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Dive into the research topics where Rajeev Nayak is active.

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Featured researches published by Rajeev Nayak.


Journal of Clinical Neuroscience | 2013

Acute onset distal symmetrical vasculitic polyneuropathy associated with acute hepatitis B.

Manmohan Mehndiratta; Sanjay Pandey; Rajeev Nayak; Ravindra K. Saran

Hepatitis B can have varied extrahepatic manifestations involving the skin, renal, haematological and nervous systems. Neurological manifestations in hepatitis B may take the form of Guillain-Barré syndrome and secondary systemic vasculitis-related mononeuritis multiplex. The clinical course of hepatitis B-related, vasculitis-related neuropathy is usually subacute to chronic and clinical evolution is relatively benign. To our knowledge, acute hepatitis B-associated vasculitis manifesting as acute distal symmetric polyneuropathy has not been reported. We report a 60-year-old man who presented with fever, mild hepatomegaly, skin lesions in the form of non-palpable purpura and acute onset distal symmetric sensorimotor polyneuropathy. Serum transaminase levels were raised and viral serological markers revealed acute hepatitis B. The patient remained anicteric throughout his clinical course. Nerve conduction studies showed severe axonal sensorimotor polyneuropathy and histopathological examination of sural nerve biopsy was suggestive of vasculitic neuropathy. The patient was first given a course of intravenous immunoglobulin with the antiviral drug entecavir. The fever subsided after 1 week of treatment. The patient was started on prednisolone in addition to the entecavir, and showed significant improvement in motor power and marked resolution in paresthesia after 2 weeks of treatment. Thus, acute onset distal symmetric sensorimotor polyneuropathy of vasculitic etiology can be a manifestation of acute hepatitis B.


The Neurohospitalist | 2012

Posterior circulation ischemic stroke-clinical characteristics, risk factors, and subtypes in a north Indian population: a prospective study.

Manmohan Mehndiratta; Sanjay Pandey; Rajeev Nayak; Anwar Alam

Background and Purpose: Posterior circulation stroke accounts for approximately 20% of all strokes with varied clinical presentation, which differ from strokes in anterior circulation, with reference to etiology, clinical features, and prognosis. Short penetrating and circumferential branches in the posterior circulation supply the brain stem, thalamus, cerebellum, occipital, and medial temporal lobes. Materials and Methods: We prospectively analyzed 80 participants of posterior circulation ischemic stroke from a registry of 944 participants attending a tertiary care referral university hospital. Patients were analyzed for demographics, stroke risk factors, clinical characteristics, neuroimaging, and stroke subtypes. Results: Posterior circulation ischemic stroke accounted for 80 (8.5%) of 944 of all strokes and 80 (10.45%) of 765 of ischemic stroke. Sixty-three were males with mean age 51.7 ± 14.4 years. Twenty-one participants were young (defined as age less than 45 years). Hypertension was found to be the most common risk factor (63.75%). Vertigo was the most common clinical symptom reported in 45 (56.25%) cases. Sixty-eight (85%) patients had large artery disease, 8 (10%) had documented cardioembolic source, 3 (3.75%) small artery disease, and 2 (2.5%) vasculitis. Posterior cerebral artery was most commonly involved. Topographically distal intracranial involvement was most frequent (66.25%) followed by proximal (30%) and middle intracranial territory (3.75%). Conclusions: Our study demonatrated the occurrence of posterior circulation stroke in relatively younger age group compared to the Western world. We also found higher percentage of large artery disease, while cardioembolism as a less frequent cause of posterior circulation ischemic stroke in North Indian population. Distal territory involvement was most common in our study.


Annals of Indian Academy of Neurology | 2016

Ventilators in ICU: A boon or burden.

Man Mohan Mehndiratta; Rajeev Nayak; Sana Ali; Ajay Sharma; Natasha Singh Gulati

Background and Aims: Ventilator-associated pneumonia (VAP) is a major challenge in intensive care units (ICUs). This challenge is even more discernible in a neurological setting owing to the predispositions of patients. Data on VAP in the neurology and neurosurgery ICUs (NNICUs) are scanty in developing countries. This study was conducted to find out the occurrence of VAP, its risk factors, microbiological profile, and antibiotic resistance in patients admitted to the NNICU of a tertiary care institute in India. Materials and Methods: Endotracheal aspirate and blood samples were collected from 100 patients admitted to the NNICU. Complete blood count, microscopic examination, culture and sensitivity testing of aspirate were done. Chest x-ray was also performed to aid in the diagnosis of VAP. Results: Incidence rate of VAP was found to be 24%. Acinetobacter baumannii was the most common pathogen (24.3%) isolated from patients with VAP, and all of these isolates were sensitive to meropenem. Duration of mechanical ventilation (P < 0.0001) and associated comorbid illness (P = 0.005) were found to be significantly associated with VAP, and the duration of mechanical ventilation was found to be the only independent risk factor (P < 0.0001). Conclusions: This study highlights the risks and microbiological perspective of ventilator use among neurology patients so that adequate preventive strategies can be adopted on time.


Annals of Indian Academy of Neurology | 2014

Pregnancy related symptomatic vertebral hemangioma

Meena Gupta; Rajeev Nayak; Hukum Singh; Geeta Anjum Khwaja; Debashish Chowdhury

Vertebral hemangiomas are benign vascular tumors of the spine that remain asymptomatic in most cases and incidentally encountered on imaging. Rarely, altered hemodynamic and hormonal changes during pregnancy may expand these benign lesions resulting in severe cord compression. The management of symptomatic vertebral hemangioma during pregnancy is controversial as modalities like radiotherapy and embolization are not suitable and surgery during pregnancy has a risk of preterm labor. Few cases of pregnancy related symptomatic vertebral hemangioma with marked epidural component have been reported in the literature. We report a case of 23-year-old primigravida who developed rapidly progressive paraparesis at 28 weeks of gestation and spine magnetic resonance imaging (MRI) revealed upper thoracic vertebral hemangioma with extensive extra-osseous extension and spinal cord compression. Laminectomy and surgical decompression of the cord was performed at 32 weeks of the pregnancy. There was significant improvement in muscle power after a week of surgery. Six weeks postoperatively she delivered a full term normal baby with subsequent improvement of neurologic deficit. Repeat MRI of dorsal spine performed at 3 months postoperatively showed reduced posterior and anterior epidural components of vertebral hemangioma.


Tropical Doctor | 2013

Post-malaria neurological syndrome: a rare manifestation of common disease.

Rajeev Nayak

Several systemic and neurological complications can occur with Plasmodium falciparum malaria, of which cerebral malaria is well known and is the most serious. Rarely, patients may suffer a neurological disorder that occurs after complete recovery from P. falciparum infection, an entity known as post-malaria neurological syndrome (PMNS). It is a rare and transient clinical syndrome in which patients with symptomatic malaria infection, after parasitic clearance from the peripheral blood, develop neurological symptoms within 2 months of recovery. We report a case of PMNS manifesting as bilateral common peroneal nerve palsy leading to foot drop.


The Neurohospitalist | 2017

Intractable Hiccups in a Middle-Aged Female

Rajeev Nayak

A previously healthy 50-year-old female was admitted with recurrent hiccups and nausea for 2 weeks. She had previously taken several consultations from physicians and gastroenterologist without getting any relief. She denied any abdominal symptoms, visual impairment, motor weakness, incoordination, gait imbalance, or abnormal sensation. General physical and neurological examinations were normal. A magnetic resonance imaging (MRI) scan of the brain showed a hyperintense signal in the region of dorsal medulla on T2-weighted and fluid-attenuated inversion recovery sequences (Figure 1A-C) without diffusion restriction or postgadolinium enhancement. Screening of the spine MRI and visual evoked potentials were normal. Serum aquaporin-4 (AQP4)/neuromyelitis optica (NMO)-IgG antibody test (by indirect immunofluorescence assay) was positive. A diagnosis of neuromyelitis optica spectrum disorder (NMOSD) with isolated medullary involvement and without optic neuritis and transverse myelitis was made. The patient was given intravenous methylprednisolone 1 g daily for 5 days and showed clinical improvement. Subsequently, azathioprine was initiated to prevent further attacks. Neuromyelitis optica or Devic disease is an immunemediated demyelinating disorder of the central nervous system that predominantly affects the optic nerves and spinal cord. The term NMOSD is used to include AQP4-IgG-seropositive patients with limited or atypical forms of NMO (eg, isolated longitudinally extensive transverse myelitis, isolated recurrent optic neuritis, or area postrema syndrome). Intractable hiccups, nausea, and vomiting (area postrema syndrome) could be the initial or isolated presence of NMOSD. Brain lesions in NMOSD are present in more than half of the patients at onset and usually seen at sites of high AQP4 expression, such as the diencephalon, the hypothalamus, and the periaqueductal region. The NMOSD, sarcoidosis, Sjogren syndrome, systemic lupus erythematosus, tumor, and Behcet disease are the main differential diagnosis for solitary brain stem white matter lesion on brain MRI. Figure 1. Axial T2 (A), FLAIR (B), and coronal T2-weighted (C) MRI sequences showing hyperintense signal in the region of dorsal medulla. FLAIR indicates fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.


Annals of Indian Academy of Neurology | 2016

Bloodstream infections in NNICU: Blight on ICU stay.

Man Mohan Mehndiratta; Rajeev Nayak; Sana Ali; Ajay Sharma

Background: Bloodstream infections (BSIs) are among the serious hospital-acquired infections. Data regarding BSIs in intensive care units (ICUs) are available but there is limited information regarding these infections in neurology and neurosurgery intensive care units (NNICUs). Objectives: This study was conducted to find out the occurrence of BSI in NNICU patients of a tertiary care institute in India, along with the microbiological profile and risk factors associated with it. Materials and Methods: One hundred patients admitted in the NNICU of a tertiary care hospital for more than 24 h were included in the study. After detailed history, blood samples were collected from catheter hub and peripheral vein of all patients for culture, followed by identification and antibiotic sensitivity testing of the isolates. Results: Out of 100 patients, laboratory-confirmed bloodstream infection (LCBI) was detected in 16 patients. Five patients had secondary BSI, while 11 had central venous catheter (CVC)-related primary BSI. Gram-positive organisms constituted 64% of the isolates, especially coagulase-negative staphylococci and Staphylococcus aureus. Increased duration of CVC was a significant risk factor for catheter-related BSI (CR-BSI). Conclusion: BSIs pose a significant burden for NNICU patients, and increased duration of catheter insertion is a significant risk factor for CR-BSI.


Clinical Neurology and Neurosurgery | 2013

Hansen's disease manifesting as acute distal symmetric microvasculitic polyneuropathy.

Sanjay Pandey; Rajeev Nayak; Man Mohan Mehndiratta

Leprosy or Hansen’s disease is the commonest infectious periphral neuropathy caused by Mycobacterium leprae that mainly afflicts kin and peripheral nerves. The disease is widely prevalent in cerain geographical areas like Asia, Africa and Latin part of America. everity and clinical spectrum is principally dependent on the mmune status of the host. Nerve involvement in leprosy usually follows the pattern f mononeuropathy or mononeuritis multiplex. Bilateral, symetrical, distal polyneuropathy can also be a manifestation of epromatous leprosy, albeit, neuropathy is slowly progressive in hese cases [1]. Also, rare case reports of Guillain-Barre syndrome GBS) like presentation in a diagnosed or treated case of leproatous leprosy have been published previously [2–4]. However, cute distal symmetric vasculitic neuropathy as an initial maniestation of leprosy has never been reported. We report a case of cute onset rapidly progressive distal symmetric vasculitic polyeuropathy along with facial paresis and skin lesions. Skin and sural


Journal of Neurology Research | 2013

Early Syringomyelia in Tubercular Meningitis: A Rare Occurrence

Sanjay Pandey; Rajeev Nayak; Man Mohan Mehndiratta


Neurology | 2017

NNICU acquired VAP: Spectrum, risk factors and antibiotic sensitivity profile (P1.323)

Man Mohan Mehndiratta; Rajeev Nayak; Sana Ali

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Prachi Mehndiratta

Case Western Reserve University

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Geeta Anjum Khwaja

Maulana Azad Medical College

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