Background: Tardive dyskinesia is a debilitating hyperkinetic movement disorder characterized by repetitive involuntary movements involving the orofacial musculature. The disorder most commonly arises following exposure to dopamine receptor–blocking medications and reflects dysfunction within cortico-basal ganglia-thalamocortical motor circuits¹. Structural brain lesions may further destabilize motor network function and contribute to abnormal movement patterns. Cerebral arteriovenous malformations (AVMs) are congenital vascular anomalies that typically present with intracranial hemorrhage, seizures, headaches, or progressive neurological deficits². Movement disorders associated with AVMs are rare. Case Description: We report a case of severe refractory oro-buccal dyskinesia in a patient with a cerebral AVM and seizure disorder. Neuroimaging demonstrated a left posterior temporal arteriovenous malformation located near the temporoparietal junction. Despite withdrawal of the offending medication and trials of tetrabenazine and botulinum toxin injections, the dyskinesia persisted. The patient underwent microsurgical AVM excision, which resulted in angiographic cure and seizure control but did not resolve the abnormal movements. Because of persistent disabling dyskinesia, the patient subsequently underwent bilateral globus pallidus internus deep brain stimulation (GPi-DBS). Intraoperative microelectrode recordings confirmed appropriate pallidal neuronal activity. An implantable pulse generator was implanted during the same procedure and stimulation was activated immediately in the recovery period, resulting in rapid suppression of dyskinetic movements. Conclusion: This case highlights the complex interaction between structural cerebrovascular pathology and dysfunctional basal ganglia circuitry. Successful treatment required a staged neurosurgical strategy combining vascular and functional neurosurgery. Immediate activation of pallidal stimulation produced dramatic clinical improvement and demonstrates the therapeutic role of neuromodulation in refractory dyskinetic disorders.
Background: Primary intracerebral hemorrhage (ICH) is a leading cause of stroke-related mortality in South Asia, yet data from western Nepal remain limited. This study describes the clinical profile, radiological characteristics, management strategies, and three-month outcomes of primary ICH patients at a tertiary care center in western Nepal. Material & Methods: This prospective analytical study was conducted at the Department of Neurosurgery, Nepalgunj Medical College and Teaching Hospital (NGMCTH), Kohalpur, Nepal. Sixty-three adult patients with confirmed primary ICH on non-contrast CT head were enrolled over three months using consecutive sampling and followed up for an additional three months. Clinical, demographic, and radiological data were collected at the time of admission. Neurological status was assessed using the Glasgow Coma Scale (GCS) at admission and at three months. Results: The median patient age was 62 ± 12.8 years, with male predominance (65.1%). Hypertension was the most common comorbidity (74.6%). \Approximately 74.6% presented with moderate-to-severe neurological compromise. Admission GCS was significantly associated with three-month neurological outcome. Conservative management was employed in 63.5% of patients, and 17.5% underwent surgical intervention. A notable 25.4% left against medical advice (LAMA). Conclusion: Primary ICH in western Nepal predominantly affects middle-aged hypertensive males. Admission GCS is the strongest predictor of short-term neurological outcome. The high LAMA rate reflects critical socioeconomic barriers that likely underestimate true ICH mortality. Strengthening community-level hypertension control, expanding financial protection for neurosurgical emergencies, and improving patient retention seem essential to improving outcomes in this region.
Decision making plays a substantial role in our daily activities. The entire mechanism of perceiving, thinking and actively deciding is primarily controlled by neurology circuits. Recent studies in genetics, sociology and behavioural sciences has proven that environmental factors tend to influence our decisions indirectly by altering the neurological mechanisms.
Posterior reversible encephalopathy syndrome (PRES) is also called Reversible posterior leukoencephalopathy syndrome (RPLS). PRES typically manifests as parieto-occipital vasogenic edema, but radiologic investigations show a much wider range of involvement. Large studies have shown extension of the imaging findings in atypical areas and in atypical pattern. Also PRES has large number of etiological factors. Given its wide range of triggers, such as hypertension, renal failure, eclampsia, autoimmune illness, and cytotoxic treatments, prompt identification is crucial to enable prompt treatment of underlying causes and avoid irreparable damage or complications. Therefore, being aware of abnormal imaging patterns is essential for timely and efficient treatment and this article aims to review the imaging features of classical PRES and its variants.
Degenerative spine disorders are a leading cause of disability worldwide and impose a growing burden on health systems, particularly in low- and middle-income countries. Large language models are emerging as powerful tools capable of supporting clinical decision-making, synthesising complex evidence, generating patient-specific explanations, and improving clinical documentation. Their ability to process free-text clinical narratives and integrate multiple sources of information makes them particularly suited to degenerative spine care, where decision-making requires the integration of symptoms, neurological findings, imaging, and patient preferences. This narrative review examines the evolving role of artificial intelligence in spine surgery, with particular emphasis on large language models in degenerative conditions of the cervical and lumbar spine. We describe current and emerging applications across clinical triage, radiological interpretation, guideline synthesis, patient communication, and workflow optimisation. Building on these insights, we propose a structured six-level clinical decision-making framework spanning initial patient contact to postoperative care. We also discuss key ethical, medico-legal, and governance considerations relevant to the safe implementation of these technologies, particularly in resource-constrained environments. Large language models are unlikely to replace clinical judgement; however, when integrated within structured workflows and appropriate safety systems, they have the potential to enhance the quality, efficiency, and equity of degenerative spine care globally over the coming decade.
