A call for neurologists to take up stroke intervention.

Recent data have provided overwhelming evidence in favor of benefits of emergent endovascular intervention in large vessel acute ischemic stroke (AIS). India with its large population has a huge burden of AIS. Hence, neurologists need to gear up to the new challenge of providing interventional care to huge populations of AIS in the country. The best way to cover this unprecedented unmet need is to encourage neurologists to take up interventional subspecialty interests through new but sound training pathways.

Influence of socioeconomic status on in-hospital mortality and morbidity after stroke in India: retrospective hospital-based cohort study.

OBJECTIVES: To determine an association between socioeconomic status and in-hospital outcome in Indian patients with stroke. MATERIALS AND METHODS: Retrospective hospital-based cohort study. The hospital stroke register was used for this study. The independent variables were demographic job status, education, cardiovascular risk factors, comorbidities and the score on the Glasgow Coma Scale (GCS). The outcome variables were mortality and Barthel's index (BI) score at discharge. RESULTS: Data of 599 consecutive patients comprising 370 men (54.3%) and 229 women (33.6%) was available for analysis. Their mean age was 55.63±15.36 years. Age, diagnosis (ischemic or hemorrhagic), midline shift, smoking and GCS were significantly associated with mortality and BI score (P<0.05). There was a statistically significant association between employment status and BI at discharge (P=0.03) in univariate analysis. In multivariate analysis, joblessness was associated with lower BI at discharge (P=0.02) after adjustment for GCS motor score and stroke subtype. CONCLUSION: Our study shows that in patients with stroke, lower employment status is associated with poor outcome at discharge from the hospital. The association is independent of other prognostic factors.

Surgery for medically intractable epilepsy due to postinfectious etiologies.

Medically intractable epilepsy (MIE) resulting from postinfectious etiologies requiring surgery have been uncommonly reported. A series of 28 cases are presented (hospital prevalence 5.7%). The mean duration of epilepsy prior to surgery was 8.2 +/- 2.1 years. The mean time of onset of epilepsy after central nervous system infection was 1.4 +/- 0.9 years (range 0-19 years). The pathologies included postpyogenic meningitic/encephalitic sequel (8), neurocysticercosis (6), tuberculomas/posttuberculous etiology (4), postpyogenic abscess of otogenic etiology (4), posttraumatic abscess-related gliosis (2), and gliosis of unknown infectious etiology (4) cases. Surgery included mesial temporal (11), lateral temporal (4), frontal (9), parietal (2) resections and hemispherotomy (1). Hippocampal sclerosis was seen in nine cases (4 neurocysticercosis) and this occurred in younger persons as compared to neocortical epilepsies. Good outcome (Engel class I and II) was seen in 23 of 28 cases (Engel class I in 17).

Hemispherotomy for intractable epilepsy.

CONTEXT: Hemispherotomy is a surgical procedure for hemispheric disconnection. It is a technically demanding surgery. Our experience is presented here. AIMS: To validate and compare the two techniques for hemispherotomy performed in patients with intractable epilepsies. SETTINGS AND DESIGN: A retrospective study 2001-March 2007: Nineteen cases of hemispherotomies from a total of 462 cases operated for intractable epilepsy. MATERIALS AND METHODS: All the cases operated for intractable epilepsy underwent a complete epilepsy surgery workup. Age range 4-23 years (mean 5.2 years), 14 males. The seizure frequency ranged from 2-200 episodes per day; four were in status; three in epilepsia partialis continua. The pathologies included Rasmussen's, hemimegelencephaly (unilateral hemispheric enlargement with severe cortical and subcortical changes), hemispheric cortical dysplasia, post-stroke, post-traumatic encephalomalacia and encephalopathy of unknown etiology. The techniques of surgery included vertical parasaggital approach and peri-insular hemispherotomy. Neuronavigation was used in seven cases. RESULTS: Class I outcome [Engel's] was seen in 18 cases and Class II in one assessed at 32-198 weeks of follow-up. The four patients in status epilepticus had Class I outcome. Four patients had an initial worsening of weakness which improved to preoperative level in five to eight weeks. Power actually improved in three other patients at 32-36 weeks of follow-up, but hand grip weakness persisted. In all the other patients, power continued to be as in preoperative state. Cognitive profile improved in all patients and 11 cases returned back to school. CONCLUSIONS: Both techniques were equally effective, the procedure itself is very effective when indicated. Four of our cases were quite sick and were undertaken for this procedure on a semi-emergency basis.