Neurological Disorders

Viral encephalopathy is a very rare, but a serious neurologic condition. We present a patient who was admitted to our hospital because of drowsiness, memory disturbances, non-compliance, and disorientation. Treatment with methylprednisolone pulse treatment facilitated recovery without severe sequela. Therefore; when acute viral encephalopathy is actually suspected, steroid pulse therapy should be considered during the treatment.

Background: In patients with Parkinson's disease (PD), the impairment of voluntary and involuntary movement during sleep might affect their natural sleep and quality of life; however, there is no reliable method to evaluate turnover movements during sleep. We aimed to clarify whether overnight monitoring of turnover movements in bed using a wearable three-axis accelerometer is a feasible and reliable tool for evaluating the impact of motor complications during sleep in PD.

Methods: The number of turnover movements in bed was counted based on the graphic pattern in the X, Y, and Z axis using threshold values in each axis to discriminate turnover movements from other movements mainly associated with respiration or cough. These threshold values were defined by the recordings of various turnover movements in normal volunteers. Overnight monitoring of turnover movements in bed from 9:00 pm to 7:00 am was performed in 7 normal volunteers and 5 patients (mean age, 76.4 ± 4.6 yrs, Hoehn-Yahr stage, 3.6 ± 0.5; duration of disease, 8.8 ± 5.6 yrs). In patients with PD, monitoring was performed before and after adjustment of anti-Parkinson medications.

Results: The number of turnover movements was significantly more restricted in PD before drug control than in control subjects (p=0.005). The median number of overnight turnover movements increased from 0 to 5 times after drug control in patients with PD. The number of overnight turnover movements increased significantly in all 5 patients after adjusting their anti-Parkinson medications (p=0.041).

Conclusion: Overnight monitoring of turnover movements in bed using a wearable three-axis accelerometer is feasible. Further studies are warranted to evaluate the impact of movement disorders during sleep on patients with PD.

Wound healing and infection is a concern for all surgeons, especially in cases of repeat surgical intervention. The osteoplastic flap is a technique that was previously used frequently in cranial surgery but since the introduction of cranial plating systems, it is now used only rarely. A retrospective study showed that although the infection rates of osteoplastic flaps were similar to free flaps, the need for another surgery for surgical washout and bone flap removal was lower (but not statistically significant) in the osteoplastic flap group.

The Bilateral Medial Medullary Infarction presents with progressive tetraparesis, bilateral profound sensory loss, dysphagia and dysarthria, progressing to respiratory failure, which can be misdiagnosed with Guillain-Barré syndrome. The main cause its vertebral artery atherosclerosis and thrombosis affecting the anteromedial (supplied by branches of vertebral artery and anterior spinal artery) and anterolateral (fed by short and long transverse branches of vertebral artery) territories of medulla bilaterally. The diagnosis is facilitated by Diffusion Weighted Image and ADC-map on MRI, which shows a V-shape infarction, or, as known, the “heart sign” (Figure 1 and Figure 2), which is typical of this disease. The outcome is poor, with high mortality.

Objective: To investigate the effect of dietary factors such as calorie intake and dietary fats on the progression of aortic arch atheroma (AA). Background: In stroke/TIA patients, progression of AA is associated with recurrent vascular events. Design/Methods: Consecutive patients with measurable (>1 mm) AA atheroma on baseline transesophageal echocardiogram (TEE) evaluation consented to a protocol mandated follow-up TEE at 12 months. Patients that had adequate paired AA images were assessed for progression, defined as Δ ≥ 1 grade worsening (based on plaque thickness over 12 months). Stroke risk factors and fasting lipid profile were assessed at baseline. The patient’s nutritional intake was measured at baseline using the Gladys Block Food Frequency Questionnaire. Results: One-hundred-nine patients (70 strokes, 33 TIAs) had sequential TEEs, of whom 27% (N=30) progressed and 73% (N=79) did not. Patients with progression had higher daily calorie (1778 ± 623 vs. 1378 ± 406 Calories, p=0.008), fat (76 ± 33 vs. 52 ± 23 grams, p=0.0002), carbohydrate (208 ± 78 vs. 169 ± 57 grams, p=0.01) and protein (73 ± 26 vs. 57 ± 21 grams, p=0.005) intake. On Further analysis among different fats showed a higher consumption of saturated fats (25 ± 12 vs. 17 ±8 grams, p=0.00051) as well as unsaturated fats (44 ± 20 vs. 30 ± 13 grams, p=0.002). These differences remained significant after we adjusted for the medication use. However the significance of these differences was attenuated after adjusting for the calorie intake. Cholesterol consumption did not differ between the progression and no-progression group (262 ± 125 vs. 213 ± 149 mg, p=0.2). Conclusions/Relevance: Calorie intake plays a significant role in the progression of AA. Further studies are needed to confirm these findings and determine the specific dietary modifications that may prevent AA progression and associated recurrent vascular events.

We report the case of a 40-year-old man with ventriculo-peritoneal shunt who presented with chronic subdural hematoma (CSDH). He underwent burr-hole craniostomy with a closed drainage system. A computed tomography scan conducted on postoperative demonstrated a bilateral acute epidural haematoma in the occipital location. Craniotomy and haematoma evacuation were immediately performed. To the best of our knowledge, this is the first reported case of an acute bilateral hematoma after drainage of a chronic bilateral subdural hematoma complicating ventriculo-peritoneal shunt. Although extremely rare, it should be considered as a possible complication.

Background: Cerebral palsy (CP) is a persistent disorder of movement and posture caused by non-progressive pathological processes of the immature brain. This is the natural history of the gait disorder in children with more severe diplegia and in the majority of children with spastic quadriplegia. One of the most common movement abnormalities among children with cerebral palsy is a crouched gait. Neuromuscular electrical stimulation (NMES) is the application of electrical current transcutaneously to innervated, superficial muscle to stimulate muscle fibers, augment muscle contraction, increase range of motion (ROM), and increase sensory awareness. The purpose of the study was to investigate the effects of NMES on Gluteus maximus and Quadriceps strength in cerebral palsy children with crouch gait, and the subsequent effect on their gross motor function.

Methods: Total 40 children (13 females, 27 males, age group 5 years to 11 years) were recruited for study from the paediatric section of physiotherapy department of Swami Vivekanand National Institute of Rehabilitation Training and Research according to the inclusion and exclusion criteria and were randomly allotted in 2 groups. All were randomly assigned to either the stimulation (group 1) or control group (group 2). The stimulation group received neuromuscular electrical stimulation to gluteus maximus and quadriceps muscles for 15 minutes each, 5 days/week for a period of 6 weeks.

Results: Both the groups showed significant improvement in strength of gluteus maximus and quadriceps of CP children with crouch gait, but experimental group showed significantly more improvement as compared to control group. There was also statistically significant difference in dimension D and E (standing and walking) of the gross motor function measure between the experimental group and control group.

Conclusion: This study has shown that neuromuscular electrical stimulation in addition to conventional exercise is found to be effective in improving strength and function than conventional exercise alone.

Susceptibility to suicide and suicidal ideation is a very serious issue in patients with Parkinson’s disease (PD). There is much that is still unknown about the relationship between suicide, age, medical treatment and disease in the PD patient population. Depression is the most common psychiatric disturbance that affects people with PD. On multivariate analysis, severity of depression and psychosis were the only predictors of suicide or death ideation for PD patients.