Rajesh Kumar Singh

Niemann–Pick disease type C (NPC) is a lipid storage disorder having varied neurological, psychiatric, and visceral manifestations. Twenty‐seven‐year‐old female presented to the hospital with recurrent episodes of seizures for the last one and half year. She had delayed motor and language milestones and was scholastically poor in school. On examina...

The study aimed to determine the concordance and discordance of epileptiform discharges on scalp video EEG and magnetic resonance imaging (MRI) of brain in drug resistant epilepsy (DRE)

TITLE: Concordance of epileptiform discharges on video-Electroencephalogram (EEG) with the Brain Imaging of focal lesions in drug resistant epilepsy: Experience from a tertiary Centre in India OBJECTIVE: To determine the concordance and discordance of epileptiform discharges on scalp video EEG and magnetic resonance imaging (MRI) of brain in drug...

Background and aims Complications of Tuberculous Meningitis (TBM) include hydrocephalus, vasculitis infarcts, arachnoiditis (optico-chiasmatic and spinal), and increase in size/number of tuberculomas. We aimed to study the association of these complications with morbidity and mortality trend over their follow up period of nine months. Methods The...

Background and aims Despite advances in anti-tubercular treatment (ATT), the mortality of central nervous system tuberculosis (CNSTB) is upto 20%. The determinants of poor outcome and mortality have been studied in small single center studies. We aimed to study a multicentric cohort of CNS tubercular mass lesions in an ambispective cohort design to...

Objective F-18 Fluorodeoxyglucose PET/CT (FDG-PET) is emerging as a useful imaging adjunct to MRI in the initial diagnostic evaluation of autoimmune encephalitis (AIE)-though presently it is not included in the diagnostic criteria. Materials and methods In this prospective study we enrolled a total of 52 patients with clinically diagnosed and trea...

Primary angiitis of the central nervous system (PACNS) is an autoimmune disease with myriad presentations in the form of headache, focal neurological deficits, seizures and rapid cognitive decline. Predilection or isolated and recurrent involvement of one hemisphere is rarely described in literature. This leads to low clinical suspicion and often d...

Rare presentation of post-dengue autoimmune encephalitis with dystonic storm and refractory seizures. While dengue-associated ADEM is a known complication, this case emphasizes the broader spectrum of neurological manifestations that may follow dengue fever i.e. autoimmune encephalitis, particularly when MRI brain and autoimmune markers are negati...

Background and aims: Early neurological deterioration (END) in acute ischemic stroke (AIS), patients is defined as clinical worsening or recurrence during first 72 h after onset of AIS. We have conducted this study to determine the association between END and functional outcome at 3 months of onset of AIS along with associated risk factors of END...

Objectives: Depression in persons with epilepsy (PWE) goes undiagnosed and untreated. Despite being common, there are no direct efficacy comparisons of available antidepressants in PWE. Our aim was to compare the effectiveness of Venlafaxine (VEN) and Escitalopram (ESCIT) in comorbid depression in PWE. Methods: In a single-center, prospective, d...

Parry–Romberg syndrome presents with atrophy of one‐half of the face involving skin, soft tissue, muscle, and bone. It usually progresses slowly over 2–20 years and finally stabilizes. Neuropsychiatric abnormalities are subtle, seen in about 10% of the patients, and include cognitive disturbances, aphasia, hallucination, and other psychiatric disor...

Introduction: Post-stroke sleep disorders (PSSD) are an important part of post-stroke disability. PSSD is neglected as a part of stroke rehabilitation. We aimed to study the prevalence and determinants of PSSD in a hospital based, single center setting. Methods: In a cross-sectional study, adult patients (≥ 18 years) with stroke (one month to on...

OBJECTIVE: To develop an automated algorithm to detect, quantify, and differentiate between tremor using pen-on-paper spirals. METHODS: Patients with essential tremor (n = 25), dystonic tremor (n = 25), Parkinson’s disease (n = 25), and healthy volunteers (HV, n = 25) drew free-hand spirals. The algorithm derived the mean deviation (MD) and tremor...

Background Rapidly progressive encephalopathy in a young adult has a range of differentials requiring an exhaustive workup. We present a man with a history of encephalopathy with neuropathy and a rare diagnosis. Case presentation A 40 year-old man presented with a 6-month history of cognitive dysfunction and an asymmetric gradually progressing asce...

Objectives The aim of the study was to study the demographical, clinical, radiological features, and outcome of anti-myelin oligodendrocyte glycoprotein (MOG) antibody spectrum disorder and compare these features with patients negative for anti-MOG antibody. MOG antibody-associated disease (MOGAD) and aquaporin-4 (AQP4) antibody-related diseases ar...

Introduction: Parkinson's disease (PD) is a neurological condition that impacts the physical and psychological functioning of the patients. The physical and cognitive changes come with social stigma and threats to roles previously associated with their identities. Objectives: The current paper attempts to study the influence of the disease on th...

Introduction Astrocytoma is a diffusely infiltrating malignant CNS tumor characterized by varied presentation with signs of raised intracranial pressure. Involvement of the brainstem and initial presentation as 3rd nerve palsy is rare in adults. We hereby report of case with third nerve palsy with pupil involvement with underlying astrocytoma. Case...

Background The reported incidence of leptomeningeal carcinomatosis is 3–8% in patients with solid tumours. More commonly, it has been described in the setting of advanced cancers of the lung, breast and malignant melanoma. Case presentation A 50-year-old diabetic patient with recurrent unresectable squamous cell carcinoma (SCC) of the right retrom...

The pharyngeal-cervical-brachial (PCB) variant is a rare presentation of Guillain-Barré syndrome (GBS), and there is a handful of case reports that overlap with the Miller-Fisher syndrome (MFS) variant of GBS. This overlap produces varied symptoms that may be confusing and challenging for physicians to diagnose timely and start appropriate treatmen...

Objective To compare efficacy and safety of Intranasal and Intramuscular routes of midazolam administration in terminating seizures. Method This was an open label Randomized controlled trial (RCT). People with drug resistant epilepsy (DRE) undergoing Video Electroencephalogram (VEEG) monitoring, were randomized in a 1:1 ratio to receive either Int...

Parkinson’s disease (PD) is a neurodegenerative disease that on average causes 3.2 million DALY’s (Disability-adjusted life years) and over 2,00,000 deaths globally [1]. The disease presents with debilitating cognitive and behavioural symptoms leading to a compromised quality of life. Repetitive Transcranial Magnetic Stimulation (rTMS) is a contemp...

Aim of the study: Activating Transforming factor 3 (ATF3) is a stress induced gene and closely associated with neuro-inflammation while Transforming growth Factor Beta (TGFβ) signalling is also reported to be involved in neuro-inflammation and hyper-excitability associated with drug resistant epilepsy. Animal model studies indicate the involvement...

(1) Background: During the second wave of COVID-19, India faced a rapid and sudden surge of not only COVID19-delta variant cases but also mucormycosis, making the infection even more fatal. We conducted a study to determine factors associated with the occurrence of mucormycosis in patients with COVID-19. (2) Methods: This case–control study compris...

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating central nervous system illness encountered in the setting of immunosuppressive conditions like human immunodeficiency virus / acquired immunodeficiency syndrome, autoimmune diseases and hematologic malignancies. We had a 54‐year‐old woman with systemic lupus erythematosus and...

Introduction Micro-embolic signals (MESs) detected using transcranial Doppler (TCD) help in risk stratification in stroke patients. A systematic review and meta-analysis were performed to estimate the prevalence of MES and its association with stroke recurrence, functional outcome, and mortality in different stroke subtypes. Methods A comprehensiv...

Systemic lupus erythematosus (SLE) is an autoimmune disorder affecting multiple organs of body. We present a case having history of fever, headache, vomiting for 1 month and quadriparesis with urinary retention and constipation for 5 days. MRI Brain contrast showed T2/FLAIR hyperintensities in the region of bilateral cingulate gyri and midbrain wit...

Niemann Pick disease type C (NPC), is a rare lysosomal storage disorder, which has a variable presentation based on the age of onset. We describe 5 adult/adolescent-onset NPC cases presenting with a range of movement disorders along with vertical supranuclear gaze palsy as part of the clinical presentation. A diagnostic delay of 4 to17 years from t...

Objectives Stroke constitutes a significant public health problem in developing countries. Caregivers provide an important support system for patient care but usually lack knowledge and skill to attend their stroke patients. We assessed whether a caregiver-directed educational intervention would reduce hospital-acquired complications and improve st...

Multiple cranial nerve palsies have many possible causes, including infective, inflammatory, neoplastic and infiltrative diseases of the meninges or skull base. We present the clinicopathological conference of a 27-year-old man with a smouldering course of sequential cranial nerve palsies. His imaging showed dural thickening and osteosclerosis of t...

Introduction Stroke is the most common cause of epilepsy in the adult population. PSS are classified into ES and LS. ES can significantly affect the clinical outcome and occurrence of LS. Methods We analyzed data from a prospective cohort of acute ischemic stroke patients between June 2018-May 2020 in a neurology unit at a tertiary hospital. We scr...

Background: Disability evaluation as per World Health Organization includes assessment of impairments, activity limitations, and participation restriction, which unfortunately is not assessed by the existing guidelines of disability in India. Aim: The aim of this study wasto comparea new study criterion with the existing guidelines for assessing...

Background: Teleneurology consultations can be highly advantageous since neurological diseases and disabilities often limit patient's access to health care, particularly in a setting where they need to travel long distances for specialty consults. Patient satisfaction is an important outcome assessing success of a telemedicine program. Materials an...

Purpose The aim of this study was to compare the diagnostic value and accuracy of ictal SPECT and inter-ictal magnetoencephalography (MEG) in localizing the site for surgery in persons with drug resistant epilepsy. Method This was a prospective observational study. Patients expected to undergo epilepsy surgery were enrolled consecutively and the l...

We present here a 52 years old man with rapidly progressive cognitive decline and ataxia. Brain MRI showed confluent white matter changes and spinal MRI showed posterior column changes. The patient had vitamin B12 deficiency from pernicious anemia. There was clinical and radiological improvement by vitamin B12 replacement. There is no previous repo...

Objective: We evaluate the potential utility of F-18 FDG PET in addition to MRI in the diagnostic work-up of patients with autoimmune epilepsy (AE) and propose the inclusion of functional imaging in the antibody prevalence in epilepsy (APE) scoring system. Methods: This was a retrospective analysis in 60 patients, diagnosed and treated for AE, o...

Introduction: The lockdown due to COVID-19 pandemic led to temporary closure of routine hospital services. This prompted the initiation of teleconsult follow-up in our department. The study outlines the experience of tele-follow-up at a tertiary care teaching hospital in India, and the perspective of neurologists about this novel approach. Methods:...

Alien Limb phenomenon as a heralding manifestation of Toxic Leukoencephalopathy - Pranjal Gupta, Deepa Dash, Rajesh Kumar Singh, Leve Joseph Devarajan Sebastian, Manjari Tripathi

Objective To evaluate the effectiveness of yoga as an adjuvant to conventional medical management on clinical outcomes in patients with migraine. Methods CONTAIN was a prospective, randomized, open-label superiority trial with blinded endpoint assessment carried out at a single tertiary care academic hospital in New Delhi, India. Patients enrolled...

Objective: To evaluate effectiveness of yoga as an adjuvant to conventional medical management on clinical outcomes in patients with migraine.Background: Standard therapy for prevention of migraine attacks entails use of pharmacological agents. However, not all patients are either compliant or respond optimally and many of them develop adverse effe...

Purpose of study Ultrasound (US) for lumbar puncture has seen the most success in obese patients and in patients with difficult to palpate landmarks. We aimed to elucidate the advantage of the use of routine US for performing lumbar punctures over the traditional landmark method. Study design This was a prospective study with consecutive sampling...

Objective Prognostic scores help in predicting mortality and functional outcome post intracerebral hemorrhage (ICH). We aimed to validate the ICH and ICH-GS scores in a cohort of Indian patients with ICH and observe the impact of any surgical intervention on prognostication. Methods This was an ambispective observational study of primary ICH cases...

Langerhans cell histiocytosis (LCH) is a rare disorder in adults which usually manifests with involvement of multiple organ systems, including the central nervous system. We describe an unusual case of biopsy-proven LCH presenting with frontotemporal-dominant cognitive impairment with hypothalamic involvement, along with multisystem disease. We pro...

We report the case of a pregnant female presenting with behavioral change and hallucinations followed by focal seizures with impaired awareness. EEG revealed generalized slowing interspersed with extreme delta-brush pattern and MRI brain was normal. Both Serum and CSF anti-N-methyl-D-aspartate receptor (NMDAR) antibodies were positive. Patient had...

Subacute sclerosing panencephalitis (SSPE) is a slowly progressive degenerative disorder caused by measles virus. It is characterised by typical clinical and electrophysiological features in the form of slow myoclonic jerks, with progressive cognitive impairment, visual symptoms, and periodic complexes on EEG, with raised titres of anti-measles ant...