ASSOCIATION AND CORRELATION OF MEAN PLATELET VOLUME AND PLATELET COUNT IN ACUTE ISCHEMIC STROKE

Objective: Role of platelets in the pathogenesis of the atherothrombosis and ischemic stroke has been documented. Mean platelet volume (MPV) and platelet count (PC) could be important predictors of acute ischemic stroke (AIS), its severity; therefore we investigated the correlation of MPV & PC in AIS patients. Methods: We studied MPV and PC of 52 AIS patients consecutively admitted in Neurology department at Geetanjali Medical University, India. Platelet variables were measured and compared with control of similar age, sex and without vascular events. Results: Out of 52 patients, 30 (57.69%) had Thirty (57.69%) patients had significantly higher MPV in AIS group (12.45fL compared with normal range of 6–11 fL in control,p<0.001). No significant differences were found between male and females, but the total mean was elevated. The mean of PC was 1.76×105 cells/cumm (normal range) and there was no correlation between the change in PC and AIS in both sexes. Repeated measurements of MPV and PC were also recorded on follow-up which showed no significant changes from the acute phase; however, MPV remained elevated. The comparison of MPV in patients with mRS score 2 versus 4, 2 versus 5, 3 versus 4 and 5, and 4 versus 5 were found to be statistically significant (p<0.05). Conclusion: Increased MPV has an independent association with AIS and its severity and it could not change after acute treatment. It is possible that these changes precede the vascular event, and further studies are warranted to unravel the underlying mechanism

CORRELATION OF BRAIN MAGNETIC RESONANCE IMAGING INCLUDING DIFFUSION WEIGHTED IMAGING (MRI-DWI) WITH NEUROCOGNITIVE OUTCOME IN CORONARY ARTERY BYPASS GRAFTING (CABG) PATIENTS

Objectives: To evaluate the new lesions on Magnetic Resonance Imaging including diffusion weighted imaging (MRI-DWI) in patients undergoing CABG and its relationship with neurocognitive outcome. Methods: In this prospective study Bilateral Carotid and Vertebral Doppler study was done before CABG surgery and Brain MRI protocol including fluid attenuation inversion recovery (FLAIR) and DWI was applied 1–4 days before surgery and 6-12 weeks after surgery. Neuropsychological tests were performed before and after 6-12 weeks of surgery in both the groups. Results: Total sixty six patients were included in study. On preoperative angiogram CABG had less double-vessel (31.8%) and more triple-vessel disease (65.15%). MRI Brain with DWI was performed preoperatively in 50(75.75%) of 66 CABG patients. Before surgery, no diffusion abnormalities were found on DW images. In those who underwent MRI, no lesions were found in 21 (31.82%) CABG patients. Bilateral small vessel ischemic disease (SVID) or periventricular lucencies (PVL) was seen in 23(34.85%%) CABG patients. Bilateral SVID with lacunar infarct was seen in 4 (6.06%) CABG patients. Lacunar infarct and wedge infarct was seen in 1(1.52%) patient each. At follow up, MRI Brain with DWI was performed only in 54(81.82%) CABG patients. There was no significant change was found postoperatively on brain MRI imaging. There was also no significant difference before and after CABG patients in cognitive function. Conclusion: This study concluded that CABG has no relation in the form of brain MRI changes with the cognition function of the patients

A STUDY TO CORRELATE THE SERUM URIC ACID LEVELS WITH THE DURATION AND SEVERITY OF MIGRAINE

Objectives: To assess the serum levels of uric acid in patients of migraine and to correlate the levels of uric acid with duration and severity of migraine. Methods: This observational study was conducted in patients with complaint of headache, due to migraine who attended Neurology and General Medicine out patients department of tertiary care teaching hospital of Udaipur, Rajasthan. Uric acid levels were compared between both the genders with respect to age group, frequency of attack and duration of migraine. Uric acid levels were also correlated with different parameters. Results: Total 500 patients were evaluated during the study period of 2 years.  Mean uric acid in male patients was 5.02±1.40 mg/dl, and in females it was 4.99±1.39 mg/dl. Uric acid levels in male and female patients were found non-significant across all age groups, with duration of migraine and frequency of migraine attack (p>0.05). There was a significant correlation between uric acid levels and migraine severity in present study (p˂0.05), but there was no correlation with age, duration of migraine and frequency of migraine attacks per month (p>0.05). Conclusion: The study concluded that uric acid levels are within normal range in all age group as well as either of gender in patients of migraine. So there is no relation between uric acid and duration and frequency of migraine but positive correlation with severity of migraine

Apogeotropic posterior semicircular canal BPPV—A case series from South Rajasthan

Apogeotropic variant of posterior semicircular canal benign paroxysmal positional vertigo (apo-PSC-BPPV) is a rare peripheral vestibular disorder, characterized by paroxysms of positionally triggered dizzy spells associated with non-positional disequilibrium. It is diagnosed by observing characteristic diagnostic oculomotor responses (torsional downbeating positional nystagmus) during positional testing (Dix-Hallpike and enhanced straight head hanging tests), in conjunction with a response to physical therapy. Much rarer anterior semicircular canal benign paroxysmal positional vertigo (ASC-BPPV) elicits identical oculomotor responses during positional testing. Propter hoc, response to physical therapy at short-term follow-up is crucial in distinguishing the apo-PSC-BPPV from ASC-BPPV. We are presenting a case series of seven patients of apo-PSC-BPPV (of which three were bilaterally affected), who attended our otoneurology center, between February 1, 2023, and July 31, 2023. Demographic profile, clinical course, and physical therapy with responses at short-term follow-up at 1 hour and after 24 hours are discussed

Inversion test and sitting-up oculomotor patterns in patients with graviceptive heavy posterior cupula – A case series

A graviceptive heavy posterior cupula typically results from cupulolithiasis and clinically manifests as short vertigo spells when the head moves in the provocative position. Half-Hallpike test (HHT) in posterior cupulolithiasis (PSC-BPPV-cu) elicits an upbeating ipsitorsional nystagmus (UBITN), which lasts more than a minute as per the consensus criteria developed by the Barany Society. In the last decade, cases with canalolithiasis in the short arm of the posterior semicircular canal (PSC-BPPV-sa), wherein the otoconial debris falls on the utricular side of the posterior cupula on getting up from supine, rendering it heavy (graviceptive), have been reported. Such patients complain of sitting-up vertigo, associated with a constant disequilibrium, and anteroposterior truncal oscillations are recorded by ad hoc posturography in many of these patients. The oculomotor patterns generated in such patients during the HHT may be identical to those resulting from PSC-BPPV-cu. Rarely do the two conditions (PSC-BPPV-cu and PSC-BPPV-sa) coexist. Nine cases of graviceptive heavy cupula were diagnosed at our center over a period of 6 months from September 1, 2022, to March 31, 2023, with their characteristic diagnostic oculomotor patterns, distinguishing features, and management discussed. We propose a grading system for the inversion test during the HHT that reliably distinguishes PSC-BPPV-cu from PSC-BPPV-sa, as well as when the two conditions coexist

Cysticercosis of midbrain presenting with fluctuating ptosis

Fluctuating ptosis is usually caused by Myasthenia gravis. There are a few case reports of central causes of fluctuating ptosis. A 58-year-old man presented with fluctuating ptosis of one year duration. He was diagnosed as having ocular myasthenia and investigated. On evaluation, his electrophysiological tests revealed negative decremental response and results of neostigmine test was negative. During follow-up, patient developed headache. Imaging of the brain revealed midbrain cysticercosis granuloma. The focal encephalitis and edema was responsible for fluctuating ptosis. It is therefore essential to be aware of conditions that cause such pseudomyasthenic features. Patients with ptosis need to be evaluated for other rare central cause especially when neostigmine test is negative