217

Session: Eposter stroke 2.9

Date and Time: 14:00 - 15:00, Saturday 08 Nov 2014

Venue: Poster area

Factors influencing non administration of thrombolytic therapy in early arrival strokes in a university hospital from hyderabad India

Abhijeet Kumar Kohat, Subhash Kaul, Suvarna A, Suryaprabha T, Anitha

Assistant Professor, Hyderabad.

Aims and Objectives: It is a well-known that very few patients of stroke arrive in hospital within the window period of thrombolysis. Even among those who arrive within the window period all do not receive thrombolytic therapy. We studied the proportion of early arrival strokes and to evaluate causes of non-administration of rt-PA. Methods and Material: We included all patients of acute strokes who reached the hospital within window period between January 2010 and December 2013. Factors determining rt-PA administration and factors causing intra-hospital delays in administering rt-PA were analyzed. Results: Out of 93 ischemic stroke patients 71(76.3%) received intravenous rt-PA. Among the 22 non-thrombolysed patients (23.7%) one patient had a large infarct on imaging one had hemorrhagic conversion one had preceding upper gastrointestinal (UGI) bleed and one patient had recent cataract surgery. Five patients were not thrombolysed because of rapidly improving symptoms. Four patients could not afford the treatment. One patient was on oral anticoagulants with INR 3. In one patient infusion was stopped because of bleeding diathesis in another patient it was stopped because of persistent hypertension. Two patients were notified late to the neurologists by the emergency department. Two patients could not be thrombolysed because of logistic difficulty in organizing the endovascular treatment. Conclusions: Our study highlights the fact that about one fourth of ischemic stroke are not thrombolysed even after arriving in the window period. Some of the reasons are potentially preventable like non affordability intra-hospital delay and non-availability of newer endovascular interventions.

0

Session: Platform clinical 1.1

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall A

A hospital based registry of cruetzfeldt jakob disease -impact of clinical criteria on diagnosis

Divya KP, Ramshekhar N. Menon, Bejoy Thomas, MD Nair

Department of Neurology, Sctimst, Trivandrum.

Background:  Creutzfeldt-Jakob disease More Details (CJD) is a rare yet well-known cause of rapidly progressive dementia with a fatal outcome. However, given the variable sensitivity of available clinical criteria , the diagnosis of CJD still remains complicated Objective: To study the clinic-radiological heterogeneity of sporadic CJD and the impact of available clinical criteria in comparison to the WHO criteria Materials and Methods: Patients of rapidly developing dementia fulfilling the diagnostic criteria for CJD from January 2000 to December 2013 were included. The clinical details were collected and all patients underwent electroencephalography (EEG), magnetic resonance imaging (MRI) of brain and results were documented. Results: A total of 41 patients of CJD were diagnosed using the WHO 1998 diagnostic criteria between January 2000 and October 2013. All presented with rapidly progressive dementia in addition to two of myoclonus, visual disturbances,cerebellar,pyramidal ,extrapyramidal dysfunction or akinetic mutism. 92 patients satisfied the UCSF 2007 and European criteria (2009),73% satisfied the proposed UCSF MRI criteria. The mean disease duration from symptom onset to death was 7.2 months. Conclusions: Siginficant clinical heterogeneity exists in the presentation of CJD , rapidly progressive dementia and myoclonus being the dominant presentation in our cohort. It is important to make an accurate diagnosis of CJD given its high morbidity and mortality

0

Session: Platform clinical 1.2

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall A

Carpal tunnel syndrome: A comprehensive study from western india

Gaurav M. Kasundra, Amita Narendra Bhargava, Bharat Bhushan, S. Khichar, Isood, M. Yasin, Janardan

Department of Neurology and Medicine, SN Medical College, Jodhpur, Rajasthan.

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, but not adequately studied in India. Objectives: To study clinical tests, nerve conduction studies (NCS), ultrasonography (USG) and magnetic resonance imaging (MRI) in diagnosing CTS. Methods: We diagnosed CTS in 60 patients (105 hands) out of 82 screened patients with symptoms compatible with CTS, including 19 control patients (23 hands). We conducted provocative tests and calculated Boston Carpal tunnel Questionnaire (BCTQ) symptom (S) and function (F) severity scores. NCS positive patients were classified into mild, mild-to-moderate, moderate, severe and all NCS positive CTS (ACTS) groups. Median nerve antero-posterior (AP), transverse (TR), circumference (CIR) and cross-sectional area (CSA) at inlet (I), middle (M) and outlet (O) each was measured by USG in all NCS positive patients (54 patients, 93 hands). MRI was done in 26 patients (39 hands). Results: Phalen, hand elevation and pressure provocation tests had higher sensitivity, Tinel's test had higher specificity and tethered median nerve and tourniquet tests had low sensitivity and moderate specificity. Sensitivities of NCS, USG and MRI were high, low and moderate respectively. Both NCS and USG had high specificity. USG in patients compared to controls was significantly abnormal in CSA-I, CIR-I and CSA-O. Significant correlation was found between BCTQ-S and NCS and BCTQ-S and CIR-O. CIR-C, CIR-O, CSA-C and CSA-I had correlation with NCS. MRI was significant in moderate and in moderate+severe groups combined. Conclusion: NCS remain gold standard but USG and MRI help increase sensitivity and detect mass lesions amenable to surgery.

206

Session: Platform clinical 1.4

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall A

A study of the impact of chronic daily headache on quality of life in a tertiary care centre in South India

A. C. Somasundaram, Mohamed Kilji, Praveen Chander, T. Muthu, S. Balasubramanian, K. Bhanu

Institute of Neurology Madras Medical College Ch, Chennai.

Background: Chronic daily headache (CDH) is a very common and difficult-to-treat entity impairing the quality of life in various domains. Objective: The main objective of this study was to investigate the degree of impairment of the quality of life in patients with CDH. Materials and Methods: 40 consecutive patients (more than 13 years of age) fulfilling criteria for CDH and 40 age matched healthy controls were recruited. Quality of life across various domains was then assessed and compared with the SF-36 questionnaire. Results: Of the 40 CDH patients 26 (65%) and among the 40 controls 23 (57.5%) were female. The mean age of patients with CDH was 37.5 years and that of the control group was 39.5 years. The SF-36 scores were significantly and consistently lower in the CDH group across all domains when compared with controls. The mental health domain was the most affected with mean score of 27.2 in CDH patients when compared to controls with score of 73.2. The bodily pain domain followed with mean score of 24.7 in CDH patients and 62.6 in the control group. The mean scores across physical functioning (48.3 and 68.1) role physical (49.4 and 69.5) general health (50.2 and 69.4) vitality (36.8 and 55.2) social functioning (39.7 and 63.6) and role emotional (47.4 and 73.1) domains also showed significant difference. Conclusion: CDH impairs the quality of life across all domains especially in the mental health and bodily pain domains.

233

Session: Platform clinical 1.5

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall A

A study of dengue encephalitis in tertiary center of North India

Rajesh Verma, Vinod Kumar Mehta, Ravindra Kumar Garg,

Hardeep Singh Malhotra, Praveen Sharma

King George Medical University, Lucknow, UP, India.

Objectives: Dengue infection caused by a flavivirus is endemic in more than hundred countries including India. With expanding clinical spectrum encephalitis has been documented with increased frequency. This study evaluate the incidence of Dengue encephalitis(DE) and correlates their outcome with clinical laboratory and Neuroimaging (MRI/CT) profile in patients with dengue virus infection. Methods: It's a hospital based prospective cohort study conducted at King George's Medical University in Lucknow India over a period of 2 years (August2012 to July2014) which included laboratory confirmed DE cases. We estimated incidence and analyzed clinical laboratory and neuroimaging data on admission discharge and follow-up for 3 months to assess outcome predictors of DE. Results: Out of screened 540 confirmed Dengue cases 27 patients had DE representing 5% incidence. Two third were 20 years of age or younger with male preponderance (75%). Fever Headache Seizure and Altered sensorium was present in >90% while 8 (29.63%) patients had poor glassgow coma scale(GCS). Rashes and Bleeding manifestations were present in only 3(11%) while thrombocytopenia and liver dysfunction in 10 and 3 cases respectively. Cerebrospinal fluid(CSF) was abnormal in 23(85%) and cerebral edema on neuroimaging in 16 (59%). One third patients died during hospital course and at 3 months follow up remainder were recovered. Conclusion: An increasingly higher incidence rate with high mortality of DE is reported. Clinical and laboratory parameters such as poor GCS dengue shock syndrome thrombocytopenia liver dysfunction and abnormal Neuroimaging are poor outcome predictors. Keywords: Dengue Flavivirus Dengue encephalitis..

82

Session: Platform clinical 1.6

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall A

Study on clinical profile of neurological manifestations in patients with hematolymphoid neoplasms

Kishalaya Karan, Kishalaya Karan, Koushik Dutta, Chiranjib Das, Jacky Ganguly, Prasenjit Sengupta, Sandip Pal, Debasis Basu, Prantar Chakraborty,

DM Trainee Neurology Medical College, Kolkata.

Background: Neurological manifestations(NM) in hematolymphoid neoplasms(HN) often lead to increased morbidity in patients. This study proposes to characterise those manifestations. Aims and Objectives: To characterise NM at presentation & during/after therapy of HN to determine causes of neurological disorders disease / therapy related. Materials and Methods: A prospective observational study of 194 newly diagnosed HN patients attended/admitted Department of Neurology and/or Hematology Medical College Kolkata from February 2013 to January 2014. At presentation history taken detailed neurological examination done therapy for neoplasm given by Hematology Department patients followed up for six months investigations done accordingly. Results: Among 194 patients NM seen in 53.6% cases (72.3% 43.5% 45% of total myeloma leukemia lymphoma patients). Among patients with NM(104) majority developed only during/after therapy (78%) followed by both at presentation & during/after therapy (16%) only at presentation (6%). Regarding causes of NM therapy related causes more (78.8% of patients with NM ) than directly disease related (28.8%) & indirectly disease related (24%) ones. Most common NM are peripheral neuropathes seen in 58.5% 33.3% 27.5% of total myeloma leukemia lymphoma patients. Among neuropathies (78) sensory axonal 52% sensory-motor 44% entrapment 3% demyelinating 1%. Chemotherapeutic agents causing peripheral neuropathies are bortezomib Thalidomide Vincristine. Conclusion: NM are common in HN particularly in myeloma. Most are therapy related (chemotherapy induced peripheral neuropathies). They developed during /after therapy. These findings may help for formulation/ modification of proper management strategies of HN.

6

Session: Platform clinical 2.2

Date and Time: 8:30 - 9:30, Saturday, 08 Nov 2014

Venue: Hall B

Evaluation of efficacy of existing criteria in diffentiating the various etiologies of acute and subacute meningoencephalitis

Uma Sundar, Ankit Riyani, Wasim Mujawar, Sameer Shrirangwar, Meenakshi B. A, Abhilasha M, D. Asole, S. Gulhane, Bhushan Chopade

Lokmanya Tilak Mun Med College & Hospital Sion M, Mumbai.

Aims: To evaluate early and final diagnosis and efficacy of existant criteria in diagnosing acute meningo-encephalitis. Methods: Prospective1 year serial recruitment - clinical and final diagnosis using standard criteria with serology+CSF+ imaging. Results: 112 patients1. Category-wise ( Admitting vs Final diagnosis): TB meningitis(42 vs35)Pyomeningitis (14 vs11)Cryptococcal ( 02 vs 03) Viral Encephalitis ( 11vs06)Cerebral Malaria ( 42vs 31)Leptospirosis (01 vs 07)Dengue (00 vs 01)SSPE ( 00vs 01) Unclassified( 00 vs 17).2. Efficacy of existing criteria: Sensitivity Specificity PPVNPV respy. - TB M- 97.1%89.6% 0.8 0.98. Pyomeningitis 100% 97% 0.78 1. Cerebral Malaria 100% 87.9% 0.73 1. Viral encephalitis 83.3%94.3%0.45 0.95 3. Criteria unsatisfied in finally - diagnosed TBM (35):- 5 / 35 - CSF 7 / 35- MRI25/ 35 - no extra CNS Tuberculosis.4. Positive investigations in a possible TBM (5) 3 / 5 satisfied all CSF criteria3 / 5 satisfied MRI 1 had extra CNS tuberculosis.5. 3 / 40 patients with definite or probable TBM had fever < 2 weeks6. Out of 17 (15.1%)unclassified patients" - 5 were possible TBM and 4 were possible viral encephalitis (treated accordingly ). 8/112 (7.1%) remained truly unclassified with fever of mean 12.5 days 37.5 % meningism mean GCS 12 mean CSF cells 56/cu. mm and focal imaging in 37.5% mortality 26%.7. Mortality- Cryptoccosis 100% TBM 26% Viral Encephalitis 47% Malaria 4%.

105

Session: Platform clinical 2.3

Date and Time: 8:30 - 9:30, Saturday, 08 Nov 2014

Venue: Hall B

Role of brain biopsy in neurological disorders

Y.S. Sirohi, Vikram Asturkar, S. P. Gorthi, Y. S. Sirohi, A. K. Sharma, V. Dutta

Army Hospital R&R Delhi, New Delhi.

Context: Brain biopsy and excision is the standard clinical practice in neurological malignancies. However its role has not otherwise been clearly established for other neurological differentials. Recent advances in multimodal neuroimaging has revolved the diagnosis in neurological cases and the brain biopsy is not carried out routinely either for diagnosis or confirmation of diagnosisAim: We conducted this study to determine the value of brain biopsy for difficult to diagnose patients at this hospital. Settings and Design: This is a prospective observational study conducted at a single centre tertiary care hospital. Methods and Material: We included ten patients who were difficult to diagnose even after extensive noninvasive evaluation. These patients underwent brain biopsy as per decision taken by the treating physician. The patients were followed up for a period of one year. Results: The biopsy was helpful in arriving at a diagnosis in 90% cases and the biopsy result made a change in treatment modality in 60% cases. Only one patient had symptomatic intracerebral haemorrhage post biopsy. Conclusion: A timely decision regarding biopsy is very important for good neurological as well as overall outcome.

177

Session: Platform clinical 2.4

Date and Time: 8:30 - 9:30, Saturday, 08 Nov 2014

Venue: Hall B

Photostress test: Normative data and its application in patients of migraine without aura

Arun Koul, Anirban Ghoshal, S. P. Saha

NRS Medical College and Hospital, Kolkata, India.

Background: Photostress test is a simple bed side test which can help differentiate retinal from optic nerve disease. However due to the paucity of reliable reference values the test is not widely used. Besides visual symptoms and hypersenitivity to light stimuli are common in patients with migraine headache. This led us to postulate that photostress test might be abnormal in patients of migraine headache. Objectives: To provide reference values for the photostress recovery time and to apply the test in patients of migraine without aura. Materials and Methods: It was a prospective hospital based study which included 50 healthy volunteers and an equal number of patients diagnosed as migraine without aura as per the ICHD-3 criteria. Baseline visual acuity was noted using Snellen's chart and then the test was done by exposing one eye at a time to the light from an ophthalmoscope for a duration of 10 seconds. The time taken for the acuity to return to within one line of pre bleach acuity was measured. Results: The photostress recovery time in the 50 healthy volunteers ranged between 3 and 15 seconds (mean: 8.6 standard deviation 3.51). The recovery time in the patients with migraine headache also came to be within the normal range. Conclusions: The mean photo stress recovery time in normal healthy individuals is 8.6secs and it doesn't show any significant prolongation in patients with migraine without aura.

265

Session: Platform clinical 2.6

Date and Time: 8:30 - 9:30, Saturday, 08 Nov 2014

Venue: Hall B

A case series of cortical venous thrombosis with polycythemia in alcoholics

Youmash V P, Jawahar M, Uma Maheswari E, Usha, Bhoopathy R. M

TN Govt Multisuperspeciality Hospital Chennai, Madurai.

Introduction: Cerebral venous thrombosis is a rare initial presentation of polycythemia. If diagnosed early treatment can reduce mortality and morbidity significantly. Often it may present with headache as the only complaint. Here we present three patients with CVT as initial presentation of polycythemia related to alcoholism. Case vignette: Three medically stable males chronic alcoholics all between 30- 40 yrs of age after an alcoholic binge were admitted with gradually worsening severe throbbing headache with visual disturbances. Initial neurological examination revealed bilaleral papilledema with ophthalmoparesis. Initial laboratory workup showed hemoglobin >18 g/dl and hematocrit > 54%. Further evaluation by MRI with MRA/MRV of the brain suggested extensive and complete thrombosis of the superior sagittal sinus in common along with few other sinuses involvement. Given that the patient first presented with a thrombotic event workup for primary polycythemia and hypercoagulable disorders was carried out including JAK2 mutation evaluation which was negative. This left us with alcoholism as the only significant risk factor and possible cause for polycythemia. They improved significantly with phlebotomy and anticoagulation treatment. Discussion: Acute abuse of alcohol inhibits the release of antidiuretic hormone and the result may be a high packed cell volume due to a low plasma volume ("relative polycythaemia"). The evidence that chronic abuse of alcohol might lead to increased erythropoiesis and absolute polycythaemia rather than just a fall in plasma volume is circumstantial. Erythropoietin levels in the serum of our patients were low normal which was suggestive of absolute polycythemia. Conclusions: Firm evidence linking alcohol and polycythaemia is still scanty. These cases demonstrate an unusual initial presentation of polycythemia as CVT in alcoholics.

30

Session: Platform dementia 1.1

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall B

Role of biomarkers in Alzheimer and vascular dementia

Vishnu V Y, Manish Modi, Manju Mohanty, Niranjan Khandelwal, B. R. Mittal, Vivek Lal, Sudesh Prabhakar

Postgraduate Institute of Medical Education and Re, Chandigarh.

AbstractIntroduction: The objective of the study was to find the relationship between CSF plasma & imaging biomarkers with dementia (Mild Cognitive Impairment Alzheimer's disease and Vascular dementia). Materials and Methods: Seventy patients who gave consent for performing at least two of the biomarkers (CSF Plasma or FDG PET) were included in the study. FDG PET brain was done in all these 70 patients. Three plasma biomarkers Fibrinogen d dimer CRP and Homocysteine were done in 70 patients. Plasma Clusterin and IL6 were done in 48 patients. CSF biomarkers (Aο Ͳ42Amyloid Total Tau) were done in 48 patients. Results: CSF Aο Ͳ42 Amyloid and Tau was significantly different from the control samples (p=0.000). There was significant difference between Alzheimer and Vascular group ((p=0.000). Plasma Clusterin and IL6 was significantly lower in patient group compared to control group. But there was no significant difference among Alzheimer & Vascular group or among the Alzheimer group. Fibrinogen and D-dimer were significantly different in Vascular compared to Alzheimer group. The relation of biomarkers with neuropsychological tests will be discussed. There was significant correlation between FDG PET Brain and Aο Ͳ42 Amyloid (p=0.000) Total tau (p=0.000) Tau/Amyloid Ratio (0.000). But other biomarkers studied (plasma clusterin IL 6 Fibrinogen d dimer CRP) was not significantly related to FDG PET Brain. Conclusion: The CSF biomarkers (Aο Ͳ42 amyloid and total tau) are significantly correlated with FDG PET Brain imaging in Alzheimer patients. Plasma Clusterin and IL 6 were reduced in dementia patients whose relevance need to be probed further. Fibrinogen and d-dimer may help in differentiating between Alzheimer and vascular dementia.

109

Session: Platform dementia 1.2

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2015

Venue: Hall B

Structural correlates of mild cognitive impairment: a clinico-volumetric case-control study

Ramshekhar N. Menon, Sheela Nair, Lekha V. S, Sunitha Justus, Sankara P. Sarma

SCTIMST Trivandrum 11, Trivandrum.

Aims: To examine the structural brain abnormalities in amnestic mild cognitive impairment (a-MCI) relative to early Alzheimer's disease (AD) and cognitively normal elderly healthy controls (CNHC) using voxel based morphometry (VBM) and its correlation with neuropsychological measures between cohorts. Methods: Fifteen subjects with a-MCI (60-80 yrs) were compared to 11 patients of early AD (62-79 yrs) with Clinical Dementia Rating Scale<2 and 22 CNHC (55-84 yrs). Neuropsychological measures included Malayalam versions of Adenbrook's Cognitive Examination (ACE) battery and Rey Auditory Verbal Learning Test (RAVLT) cumulative learning-recall scores. The structural MRI data were acquired using a 1.5 Tesla scanner and analysis was performed using VBM5.1 toolbox. Group comparisons for grey matter (GM) morphometry and statistical parametric mapping (SPM) were performed between the 3 groups with age sex and total intracranial volume as covariates using analysis of covariance (ANCOVA) within the framework of general linear model in SPM5. Results: The cohorts were matched for education status. On ANCOVA between a-MCI and CNHC reduced GM and precuneus volumes correlated with impairment in ACE-recall (P=0.0070.003respectively) total ACE (P=0.003 0.001) & and RAVLT learning (P<0.001) and recall (P<0.001) scores. Comparisons between a-MCI and AD groups demonstrated significant atrophy in AD over GM (P=0.002) hippocampi (p=0.007) parahippocampal gyri (p=0.003) right amygdala (p=0.003) left inferior temporal gyrus (p=0.003) and left posterior superior temporal gyrus (p=0.042) that variably accounted for differences in ACE-recall total ACE RAVLT registration and recall scores. Conclusion: Morphometric measures of learning and recall impairment in a-MCI are realistic and confirm the deficits evident this group of patients at risk for conversion to AD. The study highlights the importance of VBM in MCI populations.

141

Session: Platform dementia 1.3

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2016

Venue: Hall B

Behavioral and psychological symptoms in vascular dementia;difference between small and large vessel disease

Vadivel s, Prof. Dr. K. Bhanu, Prof. Dr. V. Kamaraj

Madras Medical College&Rgggh, Coimbatore.

Introduction: Vascular dementia is the second most common type of dementia next to Alzheimer's disease. Behavioral and psychological symptoms are increasingly recognized as important clinical features of the dementia syndrome. These symptoms impact the quality of life of the patients with dementia and their care givers. Aim: To determine the prevalence of behavioral and psychological symptoms in patients with Vascular Dementia and compare the severity and frequency of symptoms between small and large vessel disease Material and Methods: Design of study: Prospective analytical study. Period of study: 6 months. No. of patients: 30 Place of study: Madras Medical College and RGGGHVascular dementia fulfilling the NINDS-AIREN criteria was included in this study. This includes probable and possible dementia only. Symptoms were assessed by NPI score (12 items) and it was considered present when the score was β‰͵ 1. Based on MRI patients were classified as small and large vessel disease. Results: Behavioral and psychological symptoms were reported in all VaD patients (100%). Depression was most prevalent (83.3%) followed by agitation(63.3%)apathy(60%) and irritability (60%). Patients with small vessel disease reported more apathy and aberrant motor behavior (p<0.05). In contrast patients with large vessel disease reported a high prevalence of agitation/ aggression and irritability (p<0.05). Depressive symptoms were statistically equally distributed in both groups. Conclusion: Behavioral and psychological symptoms are common in VaD. Patients with small and large vessel VaD demonstrate different profiles of symptoms with especially more apathy in small vessel and more agitation/aggression in large vessel vascular dementia.

240

Session: Platform dementia 1.4

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2017

Venue: Hall B

Gait impairment in normal pressure hydrocephalus

Remya Prakash, Robert Mathew, Sauda, Selvi

SK HospitalEdapazhanchyTrivandrum, Trivandrum.

Aim: To study the pattern of gait impairment in patients with normal pressure. Methods: Prospective cross sectional descriptive study. Patients with possible or probable Normal Pressure Hydrocephalus( NPH) as per the consensus criteria were included. Patients availing dementia care service during the period 2007 to 2013 were selected. All the patients underwent detailed neurologic neuropsychologic and neuroradiologic evaluationPatients were made to walk 5 to 10 meters and video of the gait was recorded. The videos were analyzed by a neurologist blinded to the clinical details as well a neurologist experienced in cognitive neurology.and scoring was done using a formal Gait Scale developed as part of the Dutch normal pressure hydrocephalus study. Results: Of the 50 patients with NPH video recording could be done in 28 patients. Mean age was 71.21(SD78.15)yearsMales 71%. Mean duration of illness 3.04(SD 2.61). All patients have cognitive impairment(mean ACE 25.37 SD 14.05). Of the eight parameters studied most common impairment was small steps [percentage of maximum score (PMS) 87.5] and the least common impairment was in tendency towards falling PMS.43. No correlation was seen between age duration of illness or mean ACE score. Good correlation was seen among the gait subscores (p<.05Pearson co-relation ). No correlation was seen between any of the ACE subscore and gait total or subscores. Conclusions: In this cohort of NPH patients with gait abnormality and cognitive impairment the most common gait abnormality was small steps. No correlation was seen between cognition and gait abnormality.

111

Session: Platform dementia 1.5

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2018

Venue: Hall B

Brain SPECT study in degenerative and vascular dementia patients

Subhasis Maitra, Dr. Atanu Biswas, Dr. Saikat Choudhury

DM resident(Neurology) BIN Kolkata, Kolkata.

Background: Degenerative dementias are diagnosed by validated clinical criteria and neuroimaging like MRI brain. Functional neuroimaging like SPECT PET can reliably distinguish different subvarieties of dementias. Objectives: This observational cross sectional study intended to find out the pattern of hypoperfusion of different brain areas in demented patients by using 99mTc ECD radionuclide brain SPECT. Methods: Dementia patient attending the OPD and dementia clinic of BIN Kolkata were taken from March 2013 and continuing till date. Disease severity and ADL were assessed using clinical dementia rating (CDR) scale and Instrumental Activities of daily living in the elderly (IADL-EDR) respectively. SPECT study of brain was done using ECD radionuclide injection. Results: Out of 21 patients assessed so far 13 were male and 08 were female. The average age was 62.3 Β΁9.3. The mean CDR was 1.86Β΁0.84 and IADL-EDR score was (expressed in CDI) 0.64Β΁0.25. Out of 21 patients 8 were clinically AD 4 were FTD 2 were VaD 1 each for DLB CBGD Mixed dementia and PDD. Three were clinically unclassifiable. SPECT showed typical fronto-temporal hypoperfusion in all 4 FTD patients; typical temporo-parietal hypoperfusion in 4 AD patients parietal lobe hypoperfusion in DLB patient and basal ganglia hypoperfusion in VaD patient. Conclusion: SPECT study of brain was helpful in establishing the diagnosis of dementias. When clinical criteria fails to categorize patients in a particular subtype of dementia SPECT can definitely help.

149

Session: Platform dementia 1.6

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2019

Venue: Hall B

Dementia in developing countries: Does education play the same role in India as in the West.

Suvarna Alladi, Suvarna Alladi, Gowri K. Iyer, Thomas H. Bak, Mekala Shailaja, Annapurna Mamidipudi, Amulya Rajan, Divyaraj Gollahalli, Jaydip Ray Chaudhuri, Subhash Kaul

Nizam's Institute of Medical Sciences, Hyderabad.

Background: Evidence suggests that education protects from dementia by enhancing cognitive reserve. However this may be influenced by several socio-demographic factors. Rising numbers of dementia in India high levels of illiteracy and heterogeneity in socio-demographic factors provide an opportunity to explore this relationship. Aims: To study the association between education and age at dementia onset in relation to socio-demographic factors. Methods: Association between age at dementia onset and literacy was studied in relationship to potential confounding factors such as gender bilingualism place of dwelling occupation vascular risk factors stroke family history of dementia and dementia subtypes. Results: Case records of 648 dementia patients diagnosed in a specialist clinic in a University hospital in Hyderabad India were examined. All patients were prospectively enrolled as part of an ongoing longitudinal project that aims to evaluate dementia subjects with detailed clinical etiological imaging and follow-up studies. Of the 648 patients 98(15.1%) were illiterate. More than half of illiterates were engaged in crafts unlike literates who were in trade or clerks. Mean age of onset in illiterates was 60.1years and in literates 64.5 years (p=0.0002). Factors independently associated with age at dementia onset were bilingualism rural dwelling and stroke but not education. Conclusions: Our study demonstrates that in India rural dwelling bilingualism stroke and occupation modify the relationship between education and dementia.

126

Session: Platform Epilepsy 1.1

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall A

Effectiveness of model of comprehensive acute stroke care program in government tertiary care centre

Dr. Priyank shah, Dr. Shalin Shah, Dr. Mayank Patel, Dr. Sudhir Shah

DM Neurology Resident-NHL Medical College VS Hospi, Ahemedabad.

Background: To improve utility and outcome of thrombolysis in government tertiary care hospital a model of comprehensive stroke care program was developed and effectiveness of it was evaluated in this study. Methods: We collected data of patients of ischemic stroke aged 18 -80 years in whom IV rtPA was given within 4.5 hours of onset during year 2013-14. NIHSS was calculated at the time of admission and discharge and MRS done in follow up ( 3 months) to see for outcome. This was compared with data of patients who received IV thrombolysis between 2010-11 when program was launched in the institute. Results: In year of 2013-14 out of 23 patients with NIHSS <4 at the time of admission are 1 (4%) and at the time of discharge are 12 (52%). Number of patients with MRS <3 at 3 months are 15(65%) and admitted <3 hours are 18(78%). In year 2010-11 out of 19patients with NIHSS <4 at the time of admission are 0(0%) and at the time of discharge are 6 (32%). Number of patients with MRS <3 at 3 months are 11 (58%) and admitted within < 3 hours are 5 (26 %). Conclusion: There is significant improvement in NIHSS score at the time of discharge and MRS at 3 months in patients who were thrombolysed with IV rtPA in the year 2013-14 mainly due to reduced onset to needle time. This reflects effectiveness of model of comprehensive acute stroke care program in government tertiary care hospital

222

Session: Platform Epilepsy 1.2

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall A

Clinical demographic profile and outcome of patients with Lennox-Gastaut syndrome (LGS)

Bhanu Pratap Singh Rathaur, Dr. R. K. Garg D. M., Dr. R. Verma D. M., Dr. H. S. Malhotra D. M., Dr. P. K. Sharma D. M., Dr. R. Kumar M. D.

Senior Resident Neurology, Lucknow.

Background: LGS is an epileptic encephalopathy & resistant to treatment. There is marked variability in studies on clinical features & treatment response. This study was planned to find out clinical profile & outcome. Material and methods: In this prospective study 43 patients of LGS were evaluated. Baseline clinical assessment including seizure semiology & frequency developmental quotient(D. Q.) modified barthal index electro-encephalography neuroimaging were evaluated and antiepileptics used were valproate clobazam levetiracetam lamotrigine & topiramate in various combination. Patients were followed at monthly interval for seizure semiology & frequency developmental quotient modified barthal index & treatment response for 6 months. Results: Tonic atypical absence myoclonic generalized tonic clonic and atonic seizures were present in 65% 39.5% 37.2% 67.4% and 46.5% of patients respectively. The mean D. Q. was 46.51 at baseline. On risk factor evaluation perinatal asphyxia acute encephalitis tuberous sclerosis & no risk factor were present in 60% 9.3% 4.6% and 18.6% patients respectively. On paired sample t-test tonic atypical absence myoclonic GTC & atonic seizures were reduced from 88.26/month to 7.28/month(p=.002) 73.88/month to 1.12/month(p=.047) 139.42/month to 19.07/month(p=.06) 63.95/month to 0.74/month(p=.03) & 72.58/month to 1.79/month(p=.002) respectively at 6 month on treatment with valproate+clobazam+levetiracetam (VPA+CLB+LEV) valproate+clobazam (VPA+CLB) valproate+clobazam+levetiracetam +lamotrigine (VPA+CLB+LEV+LTG) and valproate+clobazam +levetiracetam+lamotrigine+ topiramate (VPA+CLB+LEV+LTG+TPM) in 46.5 % 32.6 %7% & 7% of patients respectively. Conclusion: Perinatal asphyxia is commonest risk factor for LGS. The combination of VPA CLB & LEV provide good response to seizures reduction in majority of patients.

249

Session: Platform Epilepsy 1.3

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall A

Is mesial temporal sclerosis associated with diffuse white matter changes in limbic system: A diffusion tensor metrics study to validate network hypothesis

Anu Sundar, Anu Sundar, Smitha K. A, Sheela Kumari R, Ashalatha Radhakrishnan

Sree Chitra Tirunal Institute for Medical Sciences, Trivandrum.

Background: TLE is the most common type of partial epilepsy and is mostly caused by mesial temporal sclerosis (MTS). They have gray and white matter abnormalities both ipsilateral and contralateral to the epileptogenic zone re-emphasizing that mesial structures are part of a network that is activated to cause seizures. Objective: To define abnormalities in the afferent and efferent tracts of limbic system using diffusion tensor imaging (DTI) connecting the hippocampus to understand the pathophysiology of TLE and epileptogenesis. Methods: 53 MTS patients and 22 healthy controls were included. DTI data were obtained as 40 slices with voxel dimensions 1.98 X 1.98 mm. In 1.5 Tesla MRI (Magnetom Avanto) DTI was acquired in 30 non-collinear directions (TR=3500ms TE=105ms slice thickness=5mm slice spacing=6.5mm b factor 0 and 1000 mm2/sec). Fractional anisotropy (FA) apparent diffusion coefficient (ADC) relative anisotropy (RA) and volume ratio (VR) were obtained by drawing ROI (3-4 mm) in fornix cingulum uncinate fasciculus inferior/superior longitudinal fasciculus genu and splenium of the corpus callosum in TLE patients and controls. The significance was assessed using student's t-test. Results: In patients reduced mean FA ADC and RA were observed in tracts ipsilateral to MTS when compared to contralateral hemisphere and controls (p=0.013). Among the tracts evaluated ipsilateral cingulum showed markedly reduced mean FA (p=0.017) and RA (p=0.019). Conclusion: FA/RA reflects the fiber density axonal diameter and myelination in white matter. Among the extra hippocampal structures cingulum showed the maximum affliction in MTS thereby proposing the network hypothesis causing epileptogenesis. The mechanisms of epileptogenesis will be discussed.

11

Session: Platform Epilepsy 1.4

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall A

Endocrine Reproductive and Psychiatric comorbidity in Women with Epilepsy (WWE)- a prospective study

Dnaneshwar Asole, Sonal Thakur, Uma Sundar, Asheesh Patil, Meenakshi B. A, Abhilasha M, S. Gulhane, Wasim Mujawar, Sameer Shrirangwar, Bhushan Chopade

Lokmanya Tilak Mun Med College & Hospital Sion M, Mumbai.

Aim: To evaluate prevalence of reproductive endocrine dysfunction in WWE. M&M: 102 WWE ( median age 27; 76 SE 21 IGE 5 cryptogenic) were prospectively studied over 1 year. 59 women were included in Reproductive health study ( 43/102excluded- 17 pregnant 18 menopausal 3 metabolic seizures and 5 lost to review) Tests-2 recordings of FSH LH Prolactin TFTUSG pelvisin 3 cycles for follicular study Monthly weight charting (70 women) and psychiatric evaluation(100 women) were done over 6 months. Results: Of the 9/59 patients (15.2%) with irregular menstrual cycle 8 had SE (5/8 limbic localization). Menstrual irregularity was independent of seizure frequency or polytherapy.13/36 patients (36.11%) had anovulatory cycles.5/13 patients (38.5%) had PCOS on USG- 3 had acne and high BMI 2 had hirsuitism & 4 had irregular menses. CBZ and Valproate singly or in combination had most anovulatory cycles (50% and 30.7% respy.). FSH- LH axis abnormality was seen in 17/38 (44.7%) patients (3/17 s/o PCOS2/17 s/o menopause 6/17 s/o hypopothalamic amenorrhea 6 non-specific) abnormal prolactin in 6/32(18.7%) patients. Anovulatory cycles and FSH-LH abnormality were comparable in IGE and symptomatic epilepsy (28.6%:42.9% and 46.6%:45.4% respectively). Anovulatory cycles correlated significantly with polytherapy (p 0.004) but not with seizure control or type ( p 0.3 and 0.2 respy.).11/100 patients had psychiatric comorbidities commonest being depression (3/11) Panic and OCD ( 2/11 each).20/70(24.3%) patients gained weight over 5 kgs in 6 months( maximum in Valproate-53.3%). Polytherapy did not correlate with significant weight gain.

92

Session: Platform Epilepsy 1.5

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall A

Prevalance of depression and its predictors in patients with medically refractory temporal lobe epilepsy (TLE)

Sandeep P, Pradeep P. Nair, Sanjeev V. Thomas, Ashalatha R, Ramshekhar N. Menon

Sree Chitra Tirunal Institute for Medical Sciences, Trivandrum.

Introduction: Depression is a common comorbid condition in patients with epilepsy that reduces the quality of life. It has a prevalence of 20% - 50% reported in tertiary care centers in patients with active epilepsy. Depression is under-recognized and undertreated in patients with epilepsy. Depression is more prevalent in temporal lobe epilepsy (TLE). AimThis is a prospective observational study to determine the hospital based prevalence and severity of depression and its relation with clinical and investigational characteristics of patients with medically refractory TLE. Methods: 50 consecutive patients with refractory TLE admitted for pre-surgical evaluation at Sri Chitra Tirunal institute for medical sciences and technology were screened for depression using Beck's depression inventory II (BDI-II). Demographic and clinical characteristics of patients were studied. Patients with BDI-II score of more than 11 were classified as depressed. Results: 17 patients (34%) had depression as screened by BDI-II 12 of whom were female. 13 of the 17 (74%) patients had left sided temporal lobe epilepsy. 12 of the 17 patients had hippocampal sclerosis which was equally represented in the non-depressed group as well. The depression group had poor seizure control compared to the patients without depression (p<0.05). Conclusion: Patients with TLE especially left sided are particularly prone for depression. Screening TLE patients for depression helps to identify and treat this co-morbid condition which will improve their quality of life.

115

Session: Platform Epilepsy 1.6

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall A

Intrasinus thrombolysis in cerebral venous sinus thrombosis experience from a university hospital Andhra Pradesh India

Dr. M. L. Neeharika, Dr. Subash Kaul

Nizam's Institute of Medical Sciences, Hyderabad.

Background: In CVST unresponsive to conventional heparin therapy intrasinus thrombolysis is life saving. Purpose: To discuss the role of local thrombolysis in patients with unresponsive CVST. Methods: Hospital databases were sought and patients with cerebral venous sinus thrombosis who underwent intrasinus thrombolysis from 2011 till date were identified. Data on clinical presentation predisposing conditions imaging findings indications for local thrombolysis dose of thrombolytic duration of therapy and clinical outcomes retrieved. DSA was assessed using the Rabinstein score. Outcome analyzed included short term mortality complications and functional outcome. Results: 24 patients identified over a period of 3.5 years with a median age of 30.5 years. The presenting symptoms included headache (n-19) seizures (n=16) altered sensorium (n=14) and vomiting (n=16). Signs found included papilloedema (n=20) UMN facial palsy (n=16) and hemiparesis (n=15) 6th N palsy (n=4) 3rd N palsy (n=2) and aphasia (n=5). The most common association was hyperhomocysteinemia (n=7). 20 patients received unfractionated heparin and 5 received LMWH for a median period of 2 days before receiving local pharmacological thrombolysis. At the time of discharge 41.6% of cases had good improvement with mRS < 2 33.3% had partial improvement 2 patients (6.6%) died of expansion of hematoma size and mass effect and 2 patients died of sepsis. 2 patients bled intracranially and 2 more had local and nonintracranial systemic bleeds. Rapid and sustained recovery observed in about 75% of our patients is more than the most of previous published reports. Conclusion: Local thrombolysis is well tolerated and may be more effective than systemic heparin anticoagulation in moribund & unresponsive patients despite the potential for bleeding manifestations. However a randomized prospective study comparing heparin anticoagulation with intrasinus thrombolysis is warranted.

121

Session: Platform Epilepsy 2.1

Date and Time: 8:30 - 9:30, Saturday, 08 Nov 2014

Venue: Hall C

Status epilepticus: our experience in a tertiary care centre in North-Western India

Biplab Das, Parampreet K. Singh, Ashish Bhalla, Manoj Kumar Goyal, Rimi Som, Sudesh Prabhakar, Vivek Lal

Pgimer Chandigarh, Chandigarh.

Introduction: Status epilepticus (SE) is one of the most commonly encountered medical emergencies. Aim of this study was to examine the etiology and outcome of adult patients with SE presenting to our center. Patients and Methods: A prospective study was conducted from January 2009 to December 2010. Newly diagnosed patients as well as known case of seizure disorder presenting with SE were included. Detailed history clinical examination baseline investigation neuroimaging electroencephalogram findings were recorded. Patients were treated using a standard protocol and were followed-up for 2 weeks after discharge. Quantification of precipitating factors was done using proportion mean and standard deviation. Results: 86 consecutive patients were studied. Mean age was 38.43 Β΁ 16.56 years (range 13 to 78 years). Male to female ratio was 4:1 while upto 57% were known cases of seizure disorders. Generalized tonic-clonic seizure was commonest presentation (upto 90%). Majority had convulsive SE. Poor drug compliance was found to be the commonest precipitant (50% patients) followed by central nervous system infection (20% patients). Alcohol intake contributed upto 12% cases whereas precipitating factor couldn't be traced in 7.5% patients'. In 55% patients SE was controlled with no recurrence or complication and in 25% there was recurrence after control of SE. 15% patients ended up with persistent sequel (cognitive and psychosomatic dysfunction neurological deficit etc.) lasting for 2 weeks or more. The mortality was 5%. Conclusion: Poor compliance with drugs (in established cases of seizure disorders) and central nervous systems infections/structural lesions (in new onset cases) were commonest causes of SE in our study group. Conventional first line antiepileptics were able to control seizures upto 55% patients.

133

Session: Platform Epilepsy 2.2

Date and Time: 8:30 - 9:30, Saturday, 08 Nov 2014

Venue: Hall C

Epilepsy with myoclonic absences: Clinico-electroencephalography-imaging characteristics and long term outcome: Our experience from comprehensive epilepsy care center in southern india

Paresh Zanzmera, Ramsekhar Menon, Ashalatha Radhakrishnan, Sanjeev Thomas,

Government Medical College Surat & Sree Chitra Ti, Surat.

Purpose: To study clinico-electroencephalographic-imaging characteristics and long-term outcome of patients with epilepsy with myoclonic absences (EMA). Methods: In retrospective-cohort study we reviewed computer-database clinical records of EMA patients who attended epilepsy centre of institute. Each patient's detailed history video-electroencephalography and neuroimaging data were reviewed. Response to AEDs and change in seizure frequency on follow-up were noted. Responder was defined as >50% reduction in seizure frequency on follow-up. Results: During study period (2009-2013) 12 children had EMA [50% male mean age at onset 3.5 years (range 0.75-8 years)]. 50% had developmental delay and 66% had behavioral problems. Main seizure types were myoclonic absence (100%) and generalized tonic-clonic seizures (42%). Ictal correlate on VEEG was 3-3.5Hz spikes-and-wave discharges (82%). One patient had abnormal MRI. Drug tried before first evaluation was valproate-100% levetiracetam-75% clobazam-50% and clonazepam-41%. Mean duration of follow-up was 23.9 months (range 4-63 months). On follow-up seizure frequency had significantly improved (p=0.005) and at last follow-up nine-90% patients were in responder group: Four-45% seizure-free two-22% with >90% and three-33% with >50% reduction in seizure frequency. AEDs numbers were significantly lesser at last follow-up among responders (2.55 vs. 1.77 p=0.02) vs. non-responders (3 vs. 3). Two patients on follow-up developed complex partial seizures. Conclusion: This cohort one of the largest on EMA reveals heterogeneity of seemingly homogenous electroclinical phenotype. Clinical semiology while unique may demonstrate focality and variable ictal patterns. Most patients respond with either valproate monotherapy or valproate-lamotrigine combination. Fewer patients remain drug refractory and may evolve into complex partial seizures.

174

Session: Platform Epilepsy 2.3

Date and Time: 8:30 - 9:30, Saturday, 08 Nov 2014

Venue: Hall C

Status epilepticus severity score (STESS): A useful tool to predict outcome of status epilepticus

Sudheer Chakravarthi, Manish Modi, Manoj K Goyal, Aashish Bhalla, Sahil Mehta, Dheeraj Khurana, Parampreet S. Kharbanda, Vivek Lal, ,

PGIMER, Chandigarh.

Background: The treatment protocols for status epilepticus (SE) still remain elusive and therapeutic strategies range from small doses of benzodiazepines to induction of coma. The pros and cons of administration of aggressive treatment regimen is yet a debatable topic. A score which can determine severity of SE may help in guiding the intensity of treatment. SE severity score (STESS) is one such score useful for predicting outcome of SE. Methods: 44 consecutive patients of SE were studied to determine utility of STESS in predicting outcome of SE. Outcome measures studied were a) mortality b) final neurological outcome at discharge as defined by functional independence measure (FIM) (Good outcome: FIM score 5-7; Bad outcome: FIM score 1-4) c) control of SE within 1 hour of start of treatment and d) need for coma induction. Results: A higher STESS score correlated significantly with poor neurological outcome at discharge (p=0.0001) need for coma induction (p=0.0001) and lack of response to treatment within one hour (p=0.001). A STESS of <3 was found to have a negative predictive value of 96.9% for mortality 96.7% for poor neurological outcome at discharge and 96.7% for need of coma induction while a STESS of < 2 had negative predictive value of 100% for mortality coma induction and poor neurological outcome at discharge. Conclusion: STESS can reliably predict the outcome of status epilepticus and may act as a guide for the determining the degree of therapeutic aggression.

176

Session: Platform Epilepsy 2.4

Date and Time: 8:30 - 9:30, Saturday, 08 Nov 2014

Venue: Hall C

Levetiracetam versus phenytoin in management of generalized tonic clonic status epilepticus: A randomized open label study

Sudheer Chakravarthi, Manish Modi, Manoj K Goyal, Aashish Bhalla, Sahil Mehta, Dheeraj Khurana, Parampreet S. Kharbanda, Vivek Lal

PGIMER, Chandigarh.

Background: Drugs commonly used in management of status epilepticus include intravenous benzodiazepines as the first line agents and phenytoin fosphenytoin and valproate as the second line. The relative lack of serious side effects and favourable pharmacokinetics made levetiracetam (LEV) an attractive alternative in management of status epilepticus. However the data is sparse regarding the relative efficacy of second line agents. The purpose of this study was to compare safety and efficacy of IV LEV vis-a-vis IV PHT in management of SEMETHODS: 44 consecutive patients of SE whose seizures failed to get controlled with a bolus injection of lorazepam were randomized into two groups A and B to receive IV PHT (20 mg/kg) and IV LEV (20 mg/kg) respectively. The primary end point was clinical seizure control within 30 min of drug administration. Secondary outcome measures included (1) recurrence of seizures within 24 hours of control of SE; (2) drug related adverse effects 3) neurological outcome at discharge (4) need for ventilatory assistance during hospitalization and (5) mortality during hospitalization. Results: PHT achieved control of SE in 15 (68.2%) patients compared to LEV in 13 (59.1%) patients (p=0.53). Both the groups showed comparable results with respect to secondary outcome measures as well. Conclusion: LEV is equally effective as PHT in management of SE and has fewer adverse effects.

248

Session: Platform Epilepsy 2.5

Date and Time: 8:30 - 9:30, Saturday, 08 Nov 2014

Venue: Hall C

Clinicoradiological features and outcome of Moya moya disease and syndrome in a tertiary level teaching hospital

Karthik Muthusamy, Dr. Mathew Alexander, Dr. Sanjit Aaron, Dr. Maya Mary Thomas, Dr. Vivek Mathew, Dr. Anil B. Patil, Dr. Ajit Sivadasan, Dr. Prabhakar, Dr. Sangeetha Yoganathan, Dr. Sunithi Mani

Assistant Professor, Vellore.


Moya moya disease is an idiopathic vasculopathy affecting terminal internal carotid arteries with bimodal distribution of age at presentation. Type of study: Retrospective Place of study: Christian Medical College Vellore Tamilnadu. Methodology: Chart of patients diagnosed to have Moya Moya disease and syndrome (2003 to 2013) were analysed for demographic characteristics clinical presentation radiological features management and outcome. Results and Discussion: 115 patients (62 males and 53 females) were studied. Age at onset of stroke was 15.4 years (Range 6 months - 60 years). Children formed majority of the group(69.5%). Anterior circulation was involved in all patients and posterior circulation in 69 patients(60%). Most common presentation was hemiparesis(44%) followed by seizure (43%) headache(6%) language disturbances(2%) cognitive decline(0.08%) chorea(0.08%) visual symptoms(0.08%) and asymptomatic (0.08%). Family history was positive in 4 patients. 13 patients had syndromic diagnosis Neurofibromatosis (4) tuberous sclerosis (1) downs syndrome(1) PHACES syndrome (1) EBV infection (1) Sickle cell anemia (2) thalessemia(1) and megaloblastic anemia (1). All children presented with ischaemic events and 4 adults presented with hemorrhage. One patient had coexistent basilar artery aneurysm. 26 patients (22.6%) underwent surgical revascularisation (EncephaloDuroArterioSynangiosis). Mean follow up period was 2.19 years (Range 2 months to 10 years). The residual deficits disability and frequency of recurrent events were comparable in surgical and non surgical group though children did well. Conclusion: Moya moya disease and syndrome is most important cause for recurrent ischemic and hemorrhagic events both in children and adults. Clinical presentation and outcome are heterogenous. High index of suspicion evaluation of secondary causes and early medical / surgical intervention leads to better outcome.

275

Session: Platform Epilepsy 2.6

Date and Time: 8:30 - 9:30, Saturday, 08 Nov 2014

Venue: Hall C

Effect of an Antiepileptic drug(AED) holiday in the Epilepsy monitoring unit (EMU) on subsequent seizure frequency after reinstituting in medically refractory epilepsy patients: A prospective observat

Geetika Bajpai, MamtaBhushan Singh, Manjari Tripathi, Rohit Bhatia, M. V. Padma, K. Prasad, V. Sreenivas, S. Vivekananda

All India Institute of Medical Sciences, New Delhi.

Objective: The objective of the study was to prospectively observe the effect of temporarily withholding/ reducing AEDs on subsequent seizure frequency in patients with medically refractory epilepsy[MRE]. Methodology : The study was a prospective controlled observational study. Cases were MRE patients who were admitted in EMU for work up for epilepsy surgery. These patients underwent 25% reduction in at least one of their AED for at least 24hours. 124 cases were included and their baseline frequency demographic & clinical data was noted. 93Controls were enrolled from OPD or Electrophysiology lab. The follow up; telephonically or in person was for 1236 and 9 months post discharge from EMU for cases or from point of induction for controls. Result: Of 124 cases enrolled 55 showed decreased frequency significantly [p0.0002- Wilcoxon signed-rank test] and Carbamezapine had significant association [p=.015: Fisher's exact] in this group. There was no change in 56 cases and 11 were lost to follow up. There was no significant correlation with MRI substrate any defined epilepsy risk factor any other AED age or sex. There was no significant frequency change in control group. Conclusion: Brief drug holiday lowers the seizure frequency in MRE patients and can be an avenue in patient management by drug cycling. Though further large scale studies are needed.

0

Session: Platform inflamm 1.1

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall A

A cohort study of cognitive impairment in patients of multiple sclerosis

Rima Ram Paul, S. P. Gorthi, Y. S. Sirohi, C. S. Narayanan

Army Hospital, R & R, Delhi Cantt. New Delhi 110010.

Introduction: Multiple sclerosis (MS) is an inflammatory disease which disrupts the ability of nervous system to communicate, resulting in a wide range of signs and symptoms including physical, cognitive and psychiatric. Cognitive dysfunction is increasingly recognized as a critical factor in the quality of life of patients with MS. Remission of cognitive symptoms is uncommon, and cognitive decline may indicate progressive disease despite stable physical symptoms. Methods: A total of 30 patients of MS diagnosed by modified Mc Donald criterion 2010 had undergone MACFINS battery of Cognitive testing twice, first at the time of initial recruitement and then after a period of 6 months. Results: No significant cognitive decline was observed in patients after a mean follow up of 11 months. There was mild but not significant impairment in EDSS. There appears a strong direct correlation between all neuropsychological tests and physical disability. Most significant correlation of EDSS is seen with PASAT (P=0.002), BVMT1(P= 0.008), BVMT2(P=0.007), COWAT(P=0.0002) and Stroop B(P=0.009). Conclusion: Cognitive deterioration occurs probably insidiously and inconsistently in patients with MS. EDSS has significant direct correlation with cognitive impairment in these patients. A larger sample size study is required to conclusively establish cognitive performance in MS patients.

203

Session: Platform inflamm 1.2

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall A

A study of clinical spectrum and outcome profile in Aquaporinopathy: Experience from an Indian tertiary care hospital

Subhransu Sekhar Jena, Prof. Dr. Mathew Alexander, Prof. Dr. Sanjith Aaron, Dr. Ajith Sivadasan, Karthik Muthusamy

Christian Medical College Vellore, Vellore.

Background: Indian studies have consistently reported high incidence of optico-spinal syndrome in multiple sclerosis (MS). Though speculated it is not clear whether the NMO spectrums of disorders are responsible for this site specificity. Highly specific serum autoantibody marker (NMO IgG) helped to define a characteristic clinical and diagnostic spectrum. There is lack of natural history studies of aquaporinopathy from India. Objective: To study the clinical spectrum imaging electrophysiological and CSF characteristic of NMO-IgG positive patients with respect to outcome. Methods: Retrospective analysis of NMO-IgG positive patients in the Dept. of Neurology at Christian Medical College Vellore India during a period of 5 years. Results: We retrospectively studied 26 patients with NMO-IgG positivity with complete work up. We compared our data with other recent studies on NMO. None of our patient fulfilled the Mc Donald diagnostic criteria for MS (2010). The MRI of brain is found to be abnormal in 6(23.1%) patient most common location being periventricular location. The EDSS of patients at presentation and after follow up of 3.07 Β΁2.23 (0.1-8.0) years was mean 5.88Β΁1.86 (range 2-9) and 4.6Β΁2.0 (range 2-10) respectively. One patient in our series died due to respiratory failure. We found good clinical outcome in patients with NMO spectrum disorders. Other autoimmune disease was associated with 9(34.6%) patients in our series. All NMO patients should be have complete screening of systemic vasculitic diseases at onset and throughout the follow-up. Conclusion: In this small case series the varied presentation of Aquaporinopathy was demonstrated. The NMO-IgG has definite implications for prognostication and long term immunotherapy.

289

Session: Platform inflamm 1.3

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall A

Utility of 3D double inversion recovery sequences in detecting gray matter lesions in patients with multiple sclerosis

Dr. R. Ramya, Cheran Elangovan, Kalaimani Elango, R. Laxmi Narasimhan, V. Kannan, C. Amarnath, K. Bhanu

Institute of Neurology Madras Medical College, Chennai.

Introduction: Multiple sclerosis a disease of white matter as initially thought of is now been explored to involve cortical gray matter deepgray matter juxta of cortical region. GM involvement isdetected even in early stages of MS and GM atrophy occurs at a faster rate than white matter atrophy GM involvementand cortical demyelination can be extensive in MS can occur independently of white matter lesion may be the earliest manifestation ofMS and associated with physical disability fatigue and cognitive impairment in MS. Thenature of intra cortical plaques differ from those in white matterwith less inflammation and considerable reactive microgliosis. Despite the high sensitivity in detecting MS conventional T2 weighted MR imaging is unable to detect GM lesion. A More recently established double inversion recovery sequences is highly sensitive in demonstrating the lesion in cortex. MR imaging with 3D DIR enables increased intra cortical lesion detection as well as juxta cortical white matter and gray matter lesion. We did this for 3 of our known asymptomatic MS patients which detected cortical lesion even before signs of GM disease flares up. Reassessment of cognitive functions showed correlation with radiological findings. Conclusion: 3D DIR is highly sensitive up to five fold increase in detection of cortical GM lesion which are regarded as better predictor of cognitive impairment in patients with MS.

101

Session: Platform inflamm 1.4

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall A

Hyperreflexia and preserved reflexes in relatively weak muscle(s) in Guillain Barre syndrome correlates with pure motor neuropathy: A Clinico electrophysiological study

Subasree R, Prof. M. Veeremdrakumar, Dr. Thennarasu K

Nimhans, Bangalore.

Objective: To compare the clinical characteristics and electrophysiology of Guillain Barre syndrome patients (GBS) havinghyperreflexia and preserved reflexes in a moderately weak muscle with the group of GBS patients having sluggish reflex in a muscle with normal power arreflexia in a muscle with proportionate weakness or normal reflex in muscle with normal power. Methods: 50 patients fulfilling NINDS criteria for GBS were evaluated. Clinical evaluation was performed at 8.5Β΁5.1 days and nerve conduction studies at 12.26Β΁6.45 days after onset of illness. If Tendon reflexes were β‰͵ 1+ in muscle(s) with severe weakness (MRC β‰ʹ 3) β‰͵ 2+ in muscle(s) with moderate weakness or β‰͵ 3+ in a muscle with mild or no weakness they were grouped under hyperreflexia /preserved reflex. Results: 20/50 patients had brisk (8) or relatively preserved reflexes (12) in one or more muscles. The hyperreflexic /preserved reflex group were younger had shorter onset to peak milder functional disability earlier onset of recovery and lesser sensory signs compared to the other group. No difference was noted between respiratory distress cranial palsy or autonomic involvement. Sensory amplitudes and conduction velocities were significantly higher in hyperreflexic group. Pure motor neuropathy was seen 18/20 patients in hyperreflexic /preserved reflex group [motor demyelinating neuropathy (11) motor axonal neuropathy (4) pure motor unspecified (2) pure motor uncertain (1)] and only 2 had sensory abnormalities. This was statistically significant. Conclusion: GBS patients with hyperreflexia/preserved reflex variant needs to be identified and addressed in NINCDS criteria for better prognostication.

110

Session: Platform inflamm 1.5

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall A

Efficacy and safety of delayed-release Dimethyl Fumarate in patients with relapsingremitting multiple sclerosis from India: An integrated analysis of the phase 3 define and confirm studies

Dr. Rahul V. Kulkarni, Dr. Rahul V. Kulkarni, Dr. A. K Meena, Dr. Madhuri Behari, Dr. Anjali Nagpal, Dr. Lokesh Jha

B. J. Medical College & Sassoon General Hospitals, Pune.

Objective: To report the clinical efficacy and safety of delayed-release DMF (also known as gastro-resistant DMF) from a post hoc subgroup analysis of integrated data of Indian patients with RRMS enrolled in the Phase 3 DEFINE and CONFIRM studies. Background: In the DEFINE and CONFIRM studies DMF significantly reduced the risk of relapse and the ARR at 2 years compared with placebo. Design/Methods: Eligibility criteria included age 18-55 years RRMS diagnosis (McDonald criteria) and Kurtzke EDSS 0-5.0. Patients were randomised to receive oral DMF 240 mg BID or TID or placebo for 2 years. CONFIRM also included GA 20 mg subcutaneously QD as a reference comparator. Results: The post hoc analysis was performed on data from Indian patients (n=221) which were part of the pooled ITT population from DEFINE and CONFIRM considered for integrated analysis (n=2301). The relative risk reduction (RRR) in DMF BID and TID groups respectively associated was 36% and 43% in ARR; 34% and 45% in the risk of relapse as compared to placebo. The RRR in 12-week confirmed disability progression was 36% and 38% in the DMF BID and TID group respectively versus placebo. DMF BID and TID were associated with RRR of 77% and 23% in Gd+ lesion activity 72% and 61% in the number of new/enlarging T2 hyperintense lesions and 69% and 71% in the number of new T1 hypointense lesions respectively versus placebo. The most commonly reported AEs were gastrointestinal symptoms (4%) relapses (27%) UTIs (9%) and RTIs (6%) versus 0% 40% 9% and 3% respectively in the placebo group. Treatment discontinuation due to AE was 5% in DMF groups (BID and TID combined) versus 12% in the placebo group. Conclusion: There was clinical benefit with DMF in patients from India which was generally well tolerated.

113

Session: Platform inflamm 1.6

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall A

A study of profile of patients with clinically isolated syndromes(CIS) and predictors of conversion to multiple sclerosis(MS) in a tertiary care centre of Eastern India

Dr. Shivakumar Masaraddi, Dr. Goutam Ganguly, Dr. Arijit Roy

Dm- Pdt Dept. of Neuromedicine, Kolkata.


A study of Profile of patients with Clinically Isolated syndromes(CIS) and Predictors of Conversion to Multiple Sclerosis(MS) in a tertiary care centre of Eastern India Dr. Shivakumar. K. Masaraddi Dr. Goutam Ganguly Dr. Arijit Roy. Background: CIS is the first neurologic episode of MS. MRI and clinical features are used to predict risk conversion to MS. Objective: The aim of our study is to assess the clinical and radiological prognostic factors in CIS patients and to evaluate the risk of conversion to McDonald MS. Methods: This ongoing descriptive longitudinal study from March 2013 included patients presenting with CIS at BIN Kolkata who were evaluated and assessed clinically and radiologically at regular intervals. Results: In the ongoing study - 46 patients of CIS female: male ratio of 2.2:1. The mean age at presentation was 32.5 years females presenting much earlier(Avg-29 yrs) than males(Avg- 38yrs). 38 patients(82.6%) presented with optic neuritis 6(13.04%) had myelitis and 2(4.34%) cerebellar symptoms. MRI abnormality found in 43.47%(20/46) patients and in those with myelitis(100%) with 36.84%(14/38) in Optic neuritis group. Single lesion on MRI- 15.78%(6/38) 2 lesions in 10.52%(4/38) and >3 to <9 lesions found in 5.26%(2/38) in optic neuritis group. VEP abnormality found in 86.95%(40/46) patients and CSF-OCBs +ve only in 4 of 15 investigated.The improvement with steroid therapy found in 56.52%(26/46) patients. Follow up MRI of 20 patients till date showed 6 had developed new lesions. Discussion & Conclusions: Lesser the number of lesions on MRI negative CSF- OCBs and those with optic neuritis compared to myelitis have better chances of improvement with steroids in CIS and lesser progression to McDonald's MS.

0

Session: Platform MD 1.1

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall B

Study on Parkinsonism in young patients in a tertiary care hospital

Debjani Roychowdhury, A. Senapati, K. B. Bhattacharya, A. Biswas, A. Roy

Department of Neurology, BIN, Kolkata.

Backgound: Parkinsonism in young patients mostly comprises early onset Parkinson disease (EOPD), secondary parkinsonism (SP), and some heredodegenerative disorders. Aims and Objectives: Classify young patients (<40yrs) with parkinsonism into possible clinical syndromes and studying clinical profile of EOPD. Materials and Methods: This prospective study is going on in xxx from June 2013 to be continued to August 2014. History and detailed clinical examination were carried out in pre-structured proforma used in the movement disorder clinic of the institute. Relevant biochemical tests and MRI were done. EOPD were studied following Unified Parkinson's Disease Rating Scale, Modified Hoehn and Yahr Staging (H&Y), Schwab and England Activities of Daily Living Scale. Results: Out of 35 patients 20(57.14%) have EOPD (2 juvenile Parkinson disease, 18 young onset Parkinson disease), 5 Wilson's disease, 2 post encephalitic sequelae, 2 Extra pontine myelinolysis, 3 Drug induced parkinsonism, 1 congenital hypothyroidism, 1 multi infarction state, 1 undiagnosed. Five (33.33%) SP have asymmetric presentation. Four (20%) EOPD have h/o significant head trauma, 4(20%) have family h/o either tremor or PD in 1st degree relatives. Tremor{17(85%), gait abnormality{18(90%}, postural instability{13(65%)} are common in EOPD. Twelve(60%) EOPD have dystonia compared to 8(53.33%) SP. Drug induced dyskinesia present in 6. Eight(40%) are in H&Y stage-2.5. Discussion and Conclusion: Asymmetric onset parkinsonism does not rule out SP. Tremor, gait abnormality, postural instability are common in EOPD contradicting other studies. Positive family history, frequent presences of dystonia, early levodopa-related dyskinesias are characteristic in EOPD.

57

Session: Platform MD 1.2

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall B

Psychogenic movement disorders: A clinical profile of 73 patients

Pramod Kumar Pal, Nitish Kamble, D. K. Prashant, Menka Jha, M. Netravathi, Janardhan Y. C. Reddy

Department of Neurology National Institute of Men, Bangalore.

Background: The profile of Psychogenic Movement Disorders (PMD) vary according to country and socio-economic factors. Aims: To report the clinical profile of 73 patients with PMD seen at the National Institute of Mental Health and Neurosciences Bangalore. Methods: Seventy three patients with documented or clinically established PMD were seen over a period of 14 years. All patients underwent detailed neurologica and psychiatric examinationrelevant investigationsand admitted when required. Results: The mean age at presentation was 29.12Β΁15.1 years (women-51%). Approximately 30% were β‰ʹ18 years with boys 63.6%. The duration of PMD was 2 days to 10 years and the symptoms were abrupt in onset in 61.6%. The initial body part most often affected was right upper limb (adults-29.4% children-31.8%). Tremor was observed in 31.4% of adults and 9% of children whereas jerks were more common in children (36.4%) than adults (9.8%). Tremors were more often seen in women (42.3%) than in men (20%). In children jerks were almost equally prevalent in girls (37.5%) and boys (35.7%) whereas in the adults it was only seen in women (19.2%). Depression was the most common psychiatric comorbidity(women-15.4% men-16%). Electrophysiological confirmation of PMD was obtained in 27.3% of children and 31.4% of adults. About 42.5% required hospital admission and 23.3% had significant reduction or complete cessation of PMD after counselling antidepressants and/ or placebo. Placebo effect was more readily observed in children (31.8%) as compared to adults (19.6%). Conclusions: PMD was equally prevalent among women and men. However in children boys outnumbered girls. Tremor was most often observed in adults while jerks in children. Electrophysiology and placebo injections were useful supplementary tools for making a diagnosis of PMD.

163

Session: Platform MD 1.3

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall B

Spectrum of restless leg syndrome in a tertiary care neurology service

Usha Kant Misra, Jogendra Kumar Bastia, J. Kalita, S. K. Bhoi

Sanjay Gandhi PGIMS Lucknow, Lucknow.

Study Objective: Restless Leg Syndrome (RLS) is a common condition which may have regional differences. There is paucity of studies on RLS from India. In the present study the spectrum of RLS in a tertiary care teaching hospital is presented; primary and secondary RLS and those with low and normal serum ferritin level have been compared. Method: The consecutive patients with RLS were included. The severity of RLS was graded on basis of IRLS (international restless leg syndrome scale) score 0-10 sleep disturbance by Epworth sleepiness scale. The patients were divided into primary and secondary RLS. Serum ferritin cut off value was 50ng/ml. The secondary RLS patients were comprised of RLS with neuropathy renal failure prolapsed intervertebral disc thyroid dysfunction and anemia. Result: 72 patients with RLS median age 41 years (18- 90 yrs.) 39 (54.2%) females were included. 28 (39%) patients had primary and 44 (61%) secondary RLS. Radiculopathy (36%) neuropathy (31%) and iron deficiency anemia were common causes of secondary RLS. The primary RLSpatients had longer duration of illness and unilateral symptoms. Low serum ferritin level correlated with younger age of disease onset female gender more than 2 co-morbidities renal failure and good response to treatment. Long term RLS remission was related to serum iron level and good compliance to iron therapy. Conclusion: 61% of RLS patients have a secondary cause and neuropathy radiculopathy and anemia being the common causes. Low serum iron and good compliance to iron therapy predicts long term RLS remission.

26

Session: Platform MD 1.4

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall B

Levosulpiride induced extra pyramidal symptoms: A case series

Kuljeet Singh Anand, Rohit Verma, Jyoti Garg

1 Department of Neurology PGIMER Dr. Ram Manohar Lo, Delhi.


Levosulpiride induced extra pyramidal symptoms: A case seriesKuljeet Singh Anand1 Rohit Verma2 Jyoti Garg11 Department of Neurology PGIMER Dr Ram Manohar Lohia Hospital New Delhi2Department of Psychiatry Lady Hardinge Medical College New DelhiAbstractIntroductionEven though the peripheral anti-dopaminergic action of Levosulpiride is robust its central action is limited because it lacks the ability to penetrate the blood brain barrier easily which may be why literature rarely mentions its motor side effects. The current series report of eleven cases presenting with levosulpiride induced extra pyramidal symptoms at usual therapeutic doses. ObjectiveTo report levosulpiride induced extra pyramidal symptoms. MethodologyAll consecutive subjects taking levosulpiride and presenting with extra pyramidal symptoms to the movement disorder clinic were included. ResultsLevosulpiride was being prescribed for management of dyspepsia dysmotility gastro-esophageal diseases and emesis. With near equal gender representation the cases presented with symptoms of parkinsonism (n=8) isolated tremors (n=1) orofacial dyskinesia (n=3) and generalized rigidity (n=1). The mean age of the subjects was 65.45 Β΁ 7.51 years with a median dose of levosulpiride 50mg/day for a median duration of 6 Β΁ 15.29 months. The motor symptoms were reversible in all cases on removing the offending agent. ConclusionLevosulpiride should be cautiously used particularly in elderly subjects. Key words: Levosulpiride Parkinsonism Pyramidal Dyskinesia Movement.

51

Session: Platform MD 1.5

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall B

Sleep quality in young onset and older onset parkinson's disease: A questionnaire based comparitive study

Rohan R. Mahale, Ravi Yadav, Pramod Pal

Department of Neurology MS Ramaiah Medical Colleg, Bangalore.

Background: Sleep disorders occur commonly in Parkinson's disease (PD) and are under-recognized and treated in clinical practice. Objectives: To determine the quality of sleep in patients with Young onset (21 to β‰ʹ 40 years; YOPD) PD and to note whether there is any difference in quality of sleep from those patients with older onset PD (β‰͵ 41 years; OOPD). Methods: 156 patients with PD (YOPD-51 OOPD-105) were clinically examined and quality of sleep was determined using Pittsburgh sleep quality index (PSQI) Parkinson's disease Sleep Scale (PDSS) and Epworth Sleep Scale (ESS). Results: The frequency of insomnia was lesser in YOPD (27.5%) group as compared to OOPD (55.2%) (p=0.001). The frequency of nightmares was lower in YOPD (7.8%) as compared to OOPD (24.8%) group (p=0.012). The mean hours of actual sleep per night were higher in YOPD patients. Global PSQI score was better in YOPD indicating good overall sleep quality in YOPD patients. The total ESS score was significantly lower in YOPD (p= 0.019). The total PDSS score was significantly better in YOPD patients (p=0.018). Discussion: YOPD patients had better quality of sleep as compared to OOPD patients. These findings suggest relative sparing of central sleep regulatory centres in YOPD patients. The observation needs to be confirmed with prospective study including larger cohort of YOPD patients. Conclusions: Patients with YOPD had an overall better quality of sleep with lesser incidence of insomnia nightmares daytime sleepiness and restlessness during sleep.

98

Session: Platform MD 1.6

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall B

A Study of prevalence onset and pattern of Gastrointestinal symptoms in patients with parkinson's disease

Kannan N, Kannan N, Shanmugasundaram N, Thamilpavai N, Bhanu K

Madras Medical College Chennai, Tamil Nadu, Chennai.

Background: Gastrointestinal dysfunctions occur in the majority of patients with Parkinson's disease (PD). They are often unrecognized because many patients remain relatively asymptomatic in the early stage. Gastrointestinal dysfunction in PD is attributed to involvement of the dorsal motor nucleus of the vagus paravertebral sympathetic ganglia and intrinsic neurons of the enteric nervous system. Objective: To study the prevalence of Gastrointestinal symptoms in Idiopathic PD. Materials and Methods: The study was conducted in Institute of Neurology Madras medical college. Thirty six patients with Idiopathic PD were enrolled. A detailed history clinical examination and gastrointestinal symptom questionnaire were obtained from them. Results: AOut of thirty six patients studied twenty nine patients (80%) had GI symptoms. The onset of GI symptoms was before the onset of motor symptoms in 27 patients (75%). Two patients reported simultaneous onset of bowel and neurological symptoms. The pattern and frequency of GI symptoms are as follows: drooling (41.66%) sense of getting stuck/choking (13.8%) repetitive deglutition (11.1%) pain during swallowing (11.1%) food regurgitation/acid reflux (27.77%) nausea/vomiting (13.88%) early satiety (16.67%) postprandial fullness(11.1% ) epigastric soreness/abdominal pain (5.55%) constipation (41.67%) and loose stool(5.55%). Conclusions: Majority of the PD patients had GI symptoms before the onset of motor symptoms. Drooling and constipation were the most common GI symptoms in them.

165

Session: Platform MD 2.1

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall B

Study of nonmotor manifestations in parkinson's disease: A hospital based study

Anand Kumar Rai, Dr. A. K. Kayal, Dr. M. Goswami, Dr. M. Das, Dr. L. J. Basumatary

Gauhati Medical College, Guwahati.


Study of nonmotor manifestations in parkinson's disease: A hospital based study Anand Kumar Rai L. J. Basumatary* M. Das* M. Goswami* A. K. Kayal**Department of Neurology G. M. C. H. Guwahati Assam 32Abstract: Nonmotor symptoms in Parkinson's disease constitute a major clinical challenge as they are common but often overshadowed by the dominance of motor symptoms. Their early recognition and treatment may improve the quality of life of Parkinson's disease patients. We conducted a study regarding nonmotor symptom complex of Parkinson's disease in Gauhati Medical College and Hospital Guwahati Assam. Total numbers of patients included till the date of submission of abstract were 56. The most common symptom was olfactory dysfunction [93%]. The other symptoms detected were neuropsychiatric disturbance [81%] dysautonomia [68%] urinary dysfunction [66%] constipation [63%] sleep disorders [57%] sexual disturbance [45%] sensory symptoms [31%]. Key Words Nonmotor symptoms Parkinson disease quality of lifeFor correspondence: Dr. A. K. Kayal Department of Neurology G. M. C. H. Guwahati Assam-32E-mail: dr.ashok_kayal@yahoo.co.in

276

Session: Platform MD 2.2

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall B

Neuropsychiatric disorders in idiopathic Parkinson's disease

Hrishikesh Kumar, Alakananda Dutt, Marium Umme Kulsum, Muktolekha Mukherjee, Chitrita Sengupta, Swagata Sen, Banashree Mondal, Payel Chatterjee, Akanksha Gupta

Institute of Neurosciences Kolkata, Kolkata.

Aims and Objectives: To compare sociodemographic clinical cognitive profile and activities of daily living in patients with and without psychiatric disorders in Idiopathic Parkinson's disease (PD). Methodology: 148 patients with PD diagnosed by UK Brain Bank Criteria were assessed on socio-demographic and clinical profile the Unified Parkinson's Disease Rating Scale Modified Hoehn and Yahr staging and Schwab and England activities of daily living scale. Cognitive assessment was done by the Mini Mental State Examination. The Mini International Neuropsychiatric Interview was used to screen for psychiatric illness and the National Institute of Neurological Disorders and Stroke National Institute of Health (NINDS-NIMH) criteria was used to assess Parkinson's associated psychosis. Results: 59.5% patients had comorbid psychiatric disorders. Depressive disorder (33.2%) was the most common diagnosis followed by psychotic illness (23%) and anxiety disorder (19.7%). Patients with psychiatric disorders had significantly higher difficulties in activities of daily living motor impairment and cognitive impairment than those without psychiatric disorders. Conclusion: Findings highlight the importance of addressing psychiatric disorders in patients with PD as they are quite common and are associated with greater impairment in activities of daily living and quality of life.

286

Session: Platform MD 2.3

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall B

Effect of bilateral STN DBS on impulse control disorders in PD patients

Rukmini Mridula Kandadai, Jogu Siva Kumar, Shaik Afshan Jabeen, Ankathi Praveen, Meena A. Kanikannan, Rupam Borgohain

Nizam's Institute of Medical Sciences, Hyderabad.


Impulse control disorders (ICD) cause impairment of quality of life in Parkinson's disease(PD) patients and are under recognized and under reported. They may be intensified by dopamine agonists or after deep brain stimulation (DBS). Objectives: To evaluate the prevalence of ICDs in PD patients and the effect of bilateral subthalamic DBS on them. Methods: We studied 50 patients with PD.25 patients had undergone DBS while 25 were on medical management. Detailed history was taken and neurological examination performed in all. ICD was studied using Questionnaire for Impulsive-Compulsive Disorders In Parkinsons Disease (QUIP-RS) which evaluated - pathological gambling sexual impulses eating buying hobbying & punding and PD medication overuse. Results: Among 50 PD patients 35 were men; mean age was 55.0Β΁10.7 years mean duration was 6.6Β΁3.7 years mean Hoehn and Yahr score was 2.5Β΁1.0. ICD was present in 64 % of patients. None of our patients gambled. Hobbying/punding was commonest ICD seen in 40% with avereage score of 4.3Β΁7.4 followed by hypersexuality(28%) eating (26%) PD medication overuse (22%) and buying (10%). Comparing various parameters dyskinesias was significantly more in patients with ICD (p=0.004). Bilateral STN DBS was strongly associated with ICDs with an odds ratio of 6.25 with 95% CI of 0.9409 to 41.5178 compared to medical treatment. PD medication use and buying were more in DBS group compared with non DBS (P=0.0004 & 0.03 respectively). Conclusions: ICD are common feature in PD patients. Compared to the west our profile is different with hobbying/punding being the most common. STN DBS confers increased risk of developing ICD.

19

Session: Platform MD 2.4

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall B

Dopa responsive dystonia-clinical variability in presentations

Sujith Ovallath, E. K. Nimisha

James Parkinson's Movement Disorder Research Centr, Kannur.


Dopa Responsive dystonia ia a rare form of dystonia often misdiagnosed as cerebral palsy and equinovarus deformity. Misdiagnosis can result in dealay in motor development. Aim: To find out the clinical variability in presentations in suspected cases of DRD which had excellent clinical improvement with levodopa Method: The cases were selected from those attended the James Parkinson's Movement Disorder Clinic from 2008 january to 2013 october. All suspected cases underwent oral levodopa trial as inpatient to look for objective clinical improvement. Results: We identified 7 cases in last 5 years at the James parkinson's movement Disorder centre. This videobased presentation will highlight the salient features of the cases. Conclusion: Dopa responsive dystonia can have variable clinical symptoms and signs during presentation.spasticityequinovarus deformityturning difficultyfrequent fallssubtle movement in resting time in lowerlimbsnew onset kyphosis should make one suspect DRD and try on oral levodopa trial.

40

Session: Platform MD 2.5

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall B

Non-motor symptoms in Indian patients with Parkinson's disease

Aaron de Souza [LM-843], Varun R Pai Kakode, Siddesh K Bhonsle, Zico D'Costa,

Department of Neurology Goa Medical College Bamb, Goa.


Non-motor symptoms (NMS) are increasingly recognised as important determinants of disability and quality of life in patients with Parkinson's disease (PD). Aim: A prospective cross-sectional study on NMS in Indian patients with PD describing their relationship to motor function and other NMS. Methods: Consecutive patients with PD administered a detailed questionnaire by a neurologist. Results: 171 patients (M-59.6%) recruited over six months. Mean age was 67.1 years (range 42-92). Median duration of PD was 4 years (range 1-22) with mean age of onset 62.5 (range 37-91). 16.2% were <50 years old at PD onset. 75.6% were in H&Y stages 1-2.5. 91.8% reported NMS; number of NMS ranged 0-8 (median 3). Anxiety urinary urgency constipation and rapid-eye movement sleep behaviour disorder were commonest NMS each seen in >35% of patients. 8.2% reported NMS antedating onset of motor symptoms. Anxiety was commoner in females while males reported more urinary frequency/nocturia. Number of NMS was related to H&Y stage age >70 and later onset of PD but not to PD duration. Anxiety and depression were commoner in the earlier stages while psychosis and memory impairment were prevalent in advanced PD. Pedal oedema was commoner in patients <50 years old but most other NMS were prevalent in older patients and those with later onset or longer duration of PD. Associations between various NMS are described. Conclusions: NMS common in Indian patients with PD and may antedate motor symptoms. NMS number increases with H&Y stage age>70 years PD duration and later onset. Mood symptoms and pedal oedema are prevalent in younger patients other NMS commoner in older patients. The relationships between various NMS need further study.

69

Session: Platform MD 2.6

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall B

Postural and striatal deformities in Parkinson's disease

Sanjay Pandey, Hitesh Kumar, M. M. Mehndiratta

Professor Department of Neurology GB Pant Hospit, Delhi.

Aim: Study was conducted to find the occurrence of various striatal and postural deformities among Parkinson's disease (PD) patients. Background: PD patients may develop postural and striatal deformities which are usually seen in advanced stage. They can be mistaken for joint or orthopaedic pathology leading to unnecessary investigations. There is limited data regarding these deformities in PD patients. Methods: Study was conducted at tertiatry care teaching institute and 70 PD patients were recruited. Various postural (Antecollis Camptocormia Scoliosis Pisa syndrome) and striatal (Striatal hand & foot) deformities and their relation with duration of disease severity measured by Unified Parkinson's Disease Rating Scale (UPDRS) and levodopa intake were analyzed. Result: Out of 70 PD patients 34 (48.57%) patients had either postural or striatal deformities. Striatal foot was most common deformity observed (25.71%). Camptocormia was 2nd most common deformity (20%). Striatal and postural deformities were seen in more advanced PD as suggested by significantly higher UPDRS and H&Y score [P <0.001]. Striatal deformities were more ipsilaterally to PD symptom onset side (agreement 94.44%). PISA and scoliosis concavity was more on contralateral side to PD symtopm onset side (agreement 66.67%). Conclusion: Postural and striatal deformities are common and are present in upto half in PD patients. These are related to disease severity (UPDRS H&Y score). Though common in late stage of disease but can be early sign of disease. These should be recognized to avoid unnecessary investigations.

0

Session: Platform Neuropathy & Others 1.1

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall C

Clinical spectrum of idiopathic inflammatory demyelinating disorders in a tertiary care centre in North-West India

Soumya Darshan Nayak, Chandra Mohan Sharma, Dinesh Khandelwal, Bansi Lal Kumawat, Deepak Jain, Rajiv Yadav, Himakshi Parikh

Departments of Neurology and PSM SMS Medical College Hospital,Jaipur, Rajasthan.

Background: Idiopathic inflammatory demyelinating disorders of the central nervous system (IIDCDs) represent a broad spectrum of disorders including Multiple sclerosis (MS), NMO spectrum disorders (NMOSDs), clinically isolated syndromes (CIS) and acute disseminated encephalomyelitis (ADEM). Understanding the varied clinical profile is important for diagnosis & management. It is also important to identify grey areas in categorization. Objective: To study the clinical, imaging & laboratory profile of patients of IIDCDs & categorize them into specific groups. Method: Retrospective case series of 81 pts. Cases effectively categorized into 4 groups: MS, NMOSDs, CIS & ADEM and their subgroups. Cases with diagnostic difficulty later sorted out into 3 groups: Atypical, crossovers & converters. Results: 32% categorized as NMOSDs, 28.4% as MS, 25.9% as CIS & 13.6% as ADEM. Disease course was monophasic in 64.2% & multiphasic in 29.6%. Polysymptomatic clinical presentation was most common, followed by pyramidal & optic neuropathy. 23.46% had Optico-spinal presentation; LETM seen in 44% cases. Aquaporin-4 positivity seen in 31.25% NMOSDs. Discussion: Higher relapse rate & disability in NMOSDs but longer duration of disease & frequent relapses in MS group. 30% CIS fulfilling criteria for MS-DIS. Higher gray matter involvement in MS & ADEM patients. Low Aquaporin-4 seropositivity (5/30) in tested IIDCDs. No significant difference between seropositive & negative pts. In terms of relapses, cord length & disability. Conclusion: IIDCDs a spectrum of disorders because of atypical cases, optico-spinal involvement in all groups. Clinical features, course & severity play a dominant role in categorization.

224

Session: Platform Neuropathy & Others 1.3

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall C

Study of therapeutic outcome of small volume plasma exchange in guillain barre syndrome patients

Dr. Sowjanya Poosarla, Dr. Dhairyawan P, Dr. Veena. N, Dr. Sateesh K, Srilatha S, Amareswar K, Santosh B

Gandhi Medical College Hyderabad, Secunderabad.

Introduction: In 1916 Guillain Barre and Strohl emphasized the main clinical features of GBS: motor weakness areflexia paraesthesias with minor sensory loss. The diagnosis of GBS depends on clinical criteria supported by electrophysiological studies and CSF findings. The annual incidence reported is 1.8 per 100000 populations. Abnormalities of EDX studies are found in 90% of established GBS cases. Objective: To assess therapeutic outcome of small volume PE after 1 month and 3 months. Material and Methods: The study was a prospective study done in the Department of Neurology Gandhi Medical College over 2 years during the period from August 2012 to July 2014. All patients were evaluated at admission1 month and 3 months after discharge. Nerve conduction studies were done in all patients and modified Asbury criteria is applied and diagnosed as GBS. Small volume plasma exchanges (PE) were done in our blood bank by removing 5-7 ml plasma/kg body weight daily. Results: Treated group was compared with 30 control patients. The PE group started recovering earlier than in controls and bed ridden patients(9/30) started walking without support earlier than in controls at the end of 3 months. The time taken for improvement in the clinical grades at the end of the 1st and 3rd month was shorter. Conclusion: By giving small volume plasma exchanges the recovery time can be shortened. It can be considered in patients who has poor economic background and who cannot afford IVIG and large volume plasma exchange.

80

Session: 72Platform Neuropathy & Others 1.4

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall C

Study from a tertiary care referral centre in India-diagnostic yield of sural nerve biopsy

Dr. Vijay Nandmerdr Ajay Nandmer, Dr. Vijay Nandmer, Dr. Ajay Nandmer, Dr. V. N, Mishra

Imsbhu, Varanasi.

Background: Peripheral neuropathies are a heterogenous group of disorders with varying etiologies. A systematic approach is required for patient evaluation for cost effective diagnosis. Nerve biopsy has a good diagnostic yield if done in properly selected cases. This is especially so for the asymmetrical neuropathies particularly infectious causes like leprosy vasculitis and amyloidosis. This was a prospective study of 100 consecutive patients of peripheral neuropathy who referred to us and were undiagnosed after evaluation by physicians. Only seventy three of them underwent sural nerve biopsy for a disabling neuropathyThus in carefully selected patient group nerve biopsy is a useful aid for etiological diagnosis and management of patients more so in patients with mononeuropathy multiplex group. In this prospective planned study sural nerve biopsy altered the diagnosis in 41% and overall contributed in 80% in 36 consecutive patients. Hansen's disease was the commonest cause of neuropathy in our series and being one of the commonest treatable causes of neuropathy in an endemic country like India one must have a high index of suspicion so that early can be started and long term complications prevented.

81

Session: Platform Neuropathy & Others 1.5

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall C

Clinical and Neuro-ophthalmologic predictors of visual outcomes in Idiopathic Intracranial hypertension (IIH) - Managing IIH early enough Ͷ

Dr. Vivek Lal, Dr. Aastha Takkar, Dr. Amod Gupta, Dr. Manoj Goyal

Department of Neurology Postgraduate Institute of, Chandigarh.

Background: Once thought benign Idiopathic Intracranial hypertension is now being recognized as a potentially devastating entity which may lead on to loss of vision. Predictors of worse outcome may aid in early and appropriate management of patients of IIH. Objective: To assess visual morbidity in patients of IIH in terms of clinical and neuro-ophthalmological parameters. Methods: In a prospective study of 40 adult patients of IIH detailed history examination CSF analysis and features on MRI Brain were noted. Neuro-ophthalmological parameters were noted in the form of visual acuity visual field contrast sensitivity retinal nerve fibre layer thickness and visual evoked potential. All the parameters were graded and final visual outcome of patients was compared. Results: Visual impairment was noted in 70 eyes at presentation. 47 eyes achieved normal vision by the end of 6 months. Presence of headache and transient visual obscuration at presentation was significantly associated with good visual outcome. Higher CSF opening pressure increased RNFL thickness (>178 Β΅m) abnormal contrast sensitivity at high frequency and prolonged P100 latency on visual evoked potential were associated with poor visual outcome. No definite correlation between presence of cranial nerve palsies other clinical features obesity grade of papilledema and findings on neuroimaging with the final visual outcome was established. Conclusion: Visual outcome in patients of IIH can be predicted at presentation by various parameters providing window for early and adequate treatment. Close follow up of these patients may help segregating the potential candidates for aggressive management early in the disease course.

9

Session: Platform Neuropathy & Others 1.6

Date and Time: 16:45 - 17:45, Friday, 07 Nov 2014

Venue: Hall C

Prospective evaluation of determinants of choice of medication in migraine prophylaxis and prevalence of refractory migraine after appropriate therapy

Dnaneshwar Asole, Sameer Shrirangwar, Uma Sundar, Waseem Mujawar, S. Gulhane, Meenakshi B. A, Abhilasha M, Bhushan Chopade

Lokmanya Tilak Mun Med College & Hospital Sion M, Mumbai.

Aims: To prospectively evaluate the prevalence of associated co-morbidities and contra-indications to particular drugs which influence choice of migraine prophylaxis. To assess prevalence of Refractory migraine after appropriate double-medication prophylaxis at 6 months follow-up. M&M- 109 migrainous patients ( mean age 32 67% females 27% with aura) were assessed. Co-morbidities and preferred medications noted- Epilepsy- ( Valproate Topiramate )Vestibular migraine- Flunarizine Depression- AmitryptilineHypertension IHD- BetablockersContra-indications noted- Diabetes Asthma - BetablockerYoung women- ValproateObesity- VPA FlunarizinePatients with relevant co-morbidity received appropriate drug. Randomisation to medications was done after noting contra-indications. The distribution was- Amitriptyline 25/109(22.93%) Propranolol 27/109(24.77%) Valproate 22/109(20.18%) Flunarizine 32/109(29.36%) Topiramate 3/109(2.75%). At each visit improvement denoted reduction of headache frequency and severity (visual analog scale) over 30% from last evaluation. Standard abortive medications were used. Results: Associated disorders were seen in 18.6% patients ( Vertigo 50% Hypertension 20% Epilepsy 15% Depression 10% IHD 5% obesity11 %).67.4% had one or more contra-indications to medication(youngfemale 89.8% Diabetes 8.4% Asthma 5% Cardiac failure 1.5%).30.2% (33/109) patients were truly randomisable to any prophylactic medication. Statistically all the 5 prophylactic medications showed similar efficacy at 3 months. Sustained improvement over 3 months was seen maximally in Flunarizine group (48% vs 31-34% for other prophylactics). Significant improvement in 1st month itself was seen maximally in Propranalol(17.8%). 17/109 patients remained unimproved at 3 months and needed 2nd drug. At the end of another 3 months 4 (3.66% of original 109) remained unimproved denoting 'Refractory migraine'.

273

Session: Platform NM 1.1

Date and Time: 08:30 - 09:30, Saturday, 08 Nov 2014

Venue: Hall A

Duchenne muscular dystrophy- Natural history in Indian patients

Ravinder Jeet Singh Sidhu, Manjunath M, A. Nalini, K. Thennarasu, Piyush Ostwal, Kiran Polavarapu

National Institute of Mental Health and Neuro Scie, Bangaluru.

Background: Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy affecting one in 3500 live male births. There are no studies from India to describe natural history of DMD in our population. Objectives: To study natural history of DMD in selected cohort of DMD patients attending Neuromuscular clinic at NIMHANS. Materials and Methods: 500 immunohistochemically/ genetically confirmed DMD patients were sent simple questionnaire in postage-paid return envelope and data was also collected during follow-up OPD visits. Results: Of the 500 patients initially selected 275 responded/followed up. Mean age at onset of symptom in this cohort was 45.97Β΁24.79 (12-132) months. 122 patients lost ambulation and were wheelchair bound with mean age at loss of ambulation being 126.33Β΁22.86 (60- 240) months. 24 patients were in bed bound state with mean age of 143.25Β΁26.66 (108-204)months. Only 7 patients had died in this cohort during follow-up. Mean age at death was 182.85Β΁ 29.23(144-232) months. Details of correlation with demographic clinical and genetic variables and there correlation with major milestones in the natural history will be presented. Conclusions: This is the first study from India describing natural history of DMD in a large cohort of immunohistochemically/ genetically confirmed cases of DMD. Pattern of major DMD milestones viz. age at onset age at loss of ambulation and death in our cohort is comparable with data from Western population despite variability in the standard of care.

14

Session: Platform NM 1.2

Date and Time: 08:30 - 09:30, Saturday, 08 Nov 2014

Venue: Hall A

Clinical & electrophysiological profile of nutritional deficiency neuropathy among hostel students of Bhutan

Rupjyoti Das Mddnb (Neurology), P. S. Deb Mddm (Neurology), N. C. Borah Mddm (Neurology)

Consultant Neurologygnrc Hospital Guwahati, Guwahati.

Background: Nutritional neuropathy is well known due to B12 deficiency. B1 deficiency causes neuropathy especially in alcoholics. Outbreaks of the micronutrient deficiency disease beriberi have occurred frequently in refugee and displaced populations. Objective: To asses the clinical and electrophysiological features of nutritional neuropathy found in Bhutan. Materials and Methods: Thirty four students of a school hostel in Bhutan were hospitalized locally suspected to have Beriberi. Out of them six were referred to us with severe illness. One died on the way due to cardiac failure. We have seen 5 patients admitted during June2012 with acute flaccid paralysis due to poor diet. They were examined thoroughly. Besides routine blood tests vitamine B12 and thyroid function tests were done in all patients. Serum vit. B1 was sent outside in 3 patients suspecting Beriberi. Neurophysiological tests done in all patients. Results: All the students in the age group of 19-20presented with swelling & pain in the extremities followed by flaccid paralysis. Serum Vit. B12 was found to be low in 3 patients & normal range in 2 patients. Serum Vit. B1 was sent in 3 patients found to be lower normal range. NCS study showed features of motor & sensory axonal neuropathy in 4 and attenuation of H-reflexes in 1 patient. After supplementation of good nutrition along with B1 & B12 all of them improved significantly. Discussion: Williams (1961) reported that thiamine deficiency usually presented a symptom complex with three main features: (1) those of peripheral neuritis; (2) cardiac insufficiency; and (3) a generalized tendency to oedema. All of our patients showed some features of thiamine deficiency. Conclusion: B1 deficiency is relatively uncommon in India due to commonly supplementing multivitamins in our prescription. However unusual presentation with edema feet in non alcoholic it should be suspected and treated accordingly.

67

Session: Platform NM 1.3

Date and Time: 08:30 - 09:30, Saturday, 08 Nov 2014

Venue: Hall A

Clinical etiological biochemical profile of a group of patient of Periodic paralysis

Annada Prasad Bhattacharya, Hilal Ahmed, Souvik Dubey, Bitoti Chatterjee, Arunima Bhaduri, Debal Laha, Samar Biswas, Sandip Pal, Jharna Ray, Shyamal Kumar Das

Yeshod (Shyamal Kumar Das) Dept of Neurology Burdwa, Birrhabankura.


Clinical etiological biochemical profile of a group of patient of Periodic paralysis A Study from Burdwan Medical College West Bengal. Background: Periodic paralysis commonly present with acute muscular weakness which may be hypokalemic hyperkalemic or normokalemic. Hypokalemic Periodic Paralysis was the commonest form which is a voltage gated ion channelopathy (typically calcium or sodium) due to mutation of CACNA1S or SCN4A genes. If properly diagnosed and treated patients recover without much clinical squeal. No genetic study has been carried from India. Objectives: To study the varied clinical profile etiological factors and underlying genetic abnormalities of subjects presenting with periodic paralysis. Methods: The clinical and laboratory data of these patients were analysed. Patients are further investigated for possible secondary causes. Result: From 1st January 2013 to 15th July 2014 50 cases presented with periodic paralysis range 3-73 years; M: F-2.8:1. Hypokalaemia was present in 48 and normokalamia in 2 patients. The clinical presentation was sudden onset quadriparesis-42 paraparesis-5 and hemiparetic presentation-2 and isolated neck muscle weakness-1. In idiopathic hypokalaemic cases 11 cases were alcoholic 6 cases tribal and 2 cases with positive family history. Among the secondary cases causes were renal tubular acidosis-8 Gitelman Syndrome-2 Conn's syndrome-2 2 cases of thyrotoxic periodic palsy-2 two cases of alcohol induce hypokalaemia-2 one case is hypothyroid induced-1) another was iatrogenic-1. Conclusion: Among the primary cases blood samples of 25 patients have already been sent for further genetic analysis. Results are waiting. Result will be discussed during presentation. This is the first study from West Bengal and second from Eastern India. Predominant cases are idiopathic and further genetic study result will determine underlying genetic abnormalities.

157

Session: Platform NM 1.4

Date and Time: 08:30 - 09:30, Saturday, 08 Nov 2014

Venue: Hall A

Clinical profile and outcome of myasthenic crisis

Yoshitha Siripurapu, Yoshitha Siripurapu, U. Meenakshisundaram, C. U. Velmurugendran, V. Shankar, P. R. Prabash

Department of Neurology Sri Ramachandra Universit, Chennai.

Background: Myasthenic Crisis is a life threatening medical emergencydue toparalysis of respiratory muscles which necessitates assisted ventilation. Aim: To analyse the precipitating factorsclinical features and outcome of myasthenic crisis. Materials and Methods: This is a retrospective study of patients who presented with myasthenic crisis over a period of six years in Sri Ramachandra UniversityChennai from January 2008 to June 2014. Results: 23 patients of myasthenic crisis were included in this study. The median age of the patients was 65 years[range 18-82 yrs].17 were males and 6 were females. Infection was the most common triggering factor accounting for 8 cases[upper airway infection urinary tract infection and pneumonia]. Inadequate treatment/drug withdrawal was noted in 3cases and aminoglycoside administration in 3 cases. Dysphagiadysphoniadysarthriadysnoeaptosis and generalized weakness were the most common clinical features. Out of 23 patients of myasthenia crisis15 patients presented with crisis within 2 years of diagnosis of myasthenia gravis and 8 patients within 2-5 years of diagnosis of myasthenia gravis. Median duration of the hospital stay was 22 days. All the patients were treated with anticholinesterase drugs16 were treated with steroids and immunoglobulins as adjuvant to anticholinesterases.3 of them were treated with only steroids.4 with only immunosuppressive agents. 7 required tracheostomy.10 patients were found to have ventilator associated pneumonia[VAP]. Recovery was seen in 19 patients. Out of 16 patients who were treated with immunoglobulins75% showed good recovery and 25% died. Conclusion: Out of 23 patients who presented with myasthenic crisisthe precipitating factor was found to be infection[35%]inadequate treatment/drug withdrawal and also drug induced [aminoglycoside]. All patients needed ventilatory support. Outcome was found to be better in patients treated with steroids and immunoglobulins [70%].

269

Session: 88Platform NM 1.5

Date and Time: 08:30 - 09:30, Saturday, 08 Nov 2014

Venue: Hall A

Clinical spectrum autonomic profile and electrophysiological features of sjogren's syndrome- associated neuropathy

Ajith Sivadasan, Mathew Alexander, Sanjith Aaron, Vivek Mathew, Maya Thomas, Anil Kumar Patil, Karthik Muthusamy, Prabhakar A. T, Sangeetha Y

Christian Medical College Vellore, Vellore.

Background: There is scarce literature on the spectrum of manifestations in Sjogren's syndrome associated neuropathy. Objectives: To study the clinical spectrum autonomic profile and electrophysiological features of Sjogren's syndrome-associated neuropathy in a tertiary care centre in south India (2010-14). Results: Forty seven patients (35 females 12 males) were diagnosed to have Sjogren's syndrome-associated neuropathy. 37 (78.7%) had primary Sjogren's syndrome. Mean age was 48.98 years (SD 14.23 years). The mean duration of symptoms was 2.29 years (SD 2.41). The distribution of neuropathy was as follows: Sensory ataxic neuropathy 15 (31.9%) radiculoneuropathy 12 (25.5%) painful sensory neuropathy without sensory ataxia 10(21.3%) mononeuritis multiplex 4 (8.5%) isolated cranial neuropathy 2 (4.3%) motor neuronopathy 3 (6.4%) and pure autonomic neuropathy 1 (2.1%). Thirty six (76.6%) patients had autonomic dysfunction. Clinical autonomic dysfunction was seen in 12 (25.5%). Mean duration of autonomic symptoms was 1.54 years (1.09). Autonomic involvement included secretomotor (35%) genitourinary (20%) gastrointestinal (225%) orthostatic hypotension (15%) and pupillomotor (5%). CSF protein was elevated in 21 (44.6%). Minor salivary gland biopsy revealed grade 3 or grade 4 inflammation in 38 patinets (80.8%). Serological testing for anti SS-A anti SS-B antibodies were positive in only 15 (31.9%). Sensory ataxic form was significantly associated with autonomic involvement (OR 3.78 p 0.04). Conclusion: There is a varied spectrum of neuropathy in Sjogren's syndrome with high prevalence of autonomic dysfunction. Minor salivary gland biopsy can be used as a useful diagnostic modality as serological markers are negative in majority.

291

Session: 88Platform NM 1.6

Date and Time: 08:30 - 09:30, Saturday, 08 Nov 2014

Venue: Hall A

Myasthenic crisis: Experience from a tertiary hospital center

Mathew Alexander, Ajith Sivadasan, Sanjith Aaron, Maya Thomas, Vivek Mathew, Anil Patil, Karthik M

Professor of Neurology Department of Neurological, Vellore.

Objective: To look at the disease characteristics and predictors of outcome in patients with Myasthenic Crisis (MC)Methodology- All patients who were admitted with an exacerbation of Myasthenic Weakness with respiratory failure leading to institution of mechanical ventilation was included in the study (Period 2000-2013). Design: Retrospective Descriptive Study. Results: A total of 47 patients were studied 27 males and 20 females. The Mean age was 40.49 and there were 16 (34%) patients who had age > 50. The mean duration of symptoms was 29.2 m (range 1m -204m). 21/ 47 patients (44.7%) had a Thymoma 12/47 (25.5%) had Thymectomy. The timing of crisis was immediate in 3 and delayed in 9. Recurrent crisis was seen in 20/40 patients (42.6%) and history of Radiotherapy was present in 9/47 (19.1%). The mean duration of ventilation was 5.55 weeks (range 1-16 weeks). Mortality was 7/47 (14.9%) 5 died of septicemia with shock 2 of pulmonary embolism. 24 patients (51.1%) had prolonged ventilation (> 4 weeks). The predictors for prolonged ventilation were post thymectomy status (OR 2.46 p<.001) and presence of thymoma (OR 1.92 p0.05). The predictors for mortality which were found to be statistically significant were prolonged ventilation > 4 weeks in 6/7 patient (OR1.90 p0.047). Conclusion: With improved ICU/Ventilatory care newer antibiotics and immunotherapy the mortality in Myasthenic crisis has come down but not the duration of MC.

0

Session: Platform stroke 1.1

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall C

Prevalence of obstructive sleep apnea in acute ischemic stroke and its impact on stroke recovery

deepak menon, A. Radhakrishnan, Sajith Sukumaran

Department of Neurology, SCTIMST, Trivandrum.

Introduction: There is accumulating evidence regarding far-reaching consequences of OSA in stroke and stroke related morbidity. It has been recognized as a modifiable risk factor of stroke but remains under-evaluated and under-recognised. Objective: To determine prevalence and severity of OSA in acute ischemic stroke and to compare the outcome of stroke in those with and without OSA at 3 months post stroke. Methods: Prospective study in which patients with acute ischemic stroke were evaluated with Resmed Apnea link device for detecting OSA, with attention to NIHSS and mRS at admission, discharge and follow-up. Results: 100 patients with acute ischemic stroke recruited(mean age 60.1yrs). Prevalence of OSA was 59%. None of the baseline characteristics significantly deferred between those with and without OSA including sex, etiology, vascular territory and admission NIHSS except for age (p=0.015) and diabetes(0.016). The two groups differed in mRS(p=0.022); higher mRS for patients with more severe the OSA(p=0.015). There was significant difference at discharge and at 3 month follow-up with higher NIHSS and mRS in those with OSA(p=0.0001 and p=0.001 respectively). Recovery from stroke at 3 months based on mRS was less in the combined moderate and severe OSA group (p-0.006). Conclusion: This large prospective study reveals a high prevalence of OSA in stroke, and points to more severe stroke as well as stroke related disability, at discharge and at 3 months, in patients with OSA. Hence due efforts must be taken to identify this modifiable risk factor which has an impact in stroke severity and recovery.

0

Session: Platform stroke 1.2

Cerebral venous thrombosis in hiv seropositive individuals: a clinical, hematologicaland radiological correlation

Jaychandran R, Netravathi M,Rita Christopher, Satishchandra P

Departments of Neurology and Neurochemistry National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore,

India 560029.

Background: Cerebral Venous Thrombosis (CVT) is more common in India than in Western population. There are very few isolated case reports of CVT in HIV seropositive individuals with varying etiological agents implicated. Objective: To study the clinical, haematological, radiological and immunological features of HIV seropositive patients with CVT. Materials And Methods: This was a prospective cum retrospective study carried out in a tertiary neurology centre. Prospective analysis (N-11) was carried out between April 2013 to December 2014; and retrospective analysis (N-21) was done as a chart review from January 1997 to March 2013. Results: Thirty two (M: F - 23:9) subjects were found to have CVT with an incidence of 1.1%. Among the etiological agents, elevated homocysteine was found in 60%, B12 deficiency in 43.9%, anemia in 31.2% and 12.5% had polycythemia. Protein C, Protein S and Antithrombin III levels were found to be normal. In four of the subjects, CD4 count increased by greater than 25 cells/cmm in 6 months suggesting the possibility of IRIS (Immune reconstitution inflammatory syndrome). Lateral sinus was most commonly involved in 68.75%. Sensorium of the patients were relatively well preserved compared to the size of the parenchymal lesion. Discussion&Conclusion: HIV seropositive individuals with CVT are found to have increased incidence of hyperhomocysteinemia and nutritional deficiency. The immunological status may not have a direct effect in the causation of CVT in HIV seropositive individuals. CVT as a manifestation of IRIS is rarely reported. Further studies are needed to explore the mechanisms of CVT in HIV seropositive individuals.

0

Session: Platform stroke 1.3

in stroke thrombolysis": Experience from 100 consecutive stroke patients

Sagar Badchi, Thomas Mathew, R. Nadig, GRK Sarma

Department of Neurology, St. John's Medical cCollege, Bangalore.

Background: Acute management of ischemic stroke involves thrombolysis within 4.5 hours. For a successful outcome, early recognition of stroke, transportation to the hospital emergency department immediately after stroke, timely imaging, proper diagnosis and thrombolysis within 4.5 hours is of paramount importance. Aim: To analyse the obstacles for thrombolysis in acute stroke patients. Methods: Hundred consecutive patients of acute ischemic stroke who were not thrombolysed but otherwise fulfilled the criteria for thrombolysis were evaluated prospectively for various factors that prevented thrombolysis.The constraints to thrombolysis were categorized into 1) failure of patient to recognise stroke 2) failure of patient's relative to recognise stroke 3)failure of primary care physician to recognize stroke 4) transport delays 5) lack of neuroimaging and thrombolysis facility 6) non affordability. Results: The biggest hurdle for early hospital presentation is failure of patients to recognize stroke (73 %) followed by lack of neuroimaging facility(58 %), non-affordability (56 %), failure of patient's relative to recognize stroke(38 %), failure of the primary care physician to recognize stroke (21%) and transport problem(13%). Conclusion: Considering the urgency of therapeutic measures in acute stroke, there is necessity and room for improvement of medical and non-medical factors influencing delays. Streamlining standardized stroke pathways may help to shorten pre hospital time consumption. Educational efforts should not only focus on the public, but also on the training of emergency physicians and other medical personnel.

21

Session: Platform stroke 1.4

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall C

Clinicoradiological presentation and outcome of cerebral venous sinus thrombosis in puerperal and nonpuerperal subjects.

Bharat Bhushan, Bharat Bhushan, Amita Bhargava, Gaurav Kasundra M, Khichar Shubhakaran, Banakar Basavaraj, Pujar Guruprasad, Yasin Mohamad, Janardhan Sharma

Dr. S. N. Medical College Jodhpur RajasthanIndia, Jodhpur.

Background: Literature of cerebral venous sinus thrombosis (CVST) in nonpuerperal subjects are lacking in India. Aim: Study of clinicoradiological presentation and outcome of CVST in puerperal and nonpuerperal subjects. Method: Prospective cohort study (September 2012 to March 2014) of 79 CVST cases. Result: Total 79 patients (33 males 46 females with age range 16-67years) of CVST were dichotomized in puerperal (32cases) and nonpuerperal (47cases) group. Subacute onset of symptoms was commonest (51.9%) followed by acute (34.2%) chronic (13.9%). Headache (89.9%) and seizure (64.6%) were common symptoms. Only 74.7% had papilledema. Assumed risk factors for CVST were anemia (57%) alcohol (48.1%) pregnancy (40.5%) thrombocytosis (43%) septicemia (31.6%) high hematocrit (24%) and others. Only 59 were evaluated for coagulopathy risk of which hyperhomocystenemia was most common (30.5%) followed by combined deficiency (23.7%) protein S (15.26%) protein C (8.5%) MTHFR mutation AT-III deficiency FVL mutation APLA and Prothrombin mutation. MRI showed significant (P< 0.01) right lateralization in nonpuerperal (59.5%) and left lateralization in puerperal group. Hemorrhage was significant (P <0.017) in puerperal group (36.7%) however infarct was commonest (46.8%) and higher in nonpuerperal. Venogram revealed superficial vein thrombosis in 69(87.34%) deep vein in 45 and mixed in 54 cases. SSS was occluded in 65(82.28%) followed by transverse sigmoid straight and IJV. Complete recanalization was achieved maximum (22/77) at third month. Mortality during hospital stay and recurrence both were 2.5% (2/79). Conclusion: Alcohol and hyperhomocystenemia in nonpuerperal and anemia in puerperal group were assumed significant risk factor with minimal mortality and recurrence for CVST.

129

Session: Platform stroke 1.5

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall C

Outcome in malignant MCA territory infarctions does surgery make a difference?

Daanish, Dr. A. O. Saroja, Dr. K. Ravishankar Naik

Jnmckle University, Belgaum.

Introduction: Large hemispheric infarcts secondary to occlusion of middle cerebral carry high mortality and morbidity due to herniation and cerebral damage. Early decompressive craniotomy has been found to improve the outcome. This retrospective study was undertaken to evaluate the outcome with surgical management in comparison with conservative management in treatment of malignant MCA territory infarct. Methods: Patients with malignant MCA territory infarcts admitted from Aug 2009 to Jan 2014 were included in the study. Clinical laboratory and radiological data were collected from hospital records. Outcome was measured using modified Rankin score at discharge. Results: 62 patients with malignant MCA were treated during this period whose age was 52.68 Β΁ 14.38 years. Majority were males with female: male ratio 1:3.4. Risk factors included hypertension in 17 diabetes in 15 ischemic heart disease in 10 and rheumatic heart disease in 4. 19 patients had Glasgow coma score less than 8. 27 underwent surgical decompression and were younger (40.41Β΁ 8.8 years). 35 were medically treated and were older (62.14 Β΁ 9.94 years). Right cerebral infarctions were seen in 27 patients and left cerebral infarction was seen in 32 patients with 3 patients having bilateral territory infarcts. There was no significant difference in the baseline characteristics between the 2 groups including the GCS score. Complications in the surgical group included intestinal obstruction hypernatremia and pressure sore (1 each) aspiration pneumonia and infections in 4. Complications in medically treated patients were aspiration pneumonia in 5 and GI bleed in 1 patient. 15 patients died (9 among the surgically treated and 6 among the medically treated). They are no difference in the MRS at discharge between the two groups. Conclusion: In hospital mortality was higher among the surgical group compared to medically treated patients

77

Session: Platform stroke 1.6

Date and Time: 8:30 - 9:30, Friday, 07 Nov 2014

Venue: Hall C

Vit D3 as a prognostic factor in cerebro vascular stroke

venu gopal basam, venugopal basam, sampath kumar. N. S.

Narayana Medical College

Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. Serum vit D3 is one of the modifiable risk factor for stroke. There are few studies regardingrole of vit D3 as a prognostic factor in Stroke. Objectives: In this study we investigated the risk factors for the stroke and role of vit D3 as a prognostic factor in Stroke. Material and Methods: A total of 160 patients who had cerebro vascular stroke diagnosis was confirmed by CTand MRI were evaluated prognosis by NIHSS score at the time of admission as well as discharge 3 &6 months after discharge and serum vit D3 was measured in all patients plotted the prognosis against the controls. Results: Out of total 160 patients of stroke 129 had intracerebral infarct & 31 had intracerebral hemorrhage. In stroke patients 40 had normal serum vit D3 levels (β‰͵25micro grams per litre)120 had low serum vit D3 levels (<25micro grams per litre). However there was significant low level of serum vit D3in intracerebral infarct than intracerebral hemorrhage(p value=0.0496). There were no significant relationship of low level serum vit D3 with prognosis of stroke. Conclussion: The present study concluded that low level serum vit D3 seems to be a significant factor for stroke in intra cerebral infarct than hemorrhage in addition to conventional risk factors. There were no significant relationship of low level serum vit D3 with prognosis of stroke.

0

Session: Platform stroke 2.1

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall C

Factors predictive of return to work after stroke in patients with mild-moderate disability in India

Sandeep Nayani, Deepak Menon, Bryant Bonner, Ratheesh Pillai, P. Sankara Sarma, Kasia J. Lipska, Jeyaraj Pandian P. N. Sylaja P.N

Harvard Medical School, Boston, MA; Department of Neurology, Comprehensive Stroke Program, Department of Neurology , Sree Chitra Tirunal for Medical Science and Technology, Trivandum, India; Section of Endocrinology, Department of Internal Medicine, Yale Sc.

Background: Successful return to work after stroke may improve economic circumstances, quality of life, and overall life satisfaction but not all stroke survivors are able to return to work. Aim: To determine what proportion of previously employed patients return to work after an acute stroke resulting in mild to moderate disability and examine factors associated with successful return to work. Methods: We recruited patients 18 - 60 years of age who were previously employed and who had a first-ever stroke 3 months to 2 years prior, resulting in mild to moderate disability (modified Rankin score ≤ 3). We collected socio-demographic and clinical information using patient interviews and chart review andwe assessed anxiety and depression using previously validated instruments. We used multivariate logistic regression to assess factors associated with return to work. Results: Among 141 patients (mean age 48 ΁ SD 8.8 years), 74 (52.5%) returned to work after stroke. Multivariate analysis, demonstrated a lower modified Rankin scale at 3 months, younger age and professional or business jobs were significantly associated with return to work and revealed anxiety, depression and social support score were not associated with return to work (p=0.30, 0.37and 0.27 respectively) Conclusions: Among patients with mild disability after stroke, almost half do not RTW, and this is associated with functional disability rather than psychosocial factors such as anxiety and depression.

0

Session: Platform stroke 2.2

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall C

A retrospective study of decompressive craniectomy in acute cerebrovascular accidents - functional outcomes and psychosocial consequences

Moncy Thomas, S. Kumar, D. Arjundas, S. S. K. Ayyar, S. S. Abrahyam, C. R. Preetham, R. Jothi, R. Santhanam

Department of Neurology Sri Balaji Medical College Chrompet Chennai, Deparment of Neurology Vijaya Health Center Vadapalni Chennai


The overall aim was to evaluate the outcome of decompressive-craniectomy (DC) in patients with acute massive cerebrovascular accidents in a tertiary referral center with the primary outcomes being survival, functional ability and psychosocial consequences. Methods: The study was a retrospective study over the last four years. Data derived from case sheets, reports and operative notes. The main outcome measures were noted from Glasgow Scale (GCS), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and Modified Rankin Scale (MRC). Changes over time for follow-up were obtained by telephonic communication withpatient. Analysis was done using a statistical method that is suitable for small data sets. Results: The retrospective data was analyzed for a period of four years, of which 51.11% patients had ischaemic stroke and 48.89% had intracranial hemorrhage respectively. All patients who underwent decompressivecraniectomy survived and did well with the surgery 85.07% people improved to MRC scale of 3 and 14.93% patients expired due to secondary causes such as MI aspiration pneumonia etc which occurred duringhospitalization. The therapeutic algorithms ,time to tracheostomy time to cranioplasty were also noted. The control group who recieved only medical management saw only 1.5% survival. Conclusions: The studies show that an effective chain of medical surgical and rehabilitation activities can produce a good outcome/living situation and that life can be satisfactory for patients after massive cerebrovascular accidents in spite of neurological deficits.

0

Session: Platform stroke 2.3

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall C

Stroke in young adults: A retrospective study from Tertiary care teaching hospital

Manjesh Rathi, S. Kumar, D. Arjundas, S. S. K. Ayyar, S. S. A. Suresh Kumar, C. R. Preetham

Department of Neurology Sri Balaji Medical College, Chrompet, Chennai, Deparment of Neurology Vijaya Health Center, Vadapalni, Chennai.

Background: Stroke is one of the leading cause of morbidity and mortality. Stroke in young has special significance in developing countries. This is because of etiological variation from developed countries, and the affection of economically productive group adds further to the overall disease burden. Material/Methods: The present study is a retrospective study conducted in order to analyse stroke types, clinical characteristics and aetiology of stroke in young persons (15-45 yrs). Results: A total of284(188 males and 96 females) cases of stroke in youngwere admitted to the Department of Neurology between Jan 2011 to July 2014. Ischemic stroke accounted for 67.25 %(191/284) ofyoung stroke, 17.25 %( 49/284) had spontaneous intracerebralhaemorrhage (ICH), while 15.49 %( 44/284) had cerebral venous thrombosis. In cerebral infarction, 15.18% of these patients (29/191) had cardio embolic stroke. Major risk factors wereHTN in 37.32%(106/284), DM in 13.02%(37/284), smoking in 31.69%(90/284), dyslipidaemia in 27.46%(78/284), alcoholism in 29.92%(85/284). Cardiac lesion were present in 15.18%(29/191), hypercoaglable state was in 5.23% of nonhemorragicstrokes(10/191) andvasculiticaetiology in8.37 %( 16/191 ischemic stroke), while the cause was undetermined in 26 cases (9.21%). Conclusions: Major risk factors for stroke in our young patient werehypertension,dyslipidemia, diabetes, smoking and alcoholism. Cardioembolic stroke and atherosclerotic occlusive disease were the most common cause of ischemic stroke. Incidence of CVT is high in young. Transesophageal ECHO is advocated in all stroke in young

0

Session: Platform stroke 2.4

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall C

The correlation of blood pressure on admission and outcome measure at 90 days in cases of spontaneous hypertensive intracerebral hemorrhage (sICH)

Sreenath, S. P. Gorthi, Y. S. Sirohi, P. Dhull, C. S. Narayanan

Army Hospital, R & R, , Delhi Cantt, New Delhi 110010.

Background: Hematoma expansion after sICH secondary to uncontrolled hypertensioncontributes to the morbidity and mortality. However, the association between elevated BP and functional outcomes after ICH remains unclear and forms the basis of this study. Methods: All consecutive subjects of hypertensive intracerebral hemorrhage meeting the inclusion and exclusion criteria admitted in a tertiary care hospital from 01 Apr 2012 to 30 Apr 2014 constituted the study subjects. The mean arterial pressure (MAP) as ascertained by three consecutive readings five minutes apart was kept at or below 130 mm Hg with appropriate treatment. The hematoma volume and an ICH score were calculated. Funtional outcome was assessed after 3 months with modified Rankin Scale. A correlation of MAP with functional outcome was studied. Results: A total of fifty (50) patients were studied. Functional outcome at 90 days poorly correlated with the MAP at onset but was significantly associated with a higher MAP at 72hrs. The ICH score reflecting Hematoma volume, mass effect or presence of infra-tentorial hemorrhage had a statistically significant inverse effect on the outcome at 90 days. Intervention of raised ICP with Mannitol, Hypertonic saline or EVD made no difference for functional outcome. Conclusions: Thisstudy demonstrates that the factors which has a significant bearing on the functional outcome at 90 days were MAP at 72 hrs and ICH score.

0

Session: Platform stroke 2.5

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall C

Cerebral venous sinus thrombosis: Impact of anticoagulation on recanalization and outcome in puerperal and non-puerperal subjects

Bharat Bhushan, A. Bhargava, K. Gaurav, K. Subhakaran, H. Jangid, I. Sood, P. Guruprasad, B. Basavaraj

Department of Neurology, Dr. S. N. Medical College and M. G. Hospital, Jodhpur.

Background: Prospective data are lacking for recanalization in cerebral venous sinus thrombosis (CVST) in Indian context. Aims: To study the recanalization and outcome after CVST in puerperal and non-puerperal subjects. Method: Prospective, observational cohort study (September 2012 to March 2014) of 79 patients of CVST (46 female, 33 male; mean age 35΁7 years). All were treated according to institutional protocol and oral anticoagulation for 12 months. Follow up MR brain with MR venogram was performed on 3, 6 and 12 months. Complete (CR), partial (PR), or no recanalization (NR) were categorized on vessels status. NIHSS for deficit and modified Rankin Scale (mRS) for functional outcome were used. Results: Only 77 cases (31 puerperal, 46 non-puerperal) were evaluated till 1 year follow up due to mortality (2/79). At one year 22 (28.57%) achieved CR, 23 (30%) PR and 32 (41.6%) had NR. Maximum CR (20/77) was achieved at three months, but insignificant later on. Highest recanalization rate was in superior saggital sinus, followed by transverse, internal cerebral veins, straight sinus and lowest in sigmoid sinus. Overall recanalization rate (CR+PR) was significant (p <0.027) in thrombophilic cases than non-thrombophilic, but insignificant (p=0.26) in puerperal versus non-puerperal group. Correlation for involvement of sinuses with initial NIHHS and mRS was significant (Pearson correlation coefficient- 0.48, 0.35 respectively; p < 0.0001). Correlation for recanalization with mRS, age and hemoglobin was insignificant at 1 year. Conclusion: On long term anticoagulation overall recanalization rate was 58.44%, tended to achieve peak within 3 month and unexpectedly significantly higher in thrombophilic cases.

85

Session: Platform stroke 2.6

Date and Time: 15:00 - 16:00, Saturday, 08 Nov 2014

Venue: Hall C

Association of APOE gene polymorphism with different types of stroke patients from rural Eastern India

Dr. Hilal Ahmad Ganie, Dr. Arindam Biswas, Dr. Annada Prashad Bhattachrya, Dr. Souvik Dubey, Dr. Bitoti Chattopadhyay, Dr. Shankar Prasad Nandi, Dr. Debal Laha, Dr. Sandip PaL, Dr. Jharna Ray, Dr. Shyamal Kumar Das

Deptt of Neurology Burdwan Medical College, Burdwan.

Background: Studies from the different ethnic regions of world have reported variable results on association of APOE gene polymorphism in stroke. On this background present study was performed to find out the possible association of APOE polymorphisms with stroke. Material and Methods: A prospective case control study was undertaken in department of Neurology Burdwan Medical College over a period of two years. We collected 10 ml venous blood samples from126 clinically and radiological diagnosed stroke patients and 108ethnically age and sex matched controls in EDTA vials after a taking proper consent. Genomic DNA was prepared at S. N. Pradhan Centre of Neurosciences University of Calcutta. Exotic SNPs (rs429358 rs 7412) were analyzed by PCR-RFLP for genotype of APOE. Results: We have screened APOE gene in 126 patients and 108 control individuals. The frequencies of different APOE allele among 126 patients were 7% (n=18) for E2 78% (n=197) for E3 and 15% (n=37) for E4. The E3 allele is significantly over represented (P = 0.004) in controls compared to the patients (88% vs 78% respectively). A significantly high frequency of APOE4 allele was observed in patients compared to controls (15% vs 8%) and patients with E4 allele had a twofold higher odd to develop Stroke (OR=2.015; 95% CI: 1.059 3.863) among eastern Indians. The E4 allele also plays a major risk for developing Ischemic Stroke (OR=2.744; 95% CI: 1.322 5.699) and E3 plays a protective for Hemorrhagic Stroke (OR=0.528; 95% CI: 0.28 0.995) among our patient cohort. Conclusion: There is significant association of APOE gene polymorphism instroke patients of Rural Bengali population The E4 allele increases significant risk for development of ischemic strokes and it also plays a limited role for hemorrhagic strokes

32

Session: Poster clinical 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Primary intramedullary cysticercosis: An  

Rameshwar Nath Chaurasia

Department of Neurology IMS BHU Varanasi.

Objective: Spinal intramedullary cysticercosis is an uncommon clinical condition which may mimic an intramedullary tumor and can lead to irreversible neurological deficits if untreated. We are reporting a patient who developed subacute onset sensory motor monoparesis secondary to spinal cysticercosis. Case: A 35 year male presented with weakness of right lower limb hesitancy and constipation for last 2 weeks. On examination there was 4-/5 (MRC Scale) power in the right lower limb with brisk deep tendon reflexes absent cremastric and extensor plantar on the right side. There was impairment of pain and temperature sensation on left side and joint position and vibration on right side from T11 dermatome and clinical condition defined as Brown Sequard Syndrome (BSS). Magnetic resonance Imaging (MRI) study of the spine showed a ring shaped cysticercus lesion with an eccentric dot representing the scolex of larvae at the T11 level. Discussion: The common clinical manifestations included pain paraparesis spasticity bowel and bladder incontinence and sexual dysfunction. In our case primary intramedullary cysticercosis presented typically like Brown Sequard Syndrome which is not reported till date. The reason for brown sequard syndrome presentation not as paraparesis in our case might be due to small lesion compressing to one side with minimal perilesional edema. Result and Conclusion: Patient was treated conservatively with combination of albendazole and steroids. Intramedullary cysticercosis represents a diagnostic challenge and keep high index of suspicion for such type of lesions so that early diagnosis and conservative treatment will cure disease and prevents irreversible complications

306

Session: Poster clinical 1.10

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Congenital myasthenic syndromes (cms): A case series

Matta Gopi Srikanth, Pradeep K, Satish T, Gopi S, Butchi Raju G

Andhra Medical College Visakhapatnam Andhra Prad, Visakhapatnam.

Introduction: Congenital myasthenic syndromes(CMS) are a heterogeneous group of disorders which are either Presynaptic(~6%) Synaptic(~14%) Postsynaptic(~68%) or with Defects in endplate development & maintenance(~12%). Rapid advances in molecular genetics & electrophysiology is resulting in better understanding of already identified CMS and discovery of new CMS types. AChR subunit mutations are the commonest and purely presynaptic CMS are least common. Case series: We are presenting a series of 8 patients who presented with myasthenia gravis in the past 1yr. Of these three patients had their first degree relatives having similar complaints and were subsequently evaluated and included in this series. Youngest is 2.5yr old and the oldest is 28yrs. All of them had ptosis significant fatigue on minimal exertion three of them are very thin built with minimal muscle mass five of them had significant weakness of muscles of mastication and three of them had difficulty in swallowing. Three had history of myasthenic crisis during intercurrent illnesses. Routine biochemical tests were normal with no evidence of thymic hyperplasia on imaging in appropriate cases. 5 of the 8 were evaluated for AChR antibodies and were negative. NCS RNS and needle EMG were performed in all and revealed decremental response on slow RNS. All of them responded well to oral pyridostigmine and are on regular followup. Conclusion: Though CMS are rare disorders of NMJ searching for similar cases amongst the family members of presented cases would result in identification of significantly higher number of cases. Identification of autoimmune myasthenic syndromes from that of CMS is essential to optimize treatment in these treatable genetic disorders.

55

Session: Poster clinical 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Treatment of migrane causing acute glaucoma -an eye opener for ophthalmologists and a caution for Neurologists

Dr. N. D. Patil, Dr. Chandrashekhar Meshram

Brain And Mind Institute Nagpur, Nagpur.


Treatment of migrane causing acute glaucoma -an eye opener for Ophthalmologists and a caution for Neurologists. Case report- A women aged 35 years being treated for migrane developed sudden diminution of vision and increase in headache. Clinical examination revealed myopia of 3 D very shallow anterior chamber applanation IOP 60 both eyes and Gonioscopy showed completely closed angle of anterior chamber of both eyes. Patient was on Topiramate for last one week. Patient recovered after stoppage of Topiramate and anti-glaucoma medication without any visual loss. Various aspects of ADR (Adverse Drug Reaction) of Topiramate discussed with recommendation for prevention and management.

72

Session: Poster clinical 1.3

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Spinal epidural hematoma an unusual complication of dengue fever

Chaithra S. P, Dr. Agadi. J. B., Dr. Praveen Kumar. S, Dr. Archana B. Netto, Dr. Karthik N

Bangalore Medical College and Research Institute, Bangalore.


CNS involvement in dengue is rare with reported rates varying from 0.88 to 5.4%. Spinal epidural bleed as a complication of dengue fever is even rare in the published literature until now. We report a 65 year old female patient presenting with rapidly progressive paraparesis and urinary retention following an episode of dengue fever. The platelet count was 50000. Dengue serology IgM and Ig G were positive. MRI thoracic spine was done which showed a spinal epidural hematoma which was extending from T4 to T6. She underwent hematoma evacuation and laminectomy and she is undergoing physiotherapy. Dengue fever with thrombocytopenia is found to be quite a rare cause of a spinal epidural hematoma. The bleeding tendency in Dengue is due to thrombocytopenia capillary leakagecoagulation abnormalities and hepatic dysfunction. The present case expands the clinical spectrum of dengue fever.

99

Session: Poster clinical 1.4

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

An interesting case of tremors in a child

Dr. C. Leema Pauline, Dr. Viveka Saravanan, Dr. Ravi, Dr. Seenivasan

Ich & Hc Madras Medical College Chennai, Chennai.


Infantile tremor is a rare clinical disorder characterised by coarse tremors anemia and regression of milestones in children of around one year of age. Herewith we report a child with infantile tremor syndrome. Case Vignette: 10 month old female child third born to her parents with developmental delay presented with lethargy loose stools vomiting and an episode of generalized seizures admitted and managed as meningitis in another hospital. metabolic parameters USG cranium were normal. CSF showed mild increase in protein with normal sugar cells and culture. Child continued to be lethargic not interested in the surroundings had refusal of feeds. Examination revealed a lethargic child with pallor hyperpigmentation of the knuckles normal cranial nerves mild spasticity of limbs brisk DTR severe coarse tremors involving the head trunk and limbs. There was no organomegaly. Investigations revealed macrocytic anemia(Hb 5.6 gm) with thrombocytopenia normal metabolic parameters including liver and renal function tests. Retroviral screening was negative. CSF analysis was normal. Blood and CSF viral studies for JEV and HSV were negative. Bone marrow examination showed a hypercellular marrow with marked erythroid hyperplasia and myeloid precursors showing megaloblastic changes. Serum vitamin B12 levels was very low <50 pg/ml folic acid levels normal. plasma homocysteine levels were very high. CT brain showed cortical atrophy.infantile tremor syndrome due to vitamin B12 deficiency was diagnosed and treated with intramuscular vitamin B12 injections along with oral folic acid and zinc supplementation. Tremors disappeared within a week. In two weeks time child got interested in the surroundings. Three months post followup child started gaining the milestones. Conclusion: Infantile tremor syndrome has to be thought of in a young child with developmental delay or regression malnutrition and tremors.

287

Session: Poster clinical 2.1

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Obesity a neurological challenge in icu

Thaseen A, Shankar B, Kannan V, LakshmiNarasimhan R, Ashwin k mani, Bhanu K

Institute of Neurology MMC, Chennai.

Introduction: Neurological disorders related to obesity are an underdiagnosed entity due to insufficient knowledge and awareness and treating these patients is a challenge. Case vignette 1: 70 yr old obese male with BMI-35 ex-smoker brought with breathing difficulty and altered sensorium for past 4hrs with past episodes of orthopnea snoring with episodes of apnea hypoapnea. ABG revealed typeII respiratory failure improved with noninvasive ventilation. PSG revealed OSAS-COPD overlap syndrome. Case vignette 2:62 yr old female presented with breathing difficulty for 2days with early morning headache impaired concentration and memory for 1yr tachypneic with tachycardia and myoclonic jerks. ABG revealed typeII respiratory failure and was managed with noninvasive ventilation. PSG later revealed OSAS. Case vignette 3:53 yr old male was brought unconscious since morning after going to sleep normally with bariatric surgery done 3years back. He was markedly obese (BMI-39) with occasional upper limb myoclonic jerks. ABG revealed typeII respiratory failure improved with non-invasive ventilation. ABG and PSG suggested obesity hypoventilation syndrome. Case vignette 4:50 yr old hypertensive male with BMI-49 OSAS presented with left hemiparesis MRI was done with difficulty as gantry couldn't accomodate him. He was thrombolysed 2 days later developed DVT of both lowerlimbs started on LMWH developed pulmonary embolism for which IVC filter was placed. He was ventilated developed VAP and improved with antibiotics. Conclusion: OSAS OSAS with COPD and OHS are a spectrum of chronic hypoventilation disorders. Management of complications like DVT and pulmonary embolism following neurologic illness is challenging.

102

Session: Poster clinical 2.2

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Partial recovery after quadriparesis caused by spontaneous spinal epidural haematoma

Dr. Maheswar Samanta, Prof A. K. Mallick, Prof. Geeta Mohanty, Dr. Biswajyoti Ratha, Dr. Kali Prasanna Swain, Dr. Seekanta.Sahu

DM student Neurology, Cuttack.


Partial recovery after acute quadriparesis caused by spontaneous spinal epidural hematoma: Case report. Background: Spontaneous spinal epidural hematoma is a relatively rare but potentially disabling disease. Prompt timely surgical management may promote recovery even in severe cases although role of conservative treatment islimited. Case presentation: We report a 29-year-old man withhistory of sudden severe right Scapular pain followed by weakness and numbness over the bilateral lower limbs progressing to intense quadriparesis and anesthesia. A spinal magnetic resonance imaging scan was performed and revealed an C7-D1 extramedullary-extradural cord compression due to enhancing soft tissue lesion compressing cord in its Rt. Side with altered signal characterstic S/O epidural spontaneous haematoma of the cervico- thoracic spine. He underwent decompression laminectomy of the cervico- thoracic spine and hematoma evacuation 2days after as he was treated out side of our institute conservatively. Just after surgery his upper & lower extremity movements improved. After 1 week ambulation with assistance was resumed with residual paresthesia & moderate weakness on lower limb upper limb. After 5months mild residual symptoms & mild weakness persisted. Conclusions: The diagnosis of spontaneous spinal epidural hematoma must be kept in mind in cases of sudden back pain with symptoms of spinal cord compression. Early recognition accurate diagnosis and prompt surgicaltreatment may result in significant improvement even in severe cases.

132

Session: Poster clinical 2.3

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Collet sicardsyndrome: A case report

Biswajyoti Rath, Dr. Maheswar Samantdm Student, Dr. Srikant Sahoodm Student, Dr. Kali Prasanna Swain Asst Prof, Dr. Geeta Mohanty Prof, Dr. Ashok Kumar Mallick Prof Hod

SCB Medical College, Cuttack.


 Collet-Sicard syndrome More Details is caused by various neoplastic and non-neoplastic lesions affecting the base ofthe skull with involvement of IX X XI and XII cranial nerves with signs and symptoms of dysphonia displacement of the palate anaesthesia of the larynx pharynx and soft palate. Among the non-neoplastic factors the most common are traumatic fractures at the base of the skull inflammatory processes (osteomyelitis Paget disease and others ) or other alterations such as diabetes mellitus or porphyrias. Neoplasm should always be kept in the differential diagnosis especially in nontraumatic cases. Tumours of the jugular foramen areuncommon constituting approximately 0.3% of all intracranial tumours. Glomus jugulare tumours account for 60 - 80% of all such cases while schwannomas the second most common tumour type in this location.A 23year male presented with hoarseness of voice nasal regurgitation of liquid and dysphagia to liquid for 3 months. Cranial nerve examinationshowed - shifting ofuvula to left diminishedgag reflex on the right atrophy and weakness ofright sternocleidomastoid and trapezius muscles atrophy ofright side oftongue. Motor and sensory system examination showed no abnormality. Laryngeal endoscopy showed right vocal cord palsy. MRIbrain including base of skull showed TIW hypointense T2W hyperintenselobulated right jugular foramen mass having intralesional flow voids which enhance intensely with TIC+(Gd)extending to hypoglossal canal and upto nasopharynx suggestive of glomus jugulare paraganglioma. The patient was referred to a higher centre and undergone primary gamma knife therapy.

185

Session: Poster clinical 2.4

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

A case report of CJD

Kandukuri Suma

Osmania Medical College, Hyderabad.


A CASE REPORT OF CJD Suma K. Srinivas Deshmukh. Vinod kumar K. Ramesh R. Sita Ramu Ch. Sri Rangalaxmi G. Viswajyothi P. Department of Neurology Osmania Medical College OGH Hyderabad. Department of Radiology Osmania Medical College OGH Hyderabad. Abstract: 50 yr old male presented with rapidly progressive dementia rigidity akinetic mutism myoclonus of 2 Β΍ months duration. C/o behavioural abnormalities in the form of formed visual and auditory hallucinations of 2 Β΍ months duration. This was followed by apathy and stiffness of whole body predominantly axial rigidity. This was followed by akinetic mutism with exaggerated startle myoclonus. On examination no purposeful movements noted. There wasrigidity of whole body predominantly axial with exaggerated startle myoclonus. EEG and MRI showedfeatures s/o CJD.

234

Session: Poster clinical 2.5

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

4H syndrome: Hypomyelination hypodontia ataxia and postural tremors. A rare case

Dr. Gunjan Kumar, Gunjan Kumar, A. Nalini, Ravinder J. S, Veeranna G, Maya Bhat, Chandrajit Prasad, Pramod K. Pal

NIMHANS, Bangalore.


dentition and hypomyelination; 2. hypomyelination hypogonadotropic hypogonadism and hypodontia (4H). Only a few cases are reported. Aims and Objectives: To describe the clinical and imaging findings in a patient with the rare hypomyelinating leukoencephalopathy i.e. 4H syndrome with additional postural tremors. Materials and Methods: Case details of a 35 year old man with classical 4H syndrome. Results: A 35/M parateacher with two children had progressive appendicular ataxia for 12 years; unsteadiness of gait for 2-3 years; rest and postural tremors for one year. Had delayed dentition with small mobile deciduous incisors and lost them at 20 years of age. Had only four molars erupted. Elder brother is reported to have tremors of the upper limbs and ataxia for last 8-10 years. Not available for examination. Examination: Oligodontia and hypodontia(dentinal dysplasia). Systems-normal(N). HMF- N; Speech-N; Visual acuity -6/24 pinhole-6/9 mild temporal pallor perioral tremors. Rest tremors of UL(L>R) postural wing beating right UL cogwheel rigidity on Froment's maneuver; spasticity of lower limbs. Power-N. Cerebellar ataxia all limbs. Hyperactive tendon jerks at knees; extensor plantar response. Gait ataxia with reduced arm swing. HBA1c-9.6; serum: LH FSHtestosterone levels-N; LFT/RFT/TFT/CK- N. Sr. Cortisol-N; NCS-N. No urinary abnormal metabolites; ABR-? initial stages of dys-synchrony SSEP- absent median and tibial responses. VEPs- P100-129/126ms. MRI- supratentorial hypomyelination(predominantly parieto-occipital)with corpus callosal signal changes. Conclusions: We report a man with classical 4H syndrome with a combination of hypomyelinating leukoencephalopathy delayed dentition and hypo/oligodontia and postural tremors. Only 8 cases have been reported with this new form of leukoencephalopathy as seen in our case.

114

Session: Poster dementia 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

A case report on cerebral amyloid angiopathy

Srikanta Kumar Sahoo, Dr. Maheswar Samanta, Dr. Nihar Ranjan Biswal, Dr. Biswajyoti Ratha, Dr. Kali Prasanna Swain, Professor Dr. Ashok Kumar Mallik, Professor Dr. Gita Mohanty

DM Studentneurologyscb Medical College and Hospi, Cuttack.


A Case Report on Cerebral Amyloid Angiopathy Department of Neurology SCB Medical College and Hospital CuttackAbstractA 58-year-old Hindu male with known Diabetic Hypertensive since last 4yrs with a history of coronary artery diseasechronic kidney disease hyperlipidemia was found in a state of altered sensorium in the way to his office but had no recollection of the event. He exhibited a inappropriate cheerfulness flat affect and dysarthria. Computed tomography of the head showed multiple tiny hemorrhagic lesions in both frontal left parietal and temporal lobes. He was treated in nearby hospital and discharged with mild weakness in left side of body. After 2 month he again presented with repeated episodes of right sided focal seizure with progressive altered mental status admitted to our institution where his motor and sensory examinations shows right hemiparesis right-sided sensory extinction dysarthria. His Mini Mental State Examination score was 22. He exhibited cognitive deficits consistent with mild dementia. Further diagnostic imaging including CT Scan and Magnetic Resonance Imaging indicated that he had multiple small intraparenchymal hemorrhagic lesions involving mostly bilateral frontal temporal occipital cortex and cerebellum without affecting basal ganglia and brainstem. His case is presumed to represent hemorrhage caused by cerebral amyloid angiopathy the clinical diagnosis of which is reviewed. He was treated with corticosteroid and improved partially but treatment was stoped due to steroid induced psychosis. Key Words: Cerebral amyloid angiopathy Dementia Intraparenchymal Hemorrhage Minimental state examination.

124

Session: Poster dementia 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Progressive multifocal leukoencephalopathy and Gerstmann syndrome

Aralikatte Onkarappa Saroja, Karkal Ravishankar Naik

Department of Neurology Jawarharlal Nehru Medical, Belgaum.

Introduction: Common clinical manifestations of progressive multifocal leukoencephalopathy (PML) include progressive hemianopia cognitive impairment gait disorders motor and sensory disturbances and rarely seizures. We report features of Gerstmann syndrome as a presenting neurological manifestation of PML within 6 months of detection of AIDS. Methods: Prospective evaluation of a middle aged man with AIDS with tuberculous lymphadenitis on antituberculous treatment (ATT) and HAART presenting with subacute inability to read write and word finding. Case Report: A 45-year old graduate presented with severe inability in reading and calculations making him abstain from work six weeks preceding the initial evaluation. He had word finding difficulty and impaired vision. He had no other cognitive motor or sensory disturbances. He was on ATT for tuberculous lymphadenitis and had tested positive retroviral infection five months earlier. Examination revealed healed cervical sinuses choroid tubercles. Western aphasia battery revealed severe alexia with moderate agraphia colour anomia and acalculia. Addenbrook's cognitive score was 39. Cerebral MRI revealed bilateral non-enhancing white matter hyperintensities in temporo-parieto-occipital lobes in T2 and FLAIR sequences with involvement of splenium consistent with PML. CSF analysis during first admission was normal including PCR for JC virus. Two months later he had seizures without any changes in cerebral MRI and the repeat CSF analysis was positive for JC virus. He continued HAART and ATT. Follow-up assessments at two and twelve months revealed remarkable improvement in language functions. Conclusion: Co-occurrence of tuberculosis and PML is rare.  Gerstmann syndrome I More Detailsn PML has not been reported earlier. It is worth repeating CSF analysis for JC virus in patients with clinical and radiological features of PML. We report remarkable improvement of the language dysfunction with HAART in a patient with PML.

47

Session: Poster epilepsy 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Ek Naya Din - important tool for epilepsy case identification

Vijaya Nath Mishra

Banaras Hindu University, Varanasi.


Educative feature film on epilepsy "Ek Naya Din" have shown to various sections of society in India. In the present study it was proposed that the film is an important tool for understanding epilepsy in easy and efficient way in the society. In 1008 shows across the nation we took 183 shows which were done in Uttar Pradesh and Bihar as our study material. Of these 122 subjects with epilepsy were identified by local populations after watching the film. 99 such patients could be brought to hospital on the pursuance of team and the management was started. It was concluded that the film was an important tool to enhance the epilepsy knowledge.

48

Session: Poster epilepsy 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Levetiracetam induced encephalopathy presenting as electrical status epilepticus: An unknown occurence

Rohan R. Mahale, Anish Mehta, Mahendra JV, Madhusudhan B. K, R. Srinivasa

Department of Neurology M. S. Ramaiah Medical Col, Bangalore.


Levetiracetam is a novel broad spectrum anti-epileptic drug with proven efficacy in generalized as well as focal onset seizures. It has renal elimination with no hepatic metabolism. Levetiracetam induced encephalopathy is rarely reported in literature. Triphasic waves in the electro-encephalogram are seen in toxic-metabolic encephalopathies of various etiology like hepatic encephalopathy uraemia. We report a patient who was on levetiracetam for acute symptomatic seizures and developed encephalopathy with electroencephalogram showing generalised triphasic waves. These triphasic waves disappeared with intravenous lorazepam but without clinical improvement in sensorium. The electroencephalographic abnormality got normalised on discontinuation of levetiracetam. This is the first report of levetiracetam induced encephalopathy presenting as electrical status epilepticus and also depicts electroencephalographic correlate of levetiracetam induced encephalopathy.

154

Session: poster epilepsy 1.3

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Beware of another a after alcohol: Anticonvulsant-induced pancreatitis

Muthukani S, Rajesh Prabhu P, Suresh P, Karthick Sn, Rakesh R. B, Meenakshi-Sundaram S

Registrar Department of Neurosciences Apollo Sp, Aruppukottai.

Background: Pancreatitis has well known associations with several medications like azathioprine sulphonamides antiretroviral agents and anticonvulsants. Valproate is by far the most commonly reported cause of anticonvulsant-induced pancreatitis. Aim: To present an unusual association of pancreatitis in a patient on phenytoin and carbamazepine. Clinical data:A 17- year-old adolescent male was admitted with a two- day history of acute severe abdominal pain. He was diagnosed with epilepsy since 5 years of age and was presently on phenytoin ( 200 mg/day ) and carbamazepine ( 400 mg/day ). Evaluation revealed features of acute pancreatitis as ascertained by imaging ( CT scan of abdomen) and enzyme studies ( serum amylase 1198 IU/L normal: 20-96 IU/L serum lipase 291 IU/L normal: upto 160 IU/L ). Systematic investigations excluded other etiologies for pancreatitis. A possibility of pancreatitis due to phenytoin and carbamazepine was considered and both medications were withdrawn. Supportive care measures were administered. Levetiracetam was instituted. This was followed by significant clinical and biochemical improvement within three days. He remained stable when reviewed at 3 months follow-up. Conclusion: Although valproate is the commonest cause of anticonvulsant-related pancreatitis such a presentation due to other anticonvulsants especially phenytoin and carbamazepine needs also to be considered. Further research is needed to elucidate underlying mechanisms.

190

Session: Poster epilepsy 1.4

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Nonconvulsive status epilepticus an unrecognized cause of altered sensorium in renal failure patients

Vineet Sehgal, Lucky Bhalla, Surabhi Awasthi, H. P. Singh

Fortis Escorts Hospital Amritsar, Amritsar.

Introduction: A neurologist opinion is often sought for unexplained altered sensorium in ICU patients. In the last 6 months we saw four patients of chronic renal failure who developed altered sensorium due to nonconvulsive status epilepticus (NCSE) following the initiation of beta (Ξ΂)- lactam antibiotics. Discussion: NCSE can be an unusual complication of antibiotic therapy. Cephalosporinspenicillins and carbapenems are all grouped in Ξ΂-lactam class of antibiotics. We are reporting here four patients of chronic renal failure who were admitted in ICU with the diagnosis of sepsis and had normal sensorium at the time of admission. Following the institution of antibiotics ( Cefipime and Imipenem in 2 patients each) sensorium of the patients worsened. EEG revealed continuous generalised 2-3 Hz sharp wave discharges consistent with NCSE. Clinically however patients did not show any evidence of motor activity. All patients improved after the initiation of antiepileptic drugs and removal of the offending drug. Ξ΂- lactam antibiotics are pro-epileptogenic as they reduce the GABA mediated inhibitory response in the brain and this effect is significantly increased in patients with renal failure because of increase in the CSF level of these drugs. Conclusion: Ξ΂- lactam antibiotics can cause NCSE in patients with renal failure and since the clinical picture is similar to that of metabolic encephalopathy so the diagnosis is often missed and hence one should always contemplate EEG in patients of renal failure with unexplained altered sensorium. A neurologist should be aware of this potentially dangerous but reversible complication.

205

Session: Poster epilepsy 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Hmsn-a short series-clinical and electrodiagnostic profile

Robert Wilsons, Dr. Ramakrishnan, Prof. Sarala

Madras Medical College, Chennai.


Hmsn-a short series-clinical and electrodiagnostic profile. Introduction: Hereditary motor sensory neuropathies are complex heterogenous group of diseases characterized by insidious onset indolent course paucity of positive sensory symptoms and uniform conduction slowing. Clinical features vary widely depending upon the genotype and inheritance pattern. We report 6 MB of HSMN with clinical and electrodiagnostic profile. Case Reports: Age of patients varied from 4 yrs to 36 yrs( 4 males and 2 females). 4 symptomatic patients and asymptomatic parents of one patient were included. All 4 patients had the following features in common- predominant distal lower limb weaknesspaucity of sensory symptomsabsent ankle reflexes uniform conduction slowing and negative family history. They differed in other features. One had distal wasting in all 4 limbs and another patient only in lower limbs. Objective sensory loss was seen in 2 patients. 2 had distal weakness in upper limbs also. Pes cavus in 1flat foot in 1ulnar and peroneal nerve thickening in 2 patients. In one patient we could evaluate family members(parents). Asymptomatic parents had thickened nerves but no deficits. All had uniform conduction slowing and demyelination pattern. Correlation between degree of clinical deficits and EDX parameters was poor. Conclusion: Examination for sensory abnormalitiesperipheral nerve thickeningskeletal deformities and evaluating family members are important in HMSN. A negative family history requires electrodiagnostic evaluation of family members. Although EDX studies have diagnostic valuethe correlation between degree of nerve conduction abnormalities and clinical deficits is poor especially in the demyelinating type.

268

Session: Poster epilepsy 1.6

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

A royal malady unleashing its varied spectrum

Dr. K. S. Raja, Professor. Dr. S. Gobinathan, Dr. Malcolm Jeyaraj, Dr. S. Sakthi Velayutham, Dr. P. R. Sowmini, Dr. R. Kalpana, Dr. R. S. A. Alexander, Dr. P. Vijayashankar, Dr. Krishna Kumar, Dr. K. Karuakaran Dr. Ravindran

Department of NeurologyStanley Medical College Ch, Chennai.


A 17 year old male was admitted with fever recurrent vomiting seizure and altered sensorium. On evaluation patient was found to have hypertension and hyponatremia (SIADH). MRI Brain was consistent with posterior reversible encephalopathy syndrome (PRES). CSF analysis was normal. Vasculitic workup and renal artery doppler were done which were negative. Subsequently patient developed acute areflexic quadriparesis (predominant proximal weakness) with preserved ankle jerks. The above features of hypertension SIADH acute areflexic quadriparesis with preserved ankle jerks in the background of abdominal complaints in the form of recurrent vomiting made us consider the possibility of porphyria. Urine samples tested positive for porphyrin precursors qualitatively and quantitatively. This case is presented for its rarity and to highlight the varied spectrum of clinical manifestations of porphyria.

272

Session: Poster epilepsy 1.7

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

A case of ischemic stroke in graves disease without cardiac arrhythmia

Ravi L. A., Viveksaravanan R, Leema Pauline C

Institute of Child Health & Hospital for Children C, Chennai.

Background: stroke in hyperthyroidism commonly occurs as a result of cardiogenic embolism due to atrial fibrillation However associations of hyperthyroidism with other stroke subtypes remain speculative. We report a case of ischemic cerebrovascular disease in graves disease without cardiac arrhythmia. Case Report: A 11 year old female child presented with complaints of weakness of all four limbs four months duration with fever for five days. On the second day of admission she developed right focal seizure with worsening of right upper and lower limbs weakness with angle of mouth deviation to left side. Physical examination revealed tachypnoeafevergoiterPulse 190/min regular respiration rate 36/min and right side UMN facial palsy. Bulk symmetrically reduced. Tone normal in both upper limb and hypotonia in lower limbs with generalised weakness proximal more than distal and right more involved than left side. DTR present. Plantar extensor on right side. Sensations normal. The electrocardiogram showed regular sinus rhythm. ECHO normal. MRI brain showed left parietal acute infarct. MRA and MRV with whole spine screening were normal. Thyroid function studies revealed reduced TSH with increased T4 and T3. Thyroglobulin and Thyroidperoxidase antibodies were positive. The diagnosis of Graves disease associated with myopathy and right hemiparesis was confirmed. She was treated with Propylthiouracil Propranolol and steroid. Her weakness improved. Conclusion: This paper is presented to highlight a rare case of ischemic stroke in graves disease without cardiac arrhythmia. Hyperthyroidism should be considered in the etiology of stroke in addition to other causes.

290

Session: Poster epilepsy 2.1

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Subacute sclerosing panencephalitis: A case of long term survival

Naveen Prasad S. V.

SVIMS.


Subacute Sclerosing Panencephalitis: A case of long term survival Subacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder of childhood and early adolescence. It is caused by persistent defective measles virus. Patients usually have behavioural changes myoclonus dementia visual disturbances and pyramidal and extrapyramidal signs. The disease has a gradual progressive course leading to death within 1-3 years. 13 year old female presented with history of decreased school performance of 1 year seizures (myoclonic and generalized tonic clonic seizures) in the year 2007.she was diagnosed to have SSPE based on clinical presentation the EEG showing periodic discharges and high titres of measles antibodies in both serum and CSF. She was treated with anti epileptics and was followed up. On follow up seizures were better and cognitive decline was static she was able to walk without support but her vision declined for the past 3 year. Serology was repeated after 7 years showed high titres in serum and CSF. CT brain showed diffuse cerebral atropy. VEP was prolonged in both eyes. EEG: showed periodic discharges. Death occurs in 1-3 years in SSPE. This is a case of spontaneous improvement which is quite unusual.

103

Session: Poster epilepsy 2.2

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

ddms

Biswajyoti Rath, Dr. M. Samant, Dr. K. P. Swain

Scb Mc, Cuttack.


Dyke Davidoff Masson Syndrome (DDMS) also called as cerebral hemiatrophy is a rare clinical condition characterized by seizures facial asymmetry contralateral spastic hemiplegia or hemiparesis with learning difficulties. A 21 year female of low socio-economic status presented to us with h/o recurrent episodes of seizure for last 15years. There was increased frequency of seizure and abnormal behaviour for last 2 months. On enquiring about her past history she had normal uneventful delivery with h/o developmental delay mentalsubnormalityand early schooldrop-out. There was no history of any serious childhood infections like feverneuroinfection or trauma. She was diagnosed of having seizure since 5years of age and since then she was on irregular oral anti-epileptic therapy. At time of presentation she was on oral eptoin 300mg/day. On physical examination - shewas moderately built no facial asymmetry no caif-au-lait spots and CNS examination showing disorientation to time place and person with abnormal behaviourmild right hemiparesis with right plantar was extensor. She had 3-4 episodes of GTCS during hospitalisation for which a second antiepileptic was added. On CT scan brain showed left cerebral hemiatrophy with prominentsinuses. She was discharged with 2 anti-epileptics - eptoin and valproic acid

202

Session: Poster epilepsy 2.3

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Case of tetatnus

Dr. Omar Farooq, Dr. Parvez Ahmad Zunga

Gmc Srinagar, Srinagar.


A 58 year Old male with no significant history of any chronic morbidity was admitted in SMHS hospital srinagar with history of injury to hand 20 days back followed by 3 days history of difficulty chewing trismus and generalized stiffness interfering with his daily activities. Patient was clinically managed as tetanus on grounds of high clinical suspicion and treated. Retrospectively his serological tests were received which overwhelmingly tested positive for tetanus. patient was treated and discharged without any sequelae to follow in neurology OPD SMHS hospital Srinagar and is doing well.tetanus is still a disease to be suspected in post trauma patients especially in developing countries like ours India. Despite active and passive immunization it continues to be a significant public health problem in developing countries and should be readily suspected and treated. Although prevention is important for tetanus the outcomes can be improved by early diagnosis and treatment.

204

Session: Poster epilepsy 2.4

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Parry romberg syndrome: A case report

Mohamed Kilji M, Muthu T, Bala Subramanian S, Bhanu K,

Madras Institute of Neurology Chennai, Erode.

Introduction: Parry Romberg syndrome a rare neurocutaneous syndrome with female preponderance occuring between 5 to 15 years of age is characterised by progressive shrinkage and degeneration of the tissues beneath the skin with certain neurologicalocular and oral manifestations. Case Report: 24 year old female presented with complaints of progressive wasting of right side of facedifficulty in chewing food and difficulty in closing mouth on right side of face for 2 years and unilateral intermittent throbbing headache for 1 year. Patient had Right temporal and right hemifacial wastingdeviation of angle of mouth to right side. Corneal and conjunctival reflex diminished on right side. Skin biopsy was taken from right nasolabial fold. MRI BRAIN AND FACIAL STRUCTURES showed atrophy of right hemifacial soft tissue structures and mild hypoplasia of right angle of mandible with normal brain parenchyma. Discussion: This syndrome occurs sporadically. The relationship of this disorder to linear scleroderma still is debated. The lesion sometimes begins after trauma to the area. The atrophy eventually stabilizes leaving facial disfigurement. Proposed mechanisms (e.g. cortical dysgenesis dysfunction of the sympathetic nervous system chronic localized meningoencephalitisautoimmune) are inadequate to explain all of the clinical features. Features such as fibrosis of the skin and adipose tissue atrophy without any features of an early inflammatory infiltration in biopsy reported in parry romberg syndrome. But in case of linear scleroderma massive lymphocytic inflammatory infiltration around the vessels of surface and deep plexuses of skin can be observed. In our patientexcept for unilateral throbbing headache and right trigeminal neuropathy no ocular and oral manifestations were noted. Differential diagnosis includes hemifacial spasm and linear scleroderma. Conclusion: This case is presented here because of rarity.

226

Session: Poster epilepsy 2.5

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Infantile tremor syndrome(its): A case report of a rare clinical disorser

Dr. Santhosh Kumar B, Dr. Dhairyawanp, Dr. Veena. N, Dr. Sateeshk, Dr. Sowjanya Poosarla, Dr. Santhosh Kumar, Dr. Amareshwer K

Gandhi Medical College Hyderabad, Hyderabad.

Inroduction: ITS is a rare clinical disorder characterized by coarse tremors anemia and regression of psychomotor milestones in children around 1 Yr of age. It has been primarily reported from India and south East Asia. Various nutrient deficiencies ( eg:vit B12 Magnesium ZincVit-C) has been found to be associated with ITS. Objective: To report a case of infantile tremor syndrome. Material and Methods: One year old boy presented with H/o regression of psychomotor milestones since 2 months and involuntary movements of both upper and lower limbs since 2 weeks. These movements were present continuosley throughout the day and are minimal during sleep.child was consciousand alerttakes breast feeding during these movements. O/E boy was Plumpy looking with pallor. Dark pigmentation was present over dorsal aspects of hands nail folds feet knees ankles and axillae.thin sparse hair noted these were fast regularcontinuous rhythmiclow amplitude oscillatory movements more prominent in distal parts of limbs head face and tonguewith diminished in intensity during sleep. No focal neurological deficit was found. Results: Serum Vit B12 was 160.0 pg/ml. Peripheral smear showed megaloblastic anaemia. EEG was normal. MRI Brain showed features of cerebral atrophy.on supplementation with Vit B12 movements were subsided. Conclusion: Recognising this clinical entity is important as it can mimic seizures and should be differentiated from it as the treatment is different for both these conditions.

131

Session: Poster epilepsy 2.6

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Dyke davidoff masson syndrome a case report

Biswajyoti Rath, Dr. Maheswar Samantdm Student, Dr. Nihar Ranjan Biswal Dm Student, Dr. Kali Prasanna Swain Asst Prof, Dr. Ashok Kumar Mallickprof Hod, Dr. Geeta Mohanty Prof

SCB Medical College, Cuttack.


In 1933 C. G. Dyke L. M. Davidoff and C. B. Masson described plain skull radiographic and pneumatoencephalographic changes in a series of nine patients. The condition is characterized by cerebral hemiatrophy facial asymmetry thickening or thinning of cranial vault contralateral hemiplegia or hemiparesisseizures mental retardation and behavioural changes like schizophrenia. The above features may be present in varying combinations and degrees of severity. Diagnosis is usually achieved by clinical examination and radiologic investigation.A 21 year female of low socio-economic status presented to us with h/o recurrent episodes of seizure for last 15years. There was increased frequency of seizure and abnormal behaviour for last 2 months. Past history- she had normal uneventful delivery with h/o developmental delay mentalsubnormalityand early schooldrop-out. There was no history of any serious childhood infections likefever neuroinfection or trauma. She was diagnosed of having seizure since 5years of age and since then she was on irregular oral anti-epileptic therapy. At time of presentation she was on oral eptoin. On physical examination - shewas moderately built no facial asymmetry no caif-au-lait spots and CNS examination showing disorientation to time place and person with abnormal behaviourmild right hemiparesis with right plantar extensor. She had 3-4 episodes of GTCS during hospitalisation for which a second antiepileptic was added. On CT scan brain showed left cerebral hemiatrophy with prominentsinuses. She was discharged with 2 anti-epileptics - eptoin and valproic acid.

169

Session: Poster epilepsy 2.7

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Rare case of isoniazid toxicity

Dushyanth Babu Jasti, Dr. B. Vengamma, Dr. Sivakumar, Dr. B. Vijayalakshmi Devi

Svims Tirupati, Tirupati.


54 year old maleknown patient of Chronic Glomerulonephritis Chronic Kidney disease on Peritoneal dialysis Dilated Cardiomyopathy and Pulmonary Tuberculosis on ATT (IsoniazidRifampicinPyrazinamide and Levofloxacin)presented with complaints of altered behaviour with psychotic symptomsan attempt of suicideslurring of speechvomiting and swaying while walking of 3 days duration. Examination showed pallor and positive bilateral cerebellar signs. Clinical Diagnosis of Posterior circulatory stroke was made in view of acute onset of symptoms. Investigations showed Autoimmune haemolytic Anaemia and transaminitis. MRI Brain showed symmetrical T2 hyperintensities in bilateral dentate nuclei. As Imaging was not suggestive of strokeIsoniazid toxicity was suspected. Isoniazid was stopped and patient was managed with high dose of Pyridoxine following patient showed improvement in symptoms significantly. Psychosis Transaminitis and Anaemia also improved. Repeat MRI Brain done after 4 weeks of treatment showed resolution of dentate hyperintensities. Cerebellitis is a very rare side effect of Isoniazid which usually presents with diffuse signal alterations in both cerebellar hemispheres. In our patient there was isolated involvement of dentate nuclei. We report this case as after thorough review of literature this is the first case report of patient having combination of very rare and less reported side effects of Isoniazid which included Cerebellar ataxia with Reversible Dentate nuclear hyperintensitiesPsychosis with Suicidal attempt Autoimmune haemolytic Anaemia and Transaminitis.

7

Session: Poster inflamm 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Ring-enhancing cerebral lesions- clinical and radiological resolution at first planned review on treatment

Uma Sundar, Wasim Mujawar, Sameer Shrirangwar, D. Asole, S. Gulhane, Abhilasha M, Meenakshi B. A, Bhushan Chopade

Lokmanya Tilak Mun Med College & Hospital Sion M, Mumbai.

Aim: To study treatment response in first 4-6 months in patients with new onset seizure/s due to ring enhancing lesion/s on MRI. M&M: 60 enrolled patients included 32 Tuberculomas (lesion> 2cms conglomerate T2 centralhypodense) 23 Neurocysticerci ( scolex seen) 4 brain abscesses ( 3 pyogenic and 1 tuberculous) and 1 Glioma. Overall single lesion was seen in 32(53.33%) & multiple lesions in 28 cases(46.77%) frontal lobe being commonest site in both. Single lesions were significantly commoner in NCC than TBoma. ( P< 0.05; 72.7% and 37.5% respy.) On treatment 40 patients were seen for 1st review at a mean of 4.5 months later. Overall 28 out of 40 cases (70.73%- 15/23 Tuberculoma 10/13 NCC3 /4 Brain abscess) showed clinico-radiologically concordant improvement at first follow-up.5/40 patients( 4 Tb with shunt- complications and 1 NCC with steroid-responsive IRIS ) needed earlier repeat MRI due to clinical worsening. Clinical improvement but persistent or worsening imaging features were seen in 3/40 (2 Tb and 1 NCC ) and 4/40 ( 2 Tb 1 NCC 1 abscess) cases respy. Clinico- radiological resolution at 1st review was comparable in Tb and NCC ( 65.21%: 76.92% ). Persistence or worsening of lesion despite clinical improvement was statistically similar - TB 17.39%: NCC 15.38%.Requirement of earlier imaging due to clinical worsening was commoner in Tb than NCC ( 17.38% vs 7.69%) attributed to shunt blockage. Diagnosis was revised from NCC to Tuberculoma in a single case at 4.5 months after repeat MRI despite clinical stability.

43

Session: Poster inflamm 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Rabies encephalomyelitis

Manivannan, Ganesan, Muthukumar, Justin, Chezian, Thirumalai Rajan, Muthuveeran, Sritharan, Ramu, Birla

Madurai Medical College Madurai, Madurai.


Rabies is a rapidly progressive acute infectious disease of central nervous system(CNS) in humans and animals that is caused by infection with rabies virus. It is usually transmitted to humans by bite of an infected animal. It has two clinical forms (1) Encephalitic form(Furious rabies) characterized by classical signs of phobic symptoms & (2) Paralytic form (dumb rabies) characterized by progressive paralysis with out an initial furious phase. Both the above forms progresses to death. We report here a rare presentation of rabies- rabies encephalomyelitisCASE VIGNETTEA 21 year old male patient presented with weakness of both upper limbs and lower limbs for 3days. On eliciting the history in detail patient had history of fever for 5 days followed by weakness of the limbs- initially started in left lower limblater progressed to involve all the four limbs.later patient developed swallowing difficulty and repeated episodes of vomiting due to the above difficulty. Past history of dog bite to his left leg 25 days back for which he was vaccinated completely On examination patient stuporous pupil -2mm sluggishly reacting quadriplegia depressed DTRs no plantar response with neck stiffness MRI BRAIN revealed T2/FLAIR hyper intensities involving both basal gangliabrainstem with no contrast enhancement of the above. MRI spine screening revealed enlarged and increased signal intensities involving the entire spinal cord including conus with contrast showing abnormal leptomeningeal enhancement & enhancing exudates in thoracic aspect of spinal cord- s/o encephalomyelitis. Corneal impression smear -direct fluorescent antibody technique which showed positive for rabies virus antigen. Patient expired on the same day itself. Postmortem CSF and serum analysis sent to NIMHANS which showed rabies virus neutralizing antibody titre by rapid fluorescent focus inhibition test(RFFIT) in serum is 2048 & in CSF is 1024 suggestive of rabies encephaltis

61

Session: Poster inflamm 1.3

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

A rare cause of progressive multifocal leukoencephalopathy: A case report

Anish Mehta, Mahendra Javali, Rohan Mahale, Aju Abraham John, Madhusudhan B. K., Suryanarayana Sharma, R. Srinivasa

Department of Neurology MS Ramaiah Medical Colleg, Bangalore.


Progressive multifocal leukoencephalopathy (PML) is an opportunistic demyelinating neurological disease caused by reactivation of JC virus. It has a prevelance of 1 to 5 % in acquired immunodeficiency syndrome (AIDS) (1). This disease has also been described in patients with hematological malignancies transplant recipients those receiving immunosuppressive agents and rare cases of Idiopathic CD4 lymphocytopenia. Idiopathic CD4 lymphocytopenia (ICL) is a syndrome defined by the centre for disease control and prevention as a CD4 count < 300 cells/UL or < 20% of total T cell count on > 1 occasion with no evidence of human immunodeficiency virus (HIV) infection and the absence of other known immunodeficiency or therapy associated with lymphocytopenia(2). The etiology pathogenesis and management of ICL remains poorly understood and inadequately defined. Hereby we report a patient who presented with insidious onset gradually progressive language dysfunction and personality change. On evaluation he was diagnosed to have PML which was histologically proven secondary to idiopathic CD4 lymphocytopenia.

125

Session: Poster inflamm 1.4

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Two unusual cases of Neuromyelitis optica mimicking intramedullary tumor

Shailesh H. Darji, Krunal Padhiyar, Pranav B. Joshi, Shalin D. Shah, Mayank A. Patel

NHL Medical College Elisebridge Ahmedabad, Ahmedabad.


Neuromyelitis optica (NMO) is a central demyelinating disorder with heterogeneous presentations. We report two unusual cases mimicking intramedullary tumor. A 55 year female presented with recurrent nausea vomiting and hiccough which was diagnosed as koch's abdomen. Then she developed left upper limb weakness gait disturbances and urinary hesitancy. MRI spine showed patchy enhancing expansile lesion extending from cervico-medullary junction to D2. There was poor response with steroids. Within two months she worsened and developed quadriparesis. Repeat MRI showed lesion extension upto D6 level. Although astrocytoma was considered biopsy showed demyelination. NMO antibody came positive and patient had partial recovery with rituximab. A 17 year female presented with acute bilateral lower limb weakness paraesthesia and bladder disturbances. MRI spine showed inhomogeneously enhancing expansile lesion from C3 to C5 with non-enhancing cystic areas within. It was diagnosed as astrocytoma by two independent radiologists and patient was advised neurosurgery consultation for biopsy. Meanwhile patient developed dimness of vision in right eye so referred for neurology consultation and advised NMO antibody testing. While awaiting report patient was operated and biopsy result came negative for neoplasm. Then patient developed left upper limb weakness. She was treated with steroids followed by azathioprine as her NMO antibody came positive. She responded to treatment and is stable at six months follow-up. NMO can present with appearance of swollen cord and cystic changes which initially may be misdiagnosed as intramedullary tumor. NMO should be considered with high priority in any patient presenting with intramedullary long segment lesion.

263

Session: Poster inflamm 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Two Interesting cases of Meningo-encephalo-radiculitis

Dr. B. Krishnakumar, Dr. S. Gobinathan, Dr. S. Sakthi Velayutham, Dr. K. Malcolm Jeyaraj, Dr. P. R. Sowmini

Stanley Medical College, Chennai.

Introduction: We present two cases of Meningo-encephalo-radiculitis due to EBV infection. Case vignette-1A 35 year male presented with acute urinary retention fever headache altered sensorium flaccid progressive weakness of both lower limbs over one week. On examination confusion neck stiffness bladder distended areflexic paralysis of both lower limbs. Motor conduction showed Tibial and peroneal nerve axonopathy with F prolongation. Sensory conduction was normal. lumbosacral roots were enlarged in MRI. Brain & spinal cord MRI was normal. CSF showed pleocytosis mononuclear cells increased protein and normal sugar. CSF and Serum tested positive for EBV infection. Case vignette: 2A 47 year male presented with fever altered sensorium dysarthria nasal regurgitation flaccid paralysis of all four limbs over two weeks. ON examination confusion meningeal signs bulbar involvement areflexic paralysis of all 4 limbs. Motor conduction showed axonopathy of all four limbs sensory conduction was normal. MRI brain & spinal cord was normal. CSF showed pleocytosis mononuclear cells increased protein and normal sugar. CSF and Serum tested positive for EBV infection. Both the cases improved with antivirals and steroids. Discussion: Both patients in our series had polyradiculoneuropathy along with meningo encephalitis. This unusual combination of peripheral and central nervous system involvement due to EBV infection has been noted in some case studies. Urinary retention as an initial manifestation of EBV infection as in our first case has also been reported. We report these cases for the unusual clinical presentation.

274

Session: Poster inflamm 2.1

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Tumefactive demyelination in a hiv patient

Dr. Karunakaran, Prof. Dr. S. Gobinathan, Dr. Sakthivelayutham, Dr. Malcolm Jeyaraj, Dr. Sowmini, Dr. Krishnakumar, Dr. K. S. Raja, Dr. Ravindran

Department of Neurologygovt Stanley Medical Colle, Chennai.


A 39 years old male admitted with acute onset of weakness of right upper and lower limbs which gradually worsened over three days. At the same time he also had progressive painless visual loss in left eye over three days to the degree of light perception only. Clinical examination showed left eye RAPD normal fundus right spastic hemiparesis with power 3 to 4 - / 5. VEP showed prolongation of p100 latency. Complete Blood Count and biochemical investigation were within normal range. ELISA was Positive forHIV1. ANA CRP HBsAg Anti HCV and Serum Toxoplamsa Abs were negative. Cerebrospinal fluid examinationshowed acellular smear with normal protein and sugar Gram staining AFB staining Fungal staining and Indian Ink preparation were negative. Cerebrospinal fluid PCR for CMVVZV EBV JC virus and HSV anti bodies were negative. MRI showed Multiple T2 hyperintensities FLAIR non suppressible lesions with surrounding edema without diffusion restriction in left and right frontal and bilateral parietal white matter. On contrast study open ring enhancement was seen. MRS showed low N-acetyl aspartate elevated choline and lactate. He was treated with corticosteroids and antiretroviral therapy. His motor power improved to 5/5 and vision improved from light perception to hand movements. Repeat MRI after 3 months shows marked shrinkage in size. Tumefactive demyelination in HIV patient is a rare neurological presentation. Worldwide very few cases have been reported. We highlight this case for its rarity.

18

Session: Poster inflamm 2.2

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Two cases of orbital apex syndrome: Case reports

Dr. Rajesh Venkat Indala, Dr. Venkatesan Nagarajan, Dr. K. Muthuraj, Dr. S. Sundar, Dr. Kamaksi Shanbhogue

SRM University Kattankulathur Chennai, Chennai.


Orbital apex syndrome (OAS) has been described as a syndrome involving damage to the oculomotor nerve (III) trochlear nerve (IV) abducens nerve (VI) and ophthalmic branch of the trigeminal nerve (V1) in association with optic nerve (II) dysfunction. The cavernous sinus syndrome (CSS) may include the features of an OAS with added involvement of the maxillary branch of the trigeminal nerve (V2) and oculo-sympathetic fibers. Superior orbital fissure syndrome (SOFS) is often applied to lesions located immediately anterior to the orbital apex involving multiple cranial nerve palsies in the absence of optic nerve pathology. The superior orbital fissure orbital apex and cavernous sinus are all contiguous although these terms define the precise anatomic locations of a disease process; the etiologies of these syndromes may be similar. We present two cases of orbital apex syndrome with multiple cranial nerve palsies and II cranial nerve involvement. Both of them underwent MRI brain and Orbit with contrast which revealed granulomatous lesion confined to orbital apex. Both cases were started on steroids following which there is complete recovery of eye movements and partial recovery in vision.

53

Session: Poster inflamm 2.3

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Thoracic cord demyelination in a patient with auto immune polyglandular syndrome type 1 a case report

Surya Narayana Sharma P. M., Surya Narayana Sharma P. M, Mahendra Javali, Rohan R. Mahale, Madhusudhan B. K, Anish Mehta, Aju Abraham John, Srinivasa R

M. S. Ramaiah Institute of Neurosciences, Bangalore.


Autoimmune polyglandular syndrome type 1 (APS-1) is a rare autosomal recessive disorder that is mainly characterized by polyendocrinopathy chronic mucocutaneous candidiasis and ectodermal dystrophy. Autoimmune neurologic disease may develop with autoimmune polyglandular syndrome type 1. Neurologic disease may also result from the associated endocrinopathies (hypoparathyroidism hypothyroidism diabetes mellitus) vitamin deficiency (vitamins B12 and E) and celiac sprue. Common neurological manifestations include cerebellar ataxia movement disorders and tetany. Here we report a 52 year old gentleman who presented with subacute onset sensory symptoms involving both lower limbs and trunk of 3 weeks duration. He had past history of vitiligo and grave's disease. He had depigmented skin lesions posterior column involvement & sensory ataxia. MRI spine revealed non enhancing T2 hyperintense lesion in thoracic cord suggestive of demyelination. Laboratory work up revealed hyperhomocystinemia normal vitamin B12 folate TSH cortisol and PTH. His HIV/ VDRL/ CSF analysis/vasculitis workup was unremarkable. TPO was elevated. Anti parietal cell antibody was positive. Endoscopy revealed esophageal candidiasis and atrophic gastritis. He had vitiligo auto immune thyroiditis pernicious anemia and chronic esophageal candidiasis suggesting the possibility of autoimmune polyglandular syndrome type 1. He was started on steroids and parenteral vitamin B12 supplementation and improved symptomatically. To the best of our knowledge this is the first case report of thoracic cord demyelination in a patient with autoimmune polyglandular syndrome type 1 in English literature

20

Session: Poster MD 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Rare causes of stroke

Jasmine Kalyani, Jasmine Kalyani P, Radha. M, Rachel C, Saravanan S

Tirunelveli Medical College, Tirunelveli.

Rarecauses of Stroke abstract: We are presenting four rare causes of stroke encountered in our hospital.1. Moya moya disease2. Takayasus disease3. Herpeszoster related vasculopathy.4.non hypertensive PRESS. CASE VIGNETTE-1: MOYA MOYA DISEASE A 21 year old patient presented with headache seizures weakness of right upper and lower limbs and dysarthria. He developed recurrent strokes with cognitive disabilities. MRI showed distal occlusion of left ICA with basal network of fine caliber and arteriographic appearance had a puff of SMOKE appearance. He was referred to higher center and underwent surgical correction. This intracranial arteriopathy is associated with a bilateral progressive obliteration of major arteries of ICA ACA and MCA. These vessels are replaced by a fine meshwork of small collateral vessels at the base of the brain that are the hallmark of Moya Moya. CASE VIGNETTE: 2-TAKAYASU-ORNISHI DISEASE A 56 year old male patient who is a known case of Parkinsonism presented with signs of ischemia of the extremeties such as cold sensation pulseless and claudication and TIAs. He belonged to the type-3 Takayasus diseaseCASE VIGNETTE: 3- HERPES ZOSTER RELATED VASCULOPATHY- A 56year old lady presented with cranial neuropathy-Ramsay Hunt Syndrome. She presented with headache vesicles over the external auditory meatus encephalomyelitis optic neuritis. Subsequently after the initial infection she developed CNS complications which are only 0.2%-due to the virus which remains latent in the dorsal root ganglia in neurons in the satellite cells. CASE VIGNETTE: 4 - RPLSDUE TO ENDOTHELIAL DAMAGE AND DISORDERED CEREBRAL AUTOREGULATION A 15 year old boy presenting with headache altered mentation visual symptoms seizures and posterior dominant white matter edema on brain MRI. With complete recovery and follow up MRI showed complete resolution.

78

Session: Poster MD 1.3

Date and Time: 113:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Vitamin B12 defeciency causing recurrent reversible encephalopathy with peripheral neuropathy: a casereport

Dr. Deepika Joshi, Prakash Sinha, Arun Singh, Ranveer Yadav, Vivek Sharda, Vijay Nandmeyer, Arun Kumar, V. N. Mishra, R. N. Chaurasia

Professor IMS BHU Varanasi, Varanasi.


Vitamin B12 deficiency is associated with varied neurological psychiatric and hematological manifestations.We report a patient who presented to us with encephalopathy and peripheral neuropathy. A forty year old pure vegetarian hindu male was admitted with symptoms of abnormal behavior insomnia restlessnessof 2 months duration with weakness of lower limbs of one and a half months duration. He also had a history of 2 episodes of generalized seizures. O/E patient was disoriented to time place and person DTR were absent in Lower limbs planters were B/L NE. His CBC revealed an Hb of 8.3g/dlwith an MCV of 104 fL. All other investigations including CSF MRI brain +spine were Normal TFT collagen weer normal. His Vitamin B12 levels were low 163pg/ml. NCS revealed sensory axonal neuropathy involving predominantly LL. His attendants gave history of similar complaints 10 yrs back with patient being thouroughly investigated with CSF MRI which was normal. However B12 levels were not done at that time. No cause could be found at that time. He improved over 5-6 months and was taking only AED+ some vitamins preparations on advice of local doctor. Patient was started on injectable B12 injections and showed significant clinical improvement in mental status plus gait. Conclusion: This report highlights the importance of evaluating patients with encephalopathy and peripheral neuropathy with B12 levels especially in cases with recurrent symptoms

168

Session: Poster MD 1.4

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Association of vitamin B12 with dementia-study of 15 cases

Philo Hazeena P, Balasubramanian, Bhanu K, Muthu T

Madras Institute of Neurologymadras Medical Colle, Chennai.

Introduction: Dementia implies a cognitive decline of sufficient severity to compromise a persons routine. They require memory impairment beyond what would be normal for aging and impairment of at least one other cognitive domain such as attention language visuospatial skills or problem solving. AIMAim of the study was to find the association of vitamin B12 with Dementia. Methods: Study was done among 15 patients admitted in Rajiv Gandhi General hospital with features of dementia. The clinical manifestations were evaluated using the MMSE and detailed lobar functions. The plasma B12 levels were measured among the patients with cognitive decline. RESULTSAmong the 15 patients included in the study 4 had plasma B12 levels below 250ng/ml 2 among them had features suggestive of Alzheimer's disease and 2 had cognitive decline due to nutritional cause and the remaining 11 patients with features of dementia had normal B12 levels. Their MMSE was found to be <21/30. Discussion: Cognitive impairment is of multifactorial originit is appropriate to detect those modifiable risk factors as the treatment may delay or slow down disease progression. A study of larger series of patients has to be done to know the relation of B12 with dementia.

254

Session: Poster MD 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Geste antagoniste in paroxysmal nonkinesigenic dyskinesia

Gulab Chandra Soni, Dr. Gulab Chandra Soni, Dr. S. Pandey, Dr. G. A. Khwaja, Dr. D. Chowdhury

G. B. Pant Hospital, New Delhi.


Geste antagoniste in paroxysmal nonkinesigenic dyskinesia G Soni S Pandey G. A. Khwaja D. Chowdhury Department of Neurology G B Pant Hospital New Delhi. Introduction: Paroxysmal nonkinesogenic dyskinesia (PNKD) is a rare movement disorder characterised by chorea and dystonia. Usual attack lasts from 10 minutes to one hour. Aims and Objectives: We presnt a case of PNKD who had dyskinesia in form of hemidystonia and hemichorea. During the attack he used to thump his chest using contralateral fist for releiving his symptoms. Methods: Patient was seen at a tertiatry care teaching institute and diagnosis of PNKD was made using the clinical criteria. ResultsWe presenta case of PNKD in an 11 year old male patient who had complaints of hemidystonia and hemichorea of either side of body fromlast10 years. Frequency of attack was 2-3 per day and abnormal movements used tosubside during sleep. The characteristic of this PNKD was that the patient used some relieving manoeuvrefor aborting the attacks. He would thump hischest with the contra lateral fistcontinuously for 3-5 minutes and then hemidystonia would subside. Patient was treated with tablet carbamazepine 100 mg twice daily and after one month follow up his movements improved significantly. Conclusions: Geste antagoniste or alleviating manoeuvres (sensory tricks) used by dystonia patients have been well described in literature. But this type of chest thumping to get relief from movement disorders in PNKD is not described in the literature. Keywords: Dyskinesia Paroxysmal Movement

44

Session: Poster MD 2.1

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Neuro acanthocytosis

Ganesan, Justin, Birla, Chezian, Muthukumar, Manivannan, Muthuveeran, Sritharan, Ramu

Madurai Medical College Madurai, Madurai.


Neuroacanthocytosis syndromes are a group of genetically defined disease characterized by the association of RBC acanthocytosis and progressive degeneration of basal ganglia. CASE VIGNETTEA 24 year old male patient presented to our department with involuntary movement of entire body and limbs- 1 year duration with history of frequent falls in the last 6 months due to his inability to control movement.he also had history of repeated biting of his buccal mucosa with history of difficulty in swallowing and emotional disturbances in the form of anger outburstthe above problems were progressive in nature.there was no history of any antipsychotics intake. The patient was born to a nonconsanguinous marriage and family history was negative. On examination patient had multiple scratch marks over his trunk. On neurological examination patient had generalized chorea orofacial dyskinesia eating dystonia and vocal +motor tics. His buccal mucosa showed multiple bite marks (self mutilation).higher function examination patient was not cooperatic for MMSE. His speech was slurred. Spinomotor system revealed normal tone and power with preserved reflexes and plantar- flexor bilaterally. Sensory and cerebellum examination were normal. His gait revealed jaunting gait.psychiatrist opinion obtained. Investigations revealed normal renal function test liver function test thyroid function test serum CPK and lipid profile. HIV ELISA VDRL& ANA were negative. Serum ceruloplasmin was 30mg/dl- normal. MRI BRAIN revealed atrophy of caudate and putamen with dilatation of frontal horn of lateral ventricle. Complete hemogram with peripheral smear study revealed normochromic normocytic anaemia with many acanthocytes(>5%). WBC and platelet count were adequate In number and morphology. NCS with EMG showed normal study.patient treated symptomatically.patient now on followup regularly

304

Session: Poster MD 2.2

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Sea "bends"

Dr. B. Kannan, Prof. R. Lakshminarasimhan

Assistant Professor Department of Neurology Thoo, Tuticorin.


Sea bends- occupational hazardstuticorin is in the southern coastal tamilnadu. The occupation of our people is deep sea diving for collecting sangu. Here i am reporting interesting case of decompression sickness otherwise called bends. Case report- 35 years old male went for deep sea diving suddenly developed giddiness backpain abdominal distension hearing loss weakness in both lowerlimbs. On the day of admission he is paraplegic next day he developed quadriparesis with respiratory failure. He is intubated. His usg abdomen shows pneumobilia. On the course of hospital hearingrespiratory failure upper limb power improved and able to feel bladder sensation. The mri picture showed t2 hypertense signal involving central portion of spinal cord extending from c2 to c5 probably due to spinal cord inafact. Mri brain shows non specific t2 hyperintense signal. We treated with steroid and supportive care. This case is reported to highlight the rarity of neurological manifestations of sea sickness

302

Session: Poster MD 2.3

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Titlehuntington's disease: Case reports and clinical profile in genetically determined cases from north eastern region of India

Amit Ranjan Barua, Amit Ranjan Barua, Nomal Chandra Borah, Parth Sarthi Deb, Rupjyoti Das

Gnrc Hospital Sguwahati-781006Assam., Guwahati.

Objectives: To evaluate the clinical and genetic profile of genetically determined 3cases of Huntington's disease over a period of four years(1st of April 2009 to 1st of April 2013) in ethnic population in North Eastern Region of India. Population in North Eastern Region of India belong to the Austro-Asiatic Sino-Tibetan (Tibeto-Burman Sino- Burman sub families) and Indo-Aryan. All the 3 cases belong to the local ethnic population. No study on genetically confirmed Huntington's disease was reported from North Eastern region of India earlier. Methods: All the patients of possible HD were assessed clinically & a detailed clinical history were obtained. All the patients were screened to exclude structural cerebral pathology as well as disorders of similar clinical presentations. Blood samples were collected after due consent from the patient for HD genomic DNA analysis and analysed at CCMBHyderabad. Results-On analysis all the three(3) patients were males and heterozygous at HD locus and upper allele size(bp) was found to be 171(number of repeats were 43)lower allele size(bp) was found to be 86(number of repeats were15). The number of CAG repeats on one of the alleles at HD locus falls beyond the normal range of 6-33 repeats. Age of occurance ranged between 3rd to 6th decades. Disease duration ranged between 5-15 years. Choreiform movements in 3 cases(100%)Cognitive impairment in 2 cases(66.6%)Psychiatric disturbances in 3 cases(100%) Dysarthria in1 case(33.3%)Ataxia in 1(33.3%)Slow saccadic eye movement in 1 case(33.3%) were found. All the patients have family history in the previous generations of autosomal dominant inheritance. In all the cases there were no family history of racial admixture. Conclusion-Study findings were comparable with similar studies done elsewhere.

140

Session: Poster MD 2.4

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

A rare case of young dementia

Swethe R, Viswajyothi P, Ramesh

Osmania Medical College, Hyderabad.


A 44 year old male presented with left ear deafness tinnitus vertigo oscillopsia since 15 years and an episode of stroke with dysarthria and clumsy hand gradually progressing to gross reduction in the previous level of occupational and social functioning with slowness in all activities perseveration memory loss gait difficulty whole body stiffness dysphagia with choking episodes and pseudobulbar effect. He was a product of consanguinous parentage with family history of stroke in younger brother and a death due to coronary artery disease of maternal uncle with neurocutaneous markers in all 4 siblings. Examination showed Angiokerotomas on buttocks and groin spastic speech reduced attention loss of executive function and abstract thinking reduced verbal fluency loss of recent and new learning memory construction and calculation and psychomotor retardation There was bilateral VIII nerve deafness and pseudobulbar palsy. Motor examination showed diffuse spasticvity brisk tendon reflexes and bilateral extensor pantar reflex. Gait was spastic ataxic gait. MRI brain showed multiple lacunar infarcts and diffuse cerebral atrophy. Skin biopsy showed glycolipid deposition and enzyme studies confirmed Fabry's disease in all 4 siblings.

172

Session: Poster MD 2.5

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Extrapyramidal syndrome with dementia in a young female

Swethe R, Viswajyothi P, Ramesh

Osmania Medical College, Hyderabad.


A 32 year female presented with 4 years history of altered behaviour depressionbradykinesia reduced level of social and occupational functioning with mild memory loss and rigidity of all four limbs more on the right side with rapid deterioration in the last 3 months to mute and rigid and disoriented state. She was a product of non consanguinous parentage and there was no family history of similar illness. On examination patient was disoriented with reduced spontaneous speech loss of comprehension and attention. Other mental functions could not be tested. On motor system examination there was straiatal toe on right side and diffuse rigidity with cogwheel phenomenon. Tendon reflexes were brisk and plantar reflexes were absent. Routine blood investigations were normal. MRI brain showed eye of tiger appearance suggestive of neurodegeneration with brain iron accumulation (NBIA).

196

Session: Poster MD 2.6

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

A case of acute hepatitis E virus associated Parkinsonism in a 17 yr old boy

Dr. Shaik Afsar Pasha, Dr. Srinivas Y, Dr. Nageswara Rao

Nri Academy of Sciences, Guntur.

Background: Hepatitis E (HEV) is a single-stranded RNA virus that is structurally similar to a Calicivirus. Infection with HEV usually causes a self-limiting acute hepatitis similar to HAV. Parkinsonism is a symptom complex comprising bradykinesia rigidity tremor postural instabiltiy. There is little data regarding the neurological manifestations of Hepatitis E although its association with few of the diseases already published like GBS acute transverse myelitis. We present a case of 17 yr old boy with acute hepatitis with extrapyramidal parkinsonism with positive Hepatitis E serology. Case Presentation: A 17 year old sportsman hailing from southern part of India came with a complaint of intermittent high grade fever associated with diffuse dull aching type of headache and flu like symptoms 3 days before the onset of parkinsonism. On 6th day of illness patient developed yellowish discolouration of eyes. On evaluation patient had grossly elevated liver enzymes (in 1000's). Contrast enhanced MRI brain shows T2 FLAIR hyper intensities noted in Bilateral temporal frontoparietal right lentiform nucleus. Sera was positive for IgM Hepatitis E virus. Patient recovered fully with symptomatic treatment. CSF was negative for Herpes virus JE virus St Louis virus. Conclusion: Neurologic signs and symptoms are an emerging extra hepatic manifestation of HEV infection. We recommend the clinicians strongly to consider the possibility of HEV infection in patients with neurologic disorders especially those with concomitant liver abnormalities as indicated by blood tests. The diagnosis may be suggested by HEV serology but should be confirmed by molecular documentation of HEV RNA in the serum CSF or both.

200

Session: Poster Neuropathy & others 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Polyneuritis cranialis with generalized hyperreflexia as a manifestation of thyrotoxicosis

Gaurav M. Kasundra, Gaurav M. Kasundra, Amita Bhargava, Bharat Bhushan, Shubhakaran Khichar, Isha Sood

Dr. S. N. Medical College Jodhpur, Jodhpur.


A 22-year-old male student with no past medical illness presented to us with a history of acute onset hoarseness of voice and binocular diplopia since 10 hours and severe hypophonia with dysphagia since 4 hours. On examination he had a tachycardia hypertension and multiple cranial nerve palsies including bilateral oculomotortroclear abducens trigeminal facial glossopharyngeal and vagus nerves. All four limbs had normal tone and power with generalized hyperreflexia but absent jaw jerk. Plantars were flexors and rest examination was unremarkable. Patient's NCS RNS neostigmine test blood sugar and glycosylated hemoglobin brain MRI and other routine biochemical tests were normal. Titres for lyme's disease HIV ANA and acetylcholine esterase levels were normal. There was no history suggestive of diphtheria sarcoidosis recent ingestion of canned food or treatment with chemotherapeutic agents. His CSF examination was normal and was negative for HSV-1 and VZV PCR. Only positive test was a TSH level <0.01 and high total and free T3 and T4 levels. Thyroid ultrasonography was normal and anti-TPO antibody negative. Patient was treated with Carbimazole 5mg thrice daily with which he improved and had only minimal residual facial paresis in 2 weeks and completely recovered in a month. Thus we present a rare case of thyrotoxicosis manifesting as polyneuritis cranialis with hyperreflexia and peripheral signs of hyperthyroidism. Literature search shows only one previous case mentioning hyperthyroidism in association with polyneuritis cranialis but that too did not highlight the same. Thus a causal rather than casual relationship may exist which needs to be emphasized.

250

Session: Poster Neuropathy & others 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Gbs mimic a rare case of porphyric polyneuropathy

Dr. Amareshwer Rao K, Dr. Dhairyawanp, Dr. Veena. N, Dr. Sateeshk, Dr. Sowjanya Poosarla, Dr. Srilatha, Dr. Santosh Kumar B

Gandhi Medical College Hyderabad, Hyderabad.

Introduction: Porphyrias are metabolic disorders involving enzyme defects in heme metabolism leading to accumulation of heme precursors and their overexcretion. Porphyrias present with acute attacks of photosensitivity cutaneous and neurovisceral manifestations and coloured urine. Neurologic manifestations include abdominal pain peripheral motor neuropathy and mental disturbances. Acute attacks are precipitated by steroid hormones drugs and nutritional changes. Objective: To report a case of Porphyric Recurrent Polyneuropathy. Material and Methods: A 17 yr old girl presented with H/o seizures recurrent abdominal pain associated with vomitings and red coloured urine from 8 months. She had recurrent episodes of quadriparesis since 4 months. She had first episode 4 months back with partial recovery in 1 month and second episode one month back. She had no sensory cerebellar cranial nerve dysfunction with normal cognition. She had significant weight loss in last 6 months. No H/o of photosensivity. Family H/o is not significant. O/E there was generalised wasting with hypotonia of all limbs with power of 2/5 in upper and lower limbs. DTR were absent and b/l plantars were flexor. Results: Nerve conduction studies showed Motor sensory axonal neuropathy of all limbs. Serum Porphobilinogen(Quant) level was 8.6 mg/24hrs (Normal: 0 - 3.4). Patient was diagnosed with Acute Intermitent Porphyria(AIP). Conclusion: AIP attacks are precipitated by steroids and most anticonvulsants which should be avoided in this condition. Treatment modalities of Porphyric neuropathy and GBS also differ so early recognition of this rare and preventable condition helps reduce the attacks and thereby associated morbidity.

10

Session: Poster Neuropathy & others 1.3

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Rapid onset metronidazole induced sensory neuropathy: An unusual presentation

Rameshwar Nath Chaurasia, R. S. Yadav, V. N. Mishra, D. Joshi

Department of Neurology IMS BHU Varanasi, Varanasi.

Objective: Metronidazole has potent activity against anaerobic bacteria several protozoa including Entamoeba Giardia. Common side-effects of metronidazole include mild abdominal pain headache nausea and a persistent metallic taste. Peripheral neuropathy is its rare side effect.We are reporting a rare case of a patient who developed acute sensory neuropathy after intake of short course of metronidazole. Case: A 16 year old male with history of intake of metronidazole for treatment of liver abscess presented with distressing paresthesia in form of tingling and burning pain in glove and stocking distribution. Neurological examination revealed graded impaired sensation for tactile and pain in glove and stocking distribution (20 to 80%). Both ankle jerks were absent. Electrophysiological Studies: This confirmed the presence of a sensory neuropathy affecting both upper and lower limbs. Motor conduction velocities were normal. Discussion: The exact mechanism of metronidazole induced neuropathy is controversial. Most reported cases developed neuropathy following metronidazole doses of 1000 - 2400 mg/day total doses of at least 50 gm and treatment duration of at least 30 days. In our case patient took about 18 gm of metronidazole over a period of 2 weeks and presented with rapid onset distal symmetrical axonal sensory neuropathy. This may reflect a genetic susceptibility to neurotoxic effects of metronidazole or a genetic variation in the metabolism of metronidazole in our patients. Result and Conclusion: Patient was put on combination of drugs for neuropathic pain such as pregabalin duoloxitine and amitriptylene. At 6 month of follow-up his symptoms resolved up to 90%. Thus patients being treated with metronidazole particularly those on high doses even for short period should be monitored for neurotoxicity

300

Session: Poster Neuropathy & others 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

A case of bilateral foot drop

Chezian, Justin, Ramu, Birla Pavalam, Ganesan, Thirumalai Rajan, Sritharan

Madurai Medical College Madurai, Madurai.


Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness irritation or damage to the common fibular nerveincluding the sciatic nerve or paralysis of the muscles in the anterior portion of the lower leg. CASE VIGNETTEA 62 year old male patient presented with thinning of muscles of leg followed by flailness of foot with tripping of toes first in right leg and then in left leg. Few months later patient noticed proximal weakness of lower limbs followed by thinning and weakness of both hands.he had difficulty in raising arm with twitching of muscles over the shoulder and thighs.the total duration of above illness was 2 years. Clinical examination revealed normal higher function with cranial nerve examination showing tongue fibrillation.spinomotor system showed fasciculations over the deltoid and quadriceps. wasting of both upperlimbs and lower limb muscles present. Tone increased in all 4 limbs with brisk DTR except ankle jerk and with retained abdominal reflexplantar showed no response. Sensory and cerebellum examination were normal.patient had high stepping gait. Investigations done which revealed normal RFTLFTcompletehemogramThyroid function testnormal USG abdomen negative HIV ELISA and VDRL. MRI spine with screening of cervical spine were normal. NCS done which showed normal CMAPSNAP with EMG showing fibrillation potentials positive sharp waves at rest and reduced recruitement pattern during action.we made a provisdional diagnosis of MND-ALS with bilateral foot drop. Discussion: Our case MND presenting as bilateral foot drop is an unusual presentation.the case is presented for its rare presentation and to highlight the importance of MND presenting as bilateral foot drop.

213

Session: Poster NM 2.1

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

An interesting case of secondary narcolepsy

Dr. Rajesh Benny, Dr. Aadijaya Bhatia, Dr. Aloke Banerjee

Mgm Medical College, Navi Mumbai.


We present this case to show an unusual feature (secondary narcolepsy) of lymphocytic hypophysitis with histiocytes. This case profile is of a 6o year old lady who presented with progressive apathy slowness for activities of daily living and excessive day time somnolence since 1 year. She had also gained 15 kg in the last 6 months. On examination she revealed evidence of frontal lobe dysfunction bilateral optic atrophy (with poor vision of which she was not aware) and mild symmetric parkinsonism (bradykinesia predominant). Even during examination she would immediately go to sleep from which she could be aroused immediately. Her MRI of brain revealed a nodular lesion involving the hypothalamic- suprasellar chiasmatic region. Her polysomnography revealed presence of Sleep onset REMs; suggestive of Narcolepsy. She had secondary hypothyroidism and elevated Sr ACE levels. Her lesion (excision) biopsy revealed a lymphocytic inflammation with histiocytes (without granulomas). The possibilities were lymphocytic hypophysitis Vs Histiocytosis Vs Sarcoidois. Post operative she had autonomic dysfunction with rapid changes in heart rate and blood pressure. She has improved with steroids.

147

Session: Poster NM 2.2

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

An unusual case of unilateral calf hypertrophy associated with filum terminale lipoma: An interesting association

Dr. Arun Kumar Singh, Dr. Deepika Joshi, Dr. Ranvir Singh Yadav, Dr. V. N. Mishra, Dr. R. N. Chaurasia, Dr. Arun Kumar, Dr. Vijay Nandmer, Dr. Prakash Kumar Sinha, Dr. Vivek Sharda, Dr Baidyanath Kumar

SR Neurology IMS Bhu Varanasi, Varanasi.

Background: Calf hypertrophy is rare a rare condition following low back pain and lumbosacral radiculopathy. We report an unusual case of calf hypertrophy in a 38-year-old man who developed progressive enlargement of the right calf in association with chronic lower back pain The pathophysiology of this is incompletely understood. The various mechanisms proposed for this condition. Case Report: A 38 year old gentleman suffering from chronic low back pain for 15 years noticed right calf hypertrophy. Subsequently his family members noticed that he walking with a slight limp.Motor examination revealed hypertrophy of right calf muscles without weakness of plantar flexion but mild weakness of right toes. Ankle dorsiflexor strength was within normal limits. The Ankle jerk was absent on the right side. The sensory examination was normal. The straight leg-raising test was negative on both sides. The family history for muscle or nerve disease was negative. Nerve conduction studies revealed no abnormalities. Needle electromyography revealed occasional fasciculations with neurogenic changes of the right gastrocnemius. MRI lumbosacral spine revealed filum terminale lipoma. The cord was tethered and ended at L2. MRI of the calves revealed diffuse fatty infiltration in posterior compartment of right leg. Conclusion: Thus we report this uncommon presentation of unilateral calf pseudohypertrophy associated with filum terminale lipoma

271

Session: Poster NM 2.3

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Duchene's muscular dystrophy with unusual mri brain findings a case report

Dinkar Kulshreshtha, Dinkar Kulshreshtha, P. K. Maurya, K. P. Malhotra, A. K. Singh, A. K. Thacker

Assistant Professor Neurology Dr. RMLIMS, Lucknow.


Duchene's muscular dystrophy is an X-linked recessive disease affecting around 1 in 3600 boys caused by a mutation in the dystrophin gene. Extra muscular manifestations of DMD include seizures reported in about 2-6% with rare description of abnormalities on neuroimaging. We report a patient of DMD diagnosed on muscle biopsy with seizures and MRI brain abnormalities. Case Report A 10 year old boy born of a non-consanguinous parentage came with motor developmental delay and mild mental retardation. Since last two years the child has had frequent generalized tonic clonic seizures for which he was on anti-epileptic drugs. On examination he had a lordotic posture with pseudo hypertrophy of the calves. He was thin built with generalized hypotonia without contractures. He had predominant proximal weakness with selective involvement of neck flexors wrist extensors brachioradialis biceps triceps tibialis anterior and quadriceps. He had a waddling gait and a positive gower's sign. As he had seizures MRI brain was done that showed T2 hyper intensities in bilateral central semi ovale corona radiata and right frontal lobe. CPK was high at 16330U/L and EMG suggested a myopathic pattern. He underwent a left biceps muscle biopsy that showed features of myopathy. On immunohistochemistry dystrophin staining was negative thereby confirming the diagnosis of Duchene's muscular dystrophy. Duchene's muscular dystrophy is rarely associated with seizures. Structural abnormalities on CNS imaging are rarely described in DMD though these patients may have functional neuroimaging abnormalities. Our patient represents this rare association of imaging abnormalities in DMD.

91

Session: Poster NM 2.4

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

An intresting case of myocyticercosis

Manivannan, Justin, Ganesan, Thirumalai Rajan, Mutuveeran, Birla Pavalam, Sritharan

Madurai Medical College Madurai, Madurai.

Introduction: Cysticercosis caused by Taenia solium larva is a major public health problem. IT can manifest as neurocysticercosis which is the commonest site followed by other sites such as eye muscle.we herewith presenting a case of muscle cysticercosis CASE VIGINETTEA 71year old female patient got admitted with sudden onset of severe pain over the right hip following a trivial trauma. She also complained of diffuse body pain.. Physical examination showed normal including CNS examination except for local tenderness over right hip area with painful restriction of right hip joint movement..routine investigations including HBTCDCESR complete hemogram LFT and serum electrolytes were normal Xray hip joint taken which showed fracture femur.inaddition the xray showed MULTIPLE CIGAR SHAPED CALCIFICATION OVER SOFT TISSUE AREAS. We later took Xray chest PA view and X ray both forearm Which also showed the same as above.then we proceeded with ELISA for tinea solium which was raised significantly. MRI brain and eyes were normal We concluded this case as muscle cysticercosis FNAC done and we confirmed it.we manged this case as isolated Muscular cysticercosis and fracture femur. Patient was prescribed albendazole and oral prednislone. orthopedician also managed the fracture femur.patient symptomatically improved and got discharged. Discussion: Cysticercosis becomes symptomatic almost exclusively in the nervous system or the eye. Three different clinical manifestations of muscle cysticercosis are described-myalgic myopathic and pseudohypertrophy type.. Hence Isolated myocysticercosis should always be kept in mind in a case of diffuse myalgia from an endemic area.the case is presented for its rarity.

24

Session: Poster others 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Complete morvans syndrome: A case report

Senthilkumar Vajramnickam, Senthilkumar Vajramanickam

SKS Hospital Salem, Salem.

Introduction: Morvans syndrome is haracterized by three cardinal features CNS manifestation of limbic encephalitisDysautonomia and myokymia. Herewith I report a case of classical morvans syndrome with all three clinical features along with VGKC antibody positivity. Case History: A 53yr old developed multiple somatic symptoms and insomnia and was treated as Major Depression. He presented to us with insomnia and periodic limb movements during sleep and occasional confusional state. He developed daytimeconfusion and became delirious. He had decreased sodium and hence sodium correction started. He developed tachycardiasweatingpulmonary edema and his cardiac evaluation showed severe LV dysfunction with apical ballooning TAKATSUBHO CARDIOMYOPATHY. CSF analysis showed increased cell count and protein and started on empirical antibioticsacyclovir and ATT. Patient gradually improved but still had intermittent confusional state inspite of normal sodium. Since clinical picture resembled LIMBIC ENCEPHALITIS other workup for AUTOIMMUNE ENCEPHALITIS like NMDA AND VGKC antibody were sent and patient started onpulse methylprednsone. Patient showed a marked improvement in sensorium and VGKC ANTIBODYCASPR2 came as positive. MRI BRAIN and CT ABDOMEN was normal. Serum paraneoplastic markers were negative. Patient had myokymia involving right calf and hamstrings and needle EMG showed significant myokymic discharges with occasional myotonia. Since patient developed severe colitis and sepsis while on steroids he was switched over to plasmapheresis. Conclusion: Hence this patient was diagnosed as a case of morvans syndrome with all three cardinal features along with VGKC antibody positivity andone unique association of takatsubho cardiomyopathy. This case is reported for its rarity and its complete syndromic presentation.

139

Session: Poster others 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

An interesting case of myeloneuropathy

Suma Kandukuri

Osmania Medical College, Hyderabad.


An interesting case of myeloneuropathy Suma K. Srinivas Deshmukh. Vinod kumar K. Ramesh R. Sita Ramu Ch. Sri Rangalaxmi G. Viswajyothi P. Department of Neurology Osmania Medical College OGH Hyderabad. Abstract: 29 yr old male presented with swaying while walking which was more during dark since 5 yrs with associated paresthesias of both tips of the fingers and toes since 3 yrs with h/o altered speech since 1yr. On examination hoarsness of voice with difficulty in pronounciation of all words. Romberg's sign was positive. Babinski sign positive on left side with brisk DTR with wasting of bilateral EDB with no evidence of cerebellar signs. Sensory examination revealed impaired vibration sensation distally in both upper and lower limbs. Serum B12 is low serum homocysteine elevated TSH elevated anti-TPO antibodies positive anti-parietal cell antibodies negative. Etiologies will be discussed.

36

Session: Poster others 1.3

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Complete opthalmoplegia. A rare presentation of Idiopathic intracranial hypertension

Irfan Yousuf Wani, Sawan Verma, Ravouf Asimi, Mushtaq Ahmad Wani, Sheikh Saleem, Maqbool Wani, Irfan Shah, Mudasir Mushtaq, Sheikh Nawaz

SKIMS Soura Srinagar, Srinagar.


Idiopathic intracranial hypertension (IIH) is a disorder defined by clinical criteria that include symptoms and signs isolated to those produced by increased intracranial pressure (eg headache papilledema vision loss) elevated intracranial pressure with normal cerebrospinal fluid composition and no other cause of intracranial hypertension evident on neuroimaging or other evaluations. The most common signs in IIH are Papilledema Visual field loss unilateral or bilateral Sixth cranial nerve palsy. Here we report a case of IIH presenting as headache with vision loss papilledema complete opthalmoplegia with proptosis in one eye and sixth cranial nerve palsy in other eye. Patient was managed with acetazolamide topiramate and diuretics. Symptoms remained static and She was planned for urgent CSF diversion procedure.

87

Sociodemographic and clinical profile disability of migraine patients attending a tertiary care neurological hospital


Session: Poster others 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Dr. Advait Kulkarni, Dr. Girish Baburao Kulkarni, Dr. Girish N. Rao, Dr. Geetha Desai

Senior Resident Department of Neurology NIMHANS, Bangalore.

Background: Migraine ranks as the 3rd most prevalent disorder and 7th leading cause of disability worldwide. There is paucity of studies looking in to large group of migraine patients from India. Objective: To describe the socio demographic clinical and disability profile in migraine patients attending OPD services of NIMHANS. Materials and Methods: Patients (> 18 years) satisfying ICHD-2 criteria for migraine with (MA) and without aura (MWOA) were interviewed between August 2012 to June 2014. Ethical clearance and informed consent was taken. Disability was assessed by MIDAS scale. Results: There were 315 patients(M: F: 1:3) (urban:rural::2:1 ) with mean age-33.4 Β΁ 9.6 years duration of symptoms- 7.6 Β΁ 6.8 years (MA-2.2% MWOA- 84% and chronic migraine-13%) seen during the period. Frequency of attacks was 6.8Β΁4.8/month with 57% of patients having >4 attacks/month. Multiple precipitating factors were seen and headache was bilateral and throbbing in majority and 98% had rated their headache as bad. Nausea vomiting photophobia and phonophobia were reported by 82% 59% 96% and 95% of patients. Only 30% patients knew that they were suffering from migraine and out of them 24.8 % patients used preventive treatments. MIDAS Disability Grade 123 and 4 were seen in 20 21 25 33% patients. It correlated positively with frequency chronicity diagnosis of chronic migraine urban residence with no significant difference with gender education occupation or socioeconomic class. Conclusion: Migraine is associated with significant disability majority require prophylactic treatment which calls for strengthening of headache services in India.

298

Session: Poster others 1.6

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Rare case of ataxia and developmental delay in girl child- joubert syndrome

Dr. Manjesh Rathi, Dr. Suresh Kumar, Dr. Ch Preetham Reddy, Dr. Stephen Abraham Suresh, Dr. Deepak Arjun Das

Sree Balaji Medical College and Hospital, Chennai.


A rare case report of a girl child with ataxia and development delayManjeshRathi* Stephen. S*ChennaReddy. P * Deepak Arjundas** SSK Ayyar**Suresh Kumar****Dept of neurology Sri Balaji Medical College & Hospital Chennai. AbstractJoubert syndrome is a rare autosomal recessive disorder characterized byhypotonia ataxia abnormal respiratory pattern and eye movements developmental retardation with neuropathologic abnormalities of cerebellum and brainstem. We report a case of ataxia and development delay in a five year old girl with clinical findings and characteristic MRI finding of MOLAR TOOTH appearance. Data from available literature and details of the case discussed.

59

Session: Poster others 1.7

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Rhombencephalosynapsis with involuntary head movement in a child: A case report

Dr. S. Velusamy

Stanley Medical College, Chennai.


Rhombencephalosynapsis with involuntary head movement in a child-A Case Report Introduction: Rhombencep-halosynapsis(RES) is a rare congenital malformation characterised by absence of vermis with fusion of cerebellar hemisphere resulting from disturbance of cerebellar development at 28-41days of gestation. Case Report: 9 year old boy 3rd child of nonconsanguineous coupleborn by normal delivery presented with involuntary head movement since 6 months of age. He had mild motor developmental delay. He was operated for squint at 6 years of age. On examinationchild had polydactylyno facial dysmorphismnormal head circumference. Speech was normal. Cranial nerves and spinal motor system were normal. There were no cerebellar signs. Child had side to side head movements on walking. The movement was absent on sitting standing and on doing activities requiring concentration. MRI Brain revealed absence of vermis with fusion of cerebellar hemisphere (RES)and hydrocephalus(dilatation of lateral and 3rd ventricle). Radiograph of spineUSG abdomen and cardiac evaluation were normal. Ophthalmologic evaluation revealed hypermetropia which was correctd with glasses. Discussion: RES is often associated with hydrocephalus agenesis of callosum and skeletal abnormalities. Stereotyped figure of 8 or side to side head movement is common in RES and it is a response to defect in central vestibular processing. Conclusion: Side to side head movement should alert clinician to possible presence of a congenital hind brain abnormality affecting vestibulocerebellum particularly RES.

123

Session: Poster others 2.1

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

An interesting case report of dural CCF

Justin, Ramu, Muthukumar, Ganesan, Chezian, Manivannan, Sritharan, Muthuveeran, Thirumalai Rajan, Birla Pavalam

Madurai Medical College Madurai, Madurai.

Introduction: A carotid- cavernous sinus fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. CCFs can be classified by etiology (traumatic vs. spontaneous) velocity of blood flow (high vs. low flow) and anatomy (direct vs. dural; internal carotid vs. externalcarotid vs. both).we herewith present a case of alcoholic cirrhosis which presented with dural CCFCASE VIGINETTE46 Year old male patient a chronic smoker and alcoholic a known SHT admitted with excessive daytime sleepiness for the last 6 months. No other positive history. Examination euvolemic no pallor or jaundice. CVS and RS examination were normal. CNS examination showed drowsy EOM full flap present DTR + plantar- bilateral extensor no meningeal signs. Investigations were done.complete hemogram sugar LFT RFT were normal. OGD revealed grade 2 - 3 esophageal varices. Echo revealed concentric LVH. USG abdomen revealed Chronic liver disease with portal hypertension. MRI brain done which showed dural AV fistula.patient treated with antibiotics neurosupportives liver supportives and other supportive measures. Patient improved clinically. Repeat MRI taken which surprisingly showed normal study. A final diagnosis of CIRRHOSIS LIVER with portal hypertension with reversible dural CCF (spontaneous remission). Discussion: Several classifications of CCF exist depending on anatomy etiology and pathophysiology. One categorization divides between traumatic and spontaneous fistulas. Another classification is established according to fistulous supply to the cavernous sinus as follows: type A: internal carotidartery (ICA); type B: dural branches of the ICA; type C: dural branches of the external carotid artery (ECA); type D: combined forms. We herewith presenting this case in view of the rarity in its presentation

148

Session: Poster others 2.2

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Fibrous dysplasia and hyperthyroidism associated with isolated superior oblique muscle palsy: An intresting association

Dr. Ranvir Singh Yadav, Dr. Deepika Joshi, Dr. Arun Kumar Singh,

Dr. Vijay Nandmer, Dr. Arun Kumar, Dr. Vivek Sharda, Dr. Prakash Kumar Sinha, Dr. V. N. Mishra, Dr. R. N. Chaurasia, Dr. Baidyanath Kumar

Sr Deptt. of Neurology Imsbhu, Varanasi.

Introduction: Fibrous dysplasia is a noninherited developmental anomaly of bone in which normal bone marrow is replaced by fibro-osseous tissue. first described in 1942 by Lichtenstein and Jaffe. Disease may be localized to a single bone (monostotic) or multiple bones (polyostotic) Polyostotic fibrous dysplasia can occur as a part of  McCune-Albright syndrome More Details which consists triad of polyostotic fibrous dysplasia cafe-au-lait spots on the skin and endocrine disturbances with precocious puberty. Endocrine dysfunctions associated with fibrous dysplasia include hyperthyroidism hyperparathyroidism acromegaly diabetes mellitus and Cushing syndrome. Fibrous dysplasia is thought to result from an activating somatic missense mutation of the GNAS1 gene on chromosome 20. Ocular manifestations are commen in thyroid disease but isolated superior oblique palsy is rare.we report a case of fibrous dysplasia with hyperthyroidism presented as superior oblique palsy. Case report- 26 years old gentlemen presented in neurology deptt. With history of vertical diplopia since 7 months on looking towards right side. With abduction and upwards rotation of right eye. On examination right eye was abducted and extorted position with head tilt towards left side right side superior oblique palsy was found other extra ocular muscles were normal.during the course of hospitalisation he diagnosed as auto immune hyperthyroidism TSH was less then 0.01 and TPO antibody was significantaly raised. MRI brain shows fibrous dysplasia of right petrous and squamous temporal bone. Serum calcium were low and phosphate was slightly higher but serum PTH was normal. no history of precocious puberty and no cafe-au-lait spots on the skin. Discussion: Endocrinopathies in fibrous dysplasia as a part of McCune Albright syndrome are commen but isolated hyperthyroidism and fibrous dysplasia are rare. Extraocular muscle involvement are commen in hyperthyroidism but isolated superior oblique palsy is rare.

167

Session: Poster others 2.3

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Β€˜boomerang sign in a patient of idiopathic intracranial hypertension

Dr. Ankur Wadhwa, Dr. Ankur Wadhwa, Dr. B. K. Bajaj, Dr. Shweta Pandey

Dr. RML Hospital & PGIMER.


Isolated transient focal lesions in splenium of corpus callosum manifesting as hyperintensities on T2 and diffusion weighted sequences on MRI are reported in literature due to various causes including infections myelin disorders drug toxicity epilepsy lymphoma metabolic and nutritional deficiencies. There is no such report of the transient splenial abnormalities in patients with idiopathic intracranial hypertension. We report a 26 year old female who presented to us with headache followed by progressive bilateral painless visual dysfunction over a period of 25 days. On examination she had visual acuity of 6/60 and bilateral papilledema. She had normal neurological examination including absent signs of meningeal irritation. MRI Brain of the patient revealed focal hyperintensity on T2 FLAIR and DWI sequences. Lumbar puncture showed raised intracranial pressure of 250 mm of H2O 15 mononuclear cells normal sugar and protein. Her blood counts biochemistry thyroid profile cortisol levels and serology for connective tissue disorders were normal. She was diagnosed as Idiopathic Intracranial Hypertension. She underwent optic nerve fenestration for progressive visual impairment during hospital stay. She recovered her normal visual acuity and the focal lesion in splenium on repeat MRI had disappeared on follow up at 4 weeks. The transient splenial hyperintensity on MRI called Boomerang sign observed as in our patient does not have a clearly known pathogenesis. There is a paucity of data on pathogenesis causation and predilection for only the splenial part of corpus callosum. This will be further discussed in the presentation.

207

Session: Poster others 2.4

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Neurotechnology course: Past present and future

Vivek Mathew, Mathew Alexander, Maya Thomas, Sanjith Aaron, Anil Kumar Patil, Ajith Sivadasan, Karthik Muthusamy, Prabhakar A. T., Sangeetha Y

Christian Medical College Vellore, Vellore.


Neuroelectrophysiology Laboratory is an integral part of any Neurological service. The first Grass EEG machine was acquired in our institution in 1951. The first technologist was a young man recruited by Dr Jacob Chandy from a Radio Service shop. He was trained on the job by Dr Baldev Singh and later by Dr GM Taori. He went on to become the Chief Instructor for Diploma Electrophysiology course which started in 1975. The program went from a one year to two year program in 1987 and since 2012 is a University recognised 3-year B. Sc. Neuroelectrophysiology with five students every year. The first year takes them through basic medical sciences basic nursing and computers. The second year has electronics electroencephalography and clinical neurology including basic microbiology pathology and pharmacology. The final year has nerve conduction studies electromyography polysomnography autonomic laboratory transcranial magnetic stimulation and intra-operative monitoring besides applications of clinical neurophysiology and a project. Allied Health Sciences are going to become increasingly relevant with further technology advances in the future. The number of institutions in India running Neuroelectrophysiology course will probably be less than five of which most would be post bachelors diploma courses. On the other hand training on the job is still the only option for other centres. Finally different centres would be stronger in different fields of Neuroelectrophysiology. The Indian Academy of Neurology stands in a unique position to facilitate the training of Neurotechnologists. We could envisage a common curriculum student exchange programs and an IAN certified exit exam besides frequent updates and CME's. Raising the bar for Neurotechnologists would increase the avenues available to them in Neurosciences besides having a ripple effect on improving departments and delivery of services to patients with neurological problems.

278

Session: Poster others 2.5

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

An interesting peri-operative neurological complication following caesarean section: A case report

Anusha Doraiswamy, Ravichandran Rajamanickam, Thamilpavai N, Shanmugasundaram N, Bhanu Kesavamurthy

Institute Of Neurology Madras Medical College Ch, Chennai.


Problem statement: Lumbar puncture is a commonly performed blind obstetric peri-operative procedure that requires sufficient expertise to prevent neurological complications. We report this case of a lumbar puncture related peri-operative neurological complication in a pregnant mother who underwent a Caeserean section (CS). Case vignette: A 28 year old 3rd gravida mother with gestational diabetes was referred to our Neurology department 5 days after undergoing an elective repeat CS. The CS was uneventful except for the sharp excruciating pain that radiated across the front of her right thigh up to the ankle during the lumbar puncture needle insertion. On recovering from anaesthesia she noted the difficulty in moving her right lower limb as well as persistent postoperative urinary retention. Examination revealed asymmetric flail lower limb paraparesis with predominant involvement on the right side. Lower limb power examination showed grade 2/5 on the right side and 4/5 on the left side. Both the lower limbs were areflexic without any evidence of sensory deficits or pyramidal involvement. Anal tone and perianal sensation was normal. Results: MRI of the dorsolumbar (DL) spine revealed T1- isointense and T2- hyperintense signal changes in the lower spinal cord extending from the D11 to the conus predominantly on the right side without any contrast enhancement. Nerve conduction studies showed decreased compound muscle action potential amplitude of the right peroneal nerve. At the end of 3 months the patient had a partial recovery of motor weakness with a power of 3/5 in right side and 4+/5 on the left side and complete recovery in bladder symptoms. A repeat MRI showed persistent spinal cord hyperintensities. Spinal anaesthesia related cauda-conus syndrome was considered to be the most likely etiology. Conclusion: This case study highlights not only the clinical diagnostic dilemma but also the medico-legal implications in the management of this clinical scenario.

244

Session: Poster others 2.6

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Neuronal ceroid lipofuscinosis-a case report

Muthukumar. P. Apollo Hospital Chennai

Apollo Hospital Chennai, Chennai.


8 year old girl born out of 3rd degree consanguineous parantages full term normal delivery without perinatal or antenatal complications with 2kg birth weight. Attained normal milestones up to 3 Β΍ years of age.she started developing cautious gait illness progressed and she started having repeated falls up to 2 to 3 times per day. She then had one episode of GTCS followed by which she started having jerky movements of whole body. At present she is able to stand momentarily but has gross in co-ordination while reaching for objects can speak few bisyllabels not able to feed by self has lost bladder and bowel control. She has slow saccades normal tone with normal reflexes plantar flexor wide based gait with in co-ordination with action induced myoclonus. Blood glucose LFT RFT calcium phosphorous uric acid electrolytes NCS serum ammonia serum lactate urine metabolic study normal. VEPSSEP- giant evoked potentials EEG-abnormal CT-brain normal MRI-brain cerebellar atrophy ophthalmology evaluation normal. CSF for anti measles anti body titer negative skin biopsy characteristic curvilinear inclusions is diagnostic of NCL. At the age of 4 years she was started on sodium valproate 4 Β΍ years clobazam added5 years prednisolone 3 weeks given partial improvement was there. currently she is on levetiracetam acetazolamide

301

Session: Poster others 2.7

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Paraplegia: A rare complication following Percutaneous nephrolithotomy (PCNL)

Dr. Prakash Kumar Sinha, Vivek Sharda, Deepika Joshi, V. N. Mishra, Arun Kumar Singh, Ranveer Singh Yadav, Arun Kumar, Vijay Nandmer, Baidyanath Kumar

Department of Neurology IMS Bhu Varanasi, Varanasi.

Background: Neurological complications following Percutaneous nephrolithotomy (PCNL) are very rarely seen with a incidence of below 0.01%. Seizure hemiplegia quardriplegia and paraplegia all can occur. We report a rare neurological complication of paraparesis in a female patient following uneventful PCNL. Case report: A 45 year old female was admitted to urology department of our hospital for PCNL indicated for 1.8 cm left renal calculus. A standard PCNL was performed under general anesthesia. After recovery from anesthesia 6 hours later patient noticed weakness and numbness predominently in left leg with mild weakness in right leg and decreased sensation below waist. Neurological examination revealed upper motor neuron type assymetrical paraparesis with sensory level at T7 dermatome with bladder and bowel involvement. MRI spine done on postoperative day 1 revealed altered cord signal intensity from D6-D9 level with asymmetrical cord involvement predominently on left half with slight encroachment on the right without any obivious cord atrophy mass lesion or external compression. MRI features were suggestive of cord infarction. Conclusion: Paraplegia is very rare but devastating neurologic complication during PCNL. We reviewed several literature and found only one case series of four paraplegia complication following PCNL from Iran by A. Basiri et. al. The possible underlying mechanism is air embolism while using room air to opacify the collecting system during PCNL. Likewise the prone position and general anesthesia may predispose to these events in the presence of air injection.

89

Session: Poster others 2.8

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

An interesting case report of thrombocytopenia

Justin, Ramu, Ganesan, Chezian, Manivannan, Sritharan

Madurai Medical College Madurai, Madurai.

Introduction: Thrombotic thrombocytopenic purpura (TTP) is an uncommon disease with fluctuating signs and symptoms. The classic pentad of TTP - Coombs negative microangiopathic Schistocytic hemolytic anemia consumptive thrombocytopenia causing severe hemorrhagic diathesis fluctuating neurologic symptoms renal impairment and fever - is recorded in only about 40% of patients while the triad of anemia thrombocytopenia and bizarre neurologic abnormalities can be observed in as many as 75% of patients. Case Viginette: 31 year old female got admitted with drowsy state with history of headacheirrelevant talk since afternoon with history of joint pain and joint swelling. she had a past history of fever with altered sensorium got treated as viral encephalitis. On Examination patient irritable disoriented EOM fullFundus normal moves all four limbs and plantar flexor. no meningeal signs. Other system were normal. Blood investigations such renal parameters blood sugar electrolytes were normal. Complete hemogram revealed low platelet count with peripheral smear showing normochromic microcytes with anisopoikilocytosis and schistocytes.. Dengue antigen smear for malarial parasite were negative. LFT revealed elevated bilirubin. LDH elevated. ANAanticardiolipin igGigM antiphospholipid igGigM were negative. USG abdomen and ECHO found to be normal.initial MRI showed Gyral edema with mild diffusion restriction and T2W / FLAIR bright signals involving left cerebral hemisphere perisylvian perirolandic and parietal cortex. Repeat MRI brain revealed multifocal T2W /FLAIR bright signal lesion with diffusion restriction noticed in both MCA-ACA and MCA-PCA water shed zone.patient was treated with cryo transfusion FFP and packed cells. Discussion: Neurologic involvement is a prominent component of TTP. As discussed above our case had the triad of bizarre neurological features anaemia and thrombocytopenia. The case is presented for its rarity

97

Session: Poster others 2.9

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Rhombencephalosynapsis: A rare cerebellar malformation

Dr. C. Leema Pauline, Dr. Viveka Saravanan, Dr. Ravi, Dr. Seenivasan

ICH& HC Madras Medical College Chennai, Chennai.


Rhombencephalosynapsis is an extremely rare cerebellar malformationwit features of vermian agenesis and fusion of cerebellar hemispheres. herewith we report a child with rhombencephalosynapsis. 7 month old male child first born of non consanguineous parents referred for developmental delay. Preterm deivered by caeserean section had respiratory distress at birth. There was no H/O seizures or abnormal odour of urine. Examination revealed dysmorphism in the form of low set ears high arched palate turricephaly. There was bilateral corneal opacity. He had hypotonia with preserved reflexes. Neuroimaging showed fusion of both cerebellar hemispheres with agenesis of vermis and partial agenesis of corpu callosum. Thyroid profile EEG were normal. This case is presented fo rits rarity.

63

Session: Poster stroke 1.1

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

A case of multiple causal factors in a single patient with cerebral venous sinus thrombosis a rare observation

Anish Mehta, Mahendra Javali, Rohan Mahale, Aju Abraham John, Madhusudhan B. K., Suryanarayana Sharma, R. Srinivasa

Department of Neurology MS Ramaiah Medical Colleg, Bangalore.


Cerebral venous and dural sinus thrombosis (CVT) is a rare condition with a wide spectrum of clinical presentations which may account up to 0.5 to 1% of all strokes. CVT is usually associated with predisposing factors such as hematologic disorders gynecologic and obstetric infectious diseases as well as other medical causes. It has numerous and complex etiologies. Recently thrombophilic defects have been identified as risk factors including factor V G1691A (FV Leiden [FVL]) the prothrombin G20210A mutation (FII G20210A) and hyperhomocysteinemia caused by gene mutation methyltetrahydrofolate reductase (MTHFR). Here we describe a case of 42 year old gentleman diagnosed of CVT where on evaluation was found to have multiple casual factors causing the same. To best of our knowledge such a case has never been described before. The detection of such abnormalities has major practical consequences on the long-term management of patients to prevent further thrombotic episodes.

308

Session: Poster stroke 1.17

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Wernicke's encephalopathy in a 9 year old child

Dr. Anuradha Nidra, Dr. G. Butchi Raju, Dr. S. Gopi, Dr. T. Sateesh Kumar, Dr. K. Pradeep

Andhra Medical College Visakhapatnam Dr, NTR Univ, Visakhapatnam.

Background: Wernicke's encephalopathy (WE) is an acute neuropsychiatric syndrome from thiamine deficiency. It usually manifests as mental status changes; ocular abnormalities most commonly nystagmus and bilateral 6th nerve palsy and gait ataxia. Ptosis is a rare manifestation occurring in only 3%. Although alcoholism is the most common predisposing factor it can occur in any patient with nutritional deficiency. Disease in non-alcoholics often goes unrecognized. Diagnosis is clinical. MRI helps in definitive diagnosis. We present a case of WE in a child. Case Report: A 9year old female child presented with h/o vomitings followed in 3 days by progressive drooping of both eyelids unsteadiness of gait malaise easy fatigue decreased interest in activities and drowsiness for over a month. On examination she had balded tongue dry scaly skin rough brownish hair thyromegaly and tachycardia. She was drowsy and apathetic with decreased attention. She had bilateral symmetric ptosis with normal extraocular movements and pupils; gait ataxia with no weakness or sensory deficit. MRI showed symmetrical nonenhancing T2 FLAIR hyperintensities in bilateral medial thalami mammillary bodies periaqueductal gray matter bilateral superior cerebellar peduncles s/o Wernicke's encephalopathy. She had dramatic improvement with intravenous thiamine replacement therapy. Clinically WE was not suspected because it was a child nonalcoholic inadequate nutritional history subacute onset and slow progression bilateral ptosis with normal ocular movements. Conclusions: Though most prevalent in alcoholics WE may occur in anyone including children with nutritional deficiency. Early recognition and rapid treatment will help prevent the devastating consequences of this treatable disease.

160

Session: Poster stroke 1.2

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

An interesting case of amyotrophic lateral sclerosis due to selenium toxicity

Muthukumaran S, Balasubramanian S, Bhanu K, Muthu T, Senthilnathan J, Anusha D

Madras Medical College, Chennai.

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive and devastating disease involving both lower and upper motor neurons. Here we present a patient of ALS residing in the island of Guam due to selenium toxicity. Case Vignette: A 44 year old vegetrarian indian male working in waste management services in the island of guam for over 15 years was admitted in our hospital with neck pain and weakness of right upperlimb and lowerlimb of 5 years duration associated with thinning and fasiculations of muscles with no sensory bowel or bladder disturbances. His higher mental function and lobar functions were normal with wasting and fasciculations of shoulderarmglutealthigh and pectoral muscles. The weakness was asymmetrical and more on the right side. Nerve conduction study was normal. EMG showed severe denervation and minimal reinervation of muscles supplied by C5-C7 roots & L4-S1 roots on right side similar but milder degree changes on left leg. MRI spine was normal. Blood heavy metal screening showed an elevated selenium level. Discussion: The Guam ALS complex (ALS-PDC) has got a higher incidence in the native chamoroo people who feed on flying foxbats which forage on seeds from cycad trees which produce neurotoxin b-methylamino-L-alanine(BMAA) causing persistant excitation of neurons. But our patient is neither a native of guam nor he feeds on bats but the nature of his occupation has lead to chronic exposure to heavy metal toxins. Conclusions: Although the etiology of ALS is mulifactorial selenium toxicity should also be considered.

189

Session: Poster stroke 1.4

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Successful thrombolysis of paradoxical embolic stroke in a young lady with deep vein thrombosis and pulmonary embolism

Nilesh Nadkarni, Nilesh Nadkarni, Mohan Kt, Jayant Shelgaonkar, Rajesh Badani, Gaurav Ganeshwala, Mona Thakre, Urvi Shukla, Santosh Konde,

Aditya Birla Memorial Hospital Chinchwad Pune., Pune

Background: Paradoxical embolism accounts for less than 2% of arterial embolic stroke. Reports of successful thrombolysis of Paradoxical embolic stroke with Pulmonary embolism [PE] and Deep Vein Thrombosis [DVT] are very rare. Case Report: We describe a case of 35 years old female who travelled from Switzerland to India and then to multiple places in India by air. She developed right leg pain and swelling. Ten days later she developed sudden onset breathlessness for which she was admitted. While sleeping in ward she developed left hemiparesis [NIHSS 12]. A diagnosis of DVT with PE and paradoxical stroke was made. Other risk factors for DVT like smoking hormonal contraceptive patch usage and obesity [Body Mass Index 31.7] were present. ECG features of S1Q3T3 were suggestive of PE. CT brain showed Hyperdense MCA sign. As she was in window period she was thrombolysed with t-PA with good recovery of both stroke and breathlessness. NIHSS was 4 after 6 hours. CT brain done 24 hours after thrombolysis showed hemorrhagic transformation of infarct. Therefore anticoagulant could not be administered for treatment of DVT and PE. CT Pulmonary Angiography confirmed partial filling defect in distal left and right pulmonary arteries. Venous Doppler showed thrombus in right popliteal vein. Echocardiography revealed Fossa ovalis Atrial Septal Defect with mild dilatation of right atrium and ventricle. Retrievable IVC filter was inserted to prevent further large embolism into pulmonary or systemic circulation. After 7 days she was airlifted to Switzerland as she opted for further management over there. NIHSS was 2 and mRS of 1 at that time. Conclusion: This is an uncommon case where thrombolysis of Paradoxical stroke led to good outcome in both stroke and Pulmonary embolism simultaneously.

257

Session: Poster stroke 1.5

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

A case report of Reversible ALS

Aju Abraham John, Suryanarayana Sharma, Madhusudhan B. K., Anish Metha, Mahendra J. V., Rohan Mahale, Prof R. Srinivasa

M. S. Ramaiah Medical College Bamgalore, Bangalore.


A case report of Reversible ALSAju Abraham John Suryanarayana Sharma Madhusudhan B. K. AnishMetha Mahendra J. V. RohanMahale Prof R. Srinivasa. M. S. Ramaiah Institute of Neurological Science Bangalore. AbstractAmyotrophic Lateral Sclerosis is the most common form of motor neuron disease characterized by involvement of motor neurons resulting in progressive muscle weakness. Treatable causes of ALS like illness are very rare. Here we present a report of 35 year old male with an initial presentation of progressive weakness and wasting of all four limbs proximal more than distal with fasciculation and electro diagnostic features compatible with diagnosis of possible ALS. After ruling out all metabolic toxic and neoplastic conditions a diagnosis of HIV associated ALS was made. He was initiated on anti-retroviral therapy and on 6 months follow up symptoms improved significantly. He had a weight gain of 10 kgs and electro diagnostic studies revealed near total normalization of neurogenic pattern. He is being continued on antiretroviral therapy and on periodic follow up. Reversible ALS like illness has been documented in literature and were mostly diagnosed HIV cases. This case identifies the importance of identifying reversible causes of ALS and near total response to treatment in a patient who presented to us with motor neuron disease features which led to the diagnosis of HIV.

277

Session: Poster stroke 1.6

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Two interesting cases of reversible sensorineural hearing loss

Surendramohan T, Surendramohan T, Thaseen A, Kannan V, Lakshminarasimhan R, Gopalakrishnan N, Bhanu K

Minmmcchennai, Kanchipuram.

Introduction: Our cases presented with a raised anion gap metabolic acidosisbifacial paralysisacute kidney injurysensorineural hearing losscranial and peripheral neuropathies. Case Vignette: Case 1: 35year old man presented after 10 days of consumption of brake oil with AKIraised AG metabolic acidosisincreased osmolal gap and acute pancreatitis. Ten days after admissionpatient developed bilateral facial paralysis and bilateral optic neuropathydiminished DTR but normal muscle power and sensory examination. EPS revealed an axonal patternprolonged VEPs and moderate sensorineural hearing loss bilaterally. Case 2: 25 year old patient presented with severe abdominal painoperated for acute appendicitislater developed a raised AG metabolic acidosisacute kidney injury and acute pancreatitisprobing revealed accidental consumption of brake oil. Third daypatient had an episode of GTCS. Day 10 patient developed pins and needles paresthesias of all limbsbifacial paralysis and sensorineural hearing loss. EPS revealed sensorimotor axonal involvement in all tested nerves. Both patients improved neurologically with hemodialysis. Discussion: Brake oil contains ethylene glycol etherssymptoms occur within 12 hours of ingestion the first stage consists CNS symptomssecond stage occurring 12 to 24 hours latershows cardiovascular features and hyperventilation. Acute renal failure occurring after 48hrs is third stage. Only few case reports exist regarding EG poisoning causing delayed multiple cranial and peripheral neurolopathiespresenting about one to two weekswhich can be severe enough causing complete paralysis. Conclusion: Patients with EG poisoning and AKI have shown both renal replacement requirement and recovery from AKI. Alertness to patients with renal dysfunction and neurological findings is needed even if there is no history of EG ingestion.

16

Session: Poster stroke 1.7

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Camphor poisoning in adult an unusual cause of seizure

Dr. Halprashanth D. S, Dr. Vijayan Puthiya Kunnon, Dr. Amshudar, Dr. Abirami T, Jen Daniel, Christe Priya

Department of Neurology Global Health City Chen, Chennai.

Background: Accidental consumption of camphor in pediatric age group is well documented. We are reporting a rare case of accidental consumption camphor in an adult causing seizure. Case Description: We present the case of a 58 year female diabetic and hypertensive who presented to the emergency department with a history of first episode generalized tonic clonic seizure (GTCS) of 1 minute duration with recurrent episodes of vomiting. She had accidentally consumed camphor cubes confusing it for sugar cubes. Onset of symptoms from the time ingestion was 20-30 minutes. On examination vital parameters were normal. No neurological deficit. She was given loading dose of injection Leverticetam 2 g Followed by stomach wash and activated charcoal. Her Blood investigations were normal EEG and MRI brain were normal.She was kept for observation for 72 hours in the hospital. She remained asymptomatic and was discharged. Conclusion: Camphor is a toxic hydrocarbon found in numerous over-the-counter medicinal products including Vick's VapoRub and Tiger Balm. Camphor is easily available in many Indian house-holds for religious purposes and believed to be toxic to insects thus sometimes used as a repellent. Poisoning due to accidental ingestion is common in infants and small children but not reported in adult. Although the exact mechanism of camphor induced seizures is unknown it is believed to be at neuronal level due to oxidation cycle of the cytochrome oxidase system leading to rapid oxidation and depletion of high energy phosphorous compounds. GTCS are usually the first sign of neurotoxicity.

37

Session: Poster stroke 1.8

Date and Time: 13:00 - 14:00, Friday, 07 Nov 2014

Venue: Poster area

Moyamoya disease: A case report

Justin, Ramu, Chezian, Sritharan, Manivannan, Muthuveeran, Ganesan

Madurai Medical College Madurai, Madurai.


Moyamoya diisease is a chronic progressive occlusive disease of the circle of willis which leads to the development of characteristic collateral vessels seen on imagingespecially cerebral angiography. By definition the pathognomonic arteriographic findings are bilateral in moyamoya disease although the severity can differ between the sides. CASE VIGNETTEA: 30 year old female presented to our hospital by july 2014 with acute onset of LOC with weakness of right upper limb and lower limb. On detailed history evaluation she presented with similar episode by 2008 for which she got treated outside and she improved. At present clinical examination revealed unconscious DEM +PERLAright UMN facial lag+ right hemiplegia +plantar extensor right.results of metabolic parameters were normal.coagulation profile were normal. CXRECG ECHO were normal. CT brain revealed left thalamic bleed with intraventricular bleed subarachnoid bleed with mild obstructive hydrocephalus.3D CT CEREBRAL ANGIOGRAPHY done which revealed complete occlusion of the supraclinoid segment of bilateral ICA multiple lenticulostriate and thalamostriate collaterals seen in the region of circle of willis- resembling the characteristic PUFF OF SMOKE APPEARENCE . Bilateral ACA and MCA are reformed through the collaterals. Tiny aneurysm in subependymal location of the body right lateral ventricle- possible source of IVH.No evidence of CVT. Overall features suggestive of MOYAMOYA DISEASE. Patient was treated with antiedema measures antiepileptics antibiotics and physiotherapy. Conclusion: Moya moya disease is probably an inherited vascular disease first described in japan and now reported from all over the world. Most common presentations are-Ischemic stroke 5075%Transient ischemic attack (including drop attacks) 5075%and Hemorrhage (in adults) 1040%.our patient presented with hemorrhagic stroke. Characteristic radiographic findings confirm the diagnosis.

197

Session: Poster stroke 2.1

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Acute ischemic stroke following pituitary apoplexy in a young lady

Dr. Shaik Afsar Pasha, Dr. Deepika, Dr. Ramakrishna Reddy, Dr. Vamsikrishna, Dr. Nageswara Rao

Nri Academy of Sciences, Guntur.


A 35-year-old young lady presented with pituitary apoplexy resulting in internal carotid artery occlusion manifesting as sudden onset of severe headache right ptosis right total ophtholmoplegia visual failure and right hemiplegia and right 7th UMN facialy palsy. Initial MRI Brain showed a sellar mass with supra and parasellar extension with internal bleed. Repeat imaging showed acute large infact in the left fronto parietal and capsuloganglionic regions. Cerebral angiography revelaed that the mass compressed the bilateral cavernous sinuses resulting in obliteration of the cavernous portion of the left internal carotid artery. Conservative therapy with steroids was given in the acute stage and repeated MR imaging showed recanalization of the internal carotid artery with reduction of the tumor size. The tumor was removed through the transsphenoidal approach to obtain a definitive diagnosis. The histopathological diagnosis was consistent with non-functioning pituitary adenoma. Patient improved in level of sensorium and eye movement of the patient showed almost full recovery after the operation. Pituitary apoplexy resulting in internal carotid artery occlusion is rare. Surgical decompression through the transsphenoidal approach is appropriate but the optimal timing should consider severe disturbance of visual acuity and visual field in the acute stage.

295

Session: Poster stroke 2.2

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Uncommon expected complication of cerebral venous thrombosis favorable outcome a case report complicated by intracranial hypertension

Moncy Thomas, Dr. Suresh Kumar M. D. D. M.,

Dr. S. Stephen Abraham Suresh Kumar M. D. Dch. D. M.,

Dr. Chenna Reddy Preetham M. D. D. M.,

Dr Ranganathan Jyothi M. S. M. Ch.

Sree Balaji Medical College Chennai, Chennai.


Thrombosis of the cerebral dural sinuses has been well described in the literature and rarely the dural sinus obstruction can result in unremitting papilledema (raised intracranial hypertension) causing blindness. We report a case of a 21-year-old man who was diagnosed to have extensive sinus thrombosis involving superior sagittal sinus thrombosis and developed visual deterioration. The patient did not respond to conservative treatment and a thecoperitoneal shunt was performed; following which he developed intracranial hypotension with bilateral SDH needing bilateral burr hole evacuation. Patient is doing well at follow-up with good outcome

307

Session: Poster stroke 2.3

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Facial diplegia with limb paraesthesia: A guillain barre syndrome variant

Nilesh Nadkarni, Nilesh Nadkarni

Ashadeep Hospital, Pune.

Background: Bifacial weakness is frequently seen in Acute Inflammatory Demyelinating Polyradiculoneuropathy [AIDP] type of Guillian Barre syndrome [GBS] where patients have hypotonic areflexic quadriparesis. This is a case report of a patient presenting with limb paraesthesia and later bifacial weakness but without areflexic quadriparesis. Case Report: A 28 year old man had loose motions for a day. After 2 weeks he developed tingling sensation in both hands and feet. Three days later he developed pain behind both ears. A day later his taste sensation decreased tears started flowing from both eyes and he noticed difficulty in gargling. Examination revealed asymmetrical bifacial weakness which was more prominent on left. Otherwise his neurological examination including muscle tone power sensations deep tendon reflexes other cranial nerves and coordination was normal. He had no hypopigmented lesions on body or thickened nerves. Possibilities of GBS sarcoidosis and Retroviral disease were kept. Serum ACE level and MRI Brain reports were normal. His HIV test was negative. Nerve conduction study was suggestive of early demyelination. Patient did not give consent for a diagnostic lumbar puncture to rule out cytoalbumino dissociation. On the basis of history and investigations a diagnosis of Facial Diplegia with Limb paraesthesia variant of GBS was made. He was advised immunomodulatory therapy in the form of plasmapharesis or intravenous immunoglobulin based on few case reports. But he refused and opted for alternative medicine elsewhere. Three weeks later through telephonic conversation it was revealed that his bifacial weakness persisted and he had still not developed any weakness in limbs.

29

Session: Poster stroke 2.4

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

A rare case of skull base metastasis from follicular carcinoma of thyroid

Dr Shyma M. M., Dr Shaji C. V., Dr. Ram Mohan, Dr. Roopchand P. S., Dr. Prasanth S. R., Dr. Parvathy G

Senior Resident Department of Neurology. Govt TDMC, Alappuzha.


Thyroid cancers represent approximately 1% of new cancer diagnoses each year. Follicular carcinoma represents about 10% of thyroid cancers. Follicular carcinoma occurs 3 times more frequently in women than in men. The mean age range at diagnosis is late in the fourth to sixth decades. Brain metastasis is an uncommon and morbid complication of thyroid carcinoma especially follicular carcinoma. Involvement of the skull base leading to associated cranial nerve palsies. We are reporting a case of skull base metastasis from follicular carcinoma of thyroid in an adult lady. She presented to us with progressive slurring of speech for one month. She gave a history of a longstanding thyroid swelling. Clinical examination showed left LMN type of hypoglossal nerve palsy and a scalp swelling over the left occipital bone. Radiological evaluation revealed contrast enhancing lesion in base of skull on left side which infiltrates the left hypoglossal canal jugular foramen and inferior aspect of the clivus. Also showed an expansile lytic lesion involving the left parieto occipital calvarium and an enhancing thyroid nodule. Pathological examination of thyroid nodule and scalp swelling revealed the diagnosis of follicular carcinoma thyroid metastasis. The patient underwent total thyroidectomy radio-iodine therapy and chemotherapy for follicular carcinoma. This case emphasize that thyroid cancer should be amongst the differential diagnoses considered in middle-aged and elderly females presenting with a cranial neuropathy and evidence of skull metastasis.

212

Session: Poster stroke 2.5

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

An interesting case of nerve abscess

Dr. V. Sriramakrishnan M. DD. M., Dr. Senthilbabu Mch

Professor Dept. of Neurologythuthookudi Medical Co, Tirunelveli.


26 Year old young male presented with pain in the elbow radiating down. Weakness &minimal wasting in ulnar distribution. Cystic tender swelling onthe back of elbow over the ulnar nerve. Sensory impairment along ulnar distribution. Wasting in hypothenar. Weakness of interrossei&lumbricals. Basic blood investigation normal. Mri lt. Elbow showed t2/pdfs hyperintnse cystic lesion seen longitutionally along the epineurium of the ulnar nerve. Surgical exploration showed abscess. Pus drained send for genexpert for mycobacterium. Positive for m. Tuberculosis. Capsule send for biopsy -suggestive of m. Tuberculosisput on att. Improved well. On follow up. No recurrence.

309

Session: Poster stroke 2.6

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Polycystic ovarian syndrome in indian women with epilepsy with reference to seizure type and anti-epileptic drug therapy

Dr. Anuradha Nidra, Dr. G. Butchi Raju, Dr. S. Gopi, Dr. T. Sateesh Kumar, Dr. K. Pradeep

Andhra Medical College Visakhapatnam Dr. NTR Univ, Visakhapatnam.

Background: Polycystic ovarian syndrome (PCOS) and other reproductive endocrine abnormalities occur more commonly in women with epilepsy (WWE). Epilepsy per se as well as AED therapy may have an impact on female hormones leading to PCOS. Data regarding the occurrence of PCOS among Indian WWE are sparse. Aim: To determine the occurrence of PCOS in Indian WWE with respect to seizure type and AED therapy. Methods: 74 WWE in reproductive age group during the period from March 2013 till July 2014 were evaluated for the presence of clinical biochemical and ultrasonographic evidence of PCOS. They were assessed for the presence of menstrual irregularities; infertility; family H/O diabetes; obesity; acne; acanthosis; hirsutism and alopecia. All of them underwent hemogram; fasting and postprandial blood sugar; fasting lipid profile; serum levels of free T4 TSH prolactin and testosterone; and pelvic ultrasound scan for PCO. Results: Of the 74 WWE 28(37.8%) had menstrual abnormalities; 35(47.2%) had acne/ hirsutism/ acanthosis/ alopecia; 4(5.4%) had infertility; 38(51.35%) were overweight/obese; 34(45.9%) had PCO; 9(12.1%) had abnormal testosterone and/or prolactin. Among the WWE with PCO 10(29.9%) used phenytoin 12(35.2%) carbamazepine/oxcarbazepine 14 (41.5%) sodium valproate. 31(91.1%) were on monotherapy and 3(8.8%) on polytherapy. Two-thirds of valproate-treated women more than half of those treated with carbamazepine and one-third of phenytoin-treated ones had PCOS. Conclusions: WWE on AED therapy had a significantly higher frequency of PCOS the risk being especially high with sodium valproate followed by carbamazepine and phenytoin. Generalized tonic-clonic seizures was the most common seizure type among these women.

310

Session: Poster stroke 2.7

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Clinical & electorphysiological profile of hansen's disease from north costal andhra pradesh

Matta Gopi Srikanth, Matta Gopi Srikanth, Pradeep K, Satish Kumar T, Gopi S, Butchi Raju G

Andhra Medical College Visakhapatnam Andhra Prad, Visakhapatnam.

Aim: To study the clinical & electrophysical profile of histologically proven Hansen's cases from May 2012 to July 2014. Introduction: Hansen's a M.leprae infection is known to mankind since 1300 BC from works of Susruta. Primarily all leprosy is neural leprosy with varied presentations. Mostly seen in South Southeast Asia Africa & South America. Tuberculoid leprosy predominates in India whereas Lepromatous formin Africa. India harbors about 65% of the world burden. Case series: Clinical characteristics: Age of presentation varied from 11yrs to 70yrs with male preponderance of 2:1 and most of them were seen from a few weeks to 1yr after symptom onset. Commonest presentation in our series was multiple mononeuritis of which ulnar neuropathy was the commonest followed by foot drop and then by median neuropathy. Ulnar neuropathy presented with clawing of varying intensity. Two presented during ENL stage. One as pure sensory neuropathy with trophic ulcers. One with only gross greater auricular nerve enlargement. One with only bilateral facial nerve involvement. NCS features: Of the 34 studies multiple mononeuritis pattern noted in 23(68%) ulnar nerve involvement in 15(44%) sural nerve involvement in 14(41%) median and tibial nerve involvement each in 10(29.4%) peronial nerve involvement in 9(26.4%) normal NCS in 4(12%) radial nerve involvement in 3(9%) greater auricular nerve involvement in 2(6%) and facial nerve involvement in 1(3%). Of the total cases 18(53%) showed prominent conduction block. Conclusion: This pre-Biblical era disease continues to bother in various clinical forms inspite of aggressive treatment campaigns. High index of suspition is needed to diagnose atypical cases early to prevent permanent neurological deficits and to initiate them on long term treatment.

195

Session: Poster stroke 2.8

Date and Time: 14:00 - 15:00, Saturday, 08 Nov 2014

Venue: Poster area

Acute ischemic stroke following septic cavernous sinus thrombosis

Dr. Shaik Afsar Pasha, Dr. Pratyusha, Dr. Nageswara Rao

NRI Academy of Sciences, Guntur.

Background: Septic cavernous sinus thrombosis (SCST) is a rare fatal disease. Acute ischemic stroke following cavernous sinus thrombosis is further rare. Hence we are reporting two cases of acute ischemic stroke following cavernous sinus thrombosis. Case Presentation: Case 1- A 60 year old lady with poorly controlled Diabetes and Hypertension presented with right side proptosis followed five days later with acute onset left hemiparesis. Case 2- A 35 year old young man with alcoholism and diabetes presented with fever left eye proptosis ptosis with acute onset right hemiparesis 15 days later. Conclusions: The presented cases emphasize the variability of signs and clinical course of SCST. SCST can result in acute ischemic stroke especially when complicated by internal carotid artery (ICA) occlusion.High index of suspicion is required for early diagnosis and treatment to prevent the morbidity and mortality of this fatal disease.




 

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