Shri K. Mishra

Stroke rates in patients with lacunar and large vessel cerebral infarctions

A stroke registry was developed to determine the value of various clinical data in distinguishing lacunar from large vessel infarctions. Adequate localization was achieved in 98% of 246 patients with brain infarcts. These and 30 transient ischemic attack patients were followed for a median of 1082 days (range 2-1657). Follow-up data on TIA patients were invalidated by evidence of serious underreporting of TIAs in our general population. Among 212 male patients with cerebral infarcts not due to cardiogenic embolism, syphilis, migraine, vasculitis, or other unusual etiologies, 1-, 12-, and 36-month recurrence rates were 23%, 31% and 39% among patients with large vessel anterior circulation infarcts; 15%, 20% and 28% among patients with large vessel posterior circulation infarcts; and 8%, 16% and 21% among patients with lacunar anterior circulation infarcts, respectively. Six patients with posterior circulation lacunes did not experience recurrence. Comparative case fatality data were also compiled. Large vessel infarcts tended to be followed by further large vessel infarcts, usually in the same vascular distribution, whereas lacunar infarcts were not predictive of the type or location of subsequent events.

The therapeutic value of yoga in neurological disorders

Background: The ancient mind and body healing methods of yoga recently sparked fervor in the scientific community as an alternative and complementary means of therapy. Since the World Health Organization officially began promoting yoga in developing countries in 1978, yoga has been cited for its therapeutic potential and has been widely recognized in Western culture. However, as an increasing number of people practice yoga for remedial purposes, researchers raise two important questions: 1) Is yoga a valid complementary management and rehabilitation treatment modality? 2) What conditions show promise of treatment with this intervention?. Objective: This review article uses comprehensive scientific, evidence-based studies to analyze the efficacy of various basic and applied aspects of yoga in disease prevention and health promotion. It specifically intends to expose the effects of yoga in neurological disorders, particularly epilepsy, stroke, multiple sclerosis, Alzheimers disease, peripheral nervous system disease, and fibromyalgia. Materials and Methods: Information was gathered from various resources including PubMed, Ovid, MD-Consult, USC, and U.C.L.A. libraries. Studies were selected and reviewed on the basis of sample size, control, randomization, double-blinding, and statistical analysis of results. Results: The pratice of yoga and meditation demonstrates statistically encouraging physiological and psychological improvements in the aforementioned neurological disorders. However, there were certain flaws and inadequacies in the study designs employed to evaluate the same. A critical analysis of these studies is presented. Conclusions: With the aim to focus attention on this widespread yet largely unexamined treatment modality, this paper seeks to provide direction and support for further research necessary to validate yoga as an integrative, alternative, and complementary therapy.

Spirituality and Religiosity and Its Role in Health and Diseases.

Religiosity is a factor involved in the management of health and diseases/patient longevity. This review article uses comprehensive, evidence-based studies to evaluate the nature of religiosity that can be used in clinical studies, thus avoiding contradictory reports which arise from misinterpretation of religiosity. We conclude that religiosity is multidimensional in nature and ultimately associated with inherent protection against diseases and overall better quality of life. However, a number of untouched aspects of religiosity need to be investigated further before we can introduce religiosity in its fully functional form to the realm of health care.

Spectrum of motor neuron diseases with HIV-1 infection

Background: The cause of sporadic motor neuron disease (MND) or amyotrophic lateral sclerosis (ALS) is unknown. During the last 20 years, at least 23 cases of MND have been reported in HIV-1 (HIV) seropositive individuals. Objective: To describe two patients with HIV infection and MND and to review the literature regarding HIV-associated MND. Setting: A multidisciplinary ALS center and Neuro-AIDS clinic at tertiary care university hospitals. Patients/Design: We prospectively studied two HIV-infected patients with motor neuron disease. A detailed review of the literature employing the PubMed search strategy revealed 23 additional cases of MND in HIV-infected persons. These were reviewed for comparison and contrast with the characteristics of sporadic classical MND. Results: The clinical features of MND in our two cases, mirrored that of the sporadic MND (upper and lower motor neuron disorder) and primary lateral sclerosis (PLS, isolated upper motor neuron disorder). The review of 23 previously reported patients with MND and HIV infection revealed that they could be categorized into clinically definite MND (6 cases) or clinically probable or possible MND (17 cases). MND commenced at different stages of the HIV; in 9 patients HIV infection was discovered contemporaneously with the diagnosis of MND. As in our one patient, 14 of 18 patients with HIV-associated MND syndrome receiving highly active antiretroviral therapy (HAART), demonstrated at least partial recovery of their motor deficit. Conclusions: A clinical picture similar to MND or PLS may occur in association with HIV infection. An aggressive HAART regimen to reduce viral load should be pursued in all such cases.

Differential involvement of brainstem pathways due to fourth ventricular epidermoid cyst: a case study

A 66-year-old man presented with progressive dysfunction of bilateral cerebellar hemispheres or its connections, corticospinal tracts and medial longitudinal fasciculus (MLF) due to a 4th ventricular epidermoid cyst for the past 47 years. Sensory, auditory and blink reflex pathways were clinically and electrophysiologically normal as indicated by clinical examination and normal median nerve somatosensory evoked responses (SER), brainstem auditory evoked responses (BAER) and blink reflex (BR) studies. These findings were unchanged fifteen months after removal of the lesion. Our findings suggest that (1) in extraaxial brainstem compression, MLF dysfunction can occur, (2) MLF, corticospinal tracts and possibly cerebellum and its connections appear to be more susceptible to longstanding compression and can be selectively and irreversibly damaged whereas pathways located in their vicinity, subserving SER, BAER and BR are spared, and (3) normal clinical and electrophysiological examination of sensory, auditory and BR pathways in presence of abnormal MLF, corticospinal and cerebellar functions should raise a clinical suspicion of an extraaxial brainstem compressive lesion.

Factors associated with occurrence of large vessel and lacunar cerebral infarctions

A stroke registry was developed to determine the localizing value of various clinical data. Adequate localization was achieved in 98% of 246 patients with infarcts. Among 212 male patients with cerebral infarcts not due to cardiogenic embolism or an unusual etiology, there were 152 with large-vessel and 59 with lacunar infarcts. Logistic regression analysis of factors associated with large vessel and lacunar stroke identified myocardial infarction on ECG as the only statistically significant variable; its presence was associated with an odds ratio for lacunar infarction of 0.19 (95% confidence interval 0.06-0.66) (P = 0.009). Logistic regression analysis of factors associated with anterior and posterior circulation large vessel stroke identified pack years of smoking as the only statistically significant variable; the odds ratio for posterior circulation infarction for a 10-year increment in pack years of smoking was 0.83 (95% confidence interval 0.73-0.94) (P = 0.0035).

Cardiac Abnormalities in Congenital and Childhood Myotonic Muscular Dystrophy Type 1

Abstract Myotonic dystrophy often presents with cardiac abnormalities, particularly conduction defects, that factor into an increased risk of sudden cardiac death. Myotonic dystrophy has two forms, myotonic dystrophy type 1 (DM1) and DM2, and is a multisystemic disorder that presents in a wide, clinical spectrum and age range. A distinguishing feature of DM1 is the existence of a congenital form. Though research on cardiac involvement has been conducted on patients with the adult form of myotonic dystrophy, there have been few studies focused on cardiac involvement in pediatric patients with congenital myotonic dystrophy type 1 (CDM1). In this study, a survey was conducted to determine the prevalence and variations of cardiac abnormalities in pediatric patients with CDM1. This preliminary study found a prevalence of 25.8% CDM1 pediatric patients with cardiac abnormalities in a sample size of 31 patients.

History of Neuroimaging: The Legacy of William Oldendorf

The field of neuroimaging witnessed remarkable progress in the post-World War II era, resulting in tremendous benefits for healthcare today. One such important milestone was the development of the computerized axial tomography (CAT) scan. This state of the art technique has paved the way for modern diagnostic imaging like magnetic resonance imaging (MRI). Dr William Oldendorf, the first designer of axial tomography, is regarded by some as the true father of neuroimaging. However, because of various reasons, he was unable to succeed with his concept and was also unfortunately denied his due entitlement of the Nobel Prize for Medicine and Physiology in 1979. This article discusses his contributions to the fields of neuroimaging and neurosciences, along with the politics that surrounded the awarding of the Nobel Prize of 1979. Another associated topic that is touched on in this article is the ever-growing dispute over the interpretations of neuroimaging between neurologists and neuroradiologists.

MELAS: Monitoring treatment with magnetic resonance spectroscopy

To assess the utility of Magnetic Resonance Spectroscopy (MRS) as a biomarker of response to L‐arginine in mitochondrial encephalomyopathy with lactic acidosis and stroke‐like episodes (MELAS).

Successive yet distinct episodes of isolated ophthalmoplegia associated with anti-GQ1b antibody

Recurrent episodes of the Miller Fisher syndrome (MFS) are uncommon.1 Furthermore, isolated internal ophthalmoplegia is rare in MFS.2,3 We report a patient who presented first with internal/external ophthalmoplegia, then 7 years later with an isolated internal ophthalmoplegia associated with elevated anti-GQ1b IgG antibodies and confirmed Campylobacter jejuni enteritis. A 20-year-old Latino man first presented to an outside neurology group with double vision, photophobia, and ataxia following a bout of diarrhea 2 days prior to symptom onset. On examination there were limited extraocular movements, dilated, non-reactive pupils, impaired vibratory sense of the distal extremities, and normal reflexes. After unremarkable brain imaging and spinal fluid results, the patient was diagnosed with atypical MFS. No treatment was initiated and symptoms resolved over the course of 3 months. At age 27 years he presented again with the gradual onset of double vision, photophobia, and paresthesias of the …