Annals of Indian Academy of Neurology
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Role of occupational therapy after stroke
Tennille J Rowland, Deirdre M Cooke, Louise A Gustafsson
January 2008, 11(5):99-107
Internationally recognized best practice care in the early management and rehabilitation of individuals following stroke includes multidisciplinary assessment and treatment by a coordinated team of health care professionals that includes occupational therapists. Occupational therapists assess the impact of changes in motor function, sensation, coordination, visual perception, and cognition on a person's capacity to manage daily life tasks. Intervention improves participation in meaningful roles, tasks, and activities; remediates deficits; minimizes secondary complications; and provides education and support to the patient and caregivers. Occupational therapists' focus on independence and function, individual goal-setting, and their specialist skills in task adaptation and environmental modification underpin the profession's contribution to the multidisciplinary stroke rehabilitation team. The aim of this paper is to provide an overview of occupational therapy practice in stroke patients.
  107,688 1,285 -
The diagnosis and management of pseudoseizures or psychogenic non-epileptic events
Aline J.C Russell
April-June 2006, 9(2):60-71
Pseudoseizures or psychogenic non-epileptic seizures (PNES) are often misdiagnosed as epilepsy. This review discusses what is known about PNES, the importance of differentiating PNES from epileptic seizures (ES), avoiding iatrogenic harm and of identifying and managing the underling psychological stressors to optimise outcome. Clinical suspicion and careful history taking with witness accounts is mandatory. Supportive investigations including video-EEG (VEEG) and the utility of VEEG and provocation are discussed. Resources to diagnose and manage PNES are an issue for most countries and clinical expertise may also be lacking. VEEG is an expensive diagnostic tool and there is variable collaboration between neurology and psychiatry which will influence how patients are managed. Confounding this, is the lack of evidence for best practice in managing PNES. The prognosis for the majority of patients with PNES appears to be poor, despite a wider recognition of the problem. Well conducted studies are needed to test the different treatment options.
  92,474 1,135 3
Asymmetric crying facies in a neonate with congenital hypoplasia of depressor anguli oris muscle (CHDAOM)
Sujit A Jagtap, Kaustubh S Chaudhari
January-March 2016, 19(1):123-124
DOI:10.4103/0972-2327.168638  PMID:27011644
  74,546 86 -
The effect of curcumin (turmeric) on Alzheimer's disease: An overview
Shrikant Mishra, Kalpana Palanivelu
January-March 2008, 11(1):13-19
DOI:10.4103/0972-2327.40220  PMID:19966973
This paper discusses the effects of curcumin on patients with Alzheimer's disease (AD). Curcumin (Turmeric), an ancient Indian herb used in curry powder, has been extensively studied in modern medicine and Indian systems of medicine for the treatment of various medical conditions, including cystic fibrosis, haemorrhoids, gastric ulcer, colon cancer, breast cancer, atherosclerosis, liver diseases and arthritis. It has been used in various types of treatments for dementia and traumatic brain injury. Curcumin also has a potential role in the prevention and treatment of AD. Curcumin as an antioxidant, anti-inflammatory and lipophilic action improves the cognitive functions in patients with AD. A growing body of evidence indicates that oxidative stress, free radicals, beta amyloid, cerebral deregulation caused by bio-metal toxicity and abnormal inflammatory reactions contribute to the key event in Alzheimer's disease pathology. Due to various effects of curcumin, such as decreased Beta-amyloid plaques, delayed degradation of neurons, metal-chelation, anti-inflammatory, antioxidant and decreased microglia formation, the overall memory in patients with AD has improved. This paper reviews the various mechanisms of actions of curcumin in AD and pathology.
  57,718 1,732 66
Cardioembolic stroke: An update on etiology, diagnosis and management
Megan C Leary, Louis R Caplan
January 2008, 11(5):52-63
Stroke and ischemic heart diseases are among the most common causes of death and disability throughout the world. Even more worrisome is the suggestion that stroke rates may further increase in certain developing nations. The purpose of this article is to review the particular subtype of stroke known as cardioembolic stroke. A cardioembolic stroke occurs when the heart pumps unwanted materials into the brain circulation, resulting in the occlusion of a brain blood vessel and damage to the brain tissue. The etiology, clinical manifestations, diagnosis and management of cardioembolic stroke are reviewed.
  50,665 957 -
Akinetic rigid syndrome: An overview
Praveen Gupta, Madhuri Behari
January-March 2007, 10(1):21-30
Akinetic-rigid syndromes can be caused by diverse etiologies. It is vital to separate idiopathic Parkinson's disease from other neurodegenerative diseases and causes of secondary parkinsonism as it has significant therapeutic implications. However even specialists may misdiagnose nonidiopathic parkinsonism as Parkinson's disease in a quarter of cases. Often the history may be nonspecific and all investigations may be normal. The diagnosis may thus rest entirely on clinical features. The etiological diagnosis of Akinetic rigid syndrome has critical therapeutic and prognostic implications. Therefore we will review the various etiologies of akinetic rigid syndrome and highlight critical clinical features to aid in differential diagnosis.
  49,768 1,248 -
Psychiatric symptoms in neurological practice
M Madhusudanan
April-June 2006, 9(2):72-89
Most of the primary psychiatric symptoms like delusions, hallucinations, illusions, depression, mania, obsessive compulsive symptoms, aggression etc can occur in organic neurological illnesses. Neurologist should have a clear understanding as to the differentiating clinical features from organic neurological and medical causes. The present review focuses on the clinical differentiating points which can help the neurologist to exclude organic aetiology.
  38,302 1,056 3
The origin of HIV and AIDS: An enigma of evolution
Sarosh M Katrak
January-March 2006, 9(1):5-10
  31,744 498 1
Neurological complications of chickenpox
AS Girija, M Rafeeque, KP Abdurehman
October-December 2007, 10(4):240-246
Aim: To assess the neurological complications of chickenpox with prognosis. Background: The neurological complications occur in 0.03% of persons who get chickenpox. There is no universal vaccination against chicken pox in India. Most patients prefer alternate modalities of treatment. Hence these complications of chickenpox are likely to continue to occur. Study Design: A prospective study was conducted for 2 years (from March 2002) on the admitted cases with neurological complications after chickenpox (with rash or scar). Patients were investigated with CT/MRI, CSF study, EEG and nerve conduction studies and hematological workup. They were followed-up for 1 year and outcome assessed using modified Rankin scale. Results: The latency for the neurological complications was 4-32 days (mean: 16.32 days). There were 18 cases: 10 adults (64%) and 8 children (36%). Cerebellar ataxia (normal CT/MRI) was observed in 7 cases (32%) (mean age: 6.85 years). One patient (6 years) had acute right hemiparesis in the fifth week due to left capsular infarct. All these cases spontaneously recovered by 4 weeks. The age range of the adult patients was 13-47 years (mean: 27 years). The manifestations included cerebellar and pyramidal signs (n-4) with features of demyelination in MRI who recovered spontaneously or with methylprednisolone by 8 weeks. Patient with encephalitis recovered in 2 weeks with acyclovir. Guillain Barre syndrome of the demyelinating type (n-2) was treated with Intravenous immunoglobulin (IVIG) and they had a slow recovery by a modified Rankin scale (mRs) score of 3 and 2 at 6 months and 1 year, respectively. One case died after hemorrhage into the occipital infarct. There were two cases of asymmetrical neuropathy, one each of the seventh cranial and brachial neuritis. Conclusion: Spontaneous recovery occurs in post-chickenpox cerebellar ataxia. Rarely, serious complications can occur in adults. The demyelinating disorders, either of the central or peripheral nervous system, can be effectively managed using methylprednisolone or I/V IG.
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Controlled release formulations in neurology practice
JK Pandit, S Singh, MS Muthu
October-December 2006, 9(4):207-216
Recently, controlled release (CR) pharmaceutical products have become a very useful tool in medical practice, offering a wide range of actual and perceived advantages to the patient. A CR product requires numerous considerations, like drugs suitable for CR formulations, techniques of fabrication and evaluation, factors affecting bioavailability of the parent drug, before it can actually be claimed to provide the purported benefits. Such complex considerations fall under the domain of pharmaceutical experts and clinicians, naturally, are not sufficiently aware and updated about these products and their biological consequences. Various CR formulations used in neurological practice are discussed in the present review. The clinical studies of the conventional and CR dosage form of the drugs used in neurology practice reflect the advantages of prescribing CR formulations over the conventional dosage forms.
  20,890 2,012 7
The role of the speech language pathologist in acute stroke
Cindy Dilworth
January 2008, 11(5):108-118
Dysphagia and communication impairment are common consequences of stroke. Stroke survivors with either or both of these impairments are likely to have poorer long-term outcomes than those who do not have them. Speech-language pathologists (SLP) play a significant role in the screening, formal assessment, management, and rehabilitation of stroke survivors who present with dysphagia and/or communication impairment. Early diagnosis and referral is critical, as is intensive intervention as soon as the patient is able to participate. The SLP is also responsible for educating carers and staff in strategies that can support the patient and for making appropriate environmental modifications (e.g. altering diet consistencies or providing information in an aphasia-friendly format) to optimize the stroke survivor's participation, initially, in the rehabilitation program and, subsequently, within the community.
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Very early mobilization following acute stroke: Controversies, the unknowns, and a way forward
Julie Bernhardt
January 2008, 11(5):88-98
Evidence that organized stroke-unit care results in better outcome has led to positive changes in stroke service delivery around the world. It is well accepted that stroke rehabilitation should commence as early as possible for optimal recovery to be achieved. Exactly how early rehabilitation should start is controversial. Early mobilization (getting up out of bed within 24 h of stroke onset) is a well-established feature of acute stroke care in many Scandinavian hospitals. Elsewhere in the world, stroke protocols enforce bed rest for the first few days or foster long periods of bed rest after stroke. This paper aims to provide an overview of the topic of very early mobilization (VEM). It is divided into three sections: section 1 reviews the effects of bed rest and outlines arguments both for and against enforced bed rest after stroke; in section 2, VEM as a treatment for stroke and the limitations of existing literature in the field are described; and section 3 outlines the systematic approach that has been taken by our team of clinical researchers to the study the effect of VEM after stroke. Conclusion: VEM represents a simple, easy-to-deliver intervention, requiring little or no equipment. It is potentially deliverable to 85% of the acute stroke population and, if proven to be effective, may help reduce the significant personal and community burden of stroke. As current opinion about when mobilization should begin is divided, one way to move forward is through the conduct of a large high-quality clinical trial (such as A Very Early Rehabilitation Trial (AVERT)). Although some inroads have been made, further research in this field is clearly warranted
  20,975 643 2
Electrodiagnostic approach to carpal tunnel syndrome
Ajith Cherian, Abraham Kuruvilla
July-September 2006, 9(3):177-182
An algorithm for an electrophysiological approach to carpal tunnel syndrome is proposed. This technical note takes into account the standard tests, comparison tests and needle electromyography. If the standard tests are negative, a comparison study can be done to identify cases of minimal or very mild carpal tunnel syndrome (CTS). If comparison studies are negative, CTS can be ruled out and a search for other causes have to be made. If the standard tests are positive, carpal tunnel syndrome can be divided into extreme, severe,moderate and mild cases. Motor comparison study is useful in extreme CTS cases. Needle electromyography is a must in all cases where the standard tests are positive. This streamlined approach allows accurate diagnosis with minimum essential tests.
  20,627 822 -
Management of treatment-resistant obsessive-compulsive disorder: An update on therapeutic strategies
Biswaranjan Mishra, Saddichha Sahoo, Baikunthanath Mishra
July-September 2007, 10(3):145-153
Background: Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder characterized by recurrent, persistent thoughts and/or repetitive compulsive behaviors that cause anxiety or distress, are time-consuming, and cause significant socio-occupational dysfunction. Although OCD can be alleviated with pharmacological and behavioral treatments, up to 40-60% of patients do not have a satisfactory outcome. This paper aims to review the operational definitions and management of treatment-resistant OCD. Materials and Methods: A computerized search on Pubmed carried from 1980 to April 2006 led to the summarization of the results. Results: There are several strategies to manage treatment-resistant OCD. To start with, it is necessary to define it and differentiate it from other comorbid psychiatric disorders. Adequate trials of selective serotonin reuptake inhibitors (SSRIs), including clomipramine, at the maximum recommended dosages for at least 12 weeks needs to be tried, along with cognitive behavioral therapy (CBT), before trying out other modalities of treatment, which include ECT, rTMS, and neurosurgery. Conclusion: OCD has various clinical and therapeutic implications as it has a chronic course. Unless diagnosed and treated in an effective manner, it carries the risk of becoming resistant to treatment. This paper attempts to present an algorithm of management that can be followed in treatment-resistant OCD. It also emphasizes the need to maximize the effect of each course of treatment before moving on to the next step of management.
  20,391 750 4
Evolution of abnormal postures in Duchenne muscular dystrophy
Maria Kinali, Marion Main, Eugenio Mercuri, Francesco Muntoni
April-June 2007, 10(5):44-54
Spinal deformities are common abnormalities of posture observed in Duchenne Muscular Dystrophy (DMD). Spinal alignment is the result of the integrity of different variables, ranging from normal vertebral development to balance and symmetry of tone and strength, normal control by central pathways and integrity of the sensory feedback. Any disturbance altering one or more of these variables increases the risk for developing abnormal postures. Scoliosis is a frequent complication (68-90%) of DMD. Although the risk of developing scoliosis is higher in non-ambulant DMD patients, scoliosis and kyphosis can be found occasionally in ambulant patients. In DMD patients the onset and the evolution of the abnormal postures are related to the onset and the progression of weakness. This review discusses the factors affecting posture in DMD, especially in relation to scoliosis and gives an overview of general guidelines on the diagnostic approach and some management issues related to DMD.
  17,255 490 1
Antemortem diagnosis and prevention of human rabies
Shampur Narayana Madhusudana, Suja Mooriyath Sukumaran
January-March 2008, 11(1):3-12
DOI:10.4103/0972-2327.40219  PMID:19966972
Human rabies still continues to be a significant health problem in India and other developing countries where dogs are the major vectors of transmission. Rabies in humans can present in two clinical forms, i.e., furious and paralytic. While diagnosis of furious rabies can be made based on the typical symptoms and signs, paralytic rabies poses a diagnostic dilemma to the neurologists who may encounter these cases in their practice. Although there are certain clinical features that distinguish this disease from other forms of Guillain-Barre syndromes, confirmation of diagnosis may require laboratory assistance. Conventional techniques such as antigen detection, antibody assays and virus isolation have limited success. The recently introduced molecular techniques show more promise in confirming the cases of paralytic rabies. There has not been much success in the treatment of confirmed rabies cases and recovery from rabies is extremely rare. Therefore, preventive measures of this dreaded disease after an exposure become extremely important. The present article reviews the current status of human rabies with regard to antemortem diagnosis, disease management and post-exposure prophylaxis.
  16,346 638 8
All that ripples is not "Motor neuron disease"
Ashok Panagariya, Vinay Agarwal, Neeraj Agarwal
April-June 2007, 10(2):88-91
Until early 80's most patients presenting with lower motor neuron syndrome characterized by weakness, wasting, diminished reflexes, fasciculations, cramps and minimal sensory involvement would have been diagnosed as motor neuron disease- LMN variant. But similar clinical picture can be seen in various disorders right from degenerative illnesses like motor neuron disease to inflammatory ones like multifocal motor neuropathy (MMN). Some of them are potentially treatable conditions with immunomodulatory therapies and are associated with characteristic electrophysiological features and high serum antibody titers. Thus every patient presenting with pure motor LMN weakness and fasciculations should not be labeled as motor neuron disease and extensive electrophysiological search is warranted to diagnose these potentially treatable conditions, changing the grim prognosis to more favorable one.
  16,400 582 -
Stroke in central nervous system infections
Francisco Javier Carod-Artal
January 2008, 11(5):64-78
Background: Stroke subtypes and etiology may differ between developing and developed countries. Infections are a relatively common cause of stroke in tropical regions. Objective: To review the main infectious diseases associated with stroke. Discussion: Prevalence of stroke in HIV patients is around 1%. Pathogenic mechanisms include HIV vasculopathy, vasculitis, cardioembolism, acquired hypercoagulability, and the effect of opportunistic infections. Treatment with protease inhibitors has been associated with premature atherosclerotic vascular disease. Emerging viral infections that are associated with stroke include viral hemorrhagic fevers, Japanese encephalitis, dengue, and West Nile virus. Vasculitis involving perforating vessels of the brain is a cerebrovascular complication of tuberculous meningitis. Small, medium, and large arteries of the anterior circulation can be involved. A progressive intracranial arteriopathy after Leptospira interrogans infection has been described, which involves the large intracranial arteries. Cerebrovascular complications of mycosis are associated with large vessel vasculitis, direct vessel damage by invasion or embolization, and subarachnoid hemorrhage due to mycotic aneurysm rupture. Pathological findings of cerebral malaria include diffuse cerebral edema, perivascular ring hemorrhages, white matter necrosis, parenchyma petechial hemorrhages, occlusion of brain vessels, and sequestration of infected erythrocytes in cortical and perforating arteries. Stroke can occur in subarachnoid neurocysticercosis and the lesions in such cases consist mostly of deep lacunar infarctions resulting from endarteritis of small penetrating arteries. Cardiac arrhythmias, congestive heart failure, apical aneurysm, and mural thrombus are the conditions that predispose patients with American trypanosomiasis to cardioembolism. Gnathostoma spinigerum infestation is a cause of hemorrhagic stroke in Asia. Conclusion: Infectious and tropical diseases should be included in the differential diagnoses of stroke.
  15,789 775 6
Radial neuropathy due to occupational lead exposure: Phenotypic and electrophysiological characteristics of five patients
N Shobha, Arun B Taly, Sanjib Sinha, T Venkatesh
April-June 2009, 12(2):111-115
DOI:10.4103/0972-2327.53080  PMID:20142857
Lead is a ubiquitous and versatile metal that has been used by mankind for many years. It is a toxic heavy metal that ranks as one of the most important environmental poisons in the world. Research conducted in recent years has increased public health concern about the toxicity of lead at low doses and has supported a reappraisal of the levels of lead exposure that may be safely tolerated in the workplace. Neuropathy is one complication of lead poisoning. The aim of this study is to describe the phenotypic and electrophysiological profile in five male patients working in a battery factory who developed radial nerve neuropathy due to lead exposure. All patients had elevated blood lead levels that were in the toxic range. The concerned regulatory bodies should make it mandatory for workers to undergo regular health checkups to detect signs of lead poisoning and must ensure that workers are aware about the ill effects of exposure to this metal. Chelation therapy removes lead from the blood and soft tissues and chronic lead exposure often requires repeated courses of treatment.
  15,863 229 7
What are relative risk, number needed to treat and odds ratio?
Kameshwar Prasad
October-December 2007, 10(4):225-230
The effects of an intervention is best measured in a randomized controlled trial (RCT) and can be expressed in various ways using the measures such as risk difference, number needed to treat (NNT), relative risk or odds ratio. Risk difference (RD) is the difference in risk of the outcome event between control and experimental group. Control group is not exposed to the intervention, whereas experimental group is the one that is exposed to intervention. The risk of outcome event in the control group is also called baseline risk. The NNT is the inverse of the risk difference and indicates the number of patients required to be treated to avoid one additional outcome event. Risk difference and NNT are absolute measures of effect. Relative risk (RR) is a relative measure and is the ratio of the risk in the exposed group to that in the unexposed group. Relative risk reduction (RRR) is one minus RR and indicates the fraction (or percent) of baseline risk that reduces with exposure to the intervention. Odds ratio (OR) is ratio of odds of having the event in the exposed group to that in the unexposed group. These measures are suitable for different purposes and appeal to different constituencies. Odds ratio is the only measure suitable for use in logistic regression and case control studies.
  15,024 652 2
Treatment guidelines for Guillain-Barré Syndrome
AK Meena, SV Khadilkar, J. M. K. Murthy
July 2011, 14(5):73-81
DOI:10.4103/0972-2327.83087  PMID:21847334
  14,918 736 6
Role of transcranial Doppler ultrasonography in acute stroke
Vijay K Sharma, N Venketasubramanian, Dheeraj K Khurana, Georgios Tsivgoulis, Andrei V Alexandrov
January 2008, 11(5):39-51
Background: Transcranial Doppler (TCD) ultrasonography is the only noninvasive examination that provides a reliable evaluation of intracranial blood flow patterns in real-time, adding physiological information to the anatomical information obtained from other neuroimaging modalities. TCD is relatively cheap, can be performed bedside, and allows monitoring both in acute emergency settings as well as over prolonged periods; it has a high temporal resolution, making it ideal for studying dynamic cerebrovascular responses. Objective: To define the role of TCD in the evaluation of patients with acute ischemic stroke. Material and methods: We have analyzed the existing literature on the protocols for performing TCD in the evaluation of patients with acute cerebral ischemia. Extended applications of TCD in enhancing intravenous thrombolysis in acute stroke, emboli monitoring, right-to-left shunt detection, and vasomotor reactivity have also been described. Results: In acute cerebral ischemia, TCD is capable of providing rapid information about the hemodynamic status of the cerebral circulation, monitoring recanalization in real-time and, additionally, has a potential for enhancing tissue plasminogen activator (TPA)-induced thrombolysis. Extended applications of TCD make it an important and valuable tool for evaluating stroke mechanisms, for planning and monitoring treatment, and for determining prognosis. Discussion and conclusion: TCD has an established clinical value in the diagnostic workup of stroke patients and is suggested as one of the essential components of a comprehensive stroke center. TCD is also an evolving ultrasound method with increasing diagnostic value and a therapeutic potential in cerebral ischemia
  14,211 520 2
Subarachnoid hemorrhage: An unusual presentation of cerebral venous sinus thrombosis
T Bindu, S Panda, HS Chandrashekar, Ravi S Shankar, D Nagaraja
January-March 2006, 9(1):32-35
The diagnosis of cerebral venous thrombosis (CVT) requires high index of suspicion owing to the varied spectrum of its clinical manifestations. Its diagnosis may be more elusive if the patient presents with subarachnoid hemorrhage (SAH). We report four cases of CVT that presented with SAH and will discuss the importance of looking for clues for the early diagnosis of CVT. Three men and one woman presented with severe headache and images initially suggested SAH with no associated parenchymal bleeding. In all patients, SAH involved the sulci of the convexity and spared the basal cisterns. Angiography showed occlusion of intracranial venous sinuses without revealing any other cause of SAH. All the patients showed improvement with anticoagulant therapy.
  14,292 401 1
Cerebral venous thrombosis: Update on clinical manifestations, diagnosis and management
Didier Leys, Charlotte Cordonnier
January 2008, 11(5):79-87
Cerebral venous thrombosis (CVT) has a wide spectrum of clinical manifestations that may mimic many other neurological disorders and lead to misdiagnoses. Headache is the most common symptom and may be associated with other symptoms or remain isolated. The other frequent manifestations are focal neurological deficits and diffuse encephalopathies with seizures. The key to the diagnosis is the imaging of the occluded vessel or of the intravascular thrombus, by a combination of magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Causes and risk factors include medical, surgical and obstetrical causes of deep vein thrombosis, genetic and acquired prothrombotic disorders, cancer and hematological disorders, inflammatory systemic disorders, pregnancy and puerperium, infections and local causes such as tumors, arteriovenous malformations, trauma, central nervous system infections and local infections. The breakdown of causes differs in different parts of the world. A meta-analysis of the most recent prospectively collected series showed an overall 15% case-fatality or dependency rate. Heparin therapy is the standard therapy at the acute stage, followed by 3-6 months of oral anticoagulation. Patients with isolated intracranial hypertension may require a lumbar puncture to remove cerebrospinal fluid before starting heparin when they develop a papilloedema that may threaten the visual acuity or decompressive hemicraniectomy. Patients who develop seizures should receive antiepileptic drugs. Cerebral venous thrombosis - even pregnancy-related - should not contraindicate future pregnancies. The efficacy and safety of local thrombolysis and decompressive hemicraniectomy should be tested
  13,644 1,026 3
Nipah virus encephalitis: A cause for concern for Indian neurologists?
Amit Halder, Ambar Chakravarty
July-September 2006, 9(3):137-144
The first and only recorded outbreak of Nipah virus (NV) encephalitis in India occurred in the winter of 2001, although the causative organism could only be identified 5 years down the line in 2006. The first ever-recorded outbreak of NV encephalitis occurred in the Malaysian peninsula in 1998-99; though between 2001 and 2005, at least four outbreaks occurred in our neighboring country of Bangladesh. The threat of further outbreaks of this dangerous disease looms large on the Indian subcontinent, given the natural reservoir of the definitive host, namely, fruit-eating bats of the genus Pteropus. This review would briefly highlight the epidemiology, clinical aspects and diagnosis of NV encephalitis to enlighten the neurological community of the country for early detection and implementation of preventive measures in the event of further outbreaks, especially those which are generally passed of as 'mystery diseases' in the lay press and even by governmental agencies.
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