International Journal of Neurology and Neurosurgery

Arteriovenous malformation (AVM) is a defect of the circulatory system consisting of an abnormal connection between the arterial system, which normally has a higher intravascular pressure and the lower pressure venous pathways.Arteriovenous malformation presents later in childhood or, more frequently, in adults in the second to third decade of life. These abnormal communications are divided into two types, plexiform and fistulous.Cerebral arterio-venous malformations are one of the challenges for neuro surgeons. Medial temporal AVM are a special group in the medial hemispheric AVM and may be successfully resected using a direct microsurgical approach with limited morbidity and excellent prognosis for recovery.

Keywords: Arteriovenous Malformation; Arterial Channels; Craniotomy.

Regression of herniated disc fragments with subsequent improvement in clinical symptoms has been reported in the lumbar and cervical spine. Such regressions in the thoracic spine are extremely rare. We report a 38-year-old thalassemia patient who had regression of a large calcified herniated thoracic disc causing cord compression, with subsequent herniation of a second calcified disc at a different level, and discuss the possible etiopathogenesis. This is the first such case reported in the thalessemia population.

Keywords: Calcification; Iron chelation; Regression; Thalessemia; Thoracic disc herniation.
 

Tuberous sclerosis complex (TSC) is a relatively rare autosomal dominant disorder characterized by widespread benign tumor formation in a variety of organs. Mutations in either TSC1 or TSC2 tumor suppressor gene are responsible for TSC. The gene products of TSC1 and TSC2, also known as hamartin and tuberin, respectively, form a physical and functional complex and inhibit the mammalian target of rapamycin complex 1 (mTORC1) signaling. The mTORC1 pathway is an evolutionarily conserved growth promoting pathway. mTORC1 plays an essential role in a wide array of cellular processes including translation, transcription, trafficking and autophagy. In this review, we will discuss recent progresses in the TSC-mTOR field and their physiological functions and alterations of this pathway in pathophysiology. Our case is 9 years male child presented to us with skin lesion prominent on face.

Keywords: Tuberous sclerosis; Shagreen patch; Adenoma sebaceum.

Background: Neurodynamics is the concept based on a close interaction of mechanics and physiology of the nervous system which is focused on mechanical properties of peripheral nerves to be considered while assessing and treating patients’ neuropathic symptoms via nervous system mobilization and manual therapy. Purpose: The objective of this study was to evaluate the existing evidence for neurodynamics in Diabetic peripheral neuropathy (DPN) from a research-informed perspective. Methods: A systematic review using search terms “neurodynamics and diabetic neuropathy” in PubMed, CINAHL and Google Scholar was done and the obtained articles were descriptively synthesized into examination and treatment of neurodynamics in DPN population. Results: Out of the 12 included studies, there were four studies on healthy subjects which found neurodynamic techniques to have desirable neurophysiological effects and they were safe to use without any reported major detrimental effects on neurological function. The three evaluation studies, unanimously found altered responses to lower extremity neurodynamic testing in DPN population when tested to initial pain, in terms of range of motion changes during structural differentiation, and these studies found that neural mechanosensitivity was high among people with painful diabetic neuropathy compared to painless DN, or type-2 diabetes or normal persons, and correlated to neuropathic pain, sensory perception thresholds and quality of life. The five intervention studies (one on all three nerves, two on tibial nerve, one each on tibial and sciatic nerves) that studied community-based weekly intervention of neurodynamic mobilization in addition to standard care demonstrated beneficial effects in favor to the NDM group compared to standard care and/or sham intervention. Conclusion: There is limited evidence for altered neurodynamics in DPN population, and that neurodynamic mobilization was an effective therapeutic adjunct to standard care, although population-based pragmatic clinical trials are yet to done to provide effective recommendations for practice.

Keywords: Diabetic peripheral neuropathy; Neurodynamics; Nerve palpation; Nerve massage; Nerve mobility.

Background: Assessment of vibration sensation is essential for diagnosing large-fiber dysfunction in peripheral neuropathies and is considered as a gold standard for diagnosis of diabetic peripheral neuropathy (DPN), since it can efficiently predict the natural history and progression of the disorder. Purpose: To explore the existing evidence for vibration perception in DPN in terms of evidence from published assessment and treatment studies. Methods: A systematic review of PubMed using the search terms– ‘vibration and diabetic neuropathy’ was done to identify articles from 2008 to 2012. The obtained articles were categorized under assessment and treatment studies depending upon their scientific objective. The data were extracted and descriptively synthesized. Results: Tuning fork (sensation) and biothesiometry (sensory threshold) was used for diagnosis of vibration sensation. Vibration perception threshold (VPT) had good measurement properties that merit its clinical use in bedside screening as well as population-based estimation of prevalence of DPN. Medical management (hypoglycemic drugs, neurotropic drugs, vasoactive drugs, herbal medicine and acupuncture), electrical and mechanical treatments were shown to influence VPT. VPT had good predictive ability to identify large-fiber dysfunction and impending risk for other comorbidities/ complications of DPN such as foot ulcers and amputations. Conclusion: Vibration perception was used as a diagnostic, therapeutic and prognostic tool in DPN.

Keywords: Diabetic peripheral neuropathy; Neurological examination; Sensory evaluation; Large-fiber dysfunction.