Comparing Intraocular Pressure, Ocular Blood Flow, and Retinal Nerve Fiber Layer Thickness in Early and Chronic Hypertensives With Normotensives.

PURPOSE: To compare blood pressure (BP), intraocular pressure (IOP), ophthalmic artery flow (OAF) velocity, retinal nerve fiber layer (RNFL) thickness, and visual fields in newly diagnosed hypertension (HT) patients (before treatment), chronic HT (on antihypertensive medications >5 years) and normotensives. METHODS: A prospective, cross-sectional study at a tertiary care centre in India. Three groups of 45 patients each: group 1 - early HT, group 2 - chronic HT, and Group 3 - normotensives, underwent evaluation of BP, IOP by Goldmann applanation tonometry (GAT), OAF velocity by transcranial doppler (TCD), RNFL analysis by spectral-domain optical coherence tomography (SD-OCT), and visual fields. RESULTS: The BP was highest in early HT > chronic HT > normotensives (p < 0.001). The IOP of early HT, chronic HT, and normotensives were 15.87 ± 2.19 mmHg, 13.47 ± 1.92 mmHg, and 15.67 ± SD 1.75 mmHg (p < 0.001). The OAF velocity [peak systolic velocity (PSV), end-diastolic velocity (EDV) in cm/sec] was lowest in chronic HT (30.80 ± 7.05, 8.58 ± 1.58) < early HT (35.47 ± 5.34, 10.02 ± 1.74) < normotensives (36.29 ± 4.43, 10.44 ± 2.29), (p < 0.001). The average RNFL thickness was significantly lower in chronic HT (p = 0.022). The PSV, EDV, and MFV showed significant correlation with IOP (r = 0.247, p = 0.004; r = 0.206, p = 0.016; r = 0.266, p = 0.002) and average RNFL thickness (r = 0.309, p= <0.001; r = 0.277, p = 0.001; r = 0.341, p < 0.001). CONCLUSIONS: Patients with chronic HT demonstrated the lowest retrobulbar flows, IOP and lower RNFL measurements. Lower ocular perfusion may be associated with lower IOP and may be a risk factor for end-organ damage (RNFL) independent of IOP.

The Administration of Levodopa in a Patient With Parkinson's Disease Using a Novel Maxillofacial Route: A First-in-Human Report.

Parkinson's disease is characterized by the loss of nigrostriatal dopaminergic neurons in the brain. Dopamine cannot be administered systemically because it does not cross the blood-brain barrier. Oral levodopa remains the gold standard to date. Currently, for patients who show a poor response to oral levodopa and for those who cannot take it orally, the alternate routes available are inhalation and continuous administration via intestinal and subcutaneous routes. In this report, a novel maxillofacial route was used for the first time in the world to administer levodopa to a Parkinson's patient. Furthermore, the efficacy of maxillofacial administration was compared with the oral route of administration.

Effectiveness of Wii sports- based strategy training in reducing risk of falling, falls and improving quality of life in adults with idiopathic Parkinson's disease- a randomized comparative trial.

OBJECTIVE: To assess the effectiveness of Wii sports-based strategy training on risk of falling, falls and quality of life in adults with idiopathic Parkinson's disease. DESIGN: Single blind, Randomised comparative trial. SETTING: Hospital and home. SUBJECTS: Diagnosed as idiopathic Parkinson's disease, Hoehn-Yahr stage 2.5 to 4, history of at least 3 falls in the last 3 months. INTERVENTION: Experimental group participated in 30-40 min of Wii training, 3 session/week for 12 weeks and control group participated for the same duration in traditional balance training. During each session both the group received 30 min of conventional physiotherapy. OUTCOMES: Number of fallers, Fall rate, Berg balance scale, Timed up and go test, Parkinson's disease questionnaire 39, at baseline, 12th and 36th week after baseline. RESULTS: We randomised 192 participants. Participant's characteristics were similar between Wii and control group at base line, in age 69.7 ± 10, 68.5 ± 9.8, disease severity 3.43 ± 0.56, 3.42 ± 0.59, and fall rate 10.47 ± 15.78, 11.80 ± 18.95 (in mean ± SD). At 12th week 28%(27), 51%(49) & 36th week 45%(42), 60%(57) in Wii-group, control group fell at least once, respectively. Wii group improved more than control group at 12th, 36th week in number of fallers (-23%, p < 0.001) (-15%, p < 0.039), fall rates -2.635(-5.38 to 0.112), -1.476(-5.09 to 2.142) (difference in mean, Confidence Interval) and bodily discomfort component of PDQ 39. CONCLUSION: A 12 weeks exercise training using the Wii sports-based strategy decreases the number of fallers, fall rate, measures of risk of falling but did not alter the quality of life in adults with idiopathic Parkinson's disease.

Effect of Blood Pressure Reduction on Intraocular Pressure and Ophthalmic Artery Blood Flow Velocity in Hypertension.

Purpose: To evaluate the effect of reducing blood pressure (BP) by atenolol and amlodipine on (1) intraocular pressure (IOP) and (2) ophthalmic artery blood flow (OAF) velocity in new hypertensives. Methods: A prospective, observational cohort study conducted at a tertiary care center in India after IRB approval. New hypertensives treated with atenolol 25 mg or amlodipine 5 mg were divided into 2 groups of 30 patients each. BP, IOP by Goldmann applanation tonometry and OAF velocity by transcranial doppler sonography was performed before medication and post medication on day 1, 7, and 30. Results: There was a significant decrease in IOP with both drugs; the effect was greater with atenolol. Atenolol: premedication IOP - 16.06 ± 2.13 mmHg and day 30-12.46 ± 1.94 (22.4%) [P < 0.001], amlodipine: premedication IOP-15.13 ± 2.55 mmHg and day 30- 13.06 ± 2.14 (13.68%) [P < 0.001]. A decrease of 0.5 mmHg in IOP with every 10 mmHg (95% CI: 0.121-0.826, P value = 0.01) decrease in systolic BP was noted after oral atenolol. The OAF peak systolic velocity and mean flow velocity were equally reduced with both drugs (P < 0.001). The end-diastolic velocity, reduced only with atenolol (P = 0.049) but returned to baseline with amlodipine at 1 month. Conclusions: BP reduction by atenolol and amlodipine led to decreases in IOP and OAF velocity, greater with atenolol. The IOP decrease was likely due to reduced blood flow. A slight decrease in the diastolic flow of the ophthalmic artery was noted with atenolol.

Cortical Clefts and Cortical Bumps: A Continuous Spectrum.

Cortical 'clefts' (schizencephaly) and cortical 'bumps' (polymicrogyria) are malformations arising due to defects in postmigrational development of neurons. They are frequently encountered together, with schizencephalic clefts being lined by polymicrogyria. We present the case of an eight-year-old boy who presented with seizures. Imaging revealed closed lip schizencephaly, polymicrogyria and a deep 'incomplete' cleft lined by polymicrogyria not communicating with the lateral ventricle. We speculate that hypoperfusion or ischaemic cortical injury during neuronal development may lead to a spectrum of malformations ranging from polymicrogyria to incomplete cortical clefts to schizencephaly.

A rare case of intramedullary tuberculoma: Complete resolution after medical treatment and role of magnetic resonance imaging in diagnosis and follow-up.

Intramedullary tuberculoma (IMT) is a rare form of spinal tuberculosis. IMT has an incidence of 2 cases per 2000 cases of central nervous system tuberculosis. Magnetic resonance imaging (MRI) can be helpful for diagnosing IMT at an early stage and it is also very useful in follow-up. Three stages of IMT have been described in MRI based on the evolution of the lesion. Medical therapy is the mainstay of treatment for IMT though there are surgical options for select patients. Here, we describe a patient with dorsal IMT who improved clinically as well as radiologically with antituberculous treatment and steroids.

Temporal and pontine involvement in a case of herpes simplex encephalitis, presenting as kluver bucy syndrome - a case report.

Bilateral temporal and frontal lobe involvement is a common characteristic of herpes simplex encephalitis (HSE). Clinical sequelae of herpes simplex encephalitis may manifest sometimes as Kluver Bucy syndrome (KBS). In herpes simplex encephalitis, apart from frontal lobe, extra temporal involvement is rare and uncommon. We report a case of HSE manifesting clinically as KBS with a rare radiological finding of temporal and extratemporal involvement of pons.