Gyanendra Kumar

Central Poststroke Pain : A Review of Pathophysiology and Treatment

BACKGROUND: Central poststroke pain (CPSP) is a disabling morbidity occurring in 8%–14% of patients with stroke. It is infrequently recognized and difficult to manage. OBJECTIVE: We systematically reviewed the pathophysiology and treatment of CPSP. METHODS: We conducted a Medline search using the key words “central post-stroke pain,” “post-stroke pain,” “CPSP and basic studies,” “CPSP and clinical features,” “CPSP and pharmacological treatment,” “CPSP and nonpharmacological treatment” and “CPSP and treatment guideline.” The articles related to CPSP were categorized into clinical features, pathophysiology and treatment, and then systematically reviewed. RESULTS: Stroke along the spinothalamocortical pathway may result in CPSP after a variable period, usually after 1–2 mo. CPSP may be spontaneous or evoked, variable in intensity and quality. It tends to improve with time. CPSP is associated with mild motor symptoms with relative sparing of joint position and vibration sensations. The pathophysiology of CPSP is not well understood, but central disinhibition, imbalance of stimuli and central sensitization have been suggested. There are few class I and class II studies regarding its management. Amitriptyline and lamotrigine (class IIB) are recommended as first-line and mexiletine, fluvoxamine and gabapentin as second-line drugs. In pharmacoresistant patients, repetitive transcranial magnetic stimulation and deep brain stimulation have been beneficial. CONCLUSIONS: CPSP patients present with diverse sensory symptoms and its pathophysiology is still poorly understood. Amitriptyline and lamotrigine are effective treatments. Further studies are needed to understand the pathophysiology and investigate newer therapeutic modalities.

Central post-stroke pain: Current evidence

This article reviews the definition, epidemiology, and current evidence on pathophysiology, neuroanatomy, clinical features, and treatment of central post-stroke pain.

Perception and usage of e‐resources and the internet by Indian academics

Purpose – This paper aims to examine the perception and use of e‐resources and the internet by the engineering, medical and management academics in Bangalore City, India. The prime objective is to find out how academics compare e‐sources with print sources and how they perceive the advantages of e‐sources and problems for accessing them. It further aims to establish the extent of internet use, the purpose of such use and factors influencing it.Design/methodology/approach – Data were collected from 300 students and faculty members in selected engineering, medical and management colleges of Bangalore City. The questionnaire consists of 15 main questions with many of them having a number of subsidiary questions. The questions are designed for the students and faculty members to elicit their experience with the e‐sources and internet use for their study and research work.Findings – Study results show that the students and faculty who participated in this survey are aware of e‐sources and also the internet. Ev...

Raised intracranial pressure in acute viral encephalitis

There is paucity of data evaluating intracranial pressure (ICP) rise and its management in acute viral encephalitis (AVE). Noteworthy is the current prevalence of unselective and broad utilization of ICP lowering therapies in clinical practice. Trends in current management of ICP in AVE emanate from data extrapolated from results of studies done on cerebral malaria, bacterial meningitis, stroke, and brain trauma patients. In this article we review (1) clinical correlates of raised ICP, (2) pathology, (3) imaging data, (4) monitoring, and, (5) treatment, of raised ICP in AVE. ICP monitoring is a useful adjunct to management of raised ICP in adults, becoming especially important in Herpes encephalitis and encephalitis with status epilepticus. In children it substantially influences clinical management and continuous monitoring of mean blood pressure (MBP) and ICP can aid in early diagnosis and treatment when cerebral perfusion pressure (CPP) falls below critical levels. Current evidence suggests that the pathomechanisms that contribute to the development of raised intracranial pressure vary in viral encephalitides of different etiology, and different forms of cerebral edema result at different times in the course of the illness, thus creating a need for studies to investigate the usefulness of various edema-specific ICP lowering modalities in AVE.

Penumbra, the basis of neuroimaging in acute stroke treatment: Current evidence

In modern medicine brain imaging is an essential prerequisite not only to acute stroke triage but also to determining the specific therapy indicated. This article reviews the need for imaging the brain in acute stroke, penumbral pathophysiology, penumbral imaging techniques, as well as current status of various imaging modalities that are being employed to select patients for specific therapeutic approaches.

Necrobacillosis resulting in isolated carotid thrombosis and massive stroke: A unique Lemierre variant?

We describe a healthy, young adult male patient who developed isolated carotid artery thrombosis and occlusion following acute pharyngitis due to Fusobacterium necrophorum. We believe this is the first case of isolated occlusion of internal carotid artery (ICA) with F.necrophorum without associated internal jugular vein (IJV) thrombosis. Lemierres syndrome (LS) is characterized by a history of recent oropharyngeal infection in previously healthy individuals, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of anaerobic pathogens, mainly F.necrophorum. We discuss literature on this rare, previously unreported, variant of LS.

Magnetic Resonance Angiography Findings in Patients with Ischemic Stroke from North India

BACKGROUND We sought to evaluate the magnetic resonance (MR) angiography (MRA) findings in patients with ischemic stroke (IS) from North India and correlate the changes with various conventional and nonconventional risk factors. METHODS The study took place at a tertiary care teaching hospital. The patients with IS were clinically evaluated including body mass index, dietary habits, and family history of stroke. MR imaging, MRA, and testing for blood sugar, lipid profile, B12, folic acid, and homocysteine were carried out. The MRA abnormalities were considered significant if stenosis was 50% or greater and these were categorized into extracranial (EC), intracranial (IC), or combined lesions. The location of infarct on MR imaging was also noted. RESULTS There were 151 patients whose median age was 60 (22-85) years. The EC MRA was abnormal in 56.3% and the IC MRA in 63.3% of patients, the internal carotid artery being the most common site. Corresponding infarct was present in 64.7% and noncorresponding in 45.3% of patients. The MRA abnormality positively correlated with hypertension and diabetes, and negatively with alcohol consumption. The EC MRA abnormality was more common in upper caste Hindus and Muslims and in the city dwellers. CONCLUSION In North Indian patients with IS, the frequency of EC and IC MRA abnormality lies between Whites and the Orientals.

Reversible sensorineural hearing loss with normal brainstem auditory evoked potentials in pontine hemorrhage due to capillary telangiectasia

Capillary telangiectasias are vascular malformations most commonly found in the pons that are rarely associated with hemorrhage. We describe a unique case of pontine capillary telangiectasia causing central brainstem hemorrhage leading to reversible sensorineural deafness associated with a normal brainstem auditory evoked response.

Isolated Hypersomnia Due to Bilateral Thalamic Infarcts

We describe a unique patient who developed hypersomnia as the sole presenting symptom of bilateral thalamic infarcts.

Salmonella brain abscess in a patient on chronic azathioprine therapy for myasthenia gravis: report of an unusual case and review of literature in the postantibiotic era

Focal intracranial infections caused by Salmonella species in adults are exceedingly uncommon. Structural brain injury with coexisting immunocompromised status appears to predispose adults to this rare manifestation of Salmonella infection. We report a case of Salmonella brain abscess in a patient with myasthenia gravis on chronic azathioprine therapy without any prior structural brain lesion. We reviewed world literature and discuss their analysis of Salmonella brain abscess in adult population in the postantibiotic era.