Journal of Neurosciences in Rural Practice
 
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April-June 2018
Volume 9 | Issue 2
Page Nos. 175-286

Online since Wednesday, April 11, 2018

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EDITORIAL  

Expert commentary on rare (nonvestibular, nontrigenimal) cranial nerve schwannomas p. 175
Murat Alemdar
DOI:10.4103/jnrp.jnrp_546_17  PMID:29725164
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Postdecompressive craniectomy surgery, ventriculomegaly, or hydrocephalus development: imaging, prevention, and management p. 177
Guru Dutta Satyarthee
DOI:10.4103/jnrp.jnrp_547_17  PMID:29725165
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ORIGINAL ARTICLE Top

Caregiver burden among caregivers of mentally ill individuals and their coping mechanisms p. 180
Sujata Chodankar Walke, Varalakshmi Chandrasekaran, Shreemathi S Mayya
DOI:10.4103/jnrp.jnrp_312_17  PMID:29725166
Background: During a given year, almost 30% of the people around the world are affected by mentally ill health. In India, it accounts for about 20%. Caregivers face a lot of strain, ill health, and disrupted family life, with literature suggesting an increasing concern about their ability to cope up. The needs of caregivers of the mentally ill are given low priority in the current health-care setting in India. Aim: The aim of the study was to assess the burden of caregivers of mentally ill individuals and their coping mechanisms. Methods: A cross-sectional study was employed with a quantitative approach. A convenient sample of 320 caregivers was taken from two private tertiary care centers and one public secondary care center in Udupi taluk. This study was conducted using the Burden Assessment Schedule (BAS) and Brief Cope Scale (BCS). Statistical analysis was done on categorical variables, and they were expressed as frequencies and percentages. Continuous variables were measured using mean and standard deviation. Univariate and multivariate analysis using binomial logistic regression was done. SPSS version 15 was used to analyze the data. Results: According to BAS, severe burden accounted for 40.9% and moderate for 59.1%. The highest amount of burden was seen in the areas of physical and mental health, spouse related, and in areas of external support. The BCS showed that the most frequently used coping styles were practicing religion, active coping, and planning. Conclusion: This study concluded that caregivers of the mentally ill individuals do undergo a lot of burden. Hence, there is a need to develop strategies that can help them such as providing them with a support structure as well as counseling services.
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The role of clinical variables and VKORC1 polymorphism in efficacy and stability of acenocoumarol in neurological patients p. 186
Surendra Kumar, Ashish Kant Dubey, Jayantee Kalita, Usha Kant Misra
DOI:10.4103/jnrp.jnrp_306_17  PMID:29725167
Objective: To analyze the clinical importance of VKORC1 polymorphism and its correlation with stability of oral anticoagulation. Patients and Methods: In a hospital-based study, the patients on oral anticoagulant (OAC) were included during 2013–2016. The patients received OAC for cardioembolic stroke, cerebral venous sinus thrombosis (CVST), and prevention of deep vein thrombosis (DVT). Demographic, clinical, and neurological findings were recorded. Stability of anticoagulation was determined by percentage of time international normalized ratio (INR) values were in therapeutic range. Time in therapeutic range (TTR) >65% was defined as stable and <65% was defined unstable. VKORC 1 polymorphism was studied by polymerase chain reaction and correlated with daily dose of OAC and stability of INR. Results: A total of 157 patients with a median age of 40 years were included in the study. Ninety-two patients received OAC for secondary stroke prevention, 62 for CVST, and 3 for DVT. Out of 2976 INR reports, 1458 (49%) were in the therapeutic range, 997 (33.1%) were below the therapeutic range, and 521 (17.5%) were above the therapeutic level. Stable INR was obtained in 75 (47.77%) patients which was improved by drug modification in 3 and dietary adjustment in 12 patients. VKORC1 polymorphism revealed GG genotype in 127 (80.9%), GA genotype in 22 (14%), and AA genotype in 8 (5.1%) patients. Therapeutic range of INR was seen in 49%, below therapeutic range was seen in 31.5%, and above in 17.5%. Conclusion: VKORC1 polymorphism was related to mean daily dose of OAC but not to the stability of INR.
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Prevalence of psychiatric illness among residents of old age homes in Northern India p. 193
Shamsi Akbar, SC Tiwari, Rakesh K Tripathi, Nisha M Pandey, Ambrish Kumar
DOI:10.4103/jnrp.jnrp_340_17  PMID:29725168
Context: There are many factors which compelled older adults to live in old age homes (OAHs) and vulnerable to psychological problems. Studies reported high prevalence of mental health problems (20%–60%) among elderlies of OAHs. Therefore, the study was conducted to explore prevalence of psychiatric illness (PI) among residents of OAHs of Northern India. Settings and Design: The present study was conducted in OAHs of Districts Bareilly, Lucknow, Varanasi, Dehradun, and Haridwar, using cross-sectional descriptive study method. Sample Size were 306 (male – 98 [32.5%] and female n = 208 [68%]) residing in OAHs selected by means of purposive sampling. Subjects and Methods: Inclusion criteria: (a) older adults aged 60 years and above residing in OAHs and able to communicate. (b) Staying in OAHs for 6 months or more. (c) Able to understand comprehends and reply to questions and (d) Giving written informed consent. Exclusion criteria: (a) Residents who declined/not interested to participate in the study. (b) Residents having any sensory impairment/physical health problem which can impede the interview. Research tools were (i) a semi-structured pro forma, (ii) Hindi Mental Status Examination, (iii) Survey psychiatric assessment schedule, and (iv) Schedules for clinical assessment in neuropsychiatry-based clinical interview for diagnosis of PIs according to International Classification of Disease 10. Statistical Analysis Used: The quantitative data obtained was analyzed by means of frequency tables. Results: The results show overall prevalence of PI is 43% among residents of OAHs. The prevalence of PI was found to be higher among females compared to males. Depression was the most common among the residents of OAHs. Conclusions: There is an urgent need of trained professionals to provide professional help for highly prevalent psychiatric disorders among residents of OAHs.
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The role of ejection fraction to clinical outcome of acute ischemic stroke patients p. 197
Fidha Rahmayani, Paryono , Ismail Setyopranoto
DOI:10.4103/jnrp.jnrp_490_17  PMID:29725169
Aims: The aim of the study was to determine the effect of left ventricular ejection fraction on clinical outcomes of acute ischemic stroke patients. Study Design: This study design was a prospective cohort observational study. Place and Duration of Study: This study was conducted at Stroke Unit, Neurology Ward, and Cardiology Ward at the Dr. Sardjito Hospital, Yogyakarta, Indonesia, between July and December 2016. Materials and Methods: Hospitalized acute ischemic stroke patients were recruited, with sample was taken by consecutive sampling until reaching amount fulfilling inclusion criterion was 62 persons. In this study, clinical outcomes were measured by National Institutes of Health Stroke Scale (NIHSS) scores as well as dependent variables and left ventricular ejection fraction as independent variables. Logistic regression analyses were performed to discover any potential independent variable that can influence the left ventricular ejection fraction role at the clinical outcomes with NIHSS scores. Results: Multivariate analyses revealed that several variables were significantly interacted with the influence of left ventricular ejection fraction at the clinical outcomes with NIHSS scores. These variables were the left ventricular ejection fraction <48% (95% confidence interval [CI]: 0.691–0.925; P = 0.001), left ventricular ejection fraction + low high-density lipoprotein (HDL) (95% CI: 0.73–0.949; P = 0,001), left ventricular ejection fraction + diabetes mellitus (DM) (95% CI: 0.799–0.962; P = 0,001), and left ventricular ejection fraction + low HDL + DM (95% CI: 0.841–0.98; P = 0,001). Conclusion: The influence of the lower left ventricular ejection fraction to clinical outcome of ischemic stroke patients has a worsening of neurological deficit outcome by considering the combination of several independent variables including the DM and low HDL.
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Changing pattern of childhood epidemic cerebrospinal meningitis in North-Western Nigeria p. 203
Sani Mado, Ibrahim Aliyu, Rabiu Murtala
DOI:10.4103/jnrp.jnrp_384_17  PMID:29725170
Introduction: Nigeria lies within the meningitis belt which extends from the Gambia, Senegal through Nigeria to Eritrea; however, outbreaks have been shown to extend further south involving countries such as Angola and Namibia. Epidemic outbreaks are often recorded every 8–12 years averaging in a 10 yearly circle however endemic cases still occurs. Materials and Methods: The study was retrospective; all results of cerebrospinal fluid (CSF) samples of children with cases of meningitis from January 2010 to December 2010 were collected from the register of the microbiology laboratory of General Hospital Gusau. Relevant information such as their age, sex, CSF macroscopy/microscopy reports, latex particle agglutination test report, and CSF culture report were retrieved and entered into a pro forma. Results: There were 89 (73%) males and 33 (27%) females with male to female ratio of 2.7:1. The age ranged from 2 months to 14 years; the mean was 6.27 ± 4.00 years. Meningitis was mostly recorded from January to April. W135 was the most common serotype identified. Majority of the samples (54) which were nonreactive for any of the tested antigens had clear CSF (36), while among those that reacted; the W135 group had a high proportion of cases that had turbid CSF (44); (Fisher's exact test = 30.650, P = 0.000). Majority of the samples (99) had no cell count; although those of the W135 group had higher cell counts followed by those in the nonreactive group (Fisher's exact test = 11.226, P = 0.181). Conclusion: Meningitis was highest between January and April, and W135 was the most common serotype.
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Does metabolic syndrome determine severity and disability of chronic low backache? p. 208
Jayantee Kalita, Kamlesh Kumar Sonkar, Usha Kant Misra, Sanjeev K Bhoi
DOI:10.4103/jnrp.jnrp_430_17  PMID:29725171
Introduction: Obesity may be associated with more severe and disabling low backache (LBA) due to alteration in biomechanics, but there are no such studies from developing countries. Aims: We report the frequency of metabolic syndrome (MS) in chronic LBA (CLBA) and its association with severity and disability of CLBA. Subjects and Methods: Consecutive patients with CLBA attending to the neurology service from October 2015 to February 2016 were included in the study. Clinical and demographic parameters were recorded. Routine biochemical test was done. The severity of pain was assessed by a 0–10 Numeric Rating Scale (NRS) and disability by Oswestry Disability Index (ODI) version 2. Comparison of variables was done by Chi-square or independent t-test and correlation by Karl Pearson or Spearman's rank correlation test. Results: Seventy-none (39.3%) patients had MS as per the International Diabetic Federation (IDF) criteria and 68 (33.8%) as per the National Cholesterol Education Program Adult Treatment Panel III criteria. Abdominal obesity was the most common (171 [85.1%]) feature of MS. The patients with MS had longer duration of sitting work and did less frequently exercise. The NRS score (6.95 ± 1.06 vs. 6.65 ± 0.95; P = 0.04) and ODI score (54.91 ± 8.42 vs. 51.89 ± 8.54; P = 0.01) were higher in CLBA patients with MS compared to those without MS. Conclusion: About 40% patients with CLBA have metabolic syndrome, and they have more severe pain and disability.
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Clinical profile of parkinson's disease: Experience of niger p. 214
Hamid Assadeck, Moussa Toudou Daouda, Fatimata Hassane Djibo, Djibo Douma Maiga, Eric Adehossi Omar
DOI:10.4103/jnrp.jnrp_337_17  PMID:29725172
Background: Parkinson's disease (PD) is a chronic neurodegenerative pathology with unknown etiology. It is characterized clinically by the classic triad that associated tremors, bradykinesia, and rigidity. In Niger, there are no data on PD. Aims: We aimed to provide the demographic and clinical profile of PD in patients from Niger to create a database on PD in Niger. Patients and Methods: We conducted a retrospective study at the Neurology Outpatient Clinic of the Hôpital National de Niamey (HNN, Niger) over a period of 4.42 years from February 2009 to July 2013 collecting all cases of PD. The demographic and clinical features of all patients were collected and analyzed. Results: During the period of the study, 1695 patients consulted at the Neurology Outpatient Clinic of the HNN, among which 76 patients (4.48%) had secondary parkinsonism and 25 patients (1.47%) had features compatible with PD. Only patients with PD were included in this study. The mean age at onset of symptoms was 58 years (range: 42–74 years). The male sex was predominant (60%) with a sex ratio of 1.5. The mean time interval from the onset of symptoms to diagnosis of PD was 1.8 years (range: 1–5 years). The tremor was the most common symptom (84%). Bradykinesia represented 64% of the symptoms and rigidity 20%. At the time of the diagnosis of PD, 8 patients (32%) were in Stage I of the classification of Hoehn and Yahr, 16 patients (64%) in Stage II, and 1 patient (4%) in Stage III. The levodopa/carbidopa combination was the most used antiparkinsonian drug in our patients (88%). The mean time of follow-up of the patients was 2.5 years (range: 1–4.42 years). During the course of the disease, 9 patients (36%) were in Stage II of the classification of Hoehn and Yahr, 13 patients (52%) in Stage III, and 3 patients (12%) in Stage IV. Conclusion: Our study provides demographic and clinical data of PD in patients from Niger and shows that the hospital frequency of this disease is low (1.47%). The demographic and clinical features of our patients are similar to those of the patients of the prior studies reported in sub-Saharan Africa.
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Obsessive-compulsive inventory-revised: Factor structure, reliability, validity, and suicide risk screening characteristics among nigerian patients with schizophrenia p. 219
Tolulope Opakunle, Olutayo Aloba, Adesanmi Akinsulore, Olubukola Opakunle, Femi Fatoye
DOI:10.4103/jnrp.jnrp_538_17  PMID:29725173
Objective: This study attempted to explore the feasibility of use of the 18-item Obsessive-Compulsive Inventory-Revised (OCI-R) as a subjective suicide risk assessment tool in a cross-sectional sample of Nigerian patients with schizophrenia. Materials and Methods: Two hundred and thirty-two outpatients with schizophrenia were recruited from the mental health clinic of a university teaching hospital in Southwestern Nigeria. They completed the OCI-R in addition to the Social and Occupational Functioning Assessment Scale, the Positive and Negative Syndrome Scale, and a sociodemographic and illness-related questionnaire. The patients were objectively interviewed with the Mini-International Neuropsychiatric Interview suicidality module items to assess their suicide risk. Results: The 18-item OCI-R demonstrated satisfactory sensitivity (0.900) and specificity (0.662) at a total cutoff score of 10 in relation to the identification of Nigerian patients with schizophrenia with significant suicide risk. At this cutoff score, the area under the receiver operating characteristic curve was 0.817 (95% confidence interval: 0.735–0.898), and positive predictive value (0.726) and negative predictive value (0.869) were also satisfactory. The OCI-R also demonstrated satisfactory internal consistency and construct validity. Conclusion: The OCI-R has demonstrated to be useful as a subjective suicide risk assessment tool among Nigerian schizophrenia patients.
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Clinico-radiologic profile of pediatric traumatic brain injury in Western Rajasthan p. 226
Pawan Kumar Dara, Manish Parakh, Shyama Choudhary, Hemant Jangid, Priyanka Kumari, Satyendra Khichar
DOI:10.4103/jnrp.jnrp_269_17  PMID:29725174
Objective: The aim of this study was to evaluate clinico-radiological profile and outcome of pediatric traumatic brain injury (TBI). Design: Prospective observational study Setting: Intensive Care Unit, ward and OPD of Pediatrics, Dr. S. N. Medical College, Jodhpur (tertiary care hospital). Participants: A total of 188 children (1 month–18 years) were enrolled and 108 admitted. Intervention: TBI classified as mild, moderate, or severe TBI. Neuroimaging was done and managed as per protocol. Demographic profile, mode of transport, and injury were recorded. Outcome: Measured as hospital stay duration, focal deficits, mortality, and effect of early physiotherapy. Results: Males slightly outnumbered females mean age was 5.41 ± 4.20 years. Fall from height was the main cause of TBI (61.11%) followed by road traffic accident (RTA) (27.78%). Majority (56.56%) reached hospital within 6 h of injury, out of which 27% of patients were unconscious. Mild, moderate, and severe grade of TBI was seen in 50%, 27.78%, and 22.22% of cases, respectively. About 12.96% of cases required ventilator support. The average duration of hospital stay was 11.81 ± 12.9 days and was lesser when physiotherapy and rehabilitation were started early. In all children with temporal bone fracture, magnetic resonance imaging (MRI) brain revealed a temporal lobe hematoma and contusion in spite of initial computed tomography (CT) head normal. Children who have cerebrospinal fluid (CSF) rhinorrhea/otorrhea had a high chance of fracture of base of skull and contusion of the basal part of the brain. Conclusion: In India, fall from height is common setting for pediatric TBI besides RTA. Early initiation of physiotherapy results in good outcome. MRI detects basal brain contusions in children presenting with CSF rhinorrhea/otorrhea even if initial CT brain is normal.
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The conundrum of ventricular dilatations following decompressive craniectomy: Is ventriculoperitoneal shunt, the only panacea? p. 232
Raja K Kutty, Sunilkumar Balakrishnan Sreemathyamma, Jyothish Sivanandapanicker, Prasanth Asher, Rajmohan Bhanu Prabhakar, Anilkumar Peethambaran, Gnanaseelan Kanakamma Libu
DOI:10.4103/jnrp.jnrp_395_17  PMID:29725175
Introduction: Ventriculomegaly and hydrocephalus (HCP) are sometimes a bewildering sequela of decompressive craniectomy (DC). The distinguishing criteria between both are less well defined. Majority of the studies quoted in the literature have defined HCP radiologically, rather than considering the clinical status of the patient. Accordingly, these patients have been treated with permanent cerebrospinal fluid (CSF) diversion procedures. We hypothesize that asymptomatic ventriculomegaly following DC should undergo aspiration with cranioplasty and be followed up regularly. Materials and Methods: All patients with post-DC who were scheduled for cranioplasty and satisfied the radiological criteria for HCP were included. These patients were categorized into two groups. Group 1 included ventriculomegaly with clinical signs attributable to HCP and Group 2 constituted ventriculomegaly but no clinical signs attributable to HCP. All patients in Group 1 underwent ventriculoperitoneal shunt followed by cranioplasty, whereas all patients in Group 2 underwent cranioplasty along with simultaneous ventriculostomy and temporary aspiration of the lateral ventricle. All patients were regularly followed as the outpatient basis. Results: There were 21 patients who developed ventriculomegaly following DC. There were 10 patients in Group 1 and 11 patients in Group 2. The average duration of follow-up was from 6 months to 2 years. Two patients in the shunt group - [ group 1] had over drainage and required revision. One patient in aspiration group - [ group 2 ] required permanent CSF diversion. Conclusions: Cranioplasty with aspiration is a viable option in selected group of patients in whom there is ventriculomegaly but no signs or symptoms attributable to HCP.
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Clinical outcomes of endovascular thrombectomy in tissue plasminogen activator versus non-tissue plasminogen activator patients at primary stroke care centers p. 240
Gregory Imbarrato, Joshua Bentley, Ajeet Gordhan
DOI:10.4103/jnrp.jnrp_497_17  PMID:29725176
Background: The effect of intravenous tissue plasminogen activator (IV tPA) administration before endovascular intervention as compared to without at thrombectomy-capable low-volume centers on procedural aspects and patient outcomes has not been investigated. Methods: Retrospective chart review was performed in all consecutive large vessel cerebrovascular accident patients treated with endovascular therapy at two select rural primary stroke centers between 2011 and 2015. Patients' data regarding age, sex, and medical history, as well as thrombus location by catheter-based cerebral angiography, postprocedural reperfusion status, and clinical outcomes were reviewed. The primary outcome measure of the study was a comparison of modified Rankin scale (MRS) at 90 days in patients' postendovascular thrombectomy with prior IV tPA administration versus those who underwent thrombectomy and did not qualify for preprocedural IV tPA. Results: After application of the set inclusion and exclusion criteria, data of 46 out of 65 patients were analyzed. Twenty-three patients (50%) received IV tPA before thrombectomy and 23 patients did not qualify for IV tPA (50%). Successful recanalization (thrombolysis in cerebral infarction 2b/3) was achieved in 86% (20/23 patients) of thrombectomy patients without preprocedural IV tPA and 82% (19/23) of patients who received it (odds ratio [OR]: 0.03, confidence interval [CI]: 95% 0.062–0.16, P < 0.0001). MRS of 2 or less at 90 days was 43.4% (10/23) in patients with no preprocedural IV tPA and 39.1% (9/23) in the combined therapy group (OR: 0.84, CI: 0.26–2.70, P = 0.8). Conclusion: Patients undergoing endovascular thrombectomy for large vessel occlusion at select low-volume rural centers showed benefit from this treatment regardless of IV tPA administration. Clinical outcomes and complications at select low-volume thrombectomy-proficient centers are comparable to large volume comprehensive stroke centers as well as the landmark studies proving the efficacy of endovascular treatment.
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REVIEW ARTICLE Top

Involvement of the spinal cord in mitochondrial disorders p. 245
Josef Finsterer, Sinda Zarrouk-Mahjoub
DOI:10.4103/jnrp.jnrp_446_17  PMID:29725177
This review aims at summarising and discussing the current status concerning the clinical presentation, pathogenesis, diagnosis, and treatment of spinal cord affection in mitochondrial disorders (MIDs). A literature search using the database Pubmed was carried out by application of appropriate search terms and their combinations. Involvement of the spinal cord in MIDs is more frequent than anticipated. It occurs in specific and non-specific MIDs. Among the specific MIDs it has been most frequently described in LBSL, LS, MERRF, KSS, IOSCA, MIRAS, and PCH and only rarely in MELAS, CPEO, and LHON. Clinically, spinal cord involvement manifests as monoparesis, paraparesis, quadruparesis, sensory disturbances, hypotonia, spasticity, urinary or defecation dysfunction, spinal column deformities, or as transverse syndrome. Diagnosing spinal cord involvement in MIDs requires a thoroughly taken history, clinical exam, and imaging studies. Additionally, transcranial magnetic stimulation, somato-sensory-evoked potentials, and cerebro-spinal fluid can be supportive. Treatment is generally not at variance compared to the underlying MID but occasionally surgical stabilisation of the spinal column may be necessary. It is concluded that spinal cord involvement in MIDs is more frequent than anticipated but may be missed if cerebral manifestations prevail. Spinal cord involvement in MIDs may strongly determine the mobility of these patients.
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SHORT COMMUNICATION Top

Bedside ultrasonography as an alternative to computed tomography scan for the measurement of optic nerve sheath diameter p. 252
Uday Yanamandra, Amul Gupta, Sushma Yanamandra, Subrat Kumar Das, Sagarika Patyal, Velu Nair
DOI:10.4103/jnrp.jnrp_537_17  PMID:29725178
Background: Optic nerve sheath diameter (ONSD) as measured by optic nerve sheath ultrasonography (ONSU) is used as a surrogate marker of intracranial pressure (ICP), especially in resource-limited settings. There is a growing interest in the use of ONSU in emergency and high-altitude setups. Notwithstanding multiple studies done on this subject, there is a paucity of data regarding standardization of techniques and comparison of ONSU with computed tomography (CT). Materials and Methods: Thirty-five patients with a diagnosis of high-altitude cerebral edema were enrolled in the study. ONSD was measured in all patients using ONSU, along visual and coronal axis, and CT scan. We repeated ONSU in these patients on days 3, 7, 10, and 15 (day of discharge). Correlation between visual and coronal axis as well as CT scan was analyzed. Results: The correlation of visual to coronal and coronal to visual was equally significant (both correlation coefficients being R2 = 0.983). Correlation of ONSD by visual axis to CT scan was better than coronal axis (correlation coefficient R2 = 0.986 vs. 0.96, respectively). Conclusion: In our study, we found a strong correlation between the visual and coronal axes. Thus, either of the two axes can be used for monitoring ICP. However, it has been found that measurements along the coronal axis are challenging, especially in the emergency setup. ONSD measured along visual axis correlated better with CT scan as compared to the coronal axis.
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IMAGESIN NEUROSCIENCES Top

Diagonal earlobe crease revealing intracranial atherosclerosis p. 256
Oscar H Del Brutto, Aldo F Costa
DOI:10.4103/jnrp.jnrp_511_17  PMID:29725179
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CASE SERIES Top

Rare cranial nerve schwannomas: A retrospective review of nontrigeminal, nonvestibular cranial nerve schwannomas p. 258
Harsh Deora, Dwarakanath Srinivas, Manish Beniwal, V Vikas, K V. L N. Rao, Sampath Somanna
DOI:10.4103/jnrp.jnrp_469_17  PMID:29725180
Introduction: Intracranial schwannomas arising from non-trigeminal and non-vestibular sources are extremely rare constituting <0.8% of all schwannomas. In this article, we have analyzed our experience in the management of these rare tumors over a 10-year period. Material and Methods: There were a total of 16 cases, with 11 of them undergoing microsurgical resection and 5 undergoing stereotactic radiosurgery (SRS). Results: There were no fresh neurological deficit in any of these patients and two patients underwent postoperative SRS for residual tumor. One patient died due to postoperative septicemia. Conclusion: Knowledge of these lesions along with their clinicoradiological profile is essential to maintain a high index of suspicion and understand the nuances of treatment.
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CASE REPORT Top

Supratentorial pure cortical ependymoma: An unusual lesion causing focal motor aware seizure p. 264
Manish Beniwal, Ajit Mishra, K V. L Narasinga Rao, Vikas Vazhayil, Bevinahalli N Nandeesh, Sampath Somanna
DOI:10.4103/jnrp.jnrp_31_18  PMID:29725181
Ependymomas usually arise from the ependymal lining cells of the ventricular system and central canal of the spinal cord. Supratentorial ependymoma is a rare entity with the variable clinical course. In a small number of cases, ependymoma arises from supratentorial parenchyma. Only a few cases are reported in the literature. We report a case of 3-year-old girl with left frontal mass. Total removal of the mass lesion was performed without any neurological deficit. Pathological examination of the excised tumor was consistent with anaplastic ependymoma. We have discussed management strategy of this rare entity.
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Repeated peritoneal catheter blockage caused by neurocysticercosis following ventriculoperitoneal shunt placement for hydrocephalus p. 268
Zhi Hua Li, Zhong Quan Wang, Jing Cui, Fu You Guo
DOI:10.4103/jnrp.jnrp_462_17  PMID:29725182
Cerebral cysticercosis is common, but the possibility for repeated occurrence of peritoneal catheter blockage caused by neurocysticercosis (NCC) after two revisions following ventriculoperitoneal shunt placement for hydrocephalus is unusual. Herein, we describe one rare case in which peritoneal catheter revision was performed two times unsuccessfully. Endoscopic cysternostomy rather than peritoneal catheter adjustment was performed successfully, and histopathological examination of excised cystic samples confirmed NCC in our hospital. The present case highlights the need for awareness of NCC as a possible etiology of hydrocephalus, especially in developing countries. Uncommon findings in both lateral ventricles following low-field magnetic resonance imaging scans as well as the rarity of this infection involved in unusual location play important roles in misdiagnosis and incorrect treatment for hydrocephalus; thus, endoscopic cysternostomy, rather than multiple shunt adjustment of the peritoneal end, is recommended in the selected patient. To the best of our knowledge, this is the first report describing the misdiagnosis and inappropriate treatment of hydrocephalus caused by cerebral cysticercosis in China.
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Dihydroergotamine complicating reversible cerebral vasoconstriction syndrome in status migrainosus p. 272
Naresh Mullaguri, Madihah Hepburn, Christopher Ryan Newey, Premkumar Chandrasekharan Nattanmai
DOI:10.4103/jnrp.jnrp_449_17  PMID:29725183
Reversible cerebral vasoconstriction syndrome (RCVS) is a clinicoradiological syndrome that occurs due to dysfunction of cerebrovascular autoregulation. It is characterized by recurrent thunderclap headache from cerebral vasoconstriction which can cause ischemic infarction, spontaneous intraparenchymal and subarachnoid hemorrhage. This syndrome can be triggered by a variety of etiologies including medications, infectious, and inflammatory conditions. The diagnosis is often delayed due to unawareness among the health-care providers and delayed neuroimaging evidence of vasoconstriction with or without ischemic and/or hemorrhagic infarction. Status migrainosus is a prevalent condition requiring emergency room visits and inpatient admission. Thus, patients with RCVS can be easily misdiagnosed with migraine. We report a patient with RCVS misdiagnosed as status migrainosus with visual aura, treated with intravenous dihydroergotamine with worsening of cerebral vasoconstriction and lead to ischemic and hemorrhagic complications. We discuss this complication and provide guidance on differentiating between migraine and RCVS.
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DOI:10.4103/jnrp.jnrp_516_17  PMID:29725184
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DOI:10.4103/jnrp.jnrp_522_17  PMID:29725188
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DOI:10.4103/jnrp.jnrp_341_17  PMID:29725189
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