Browsing by Author "Nair, M"

Now showing 1 - 11 of 11
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    A hospital-based registry of Creutzfeldt-Jakob disease: Can neuroimaging serve as a surrogate biomarker?
    (NEUROLOGY INDIA, 2016) Divya, KP; Menon, RN; Thomas, B; Nair, M
    Aim: This study addresses the role of neuroimaging in addition to the available clinical criteria for Creutzfeldt-Jakob disease (CJD) and its impact on its diagnosis in the absence of cerebrospinal fluid (CSF) biomarkers and tissue-based approaches. Methods: From a tertiary referral center in the city of Trivandrum, Kerala, South India, patients with rapidly progressive dementia (RPD) who fulfilled the World Health Organization (WHO) 1998 diagnostic criteria for CJD were included in this study. Their electrophysiological-clinical-radiological data were retrospectively studied and the results were analyzed. The other biomarkers of CJD were not assessed in the study. Results: Of the 96 patients with RPD, 41 patients were diagnosed as having a 'probable' and 'possible' CJD using the WHO 1998 diagnostic criteria between 2000 and 2013. While 92% patients satisfied the University of California, San Francisco (UCSF) 2007 and European magnetic resonance imaging (MRI)-CJD consortium criteria (2009), only 73% satisfied the MRI components of these criteria in addition to the more stringent, proposed UCSF MRI criteria (2011). The latter required the presence of diffusion weighted imaging abnormalities more than fluid attenuation inversion recovery abnormalities in the cortical and subcortical regions for the establishment of diagnosis on MRI of 'definite' (53.7%) and 'probable' CJD (19.5%). Conclusions: Significant heterogeneity exists in the presentation of CJD with only 48.8% patients simultaneously satisfying the MRI and electrophysiological criteria, suggesting that the diagnosis is impacted by these components in any of the currently prevalent criteria. With 27% of the cohort not meeting the radiological criteria, CSF and molecular biomarker assays may be reserved for MRI negative patients with suspected CJD and in atypical presentations.
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    An audit of the predictors of outcome in status epilepticus from a resource-poor country: a comparison with developed countries
    (EPILEPTIC DISORDERS, 2016) Hassan, H; Rajiv, KR; Menon, R; Menon, D; Nair, M; Radhakrishnan, A
    Aim. Status epilepticus is a neurological emergency with significant morbidity and mortality. This study describes the clinical profile, treatment, and predictors of outcome of status epilepticus in a tertiary referral centre in a developing country and aims to highlight the similarities and differences from data available from the western world. Methods. A retrospective analysis of data of patients treated for status epilepticus was conducted from prospectively maintained records, between January 2000 and September 2010. The demographic data, clinical profile and investigations (including neuroimaging and EEG), aetiology, treatment, and outcomes were studied and compared with data available from the western world. Results. The analysis included 108 events in 84 patients. A single episode of status epilepticus was treated in 72 patients (86%) and multiple status epilepticus events, ranging from two to six per patient, were managed in 12 patients (14%). Mean age was 24.1 +/- 20.3 years and 63% were males. The types of status epilepticus included convulsive status in 98 (90.7%), non-convulsive status in seven (6.5%), and myoclonic status in three (2.8%). The majority of events (60%) were remote symptomatic, 16% were acute symptomatic, 16% were of unexplained aetiology, and 8% were progressive symptomatic. In 85 events (79%), status epilepticus could be aborted with first and second-line drugs. The remaining 23 events (21%) progressed to refractory status epilepticus, among which, 13 (56%) were controlled with continuous intravenous midazolam infusion. Case fatality rate was 11%, neurological sequelae were reported in 22%, and 67% returned to baseline. Acute symptomatic status, older age, altered sensorium at the time of admission, and delayed hospitalisation were predictors of poor outcome. Conclusions. Aetiologywas the most important determinant of outcome of status epilepticus, as in reports from the western world, with remote symptomatic aetiology secondary to gliosis being the most common. Treatment delay was frequent and adversely affected the outcome.
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    Clinico-radiological spectrum and outcome in idiopathic hypertrophic pachymeningitis
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2015) Dash, GK; Thomas, B; Nair, M; Radhakrishnan, A
    Objective: To elucidate the clinico-radiological features, treatment response and outcome of a large cohort of patients (n = 20) with idiopathic hypertrophic pachymeningitis (IHP) and to examine if any of these features could differentiate between IHP and secondary causes of hypertrophic pachymeningitis (SHP). Methods: 20 patients with IHP diagnosed between 1998 and 2009 formed the study cohort. We adopted a validated clinical score to quantitatively assess and document their neurological disability and to compare their pre- and post-treatment outcomes. Appropriate statistical analysis was done to look for any clinical and/or radiological features to differentiate IHP from SHP. Results: Out of the twenty eight consecutive patients with pachymeningitis, 20 were having IHP and 8 were having SHP (Tuberculosis-5, Sarcoidosis-2, Wegener's granulomatosis-1). In IHP, headache and visual symptoms dominated the clinical symptomatology (80% and 75%). In MRI, the peripheral pattern of contrast enhancement was more common with IHP (p = 0.03). The posterior falx and tentorium showing a hypointense center ("fibrosis") and enhancing periphery ("active inflammation") together mimicking "Eiffel-by-night" sign was found to be more commonly associated with IHP (60% vs 12.5%, p = 0.03). Biopsy was done in 9 patients. At a mean follow-up of 51 months (range 24-144 months), the mean pretreatment clinical score improved from 6.55 to 1.80 in 20 patients with IHP (p < 0.001). Conclusions: Our data on the largest cohort of patients with IHP would shed light into its dinico-radiological spectrum, treatment and outcome. The prognosis is satisfactory if managed appropriately. We have highlighted the role of MRI in differentiating between IHP and other causes of SHP. (C) 2015 Published by Elsevier B.V.
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    Factors Associated With Underweight and Stunting Among Children in Rural Terai of Eastern Nepal
    (ASIA-PACIFIC JOURNAL OF PUBLIC HEALTH, 2009) Singh, GCP; Nair, M; Grubesic, RB; Connell, FA
    Malnutrition continues to affect a large proportion of children in the developing world. The authors undertook this study to identify biologic, socioeconomic, and health care factors associated with underweight and stunting in young children in an the eastern Tarai (plains) district of Nepal. Data were collected via questionnaires from mothers of 443 children aged 6 to 36 months in Sunsari district. Multistage cluster sampling was used to select villages and children. Anthropometric measurements were made on both children and their mothers. Logistic regression was used to measure the independent (adjusted) effect of risk and protective factors on the odds of underweight or stunting. More than half (53.3%) of the children were found to be underweight (< 2 standard deviations weight for age below reference median) and more than one third (36.6%) had stunting (< 2 standard deviations height for age below reference median). Low maternal body mass index, child's age, higher birth order, and lower standard of living score were strong predictors of underweight, whereas mother's education > 5 years and participation in vitamin A and nutritional programs were protective. Infant age, low maternal body mass index, and low standard of living score were significant risk factors for stunting, whereas mother's education > 5 years was strongly protective. These results suggest that underweight and stunting are the result of a nexus of biological, socioeconomic, and health care factors.
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    Garland sign in amyotrophic lateral sclerosis
    (NEUROLOGY INDIA, 2009) Bansal, AR; Dash, GK; Radhakrishnan, A; Kesavadas, C; Nair, M
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    Hyperreflexic Guillain-Barre syndrome
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2010) Baheti, NN; Manuel, D; Shinde, PD; Radhakrishnan, A; Nair, M
    Guillain-Barre syndrome (GBS) is an acquired acute autoimmune polyradiculoneuropathy. The 2 features considered essential for the diagnosis of GBS are progressive motor weakness and areflexia. There have been several descriptions of reflex preservation and hyperreflexia in axonal variant of GBS in Chinese, Japanese, and European populations but it is not common in the Indian subcontinent. We report 2 such cases discussing the pathophysiology and management aspects. This case report is to impress upon treating physicians and neurologists in training that a hyperreflexic variant of GBS albeit rare, should not be missed in a given clinical setting.
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    Immunocytochemical method for the diagnosis of tuberculous meningitis.
    (JOURNAL OF NEUROPATHOLOGY AND EXPERIMENTAL NEUROLOGY, 2004) Radhakrishnan, VV; George, SM; Reuben, S; Nair, M
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    Ischaemic stroke in the young adult: Clinical features, risk factors and outcome
    (NATIONAL MEDICAL JOURNAL OF INDIA, 1997)
    Background. Stroke is an important cause of morbidity and mortality in young adults, especially in developing countries. This study aimed to evaluate the clinical features, risk factors and outcome of ischaemic stroke in young adults aged 15-45 years.Methods. A retrospective review was done of the medical records of 177 patients seen in a tertiary referral centre in Thiruvananthapuram, Kerala between January 1988 and Anarch 1994.Results. There were 135 males and 42 females with a mean (SD) age of 34.7 (8) years at onset of stroke. An aetiological categorization of stroke was obtained in 111 (63%) patients and it was uncertain or unknown in the rest. Athero-thrombotic stroke and cardio-embolic stroke occurred in 24% and 17%, respectively. Hypertension, smoking, hypertipidaemia and athero-thrombotic stroke were significantly more prevalent in the 31-45 year age group competed to the 15-30 year age group. There was only one patient with postpartum intracranial sinovenous thrombosis. At a mean follow up of 7 months (range 1-62 months), 75% of the patients were independent or only mildly disabled. The case-fatality rate was 1%.Conclusion. Ischaemic stroke in the young adult is more frequent in males. The aetiopathogenesis can be determined in the majority and the athero-thrombotic process predominates. The mortality is negligible and the functional outcome is good in most patients.
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    Mucolipidosis and progressive myoclonus epilepsy: A distinctive phenotype
    (NEUROLOGY INDIA, 2013) Menon, RN; Jagtap, S; Thakkar, R; Narayanappa, G; Nair, M
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    Neurocysticercosis: a clinical and radiological appraisal from Kerala State, South India.
    (Singapore medical journal, 2001)
    OBJECTIVES: Little has been published on Neurocysticercosis (NCC) in the State of Kerala, South India. This study was conducted to describe the clinical and radiological features of NCC in Kerala and also to study the frequency of NCC as seen in a tertiary referral setting.MATERIALS AND METHODS: We evaluated retrospectively 11 patients who were admitted with a diagnosis of NCC from 1986 to 1998. A pre-abstracted proforma containing detailed demographic data, dietary habits, clinical features and history of travel outside Kerala and neuroimaging findings were obtained from patient records and the data was tabulated and analysed. Follow up assessment was made three months after treatment.RESULTS: There were a total of 11 patients, including nine males and two females in the age range of 24 to 62 years and a mean age of 35.2 years. All were nonvegans, only 36% were pork eaters while 18% claimed consumption of salads and uncooked vegetables. 55% of patients were migrants. Migrants were defined as those who lived outside the state of Kerala for more than six months. Seizure was the most common presenting complaint and occurred in all patients (100%). Multiple ring enhancing lesions were seen on computerised tomography (CT) and magnetic resonance imaging (MRI) scans in 60%. Calcified lesions were noted in two patients. An isolated instance of miliary or disseminated cysticercosis with subcutaneous nodules and multiple brain lesions in MRI scan was observed. All patients received anticysticercal therapy besides anticonvulsants.CONCLUSIONS: It appears that NCC is rather uncommon in Kerala. Better socioeconomic status, high literacy rate, improved sanitation and health care in the state of Kerala could be reasons for this observation. A prospective case-control study of NCC in Kerala is needed to study these factors.
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    Pseudoseizures versus epileptic seizures in pregnancy
    (LANCET, 2000) Kuruvilla, A; Nair, M