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Background: Stroke is the second leading cause of mortality and morbidity worldwide. Cardioembolic stroke accounts for 15-30% of Ischemic stroke. There have been very few clinical studies on cardioembolic stroke, especially from India. Our aim was to provide a demographic, risk factor and clinical profile of patients with cardioembolic stroke in South India.Methods: A prospective study was conducted at the Neurology Inpatient Department over a period of 5 years from January 2013 to January 2018 collecting necessary information and data from all cases diagnosed as cardioembolic stroke.Results: 651 patients were diagnosed to have acute Ischemic stroke. Of the 76 patients (11.6%) diagnosed with cardioembolic stroke, 35 (46%) were females. Mean age was 53.5±12.2 years. Occurrence of cardioembolic stroke was seen to be higher (71% vs 28.9%, p value<0.0001) in patients of older age group (46 years or more). A significant proportion of patients of the older age group (37%) had hypertension (p value=0.0048). Coronary artery disease (CAD) was the most prevalent cardiac disorder, observed in 42 patients (55.2%), valvular heart disease in 22 patients (28.9%) and atrial fibrillation in 14 patients (18.4%). Limb weakness (84.2%) and Middle Cerebral Artery (MCA) territory (73.6%) infarct were observed in majority of the patients.Conclusions: Prevalence of cardioembolic stroke in this region is lower than reported worldwide. While male predominance of cardioembolic stroke was noted, old age and hypertension were the major vascular risk factors identified. CAD was the major source of cardioembolism.

Background: Stroke is the leading cause of acquired disability worldwide. Better understanding of risk factors helps to reduce the community burden of stroke. Aim of the study was to determine pattern of ischemic stroke subtype and associated risk factors. Methods: Of 220 patients with first ever stroke, 168 patients of ischemic stroke were enrolled prospectively from January 2016 to May 2016 at ESIC Superspeciality hospital, Hyderabad. Patients were categorized in accordance with the Trial of Org 10172 in Acute Stroke treatment (TOAST) criteria. Results: Of 168 patients, 110 (65.4%) were males; male to female ratio was 1.8:1. The mean age was years. Small vessel occlusion (SVO) occurred in younger age group as compared to other stroke subtypes. Frequency of large-artery atherosclerosis (LAA) (46.4%) was highest (Extracranial: 41.1%, intracranial: 36.9%), followed by SVO (32.4%), cardio embolism (15.4%), undetermined (4.7%) and other determined causes (1.1%). Risk factors included dyslipidemia (79%), hypertension (67.8%), smoking (58.3%), alcohol use (54.7%), diabetes (40.4%) and physical inactivity (27.3%). Common association observed was smoking (P -0.004) and alcohol (P -0.003) with LAA and SVO, and dilated cardiomyopathy with cardio embolism. Conclusions: LAA was observed frequently than SVO. Frequency of SVO was lower than Asian but higher than western, while cardio embolism was lower than Western and similar to Asian stroke studies. Dyslipidemia was the predominant risk factor than hypertension reported from Asian and Western stroke registry. This unique pattern can be attributed to differences in demographic and risk factor profiles. The study confirms the need for vigorous primary and secondary prevention measures targeting modifiable risk factors of stroke.

Background: Guillain-Barré Syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy and an important cause of acute flaccid paralysis (AFP) worldwide. Respiratory insufficiency requiring ventilator occurs in 30% of patients that prolong the hospital stay, leading to morbidity and mortality. There had been relatively few studies of Guillain-Barre syndrome in adults from South India. Aim: To evaluate clinical profile, epidemiological, laboratory, and electro diagnostic features of patients with GBS in adults. Settings and design: A prospective study was conducted over a period of 4 years at ESIC Superspeciality Hospital, Hyderabad. Materials and methods: Total 36 patients were identified and data was collected. We studied the epidemiological, clinical, electrophysiological features and their outcome. We subdivided Hughes grade 5 into 5A and 5B based on the requirement of ventilator. Statistical Analysis: Data obtained in the study were subjected to statistical analysis with Statistical Package for Social Sciences (SPSS) version 18. Bivariate analysis was done using chi-square test. Results: Of 36 GBS patients, 21(58.3%) were males; the mean age was 35 years. Antecedent infection was found in 23(63.8%). Majority 12 (33%) were in Hughes grade 4, 10 (27.7%) were in Hughes grade 5A. 97.2% had limb weakness. A significant association was found between low Medical research sum score (MRC) and respiratory failure. Most predominant neurophysiological variant was acute inflammatory demyelinating polyradiculoneuropathy (AIDP) 12 (33.3%). Duration of illness was less than 1week in 19 (52.7%) of cases. Asymmetry was observed in 5 (13.8%) and recurrence of Guillain-Barre Syndrome seen in 2 (5.5%) cases. Complete recovery was noted at 6 months in 34 (94.4%) cases. Conclusion: Early diagnosis of respiratory failure and prompt intervention improves patient outcome. Further large sample studies are required to assess respiratory failure and subdivision of Hughes grade 5.

Background and Objective: Diet plays a crucial role in the occurrence of stroke. But very few studies have so far been conducted with focus on this aspect of acute stroke in India. The objective of the study was to identify the dietary pattern in patients with acute stroke in South India. Materials and Methods: Patients with first-ever acute stroke (ischemic and hemorrhagic) admitted between June 2017 and November 2017 were enrolled and compared with age- and sex-matched controls. Information was collected using a pro forma. Results: Out of 293 acute stroke patients, 150 were enrolled and compared with 150 controls. The mean age was 52.3 ± 12.6; years 112 (74.6%) patients were male. The majority of them were on traditional diet that included a daily intake of rice (98.6%) and pulses (40.6%). Hypertension (73.3%) was the major vascular risk factor for stroke (P < 0.0001). Significant differences were observed in risk factors such as diabetes (P < 0.0001), smoking (P = 0.0001), alcohol use (P = 0.0017), and heart disease (P = 0.0002), when stroke patients were compared with controls. Stroke patients reported a lower intake of green leafy vegetables (P = 0.0001; odds ratio [OR] 0.17), roots and tubers (P = 0.0016; OR 0.21), and fruits (P = 0.0022; OR 0.29). There was at the same time a higher intake of red meat products (P = 0.04; OR 2.41), organ meats (P = 0.0093; OR 4.35), fried snacks (P = 0.0038; OR 2.01), and pickles (P = 0.04; OR 1.81) although the data suggested lesser consumption of prawn and crab (P = 0.04; OR 0.55) and water (P = 0.0001 OR 4.59) among stroke patients. Higher consumption of fruit juices (P = 0.0008) and junk foods (P = 0.03) was observed in young stroke patients (age ≤45 years) whereas the intake of chicken (P = 0.03) and alcohol (P = 0.0001) was observed to be more among men than among women. Conclusion: Majority of stroke-afflicted patients in South India consume white rice and dal. There is lower intake of water, green leafy vegetables, and fruits and higher consumption of red meat, organ meat, and pickles among stroke patients.

Introduction: Essential tremor (ET) is the most common adult movement disorder. Classic ET is characterized by action tremor of hands (95% cases), and tremor involving other regions is less common. Recent studies have revealed a few patients exhibiting nontremor features that include cognitive disorders, tandem gait abnormality, mood fluctuations, olfactory abnormality, hearing impairment, and sleep disorders. Very few studies on ET have so far been conducted in India, and the present study is a pioneering attempt to evaluate the clinical characteristics of patients diagnosed with ET. Materials and Methods: A standardized assessment protocol was used to collect data. Diagnosis of ET was established using consensus criteria established by the Movement Disorder Society. Tremor Research Group Essential Tremor Rating Assessment Scale was used to evaluate tremor impact. The severity of hand tremor was assessed by Glass Scale, and cognitive function was assessed by Mini–Mental Status Examination. Results: Out of the 45 patients enrolled, 73.3% were male and 26.6% were female, with a mean age of 44 ± 15 years. Postural tremor was observed in all, followed by intention tremor in 9 and rest tremor in 6 patients. Tremor of the hand was identified to be most predominant (100%). Voice tremor was observed in 15 (33.3%) patients and head tremor in 12 patients (26.6%) who were all females. Leg tremor was observed in 12 patients (26.6% of patients) and tongue tremor in 6 (13%) patients. Baseline asymmetry of tremor was observed in 60% of patients and positive family history in 35% of patients. The most common nontremor feature was tandem gait abnormality (40%). Moreover, most of the patients had Glass Scale II. Conclusion: Baseline asymmetry of tremor and male predominance were observed in the study. While hand tremor was the most common form of tremor, tandem gait abnormality was the most common nontremor feature as observed in patients with ET.

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Albright hereditary osteodystrophy (AHO) is a hereditary metabolic disorder that presents with seizure secondary to hypocalcaemia. A careful phenotypic assessment of patients presenting with seizure clues to the diagnosis of AHO. The characteristic features are short stature,obesity and brachydactyly.Pseudohypoparathyroidism (PHP) is observed in patients with AHO and is characterized by inability of the body to respond appropriately to parathormone, mainly characterized by hypocalcaemia, increased serum parathormone concentration, insensitivity to the biological activity of parathormone, and hyperphosphatemia. In this study, we report a 14-year-old boy with distinctive phenotype of AHO, oral manifestations, and signs of tetany with PHP presenting as recurrent generalized seizure.