Primary angiitis of central nervous system - A challenging diagnosis.

Primary angiitis of the central nervous system is a rare disease characterized by vasculitis of the central nervous system without any systemic involvement. This review aims to provide an insight into the existing stagnancies in the diagnostic approach and management of this disease. The clinical presentation is typically nonspecific, ranging from headaches, altered sensorium, and seizures to recurrent ischemic strokes. The definitive diagnosis can only be ascertained by histopathological studies of tissue obtained from a brain biopsy. While angiography can provide clues to diagnosis, it has often been normal, even in biopsy-proven cases. Primary angiitis of the central nervous system continues to be a diagnostic challenge as little progress has been made over the years in the diagnosis and management strategies. Considering the vast list of mimickers of primary angiitis of the central nervous system and the existence of a significant proportion of imaging-negative and biopsy-negative cases, it becomes imperative to devise universally accepted diagnostic criteria for this disease. Steroids in combination with cyclophosphamide are the agents used to achieve remission. Rituximab can be an alternative. The treatment-related toxicity of cyclophosphamide warrants larger trials for alternative drugs to be studied.

Clinical Spectrum of Movement Disorders in Neurology Inpatients in a Tertiary Care Centre.

Background Little data are available on the spectrum of movement disorders in inpatients, particularly those admitted in neurology specialty. This may be related to the fact that patients presenting with movement disorders are usually evaluated from outpatient clinics. Objective The aim of this study is to provide data on the pattern of movement disorders in neurology inpatients. Materials and Methods Patients admitted through emergency department or neurology clinic with complaints of movement abnormalities were recruited in this study from October 2019 to September 2020. Cases were subjected to proforma-based detailed history, examination, and appropriate investigations. Statistical Analysis Descriptive statistics using SPSS 20. Results and Conclusion Bradykinesia with or without tremor was the most common movement disorder (28.3%), followed by ataxia and dystonia (24.5% each) and hemifacial spasm and myoclonus (7.5% each). Chorea, tic disorder, and hemiballismus were also reported. Etiologies included Parkinson disease, Wilson's disease, subacute sclerosing panencephalitis (SSPE), drugs, stroke, spinocerebellar ataxia, Huntington's disease, neuroacanthocytosis, and others. Dystonia represented the most common disorder in the younger age group (44.4%), whereas bradykinesia and/or tremor represented the most common movement disorder in the older age group (46.4%). This study demonstrates the characteristic distribution of movement disorders in neurology inpatients.

Neuromyelitis optica spectrum disorders.

The disease concept of Neuromyelitis Optica Spectrum Disorders(NMOSD) has undergone a significant change over the last two decades including the detection of Myelin Oligodendrocyte Glycoprotein(MOG) antibody in patients who are seronegative for aquaporin-4 antibody. Aquaporin-4 antibody positive NMOSD is now regarded as an immune astrocytopathy. Conversely, MOG antibody associated disease is known to target myelin rather than astrocytes, leading to an NMOSD syndrome with distinct clinical and radiological features. Incorporation of clinical features like area postrema syndrome, brainstem syndrome, diencephalic syndrome and cortical manifestations as core clinical characteristics into the revised diagnostic criteria has widened the clinical spectrum of NMOSD. With the development of these criteria, it is possible to make the diagnosis at an earlier stage so that effective immunosuppression can be instituted promptly for a better long-term prognosis. Newer therapeutic agents have been introduced for aquaporin-4 seropositive NMOSD disease; however, challenges remain in treating seronegative disease because of limited treatment options.

The effect of citicoline on stroke: A comparative study from the Eastern part of India.

BACKGROUND: Citicoline is a novel neuroprotective agent used in acute stroke with a significantly favorable outcome. MATERIALS AND METHODS: A hundred patients who suffered from either an ischemic and hemorrhagic stroke and who presented to the hospital within 48 h of stroke onset were enrolled for the study. Of these 100 patients (age- and sex-matched), 50 patients were treated with citicoline along with the standard stroke management and considered as 'cases'. The other 50 patients who were administered the standard stroke treatment were considered as 'controls.' The baseline parameters of the patients was assessed using the National Institute of Health Stroke Scale. The patients were reassessed at follow up at the end of the 1st and 3rd month of the commencement of the therapy and their outcome was evaluated by the Barthel Index score (BI). RESULTS: The mean BI scores of all categories at the 1st and 3rd month were significantly higher in the citicoline treatment group (P < 0.001 at the 1st month and P = 0.002 at the 3rd month). An analysis of the categorized BI score showed that there was a significant difference in the number of patients in the categorized BI score (85-100) (at the 1st month follow-up: 0% in control vs. 7% in case group [P < 0.05]; and, at the 3rd month follow-up: 10% in control vs. 36% in citicoline case group [P < 0.05]). In the subgroup analysis, both patients suffering from either ischemic and hemorrhagic stroke (including all categories of BI score) in the citicoline treatment group showed a significantly higher mean BI score at the 1st month (ischemic: P = 0.003, hemorrhagic: P =0.04) and also at the end of the 3rd month (ischemic: P = 0.03, hemorrhagic: P = 0.03). An analysis of the categorized BI score (85-100) at the end of the 3rd month in both the hemorrhagic as well as the ischemic subgroups showed a significant incidence of improvement in the citicoline group compared with the control group (hemorrhagic-- control: 6.66% vs. CASE: 31.81%, P < 0.05 and ischemic-- control: 11.41% vs. CASE: 35.71%, P < 0.05). CONCLUSION: In patients suffering from stroke and presenting within 48 h of onset, treatment with citicholine increases the probability of complete recovery and a favorable outcome at the 1st month and at the end of the 3rd month in all the stroke groups.

A clinical study of ischaemic strokes with micro-albuminuria for risk stratification, short-term predictive value and outcome.

Stroke results more than 4.3 million deaths worldwide per annum and 85% of all strokes are ischaemic in nature. Besides numerous modifiable and non-modifiable known risk factors, microalbuminuria is thought to be an important marker of global endothelial dysfunction and associated with cardiovascular disease including stroke. Fifty ischaemic stroke cases and 50 (age, sex matched) control subjects were subjected to study to compare and evaluate risk stratification of micro-albuminuria, its predictive value and outcome on day 1 and day 7 among admitted ischaemic stroke cases.The result was found that micro-albuminuria was present in 66% of ischaemic stroke cases compared to only 8% of control group (p < 0.001). Most validated National Institute of Health Stroke Scale (NIHSS) score was used for evaluation and calculation of predictive value and outcome of micro-albuminuria positive patient where higher value indicates poor prognosis, and the result was mean NIHSS score 29.12 versus 18.88 between two groups of strokes ie, with and without micro-albuminuria. Out of 50 ischaemic stroke patients 33 (66%) had micro-albuminuria. Among 11 patients who died, 10 (90.9%) had micro-albuminuria and NIHSS score was 33.64 and 25.0 on day 1 and day 7. Among 39 patients who were discharged, 23 patients (58.97%) were MA positive and NIHSS score was much less than death group ie, 23.38 and 16.38 on day 1 and day 7 respectively. So this study reveals micro-albuminuria itself results higher risk for ischaemic stroke compared to control group and it shows good predictive value for early assessment of clinical severity and subsequent fatal outcome. This is also simple, cost effective and affordable.