International Journal of Neurology and Neurosurgery

Intracranial subdural empyema along with brain abscess are serious debilitating conditions with increased risk in patients undergone cranial surgery and to those with immunosuppression, extremes of age, malnourishment. Here we present a case with the subtlest neurological deficits and its progression with time. We shall review our goals and attitude in treating this patient.

Keywords: Intracranial subdural empyema; Brain abscess; Chronic subdural hematoma.

One of the most understudied tissues of brain, choroid plexus (ChP), universally recognized as the source of cerebrospinal fluid (CSF). ChP and its secretions, CSF have significant intimacy with health status of brain and they dynamically regulate the central nervous system (CNS) related diseases. In spite of various experimental issues and lack of clinical salience, resent research sparked some new hypothesis, which provides the possible means how ChP and CSF regulate nervous system structure and function. As the key producer of cerebrospinal fluid, the choroid plexus endows with an essential and unique protective system, brain development, homeostasis and disease conditions that are merrily regulated by active signaling milieu of CSF. From the childhood to adult, the role of CSF and the key neurogenic pathways have been illustrated by various scientific research groups. CSF is an excellent source of biological information of central nervous system and the identification of putative CNS disease biomarkers highlighted recently. The families of proteins which are involved in development, neuronal cell growth, maturation, migration, neurotransmitter mediated cellular communication represent the CNS pathogenesis and help in clinical management of CNS diseases. The advanced proteomic researches have enabled to improve the characterization of CSF in diseased brain. CSF function continued to be an intensive area of research today. As the ChP-CSF system interacts with essentially every other system in the CNS, in this review article, the igniting role of CP-CSF function will be discussed.

Keywords: Choroid plexus; Cerebrospinal fluid; Neural stem cells; Neurogenesis.

Background and Purpose: Vitamin-D deficiency is common across all age groups and may contribute to cardiovascular diseases. Serum 25-hydroxyvitamin-D deficiency causing acute arterial stroke has been documented in recent reports. Aim: To investigate the levels of serum 25-hydroxyvitamin-D in acute arterial stroke and association of 25-hydroxyvitamin-D deficiency with severity of acute arterial stroke at presentation. Methods: A total of 344 consecutive acute arterial stroke patients and 87 controls attending the Department of Neurology, at Sri Venkateswara Institute of Medical Sciences, Tirupati, India, from April 2015 to October 2016 were enrolled into the study. Stroke severity was assessed at admission by using the National Institutes of Health Stroke Scale (NIHSS) score and ICH score. 25-hydroxyvitamin-D levels were measured by chemiluminescence test. Serum calcium, phosphorus, alkaline phosphatase, and parathyroid hormone were also measured in both cases and controls. Results: Out of 344 stroke patients, 218 (63.4%) were men and mean age was 58.01 ± 13.8 years (age range: 15– 90 years). 25-hydroxyvitamin-D deficiency was observed in 156 (45.3%) stroke patients and 31 (35.6%) controls (p < 0.0001). Among stroke patients, 25-hydroxyvitamin-D deficiency in ischemic stroke patients were 109/251 (43.4%) and haemorrhagic stroke patients were 47/93 (50.5%) respectively. Among stroke patients, serum 25-hydroxyvitamin-D levels reduced with increasing severity of stroke as defined by the NIHSS score and ICH score. Conclusions: We found that 25-hydroxyvitamin-D deficiency had an independent association with acute arterial stroke. Increasing severity of stroke showing low Serum 25-hydroxyvitamin-D levels.

Keywords: Acute arterial stroke; 25-hydroxyvitamin-D; Stroke; South-India.

Introduction: Cervical Spondylotic Myelopathy is a common degenerative disorder of the cervical spine that can potentially cause devastating and irreversible impairment of neurological function. It’s a major source of disability in adult population leading to acquire Spinal Cord Dysfunction. The anterior cervical discectomy and fusion (ACDF) is established gold standard for degenerative cervical spine diseases. A clear overview of other surgical techniques is lacking. Cervical disc Prosthesis is not inferior to disectomy and fusion probably some superior in terms of neck pain. Material and methods: This Prospective study was done in Gandhi Medical College and Associated Hamidia Hospital Bhopal from Sep 2014 to August 2018. We included 124 patients: 89 male and 35 female. The age range is between 16 and 84 years, and means age was 58. Result: Our study suggest that patients with Nurick Grade 2 cervical spondylotic myelopathy are likely to improve from surgery and the duration of myelopathy symptoms do not have relation with the severity of the disease but is an independent prognostic factor of surgical outcome. Nurick Grade 2 cervical spondylotic myelopathic patients have good chance of resolution of symptom (p < 0.001) following surgery. Conclusion: The cervical discectomy with interbody fusion for cervical spine disease reduces pain and improve quality of the life of the patients. In light of the tremendous suffering associated with cervical spine disease, the development of new non-pharmacologic strategies to alleviate chronic pain and improve the quality of life for cervical spine disease patients deserves immediate attention and encouragement. The use of SCS has been shown to reduce opioid use and improve function in patients with other pain conditions: a very important consideration in light of the current epidemic of opioid addiction and abuse. The most important predictors of outcome were preoperative severity and duration of the symptom, also the patients selection is a key factor in determining functional outcome with good result if the pathology, clinical presentation and the radiological changes correlate.

Keywords: Cervical spine surgery; Cervical spondylotic myelopathy; Clinical outcome; Prognostic indicators.

Developing country like India is facing a double burden of communicable and noncommunicable diseases. Ischemic stroke is a heterogeneous disorder with multiple etiological mechanisms. Large artery atherosclerotic disease of both intracranial and extracranial arteries is one of the main cause of ischemic stroke disease. A Cross-sectional study was done in 90 patients in Saveetha Medical College Hospital analyzing the clinical features, risk factors and distribution of large artery disease in patients with ischemic stroke. Patient underwent clinical examination, information regarding demographic profile, risk factors of stroke were collected, blood investigations including complete blood count, blood glucose, renal and liver function, lipid profile and electrolytes were done. Each patient underwent magnetic resonance imaging (MRI) of brain with MRA. Out of 90 patients 73 had middle cerebral artery occlusion, 2 had anterior cerebral artery occlusion, and 15 had posterior cerebral artery occlusion. 71 patients (78.9%) had hemiplegia, 34 (37.77%) patients had speech involvement, 42 (46.66%) had giddiness, and 28 (31.1%) had altered sensorium. Headache was present in 25 (27.77%) patients, and 35 (38.88%) had visual disturbances. The site of extracranial occlusion was determined using Carotid Doppler. Among the 2 patients who had ACA occlusion, 1 had occlusion at the level of CCA and 1 at carotid bulb. Among the 15 patients who had PCA occlusion, 1 had CCA occlusion and 3 had occlusion at the level of carotid bulb. 73 patients who had MCA occlusion had 7 CCA occlusion, 16 ICA occlusion, 14 carotid bulb occlusion and 28 ICA and CCA combined occlusion. MCA occlusion is commonest among the intracranial artery occlusion and when MCA is involved majority of patients have extracranial involvement (CCA/ICA/ carotid bulb) pointing to the fact that extracranial occlusion is almost invariable present when the MCA infarct is present.

Keywords: Stroke; Large artery occlusion; Extracranial occlusion; Intracranial stenosis.

Objectives: There is paucity of literature regarding health related quality of life in Oromandibular dystonia (OMD) especially from India. This study assessed HRQoL in its global and disease specific aspect by previously validated instruments in patients with OMD. Method: Subjects with OMD as well as age and gender matched healthy controls were enrolled from Movement Disorder OPD and botulinum toxin clinic. Uneducated patient, those could not read questionnaires, cases that had associated other neurological or debilitating systemic disorders, secondary / pediatrics dystonias, pregnancy or received botulinum toxin within 6 months or underwent surgical treatment were excluded from the study. Each patient filled SF-36 ( HRQoL), BDI (Beck Depression Inventory for depression) and Oromandibular dystonia rating (OMDRS for Disease Severity Scale). Results: 42 pts of OMD were enrolled. There was no significant difference in demographic details between patients with OMD and control. Compared with controls, OMD patient group suffered from statistically significant impaired global health related quality of life (SF 36) in all domains (p < 0.05). More than 60% of patients with OMD had depression (compared to <25% of controls) out of whom 11% had moderate to severe depression (compared to 3.6% of controls). 4.7% of OMD patients had minimal severity scale scoring while 76.2% had moderate, 19.1% had severe disease scoring. Conclusion: This study clearly demonstrated that patients with OMD suffered from significant impairment in HRQoL as compared to controls. Higher proportion of patients with OMD suffered from moderate to severe depression compared to their control.

Keywords: OMD = Oromandibular dystonia; HRQoL = Health related quality of life; SF -36 = 36 item short form health survey; BDI = Beck’s depression inventory; BRS: Blepharospasm rating scale; OMDRS = Oromandibular dystonia rating scale

Introduction: Majority of the cases of cervical radiculopathy are due to the anterior relations of the cervical nerve root, with disc herniation and uncovertebral osteophytes. The standard techniques of surgery were posterior laminoforaminotomy and anterior discectomy with or without fusion. The main limitation of these techniques being excessive bleeding and fusion related adjacent segment disease. The disk preserving functional cervical disc surgery is minimally invasive anterior cervical disc preserving technique of upper vertebral transcorporeal anterior microforaminotomy. Objectives: To assess the Disk Preserving Functional Cervical Disc Surgery for cervical radiculopathy cases. Methodology: This is a non randomized prospective study carried among 11 consecutive patients who were operated for cervical radiculopathy with the new technique at the Department of Neurosurgery, Manipal Hospital, Bangalore. The patients were considered for surgery on the basis of Inclusion criteria: Unilateral cervical radiculopathy not responding to conservative treatment of more than 6 weeks (or earlier if patients exhibited profound weakness). Imaging studies were corresponding to the clinical features. Results: The majority of patients mean preoperative disc height was in the 5.5 to 6.0 group. One patient disc height was in the 6.0 to 6.5 group. The mean disc height was 5.59 mm preoperatively and 5.49 mm postoperatively. There was no significant reduction in the disc height postoperatively. The spinal motion was preserved at the operated level in all patients. Conclusion: The modified transcorporeal anterior cervical microforaminotomy technique is a minimally invasive procedure for the treatment of cervical radiculopathy as it preserves most of the disc tissue.

Keywords: Cervical disc surgery; Cervical radiculopathy; Disk preserving technique.

Rohingya people who escapes from Myanmar due to violence settled in neighboring countries like Bangladesh, India and some even in Nepal. The burden of extra people in the countries have made a humanitarian crisis not in terms of food, water, shelter and basic needs but also affecting their health as well. Lack of nutrition, health education, immunization, maternal and newborn child health care along with existing mass attack by beating and arms like rifle, bullet, bomb blast by the Myanmar army leads to various neurosurgical conditions that need to be addressed by the Department of Neurosurgery, Chattogram Medical College Hospital as an urgent basis. Here we will put an emphasis on their neurosurgical disease we commonly encountered in our nearby government hospital with their appropriate managements.

Keywords: Rohingya Myanmar; Bangladesh; Chattogram Medical College; Neurosurgical disease.