Orthostatic Myoclonic Jerks in a Case of Hashimoto's Encephalopathy.

Hashimoto's encephalopathy (HE) is an uncommon syndrome with the characteristic triad of positive antithyroid antibodies (most commonly antibodies to thyroid peroxidase), response to steroids, and clinical picture presenting either as stroke-like pattern of focal neurological deficit or slowly progressive cognitive impairment. Myoclonus or tremors, seizures, and psychosis are other associated features which can be seen in HE. Herein, we report a girl with an uncommon presentation of orthostatic axial and myoclonic jerks in bilateral lower limbs in a case of HE.

Unilateral Vertical Pendular Nystagmus in Multiple Sclerosis: A Distinctive Neuro-Ophthalmological Sign.

Lesions in multiple sclerosis can involve brain, optic nerve and spinal cord. We here report a patient of multiple sclerosis, who had unilateral vertical pendular nystagmus, because of simultaneous involvement of optic nerve and asymmetric brain stem lesions. This specific combination is rarely seen in other disorders, therefore can be considered as a distinctive neuro-opthalmoloical sign of multiple sclerosis.

Unilateral Parkinsonism: Symptomatic of Brain Tuberculoma.

We present the case of a patient having left-sided Parkinsonism due to multiple brain tuberculoma on the right side and review the reversible causes of secondary parkinsonism.

Role of erythrocyte sedimentation rate in ischemic stroke as an inflammatory marker of carotid atherosclerosis.

BACKGROUND: Inflammation mediates a key role in the pathogenesis of atherosclerosis which is an important cause of ischemic stroke. An elevated erythrocyte sedimentation rate (ESR) may, therefore, be a marker of the extent andor intensity of a general atherosclerotic process and thus a marker for advanced atherosclerosis heralding increased risk of arterial thrombosis leading to ischemic stroke. MATERIALS AND METHODS: ESR was calculated in ischemic stroke patients by Westergren's method along with carotid sonography using high resolution 7.5 MHz techniques to find the prevalence of increased carotid intima-media thickness (CIMT) and presence of plaque according to Mannheim Carotid Intima-Media Thickness Consensus. RESULTS: Average value of ESR in all patients was 27.89 ± 9.73 mm/h. A significant association was found between ESR and markers of carotid atherosclerosis, that is, high CIMT of more than 0.8 mm (P < 0.0001) and presence of plaque (P-0.026) in univariate analysis. Also, a significant positive correlation was found between ESR and serum fibrinogen, another inflammatory marker. (r = 0.88, P < 0.0001). CONCLUSION: The extent of inflammation may reflect in part the propensity of atherosclerotic lesions to lead to clinical disease. Study shows the association of ESR with markers of atherosclerosis confirming the strength of the inflammatory response associated with carotid atherosclerosis and might conceivably carry important prognostic information regarding occurrence of such catastrophic events in future.

Association of carotid plaque echogenicity with recurrence of ischemic stroke.

BACKGROUND: Atherosclerosis is related to various cardiovascular and cerebrovascular events like cerebral infarction. Recurrence of ischemic stroke is specifically related to atherosclerotic load as determined by the presence of carotid atheromatous plaques and its echogenicity. AIM: This study was to evaluate the association of recurrence of stroke with echogenic characteristics of carotid plaque in ischemic stroke patients. MATERIALS AND METHODS: Carotid sonography using high-resolution 7.5 MHz along with gray-scale technique was done in each ischemic stroke patient to find the occurrence of plaque and its echogenicity according to Mannheim Carotid Intima-Media Thickness Consensus (2004-2006). Followup of patient done to know the recurrence of stroke during 6-month duration and its association with plaque echogenicity. RESULTS: A significant association found between the presence of plaque and known cerebrovascular risk factors. Also significant association found between recurrence of stroke and echolucent character of carotid plaque in bivariate analysis (P = 0.0028). CONCLUSIONS: Recurrence of stroke is related to advanced stage of atherosclerosis that is specified by carotid plaque and its characteristics. It will help us to identify groups of patients at different risk for stroke and planning better strategies to prevent such events.

Relation of glycated hemoglobin with carotid atherosclerosis in ischemic stroke patients: An observational study in Indian population.

CONTEXT: Glycated hemoglobin A1c(HbA1c) indicates long-term uncontrolled hyperglycemia in the body, which in diabetic patients leads to various vascular complications as a part of generalized atherosclerosis culminating ultimately into ischemic stroke. AIMS: Study aims to show the association between marker of uncontrolled long-term hyperglycemia HbA1c and marker of atherosclerosis (Carotid intima media thickness [CIMT] and carotid plaque) in ischemic stroke patients. SUBJECTS AND METHODS: Carotid sonography using high resolution 7.5 MHz sonography technique was done in each patient to find the occurrence of increased CIMT and presence of plaque according to Mannheim CIMT Consensus (2004-2006). Levels of HbA1c measured in blood in both diabetic and non-diabetic patients and a comparison made between them. Finally an association sought between HbA1c levels with CIMT and plaque. RESULTS: The average value of HbA1c of this cohort was 7.51 ± 1.75% with higher values in diabetic patients (9.29 ± 1.73%). The patients with high CIMT (>0.8 mm) had higher values of HbA1c then that of normal CIMT patients and this was nearly significantly (P = 0.06). However, HbA1c levels of blood were significantly associated with stroke patients with presence of carotid arteries plaque (P = 0.008). CONCLUSIONS: Prediction of future risk and prevention strategies for ischemic stroke could be formulated by utilizing HbA1c levels in both diabetic and non-diabetic population.

Carotid Intima Media Thickness as a Reflection of Generalized Atherosclerosis is Related to Body Mass Index in Ischemic Stroke Patients.

BACKGROUND: Carotid artery intima media thickness reflects the ongoing process of atherosclerosis in the body. The pathologic process occurring in the obese patients in the vascular system is atherosclerosis which is an important cause of ischemic stroke. Body mass index is an indirect measure of obesity in general population. AIM: The study was to assess the role of carotid artery intima media thickness as a marker of atherosclerosis and its relation with body mass index in ischemic stroke patients. MATERIALS AND METHODS: Body mass index of the all stroke patients was calculated by using formula body mass in kilograms divided by the square of height in meters. The patients were classified in four groups of body mass index according to Indian standards. Carotid sonography was done to assess the common carotid artery intima media thickness in millimeters by using high resolution 7.5 MHz sonography technique. RESULTS: The average Carotid intima media thickness in this study was 9.23mm. There was a significant association found between increasing carotid artery intima media thickness and groups of body mass index (P- <0.05) in ischemic stroke patients. CONCLUSIONS: Body mass index as an indicator of obesity and carotid intima media thickness both are very important risk factors for ischemic stroke and are associated with each other.