ABSTRACT:Neurocysticercosis is a frequent parasitic infection of the central nervous system. While parenchymal forms are well recognized, meningitis due to cysticercus remains underdiagnosed. This systematic review assessed clinical features, diagnostics, treatment, and outcomes of neurocysticercosis-associated meningitis. Following PRISMA guidelines and PROSPERO registration, case reports, series, and cohorts describing meningitis attributed to neurocysticercosis were analyzed. Extracted data included demographics, presentation, imaging, cerebrospinal fluid (CSF) findings, diagnostics, therapy, and outcomes. A total of 48 published cases of neurocysticercosis-associated meningitis were analyzed. Headache was the most common presenting symptom (45 cases, 94%), followed by fever and vomiting (20 cases each, 42%), visual impairment or gait disturbance (16 cases, 33%), altered sensorium (15 cases, 31%), and seizures (13 cases, 27%). Chronic meningitis (13 cases, 27%) and meningoencephalitis (10 cases, 21%) were the most frequent subtypes. Neuroimaging most often showed subarachnoid or racemose cysts (14 cases, 29%) and hydrocephalus (13 cases, 27%). Cerebrospinal fluid analysis revealed elevated opening pressure (27 cases, 56%), lymphocytic pleocytosis (25 cases, 52%), eosinophilic pleocytosis (12 cases, 25%), elevated protein (42 cases, 88%), and low glucose (35 cases, 73%). Surgical intervention was required in 26 cases (54%). Albendazole, corticosteroids, and praziquantel were used in 42 (88%), 21 (44%), and 18 (38%) cases, respectively. Complete recovery occurred in 17 cases (35%), and mortality in 3 cases (6%). Neurocysticercosis-associated meningitis is a severe, often subarachnoid disease marked by diagnostic delay and frequent surgical need, but outcomes are favorable when timely, individualized medical/ surgical management is instituted.

INTRODUCTION:Hemifacial spasm (HFS) is a disabling movement disorder characterized by involuntary, unilateral facial muscle contractions. Botulinum toxin (BTX) is the standard non-surgical treatment, but response variability exists, and predictors of outcomes remain underexplored, especially in the Asian subcontinent. This study aimed to identify clinical and neuroimaging predictors of BTX response in primary HFS. METHODS:A prospective cohort study at a tertiary care centre in North India enrolled 90 BTX-naïve primary HFS patients from September 2022 to June 2024. Clinical assessments included the Hemifacial Spasm Grading Scale (HSGS), HFS-7 Quality of Life scale (HFS-7), and the Depression, Anxiety, and Stress Scale (DASS-21). THE FIESTA MRI evaluated neurovascular compression (NVC) at the facial nerve root exit zone. Outcomes were classified as good (JFG ≥3) or poor responders (JFG<3). Univariate analysis and logistic regression identified predictors of response. RESULTS:The mean age was 51.5 ± 11.2 years; 67.8% were female. At 3 months, 76.7% had good outcomes, increasing to 85.6% after dose titration at the second visit. Poor response (14.4%) was significantly associated with hypertension (OR, 17.55; p = 0.009) and NVC (OR, 9.37; p = 0.044). These patients also exhibited worse depression, anxiety, stress scores, poorer quality of life, and required higher BTX doses. CONCLUSION:HFS responds well to BTX, but hypertension and NVC are independent predictors of poor response. Patients show higher psychiatric burden and lower quality of life. Early dose escalation may improve outcomes. The prospective study guides personalized HFS management by integrating clinical, radiological, and comorbid psychiatric predictors.

Background: The neutrophil-to-lymphocyte ratio (NLR) is a potential marker for predicting dengue severity, yet its use in pediatric populations remains under-researched. This study aimed to determine the optimal cutoff value of NLR for predicting the severity of dengue infection in children under 14 years in India. Material and Methods: Retrospective data collection was conducted for this observational study over 1 year, from May 2023 to April 2024. Sixty-three children aged 14 years or younger with confirmed dengue fever were included, excluding those with chronic illnesses or immunodeficiencies. NLR on days one and five of hospitalization was noted and associated with the Severity of dengue fever. For analysis, chi-square test, independent t-tests, and the Area under the Receiver operating characteristic (ROC) curves were applied. Results: Enrolled children had a mean (SD) age of 6.1 (3.5) years, with 57.1% being males. On day one, the mean (SD) NLR for mild dengue, moderate dengue, and severe dengue were 1.64 (1.60), 1.81 (1.22), and 1.61 (0.87) respectively (p=0.882). On day five, these values were 1.34 (1.34), 1.29 (0.71), and 1.14 (0.53) respectively (p=0.719) without any significant difference. NLR had an AUC of 0.632 (95% CI: 0.487 to 0.777) for day one and 0.477 (95% CI: 0.389 to 0.661) for day five (p=0.074, not significant). Conclusion: In conclusion, NLR did not significantly differ with dengue severity in the pediatric population during the observed period and was not a statistically significant predictor of dengue severity. Keywords: Dengue fever, neutrophil-to-lymphocyte ratio, pediatric, severity prediction.

Cytoreductive surgery and intraoperative, intraperitoneal hyperthermic chemoperfusion (hyperthermic intraperitoneal intraoperative chemotherapy) are commonly used for the management of peritoneal surface metastases. We describe a case of acute embolic infarcts in bilateral cerebellar lobes, cerebral peduncles, thalamus and left parietal lobe cortex in a postmenopausal woman in her 50s diagnosed with bilateral ovarian mucinous adenocarcinoma with peritoneal metastasis under general anaesthesia.

White matter tracts within the central nervous system are organized into ascending and descending pathways that transmit sensory input and motor output, respectively. Tractopathy, or damage to these tracts, can impair sensory or motor functions. Motor neuron diseases are pathologic processes affecting the upper or lower motor neurons. Amyotrophic lateral sclerosis (ALS) is the most common form of acquired motor neuron disease. Traditionally, ALS has affected upper and lower motor neurons of the extremities, torso, and head and neck. There are several ALS variants, some of which affect only the upper motor neurons (eg, primary lateral sclerosis), lower motor neurons (eg, progressive muscular atrophy), or motor neurons of the head and neck (eg, progressive bulbar palsy). Characteristic imaging features of ALS include abnormal T2 hyperintensity within the brain along the corticospinal tract, as well as cortical susceptibility signal intensity along the precentral gyrus, termed the "motor band" sign. Spinal muscular atrophy is a less common primary motor neuron disease and appears on images as atrophy of the anterior horn of the spinal cord, as well as proximal muscle atrophy. In addition to pure motor neuron diseases, there are numerous toxic and metabolic conditions, genetic disorders, infectious diseases, and immune-mediated disorders that can secondarily affect the corticospinal tracts (corticospinal tractopathies), producing symptoms of upper motor neuron injury. These tractopathies are visible at MRI as T2-hyperintense lesions along varying segments of the corticospinal tract. A comprehensive diagnostic approach that integrates clinical symptoms with radiologic and laboratory findings is crucial to distinguish among these varied conditions. (c) RSNA, 2024 center dot radiographics.rsna.org

Movement disorders are common, disabling sequelae of Japanese encephalitis (JE) survivors yet remain poorly characterized. This review synthesizes their epidemiology, clinical spectrum, radiological correlates and outcomes to inform early diagnosis and treatment. We searched PubMed, Scopus, Embase and Google Scholar data bases for reports of JE with subsequent movement disorders. We included case reports, case series and cohort studies. Extracted data on demographics, timing and type of movement disorder, magnetic resonance imaging findings, treatment and follow-up outcomes were recorded. In this review of 72 isolated JE cases, the mean age was 20.8 years (range < 1–66), with 39 males (54.2

A significant number of non-hypertensive individuals suffer from parenchymal bleeds at sites characteristic of hypertensive bleed. Some even present with a higher arrival blood pressure due to transient hypertensive response. We aimed to study the clinico-radiological characteristics and outcomes of spontaneous intracerebral hemorrhage (ICH) in patients with and without hypertension. We performed a single-center prospective observational study. A total of 162 patients with spontaneous ICH were recruited over 2 years. Patients with a preceding history of hypertension, having positive hypertension biomarkers, or requiring antihypertensives on follow-up were classified as hypertensive ICH; otherwise, as non-hypertensive ICH. Clinico-radiological parameters and outcome comparisons were done between the two groups. Of 162 patients (mean age 53.1 ± 13.2, 64.2% men), 35 (21.6%) belonged to non-hypertensive ICH. Among these 35 patients, 16 (45.7%) had a transient hypertensive response. Among the hypertensive ICH group, 75 (59.05%) had a history of hypertension and were taking antihypertensive medication, but only 5 (6.7%) were continuing it at the time of the event. Mortality and modified Rankin scale (mRS) ≤ 2 at the end of 3 months were 12.3% and 52.5%, respectively. 90-day and 30-day mortality, as well as good outcomes based on mRS, did not differ significantly between the two groups. Maximum mortality occurred within 30 days post-ictus, and the rates significantly declined thereafter. Of 35 patients in the non-hypertensive ICH group, 22 (62.9%) remained cryptogenic. Non-hypertensive ICH represents one-fifth of total spontaneous ICH with the majority being cryptogenic despite advanced technology and diverse causes accounting for the remainder. There was no outcome and mortality difference between hypertensive ICH and non-hypertensive ICH. Among hypertensive ICH, non-adherence to medication should be a point of concern for us.

Purpose Anti–N-methyl-ᴅ-aspartate receptor encephalitis (NMDARE) is an autoimmune disorder of the central nervous system characterized by subacute-onset neurocognitive disorders, seizures, movement disorders, and prominent neuropsychiatric features affecting young adults. This case series describes the clinical profile, neuroimaging features, and outcomes in NMDARE patients and attempts to compare its findings with previously published studies in an Indian setting. Methods All consecutive patients diagnosed with definite NMDARE over a 2-year period were evaluated and followed up with. A comprehensive literature review was conducted in PubMed, Scopus, Embase, and Google Scholar, covering studies published up to January 2025. Results The case series included six patients (four females) aged 10–19 years presenting with super-refractory status epilepticus, dystonia, rubral tremors, and psychiatric symptoms. Tumor screening was negative in all cases. Magnetic resonance imaging of the brain revealed white matter hyperintensities in the medial temporal lobe, periventricular white matter, basal ganglia, and midbrain. Electroencephalogram abnormalities included diffuse slowing, extreme delta brush, and epileptiform discharges. Patients responded to high-dose intravenous methylprednisolone and intravenous immunoglobulin in most cases, with rituximab and cyclophosphamide administered successfully in refractory cases. Our review of Indian literature on NMDARE revealed 60 studies (115 patients), among which 48 case reports were excluded and 12 clinical studies and case series were included. Included patients were aged 2–29 years and mostly female, with similar clinical and imaging profiles to our population and a comparable low yield of tumor screening. Prognosis was good with immunotherapy, with few fatality reports. Conclusion NMDARE patients present with protean clinical manifestations and difficult diagnostic and therapeutic challenges, resulting in an unclear prognosis. Early recognition, aggressive immunotherapy, and regular follow-up are key to better outcomes.

Background and objective Leprosy, an infectious disease caused by Mycobacterium leprae, induces irreversible damage, necessitating early detection. The disease's neurotropism, which extends to the peripheral nerves, is well recognized. In recent years, there has been an acknowledgment of its expanding horizon beyond this traditional boundary. This study aims to explore the involvement of atypical sites such as the central nervous system, brachial plexus, and spinal nerve root ganglion through dedicated neuroimaging via magnetic resonance imaging (MRI) across diverse spectra of leprosy. Methods In a retrospective case series conducted from July 2020 to July 2022 at a tertiary care hospital, leprosy patients with specific neurological signs were analyzed. Neurologists had recommended MRI for suspected central nervous system (CNS)/proximal nerve root involvement in these patients. Two expert radiologists assessed the MRI imaging results. Results Eleven such patients were identified, of which six with positive MRI findings were scrutinized. Six multi-drug therapy (MDT) naive male leprosy patients in the age range of 24-44 years were analyzed. MRI revealed signal intensity alterations (SIA) in the brain, cervical cord, and bilateral/unilateral brachial plexus/ganglion. After a year of MDT, follow-up imaging revealed diverse responses: complete resolution of brain SIA (n=1), persistent declining hyperintensity in the cervical cord with declining (n=1), unchanged ganglionitis/plexitis (n=2), and no observable changes in cord and brachial plexus SIA (n=1). Conclusion This study reveals diverse neuroimaging patterns in leprosy patients. Neuroimaging may reveal abnormalities, particularly in patients with leprosy presenting with lower motor neuron-type facial palsy. A deeper understanding of these radiological findings could offer valuable insights into the pathophysiology of leprosy.

Introduction:The involvement of ocular system especially optic neuritis (ON) is an important clinical aspect of inflammatory demyelinating disease (IDD) of the central nervous system. The primary IDD spectrum includes neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein-associated diseases (MOGAD), multiple sclerosis (MS), and clinically isolated syndrome (CIS). The clinical presentation of ON varies according to disease pathophysiology. Aim:We aimed to determine the clinical characteristics of treatment-naïve ON at baseline and on the 6-month follow-up and assessed the predictors of visual outcome. Methods:A prospective study of patients with treatment-naïve ON was performed with structural and functional ophthalmological evaluation. Univariate and multivariate logistic regression analyses were used to determine the predictive factors of visual outcome. Results:Out of 46 patients of IDD, ON occurred in 30 patients. The etiological subtyping included NMOSD (10), CIS (8), MOGAD (7), and MS (5) patients in our study. The ON group showed female preponderance, greater delay in diagnosis, and significant relapsing course. Bilaterality occurred predominantly in NMOSD followed by MOGAD. Optical coherence tomography analysis showed predominant thinning of superior and inferior quadrants in retinal nerve fiber layer (RNFL) and global thinning of Ganglion cell inner plexiform layer (GC-IPL) in NMOSD, but the values were not statistically significant. Univariate analysis for predictors of visual outcome showed age at onset, delay in diagnosis, NMOSD, longitudinally extensive ON (LEON) and chiasmal lesions were associated with poor outcome, while multivariate analysis showed statistical association of NMOSD and LEON with poor outcome. Conclusion:NMOSD and longitudinally extensive optic neuritis showed poor ophthalmological outcome and optical coherence tomography was unyielding.

We report two cases of tuberculosis meningitis patients developing hemichorea-hemiballismus during antituberculosis treatment. First, a 56-year-old woman experienced right-sided hemichorea-hemiballismus 3 months into treatment. MRI scans revealed a left thalamus and subthalamic infarct. After 10 days of continued treatment and corticosteroids, her movements subsided. Second, a 17-year-old female developed hemichorea-hemiballismus while on antituberculosis drugs and corticosteroids. MRI scans displayed ischemic lesions, optochiasmatic arachnoiditis, gyral enhancement, and a small tuberculoma. After shunt surgery and tetrabenazine treatment, she significantly improved and resumed daily activities. In conclusion, hemichorea-hemiballismus may paradoxically occur in tuberculosis meningitis patients, potentially linked to ischemic lesions in the thalamus and subthalamus.

BACKGROUND:In 2023, the WHO declared the end of the COVID-19 pandemic, cautioning that the virus will continue to mutate and may cause sporadic outbreaks. Vaccination was critical in controlling the pandemic, though concerns persist about long-term immunity and the need for booster doses. The study aimed to assess whether vaccination enhances immunity beyond natural infection and determine the ongoing need for booster doses. METHODS:This population-based cross-sectional study was conducted across ten districts in Uttar Pradesh, India, to evaluate humoral and cellular immune responses in vaccinated individuals (ChAdOx1nCoV-19 vaccine & BBV152) or those previously infected with SARS-CoV-2. Six hundred forty-three participants were assessed for cellular immunity and 7000 for humoral immunity. Anti-receptor binding domain (RBD) antibodies were measured using enzyme-linked immunoassay (ELISA), and various subsets of memory T-cells were analyzed via flow cytometry. RESULTS:The study revealed that vaccination significantly elevated antibody titers compared to natural infection (p < 0.001), with the most significant increase observed after the second dose (p < 0.001). While subsequent doses raised antibody levels, the increase between the second and third doses was modest. T-cell responses, particularly memory subsets such as effector memory (p = 0.009), central memory (p = 0.003), and stem cell memory (p < 0.001), showed significant enhancement after the second dose but plateaued following the third dose, suggesting further doses may not be beneficial. CONCLUSION:While vaccination effectively increases antibody levels and reduces hospitalizations and severe outcomes, additional booster doses may offer limited benefits for the general population, as there appears to be a ceiling effect in both humoral and cellular immunity after the second dose. Given the potential adverse effects of COVID-19 vaccination, the decision to administer multiple booster doses to specific population groups must be based on further studies that directly address this issue, along with a thorough risk-benefit analysis.

BACKGROUND: The prognosis of adult patients with tuberculous meningitis undergoing ventriculoperitoneal (VP) surgery is not well known. Prognostic models developed to predict the prognosis might help clinicians immensely. METHODS: This was a prospective study. Adult patients (>= 18 years) with tuberculous meningitis undergoing VP shunt surgery were included in the study. Patients were followed for 6 months. The primary outcome was death and the secondary outcome was a composite outcome of death plus disability. Prognostic models were developed using binary logistic regression. The model performance was assessed using discrimination and calibration. Internal validation of the model was performed using bootstrap. The models were plotted on a nomogram and e-calculator for bedside use. RESULTS: Of 92 patients, 28 (30.4%) died and 36 (39.1%) experienced a composite poor outcome. The final model showed Medical Research Council grade III, papilledema, seizures, and size of the temporal horn to be predictors of poor outcome. The models showed good discrimination: area under the curve of 83.7% (95% confidence interval, 75.1%-92.3%; P < 0.001) for death and area under the curve of 84.7% (95% confidence interval, 75.9%-93.5%; P < 0.001) for composite poor outcome. Both the models showed good calibration; the Hosmer-Lemeshow test P value of 0.448 for death and 0.093 for composite outcome. The model remained valid after performing a bootstrap procedure, thus signifying internal validation. CONCLUSIONS: About 39% of adult patients with tuberculous meningitis die or remain disabled after VP shunt surgery. Medical Research Council grade III illness, papilledema, seizures, and size of hydrocephalus are the important baseline predictors that can help in prognostication. The nomograms developed may help the treating physician with prognostication.

Study designA systematic review.ObjectivesTuberculous myelitis, an uncommon disorder, often manifests as transverse myelopathy. The majority of the literature comprises isolated case reports, necessitating a systematic review for better understanding and management.SettingUttar Pradesh India.MethodsOur review followed PRISMA guidelines, searching PubMed, Scopus, Embase, and Google Scholar with no language constraints. Quality assessment of reports was based on selection, ascertainment, causality, and reporting. Data synthesis was qualitative with categorical and continuous data representation.ResultsWe analyzed 34 reports describing 39 individuals. The majority (85%) had a duration of illness of one month or less. Upper motor neuron paraparesis was the most common neurological manifestation (69.2%), followed by areflexic paraparesis (15.3%). Paradoxical reactions occurred in 20.5% of cases. Microbiological confirmation was achievable in approximately 77% of cases. Neuroimaging abnormalities were present in 41% of cases, and chest imaging abnormalities in 53.9%. Longitudinally-extensive hyperintensities in cervical and thoracic regions were common spinal imaging abnormalities. Central nervous system tuberculosis was confirmed in 47.7% of cases, while pulmonary and disseminated tuberculosis were each found in 25.6%. Improvement was noted in 87.2% of cases, while 10.3% did not improve or died.ConclusionTuberculous myelitis, is a distinct spinal cord disease. Most cases had microbiological confirmation, and the majority showed improvement with treatment.