Ganglioglioma of the cranial nerves is extremely rare; only a few cases involving the optic nerves have been reported. We present a case of ganglioglioma of the trigeminal nerve, which was isointense with the brain stem on all MRI sequences and showed no contrast enhancement.
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.
Background: Hyperhomocysteinemia (HHcy) is a well-established risk factor for vascular thrombosis leading to stroke. Homocysteine (Hcy) is mainly synthesized in the methionine cycle, and it is an intermediate during the conversion of methionine to cysteine. HHcy can develop by polymorphism of several enzymes like methylene-tetrahydrofolate-reductase (MTHFR) mutation and due to deficiency of co-factor Vitamins such as B12, B6, and folic acid. This study was planned to see the association between HHcy and MTHFR gene polymorphism in patients with stroke in populations from central India. Methods: Seventy-two patients diagnosed with stroke aged 18 years and above who met the inclusion criteria were selected. Hcy level and MTHFR mutation were identified among patients of stroke. Results: Forty-two patients (58.33%) were diagnosed with acute ischemic stroke as compared to cerebral venous thrombosis (30, 41.66%) from a total of 72 patients. The statistical analysis projected that the HHcy diagnosed among more (45, 62.5.0%) cases with stroke who had aged ≤45 years as compared to cases who had aged >45 years (17, 23.6%). None of our patients tested positive for either CT (Heterozygous) or TT(Homozygous) genotypes. Conclusions: HHcy is not associated with MTHFR gene mutation in our study group, and this possibly is related to the deficiency of co-factors in Hcy metabolism. Young age group stroke patients have higher Hcy levels.
Background: Respiratory system involvement and fever are considered as a cardinal manifestation of Covid-19 infection for the screening of case detection. We (India) are into the fourth month of Covid-19 and cases are still rising, this could mean that fever and respiratory symptoms may not be the only initial symptoms. Therefore, we intend to investigate whether neurological symptoms can precede the cardinal symptoms. Methods: Totally, 391 Covid-19 RTPCR positive hospitalized patients were enrolled. All included subjects were presented with a questionnaire pertaining to systemic symptoms. For analysis of the chronology of symptoms, the study population was sub-grouped according to onset of their systemic involvement e.g., (1) Fever (2) Respiratory symptoms (3) Neurological symptoms (4) Gastrointestinal symptoms. Results: New-onset neurological symptoms were found in 106 (27.1%) out of 391 patients irrespective of their chronology to the onset of other symptoms. Of these 106 patients, altered taste (33.1%), altered smell (24.5%), and headache (22.6%) were the most common neurological symptoms. However, 38 (9.7%) subjects recognized neurological symptoms, as the initial manifestation of their illness. Mean duration of neurological symptoms before the onset of respiratory symptoms or fever was 2 ± 1.57 days. Conclusion: New-onset headache, altered taste, and smell were the most common neurological symptoms. In the context of the current pandemic, a high index of suspicion should be kept in patients presenting with these symptoms even in the absence of fever and respiratory symptoms. To the best of our knowledge, this is the first study from India comparing chronology of neurological symptoms with cardinal symptoms.
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