Browsing by Author "Sreedharan, SE"

Now showing 1 - 17 of 17
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    A novel association of ocular neuromyotonia with brainstem demyelination: Two case reports
    (MULTIPLE SCLEROSIS JOURNAL, 2014) Menon, D; Sreedharan, SE; Gupta, M; Nair, MD
    Ocular neuromyotonia (ONM) is a rare disorder of ocular mal-alignment in which painless, transient spontaneous or gaze-induced abnormal deviation of the eye manifests as episodic diplopia. With only a few cases reported in the literature, ONM mostly follows months to years after cranial irradiation for sellar or suprasellar lesions. Here we present two patients with this rare ocular condition, secondary to brainstem demyelination, the association of which is hitherto unreported in the literature. Both patients were 15-year-old girls who presented to us with episodic forced-eye deviation with diplopia. Examination during these attacks revealed ONM involving the superior rectus and medial rectus in the first and second patient, respectively. There was clinical evidence of intrinsic brainstem involvement with downbeat nystagmus and skew deviation in one patient without any other cerebellar or long tract signs. MRI showed evidence of demyelination involving the brainstem in both, with CSF showing positive immunological markers and with positive aquaporin-4 antibody in one patient. Both patients responded remarkably to immunomodulatory therapy and are asymptomatic at follow-up. That ONM can occur with brainstem demyelination has not been reported in the literature. This association may help in explaining the pathophysiology of ONM as secondary to segmental demyelination.
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    A rare cause of perioperative stroke
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2013) Sreedharan, SE; Gayatri, P; Sylaja, PN
    Perioperative stroke can occur following 0.2-0.3% of general surgical and orthopedic procedures. We are reporting a patient who developed multiple strokes in the immediate postoperative period following total knee replacement, where etiological workup revealed multiple pulmonary arteriovenous fistulae (PAVF). The significance of PAVF with paradoxical embolism in perioperative settings has rarely been reported in the literature.
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    Antisynthetase syndrome with stroke
    (NEUROLOGY INDIA, 2013) Divya, KP; Sukumaran, S; Sreedharan, SE; Sylaja, PN
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    Autonomic dysfunction in first ever ischemic stroke: Prevalence, predictors and short term neurovascular outcome
    (CLINICAL NEUROLOGY AND NEUROSURGERY, 2016) Nayani, S; Sreedharan, SE; Namboodiri, N; Sarma, PS; Sylaja, PN
    Objectives: Central autonomic dysfunction(AD) is reported post-stroke. Very few studies have looked at its impact on neurovascular outcome. We sought to study the prevalence and predictors of autonomic dysfunction in patients with first ever acute ischemic stroke and its impact on discharge and short term outcome. Patients and methods: Consecutive patients who presented between 2-4 weeks post stroke were prospectively recruited. Study period was April 2012-March 2014 (2 years). Subjects underwent clinical autonomic function testing using Ewing's battery at bedside and 24 h Holter analysis for heart rate variability(HRV). HRV parameters studied included both time domain and frequency domain measures. Neurological and cardiovascular outcomes were assessed at discharge,3 months and 1 year. Results: Of 101 patients of mean age 63yrs, 72% were men.Majority had moderate to severe strokes at onset (Mean NIHSS-13.9,MRS-3.1). Clinical bedside autonomic testing criteria were comparable to Holter detected dysautonomia in our study population (p value 0.3). Clinical autonomic dysfunction had a positive association with male gender whereas onset stroke severity and Insular involvement were associated with significantly higher incidence of autonomic dysfunction with both methodology. Those with autonomic dysfunction had more stroke severity at discharge, which was independent of onset severity. Increasing age, hemispheric laterality or presence of comorbidities had no impact on post-stroke dysautonomia. Conclusions: Insular involvement and higher disability at onset are associated with greater incidence of autonomic dysfunction post-stroke. Those with AD had higher chance of infarct expansion and in hospital cardiovascular complications and poorer outcome at 1 year, independent of onset stroke severity. (C) 2016 Elsevier B.V. All rights reserved.
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    Barriers to thrombolysis in acute ischemic stroke: Experience from a Level 1 hospital in South Australia
    (NEUROLOGY ASIA, 2011) Sreedharan, SE; Ravindran, J
    Objective: We studied the mean pre- and in-hospital delay of patients presenting with symptoms suggestive of acute stroke to assess the major barriers to thrombolysis. Methods: The study was a retrospective audit of all patients presenting to Emergency Department (ED) of Lyell McEwin Health Services, Adelaide, Australia with symptoms suggestive of acute cerebral ischemia in the year 2008. We assessed from ambulance and medical records the time of onset of symptoms, delay in presentation to ED, and in-hospital delay for evaluation and imaging. Results: Of 216 patients (Male=123, Female=93) with mean age 70.2 years, 103 (47.7%) presented within 3 hours of onset of symptoms. 42.85% of acute strokes presented within 1 hour 30 minutes. Only Australasian Triage Scale Level 1 and 2 had a positive association with completion of evaluation within 1 hour of arrival to ED. Patients with motor symptoms had less pre-hospital delay as compared with those presenting with other neurological symptoms. Arrival by ambulance or direct presentation to ED had no significant impact on pre-hospital delay. Conclusions: More number of patients are presenting to emergency services within 3 hours of onset of symptoms suggestive of acute stroke. However present triage system at ED often is inadequate in capturing all the strokes who are potential candidates for thrombolysis.
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    CEREBRAL AMYLOID ANGIOPATHY-A CLINICORADIOLOGICAL STUDY FROM SOUTH INDIA
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Sreedharan, SE; Thomas, B; Sylaja, PN; Sarma, PS
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    Clinical and polysomnographic predictors of severe obstructive sleep apnea in the South Indian population
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2016) Sreedharan, SE; Agrawal, P; Rajith, RS; Nair, S; Sarma, SP; Radhakrishnan, A
    Background: With the emergence of lifestyle diseases in epidemic proportions, obstructive sleep apnea (OSA) is being increasingly recognized in less developed countries as well. Aim: We sought to study the demographic, clinical, and polysomnographic (PSG) predictors of OSA severity in a cohort of South Indian patients. Materials and Methods: Consecutive patients with PSG proven OSA [apnea hypopnea index (AHI) >= 5/h] were prospectively recruited. The study period was from January 2012 to December 2012. Demographic data, history of vascular risk factors, substance abuse, sleep quality, snoring, and witnessed apneas were collected using a structured pro forma. In addition, PSG variables such as AHI, sleep latency and efficiency, duration of slow wave and rapid eye movement (REM) sleep, and other parameters were collected. Correlations between AHI severity and clinical and PSG parameters were done. Results: There were 152 (119 males and 33 females) subjects with a mean age of 53.8 years and body mass index (BMI) of 29.31. Mean AHI was 36.2/h (range: 5.1-110) and 66 subjects had severe OSA. Around 12% had the presenting complaint as insomnia, mainly of sleep maintenance. Of the subjects, 35% had witnessed apneas and 67% had excessive daytime sleepiness (EDS); 40% of patients had >= 2 risk factors. PSG parameters showed short sleep onset latency with a high arousal index. Mean apnea duration was 24.92 s. We found that age >55 years, BMI > 25 kg/m(2), witnessed apneas, EDS, hypertension, dyslipidemia, reduced slow wave sleep duration, mean apnea duration > 20 s, and desaturation index > 10/h correlated well with OSA severity while the arousal index, sleep latency and efficiency, and exposure to smoking and alcohol showed no association. Conclusions: Older subjects with witnessed apneas are likely to have more severe OSA. Even though overall sleep architecture was similar between the groups, severe OSA had shorter slow wave sleep, longer apneas, and higher nocturnal hypoxemia.
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    COMBINED CLOT BURDEN SCORE AND COLLATERAL SCORE PREDICT OUTCOME IN ACUTE MIDDLE CEREBRAL ARTERY STROKE
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Maniangatt, S; Jayadevan, E; Satyanarayana, M; Sreedharan, SE; Kuruvilla, A; Sajith, S; Sylaja, P
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    Employment status, social function decline and caregiver burden among stroke survivors. A South Indian study
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2013) Sreedharan, SE; Unnikrishnan, JP; Amal, MG; Shibi, BS; Sarma, S; Sylaja, PN
    Stroke leaves at least 60% of the survivors with moderate to severe disability limiting their employment status and social functioning leading to high levels of caregiver burden. Aim: We sought to study the employment status and level of change of social functioning of stroke survivors and their principal caregiver and correlate it with severity of stroke, functional disability, and anxiety and depression scores. Methods: One hundred and fifty stroke survivors and principal caregivers (3 months-2 years post-stroke) were recruited for the study. The employment status pre- and post-stroke was assessed. The social function of the patient and caregiver was analyzed using a 6 item social function scale developed for the study, encompassing culturally relevant questions. A 20 point scale adapted from Burden assessment schedule was used to assess the caregiver burden. Results: Mean age of the study group was 54.37 +/- 12.072 (range 22-75 years), with 116 males and 34 females. Spouse was the principal caregiver for 142/150 patients (94.6%). In the stroke survivors, compared to the pre-stroke employment status of 62.7%, only 20.7% were employed post-stroke with half having change of job. But the employment status of caregiver was not reduced post-stroke (34.7% vs 33.3%). Employment loss in stroke survivors had a statistically significant association with severity of functional disability, male gender and presence of limb weakness (p values 0.037, 0.0001 and 0.043 respectively). There was an overall decline in social functions among the 6 parameters assessed in both the stroke survivors and caregivers. Of the caregiver burden, financial burden was more among female and older caregivers. The functional status and motor weakness of the stroke survivors did not tend to worsen the overall caregiver burden. Conclusions: Loss of occupation among stroke survivors is high. The decline in social function among stroke survivors and caregivers was significant. Even though functional disability contributed to employment loss and social function decline among stroke survivors, it did not have a significant impact on caregiver burden. (C) 2013 Elsevier B.V. All rights reserved.
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    Hyperglycemia control and outcome in acute ischemic stroke
    (INTERNATIONAL JOURNAL OF STROKE, 2014) Nair, S; Sylaja, PN; Sreedharan, SE; Sarma, S; Lipska, K
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    MALIGNANT MCA STROKE: EARLY OUTCOMES WITH AND WITHOUT DECOMPRESSIVE HEMICRANIECTOMY
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Shetty, K; Sreedharan, SE; Sudhir, J; Menon, D; Nair, S; N, SP
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    MECHANICAL THROMBECTOMY IN ACUTE ISCHEMIC STROKE: INDIAN EXPERIENCE AT A TERTIARY CARE CENTER
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Nagesh, C; Jayadevan, ER; Kumar, S; Sylaja, PN; Sajith, S; Sreedharan, SE; Abraham, M
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    Moyamoya disease: A comparison of long term outcome of conservative and surgical treatment in India
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2014) Sundaram, S; Sylaja, PN; Menon, G; Sudhir, J; Jayadevan, ER; Sukumaran, S; Sreedharan, SE; Sarma, S
    Background: Revascularization surgery (RS) is the therapy of choice in moyamoya disease (MMD). Due to rarity of disease and ethical concerns, randomized controlled trials about the treatment options are lacking. Very little information is available on the long-term outcome of conservatively treated moyamoya patients. Aim: We compared the long-term outcome of moyamoya patients treated conservatively to those who underwent RS. Methods: Our study population included all patients with moyamoya disease/syndrome from 2002 to 2012. The demographic, clinical characteristic and imaging details were reviewed. The outcome was obtained prospectively. Results: Of the 36 patients, 26 (72.2%) had MMD and 10 (27.8%) had moyamoya syndrome. The median age at onset of symptoms was 17.5 years (range, 10 months-55 years). Fifteen patients belonged to pediatric group and 21 were adults. All the pediatric patients had ischemic events at onset and 10 (47.6%) of the adults presented with hemorrhage. Twenty (55.6%) patients received conservative treatment and 16 (44.4%) underwent revascularization procedures. The median duration of follow-up was 28 months (range, 3-90 months). Three (18%) of the surgically treated patients had recurrent ischemic events on follow-up, but none of the conservatively treated patients had events. An excellent outcome (Modified Rankin Scale of <= 2) was seen in 12 (75%) surgically treated and 16 (94%) conservatively treated patients (p = 0.17). Conclusion: Compared to East Asians, our patients had a lower stroke recurrence rate and good functional outcome even with conservative treatment. Future studies should focus on clinical and imaging predictors of progression to select moyamoya patients for RS. (C) 2013 Elsevier B.V. All rights reserved.
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    Persistent post-stroke dysphagia treated with cricopharyngeal myotomy
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2016) Nair, SS; Surendaran, AJ; Menon, JR; Sreedharan, SE; Sylaja, PN
    Post-stroke dysphagia is a common problem after stroke. About 8-13% patients have persistent dysphagia and are unable to return to pre-stroke diet even after 6 months of stroke. Use of percutaneous endoscopic gastrostomy (PEG) may be required in these patients, which may be psychologically unacceptable and impair the quality of life. In those with cricopharyngeal dysfunction leading on to refractory post-stroke dysphagia, cricopharyngeal myotomy and injection of botulinum toxin are the treatment options. We present a case of vertebrobasilar stroke who had persistent dysphagia due to cricopharyngeal dysfunction with good recovery of swallowing function following cricopharyngeal myotomy 1.5 years after the stroke.
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    Primary CNS vasculitis presenting as intraventricular bleeding
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2016) Pillai, SH; Sreedharan, SE; Menon, G; Kannoth, S; Sylaja, PN
    Primary angiitis of the central nervous system (PACNS) is a rare disorder affecting both medium- and small-sized vessels. Intracranial haemorrhages though less reported are in the form of parenchymal haemorrhage and subarachnoid haemorrhage. We report a case of PACNS with intraventricular haemorrhage due to aneurysms secondary to progression of vasculitis.
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    Sinus arrest: Complicating acute posterior cerebral artery stroke
    (NEUROLOGY INDIA, 2011) Mandilya, A; Namboodiri, N; Sreedharan, SE; Sylaja, PN
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    Successful mechanical thrombectomy of acute middle cerebral artery occlusion due to vegetation from infective endocarditis
    (NEUROLOGY INDIA, 2012) Sukumaran, S; Jayadevan, ER; Mandilya, A; Sreedharan, SE; Harikrishnan, S; Radhakrishnan, N; Sylaja, PN