Nepal Journal of Neuroscience <p>Official journal of the Nepalese Society of Neurosurgeons (NESON). Also available on its own site at <a title="NESON" href="" target="_blank" rel="noopener"></a></p> <p>The Nepal Journal of Neuroscience is now accepting online submissions. Please <a href="/index.php/NJN/user/register">register</a> with the journal and select the author role to be able to submit your manuscript using the 5 step submission process.</p> en-US (Dr Resha Shrestha) (Sioux Cumming) Fri, 10 Nov 2023 10:53:59 +0000 OJS 60 A Treatable Cause of Cervical Myelopathy in a Young Female <p>Neuromyelitis Optica (NMO) or Devics Disease is an inflammatory demyelinating disorder of the central nervous system involving the neurons of the optic nerve and the spinal cord. It is seen more commonly in females and follows a relapsing clinical course in more than eighty percent of cases. The incidence of the same is rising in the Indian subcontinent. We present here a case of a young female patient presenting with features of a subacute cervical myelopathy with longitudinally extensive transverse myelitis on imaging of the spine. Investigations revealed features of Neuromyelitis Optica. She was diagnosed and treated early which led to good long term outcome</p> Krishnan Balagopal, Jeyaseelan Nadarajah, Sreyas Santhosh, Munavira K Shams, Riya Ann Koshy, Pretty Ponnachan Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 Determination of coagulopathy in acute traumatic brain injury and its effect on outcome <p><strong>Introduction:</strong> Coagulopathy after traumatic brain injury is quite a common finding. But its role associated with poor outcomes is still debatable. This study was design to assess the frequency, and association of coagulopathy in outcome after TBI.</p> <p><strong>Material and Methods:</strong> Single institute prospective study in isolated traumatic head injury was included and outcome was evaluated based Glasgow Outcome Scale recorded at the time of discharge. Coagulopathy was defined as deranged value of aPTT &gt;39s, PT&gt;14s, INR&gt;1.2 and Platelets&lt; 1.5lakhs.</p> <p><strong>Results:</strong> Among 405 subjects, mean age of the study population was 28.65 years, majority of the subjects were in the age group of 5-25 years 40.99%, 63.70% were males, mild condition 90.37%, whereas 8.39% presented with moderate and only 1.23% was having severe injury, The mean PT, INR &amp; APTT were 13.69 seconds, 1.1 and 34.50 seconds respectively. The mean platelet count was 261231.9 . Majority of the patients were having good recovery 93.1%, 5.5% had Moderate disability and 1% had severe disability, whereas two patients expired, patients with death and severe disability had higher proportions of coagulopathy, which was also statistically significant coagulopathy.</p> <p><strong>Conclusions:</strong> Coagulopathy is significantly associated with unfavorable outcome, though coagulopathy is not an independent factor for poor outcomes in isolated traumatic brain injury.</p> Safroz Ansari, Aditya Prakash Yadav, Masood Quazi Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 A Study to Detect Risk Factors of Chronic Subdural Hematoma Recurrence <p><strong>Introduction:</strong> Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. The risk factors for recurrence of chronic subdural hematoma (CSDH) after surgical evacuation has not been completely understood until now, but several risk factors for recurrence have been reported. Meanwhile, the definitive risk factors have not been defined until now. The aim of this study was to study the potential risk factors, including preoperative, operative and post-operative ones for CSDH recurrence.</p> <p><strong>Materials and Methods:</strong> The study population comprised of all &gt; 18 year age group patients who were operated for chronic subdural hematoma in Neurosurgery Department of tertiary care center. It was prospective cohort study. Patients who met inclusion criteria, postoperative outcomes were assessed at discharge, then at one month and three months afterwards in the neurosurgery OPD. Both the treatment options i.e. BHC Burr hole craniotomy and minicraniotomy as required as per CT scan or MRI findings.</p> <p><strong>Results:</strong> 7 patients (10.7%) had recurrence, of CSDH. All the reoccurrences occurred in burr hole operated patients. There was no recurrence in mini craniotomy operated group.</p> <p><strong>Conclusions:</strong> Many risk factors for recurrence of CSDH have been found, including old age, cerebral atrophy, large hematoma, bilateral hematomas, hematoma density, inflammation markers, alcohol ingestion, bleeding tendency, and some technical aspects of surgery such as irrigation with small amount of fluid, not excising thick membrane preventing brain expansion.</p> Sajag Kumar Gupta Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 Clinico-epidemological profile of migraine and its correlation with depression, anxiety and stress in a teritiary care hospital in South India <p><strong>Introduction:</strong> We studied the clinico-epidemiological profile of patients with migraine and to study the correlation of migraine severity with depression, anxiety and stress.</p> <p><strong>Materials and Methods:</strong> 98 subjects who were meeting inclusion and exclusion criteria were studied after obtaining informed written consent. Data was collected using prestructured performa and then analysed using SPSS software.</p> <p><strong>Result:</strong> 64.3% patients had unilateral headache and 76.5% had frontal area pain. Migraine with aura was present in 40.8% with commonest aura being visual (85%). Most common visual aura was scotoma (47.5%) and the most common associated symptom was photophobia (83.7%) followed by nausea (78.6%). The most common trigger was sun exposure (70.4%) followed by sleep deprivation (69.4%). Severe disability was present in 26.5% of subjects. Severity of migraine showed significant positive association with those who were taking alternative medicine. Migraine severity showed positive correlation with depression, anxiety and stress with correlation coefficient of 0.506, 0.509, and 0.604 respectively. Maximum correlation was with stress which may be considered as an independent risk factor for severe migraine.</p> <p><strong>Conclusion:</strong> Anxiety, depression and stress were strongly associated with severe migraine. They can act as factors that trigger and perpetuate migraine, of which stress may be considered as an independent risk factor for severe migraine. Early screening and management of depression, anxiety and stress might provide better control of migraine, thus improving the quality of life of migraineurs.</p> Baishyak Renuji, Rammohan Krishna Pillai Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 Detection of interictal epileptiform discharge in focal seizures <p><strong>Introduction: </strong>Many factors underlying basic epileptic conditions determine the characteristics of epileptic seizures and the therapeutic outcome. Visual obvious abnormalities in resting baseline EEG are cardinal but incompletely understood like feature of seizure onset zone in focal epilepsy and interictal epileptiform discharge. Present study is an attempt to diagnose that evidence of epileptic discharge in temporal lobe epilepsy (TLE), would persist during interictal period in absence of abnormalities in baseline EEG, which could increase the impact of automatic analysis of EEG waves for clinical relevance.</p> <p><strong>Material and Methods</strong>: By using 10-20 system, functional connectivity was estimated in the 20 channels of delta, theta, alpha, beta and gamma frequency bands of EEG, from 16 diagnosed focal epileptic seizure patients and 16 age and sex matched controls. To observe the dynamics of the healthy brain, differ from the brain of dynamically focal epileptic patients during interictal period treated with anti-epileptic drugs in the context of resting state during eye close session of EEG. Such differences can be observed by using absolute spectral power from BESS ((Brain Electro Scan Software) of the Axxonet System and statistically measure by applied unpaired student t -test.</p> <p><strong>Result:</strong> The high significance results in slow frequency EEG waves (delta and theta) in power spectral analysis were observed that demonstrates the potential epileptic discharge occurring during interictal period without visible pathological activity for helping in the diagnosis and lateralization of TLE.</p> <p><strong>Conclusion: </strong>The detailed spectral analysis of EEG waves offers novel insight into focal epileptic patients when visually EEG findings were normal. This linear analysis helpful in extracting information from EEG signals in diagnosing specific neuronal correlates for TLE. Present findings concluded that epileptic discharges occur at different topographical regions of brain during interictal period and power spectral analysis plays a new insight in diagnosis of focal discharge.</p> Shikha Saxena, Kamal Kant Gupta Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 Frequency of Complications after Paediatric Ventriculoperitoneal Shunt Surgery for Management of Hydrocephalus: An Observational Cohort Study <p><strong>Objectives: </strong>To determine the frequency of complications after paediatric ventriculoperitoneal shunt surgery for management of hydrocephalus.</p> <p><strong>Materials and Methods:</strong> An Observational Cohort Study was conducted from 19<sup>th</sup> March, 2020 to 18<sup>th</sup> September, 2021 at Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Total 150 patients of both genders, aged between 1-18 years diagnosed with hydrocephalus were selected. Shunted patients operated for other pathologies of brain and spine and those with more than 3 shunt revisions were excluded. Based on the clinical findings and investigations, a final diagnosis was made and the treatment in individual cases was planned accordingly. Post-operatively all the patients were followed up till 6 months and any complication which occurred was documented.</p> <p><strong>Results:</strong> Age range in this study was from 1 to 18 years with mean age of 7.50 ± 4.22 years. Majority of the patients 74.0% were between 1 to 10 years of age. Out of these 150 patients, 85 (56.67%) were males and 65 (43.33%) were females with male to female ratio of 1.3:1. Shunt blockade was seen in 36 (24.0%), Shunt malfunction in 21 (14.0%), Shunt infection in 48 (32.0%) and Shunt migration in 23 (15.33%) patients.</p> <p><strong>Conclusion: </strong>This study concluded that ventriculoperitoneal shunt in children with hydrocephalus is not free of complications and should be monitored and managed properly to reduce the complications.</p> Ahtesham Khizar, Hammad Mehtab, Soha Zahid , Pradhumna Kumar Yadav , Bushra Tariq Ali, Madeha Amjad Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 Scrub typhus Meningoencephalitis : Diagnostic dilemma <p><strong>Background:</strong> Neurological involvement in the form of meningitis or meningoencephalitis, although well documented in scrub typhus, has not been extensively studied in the pediatric population. It is seldom considered in the differential diagnosis of meningitis in the Indian subcontinent.</p> <p><strong>Case Presentation</strong>: We report a case of Scrub typhus meningitis in 13year old male child. The Cerebrospinal Fluid (CSF) revealed lymphocytic pleocytosis, raised proteins and a normal glucose level. </p> <p><strong>Conclusion </strong>: Early diagnosis and prompt institution of doxycycline therapy may lead to early cure of scrub typhus even when features of meningitis supervene. However, Ceftriaxone which is commonly used to treat bacterial meningitis is suboptimal in the treatment of scrub typhus.</p> <p>Key words : Scrub typhus, Meningoencephalitis, CSF</p> Nilima Narkhede, Rajaram Weling, Sanjay Prajapati Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 A Case of Stiff Person Syndrome Treated Using Intrathecal Baclofen <p><strong>Introduction</strong>: Stiff Person Syndrome is a rare autoimmune neurological disorder with chronic muscle spasms leading to chronic pain and debilitation.</p> <p><strong>Case Report</strong>: We describe a case of a 57-year-old man with the history of Diabetes mellitus type 1 diagnosed 15 years back with high-titer positive anti-GAD antibodies and poorly controlled blood sugar levels under highly dosed insulin treatment.</p> <p><strong>Discussion</strong>: Intrathecal baclofen showed a marked improvement for the relief of spasticity with the choice of a baclofen pump for similar patients. </p> Pratik Paudel, Pritam Gurung, Manik Kumar Lama, Sambardhan Dabadi, Resha Shrestha, Rakshya Gautam, Basant Pant Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 Salmonella Epidural Abcess with Acute Paraplegia: Report of a Rare Vertebral Infection <p>Salmonella Vertebral osteomyelitis (SVO) is an uncommon entity. In this article, we reported a rare case of a 39-year-old man admitted with low backache for three days which progressed to paraparesis within 24 hours. Urgent CEMRI revealed Spondylodiscitis D7/D8 associated with an epidural abscess causing significant cord compression. He was initially diagnosed as thoracic Potts Spine and underwent emergency decompressive surgery. He was started on Antitubercular drugs, however, tissue and wound culture grew Salmonella Enterica. USG abdomen revealed hepatosplenomegaly. He was started on 6 weeks intravenous antibiotics accordingly; the patient showed postoperative improving neurological deficits with significant symptomatic relief and radiological resolution.</p> Ajay S Carvalho, Atul Jain, Subir Dey, Sudip K Sengupta Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 Isolated spinal Intramedullary Neurocysticercosis: A rare case report and review of literature <p>Neurocysticercosis is Taenia solium infection of the central nervous system and meninges. Although highly uncommon, spinal cysticercosis frequently occurs in conjunction with intracranial cysticercosis. The least frequent are often those involving the intramedullary. We report a 50-year-old male patient who presented with complaints of lower back pain with a burning sensation over bilateral thighs. A magnetic resonance imaging (MRI) scan of his dorsal spine revealed a relatively well-defined lobulated lesion at T11 vertebral level. Intramedullary cysticercosis is a challenge to diagnose, and neurocysticercosis should also be considered in cases of intramedullary space-occupying lesion.</p> Subigya Man Lama, Kumar Paudel, Narendra Shalikhe, Pradhumna Kumar Yadav, Somraj Lamichhane Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 Anti- NMDAR Encephalitis in a 28 years old female: Revisited <div><span lang="EN-US">Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the prevailing subtype of autoimmune encephalitis, commonly misdiagnosed initially as infectious encephalitis due to its symptomatology resembling that of viral encephalitis and meningitis. The condition exhibits a higher incidence in females, with a gender ratio of 4:1 compared to males. While electroencephalogram (EEG) and magnetic resonance imaging (MRI) aid in the diagnostic process, the presence of antibodies in the cerebrospinal fluid (CSF) serves as the definitive confirmation. Autoimmune encephalitis typically presents with a spectrum of neuropsychiatric symptoms</span></div> Rajiv Jha, Pankaj Jalan, Rajiv Shah, Adarsha Chaturvedi Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 Open versus Endoscopic and Microscopic Pituitary Adenoma Excision– An Institutional Experience <p><strong>Introduction: </strong>For symptomatic nonsecreting pituitary adenomas (PAs), surgical resection remains the treatment of choice. In this retrospective study, we compare the efficacy of open versus endoscopic and microscopic excision of pituitary adenoma, and to evaluate the merits and demerits of each approach.</p> <p><strong>Material and Methods:</strong> This study is a retrospective analysis of patients who underwent surgical excision for symptomatic pituitary adenoma in institute of neurosurgery, madras medical college from January 2022 to December 2022. Various parameters were analyzed including the age, sex, type of surgical resection done, duration of surgery, average blood loss, extent of resection of tumors, and intra- and post-operative complication.</p> <p><strong>Results:</strong> A total of thirty eight patients with pituitary adenoma were operated from January 2022 to December 2022. Six patients were operated by endonasal endoscopic transsphenoidal surgery and six patients were operated by microscopic transsphenoidal surgery, 26 patients were operated by Pterional craniotomy and excision of tumour. In an endoscopic and microscopic group, complete tumor excision was achieved in 8 patients (66.6%) and in open surgery group, it was achieved in 6 (23.1%) patients. In endoscopic and microscopic group, the mean operative time was 120 ± 25 min (ranged 80–135 min) and in open surgery group, it was 150 ± 15 min (ranged 130–175 min). In endoscopic and microscopic group, mean blood loss was 120 ± 30 ml (80–160 ml), and in open surgery group, it was 200 ± 15 (150–230 ml). Postoperative CSF leak from wound site was present in 1 case in open surgery group. There was no mortality in either group. Duration of hospital stay was 5 days in endoscopic and microscopic group and 14 days for open surgery group.</p> <p><strong>Conclusion:</strong> Endoscopic and microscopic approach provides a wide surgical field and broad lateral vision making easier distinction of tumor tissues. Thus, there is less blood loss, less operative time, less postoperative complication, and early discharge from the hospital.</p> Anand Shanmugaiah, Raghavendran Radhakrishnan Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 Neurointervention in Nepal: scope and challenges <p>Not applicable</p> Manoj Bohara Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000 The antidepressant and sedative properties of the ethanolic extracts of Pleurotus squarrosulus on reserpine induced depression anxiety in wistar rats <p>Depression and anxiety are common mental health conditions that can have a significant impact on an individual’s life. Although orthodox treatments for these conditions can be effective, they often accompanied with unfavorable side effects. Oyster mushrooms (<em>Pleurotus spp)</em> have been reported to possess numerous health benefits, including antitumor, antioxidant, and anti-inflammatory effects. The present study aimed to investigate the antidepressant and sedative properties of the ethanolic extracts of <em>Pleurotus squarrosulus</em>. The ethanolic extract of the sample was screened for the presence of bioactive compounds, including alkaloids, saponins, flavonoids, terpenoids, and polysaccharides. The results revealed that the ethanolic extract of <em>Pleurotus squarrulosus</em> exhibited significant radical scavenging ability against 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical, 2,2’-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid (ABTS) radical, nitric oxide (NO), and ferric reducing antioxidant power.</p> <p>The neurobehavioral assessment of rats induced with reserpine showed that <em>Pleurotus squarrulosus</em> extract reduced the immobility time in the tail suspension test (TST) and forced swim test (FST) (p&lt;0.0001), which are behavioral models of depression. Treatment of the Reserpine-induced rats with <em>Pleurotus squarrulosus</em> extract also improved the levels of neurotransmitters acetylcholinesterase, thereby combating the neurotransmitter depletion and oxidative stress induced by their depressive state. &nbsp;The group induced with depression upon reserpine administration resulted in elevated levels of MDA showing high level of peroxidation. The <em>Pleurotus squarrosulus </em>extract as well as the standard antidepressant administered, fluoxetine ameliorated this effect. The groups treated with the <em>Pleurotus squarrosulus </em>extract in the study, was found to increase the activity of antioxidant enzymes, such superoxide dismutase and glutathione peroxidase. This suggests that the extract may have potential as a therapeutic agent for neurodegenerative diseases that involve oxidative stress.</p> Babajide Akingbesote, Sule Salawu Copyright (c) 2023 Nepalese Society of Neurosurgeons (NESON) Fri, 10 Nov 2023 00:00:00 +0000