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Background: Factors associated with risk with leaving hospital against medical advice (AMA) in neurology patients is unknown. Objective: To determine prospectively, the association of gender, age, religion, care type received, economic status and prognosis of the neurology patients, with the discharge AMA (DAMA) and correlate them with the reasons for DAMA cited by the patients or their relatives. Material and Methods: In-patients who left AMA between the year 2013 and 2016 (n = 689), were prospectively included in the study. Determinants of DAMA and the factors associated with DAMA within eight hours of admission (AMAe; n = 177) were analysed. A pre-AMA questionnaire was completed by those who left AMA after 8 hours (AMAd; n = 512). Results: Higher odds of AMA were associated with female gender (OR:1.48), age beyond 50 years (OR:1.35) and admission to intensive care (OR:2.59). Financial constraint was cited as reason of AMAd by the patients with low income (OR:1.72). Higher odds of association of influence of a first degree relative in the decision of AMAd were found in women (OR: 1.33) and persons more than 50 years (OR: 2.95). Discussion: Women and person older than 50 years had higher risk of DAMA, mostly due to the influence of a first-degree relative. The risk of leaving AMA was significant in those admitted in the neurological intensive care unit. Of all cited reasons of leaving AMA, financial constraint was most significant. Conclusion:The study provides an insight into the factors for associated with risk of DAMA from neurology wards.

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Background In the list of named numerical neuro-ophthalmological syndromes, such as one-and-a-half syndrome and others, we report for the first time twenty-and-a-half syndrome, which is characterized by one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy (1.5 + 7 + 7 + 5 = 20.5) in a patient with ischemic stroke. Case presentation A 45-year-old Asian Hindu woman presented with vomiting and imbalance of 1 day’s duration. She had left-sided ataxic hemiparesis with one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy. Magnetic resonance imaging of her brain revealed acute non-hemorrhagic infarct in the right posterolateral aspect of pons and medulla, with normal brain vessels angiography. We described her disorder as twenty-and-a-half syndrome. She was put on antiplatelet therapy. Conclusions Twenty-and-a-half syndrome is reported for the first time. It is due to posterior circulation stroke; in our case, it was due to lacunar infarcts in the pons and medulla, manifesting as one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy.

<p class="abstract"><strong>Background:</strong> In patients with acute exacerbations of COPD, endotracheal intubation and complications associated with mechanical ventilation may be evaded using non-invasive ventilation.<strong> </strong>The aim of the study was to analyse the effectiveness of NPPV for hypercapnic respiratory failure secondary to acute exacerbation of COPD in India.</p><p class="abstract"><strong>Methods:</strong> In this prospective study, 63 cases of hypercapnic respiratory failure secondary to acute exacerbation of COPD admitted in the intensive care unit during 2011-13 formed the study population. Standard therapy was initiated in all the patients. Patients who failed to improve with standard therapy alone were given a trial of non invasive ventilation. Non invasively ventilated patients, showing significantly improvement in their clinical status and arterial blood gas parameters were discharged. Patients who failed to show significant improvement with NPPV were given invasive ventilation.</p><p class="abstract"><strong>Results:</strong> Standard therapy was initiated in 63 patients on admission but 25 patients failed to improve with standard therapy alone. Out of the total 25 patients non invasively ventilated, 22 patients showed significantly improvement. Significant improvement in the Mean pH, Mean paCO2 and Mean paHCO3 in both standard therapy and non invasive ventilation group. Success rate was found to be highest (88%) in standard therapy + noninvasive ventilation treatment modality group.</p><p class="abstract"><strong>Conclusions: </strong>NIV is an effective tool in hypercapnic respiratory failure secondary to acute exacerbation of COPD and its early initiation would improve the clinical status and respiratory acidosis.</p>