Covid-19 induced optic neuritis – A case report

COVID-19 illness is an evolving disorder, and many extrapulmonary manifestations have been reported. With this report, we are highlighting one of the neuro-ophthalmologic complications of Covid-19. We report a case of 16 years old boy who presented with complaints of rapid loss of vision and retroorbital pain in the Right eye during recovery from Covid -19 infection. Clinically, radiologically, CSF, Blood, and all other investigations suggest Probable Covid -19 Right Eye Optic Neuritis. The patient showed remarkable recovery following steroid therapy. This report aims to add a case to the limited literature available on Optic Neuritis following Covid-19 infection.

Guillain barre syndrome and its association with covid-19 infection – A clinical case series

A novel coronavirus (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2). This pandemic has been globally alarming in the current period. Several neurological manifestations are reported occurring with the infection. Guillain barre syndrome (GBS) or acute onset inflammatory polyradiculoneuropathy has been among the frequent manifestations observed among them. To know the pattern and outcome of GBS in COVID-19 affected individuals. We have taken six individuals admitted with flaccid quadriparesis in the last two months. All were affected recently by COVID 19 infection, which RT PCR of the nasopharyngeal swab confirmed. The study participants have undergone nerve conduction studies and have been diagnosed with Guillain Barre syndrome using Brighton criteria. We did cerebrospinal fluid (CSF) analysis after admission. We initiated all patients on Intravenous immunoglobulin according to body weight (2g/kg divided over five days). We used the Barthel index score to assess the outcome of the individuals. We observed a mean duration of 18.25 days between the COVID-19 infection and the onset of symptoms. Apart from motor quadriparesis and sensory symptoms being in common, we also noticed cranial nerves and autonomic involvement. We made the diagnosis using the nerve conduction studies and Brighton criteria. After initiating intravenous immunoglobulin, all patients had a good outcome, and quality of life was better after two months of follow up. Guillain Barre syndrome is one of the neurological manifestations of COVID-19 and has a dramatic response with intravenous immunoglobulin and better outcome with treatment.

Evaluation of C-reactive protein and magnesium level in migraine patients on pre and post prophylactic treatment

Migraine affects the day to day life of the sufferers with the symptoms of photophobia and phonophobia with pulsatile or non-pulsatile headache lasting from 1 to 4 hours. Prophylactic treatment or anti-migraine drugs were given to migraineurs to overcome the complications. C-reactive protein (CRP) and Magnesium level of symptomatic migraineurs, which act as biomarkers for the inflammatory cerebrovascular diseases before and after the treatment with Sodium Divalproex, Flunarizine and Propranolol. The evaluation of C-reactive protein and magnesium levels are noted along with symptoms when they first walk into the clinic. Treatment provided with Sodium Divalproex, Flunarizine and Propranolol for one month. After 1 month, the same tests are being performed. During the test at first instance, the values of pain scale were 31%, CRP value for negative were 20% and positive were 80% and pre-test of Serum magnesium level was 8.8% and at the second visit the pain scale reduced to 10.25%; CRP level was negative 25% and positive was 75%; Serum Magnesium was 9.35%. So, the significant values are being measured by the statistics, which we applied and found P=0.05. The patients who visited first didn’t come for the second visit. So, the results might vary and the patients who visited for the second time after one-month treatment, some got effective results while others remained ineffective. The reason for being ineffective is that they might have adapted to their current regimen.

The prevalence and burden of primary headache disorders among adults in rural villages of Bangalore District, South India: A community-based study

The prevalence of primary headache disorders (PHDs) and their burden has been seldom studied in the rural community setting of a developing country. To study the prevalence of primary headache disorders and their burden in the rural community A door to door survey was done in seven rural villages under Mugalur sub centre area, Sarjapura Primary Health Centre and Anekal taluk, Bangalore district, Karnataka State, south India, for finding the prevalence and burden of PHDs. During the study period of three months, a total of 1255 people were screened in the seven villages. 13.1% (165/1255) of people suffered from PHDs. The population prevalence of migraine without aura was 8.84% (111/1255), tension type headache was 2.86% (36/1255) and chronic migraine was 1.43%(18/1255). The mean number of headache days for all the PHDs was 4.26 (±1.64) days. 66.1% of persons with headache reported minimal or infrequent impact of headache. Among various demographic variables, headache was significantly associated with the female gender and marital status. PHDs are prevalent in the rural communities of developing countries and need urgent attention of primary care physicians, community health departments, governmental agencies and policy makers.

SUDEP in adults and children

Sudden unexpected death in epilepsy (SUDEP) represents an important cause of death in patients with epilepsy and it exceeds the expected rate of sudden death in the general population by nearly 24 times. We searched the electronic databases (Cochrane, EMBASE, Scopus, Medline, Pubmed) for studies related to etiology and risk stratification of SUDEP including data on Takotsubo cardiomyopathy (TKC) following seizures resulting in death or near death.: SUDEP is more common among males in the fourth decade of life. Risk for SUDEP is increased by early onset of seizures, low IQ, generalised tonic clonic seizures, nocturnal seizures and seizure frequency. Nonadherance to antiepileptic medications, absence of therapeutic drug level monitoring, presence of neuropathological lesions on imaging and certain subgroups like Dravet syndrome increase its risk. The risk for premature death in patients undergoing temporal lobe resection for drug resistant epilepsy decreased over time but remained above the standard population. Prolonged postictal electroencephalographic suppression was a risk factor for SUDEP in patients with generalised seizures which may indicate a cerebral electrical shutdown. Documented ictal/postictal hypoventilation, laryngeal spasm and cardiac rhythm abnormalities prior to SUDEP may suggest central apnea, neurogenic pulmonary edema, cardiac arrhythmia, or a combination of the above as a cause. Seizure triggered TKC does not seem to play a major role in the pathogenesis of SUDEP.

A review: Management of motor neuron diseases

Motor neuron diseases are a group of chronic sporadic and hereditary neurological disorders characterized by progressive degeneration of motor neurons. These might affect the upper motor neurons, lower motor neurons, or both. The prognosis of the motor neuron disease depends upon the age at onset and the area of the central nervous system affected. Amyotrophic lateral sclerosis (ALS) has been documented to be fatal within three years of onset. This activity focuses on amyotrophic lateral sclerosis as the prototype of MND, which affects both the upper and the lower motor neurons and discusses the role of inter-professional team in the differential diagnosis, evaluation, treatment, and prognostication. It also discusses various other phenotypes of MND with an emphasis on their distinguishing features in requisite detail.

Approach to an adult with an episode of seizure

A patient with known epilepsy who has had a single, habitual seizure and whose mental status has returned to baseline need not be transported to the emergency department (ED) unless other injuries require so, whereas a patient with no history of epilepsy who has returned to baseline following a seizure should be evaluated. The evaluation should include basic biochemical parameters, toxicology screening and a brain imaging. One should investigate circumstances that may have precipitated a seizure, such as alcohol withdrawal, stimulant use, or head injury. Risk of recurrence of seizures is more likely in those with a history of significant brain injury or infection. If the patient has a normal magnetic resonance imaging (MRI) and electroencephalograph (EEG), the likelihood of a second seizure is approximately 1 in 3; if either test result is abnormal, the chances are approximately 1 in 2; if both are abnormal, the probability rises to 2 in 3. Computed tomography (CT) scan head is very useful in the evaluation of first seizure in infants less than six months of age. The clinical characteristics predictive of an abnormal CT scan for patients presenting with seizures were age less than 6 months or age greater than 65 years, history of cysticercosis, altered mentation, closed head injury, recent cerebrospinal fluid (CSF) shunt revision, malignancy, neurocutaneous disorder and seizures with focal onset or duration longer than 15 minutes. MRI has been shown to be superior to CT for the detection of cerebral lesions associated with epilepsy.

Investigation of multi-site micro recordings of subthalamic nucleus neurons using machine learning MER with DBS in Parkinson`s – A simulation study

Multineural spikes were acquired with a multisite electrode placed in the hippocampus pyramidal cell layer of non-primate anesthetized snitch animals. If the impedance of each electrode-site is relatively low and the distance amongst electrode sites is appropriately miniatured, a spike generated by a neuron is parallelly recorded at multielectrode sites with different amplitudes. The covariance between the spike of the at each electrode-point and a template was computed as a damping-factor due to the volume conduction of the spike from the neuron to electrode-site. Computed damping factors were vectorized and analyzed by simple but elegant hierarchical-clustering using a multidimensional statistical-test. Since a cluster of damping vectors was shown to correspond to an antidromically identified neuron, spikes of distinct neurons are classified by suggesting to the scatterings of damping vectors. Errors in damping vector computing due to partially overlapping spikes were minimized by successively subtracting preceding spikes from raw data. Clustering errors due to complex-spike-bursts (i.e., spikes with variable-amplitudes) were prevented by detecting such bursts and using only the first spike of a burst for clustering.

GABA: A critical player for regulating synaptic plasticity and adult neurogenesis

During aging, the decrease of cognitive ability is believed to be the cause of age related neuronal damage and reduced proliferation and differentiation of adult-born neural precursor cells. To modulate the synaptic plasticity and adult neurogenesis, it is of immense importance to enhance the potential of resident neural stem cells of hippocampus and sub ventricular zone (SVZ). The necessity to restore brain functions is enormous in the neurodegenerative disease like Alzheimer, Parkinson diseases, stress induced cognitive dysfunction, depression and age-associated and HIV-associated dementia. As a pioneer transmitter, Gamma Amino Butaric Acid (GABA) influences the activity dependent adult neurogenesis and excites immature neurons in adult hippocampus. GABA holds the key for making adult immature neuron to mature functional neuron hence plays critical role in adult neurogenesis.This review aims to discuss about the spatio-temporal expression of various subunit of GABA-A receptor and how these subunits intimately modulates the synaptic plasticity. During developmental period GABAergic neurons mature at early stages and regulate overall neural activity much before the activity of glutamate. Not only during development but also during adult neurogenesis GABA plays a significant role in neurite outgrowth and establishing well network.