Artery of percheron infarction: case reports and literature review

The artery of Percheron is a rare anatomic variant supplying the thalamus and the rostral midbrain. Infarct in this territory results in a wide array of neurological signs and symptoms causing diagnostic dilemma and management issues. We describe the clinical presentations in three cases admitted and evaluated for neurological symptoms and diagnosed as artery of percheron infarct after brain imaging. In one patient, the etiology turned out to be infective while the other two patients had cerebrovascular accident secondary to dilated cardiomyopathy and hyper homcystinimea respectively. Artery of percheron infarction is a rare entity and should be considered in patients with altered sensorium and behavioral manifestations with associated eye abnormalities. MRI brain is the investigation of choice to detect this rare variant of thalamic circulation.

Early PNF exercises functional outcome and quality in patients with stroke of urban and rural area in Uttar Pradesh: a prospective community based study

Background: Early rehabilitation plays a very important role in stroke outcome. In India people from rural areas get primary treatment from district hospitals, where the rehabilitation facilities are not available, and then referred to the tertiary care hospital (after 2-3weeks) hence the rehabilitation process is delayed. It may delay the improvement in functional outcome and quality of life. These factors should be evaluated. To evaluate effects of PNF intervention in urban and rural population in Uttar Pradesh.Methods: Total 90 patients were recruited in this study and divided into rural (coming from rural areas of Uttar Pradesh) and urban (coming from urban areas) groups. Patients were given rehabilitation for 4weeks and improvement in functional activities was assessed by Barthel's-Index (BI), Quality of Life was assessed by Stroke Specific Quality of Life Scale (SSQOL) and sensory motor improvement was assessed by Fugl- Meyer Assessment before and after the intervention. Patients were again assessed at 6months.Results: 41 patients in experimental and 49 patients in control group completed the 6 months follow up and were available for analysis. On analysis urban group showed better (<0.05) improvement in functional activities, sensory motor improvement (FMA) and quality of life (SSQOL) as well. People who directly admitted to our multispecialty and tertiary care hospital and received early rehabilitation showed better improvement than the patients who received late rehabilitation.Conclusions: Early rehabilitation leads to early improvement in functional activities. PNF exercises are very effective in improving motor function and should be given from the first day after stroke

Clinical features and predictors of in hospital mortality in patients with intra cerebral haemorrhage

Background: Intracerebral haemorrhage (ICH) accounts for 15-20% of all strokes and is associated with significant morbidity and mortality. The present study was done to assess the risk factors for ICH and determine the factors responsible for poor outcome in ICH.Methods: Consecutive patients of ICH were assessed for modifiable and non-modifiable risk factors, followed by detailed examination with emphasis on ICH score and CT scan findings.Results: There were 200 patients with ICH; 108 males and 92 females. The prevalence of ICH was maximum in the age group of 61-70 years (34%). Hypertension was present in 68% of the patients and was the single most important modifiable risk factor. The most common presenting symptom was altered sensorium present in 58% patients. The mean hematoma volume in our study was 44+/-45 cm3. 45 patients with a GCS <5 and both the patients with ICH score 5 expired. On multivariate analysis, there was a significant correlation of mortality with GCS and hematoma volume.Conclusions: Hypertension is the commonest risk factor for ICH. Patients with a low GCS score, large hematoma volume and a higher ICH score have a poor prognosis and higher probability of mortality.

Muscle Tone Physiology and Abnormalities

The simple definition of tone as the resistance to passive stretch is physiologically a complex interlaced network encompassing neural circuits in the brain, spinal cord, and muscle spindle. Disorders of muscle tone can arise from dysfunction in these pathways and manifest as hypertonia or hypotonia. The loss of supraspinal control mechanisms gives rise to hypertonia, resulting in spasticity or rigidity. On the other hand, dystonia and paratonia also manifest as abnormalities of muscle tone, but arise more due to the network dysfunction between the basal ganglia and the thalamo-cerebello-cortical connections. In this review, we have discussed the normal homeostatic mechanisms maintaining tone and the pathophysiology of spasticity and rigidity with its anatomical correlates. Thereafter, we have also highlighted the phenomenon of network dysfunction, cortical disinhibition, and neuroplastic alterations giving rise to dystonia and paratonia

Clinical features and predictors of in hospital mortality in patients with intra cerebral haemorrhage

Background: Intracerebral haemorrhage (ICH) accounts for 15-20% of all strokes and is associated with significant morbidity and mortality. The present study was done to assess the risk factors for ICH and determine the factors responsible for poor outcome in ICH.Methods: Consecutive patients of ICH were assessed for modifiable and non-modifiable risk factors, followed by detailed examination with emphasis on ICH score and CT scan findings.Results: There were 200 patients with ICH; 108 males and 92 females. The prevalence of ICH was maximum in the age group of 61-70 years (34%). Hypertension was present in 68% of the patients and was the single most important modifiable risk factor. The most common presenting symptom was altered sensorium present in 58% patients. The mean hematoma volume in our study was 44+/-45 cm3. 45 patients with a GCS &lt;5 and both the patients with ICH score 5 expired. On multivariate analysis, there was a significant correlation of mortality with GCS and hematoma volume.Conclusions: Hypertension is the commonest risk factor for ICH. Patients with a low GCS score, large hematoma volume and a higher ICH score have a poor prognosis and higher probability of mortality.

Early PNF exercises functional outcome and quality in patients with stroke of urban and rural area in Uttar Pradesh: a prospective community based study

Background: Early rehabilitation plays a very important role in stroke outcome. In India people from rural areas get primary treatment from district hospitals, where the rehabilitation facilities are not available, and then referred to the tertiary care hospital (after 2-3weeks) hence the rehabilitation process is delayed. It may delay the improvement in functional outcome and quality of life. These factors should be evaluated. To evaluate effects of PNF intervention in urban and rural population in Uttar Pradesh.Methods: Total 90 patients were recruited in this study and divided into rural (coming from rural areas of Uttar Pradesh) and urban (coming from urban areas) groups. Patients were given rehabilitation for 4weeks and improvement in functional activities was assessed by Barthel's-Index (BI), Quality of Life was assessed by Stroke Specific Quality of Life Scale (SSQOL) and sensory motor improvement was assessed by Fugl- Meyer Assessment before and after the intervention. Patients were again assessed at 6months.Results: 41 patients in experimental and 49 patients in control group completed the 6 months follow up and were available for analysis. On analysis urban group showed better (&lt;0.05) improvement in functional activities, sensory motor improvement (FMA) and quality of life (SSQOL) as well. People who directly admitted to our multispecialty and tertiary care hospital and received early rehabilitation showed better improvement than the patients who received late rehabilitation.Conclusions: Early rehabilitation leads to early improvement in functional activities. PNF exercises are very effective in improving motor function and should be given from the first day after stroke

Vascular endothelial growth factor attenuates neurodegenerative changes in the NSC-34 motor neuron cell line induced by cerebrospinal fluid of sporadic amyotrophic lateral sclerosis patients

Background: Motor neuron disease or amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the selective death of motor neurons in the spinal cord as well as motor cortex. Recently, vascular endothelial growth factor (VEGF) has been identified as a neurotrophic factor in animal models of familial ALS and other neurological diseases. Objective: The present study was designed to investigate the neuroprotective role of VEGF in the more prevalent sporadic form of ALS. Methods: We studied the effect of VEGF on the NSC-34 cell line exposed to cerebrospinal fluid (CSF) from sporadic ALS patients (ALS-CSF) in terms of lactate dehydrogenase (LDH) assay as well as choline acetyltransferase (ChAT) and phosphorylated neurofilament expression by immunocytochemistry and confocal microscopy. NSC-34 cells were exposed to CSF from patients with definite ALS and compared to controls. LDH activity was assessed in the growth media, prior to and 24 h after the addition of VEGF to the cells. At similar time points, the cells were fixed and processed for immunocytochemistry to evaluate ChAT and phosphorylated neurofilament expression. Results: Exposure to ALS-CSF caused morphological changes of NSC-34 cells like reduced differentiation and aggregation of phosphorylated neurofilaments. Enhanced LDH activity and reduced ChAT immunoreactivity were also observed. Addition of VEGF to NSC-34 cells exposed to ALS-CSF was protective in terms of reduced LDH activity and restoration of ChAT expression. Conclusion: The present study confirms that VEGF exerts a neuroprotective effect on the NSC-34 cell line by attenuating the degenerative changes induced by ALS-CSF. It thus has therapeutic potential in sporadic ALS