Objectives: Embolic stroke of undetermined source (ESUS) accounts for a substantial proportion of ischemic strokes. Increasing evidence suggests that non-stenotic carotid plaques with high-risk morphological features may act as embolic sources in ESUS, leading to the concept of symptomatic nonstenotic carotid disease (SyNC). However, data on the prevalence and clinical relevance of SyNC in Indian populations remain limited. The objective of the study is to determine the frequency of SyNC in patients with ESUS and to compare the clinico-radiological characteristics and outcome between ESUS patients with and without SyNC. Materials and Methods: In this prospective observational study conducted at a tertiary care center, consecutive patients aged >12 years presenting with acute ischemic stroke or transient ischemic attack were screened between October 2023 and May 2025. Patients fulfilling ESUS criteria involving the anterior circulation were included. All patients underwent standardized neuroimaging and computed tomography angiography (CTA). Non-stenotic carotid plaques (<50% stenosis) were evaluated for high-risk features. SyNC was defined as the presence of an ipsilateral non-stenotic carotid plaque with at least one high-risk feature. Clinical characteristics, imaging findings, and outcomes at three months (modified Rankin scale [mRS]) were compared between SyNC and non-SyNC groups. Results: Of 251 patients screened, 69 met ESUS criteria and were included. SyNC was identified in 20 patients (29.0%). Baseline demographics and vascular risk factors were similar between groups, although SyNC patients had significantly higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (14.2 ± 6.8 vs. 10.9 ± 4.9; p = 0.028). Middle cerebral artery territory infarcts predominated in both groups, with a higher proportion of watershed infarcts in the SyNC group. At three months, poor outcome (mRS 4–6) was more frequent in SyNC patients compared with non-SyNC patients (45.0% vs. 21.27%; p = 0.049). Conclusion: SyNC was present in nearly one-third of ESUS patients and was associated with higher baseline stroke severity; however, its independent impact on functional outcome remains uncertain after adjustment for potential confounding factors. These findings highlight the potential clinical relevance of carotid plaque vulnerability in ESUS and support the need for larger studies to refine risk stratification and preventive strategies.
Objectives: Although rare, butterfly gliomas are notorious for their inferior clinical outcomes. The objective of the present study was to systematically review the available literature regarding the optimal management protocols and prognosis of butterfly glioma based on the available literature. Materials and Methods: We searched the selected electronic databases with appropriate search terms. The studies selected for analysis included patients with high-grade glioma (World Health Organization, 5th edition, central nervous system classification, Grade III -IV), who had at least one lesion with continuous involvement of the corpus callosum (CC) and cerebral hemispheres. Results: A standard criterion to define a butterfly glioma is lacking. However, the involvement of the CC with significant bilateral extension is considered an acceptable criterion. The standard treatment regime involves surgical resection along with adjuvant therapy, such as radiotherapy and chemotherapy, and recent evidence favors surgical resection for butterfly glioblastoma in adequately selected patient subsets. Conclusion: The current review analysis revealed high heterogeneity and publication bias owing to the retrospective nature of the included studies, varying patient populations, and the degree of resection, needing further clinical trials to evaluate the effect of surgical resection and the molecular diagnosis on the overall survival (OS).
Objectives: Traumatic brain injury (TBI) is a major cause of mortality and morbidity, particularly in low- and middle-income countries like Cameroon. Contextualizing knowledge about these injuries is crucial in improving patient care. This study aimed to identify factors associated with mortality in patients with TBI. Materials and Methods: We conducted a retrospective observational study over 6 years from 2018 to 2024 in the neurosurgery departments of Laquintinie Hospital. 8,902 patients were enrolled. Sociodemographic data, the mechanism, context, and severity of the trauma, as well as patient outcomes (death or survival), were collected using their medical records. Univariate and multivariate logistic regressions were performed to determine factors associated with mortality. Results: The factors associated with mortality from TBI were the sex (adjusted odds ratio [aOR] = 0.69, p = 0.01), lack of formal education (aOR = 3.39, p < 0.001), alcohol consumption (aOR = 0.46, p < 0.001), severity of the injury (aOR = 41, p < 0.001), self-financing of medical expenses by the family (aOR = 3.25, p < 0.001), and unavailability of funds for care (aOR = 2.54, p < 0.001). Conclusion: This study shows that among TBI patients in Laquintinie Hospital of Cameroon, there are factors associated with mortality, such as sex, lack of formal education, alcohol consumption, injury severity, and financial constraints.
Objectives: Chronic spine pain is a highly prevalent condition that requires coordinated, guideline-concordant care integrating pharmacological management, psychosocial assessment, and appropriate diagnostic evaluation. However, variations in clinical practice across physician specialties may influence the consistency of chronic spine pain management. This study examines specialty-related variation in chronic spine pain management practices among physicians in Tabuk, Saudi Arabia, and to identify differences in selected evidence-based clinical behaviors. Materials and Methods: A cross-sectional survey was conducted among physicians practicing in Tabuk, Saudi Arabia. A total of 210 physicians were invited, and 105 completed the survey (response rate 50%). The structured questionnaire assessed physician demographics, self-rated confidence in managing chronic spine pain, and key clinical practices including nonsteroidal anti-inflammatory drugs (NSAID) risk counseling, psychosocial screening using patient health questionnaire-9 (PHQ-9) and GAD-7, opioid prescribing, red-flag screening, focused physical examination prior to magnetic resonance imaging (MRI), and referral to pain specialists. Differences across specialties were assessed using the Kruskal–Wallis test for confidence scores and chi-square or exact tests for categorical practice variables. Pain Medicine was excluded from inferential comparisons because only one respondent represented this specialty. Results: A total of 105 physicians participated, including 52 Family Medicine physicians (49.5%), 24 Orthopedic Surgeons (22.9%), 15 Neurologists (14.3%), and 13 Neurosurgeons (12.4%). Self-rated confidence differed significantly across specialties ( p = 0.0027), with the highest mean scores reported in Neurology (4.40 ± 0.83) and Neurosurgery (4.23 ± 1.54), and the lowest in Orthopedic Surgery (3.21 ± 1.02). Across most clinical domains, including opioid prescribing, red-flag screening, focused examination prior to MRI, and referral to pain specialists—no statistically significant specialty-related differences were observed. However, significant variation was identified in NSAID risk counseling ( p = 0.0023) and psychosocial screening using PHQ-9 and GAD-7 ( p = 0.00062). NSAID risk counseling was reported by 44 of 52 Family Medicine physicians (84.6%), compared with 11 of 24 Orthopedic Surgeons (45.8%), 13 of 15 Neurologists (86.7%), and 10 of 13 Neurosurgeons (76.9%). Similarly, psychosocial screening practices differed across specialties, with Orthopedic Surgeons ( n = 24) reporting lower adherence to these guideline-recommended practices than other specialties. Conclusion: While physicians across specialties reported consistent adherence to several core diagnostic practices in chronic spine pain care, differences in reported practices were observed in NSAID risk counseling and psychosocial assessment, particularly within orthopedic practice. These findings highlight opportunities for targeted educational interventions, strengthened multidisciplinary collaboration, and improved implementation of the biopsychosocial model in chronic spine pain management.
Brain abscess is a rare but potentially fatal intracranial infection. In immunocompetent young adults, cryptogenic brain abscesses may mimic brain tumors and delay diagnosis. We report a 28-year-old man presenting with acute left-sided weakness, headache, and seizures. Initial evaluation suggested an intracranial tumor. Magnetic resonance imaging revealed a ring-enhancing parietal lesion with edema and mass effect. No primary source of infection was identified, and laboratory tests showed elevated inflammatory markers without leukocytosis. Craniotomy with excision and drainage confirmed a brain abscess, while cultures were negative. Empirical antibiotics were administered with regimen adjustment for metronidazole allergy, resulting in full neurological recovery. This case highlights that cryptogenic brain abscesses can closely resemble intracranial tumors in immunocompetent patients. Early recognition and prompt intervention are essential for favorable outcomes.
The COVID-19 pandemic has had a substantial effect on frontline healthcare workers, specifically nurses, who have faced both physical and psychological burdens. Despite growing studies on the short-term impact of COVID-19, few studies have examined its long-term impact on nurses’ health and professional well-being. This research targets to bridge this gap by examining the sustained effects of COVID-19 infection among nurses, integrating both quantitative and qualitative methods. This research adopts a mixed-methods approach. In quantitative phase, using simple random technique 216 nurses recovered from COVID-19 will be selected. Data will be collected from eligible nurses which includes personal characteristics, fatigue, sleep quality and brain fog measured via validated scales along with physical health parameters that will be retrieved from their annual health records. Chi-square test would be done to assess the relationship between severity of infection and post recovery physical and cognitive health impacts. Physical health parameters such as Blood pressure, Body mass index (BMI), Lab test values will be collected before and after infection and will be compared with paired t-test or Wilcoxon signed rank test. In qualitative phase, the phenomenological method will be used to carry out in-depth interview with a subset of nurses to learn more about their lived experiences and professional challenges post-infection. A purposive sampling technique will be used, targeting nurses working in tertiary healthcare settings and thematic analysis will be used to identify themes and sub-themes from their qualitative narrative. This mixed-method study is anticipated to produce evidence on the long-term physical and cognitive effects of COVID-19 among nurses that addresses a critical and underexplored consequence of the COVID-19 pandemic on the nursing workforce thereby influencing workplace policies and occupational health interventions following COVID-19.
Spinocerebellar ataxia type 2 (SCA2) is an autosomal-dominant neurodegenerative disorder caused by CAG trinucleotide repeat expansion in the ATXN2 gene, classically characterized by progressive cerebellar ataxia, dysarthria, and slow saccadic eye movements. Although white matter degeneration is increasingly recognized as part of SCA2 pathology, macroscopic tumefactive demyelinating lesions have not been well described. We report a 29-year-old woman with rapidly progressive, genetically confirmed SCA2 (56 CAG repeats) exhibiting marked anticipation compared with her affected father. Brain magnetic resonance imaging revealed diffuse cerebellar and cerebral atrophy along with a solitary, large, non-enhancing tumefactive white matter lesion in the left temporoparietal region. Extensive evaluation excluded inflammatory, autoimmune, infectious, and neoplastic etiologies. We propose that this lesion represents an extreme manifestation of ATXN2 -mediated leukodegeneration rather than a coincidental acquired demyelinating disorder. This case expands the neuroradiological and pathophysiological spectrum of SCA2 and provides clinical support for emerging evidence implicating oligodendroglial dysfunction in polyglutamine diseases.
Objectives: Despite the rising incidence of early-onset acute ischemic stroke (AIS) in India, evidence on outcomes and predictors of early neurological deterioration (END) among young adults remains scant. We aimed to evaluate the association of National Institutes of Health Stroke Scale (NIHSS)-defined END with mortality and functional dependency among young adults with AIS and to identify the clinical, radiological, laboratory, and treatment-related factors contributing to END. Materials and Methods: In this prospective observational cohort study of young adult (18–49 years) patients with AIS, we determined the association of END with functional dependency (assessed using modified Rankin scale [mRS]) and analyzed clinical, imaging, laboratory, and treatment-related data from 52 patients presenting within 4.5-hours of last known well. END was defined as a ≥2-point NIHSS increase or ≥1-point motor worsening within 7 days of the index event. Predictors were identified using modified Poisson multivariate and least absolute shrinkage and selection operator (LASSO) regression models. Results: The median interquartile range age of the cohort was 42 (31–46) years. END occurred in 21 (40.4%) patients and caused greater functional dependency (mRS, 3–6) compared to those without END (adjusted odds ratio 4.89 [95% confidence interval 1.48–11.10, p = 0.008]). Hypertension (adjusted risk ratios [aRRs] 2.98, p = 0.047), Glasgow Coma Scale ≤12 (aRR 2.56, p = 0.023), and Alberta stroke program early computed tomography score ≤7 (aRR 1.48, p = 0.051) were identified as independent predictors of END. Anterior cerebral artery involvement (β = +1.92), hyperhomocysteinemia >15 µmoL/L (β = +0.68), male sex (β = +0.59), hypoalbuminemia (β = +0.55), and middle cerebral artery involvement (β = +0.22) showed positive prediction scores for END in LASSO models. Conclusion: END occurred in 2 of every 5 young adult patients with AIS, with large-vessel occlusion as the major predictor, and poor short-term outcomes were documented in more than half. Hypertension and index-event hyperglycemia emerged as modifiable risk factors. Distinct predictors of END underscore the importance of early recognition for targeted acute interventions.
Miller-Fisher syndrome, a variant within the Guillain -Barré syndrome spectrum, may rarely present with myasthenia gravis (MG)- like features, creating diagnostic uncertainty. Although traditionally regarded as a peripheral neuropathy, transient neuromuscular junction (NMJ) transmission abnormalities have been described in anti-GQ1b spectrum disorders. A 52-year-old man presented with acute diplopia and ophthalmoplegia following an upper respiratory infection. Neurological examination revealed bilateral ophthalmoplegia and hyporeflexia without objective limb ataxia. Nerve conduction studies showed reduced tibial compound muscle action potential amplitudes and absent H-reflexes. Repetitive nerve stimulation demonstrated a modest decrement with partial post-exercise augmentation and recovery. Subsequently, the patient developed ptosis and dysphonia, which improved after symptomatic pyridostigmine therapy. Anti-GQ1b and MG-related antibodies and cerebrospinal fluid (CSF) analysis were unavailable. The clinical course was most consistent with transient NMJ dysfunction within the anti-GQ1b spectrum, but the coexistence of MG cannot be definitively excluded. Awareness of this potential overlap is crucial to avoid misclassification and guide management.
Rhino-orbito-cerebral mucormycosis (ROCM) is a rapidly progressive and often fatal opportunistic fungal infection predominantly affecting individuals with underlying metabolic and immunological compromise. Intracranial extension of the disease has invariably been associated with a high rate of mortality. Here, we present a child with type 1 diabetes mellitus diagnosed with ROCM and complete occlusion of the ipsilateral internal carotid artery, who underwent aggressive multimodality treatment with a combination of systemic liposomal amphotericin B, oral posaconazole, and intraconal liposomal amphotericin B, along with surgical debridement. The multimodality approach used in this case, comprising prolonged intravenous antifungal therapy with a defined cumulative dose, oral azole therapy, adjunctive local antifungal administration, and repeated surgical debridement, resulted in a favorable outcome. Despite intracranial extension with vascular involvement, the patient demonstrated a long-term survival with good neurological recovery.
Pituitary abscesses are rare, accounting for <1% of sellar lesions, with secondary abscesses in craniopharyngiomas being exceptionally uncommon. We report a 42-year-old male presenting with progressive visual loss and headaches, whose imaging suggested a pituitary macroadenoma or craniopharyngioma. Endoscopic transsphenoidal surgery revealed purulent material within a calcified capsule, and histopathology confirmed craniopharyngioma. Post-operative recovery included visual improvement with persistent hypothyroidism. This case underscores the diagnostic challenge of pituitary abscesses within craniopharyngiomas and highlights the importance of surgical drainage, histopathological confirmation, and prolonged antibiotic therapy for optimal outcomes.
Objectives: To evaluate the feasibility and utility of an AI-enabled prescription transcription and translation service delivered through WhatsApp in the Neurology, Neurosurgery, and Cardiology outpatient departments at a public-funded tertiary care hospital. Materials and Methods: This retrospective study analyzed prospectively collected data over a 1-month period (July 2023) at the All India Institute of Medical Sciences (AIIMS), New Delhi. Patients uploaded photographs of their prescriptions via WhatsApp to the GUDMED chatbot (Gud Medicare Private Limited, Gurgaon, Haryana), which used artificial intelligence and machine learning algorithms for prescription transcription. The platform provided optional services including local language translation, dosage reminders, digital health record storage, vital sign tracking, and generic medicine alternatives. Transcribed and translated prescription PDFs were returned to patients through WhatsApp. A total of 500 voluntarily submitted prescriptions were included for analysis. Results: A total of 500 prescriptions were analyzed: 42.8% from Neurosurgery, 33.6% from Cardiology, and 23.6% from Neurology. Male patients predominated across all departments. The median age of patients was 31 years (interquartile range [IQR]: 24.5–48.5) in Neurosurgery, 34 years (IQR: 26–69.25) in Cardiology, and 34 years (IQR: 22.5–42.5) in Neurology. Overall, 47.2% of patients requested Hindi translations, with the highest proportion from Neurosurgery (58.1%), followed by Cardiology (25.4%) and Neurology (16.5%). Diagnostic tests were frequently advised: in Neurosurgery, magnetic resonance imaging (MRI) (26.2%), CT (4.7%), and X-ray (9.3%); in Cardiology, MRI (1.2%), computed tomography (CT) (4.2%), X-ray (8.9%), and echocardiography (ECHO) (18.5%); in Neurology, MRI (9.3%), CT (11.9%), X-ray (2.5%), and ECHO (4.2%). Diabetes and hypertension were most common in Cardiology (20.2%). Antiseizure was the most prescribed drug class, accounting for 17% of prescriptions, mainly in Neurology and Neurosurgery. Conclusion: The AI-based prescription transcription and translation service effectively improved communication, patient engagement, and digital record-keeping in public hospitals. Its scalability makes it a promising solution for advancing digital healthcare, especially in low-resource settings.
The treatment paradigm for surgery in patients with Langerhans cell histiocytosis (LCH) varies depending on the size and location of the tumor. Here, we illustrate an effective treatment modality through craniotomy with local autologous bone dust. An 8-year-old child presented with a 4-month history of a bumpy scalp on the right parietal region every time he combed his hair. Contrast-enhanced computed tomography (CT) of the brain revealed a single right parietal lytic bony defect measuring 2 × 2 × 1 cm, giving a punched-out appearance. The ultrasound of the abdomen, axial skeleton, and vertebral column was normal. A craniotomy and en bloc resection, including a 2 cm surrounding bone margin, were performed. The healthy skull bone edges (outer table) were drilled, and bone dust was used for reconstruction. The bone dust was spread over the dura to completely fill the defect site, followed by tack-up stitches. The healthy periosteum was laid over the defect and sutured. A follow-up brain CT before discharge and at 1 year showed evidence of cranial bone regeneration. Histopathology specimens showed LCH features. Complete excision, including the margin, followed by covering the defect using autologous bone dust, promotes osteoblast activity in pediatric calvarial. The peripheral tack-up stitches of the dura and periosteum contribute to osteogenesis by contact. This strategy is simple, inexpensive, and has good cosmetic results.
Choroid plexus papillomas (CPPs) are rare, benign intraventricular tumours, predominantly affecting children. Adult-onset CPPs are uncommon but usually arise in the fourth ventricle and present with features of obstructive hydrocephalus and cerebellar signs. We report a case of a 42-year-old male with progressive truncal ataxia, raised intracranial pressure-type headache, and visual decline. Imaging revealed a posterior fossa mass causing obstructive hydrocephalus. Differential diagnoses included ependymoma, medulloblastoma and dermoid cyst. The patient underwent midline suboccipital craniotomy with near-total tumour excision, with intraoperative external ventricular drainage, followed by ventriculoperitoneal shunt placement later. Histopathology confirmed CPP. Postoperative complications included lower cranial nerve dysfunction requiring tracheostomy. The patient gradually improved and was successfully decannulated. At 6-month follow-up, he had a stable small residual tumour with no progression. Although rare in adults, CPP should be considered in the differential diagnosis of posterior fossa tumours presenting with cerebellar signs and raised ICP. Surgical excision remains the mainstay of treatment, with the extent of resection being a key prognostic factor. Near-total resection may be appropriate when tumour adherence to critical structures risks significant morbidity, and continued radiological follow-up is essential to monitor for recurrence.
Delayed presentation of large epidural hematomas (EDHs) is a rare but life-threatening and clinically significant occurrence, often challenging conventional assumptions about the time window for effective surgical intervention. We report a case of a 41-year-old man who presented 17 h after head trauma with progressive headache and mild drowsiness (Glasgow Coma Scale score of 13). Computed tomography revealed a large left frontal EDH measuring 96 mL, with a 10.8 mm midline shift but no associated skull fracture. Emergency left frontal craniotomy and hematoma evacuation were performed. Post-operative imaging confirmed complete evacuation and restoration of midline alignment. The patient made a full neurological recovery within 24 h and was discharged on post-operative day 5 without deficit. This case demonstrates several unusual features: A delayed presentation exceeding 12 h despite a large hematoma volume, a frontal location that may have mitigated early neurological decline, and a favorable outcome after a timely surgical intervention. The absence of a skull fracture suggests a low-energy trauma mechanism, explaining the slower accumulation rate. Clinicians should maintain a high index of suspicion for delayed EDH even after mild or seemingly trivial head injury, particularly when symptoms evolve insidiously. In such cases, early neuroimaging remains essential to avoid catastrophic deterioration. Prompt surgical decompression remains the most important predictor of recovery, regardless of the delay in presentation. This report emphasizes that large frontal EDHs can occasionally progress slowly and still have favorable outcomes when treated without delay once identified. Awareness of this atypical presentation is particularly relevant for neurosurgeons in rural or resource-limited settings, where delayed access to advanced imaging and surgical facilities is common.
Objectives: Loneliness is an emotional state and an experience consequent to social isolation. Differences in the person’s quality and quantity of both anticipated and actual social relationships contribute to loneliness. The higher prevalence of loneliness noted in persons with schizophrenia adversely affects multiple domains and outcomes. However, the impact on functionality and symptom severity consequent to loneliness remains limited. This study attempts to understand the relationship between loneliness, functionality, and symptom severity in schizophrenia. Materials and Methods: A cross-sectional study design was used. Males above 18 years of age and with a minimum duration of 2 years of illness were included in the study. Persons with comorbid psychiatric conditions, substance use disorder (except nicotine), and without the capacity to consent were excluded. Positive and negative syndrome scale (PANSS) was used to measure the symptom severity, functionality was measured using World Health Organization Disability Assessment Schedule 2.0, while loneliness was measured using University of California, Los Angeles loneliness scale 3.0. Sixty-four participants who sought outpatient treatment were selected, and quantitative data analysis was done. Results: The mean age of onset of the illness was 25.66 ± 7.16, the PANSS score was 44.92 ± 10.15, the dysfunction score was 50.92 ± 10.97, and the loneliness score was 47.14 ± 7.60. There was a significant positive correlation of loneliness with symptom severity, functional impairment, and prolonged unemployment. Multiple regression indicated that functional status and duration of unemployment are predictors of loneliness in schizophrenia. Conclusion: Psychosocial interventions focusing on functional recovery and vocational engagement influence the loneliness level in schizophrenia, further resulting in symptom reduction and overall recovery.
Objectives: This study examined differences between nurses and physicians in knowledge, attitudes, and practices related to sport-related concussion (SRC) management in resource-limited primary care settings in Indonesia. It also assessed whether professional role, knowledge, and attitudes were linked to adherence to key SRC safety behaviors. Materials and Methods: A cross-sectional survey was conducted from July to October 2025 among 136 early-career physicians ( n = 68) and nurses ( n = 68) in public primary care facilities in Greater Medan, North Sumatra, Indonesia. A validated self-administered questionnaire, developed from recent international SRC consensus statements, assessed knowledge using 25 true–false items, attitudes toward SRC severity and management, and adherence to three minimum safety-critical behaviors: Immediate removal from play after suspected SRC, structured referral, and implementation of cognitive rest. Group differences were examined using Mann–Whitney U and Chi-square tests, and associations between knowledge, attitudes, professional role, and practice were analyzed using logistic regression with complete adherence (score 100 vs. <100) as the outcome. Results: Nurses demonstrated higher overall knowledge scores than physicians (median 88.0 vs. 66.0, p < 0.001). Attitudes were generally positive (median 74.3, interquartile range 65.7–82.9), with nurses scoring slightly higher than physicians (77.1 vs. 74.3). The practice measure showed a ceiling effect, with 53.7% reporting complete adherence to all three safety behaviors—36.8% of physicians and 70.6% of nurses. Higher knowledge modestly correlated with practice scores when combined with attitudes, but this lessened after including professional role. Nurses had about 4 times the odds of full adherence as physicians after adjusting for knowledge and attitudes (odds ratio 4.1, 95% confidence interval 1.7–9.9), whereas knowledge and attitude scores alone did not independently predict adherence. Conclusion: Professional role showed a stronger association with self-reported SRC safety behavior adherence than individual knowledge or attitudes. These findings suggest that strengthening SRC management in resource-limited settings should emphasize role-specific protocols and system-level strategies rather than relying solely on individual education.
