Design and Analysis of an SPR Sensor Based on Antimonene and Platinum for the Detection of Formalin.

Detection of formalin to prevent food adulteration, especially in tropical countries, is of primary concern for public health issues. Life-threatening diseases such as leukaemia and lymphoma occur due to the regular consumption of formalin with food. Traditionally, spectrophotometry and chromatography-based sensors have been employed to detect formalin, which have limitations related to their ability to achieve high sensitivity, selectivity, and fast response. In this paper, a surface plasmon resonance (SPR) sensor for improved sensing of formalin is proposed. The Kretschmann configured SPR sensor probe is designed using silver (Ag), platinum (Pt), antimonene, and chitosan, which increases the sensitivity and selectivity. The maximum sensitivity achieved for the proposed SPR sensor is 206.86 °/RIU. The distribution of the electric field (Ey) component of the electric field is also evaluated to analyze the field enhancement at different layer interfaces and to calculate the penetration depth (176.75 nm).

Giant malignant peripheral nerve sheath tumor with cauda equina syndrome and subarachnoid hemorrhage: Complications in a case of type 1 neurofibromatosis.

Type 1 neurofibromatosis (NF1), which mainly involves ectodermal tissue arising from the neural crest, can increase the risk of developing malignant peripheral nerve sheath tumors (MPNSTs), soft tissue sarcomas and subarachnoid hemorrhage. We describe a patient with neurofibromatosis type 1 who developed soft tissue sarcoma, MPNST, and subarachnoid hemorrhage. A 22-year-old male reported right focal seizures consequence to severe headache. He had a weakness in both legs, could walk only with the support of a stick for the last 3 months and suffered from constipation and intermittent urinary retention for the past 1 week. The patient had a history of swelling in the back of left thigh for which surgical resection was done 6 months back. Cutaneous examination revealed multiple nodules of varying sizes all over the body, along with many café-au-lait spots and Lisch nodule in iris. Patient had weakness in bilateral hip abduction, extension, knee flexion, extension and ankle dorsiflexion and plantiflexion. Bilateral ankle reflexes were absent while other deep tendon reflexes were sub-optimal. A noncontrast computed tomography brain indicated subarachnoid hemorrhage in left perisylvian region. Ultrasound of left thigh showed a hypoechoic solid lesion in the posterior aspect of left thigh in muscle plane. Histopathology of the lesion following resection showed features suggestive of a low-grade pleomorphic rhabdomyosarcoma. Histology of cutaneous nodules was consistent with neurofibroma. Magnetic resonance imaging of the lumbosacral spine demonstrated a tumor arising from cauda equina. Histopathological examination of the tumor suggested high-grade MPNST. Unfortunately, the patient's MPNST was inoperable, and he received palliative radiotherapy for local control of the disease. The care of a patient with neurofibromatosis requires a comprehensive multisystem evaluation. MPNST occurs in 8-13% patients with neurofibromatosis. Early diagnosis and surgical resection are key to prolong survival. Though rare, rhabdomyosarcoma can occur with a higher frequency in NF1, necessitating through clinical investigation. Subarachnoid hemorrhage can occur due to aneurismal rupture or vascular friability in NF1 patients.

Evaluation of cerebral white-matter micro-structural alterations in patients with medically refractory epilepsy using diffusion tensor tractography.

INTRODUCTION: Diffusion tensor tractography (DTT) is a newer magnetic resonance imaging (MRI) technique that helps in evaluation of white matter. Presurgical planning with tractography may be valuable for evaluation of white matter tracts and their relationship with epileptogenic focus and for evaluation of cortical fibres around the epileptogenic zone. METHODS: This study was carried out on 33 patients diagnosed with medically refractory epilepsy (males, 27; females, 6) with a mean age of 31.93 (range: 19-50) years. Twenty age and sex matched controls were also included. DTT evaluation was done using a 3.0 TexlaMRI scanner. Single-shot spin-echo echo-planar imaging (with 32-different diffusion gradient directions) was acquired for reconstruction of the white matter tracts. Diffusion metrics within fibre bundles that were reconstructed by a continuous fibre-track algorithm were compared between groups. RESULTS: Patients had either partial seizures (21 patients; simple partial, complex partial or secondarily generalized seizure) or generalized seizures (12 patients; tonic clonic, tonic or myoclonic). Out of the 33 patients, 23 patients were classified into the lesional group and the rest into the non-lesional group. The lesions observed on conventional MRI included focal gliosis, hippocampal sclerosis, post-hypoxic encephalopathy, calcification and post-traumatic cavitation, in various parts of the brain. Significant differences were observed in terms of fractional anisotropy and mean diffusivity values amongst controls and patients, as well as on the lesional and non-lesional side of the brain; patients with a normal conventional imaging showed fractional anisotropy and mean diffusivity changes as well. CONCLUSION: We conclude that widespread diffusion abnormalities occur in the white matter tracts on the side of lesion as well as distant from the epileptic focus.

Seizure recurrence in patients with solitary cystic granuloma or single parenchymal cerebral calcification: a comparative evaluation.

BACKGROUND: Solitary cysticercus granuloma and single parenchymal calcified lesion are two common neuroimaging abnormalities in Indian patients with epilepsy. In this study, we evaluated the frequency and predictors of seizure recurrence in patients presenting with new onset epilepsy or single epileptic seizures and these two different imaging findings. MATERIALS AND METHODS: We enrolled 115 patients with newly diagnosed epilepsy. All patients were clinically evaluated and were treated with oxcarbazepine. No anti-helminthic treatment was prescribed. The patients were followed up for 6 months. In the solitary cystic granuloma group, repeat computed tomography was done after 6 months. RESULTS: The study included 80 patients with solitary cysticercus granuloma and 35 patients with a single calcified lesion. Twenty (25%) patients with solitary cysticercus granuloma and 12 (34.3%) patients with parenchymal calcified lesion had a seizure recurrence during the study period (p = 0.307). After 6 months, 57 (71.3%) patients in the solitary cysticercus granuloma group demonstrated complete resolution of the granuloma and in 21 (26.2%) patients the granuloma transformed into a calcified lesion. In the solitary cysticercus granuloma group, a family history of seizure, serial seizures and calcification on follow-up neuroimaging (p < 0.05) were significantly associated with recurrence of seizures. In patients with a single parenchymal calcified lesions, electroencephalographic abnormalities and serial seizures (p = < 0.05) were significant predictors of recurrence. Kaplan-Meier statistics revealed that the seizure recurrence rate was insignificantly higher in patients with calcified lesions than in patients with solitary cysticercosis granulomas. CONCLUSION: In conclusion, in patients with solitary cysticercus granuloma, a family history of seizures, serial seizures and calcification of the granuloma, and in patients with a calcified brain lesion, electroencephalographic abnormalities, family history of epilepsy and serial seizures were associated with an increased risk of seizure recurrence.

Bladder dysfunction and urodynamic study in tuberculous meningitis.

BACKGROUND: Micturitional disturbances in tuberculous meningitis have been reported infrequently and that too without urodynamic studies. Bladder dysfunction in tuberculous meningitis is often considered secondary to tuberculous radiculomyelopathy. We, in this study, evaluated the incidence and pattern of bladder dysfunction in tuberculous meningitis. MATERIALS AND METHOD: In this prospective study, 51 patients were included. In addition to clinical evaluation, patients were subjected to a urodynamic study along with magnetic resonance imaging (MRI) of brain and spine. Patients were followed up for 6 months. A follow-up urodynamic study was performed after 6 months. RESULTS: Out of 51 patients, urinary symptoms were present in one-third of the patients. Approximately, 70% (36) of the patients had urodynamic abnormalities. The commonest (22/51) urodynamic abnormality was detrusor hyporeflexia/areflexia. Other urodynamic abnormalities were neurogenic detrusor overactivity in 10, detrusor sphincter dyssynergia in 6, normal detrusor activity in 19, reduced bladder sensation in 12, raised cystometric capacity in 9, and larger volumes of post-void residual urine in 12 patients. Six patients were unable to void on command. Three patients with neurogenic detrusor overactivity had leak during study. MRI showed spinal meningeal enhancement in 37, lumbosacral arachnoiditis in 25, myelitis in 12 patients, CSF loculations in 6, and cord atrophy in 5 patients. Spinal arachnoiditis and urinary symptoms showed significant association with urodynamic abnormalities. Follow-up urodynamic study showed resolution of urodynamic abnormalities in 72.6% of the patients with treatment. Seven (28%) patients, with normal baseline urodynamic findings, paradoxically developed new abnormalities. CONCLUSION: Bladder dysfunctions, in tuberculous meningitis, are frequently encountered. A significant association exists between urodynamic abnormalities and tuberculous lumbosacral arachnoiditis and myeloradiculopathy.

Intracranial venous sinus thrombosis mimicking Lhermitte Duclos disease.

A middle-aged man presented with 1-month history of headache, dizziness, staggering of gait and progressive deafness. Examination revealed decreased visual acuity, papilloedema, gaze evoked nystagmus, bilateral sensorineural deafness and gait ataxia. MRI showed TI iso and T2 hyperintensity of cerebellum, prominence of folia with gyral enhancement in a tigroid pattern making impression of the rare entity, Lhermitte Duclos disease (LDD) or dysplastic gangliocytoma of cerebellum. Conservative management for the raised intra cranial pressure did not have any impact on patient's general condition for which an MR venogram was planned and it surprisingly showed non-visualisation of left transverse sinus and internal jugular vein, suggestive of thrombosis. Patient was treated with anticoagulants but he succumbed to his illness soon after. We present this case to convey that a high index of suspicion should always be there in mind for this commoner condition (venous sinus thrombosis) before diagnosing the rarer ones (here LDD disease) to prevent the disastrous consequences of the former.

Abnormal head movement in a patient with tuberculous meningitis.

The bobble-head doll syndrome is characterised by abnormal head movements. These head movements are usually 'yes-yes' (up and down) type; rarely, head movements are 'no-no' (side-to-side) type. Commonly described causes of the bobble-head doll syndrome include third ventricular tumours, suprasellar arachnoid cysts, aqueductal stenosis and other lesions in the region of the third ventricle of the brain. We report a case of tuberculous meningitis with hydrocephalus; in this patient bobble-head doll syndrome developed following external ventricular drainage. In our patient, placement of intraventricular drain led to massive dilatation of the frontal horn of the left lateral ventricle because of blocked foramina of Monro on the left side. The bobble-head doll syndrome, presumably, developed because of the pressure effect of the dilated third ventricle on the dorsomedial nucleus of the thalamus, red nucleus and dentatorubrothalamic pathways. We think that distortion of the third ventricle was responsible for the impairment of the functions of all these structures.

Bilateral ptosis: an atypical presentation of neurocysticercosis.

Isolated ptosis is a rare presentation of neurocysticercosis (NCC). Here we report the case of a 45-year-old woman who presented with acute onset bilateral symmetrical ptosis with no other neurological deficit. Her imaging revealed a single cystic ring-enhancing lesion with perilesional oedema in the midbrain suggestive of NCC. She responded well to prednisolone.

Three-day versus 15-day course of albendazole therapy in solitary cysticercus granuloma: an open label randomized trial.

BACKGROUND: Albendazole therapy has been found effective in solitary cysticercus granuloma. An optimal duration of albendazole therapy is not exactly known. Even 3-day therapy has been found effective. METHODS: We included 105 patients of new-onset seizures and solitary cysticercus granuloma. We compared 3-day albendazole therapy and 15-day therapy with a control group. Each group had 35 patients. This was an open-label randomized trial. Patients were followed for 6 months. MRI was done after 6 months. Seizure recurrences during follow-up were noted. RESULTS: After 6 months, albendazole group, in comparison to placebo group, had significantly higher proportion (43/70 versus 13/35) of patients in whom lesion had disappeared. Albendazole treatment for 15 days was insignificantly better in comparison to 3-day treatment regimen. In 15-day albendazole group lesser number of lesions (2.8%) was calcified than 3-day albendazole group (8.57%) or no treatment group (20%). After 6 months of follow-up, seizure recurrence was seen in 20 (19%) patients. The majority (15/20) of patients, experiencing seizure recurrence, had an abnormal follow-up MRI. Five patients had seizures despite normal MRI. CONCLUSION: In conclusion, albendazole was significantly better in producing lesion resolution. A 15-day treatment with albendazole was better than 3-day treatment. Albendazole, possibly, led to less number of lesions got calcified and possibly, there was less risk of seizure recurrence.

Neurological complications of dengue fever: Experience from a tertiary center of north India.

INTRODUCTION: Dengue, an acute viral disease transmitted by Aedes mosquitoes, is highly endemic in many tropical and subtropical areas of the world. Neurological complications of dengue infection have been observed more frequently in the recent past and some studies highlighted varied neurological complications arising in the course of dengue illness. In this retrospective study, we report various neurological complications observed during the last 2 years in patients of dengue fever. MATERIALS AND METHODS: The patients presenting with neurological complications with positive serology (IgM antibody) for dengue infection were consecutively recruited from the Department of Neurology/Medicine from a tertiary center of Lucknow, India. These patients were subjected to a detailed clinical evaluation, laboratory assessment including blood count, hematocrit, coagulation parameters, biochemical assays, serology for dengue fever, enzyme-linked immunosorbent assay for human immunodeficiency virus and other relevant investigations. RESULTS: Twenty-six patients with neurological complications associated with confirmed dengue infection were observed during the last 2 years. Eighteen of these patients were male. Of the 26 patients, 10 patients were suffering from brachial neuritis, four patients had encephalopathy, three patients were consistent with the diagnosis of Guillain Barre syndrome, three patients had hypokalemic paralysis associated with dengue fever and two patients had acute viral myositis. Opsoclonus-myoclonus syndrome was diagnosed in two patients, myelitis in one patient and acute disseminated encephalo-myelitis also in one patient. CONCLUSION: Dengue fever was associated with widespread neurological complications. Brachial neuritis and opsoclonus-myoclonus syndrome were observed for the first time in this study.

Risk of seizure recurrence in patients of new-onset partial seizure having a solitary cysticercus granuloma of brain or normal neuroimaging.

BACKGROUND: Solitary cysticercus granuloma - a benign form of parenchymal neurocysticercosis - is considered as the most common cause of partial seizures. This study comparatively evaluated the seizure-related prognosis in patients with new-onset seizure having solitary cysticercus granuloma and in patients with normal neuroimaging. We also assessed the factors of seizure recurrence. MATERIAL AND METHOD: Seventy-four patients of new-onset partial seizure with solitary cysticercus granuloma and 45 patients of new-onset partial seizure with normal neuroimaging were followed up for 6 months. A follow-up neuroimaging was carried out after 3 months. RESULT: Thirteen patients (17.6%) in solitary cysticercus granuloma group and 15 patients (33.3%) in normal neuroimaging group had seizure recurrences (P = 0.049). In solitary cysticercus granuloma group, family history of seizure disorder (P = 0.004), headache (P = 0.029), and serial seizures (at onset) (P = 0.001) were significantly associated with the seizure recurrence. Granuloma remained unresolved in all patients. In patients with normal neuroimaging, abnormal EEG (P = 0.043), at inclusion, was only a significant factor of the seizure recurrence. CONCLUSION: The patients with solitary cysticercus granuloma had favorable seizure-related prognosis when compared with patients having normal neuroimaging. Serial seizures and headache predicted seizure recurrence in patients with solitary cysticercus granuloma. The presence of electroencephalographic abnormality predicted seizure recurrence in patients with normal neuroimaging.

Three day albendazole therapy in patients with a solitary cysticercus granuloma: a randomized double blind placebo controlled study.

A solitary cysticercus granuloma is a benign form of neurocysticercosis. Several reports have suggested albendazole is effective in early resolution of these lesions. A short duration (7 days) albendazole therapy has been found to be effective in treatment. In this study, we evaluated a "three day course" of albendazole in a prospective randomized double- blind trial. Sixty-seven consecutive patients who presented with new-onset seizures and a solitary cysticercus granuloma were randomly allocated to receive either albendazole (15 mg/kg/day for 3 days) or placebo. All patients were treated with antiepileptic drugs. Patients were followed up for 6 months. A repeat CT of the brain was obtained at the end of 6 months of follow-up. The end points were complete resolution of the lesion on CT scan and total seizure control at 6 months follow-up. In the albendazole group complete resolution of lesions was noted in 28 of 33 patients (84.8%), while in the control group only 14 of 34 patients (41.2%) had complete resolution of the lesion (p = 0.001). Partial resolution of lesion was seen in 2 patients (6%) in the albendazole group and 4 patients (11.8%) in the control group (p = 0.06). The lesion remained unchanged in 9 cases (26.5%) in the control group only. The lesion became calcified in 7 (20.6%) and 3 (9.1%) patients in the control and albendazole groups, respectively (p = 0.187). Seizure recurrence occurred in 3 patients (9.1%) in the albendazole and 1 patient (2.9%) in the control group (p = 0.239). The three days course of albendazole was effective in resolving lesions, but there was no significant difference in seizure recurrence rates between the two treatment groups.

Neurological complications of miliary tuberculosis.

INTRODUCTION: The symptomatic central nervous system involvement is often seen in patients with miliary tuberculosis. MATERIALS AND METHODS: In this study, we evaluated 60 consecutive miliary tuberculosis patients, who presented with some neurological manifestations. Evaluation included neurological examination, a battery of blood tests, HIV serology, sputum examination, cerebrospinal fluid (CSF) examination along with imaging of the brain and spinal cord. The patients were followed up after completion of 6 months of antituberculous treatment. RESULTS: Patients ranged between 14 and 53 years in age. Three patients tested HIV positive. Forty-eight (80%) patients had tuberculous meningitis. In 12 (20%) patients, the CSF examination was normal. In 27 patients with tuberculous meningitis, neuroimaging revealed intracerebral tuberculoma. Fourteen patients showed multiple tuberculomas, while 7 had a solitary tuberculoma. In six patients, the tuberculomas were small and numerous. In two patients, neuroimaging revealed a spinal tuberculoma. For three patients with tuberculous brain masses, the CSF was normal. Nine (15%) patients presented with myelopathy. Three patients exhibited Pott's paraplegia. Three patients had transverse myelitis (with normal neuroimaging). In three patients, the spinal MRI revealed an intramedullary tuberculoma. On follow-up, 15 (25%) patients expired. Thirty-one (52%) patients showed significant improvement. Eight patients (13%) showed nil or partial recovery. Six of the patients with no improvement developed vision loss. Six (10%) patients were lost to follow up. CONCLUSION: A variety of neurological complications were noted in military tuberculosis patients, tuberculous meningitis and cerebral tuberculomas being the most frequent complications. However, a majority of patients improved following antituberculous treatment.

Prednisolone-responsive headache in patients with solitary cysticercus granuloma and seizures.

BACKGROUND: Solitary cysticercus granuloma is the commonest imaging abnormality in Indian patients with new-onset seizures. Few patients, in addition, complain of disabling headache. OBJECTIVE: To report our experience of 16 patients with new-onset headache, seizures, and solitary cysticercus granuloma. METHODS: Sixteen consecutive patients, who had moderate to severe new-onset headache and fulfilled the diagnostic criteria of solitary cysticercus granuloma, were included in the study. The inclusion criteria were: occurrence of seizures, minimal or no neurologic deficit, absence of papilledema, no evidence of any systemic disorder, and computed tomography showing a single ring/disk-enhancing lesion of <20 mm in diameter. Patients received antiepileptic monotherapy, oral analgesics, and prednisolone (1.5 mg/kg/day for 7 days). Prednisolone was then tapered over the next 7 days. Patients were followed for 6 months. Follow-up computed tomography was performed after 2 months; in all 16 patients, the scans showed complete disappearance of the lesion. RESULTS: After 14 days (at first follow-up), all patients reported significant improvement in headache. Follow-up after 2 months revealed that all patients were headache-free. None of the patients reported any recurrence of headache. CONCLUSION: This open-label study suggests the effectiveness of prednisolone for disabling headache in Indian patients with solitary cysticercus granuloma and seizures. There is a need, however, for more scientifically rigorous studies for further confirmation of our results.