BOHR International Journal of Neurology and Neuroscience

Endovascular complications: Antiplatelet management for flow diversion

Thu, 04 Jan 2024 00:00:00 +0000

Up to 3−5% of the general population is affected by cerebral aneurysms that are associated with both modifiable as well as non-modifiable risk factors ranging from familial to acquired neurovascular conditions. The initial treatment option was aneurysm clipping and evolved to including primary or adjuvant endovascular treatment. Aneurysm re-rupture, although rare, can have devastating consequences such as intracranial bleeding and carotidcavernous fistula. Emergent surgery in view of delayed aneurysm rupture in patients maintained on dual antiplatelet therapy presents with the need to carefully assess the procedure-related risk factors and evaluate the patients’ platelet function. With the advent of novel technology, flow diverters came into play. These devices utilize the deployment of metallic stents into the parent artery that serves the diversion of blood flow away from the pouching aneurysm. Despite their efficacy, flow diverter insertion and catheter manipulation come with a risk of developing ischemia and stroke, hemorrhage and aneurysm re-rupture, in-stent thrombosis and stenosis, and aneurysmal occlusion amongst other complications. The prospect of thromboembolic events necessitates the use of aggressive antiplatelet regimen with the dual antiplatelet regimen utilizing clopidogrel and aspirin used most frequently. Prasugrel and Ticagrelor have been shown to be superior to Clopidogrel in terms of thromboembolic consequences in cardiovascular literature. Given their potential benefit over the current standard of treatment in this patient population, more extensive randomized-controlled studies are warranted for the evaluation of the efficacy and non-inferiority of Prasugrel and Aspirin or Ticagrelor and Aspirin to Clopidogrel and Aspirin.

Diagnostic importance of phenotypic features of undifferentiated connective tissue dysplasia in spondylogenic vertebro-basilar insufficiency

Rhea Singh, Nekrasova Nataliya, O. Tovazhnyanska — Mon, 15 Jan 2024 00:00:00 +0000

Background: The circulatory insufficiency in the vertebrobasilar system is significantly influenced by the spondylogenic mechanism. To understand the degenerative-dystrophic changes in the cervical spine, an assessment of the connective tissue’s condition is required. The primary contributor to pathological conditions of connective tissue is undifferentiated connective tissue dysplasia (UCTD).

Aim: To assess the predictive importance of constitutional-biological markers (CBM) of UCTD in patients with spondylogenic vertebro-basilar insufficiency.

Materials and Methods: The research was carried out using the results of a comprehensive clinical and anamnestic examination of young patients with vertebrobasilar insufficiency. The study focused on investigating the main characteristics of CBM by comparing two groups of patients: one group with vertebrobasilar insufficiency (n = 136) and a control group without vertebrobasilar insufficiency (n = 136). The distribution of individual factors was analyzed using evidence-based medicine, modern clinical-statistical analysis methods such as variance and correlation analysis, as well as prognosis methods like serial analysis of Wald in modification of E.V Gubler to determine the diagnostic (I2, bit) and predictive value and impact factors of the different markers.

Results: The most significant CBM for UCTD were found to be presence of structural imbalance, scoliosis or kyphosis of the cervical spine, flatfoot, and vision impairments.

Conclusion: This study suggests that the diagnostic and prognostic value of CBM for UCTD is crucial in establishing a system of diagnostic and prognostic algorithms for evaluating the risk of developing vertebrobasilar insufficiency (SVBI).

Clinical insights and challenges: A rare case report of Leigh syndrome

S. P. Srinivas Nayak, Hini J. Patel, Khunt Vishwash Hareshbhai — Mon, 08 Jan 2024 00:00:00 +0000

Leigh syndrome is a severe neurological disorder that impairs mobility and respiration, among other bodily functions. Progressive brain deterioration is what makes it distinctive. This case report describes a 10-monthold female child who displayed symptoms such as vibratory movements in the right upper and left lower limbs, failure to thrive, decreased activity, and vomiting after consuming supplemental feeds. Multiple clinical signs of Leigh syndrome, including missed developmental milestones and mild acute malnutrition, were identified during a physical examination. So the symptoms that led to the diagnosis of Leigh syndrome were quadriparesis, dystonia, intermittent stridor (laryngeal dystonia), and bulbar weakness. This was supported by various laboratory results and diagnostic procedures, including brain imaging. The treatment included pacitane, thiamine, biotin, l-carnitine, calcium + vitamin d3, and sodium benzoate as well as dietary assistance and other medicines. Leigh syndrome is an incredibly rare disorder that has major effects on those affected and often manifests in infancy or early childhood. It is characterized by things like vomiting, feeding issues, neurological impairments, and delays in development. Sadly, because Leigh syndrome is a degenerative condition, the outlook for those who have it is frequently bleak. In cases with Leigh syndrome, this case emphasizes the value of early diagnosis and interdisciplinary treatment. The patient was instructed to have additional testing such as an EEG and a disability evaluation. Healthcare professionals must be aware of the clinical manifestation and treatment of Leigh syndrome in order to give affected people and their families the right care and support.

Balint syndrome: an unusual triad

Sumesh Raj, Khaleel Usuf, Manoj Parameswaran — Thu, 11 Jan 2024 00:00:00 +0000

The paper investigates a case of sudden loss of vision in a patient with recent history of blurred vision of right eye diagnosed with Central retinal artery occlusion (CRAO). The point of interest of this case report is that the clinical features are something different from those of a CRAO and revealed cardinal triad of simultanagnosia, optic ataxia, and oculomotor apraxia which are conclusive of a rare clinical entity known as Balint syndrome.

A case report of posterior reversible encephalopathy syndrome in a patient diagnosed with emphysematous necrotizing biliary pancreatitis

Maryam Nazir Ahmad, Anandi Damodaran, Sarah Muhammad Iftikhar, Devdutt Nayak — Mon, 22 Jan 2024 00:00:00 +0000

Posterior reversible encephalopathy syndrome (PRES), a clinical radiological syndrome, is characterized by the abrupt development of neurological symptoms such as headaches, convulsions, altered sensorium, and visual problems. PRES has been linked to a number of risk factors or etiologies, including the use of immunosuppressants or cytotoxins, hypertensive encephalopathy, eclampsia, preeclampsia, and underlying autoimmune diseases. A 41-year-old female was admitted with acute necrotizing emphysematous pancreatitis complicated by posterior reversible encephalopathy syndrome. She remained normotensive on presentation and during the hospital stay. All her investigations were within normal except double-stranded DNA, which came positive. This could explain the immune-mediated mechanism leading to endothelial dysfunction. This case has been presented for its rarity. When acute neurological abnormalities occur in the context of systemic inflammatory conditions, such as acute pancreatitis, it is crucial to take PRES into account.

A case report on spontaneous intracranial hypotension

Sarath Kumar Harikumar, Sumesh Raj, P. Manoj — Mon, 24 Jun 2024 00:00:00 +0000

A 38-year-old lady with bronchial asthma, psychiatric illness, and a suicidal attempt 6 years ago presented with persistent headache for more than 2 weeks. She was diagnosed with recurrent sinusitis and migraine and was on treatment at a local hospital and referred to a higher center for persistent headache which was orthostatic in nature. Clinically, the patient was alert, oriented, and systemic examination was unremarkable. MRI spine showed extensive extradural collection separating the anterior dural sac from the bony canal extending from C3 to D1. CT Myelogram showed cervical dural leak anteriorly at C7-D1 and bony osteophyte impinging on the dural sac – likely cause of leak. Diagnosis of Spontaneous Intracranial Hypotension was made. As no improvement was noted with trial of conservative management, we proceeded with advanced imaging-guided Epidural blood patch repair, following which the symptoms improved.