Neuroimaging abnormalities in Indian patients with uncontrolled partial seizures.

In this series we performed clinical and imaging evaluation of 77 consecutive patients with uncontrolled partial seizures. Single cerebral parenchymal calcification (22 patients) was the most common imaging abnormality. Nine patients had multiple punctate calcifications. Other CT abnormalities included persistence of granulomatous lesion (enhancing) or multiple cystic lesions. In nine patients (of 22 patients with a normal CT scan) magnetic resonance imaging (MRI) was done, and two patients were seen to have circumscribed cystic lesions in the temporal lobes. The causes for uncontrolled seizures in India are totally different and revolve around neurocysticercosis, as the parasite sometimes runs a very long course of evolution in the brain. Sequelae of neurocysticercosis in the form of calcification is often a focus of epileptogenicity.

Neurological manifestations of malaria : an update.

Several neurological complications are associated with complicated and severe falciparum malaria. Cerebral malaria is one of the most dreaded complication. The children are particularly more vulnerable to have this complication. Despite availability of several potent antimalarial drugs in recent past, the mortality status has not changed. A large number of survivors are left with disabling neurological sequelae. Few patients may experience post-malaria neurological syndrome after recovery from complicated falciparum infection. Various psychiatric syndromes have been described either as early manifestation of cerebral malaria or part of post malaria neurological syndrome. From Indian subcontinent several patients of delayed cerebellar ataxia have also been described following recovery from clinical malaria. In paediatric patients, convulsions of cerebral malaria need to be differentiated from febrile convulsions. Falciparum malaria is also associated specifically with convulsions in uncomplicated patients of malaria. Several isolated case reports of various other neurological syndromes like peripheral neuropathies, various movement disorders, myelopathies and stroke like syndrome have been described. However association of these neurological manifestations with malaria remains doubtful.

A study of transcranial magnetic stimulation in older (>3 years) patients of malnutrition.

Transcranial magnetic stimulation was performed in 40 subjects. Twenty patients in the age group of 3 to 8 years and having different grades of malnutrition were included in the 'study group' whereas 20 normal children having no complaints comprised the 'control group'. The coil of the magnetic stimulator was applied tangentially over the vertex to stimulate the cortex. The motor evoked potential (MEP) was obtained using root stimulation by applying the coil at the cervical and lumbosacral spines. Recordings were made from the abductor pollicis brevis (APB) and extensor digitorum brevis (EDB) muscles of both sides. Cortical threshold, latency and amplitude of motor evoked potential and central conduction time were recorded. Malnourished children showed significantly increased cortical threshold, prolonged cortical latency and central conduction time and reduction in amplitude of MEP. Observed delay in central motor conduction in malnourished children suggests asymptomatic involvement of corticospinal pathways.

Peripheral nerve damage following lightening injury.

A 20 year old male after being struck by lightening remained quadriplegic for several months and finally almost fully recovered. His weakness was due to extensive peripheral nerve injury (involvement of plexuses, radicles and peripheral nerve trunks) as evident by clinical and neurophysiological studies. He also showed many well known medical complications of lightening injury viz. acute renal failure, hypercalcaemia, autonomic dysfunction and cataract.

Efficacy and tolerability of oral sumatriptan in Indian patients with acute migraine : a multicentre study.

This multicentre, randomized, double-blind, cross over, placebo controlled study evaluated the efficacy and tolerability of oral Sumatriptan (100 mg) in 100 migraineurs. 59 patients completed the study. The results indicate that by 4 hours post-dose62 of patients treated with Sumatriptan achieved relief of headache, compared with 10 of patients treated with placebo. The results show that oral Sumatriptan is an effective drug for treatment of acute migraine in Indian patients, though smaller dosage may be more beneficial.

Neurocysticercosis presenting as midbrain syndrome.

Brainstem is infrequently involved in patients with neurocysticercosis, usually, it occurs in association with disseminated form of neurocysticercosis. We are reporting two cases who had large multiple cysticercus lesions and presented as acute midbrain syndrome. The diagnosis of neurocysticercosis was established by presence of characteristic granulomatous extraaxial lesions around the midbrain, and in cerebral parenchyma, along with strongly positive ELISA for cysticercal antigen in cerebrospinal fluid as well as in serum. Both patients responded well to corticosteroids. However, repeat follow-up CT scan income case did not show significant alteration in the size of the lesion.

Multiple cranial neuropathy: a common diagnostic problem.

Syndrome of multiple cranial palsies is a common clinical problem routinely encountered in neurological practice. Anatomical patterns of cranial nerves involvement help in localizing the lesion. Various infections, malignant neoplasms and autoimmune vasculitis are common disorders leading to various syndromes of multiple cranial nerve palsies. A large number of diffuse neurological disorders (e.g. Gullian-Barre syndrome, myopathies) may also present with syndrome of multiple cranial nerve palsies. Despite extensive biochemical and radiological work-up the accurate diagnosis may not be established. Few such patients represent "idiopathic" variety of multiple cranial nerve involvement and show good response to corticosteroids. Widespread and sequential involvements of cranial nerves frequently suggest possibility of malignant infiltration of meninges, however, confirmation of diagnosis may not be possible before autopsy.

Corticosteroids in tuberculous meningitis.

PIP: Corticosteroid therapy is used widely in the routine management of tuberculous meningitis (TBM). 141 consecutive children with stages 2 and 3 TBM were studied in an investigation of the mechanism of action of high dose prednisone in such subjects. Randomly assigned to either the treatment or control group, 70 subjects received steroids and 71 were in the nonsteroid group. The first 16 patients in the steroid group were given prednisone in a dose of 2 mg/kg/day, while the remaining 54 subjects in the group received it in a dose of 4 mg/kg/day for the first month of treatment. Antituberculous treatment consisted of isoniazid, rifampicin, ethionamide, and pyrazinamide all given for 6 months. Clinical outcome was assessed after completing 6 months of antituberculous treatment. The administration of corticosteroid significantly improved the survival and intellectual outcome of children with TBM. 4 patients in the second group and 13 in the nonsteroid group died before completing 6 months of therapy. No significant difference was noticed between the 2 treatment groups with regard to motor deficit, blindness, or deafness, and the clinical outcome of children receiving high- and low-dose prednisone did not differ significantly. No significant difference in intracranial pressure or the degree of hydrocephalus was noted between the 2 groups after the first month of treatment. Both the response of the tuberculoma to treatment and the incidence of delayed occurrence of tuberculomas were significantly improved after steroid therapy.^ieng