We studied the clinical, imaging, electrophysiological and laboratory features of 68 patients with multiple sclerosis (MS), diagnosed between 19We studied the clinical, imaging, electrophysiological and laboratory features of 68 patients with multiple sclerosis (MS), diagnosed between 1987 and 1997 in a neurological institute in South India. Multiple sclerosis constituted 008% of the neurological cases seen during this period. The salient findings were female preponderance, predominantly relapsing remitting course, and high frequency of optico-spinal form of presentation. On MRI there was a lower frequency of cerebellar and corpus callosal lesions. Thoracic cord and brainstem in men and cervical cord in women were more often involved.

Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid) and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.

Disconnection can be a pathophysiological mechanism in language disorders. We report three cases where disconnection is postulated as a causative factor for the aphasic syndromes. These are alexia without agraphia, conduction aphasia and aphasia. The pathophysiology is discussed and the :neural network" theory of brain function highlighted.

Spontaneous remission for a substantial period is a rare feature of SSPE. We report a 21 year old boy who was diagnosed to have SSPE at the age of 11 years, based on clinical, CSF and electroencephalographic features. Over a period of one year, he gradually deteriorated to a bedridden state, being dependent for all activities of daily living. He showed a substantial spontaneous remission in clinical and electroencephalographic features and maintained this till 18 years of age. He however slowly deteriorated after prolonged remission over three years. A combination of clinical improvement and disappearance of periodic complexes with normalization of the background activity in the EEG may indicate long-term survival.

Management of acute ischemic stroke has undergone a radical change with the advent of intravenous and intra arterial thrombolysis. We would like to share our experience of the use of combined transcranial doppler and intravenous t-PA in the treatment of acute ischemic stroke; the use of which has so far not been reported in our country. The case also highlights the usefulness of diffusion perfusion imaging techniques in determining the case selection and also the success of thrombolytic treatment.

Background : Mobius syndrome is traditionally know as a non-progressive developmental disorder of cranial nerve nuclei mainly the sixth and the seventh nerves. Recent evidences however suggest that it may have an extended spectrum and a variable course. Objective: To describe various clinical features and pathogenesis of Mobius syndrome. Patients : Clinical profile of three patients with diverse manifestations of Mobius syndrome from a university teaching hospital in South India. Results: The presenting manifestations in the three patients with Mobius syndrome were mono-ocular visual impairment due to ischemic cerebrovascular disease (Patient 1), generalized tonic clonic seizures, delayed speech, bilateral facial, eighth and vagus nerve palsy (Patient 2) and progressive cranial polyneuropathy (Patient 3). Besides disorder of ocular mobility these patients had evidence of multiple morphologic abnormalities viz- polydactyly, high arched palate, clinodactyly, absence of pectoralis major and thoracic scoliosis. CT/MR imaging of the brainstem region were normal. The child with progressive involvement of multiple cranial nerve, and normal imaging of brain particularly posed diagnostic difficulty. Conclusion: Mobius syndrome is perhaps a regional development disorder of the entire brainstem with diverse clinical manifestations, severity and course, depending on the structures involved. Our observation, similar to the other reports, suggest that there is a need to further explore the etiology and pathogenetic link with other morphological abnormalities.