Background Benign paroxysmal positional vertigo (BPPV) is considered to be the most common type of vertigo. There is strong evidence supporting the role of Dix Hallpike maneuver in diagnosing BPPV, and canalith repositioning maneuver CRM in managing it; but these maneuvers are underutilized. Material and methods: A prospective study was conducted in the Department of Neurology in a tertiary care center referral hospital in Kashmir, north India. All the patients of vertigo diagnosed as BPPV were included in study. History and examination was done and patients were followed to see the response of treatment. There referrals notes, previous records were checked for the diagnosis, treatment and investigations done for managing their complaints were studied and recorded. Results: Out of total of 101 patients diagnosed as BPPV, 77 were females and 24 were males with M:F ratio as 1: 3.2 . The frequency of various subtypes of BPPV were: posterior canal in 96 patients, horizontal canal in 4 and anterior canal in one. On reviewing records of patients only 10% of had been given diagnosis of BPPV .All patients had been treated with labyrinthine sedatives and other medications and none had been offered CRM.84% patients had undergone various unnecessary investigations . Conclusion. A vast majority of patients with BPPV don’t get an accurate diagnosis in their first contact with health care professionals. Most of the patients undergo unnecessary investigations .CRMs like Epley’s maneuver are not offered to BPPV patients even though they are the standard of care in this condition.
Background: Axonal loss is thought to occur early in the course multiple sclerosis (MS) and is supposed to be associated with, and predictive of, neurologic deficits progressing to permanent disability. Axonal loss in the retinal nerve fiber layer (RNFL) is measured by optical coherence tomography (OCT). Material and Methods: A longitudinal observational study, conducted on 30 MS patients. All subjects underwent neurological examination, including expanded disability status scale (EDSS) scoring and OCT on two visits, minimum 2 months apart. Results: Total of 60 eyes of 30 patients were subdivided into 21 eyes having optic neuritis (ON) ['MS-ON'] and 39 eyes without ON. The RNFL thickness (RNFL t) was found to be significantly reduced in all parameters except in temporal quadrant, as the duration of disease increases. Average RNFLt were found to have negative correlation (r =-0.450) with disease duration. Negative correlation (r=-0.657) was also found between EDSS score change and average RNFLt change. The eyes having ON showed statistically significant RNFL thinning as compared to the non-ON fellow eyes. The baseline EDSS score was found to be negatively correlated (moderate degree, r =-0.348) with baseline average RNFL thickness, with p-value of 0.006. Conclusions: The RNFLt is not only significantly thinner in those with history of ON, but it is also affected remarkably even in absence of prior ON, suggesting subclinical ongoing axonal loss in patients with MS. The EDSS score is inversely correlated with RNFL thickness.
Background: Vitamin D deficiency is present in India in epidemic proportions despite plenty of sunshine. Reduced plasma 25(OH) D concentrations as a diagnostic marker of vitamin D deficiency have been in past decade associated with several well-established risk factors for ischaemic stroke, such as arterial hypertension, thrombosis, atherosclerosis. The aims and objectives of this study was to compare the serum 25(OH) D levels between the first ever acute stroke patients and healthy controls.Methods: A cross-sectional, case control study was conducted in a tertiary care hospital in New Delhi situated in north India. Serum 25‑hydroxyvitamin D (25(OH) D) levels in 85 patients of ischemic stroke, presenting within 7 days of onset of stroke was measured and was compared with 70 age and gender matched controls.Results: The mean age was 61.02±11.58 years and 58.63±11.28 years in cases and controls respectively. Females constituted 37.6% of the total number of cases and 43.4% of the controls. The age and gender-distribution were comparable between the cases and controls. The median value (IQR) of serum 25(OH) vitamin D level was 7.94 ng/mL (4.59-14.00) in the cases and it was 8.82 ng/mL (5.59-14.70) in the controls. The difference between the serum 25(OH) vitamin D levels of the two groups was not found to be statistically significant.Conclusions: There is a high prevalence of biochemical hypo-vitaminosis D in apparently healthy Indians of all age and sex groups despite adequate sunshine. There is no association between low vitamin D levels and stroke.
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