International Journal of Neurology and Neurosurgery

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Background: Many COVID-19 patients experience acute respiratory distress syndrome. During the second wave of COVID, there was a massive surge in the cases of severe COVID-19, leading to paucity of healthcare resources at all levels. We aimed to assess the outcome of patients with severe COVID-19 on Ventilator. Method: This prospective study at AIIMS, New Delhi, during the second wave of COVID (4th may to 15th June 2021). 24 AgVa® ventilators were used, adult severe COVID patients saturation was <90% and required NIV or IV were included. All patients were managed on 100% FiO2 and steroids. No other drugs (except supportive treatment like antibiotics and IV fluids) were given and analysis done using SPSS (p<0.05 considered significant). Results: 125 patients were treated for COVID-19. 82 were males and 43 were females. The mean age was 51.29 years. Mean SpO2 at admission was 93.23% (±8.06). The median FiO2 on admission was 75. 43 patients were put on NIV, 82 required IV while 3 were shifted from NIV to IV. The mean duration of ventilator support for survivors was 2.5 days. The mean length of hospital stay for patients discharged was 5.52 days. The overall mortality rate was 34.4%. The difference in mortality rates in NIV and IV modes was not statistically significant, however it approached significance (p=0.06). Conclusion: This Indian study reports outcomes of severe COVID-19 patients requiring NIV or invasive ventilation who were managed in the emergency department using only oxygen and steroids during the second pandemic wave.

Human induced pluripotent stem cell (iPSC)-derived cortical organoids have emerged as transformative in vitro models for studying human neurodevelopment due to their remarkable ability to recapitulate early stages of corticogenesis in a three-dimensional environment. Unlike two-dimensional cultures, cortical organoids exhibit self-organizing properties that enable the formation of neuroepithelial regions, neuronal populations, and glial networks resembling the developing human cerebral cortex. In this study, we established a standardized and reproducible protocol for generating human cortical organoids from iPSCs and performed multiscale structural characterization using confocal microscopy, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Human iPSCs were cultured under feeder-free conditions and differentiated through embryoid body formation followed by neural induction and cortical differentiation. Mature organoids were analyzed to evaluate cellular organization, tissue morphology, and ultrastructural maturation. Confocal microscopy demonstrated well-organized cortical-like architecture characterized by uniform nuclear distribution, extensive GFAP-positive astroglial networks, and distinct neuronal cell bodies identified by NeuroTrace staining. SEM analysis revealed spherical organoids with dense and highly organized surface topology, neuroepithelial folding, and neurite-like projections suggestive of progressive neuronal connectivity and tissue remodeling. TEM confirmed neuronal maturation through the identification of well-defined neuronal cell bodies, intercellular junctions, and myelin sheath-like structure surrounding neuronal processes. These findings demonstrate that the generated cortical organoids successfully reproduce essential structural features of early human brain development. The integration of multimodal imaging techniques provides robust validation of organoid architecture and maturation, establishing this platform as a reliable and biologically relevant model for studying neurodevelopment and neurological disease mechanisms. This work further contributes toward the standardization of cortical organoid generation and characterization protocols for translational neuroscience research.

Introduction: Tuberculomas are most common lesions in India and can closely mimic neoplastic lesion, as ganglioglioma on imaging. Case Report: A 9-year-old female presented with severe headache in emergency department. Hence, she was referred to radiology department of MRI BRAIN and orbit imaging considering possibility of intracranial hypertension. On MRI, a solid-enhancing left cerebellar lesion was seen and it favored ganglioglioma. Patient was undertaken for the surgery, her histopathology suggested necrotizing granulomatous inflammation consistent with tuberculoma with no evidence of BIH. Conclusion: Cerebellar tuberculoma can present atypically and mimic neoplasm.

Background: Artery of Percheron (AOP) infarction is a rare ischemic stroke caused by occlusion of a solitary perforating artery supplying both paramedian thalami. It commonly presents with altered consciousness rather than focal neurological deficits, often mimicking metabolic encephalopathy and delaying diagnosis. We report a case of AOP infarction presenting as isolated altered sensorium in a patient with advanced chronic kidney disease (CKD), successfully treated with timely intravenous thrombolysis. Methods: A 70-year-old man with known stage 4 CKD, not on maintenance dialysis, presented with sudden-onset altered sensorium. Neurological examination revealed a low Glasgow Coma Scale score, drowsiness, confusion, impaired attention, and disorientation, while cranial nerve and motor examinations were largely preserved. Despite advanced CKD, the abrupt onset of symptoms and absence of significant metabolic derangements prompted activation of the acute stroke pathway. Magnetic resonance imaging was performed for definitive diagnosis, followed by intravenous thrombolysis within the therapeutic window. Results: MRI demonstrated acute bilateral paramedian thalamic infarction consistent with artery of Percheron occlusion. The patient showed progressive neurological recovery following thrombolysis. During hospitalization, hemodialysis was initiated under nephrology supervision, and he completed multidisciplinary rehabilitation. He was discharged with minimal residual disability, achieving a modified Rankin Scale score of 1. Conclusions: Acute isolated altered sensorium should prompt consideration of artery of Percheron infarction, even in patients with advanced CKD. Early clinical suspicion, prompt neuroimaging, and timely reperfusion therapy can result in excellent functional outcomes despite an initially deceptive presentation.