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) Mon, 10 Jun 2024 13:22:27 +0000 OJS 60 Rare presentations of Acute Acquired Demyelinating Syndromes (ADS) among children <p>Acute demyelinating syndromes (ADS) in children presents with neurological symptoms with a pathology involving either single central nervous system (CNS) location (mono focal ADS) or multiple sites (poly focal ADS), with or without encephalopathy. It is a diagnostic dilemma requiring a high index of suspicion. A thorough clinical examination with neuroimaging and cerebrospinal fluid (CSF) analysis is needed for making a diagnosis. Clear cut guidelines regarding long term management and prognosis is lacking. Myelin oligodendrocyte glycoprotein (MOG) antibody must be done in all suspected cases as it helps in prognosticating and counselling parents. Recurrence is rare, recovery is usually complete and most children respond to pulse high dose methylprednisolone injection. In this case series we map out different unique presentations of acute ADS with and without Myelin oligodendrocyte glycoprotein (MOG) antibody positivity among children from a tertiary care hospital in central Kerala, India.</p> Jeffy Joy, Rose Xavier, Ebin Jose, Binoj Varghese Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Cerebral venous thrombosis and the eye: the neuro-ophthalmology of cerebral venous blood clot <p><strong>Introduction:</strong> Cerebral venous thrombosis (CVT) is a form of venous thromboembolism which has varied clinical presentation. Ocular clinical features are quite common in CVT and may be the sole presenting feature and often tend to get misdiagnosed. This study was conducted to analyse clinical features especially neuro ophthalmological manifestations in CVT patients.</p> <p><strong>Materials and Methods: </strong>In this prospective study 60 patients were enrolled in a study period of 3 years at tertiary care hospital. Follow up visits were performed at 1 month, 3 months, 6 months and 12 months after the initial diagnosis. We analysed the clinical features as well as aetiology of CVT, special focus was on the ocular symptoms and signs.</p> <p><strong>Results: </strong>Headache was the most common clinical symptom with 93.33% patients. Among ocular symptoms 43.33 % patients presented with complaint of blurring of vision. Among ophthalmological signs papilledema was reported in 40.0 % patients, cranial nerve involvement in 10.0 % patients, diplopia was seen in 6.66 % patients. In patients with papilledema the intensity reduced as time progressed. Vision loss was seen in 2 patients who had secondary optic atrophy.</p> <p><strong>Conclusion:</strong> To avoid misdiagnosis and for the prevention of vision deterioration the ophthalmologist must pay attention to CVT symptoms and signs when patients present with ocular symptoms as the initial manifestation.</p> Ashutosh Kumar Mishra, Ruchi Shukla, Archana Verma, Rameswar Nath Chaurasia Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Decompressive craniotomy for severe traumatic brain injury: Our experience and review of literature <p><strong>Introduction:</strong> Severe traumatic brain injury (TBI) is the most devastating injury affecting physical, mental, social and financial health of an individual and a society. The research, understanding and management of TBI is mainly focussed towards the secondary effects of the traumatic brain injury. Maintaining intracranial pressure within reasonable bounds is essential for successful TBI therapy, as an uncontrolled intracranial pressure (ICP) plays a major role in determining the course and prognosis of the injury. In general, ICP can be managed medically and/or surgically. In this article, we discuss our experience, the most recent understanding, and a method for managing ICP in traumatic brain injury.</p> <p><strong>Material and Methods:</strong> This study comprised 350 patients with moderate to severe traumatic brain injury (TBI) who were treated by a single neurosurgeon at several institutions between 2005 and 2020. 76.6% (268) of the patients were men, and 64% (224) of the patients were under 60 years old. The most common mode of injury was road traffic accident followed by fall from height. The study excluded those patients with brain stem injuries, bilateral non-reacting pupils, and concomitant significant injuries in other body parts. All were first treated medically with appropriate resuscitation, hyper-osmolar therapy (mannitol, 3% saline), hyperventilation, and barbiturate coma as per the response and requirement. Surgical intervention was used for patients who did not respond to medical management. In addition, decompressive craniectomy (DC) was primarily performed on those whose GCS was less than 5 and who had reacting pupils, upon presentation.</p> <p><strong>Results:</strong> Out of the 350 patients, 53.2% (186) had moderate TBI and 46.8% (164) had severe TBI. Due to failure of medical management, 30.5% (54) of moderate and 69.5% (123) of severe TBI underwent decompressive craniectomy in the form of bifrontal craniectomy in 18% (32), unilateral fronto-temporo-parietal craniectomy (hemicraniectomy) in 64% (113) , bilateral hemicraniectomy in 6% (11) and 12% (21) underwent limited fronto-temporo-parietal craniectomy. Decompressive craniectomy was not performed for posterior fossa. The data on outcome is very poor, inadequate and unreliable due to bad follow up. 5 years Follow up could be obtained only of 127 out of 350 (36%) patients and majority of these 69% (88) were moderately or severely disabled. Of those operated ones, only 27% (48) agreed for cranioplasty. 17% (30) had to undergo VP shunt for hydrocephalus. The group with severe traumatic brain injury (TBI) accounted for the majority of deaths (17%), with respiratory tract infections being the primary cause.</p> <p><strong>Conclusion:</strong> Decompressive craniectomy is the sole option in medically refractory cases of traumatic intracranial hypertension, who continue to deteriorate clinically. Nevertheless, the benefit falls short of expectations, particularly with regard to functional recovery. However prompt and appropriate decompression in appropriately indicated patients has withstood the test of time and remains a widely accepted attempt at life saving for moderate-to-severe traumatic brain injury. </p> Krishna Sharma Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Factors affecting facial nerve outcome in vestibular Schwannoma surgery <p style="font-weight: 400;"><strong>Background: </strong>Preservation of facial nerve injury is a key important factor in vestibular schwannoma surgery as facial paralysis has devastating functional and psychological consequences for patients.</p> <p style="font-weight: 400;"><strong>Objective: </strong>To correlate different factors resulting in facial nerve preservation in vestibular schwannoma surgery by retro mastoid retro sigmoid approach.</p> <p style="font-weight: 400;"><strong>Method: </strong>This is a retrospective analysis of facial nerve status of 212 cases of vestibular schwannoma microsurgery through Retrosigmoid Retromastoid (RSRM) approach. This study was carried out in National Neurosurgical Referral Center(NNRC), National Academy Of Medical Sciences (NAMS), Bir hospital between January 2016 to December 2022.Preoperative and post operative details of facial nerve function status compared according to House and Brackmann (H and B) grading system, and factors influencing outcome in facial nerve preservation were analyzed. Recurrent and residual tumors were excluded.</p> <p style="font-weight: 400;"><strong>Results:</strong> A total of 212 cases of vestibular schwannoma were operated during the study period. The average age of presentation was 47 years. Most common affected age group was 51-60 years. Female to male ratio was 3:2.5. The most common clinical symptoms for vestibular schwannoma were sensorineural hearing loss followed by headache and difficulty in limb coordination. Tumor size and consistency was most important indicator of facial nerve function outcome.</p> <p style="font-weight: 400;"><strong>Conclusion: </strong>The incidence of post operative facial palsy is found to be correlated to tumor size and consistency. Improvement of the facial nerve outcome is detected in patients undergone simultaneous intraoperative monitoring (IONM).</p> Rajiv Jha, Rajendra Shrestha, Binod Rajbhandari, Sushil Mohan Bhattarai, Sameer Aryal, Sindhu Gautam, Binit Jha, Anuj Jung Karki Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Fostering Student Success: A Prevailing Provision for Dyscalculia and Dyslexia in the School Curriculum and Strategies for Support <p>This article examines the impact of dyscalculia and dyslexia on students' mathematics learning and proposes strategies for supporting learners with these learning disabilities. It provides a concise overview of dyscalculia and dyslexia, emphasizing their distinct characteristics and prevalence rates within the Nepalese context. The study explores the challenges faced by students with dyscalculia and dyslexia in mathematics education and discusses the importance of inclusive education. It also provides an overview of the school-level curriculum in Nepal, highlighting the effects of dyscalculia and dyslexia on mathematics learning and the specific challenges experienced by students with these disabilities. The article uncovers areas within the school-level curriculum in Nepal that require attention and offers practical ways to support learners with dyscalculia and dyslexia. Overall, this article provides valuable insights into the challenges faced by students with dyscalculia and dyslexia in learning mathematics and offers practical recommendations for developing an inclusive curriculum that caters to the specific needs of the dyscalculic and dyslexic learners.</p> Rajendra Kunwar Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Climate Change and the Nervous System <p>Climate change has received significant media attention. The recent COP 28 summit in November and December 2023 in Dubai has once again brought together the leaders of all countries and has made everyone aware of its effect on global health. Despite this attention, scholarly works on the subject, particularly from developing economies are relatively scarce.</p> Mohan Raj Sharma, Manita Pyakurel Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Spontaneous Subdural Hematoma associated with Meningioma : Two case reports <p><strong>Introduction: </strong>Spontaneous subdural hematoma rarely presents with a hyper vascular or malignant tumor but even less frequently in a benign tumor like meningioma. We encountered two cases with spontaneous subdural hematoma associated with benign meningioma.</p> <p><strong>Case Description: </strong>A 47-year-old Asian woman presented with severe headache and forgetfulness, initiated 3 months before, with no other complaints, denying any previous head trauma. Head computed tomography revealed a chronic left hemisphere subdural hematoma for this issue she underwent burr hole and evacuation of hematoma 1 month before. However her symptoms was not relieved and her magnetic resonance imaging of brain showed left frontal lesion , suggestive of meningioma. Surgical treatment was performed. The tumor was histologically confirmed as a transitional meningioma grade I. After surgery, no neurological deficits were registered, and headache subsided.</p> <p>Similarly, second case, a 56-year-old woman presented with complaints of severe headache for 6 hours. There is no history of seizure like activities, any previous history of head trauma. On examination, no neurological deficits noted. Computed Tomography (CT) of head showed a hyper dense extradural lesion with acute subdural lesion on left hemisphere. MRI brain revealed well defined extra axial round to oval lesion measuring 3.1 X 3.5 X 2.5 cm with areas of heterogeneous enhancement of the left parietal parasagittal area .She underwent left parietal craniotomy and en-bloc tumor resection done. Post operatively there was no neurological deficits and she was discharged on 5<sup>th </sup>post-operative day.</p> <p><strong>Conclusions: </strong>As we could not identify any other cause for the subacute subdural hematoma, hemorrhage from the meningioma was the most probable cause. Although meningiomas are commonly benign according to their histological traits, they can lead to spontaneous bleeding and cause neurologically unstable condition. Therefore, meningiomas need to be considered as a cause of spontaneous subdural hematoma if radiologically suspicious, which should be reflected by proper management for a positive outcome.</p> Samir Acharya, Ramesh Prajapati, Bishal Shrestha, Samridha Malla, Pritam Gurung, Basant Pant Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Post-Stroke Mania- A Case Series <p><strong>Background: </strong>Post-stroke mania is a complex neuropsychiatric phenomenon that poses challenges in both diagnosis and management. This paper presents a detailed analysis of three distinct cases, comprising two females and one male, each exhibiting post-stroke mania following cerebrovascular events. Our study aims to provide insights into the varied clinical presentations, contributing factors, and therapeutic interventions in this unique subset of stroke survivors.</p> <p><strong>Case 1</strong>: A 71-year-old female experienced a left hemispheric stroke, subsequently displaying manic symptoms characterized by elevated mood, impulsivity, and increased energy. Neuroimaging revealed damage to the parieto-occipital lobe, prompting further exploration into the neural correlates of post-stroke mania.</p> <p><strong>Case 2</strong>: A 51-year-old female presented with right hemiparesis. Shortly after the stroke, he manifested manic features, including decreased need for sleep and heightened irritability. Psychosocial factors and pharmacological interventions were investigated to better understand the interplay of biological and environmental influences.</p> <p><strong>Case 3</strong>: A 55-year-old male suffered a left hemispheric stroke. Poststroke, she exhibited manic symptoms such as distractibility and excessive goal-directed activity. The impact of lesion location on the manifestation of post-stroke mania was explored in this case.</p> <p><strong>Conclusion: </strong>Through a comprehensive analysis of these cases, we aim to contribute to the growing body of literature on post-stroke mania, shedding light on its clinical heterogeneity and paving the way for tailored treatment approaches. Recognizing the nuanced nature of post-stroke mania is crucial for healthcare providers to optimize care strategies and improve the quality of life for stroke survivors grappling with this challenging neuropsychiatric condition</p> Yogi Rana, Abhishek Pathak, Manish Singh, Vishesh Yadav, Rahul Singh Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 LGI 1 Antibody Encephaltis:Clinical characteristics and short term outcome along with review of literature. <p>LGI1 (Leucine-rich glioma inactivated protein-1) antibody disease is one of the major causes of limbic encephalitis encountered in clinical practice manifesting with clinical seizures, behavioural disturbances and movement disorders. Here we discuss the varied presentations of this disease through three cases encountered at our center emphasizing the cardinal clinical, imaging and laboratory diagnostic features. Recognition of these characteristics would lead to early diagnosis and prompt management of this eminently treatable condition.</p> Praveen Panicker, Dileep Ramachandran, Raj Satheesh Chandran, Thomas Iype Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Primary Spinal PNET: A Rare Case with Aggressive Progression. <p>PNET of spine are extremely rare, it represent less than 1% of spinal tumors. They are highly invasive and malignant, rapidly growing with grave prognosis. In this case report a 34 yrs lady presented clinically as back ache, urinary symptomps and progressive weakness &amp; spasticty of both lower limbs.</p> <p>After workup patient underwent laminectomy &amp; microscopic gross total excision of tumor, following surgery she improved symptomatically. After confirmation of HPE and IHC she underwent radiotherapy, but she not tolerated chemotherapy and later on tumor recurred and patient succumbed to the disease.</p> Vijay Kumar Gupta, Ajay Sebastin Carvalho, Nagendra Singh Shekhawat, Yelda Vyas, Ekata Gupta Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Atypical Antipsychotics and Lithium Induced Neuroleptic Malignant Syndrome associated with Acute Kidney Injury: A Case Report <p>Neuroleptic Malignant Syndrome (NMS) is a rare but serious adverse reaction to antipsychotic medications. This case report presents a 56-year-old male with bipolar disorder on a regimen of Olanzapine, Clozapine and Lithium carbonate, who developed typical NMS. He had muscle rigidity, hyperthermia, rhabdomyolysis which led to acute kidney injury. Prompt withdrawal of psychotropic medications and administration of supportive therapies was done, yet the patient's condition deteriorated, leading to Multiple Organ Dysfunction Syndrome (MODS) and eventually mortality. This case shows the complexity of managing NMS in the context of polypharmacy emphasizing the need for vigilance when prescribing antipsychotic combinations and the challenges faced in treating NMS, especially when there are associated complications.</p> Riya S. Shah, Sachin K. Akhani, Sapna D. Gupta, Supriya D. Malhotra Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Fahr Disease: Review and case Report <p><strong>Introduction:</strong> Fahr disease is a rare neurodegenerative condition characterized by diffuse calcifications within brain. It is common in the fourth to sixth decade and few cases have been described in pediatric population</p> <p><strong>Case presentation: </strong>This case report describes a twelve year old boy with suspected Fahr disease. The clinical presentation was seizure, ataxia, tremor. The patient was managed conservatively with anti seizure medication.</p> <p><strong>Conclusion: </strong>Fahr disease is a rare neurodegenerative disease and can present in pediatric population as well.</p> <p><strong> </strong></p> <p><strong>Key words</strong></p> <p>Fahr disease, Pediatric</p> Prabhat Jha Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Twig-like MCA: A Rare Vascular Anomaly <p>Twig-like middle cerebral artery (T-MCA) or rete mirabile anomaly is a rare vascular anomaly with clinical relevance characterized by the replacement of the M1 segment by a plexiform network of small vessels. With an incidence ranging from 0.11% to 1.17%, it is more prevalent in Asia. The twig arises from the distal ICA and ends at the distal horizontal portion of MCA while lenticulostriate arteries (LSAs) arise from the plexiform network of the involved M1 segment. It is crucial to distinguish this embryological anomaly from Moyamoya Disease (MMD), moyamoya-like syndrome, atherosclerotic steno-occlusive disease, and vasculitis to prevent misdiagnosis and unnecessary treatment. We present the case of a 30-year-old male who complained of left eyelid ptosis and diplopia. Incidentally, he was diagnosed with both a twig-like middle cerebral artery (MCA) anomaly and an associated anterior communicating artery (ACoM) aneurysm.</p> <p>The twig-like middle cerebral artery (T-MCA) anomaly, also known as rete mirabile anomaly, is a rare vascular variation characterized by the replacement of the M1 segment with a plexiform network of small vessels. Here, we present a case of a 30-year-old male with left eyelid ptosis and diplopia, who was incidentally diagnosed with T-MCA anomaly along with an associated anterior communicating artery (ACoM) aneurysm. </p> Niharika Pant, Saujanya Rajbhandari, Suyasha Rajbhandari, Saddam Ansari, Nipun Raghubanshi, Pravesh Rajbhandari, Basant Pant Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000 Neurogenomics contribution to neurodegenerative Diseases <p><strong>Introduction:</strong> Neurodegenerative diseases are a group of complex disorders that progressively impair the structure and function of the nervous system, resulting in debilitating symptoms and reduced quality of life for affected individuals. Over the past few decades, advances in the field of genomics have revolutionized our understanding of the underlying molecular mechanisms driving these disorders. Neurogenomics, the intersection of neuroscience and genomics, has emerged as a crucial discipline in unraveling the genetic and molecular underpinnings of neurodegenerative diseases. Neurogenomics focuses on deciphering the genetic variations that contribute to the susceptibility and progression of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis (ALS), and Huntington's disease. Advances in DNA sequencing technologies have enabled researchers to identify specific genetic mutations and variations that are associated with increased disease risk. By studying the genetic mutations involved in neurodegenerative diseases, neurogenomics has provided valuable insights into the underlying disease mechanisms. These insights have led to a deeper understanding of protein aggregation, mitochondrial dysfunction, inflammation, and other cellular processes implicated in disease progression. By harnessing the power of neurogenomics through further studies, researchers and clinicians are moving closer to the goal of effectively preventing, diagnosing, and treating neurodegenerative diseases, thus offering hope to millions of individuals affected by these challenging conditions.</p> <p><strong>Conclusion:</strong> Neurogenomics has emerged as a pivotal field in unraveling the complex interplay between genetics and neurobiology in neurodegenerative diseases. By dissecting the genetic architecture, elucidating molecular mechanisms, and paving the way for targeted therapies, neurogenomics offers new avenues for understanding, diagnosing, and ultimately treating these disorders.</p> Olufunto Omodele Adeleye, Darasimi Racheal Olorunlowu, Joshua Ayodele Yusuf, Elizabeth Kehinde Opoola, Stephen Tunmise Akanbi, Segun Samson Akindokun Copyright (c) 2024 Nepalese Society of Neurosurgeons (NESON) Mon, 10 Jun 2024 00:00:00 +0000