Annals of Indian Academy of Neurology
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   2014| April-June  | Volume 17 | Issue 2  
    Online since May 17, 2014

 
 
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CASE REPORTS
Hoff Mann's syndrome with unusually long duration: Report on clinical, laboratory and muscle imaging findings in two cases
Atchayaram Nalini, C. Govindaraju, Pramila Kalra, Prashanth Kadukar
April-June 2014, 17(2):217-221
DOI:10.4103/0972-2327.132643  PMID:25024579
Two adult men presented with the rare Hoffmann's syndrome (HS). Case 1: A 35-year-old male patient had progressive stiffness of lower limbs of 13 years and generalized muscle hypertrophy and myalgia of 3 years duration. Had periorbital edema, dry skin, generalized muscle hypertrophy and spastic dysarthria with hoarseness. Muscle power was normal. Jaw jerk and deep tendon reflexes were exaggerated. Case 2: A 24-year-old male patient presented with muscle hypertrophy from childhood, slowness in motor activities and hearing impairment. For 6 months, he had severe muscle pains, cramps and further increase in hypertrophy. He had yellow tinged, dry skin, hoarseness of voice, gross muscle hypertrophy and minimal weakness. Both had markedly elevated serum creatine kinase (CK) levels and high thyroid stimulating hormone, low free triiodothyronine and free thyroxine levels. Levothyroxine treatment demonstrated remarkable reduction in muscle bulk at 2 months in both and no symptoms at 6 months. Magnetic resonance imaging of lower limbs in both cases revealed almost identical features with involvement of the muscles of posterior and adductor compartment of thighs and posterior and lateral compartments of the legs. Differential diagnosis of long duration muscle pseudohypertrophy and elevated CK levels should include HS.
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REVIEW ARTICLE
Pseudo-dementia: A neuropsychological review
Hai Kang, Fengqing Zhao, Llbo You, Cinzia Giorgetta, Venkatesh D, Sujit Sarkhel, Ravi Prakash
April-June 2014, 17(2):147-154
DOI:10.4103/0972-2327.132613  PMID:25024563
Ever since Kiloh (1961) [2] coined the term pseudo-dementia, it has been used a little loosely for describing the cognitive deficits in depression, especially, which is found in old age. However, several diagnostic dilemmas persist regarding the nosological status of this condition. Teasing out these individual diagnostic problems is important not only for administering appropriate therapy, but also for preventing them from the unnecessary diagnostic assessments towards the other diagnoses. Thus, it is important to have a detailed knowledge of the cognitive or neuropsychological deficits in this condition. In this review, we start by addressing the important issue of diagnostic confusion between dementia and pseudo-dementia. Subsequently, we proceed by reviewing the present scientific literature on the cognitive deficits found in this clinical condition. For the sake of convenience, we will divide the cognitive deficits into:
  1. Memory deficits
  2. Executive function deficits and
  3. Deficits in speech and language domains.
Finally, we will look at the progression of this condition to see the components of this condition, which can be actually called "Pseudo".
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CASE REPORTS
Undulating tongue in Wilson's disease
M Nagappa, S Sinha, JS Saini, PS Bindu, AB Taly
April-June 2014, 17(2):225-226
DOI:10.4103/0972-2327.132646  PMID:25024581
We report an unusual occurrence of involuntary movement involving the tongue in a patient with confirmed Wilson's disease (WD). She manifested with slow, hypophonic speech and dysphagia of 4 months duration, associated with pseudobulbar affect, apathy, drooling and dystonia of upper extremities of 1 month duration. Our patient had an uncommon tongue movement which was arrhythmic. There was no feature to suggest tremor, chorea or dystonia. It might be described as athetoid as there was a writhing quality, but of lesser amplitude. Thus, the phenomenology was uncommon in clinical practice and the surface of the tongue was seen to "ripple" like a liquid surface agitated by an object or breeze. Isolated lingual dyskinesias are rare in WD. It is important to evaluate them for WD, a potentially treatable disorder.
  1 1,995 90
Primary diffuse leptomeningeal gliomatosis: An autopsy case report
Shaik Afshan Jabeen, Arikapadu Haritha Chowdary, Rukmini Mridula Kandadai, Megha S. Uppin, Angamattu Kanikannan Meena, Rupam Borgohain, Challa Sundaram
April-June 2014, 17(2):227-230
DOI:10.4103/0972-2327.132647  PMID:25024582
Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare condition, characterized by infiltration of the meninges by glial cells without evidence of the primary tumor in the brain or spinal cord parenchyma. Glioma arising primarily from the leptomeninges is extremely rare and often diagnosed only in post mortem examination and the diagnosis may be missed in meningeal biopsy. We describe a young female who presented with symptoms of raised intracranial pressure with imaging evidence of diffuse leptomeningeal enhancement in whom autopsy confirmed the diagnosis of PDLG. Our case illustrates the diagnostic difficulties in making the pre-mortem diagnosis even with multiple cerebrospinal fluid cytologies and leptomeningeal biopsy.
  1 2,861 66
IMAGES IN NEUROLOGY
A clue in the diagnosis of Cri-du-chat syndrome: Pontine hypoplasia
Tugce Aksu Uzunhan, Bahattin Sayinbatur, Mine Caliskan, Ayse Sahin, Kubilay Aydin
April-June 2014, 17(2):209-210
DOI:10.4103/0972-2327.132635  PMID:25024576
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ORIGINAL ARTICLES
A clinical profile of patients with Parkinson's disease and psychosis
B. R. Amar, Ravi Yadav, Y. C Janardhan Reddy, Pramod Kumar Pal
April-June 2014, 17(2):187-192
DOI:10.4103/0972-2327.132625  PMID:25024570
Aims: The aim of the study was to study the clinical profile of the patients with Parkinson's disease (PD) and psychosis. Settings and Design: This was a prospective, cross sectional, hospital-based study done at the Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India from September 2009 to January 2011. All patients with PD, diagnosed by United Kingdom PD Society Brain Bank criteria, having with features of psychosis as diagnosed by the neuropsychiatric inventory (NPI) were included. Patients without a caregiver who could validate the patient's symptoms were excluded. Results: A total of 40 patients (5 women, 35 men) with PD with psychosis (mean age: 54.2 ± 11.5 years, mean duration of illness: 6.5 ± 4.5 years, and mean duration of psychosis: 4.3 ± 4.3 years) were included in the study. The Global NPI score was 19.1 ± 11.5. Majority of the patients had pure hallucinations (85%), while the rest had either pure delusions (7.5%) or a combination of delusions and hallucinations (7.5%). In those with hallucinations, visual hallucinations were the commonest (60%) (pure only in 22.5%), followed by auditory (45%), minor hallucinations (45%), and tactile (20%). Only one person reported having olfactory hallucinations (2.5%). Loss of insight was most often observed during the visual hallucinations (52%), followed by tactile (44.4%), auditory (38.9 %), and minor hallucinations (33.3%). Conclusions: In patients with PD and psychosis, pure hallucinations are common and visual hallucinations are the commonest among the hallucinations. A large proportion of patients have minor hallucinations, which need to be recognized early for effective and early management. The limitations of the study were small sample size, use of a single scale to assess psychosis and subjective assessment of insight.
  1 2,014 130
A voxel based comparative analysis using magnetization transfer imaging and T1-weighted magnetic resonance imaging in progressive supranuclear palsy
Mangalore Sandhya, Jitender Saini, Shaik Afsar Pasha, Ravi Yadav, Pramod Kumar Pal
April-June 2014, 17(2):193-198
DOI:10.4103/0972-2327.132626  PMID:25024571
Aims: In progressive supranuclear palsy (PSP) tissue damage occurs in specific cortical and subcortical regions. Voxel based analysis using T1-weighted images depict quantitative gray matter (GM) atrophy changes. Magnetization transfer (MT) imaging depicts qualitative changes in the brain parenchyma. The purpose of our study was to investigate whether MT imaging could indicate abnormalities in PSP. Settings and Design: A total of 10 patients with PSP (9 men and 1 woman) and 8 controls (5 men and 3 women) were studied with T1-weighted magnetic resonance imaging (MRI) and 3DMT imaging. Voxel based analysis of T1-weighted MRI was performed to investigate brain atrophy while MT was used to study qualitative abnormalities in the brain tissue. We used SPM8 to investigate group differences (with two sample t-test) using the GM and white matter (WM) segmented data. Results: T1-weighted imaging and MT are equally sensitive to detect changes in GM and WM in PSP. Magnetization transfer ratio images and magnetization-prepared rapid acquisition of gradient echo revealed extensive bilateral volume and qualitative changes in the orbitofrontal, prefrontal cortex and limbic lobe and sub cortical GM. The prefrontal structures involved were the rectal gyrus, medial, inferior frontal gyrus (IFG) and middle frontal gyrus (MFG). The anterior cingulate, cingulate gyrus and lingual gyrus of limbic lobe and subcortical structures such as caudate, thalamus, insula and claustrum were also involved. Cerebellar involvement mainly of anterior lobe was also noted. Conclusions: The findings suggest that voxel based MT imaging permits a whole brain unbiased investigation of central nervous system structural integrity in PSP.
  1 1,742 69
CASE REPORTS
Erb's paraplegia with primary optic atrophy: Unusual presentation of neurosyphilis: Case report and review of literature
Chandramohan Sharma, Kunal Nath, Banshi LaL Kumawat, Dinesh Khandelwal, Deepak Jain
April-June 2014, 17(2):231-233
DOI:10.4103/0972-2327.132648  PMID:25024583
Symptomatic neurosyphilis (NS) can have varied syndromic presentations: Meningitis, meningovascular and parenchymatous involvement. Non-tabetic syphilis affecting the spinal cord is rare and only sporadic case reports have been published. The variant of meningomyelitis known as Erb's paraplegia refers to patients of spinal syphilis with very slow progression over many years and predominantly motor signs. Primary optic atrophy occurs twice as frequently in tabes dorsalis as in other types of NS. We describe here a case of a 32-year-old truck driver who presented with Erb's paraplegia with primary optic atrophy. This clinical overlap in NS is extremely rare and to our knowledge is the first case report of its type.
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Aromatic L-Amino acid decarboxylase deficiency: A new case from Turkey with a novel mutation
Kivilcim Gucuyener, Cigdem Seher Kasapkara, Leyla Tumer, Marcel M. Verbeek
April-June 2014, 17(2):234-236
DOI:10.4103/0972-2327.132652  PMID:25024584
Aromatic L-amino acid decarboxylase (AADC), a vitamin B6-requiring enzyme that converts L-dopa to dopamine and 5-hydroxytryptophan to serotonin. Deficiency of this enzyme results in developmental delay, muscular hypotonia, dystonia, involuntary movements, autonomic dysfunction, and oculogyric crises. We now report a 2-year-old Turkish boy with AADC deficiency confirmed by greatly reduced AADC activity in the plasma and by genetic studies. Mutation analysis revealed a homozygous mutation c.208C > T (p. His70Tyr) in exon 3 of the AADC gene which has not been described to date.
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Reversible "Pulvinar sign" in Wernicke's encephalopathy
Biju Gopalakrishnan, VV Ashraf, Praveen Kumar, Krishna Kiran
April-June 2014, 17(2):222-224
DOI:10.4103/0972-2327.132645  PMID:25024580
Young onset dementia is a challenge. We describe a case, where a patient presented with psychosis, dementia and MRI showing pulvinar sign, all of this typical of variant Cruetzfelt Jacob disease (CJD). Subsequent investigations lead to the diagnosis of a treatable illness and patient was improved and MRI sign reversed, underlining again the importance of search needed for treatable diseases in any "typical" case of fatal illness.
  - 1,712 101
GRAND ROUND
A seventy year old man with intractable vomiting, Parkinsonism, memory loss and ptosis
Jacob George, P. T. Gourisankar, Sureshkumar Radhakrishnan, Anand A. Kumar, Rajesh R. Kannan, M. R. Bindhu
April-June 2014, 17(2):155-160
DOI:10.4103/0972-2327.132614  PMID:25024564
  - 3,359 227
IMAGES IN NEUROLOGY
Atlantoaxial instability as the presenting feature of Morquio syndrome
Deepak S. Amalnath, S. Kalaimani, Tarun Kumar Dutta
April-June 2014, 17(2):202-203
DOI:10.4103/0972-2327.132630  PMID:25024573
  - 1,387 70
Acute stroke-like presentation of acquired hepatocerebral degeneration
B. Smita, V. Abdul Gafoor, K. Saifudheen, James Jose
April-June 2014, 17(2):204-206
DOI:10.4103/0972-2327.132631  PMID:25024574
Neurological manifestations in liver diseases have been well-described. Parkinsonism developing in cirrhotic patients is a unique clinical, neuroradiological, and biological entity. The symptoms are often insidious in onset and occur after liver disease has made its presentation. Acute dysarthria as the presenting manifestation of cirrhosis is rare. Here we report three cases where liver disease made an unusual presentation as acute dysarthria. In all cases the abruptness of the onset prompted the treating physicians to make a diagnosis of stroke. The computed tomography (CT) scans of all these patients did not show any evidence of stroke. This was followed by magnetic resonance imaging (MRI) which showed the characteristic symmetric high-signal intensities in globus pallidus and substantia nigra in T1-weighted images, a reflection of increased tissue concentrations of manganese that helped in making a retrospective diagnosis of liver disease, confirmed later by altered serum albumin to globulin ratios and altered liver echo texture in ultra sonogram.
  - 1,671 88
Unusual presentation of Sturge-Weber syndrome: Progressive megalencephaly with bilateral cutaneous and cortical involvement
Kundan Mittal, Jaya Shankar Kaushik, Gurpreet Kaur, Mohd Aamir, Suvasini Sharma
April-June 2014, 17(2):207-208
DOI:10.4103/0972-2327.132633  PMID:25024575
The Sturge Weber syndrome is characterized by developmental delay, seizures in infancy, unilateral cutaneous lesions with ipsilateral leptomeningeal enhancement. We report an unusual presentation of Sturge Weber syndrome with bilateral port wine nevus on the trunk and face along with bilateral cortical involvement in a developmentally normal child with progressive megalencephaly.
  - 1,525 61
Intramyelinic edema in maple syrup urine disease
Leema Pauline Cornelius, B. Kannan, Viveka Saravanan, Eswaradass Prasanna Venkatesan
April-June 2014, 17(2):211-213
DOI:10.4103/0972-2327.132638  PMID:25024577
  - 1,578 72
Pulvinar sign in acute disseminated encephalomyelitis
Varsha S. Dabadghao, Piyush Ostwal, Suresh K. Sharma, Subodh A. Garg
April-June 2014, 17(2):214-216
DOI:10.4103/0972-2327.132640  PMID:25024578
  - 2,933 105
LETTERS TO THE EDITOR
An interesting case of reversible metabolic myopathy: Tumor induced osteomalacia
Hanmayyagari Babul Reddy, Guntaka Mounika, V. Sri Nagesh, I. Satish Rao
April-June 2014, 17(2):237-238
DOI:10.4103/0972-2327.132657  PMID:25024585
  - 1,429 80
Alcohol-related seizures: Need for clarity
Raman Deep Pattanayak
April-June 2014, 17(2):238-239
DOI:10.4103/0972-2327.132660  PMID:25024586
  - 1,157 86
Seasonal and monthly trends in the occurrence of Guillain-Barre syndrome over a 5-year period: A tertiary care hospital-based study from South India
Thomas Mathew, Meghana Srinivas, Raghunandan Nadig, Ramesh Arumugam, Gosala Raja Kukkuta Sarma
April-June 2014, 17(2):239-241
DOI:10.4103/0972-2327.132662  PMID:25024587
  - 1,737 85
Accounting for attitude in a KAP Study: A comment on knowledge, attitude and practice of stroke in India versus other developed and developing countries
Sunil Kumar Raina
April-June 2014, 17(2):241-242
DOI:10.4103/0972-2327.132663  PMID:25024588
  - 1,291 64
Author's reply: Evolution of mobile plaque to complete division of carotid lumen
Petar Slankamenac, Zeljko Zivanovic, Branka Vitic, Aleksandar Jesic
April-June 2014, 17(2):242-242
DOI:10.4103/0972-2327.132666  PMID:25024589
  - 1,016 40
Brain natriuretic peptide among stroke patients
Ayhan Saritas, Zeynep Cakir
April-June 2014, 17(2):243-243
DOI:10.4103/0972-2327.132667  PMID:25024590
  - 1,086 52
Experiences and the use of BNP POCT platform on suspected stroke patients by a Chinese emergency department
Guo Qihong, Wu Zhixin, He Mingfeng, Yang Lianhong, Xu Wenchong
April-June 2014, 17(2):243-244
DOI:10.4103/0972-2327.132670  PMID:25024591
  - 1,113 35
ORIGINAL ARTICLES
Limbic encephalitis: Clinical spectrum and long-term outcome from a developing country perspective
Sujit Abajirao Jagtap, Gopal Krishna Das, Harsha J. Kambale, Ashalatha Radhakrishnan, M.D. Nair
April-June 2014, 17(2):161-165
DOI:10.4103/0972-2327.132615  PMID:25024565
Introduction: Limbic encephalitis (LE) is characterized by rapidly progressive short-term memory loss, psychiatric symptoms and seizures. We describe the clinical spectrum, underlying etiology and long-term follow-up of patients with LE from India. Materials and Methods: This prospective study included patients during the period of January 2009 and December 2011 with the clinical features consistent with LE with one or more of the following: (1) Magnetic resonance imaging (MRI) evidence of temporal lobe involvement; (2) cerebrospinal fluid inflammatory abnormalities, or (3) detection of antineuronal antibodies. Patients with metastasis, infection, metabolic and nutritional deficits, stroke, were excluded. Results: There were 16 patients (9 females), mean age of presentation was 36.6 years (range 15-69 years). The mean duration of symptoms before presentation was 11 months (range 5 days-2 years). The most common symptom at presentation was short-term memory impairment in 7 patients followed by seizures in 5 and behavioral changes in three. Nine patients had seizures, 11 had change in behavior, language involvement in eight, cerebellar features in 3 and autonomic dysfunction in two. Four patients had associated malignancy, 3 of four presented with neurological symptoms and on investigations found to be have malignancy. Antineuronal antibody testing was done in 6 of 12 non paraneoplastic and two paraneoplastic patients, one positive for N-methyl-D-aspartate and one for anti-Hu antibody. MRI brain showed typical fluid attenuated inversion recovery or T2 bilateral temporal lobe hyperintensities in 50% of patients. At a mean follow-up of 21 months (3-36 months), 10 patients improved, 4 patients remained same and two patients expired. Conclusion: Early recognition of LE is important based upon clinical, MRI data in the absence of antineuronal surface antibody screen in developing nations. Early institution of immunotherapy will help in improvement in outcome of these patients in long-term.
  - 7,221 268
Progressive limbic encephalopathy: Problems and prospects
Sadanandavalli Retnaswami Chandra, Roopa Seshadri, Yasha Chikabasaviah, Thomas Gregor Issac
April-June 2014, 17(2):166-170
DOI:10.4103/0972-2327.132616  PMID:25024566
Background: It was observed that a good number of patients presenting with psychiatric manifestations when investigated later because of unresponsiveness to treatment or late development of organic features turned out to be treatable limbic syndromes. Introduction: The aim of this study is to assess the patients presenting with new onset neuropsychiatric symptoms satisfying the criteria for probable limbic encephalitis. Patients and Methods: Patients referred to neurology department following a period of treatment for neuropsychiatric symptoms, which did not respond to conventional treatment were analyzed using Electroencephalography (EEG), magnetic resonance imaging, cerebrospinal fluid, screening for malignancy Vasculitic work-up, histopathology and autoantibody done when feasible. Results: There were 22 patients satisfying criteria for probable limbic encephalitis. Their mean age was 34.5 years. Symptoms varied from unexplained anxiety, panic and depression, lack of inhibition, wandering, incontinence, myoclonus, seizures and stroke like episodes. Three had systemic malignancy, 10 had chronic infection, one each with vasculitis, acute disseminated encephalomyelitis, Hashimoto encephalitis and two each with non-convulsive status, cryptogenic and Idiopathic inflammation. Conclusion: All patients who present with new onset neuropsychiatric symptoms need to be evaluated for sub-acute infections, inflammation, autoimmune limbic encephalitis and paraneoplastic syndrome. A repeated 20 minute EEG is a very effective screening tool to detect organicity.
  - 2,534 131
Cerebrospinal fluid cytokines and matrix metalloproteinases in human immunodeficiency seropositive and seronegative patients of tuberculous meningitis
Dheeraj Rai, Ravindra Kumar Garg, Abbas Ali Mahdi, Amita Jain, Rajesh Verma, Anil Kumar Tripathi, Maneesh Kumar Singh, Hardeep Singh Malhotra, Gyan Prakash Singh, Mohammad Kaleem Ahmad
April-June 2014, 17(2):171-178
DOI:10.4103/0972-2327.132617  PMID:25024567
Background: Some important clinical differences exist between human immunodeficiency virus (HIV)-seropositive and HIV-seronegative patients. Alterations in the cerebrospinal fluid (CSF) cytokines and matrix metalloproteinase have been noted in tuberculous meningitis. In HIV-infected patients, the immunopathogenesis is expected to be different. Materials and Methods: In this study, 64 patients of tuberculous meningitis (28 HIV seropositive and 36 seronegative) were included. The patients were followed up for six months. Cerebrospinal fluid (CSF) samples of tuberculous meningitis patients and 20 controls were subjected to tissue necrosis factor (TNF)-α, interleukin (IL)-1β, interferon (IFN)-γ, IL-10, matrix metalloproteinase (MMP)-2, and MMP-9 estimations. The levels were correlated with the patients' baseline clinical characteristics, CSF parameters, neuroimaging findings, and the outcome. The outcome was assessed and modified with the Barthel index. Results: The CSF cytokines and MMP levels were significantly elevated in tuberculous meningitis when compared with the controls. There was no significant difference seen between HIV seropositive and seronegative tuberculous meningitis, except for the IL-1β level, which was significantly lower in the HIV-infected patients. The cytokine and MMP levels did not correlate with the baseline clinical characteristics, disease severity, cerebrospinal fluid characteristics, neuroimaging findings, and outcome. Conclusion: In conclusion, HIV infection did not affect a majority of the CSF cytokines and MMP levels in tuberculous meningitis except for IL-1β level. None of the estimated inflammatory parameters correlated with the outcome.
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The sensitivity comparison of bar electrode and disposable ring electrode for recording of lateral femoral cutaneous nerve
Ahmet Z. Burakgazi, Mary Russo, Perry K. Richardson
April-June 2014, 17(2):179-181
DOI:10.4103/0972-2327.132621  PMID:25024568
Objectives: To compare the sensitivity of bar electrode and disposable ring electrode for recording of lateral femoral cutaneous (LFCN) Materials and Methods: A total of 23 subjects (13 females, 10 males, mean age: 49.6 ± 9.6 (range: 29-63) were recruited in the study. A total of 36 recordings were obtained with each electrode (with bar and disposable ring electrodes) from the subjects. The comparison of data was performed with percentages and student T-table test. Results: The response rate was 98% (35 out of 36 recordings) with bar electrode and 88% (32 out of 36 recordings) with disposable ring electrode. Although the sensitivity rate of bar electrode is slightly higher than of disposable ring electrode, there were no statistically significant differences in detecting the onset latency, peak latency, and amplitude of LFCN. Conclusion: The recording sensitivity of LFCN is higher with bar electrode than disposable ring electrode. However, disposable ring electrode can be used alternatively.
  - 2,618 55
An institutional experience of 26 patients with Moyamoya disease: A study from Northwest India
Trilochan Srivastava, Raghavendra Bakki Sannegowda, R. S Mittal, R. S Jain, Shankar Tejwani, Rahul Jain
April-June 2014, 17(2):182-186
DOI:10.4103/0972-2327.132623  PMID:25024569
Aim: Moyamoya disease (MMD) is a slowly progressive bilateral stenocclusive process of the distal internal carotid and proximal portions of the anterior and middle cerebral arteries and the formation of an abnormal vascular network at the base of the brain. The purpose of this retrospective study was to identify clinical features, salient features, radiological features and yield of diagnostic cerebral angiography in MMD. Materials and Methods: We analyzed the records of 26 patients with MMD evaluated and treated at our institute from August 2010 until March 2013. Diagnosis of MMD was made on the basis of features of angiographic findings. Cerebral angiography showed typically fine network of vessels at the base of the brain with puff of smoke appearance suggestive of MMD. CT angiography (CTA) was done in 25 (96.15%) patients where as Digital substraction angiography (DSA) was done in 18 (69.23%) patients. Results: Out of the 26 patients 13 were in the pediatric age group and 13 were adults. At presentation 14 patients had infarcts and 10 patients had hemorrhages. Among the hemorrhagic group 20% had isolated intracerebral hemorrhage (ICH), 50% patients had ICH with intraventricular extension (IVE) and 30% patients had primary intraventricular hemorrhage (PIVH). 50 % of the patients had involvement of the posterior circulation. Conclusion: Posterior circulation involvement is frequent in MMD. Though parenchymal bleed with/without intraventricular extension is the usual presentation of hemorrhagic MMD, isolated intraventricular hemorrhage could also be the mode of presentation.
  - 2,469 113
SHORT COMMUNICATION
Intact thumb reflex in areflexic Guillain Barré syndrome: A novel phenomenon
Karkal Ravishankar Naik, Aralikatte Onkarappa Saroja, Manik Mahajan
April-June 2014, 17(2):199-201
DOI:10.4103/0972-2327.132628  PMID:25024572
Introduction: Areflexia is one of the cardinal clinical features for the diagnosis of Guillain Barré syndrome. However, some patients may have sluggish proximal muscle stretch reflexes. Presence of thumb reflex, a distal stretch muscle reflex has not been documented in Guillain Barré syndrome. Materials and Methods: We prospectively evaluated thumb reflex in Guillain Barré syndrome patients and age matched controls from April to September 2013. Results: There were 31 patients with Guillain Barrι syndrome in whom thumb reflex could be elicited in all (24 brisk, 7 sluggish), whereas all the other muscle stretch reflexes were absent in 29 patients at presentation and the remaining two had sluggish biceps and quadriceps reflexes (P = 0.001). Serial examination revealed gradual diminution of the thumb reflex (P < 0.001). Rapid progression of weakness was associated with early loss of the thumb reflex. Conclusion: Thumb reflex, a distal stretch reflex is preserved in the early phase of Guillain Barré syndrome.
  - 1,719 115
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