Acute onset movement disorders in diabetes mellitus: A clinical series of 59 patients

Background and purpose: No previous study has assessed the frequency and clinical– radiological characteristics of patients with diabetes mellitus (DM) and acute onset non-choreic and nonballistic movements. We conducted a prospective study to investigate the spectrum of acute onset movement disorders in DM.Methods: We recruited all the patients with acute onset movement disorders and hyper-glycemia who attended the wards of three hospitals in West Bengal, India from August 2014 to July 2021.Results: Among the 59 patients (mean age = 55.4± 14.3 years, 52.5% men) who were included, 41 (69.5%) had choreic or ballistic movements, and 18 (30.5%) had nonchoreic and nonballistic movements. Ballism was the most common movement disorder (n= 18, 30.5%), followed by pure chorea (n= 15, 25.4%), choreoathetosis (n= 8, 13.6%), tremor (n= 5, 8.5%), hemifacial spasm (n= 3, 5.1%), parkinsonism (n= 3, 5.1%), myoclonus (n= 3, 5.1%), dystonia (n= 2, 3.4%), and restless leg syndrome (n= 2, 3.4%). The mean duration of DM was 9.8 ± 11.4 years (89.8% of the patients had type 2 DM). Nonketotic hypergly-cemia was frequently (76.3%) detected. The majority (55.9%) had no magnetic resonance imaging (MRI) changes; the remaining showed striatal hyperintensity. Eight patients with MRI changes exhibited discordance with sidedness of movements. Most of the patients (76.3%) recovered completely.Conclusions: This is the largest clinical series depicting the clinical–radiological spectrum of acute onset movement disorders in DM. Of note was that almost one third of patients had nonchoreic and nonballistic movements. Our findings highlight the importance of a capillary blood glucose measurement in patients with acute or subacute onset movement disorders, irrespective of their past glycemic status

The spectrum of intracranial hypertrophic pachymeningitis at an Eastern Indian tertiary care center

Introduction: Hypertrophic pachymeningitis (HP) is a treatable, rare inflammatory disease, either primary or secondary to systemic causes. Aims: To characterize the etiology, clinical manifestations, and treatment outcomes of HP patients and determine the factors influencing the radiological resolution of the pachymeningeal enhancement and recurrence of symptoms within the follow-up period. Materials and Methods: We collected data for this prospective observational study between March 1, 2021 and May 31, 2022, at the Bangur Institute of Neurosciences, Kolkata, and the patients were followed for a 6-month period. Demographic, clinical, laboratory, and treatment-related data were collected. A univariate logistic regression model was used for comparison between patients with and without radiological resolution of pachymeningitis and between patients with and without symptom recurrence. Results: Among 44 patients, the male: female ratio was 1.2:1. The median age at disease onset was 35.5 (28.5–49.5) years. The etiologies were idiopathic (56.8%), tuberculosis (22.8%), immunoglobulin G subtype 4 (IgG4) disease (9.2%), other infections (6.8%), and neoplastic (4.4%). Headache was the most common presentation (95.4%), followed by cranial neuropathies (68.2%). Optic and oculomotor neuropathies were the most common. In terms of radiological features, 27.27, 29.54, and 43.18% of patients had diffuse, focal regular, and focal irregular enhancement, respectively. Temporal (50%), followed by cavernous sinus (38.63%) enhancement, was the most common. Recurrence occurred in 36 and 50% of idiopathic and IgG4-related HP cases, respectively. Mycophenolate mofetil was added to their steroid regimen with no further recurrences. Conclusion: The cohort had a marked absence of (antineutrophil cytoplasmic antibodies) ANCA-associated HP. The severity of clinical manifestations or distribution of pachymeningitis did not differ significantly among the etiological groups. The presence of idiopathic etiology and focal regular enhancement had a significantly higher chance of radiological resolution. The response to therapy was satisfactory. Recurrence was significantly related to shorter steroid courses (<median duration of 5.2 months)

Analysis of Conventional Risk Factors in Stroke in Young Population (A Tertiary Care Hospital Based Study)

Background: The published literature, in INDIA, addressing risk factors and aetiology of stroke in young, is limited at best. Objectives: To assess the aetiology and conventional risk factors for stroke in young population attending a tertiary care hospital and compare risk factors in various age groups and ischemic and haemorrhagic subgroups. Material &amp; Methods: Patients aged 15-49 years attending stroke clinic at tertiary care hospital, were evaluated from January 2012 - June 2013. Diagnosis was based on clinical and imaging features. Detailed risk factor evaluation was done by history, examination, biochemistry, parenchymal imaging to determine stroke subtype. Result: 98 patients of stroke (37 were females and 61 were males) were assessed. Mean age for ischaemic stroke was 32.8 years and for haemorrhagic stroke was 31.4 years. Out of 98 patients of stroke studied, smoking was the most common risk factor (37.75%) followed by systemic hypertension (36.73%) and dyslipidaemia (30.6%). Alcohol abuse and smoking were more common in males as compared to females and the difference was statistically significant. Incidence of diabetes was 13.64% in ischemic subgroup and 9.38% in haemorrhagic subgroup. Univariate regression analysis of all risk factors revealed that smoking, family history of stroke, diabetes, hypertension, and dyslipidaemia are the potential risk factors among older age groups. Multivariate regression analysis of all risk factors also observed and found that the adjusted odds of family history, hypertension, and dyslipidaemia were statistically significant and concludes that these are more potent risk factors in older age groups

COVID-19 and optic neuritis: a series of three cases and a critical review

Abstract Background The novel coronavirus disease (COVID-19) has claimed innumerable lives globally since its onset and several extrapulmonary manifestations of the disease have been reported in association with COVID-19. Although optic neuropathy has been previously linked to a variety of infections, neuro-ophthalmological associations of SARS-CoV-2 have been sparsely reported till date. Our aim was to report the clinical profile and outcome of patients diagnosed with parainfectious/postinfectious optic neuritis (ON) associated with COVID-19. Case presentation In this case series, we have discussed the clinical presentation, laboratory parameters and outcome in a series of three patients of ON associated with COVID-19 and also compared those findings against existing literature. Among the three patients, two patients (Case 1, 3) were incidentally diagnosed with COVID-19 during the course of hospital admission and contributed to a parainfectious association with ON, while one patient (Case 2) had an antecedent history of COVID-19 as evidenced by her antibody titers thus contributing to a postinfectious association. Notably, all these patients were asymptomatic or had mild manifestations of COVID-19 and all of them tested negative for myelin oligodendrocyte glycoprotein (MOG) antibodies. They were treated accordingly and their visual outcomes were noted in follow-up. Conclusion ON with or without MOG seropositivity, probably attributed to molecular mimicry has surfaced up considerably in association with COVID-19. This article provides a comprehensive overview of clinical presentation and outcome of ON associated with parainfectious/postinfectious COVID-19 in three cases and a critical analysis of existing literature

COVID-19 Pandemic, Personality and Geriatric Population: Proposed Pragmatism

Elderly people are the most sensitive and delicate part of society who must bear the major burn of disruptive social behavior of human being amidst the 2019 coronavirus infectious disease (COVID-19) pandemic. Our aim was (1) to find out the root of disruption of societal integrity and self-centeredness by analyzing spokes of HEXACO; 2) to delineate its possible relationship with the formation of Neuroticism and eventually Psychopathy, and 3) to search for the potential ways to get rid of this darkness. Human civilization is experiencing unique psychosocial problems through emerging COVID 19. Depression, panic buying, herd behavior, yellow journalism, “infodemic” spreading through social media, immense sufferings of marginalized people, children and elderly, a surge of addictive behavior, racism, domestic violence, rape, divorce, financial constraints, and stigmatization, all possibly stem from a constellation of different negative human behaviors which probably originate from negative deflection of components of HEXACO model of personality towards the genesis of the dark triad. COVID-19 and surge of the dark triad in form of Neuroticism, Narcissism and Machiavellianism are causing major mental health threat. Cultivations and practice of positive emotions and triumph of honesty, humility and humanity are utmost desirable to save Earth and its habitants from the cruel claws of this pandemic