Annals of Indian Academy of Neurology最新文献

{"title":"Ultrasound Measurement of Optic Nerve Sheath Diameter for Detection of Elevated Intracranial Pressure in Pediatric Encephalitis.","authors":"Huynh Ngoc Le Duy, Tran Diep Tuan, Tran Thanh Thuc, Nguyen Thi Mai Anh, Phung Nguyen The Nguyen","doi":"10.4103/aian.aian_95_26","DOIUrl":"10.4103/aian.aian_95_26","url":null,"abstract":"<p><strong>Background and objectives: </strong>Elevated intracranial pressure (ICP) is a critical and potentially life-threatening complication of pediatric encephalitis. Early detection is essential for improved outcomes. This study assessed the diagnostic utility of optic nerve sheath diameter (ONSD) ultrasound for identifying elevated ICP in children with encephalitis.</p><p><strong>Methods: </strong>A prospective descriptive case series was conducted at the Infectious Disease Intensive Care Unit (ID-ICU), Children's Hospital 1, Ho Chi Minh City, from August 2023 to April 2025. Children with encephalitis underwent daily ONSD ultrasound during the first seven days of admission. Elevated ICP was defined based on clinical signs and neuroimaging findings. ONSD measurements were compared between patients with and without elevated ICP, and age-specific diagnostic cut-off values were determined.</p><p><strong>Results: </strong>Thirty-six patients were enrolled, with elevated ICP confirmed in 72.2% of cases. ONSD values were higher in patients with raised ICP than in those without at all time points. Receiver operating characteristic (ROC) analysis identified optimal ONSD thresholds for detecting elevated ICP of 5.2 mm in children younger than 60 months, 5.9 mm in those aged 60 months or older, and 5.6 mm in the overall cohort. Serial measurements showed a decline in ONSD over time. No significant difference was observed between right and left eye measurements, with strong inter-eye correlation.</p><p><strong>Conclusions: </strong>Ultrasound measurement of ONSD is a useful, noninvasive, repeatable bedside tool for early identification of elevated ICP in pediatric encephalitis. Incorporating age-specific ROC-derived ONSD thresholds may improve diagnostic accuracy and support bedside assessment in pediatric intensive care settings.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"736-742"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Macro- and Microstructural White Matter Changes in Hot Water Epilepsy.","authors":"Raghavendra Kenchaiah, Satishchandra Parthasarthy, Bhargava G Krishna, Bharath R Dawn, Jitender Saini, Karthik Kulanthaivelu, Ravindranadh C Mundlamuri, Ajay Asranna, Lakshminarayanapuram Gopal Viswanathan, Sanjib Sinha","doi":"10.4103/aian.aian_256_26","DOIUrl":"10.4103/aian.aian_256_26","url":null,"abstract":"<p><strong>Background and objectives: </strong>Hot water epilepsy (HWE) is a form of reflex epilepsy and usually lacks definitive magnetic resonance imaging (MRI) features. Although white matter abnormalities have been extensively investigated in patients with temporal lobe epilepsy or generalized epilepsies, very few studies have examined quantitative changes in reflex epilepsy. This study aims to explore the white matter changes in HWE. The objective is to investigate the white matter micro- and macrostructural changes in patients with HWE using diffusion tensor imaging (DTI) indices and three-dimensional structural-imaging-derived subcortical white matter volumes.</p><p><strong>Methods: </strong>Eighty-eight subjects with HWE and 50 age- and sex-matched controls underwent high-resolution volumetric MRI and DTI. DTI and volumetric data were processed using tract-based spatial statistics and FreeSurfer, respectively. Between-group differences in DTI metrics and regional subcortical white matter volumes were assessed. Correlations between DTI metrics, white matter volumes, and epilepsy-specific clinical variables were also evaluated.</p><p><strong>Results: </strong>Subjects with HWE showed significant alterations in DTI metrics indicative of impaired white matter integrity, including decreased fractional anisotropy and increased mean diffusivity, axial diffusivity, and radial diffusivity. These changes were evident both globally (whole-brain) and within specific supratentorial and infratentorial white matter tracts. Subcortical white matter volume loss was predominant in the thalamo-limbic, somatosensory, posterior cingulate, cuneus, and frontal regions. Positive correlations were observed between alterations in global fractional anisotropy and changes in macrostructural (subcortical) white matter volumes.</p><p><strong>Conclusion: </strong>Subjects with HWE exhibited global and region-specific white matter alterations at both micro- and macrostructural levels. Somatosensory subcortical involvement may be associated with the stimulus sensitivity characteristic of this disorder. Involvement of temporal-limbic and default mode network regions is consistent with the clinical semiology, while brainstem changes concur with the reflex nature of the disease.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"763-771"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrophysiological Profile and Comparative Analysis in Brachial Plexus Injuries.","authors":"V H Ganaraja, Deepak Menon, Suresha Kodapala","doi":"10.4103/aian.aian_222_26","DOIUrl":"10.4103/aian.aian_222_26","url":null,"abstract":"<p><strong>Background and objectives: </strong>Brachial plexopathies (BPs) are disabling peripheral nerve disorders resulting in significant motor and sensory deficits. Traumatic BP is the most common etiology, typically following high-energy injuries, while non-traumatic causes include inflammatory and other etiologies. Although imaging provides anatomical detail, electrodiagnostic studies-nerve conduction study (NCS) and needle electromyography (EMG)-remain central to functional assessment.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of patients evaluated for BP at a tertiary electrophysiology laboratory between 2017 and 2022. Patients with symptom duration ≥1 month and complete NCS and EMG datasets were included. These datasets were analyzed to determine lesion localization, including trunks, cords, anterior primary rami (APR), and preganglionic involvement. Electrophysiological patterns were compared between traumatic and non-traumatic etiologies.</p><p><strong>Results: </strong>Seventy-eight patients were included (69 males; mean age 31.7 years); 70 (89.7%) had traumatic and 8 (10.3%) had non-traumatic BPs. Pan-plexopathy was the most frequent localization (73.1%), followed by upper trunk involvement. EMG was abnormal in all patients and provided incremental diagnostic yield beyond NCS alone, identifying plexus involvement in 2.6% of patients with normal NCS and detecting APR or preganglionic involvement in an additional 6-9%. Preganglionic and root avulsion patterns were observed exclusively in traumatic cases (8.9%). Apart from proximal lesions in the form of APR and root involvement exclusivity in traumatic BP, electrophysiological patterns overlapped substantially between etiologies.</p><p><strong>Conclusions: </strong>Pan-plexopathy and upper trunk involvement predominate in BPs. EMG provides critical information beyond NCS alone, particularly for identifying proximal and preganglionic lesions, and remains indispensable for accurate localization.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"788-793"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barking Tics in Subacute Sclerosing Panencephalitis: A Rare Case Report.","authors":"Anuska Mandal, Ayush Agarwal, Divyani Garg, Achal Kumar Srivastava","doi":"10.4103/aian.aian_174_26","DOIUrl":"10.4103/aian.aian_174_26","url":null,"abstract":"","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"898-900"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epilepsy in Children with Celiac Disease: Clinical and Electroencephalographic Characteristics and Outcomes in a Ten-Patient Case Series.","authors":"Sedat Işıkay, Ayşe Demirçubuk, Hakan Bozkurt, Nurgül Işıkay, Meltem Gülşan","doi":"10.4103/aian.aian_411_26","DOIUrl":"10.4103/aian.aian_411_26","url":null,"abstract":"<p><strong>Abstract: </strong>Celiac disease is an immune-mediated systemic disorder triggered by gluten exposure in genetically predisposed individuals. Epilepsy has been reported among the neurological manifestations associated with celiac disease; however, the relationship between epilepsy and celiac disease remains incompletely understood, and their coexistence does not necessarily imply causality. This ten-patient case series describes the clinical, electroencephalographic, and follow-up characteristics of children with both epilepsy and celiac disease. Seven patients had focal epilepsy, whereas three had generalized epilepsy phenotypes, including presumed juvenile myoclonic epilepsy, presumed juvenile absence epilepsy, and sleep-related generalized tonic-clonic seizures. Electroencephalography most commonly demonstrated posterior epileptiform abnormalities. Following initiation of a gluten-free diet and appropriate antiseizure medication, seizure freedom was achieved in all patients during follow-up. These findings suggest that epilepsy may occur in children with celiac disease and that favorable outcomes may be observed after dietary treatment. However, the present data should be interpreted as an association rather than evidence of causality.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"845-851"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early GLP-1 Receptor Agonist Therapy in Acute Ischemic Stroke and High-Risk Transient Ischemic Attack: A Systematic Review and Meta-analysis of Randomized Trials.","authors":"Aasim Ali, Csilla Dézsi, Viktor Gulyás-Oldal, Piresh Kumar, Károly Szili, Sami Ullah, Nimra Akram, Muhammad Abdullah Gulzar, Ali Azhar, Muhammad Zain Ul Abidin, Usama Saleem, Muhammad Asad Shabbir, Mukesh Sharma","doi":"10.4103/aian.aian_812_26","DOIUrl":"10.4103/aian.aian_812_26","url":null,"abstract":"<p><strong>Background and objectives: </strong>The role of early glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy after acute ischemic stroke or high-risk transient ischemic attack remains uncertain. We performed a systematic review and meta-analysis of randomized evidence evaluating efficacy and safety in this setting.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance, we included randomized controlled trials evaluating early GLP-1RA therapy in adults with acute ischemic stroke or high-risk transient ischemic attack. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using inverse-variance random-effects models with restricted maximum likelihood estimation. The primary outcome was 90-day functional independence (modified Rankin Scale score: 0-2); mortality and symptomatic intracranial hemorrhage (sICH) were critical safety outcomes.</p><p><strong>Results: </strong>Four randomized trials enrolled 1,514 participants: LAMP, GALLOP-1, GALLOP-2, and TEXAIS. GLP-1RA therapy increased 90-day functional independence (547/745 vs 516/752; RR = 1.06; 95% CI: 1.01-1.11; I 2 = 5.8%), corresponding to an absolute risk difference of 4.8% and number needed to treat of 21. Mortality did not differ significantly (57/749 vs 52/756; RR = 1.13; 95% CI: 0.80-1.61; I 2 = 0%). sICH was not significantly different (23/579 vs 20/585; RR = 0.67; 95% CI: 0.13-3.42; I 2 = 67.0%). Excluding LAMP attenuated the functional effect (RR = 1.07; 95% CI: 0.92-1.24), and excluding GALLOP-2 yielded RR = 1.049 (95% CI: 0.999-1.102).</p><p><strong>Conclusions: </strong>Early GLP-1RA therapy shows a possible functional benefit, but the finding is fragile and safety evidence remains imprecise. Larger dedicated stroke trials are required before routine clinical use.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"685-696"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrathecal Hyaluronidase as Adjunctive Therapy in Paradoxical Optochiasmatic Arachnoiditis Following Tuberculous Meningoencephalitis.","authors":"Komal Gurjar, Ravi Kant, Prakash Tendulkar, Balachandra Routhu","doi":"10.4103/aian.aian_120_26","DOIUrl":"10.4103/aian.aian_120_26","url":null,"abstract":"","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"889-891"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148203717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple Intracranial Hemorrhages with Venous Stagnation on Cerebral Angiogram in Neurosarcoidosis.","authors":"Haque Shakil, Zeina Morcos, David LeDoux, Ina Teron-Molina, Krista Lim-Hing, Sneh P Munder, Justin M Thomas","doi":"10.4103/aian.aian_319_26","DOIUrl":"10.4103/aian.aian_319_26","url":null,"abstract":"<p><strong>Abstract: </strong>We describe recurrent intracranial hemorrhages (ICH) in a 22-year-old man with intellectual disability and seizures. One year after his first seizure, he presented for evaluation of a second seizure and was found to have an acute left frontal ICH on computed tomography (CT). Cerebral angiography demonstrated venous stasis of unclear etiology. One month after discharge, he was readmitted with a new right frontal ICH and subsequently developed additional bilateral frontal hemorrhages. Repeat angiography demonstrated persistent contrast opacification in the late venous phase, indicating venous congestion. Evaluation for coagulopathy revealed incidental inguinal lymphadenopathy on CT, and biopsy-confirmed sarcoidosis. Brain biopsy showed non-necrotizing granulomatous inflammation consistent with neurosarcoidosis. ICH in neurosarcoidosis is extremely rare. The proposed mechanism is meningovascular granulomatous infiltration causing venous congestion and stasis, leading to venous infarction with hemorrhagic conversion. This case highlights neurosarcoidosis as an important consideration in the differential diagnosis of recurrent ICH associated with venous abnormalities.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"863-866"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148962904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy: A Clinicoradiological Syndrome Presenting as Early-Onset Frontal Dementia.","authors":"Selvakumar Selvaganesan, George A Ninan, Deepti Bal, Mithun M Thomas, Venkateshwar Reddy, Angel Miraclin Thirugnanakumar, Aditya V Nair, Atif Si Ahmed, Prabhakar T Appaswamy, Ajith Sivadasan, Vivek Mathew, Sanjit Aaron","doi":"10.4103/aian.aian_258_26","DOIUrl":"10.4103/aian.aian_258_26","url":null,"abstract":"","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"902-904"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Integrated Whole-Genome Sequencing and In-House Targeted Testing Strategy Enhances Comprehensive Mutation Detection in Neurofibromatosis Type 1.","authors":"Rekha Aaron, Kushagra Agarwal, Aaron Chapla, G Paramasivam, Dharshini Sathishkumar, Lydia Mathew, Anju George, Leni George, Thomas Palocaren, Ajit Sivadasan, Maya Thomas, Sumita Danda","doi":"10.4103/aian.aian_172_26","DOIUrl":"10.4103/aian.aian_172_26","url":null,"abstract":"<p><strong>Abstract: </strong>Neurofibromatosis type 1 (NF1) is a common autosomal dominant neurocutaneous syndrome that affects 1 in 2,500-3,000 births. The phenotypic hallmarks include Lisch nodules, optic nerve gliomas, café-au-lait spots, axillary freckling, and benign neurofibromas. NF1 patients carry an 8-13% lifetime risk of malignant peripheral nerve sheath tumors, the leading cause of NF1 mortality. Current genetic testing detects NF1 variants in 95-97% of cases. In this prospective cohort of 103 cases, we used targeted NF1 sequencing by next-generation sequencing, multiplex ligation-dependent probe amplification (MLPA), and whole-genome sequencing to identify causative variants. Pathogenic or likely pathogenic variants were identified by in-house targeted testing in 93% of cases; six cases had large deletions detected by MLPA, and two had variants identified by whole-genome sequencing. This is the largest genetically confirmed Indian NF1 cohort reported, expanding the known mutational spectrum and demonstrating the utility of whole-genome sequencing for unresolved cases (~2%), as well as highlighting the clinical and genetic heterogeneity of NF1.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"840-844"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}