Publications by authors named "Ayush Agarwal"

42 Publications

Postictal Headache with a Single Neurocysticercal Lesion: A Comparative Observational Study.

Ann Indian Acad Neurol 2021 Sep-Oct;24(5):834-837. Epub 2021 Jun 3.

Department of Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/aian.AIAN_1176_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8680909PMC
June 2021

Clinical Features and Outcome of Stroke with COVID-19. COVID-19 Stroke Study Group (CSSG), India.

Ann Indian Acad Neurol 2021 Sep-Oct;24(5):668-685. Epub 2021 Aug 30.

Department of Neurology, Ramesh Hospitals Guntur, Andhra Pradesh, India.

Background And Purpose: Occurrence of stroke has been reported among patients with COVID-19. The present study compares clinical features and outcomes of stroke patients with and without COVID-19.

Methods: The COVID-19 Stroke Study Group (CSSG) is a multicentric study in 18 sites across India to observe and compare the clinical characteristics of patients with stroke admitted during the current pandemic period and a similar epoch in 2019. The present study reports patients of stroke with and without COVID-19 (CoVS and non-CoVS, respectively) seen between February 2020 and July 2020. Demographic, clinical, treatment, and outcome details of patients were collected.

Results: The mean age and gender were comparable between the two groups. CoVS patients had higher stroke severity and extent of cerebral involvement on imaging. In-hospital complications and death were higher among CoVS patients (53.06% vs. 17.51%; < 0.001) and (42.31% vs. 7.6%; < 0.001), respectively. At 3 months, higher mortality was observed among CoVS patients (67.65% vs. 13.43%; < 0.001) and good outcome (modified Rankin score [mRS]: 0-2) was seen more often in non-CoVS patients (68.86% vs. 33.33%; < 0.001). The presence of COVID-19 and baseline stroke severity were independent predictors of mortality.

Conclusions: CoVS is associated with higher severity, poor outcome, and increased mortality. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and baseline stroke severity are independent predictors of mortality.
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http://dx.doi.org/10.4103/aian.AIAN_122_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8680894PMC
August 2021

Antinuclear antibodies in neurology and their clinical application.

QJM 2021 Dec 1. Epub 2021 Dec 1.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

Antinuclear antibodies (ANA) are a diverse group of autoantibodies found in various systemic autoimmune disorders. They represent a key diagnostic marker in the diagnosis of connective tissue disorders (CTD). Although many techniques exist, ANA by Indirect Immunofluorescence (IIF) remains the gold standard for diagnosing CTDs. Neurologists should be aware of the type of assay used for detection and the advantages and disadvantages of using each method. Through this article, we aimed to review the methodological aspects of the detection of ANA and its subtypes and their clinical relevance in various neurologic disorders.
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http://dx.doi.org/10.1093/qjmed/hcab304DOI Listing
December 2021

Effectiveness of an inactivated virus-based SARS-CoV-2 vaccine, BBV152, in India: a test-negative, case-control study.

Lancet Infect Dis 2021 Nov 23. Epub 2021 Nov 23.

Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India.

Background: BBV152 is a whole-virion inactivated SARS-CoV-2 vaccine that has been deployed in India. The results of the phase 3 trial have shown clinical efficacy of BBV152. We aimed to evaluate the effectiveness of BBV152 against symptomatic RT-PCR-confirmed SARS-CoV-2 infection.

Methods: We conducted a test-negative, case-control study among employees of the All India Institute of Medical Sciences (a tertiary care hospital in New Delhi, India), who had symptoms suggestive of COVID-19 and had an RT-PCR test for SARS-CoV-2 during the peak of the second wave of the COVID-19 pandemic in India between April 15 and May 15, 2021. Cases (test-positives) and controls (test-negatives) were matched (1:1) on the basis of age and gender. The odds of vaccination with BBV152 were compared between cases and controls and adjusted for level of occupational exposure (to COVID-19), previous SARS-CoV-2 infection, and calendar time, using conditional logistic regression. The primary outcome was effectiveness of two doses of BBV152 (with the second dose received at least 14 days before testing) in reducing the odds of symptomatic RT-PCR-confirmed SARS-CoV-2 infection, expressed as (1 - odds ratio) × 100%.

Findings: Between April 15 and May 15, 2021, 3732 individuals had an RT-PCR test. Of these, 2714 symptomatic employees had data on vaccination status, and 1068 matched case-control pairs were available for analysis. The adjusted effectiveness of BBV152 against symptomatic COVID-19 after two doses administered at least 14 days before testing was 50% (95% CI 33-62; p<0·0001). The adjusted effectiveness of two doses administered at least 28 days before testing was 46% (95% CI 22-62) and administered at least 42 days before testing was 57% (21-76). After excluding participants with previous SARS-CoV-2 infections, the adjusted effectiveness of two doses administered at least 14 days before testing was 47% (95% CI 29-61).

Interpretation: This study shows the effectiveness of two doses of BBV152 against symptomatic COVID-19 in the context of a huge surge in cases, presumably dominated by the potentially immune-evasive delta (B.1.617.2) variant of SARS-CoV-2. Our findings support the ongoing roll-out of this vaccine to help control the spread of SARS-CoV-2, while continuing the emphasis on adherence to non-pharmacological measures.

Funding: None.

Translation: For the Hindi translation of the abstract see Supplementary Materials section.
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http://dx.doi.org/10.1016/S1473-3099(21)00674-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8610201PMC
November 2021

Status epilepticus heralding thymomatous paraneoplastic multifocal cortical encephalitis in Myasthenia Gravis.

Seizure 2021 12 14;93:169-170. Epub 2021 Nov 14.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1016/j.seizure.2021.11.005DOI Listing
December 2021

Early Post-Stroke Seizures in Acute Ischemic Stroke: A Prospective Cohort Study.

Ann Indian Acad Neurol 2021 Jul-Aug;24(4):580-585. Epub 2021 Jun 29.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

Introduction: Stroke is the most common cause of epilepsy in the adult population. Post-stroke seizures (PSSs) are classified into early-onset seizures (ES) and late-onset (LS). ES can significantly affect the clinical outcome and occurrence of LS.

Methods: We analyzed data from a prospective cohort of acute ischemic stroke patients between June 2018 and May 2020 in a neurology unit at a tertiary hospital. We screened all acute stroke patients and included consecutive patients older than 18 years of age, presenting with acute, first-ever neuroimaging-confirmed ischemic stroke. We excluded patients with a previous stroke, transient ischemic attacks, hemorrhagic stroke, cerebral venous thrombosis, prior history of seizures, or any other epileptogenic comorbidity. ES were classified as spontaneous seizures occurring within 1 week of the stroke. The main outcome assessed was the occurrence of ES. The secondary outcome was to determine predictors of ES and create an ES prediction score.

Results: We screened 432 patients; of them, 291 were enrolled. ES occurred in 37 patients (12.7%). Cortical location (OR: 4.2), large artery disease subtype (OR: 2.9), mRS at presentation (OR: 1.4), use of anticoagulants (OR: 2.6), and hypertension (OR: 0.3) were significantly associated with the occurrence of ES. Patients with ES had a statistically significant worse clinical outcome at 3 months follow-up ( = 0.0072).

Conclusion: We could formulate an ES prediction tool using the following components: (a) cortical location, (b) large vessel stroke, (c) mRS at admission, (d) anticoagulant use, and (e) presence of hypertension. This tool might help in treating patients at high risk for ES with prophylactic ASD, thereby preventing seizures and their complications.
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http://dx.doi.org/10.4103/aian.AIAN_1283_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8513968PMC
June 2021

Frequency of Neurologic Manifestations in COVID-19: A Systematic Review and Meta-analysis.

Neurology 2021 12 11;97(23):e2269-e2281. Epub 2021 Oct 11.

From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India.

Background And Objectives: One year after the onset of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to summarize the frequency of neurologic manifestations reported in patients with COVID-19 and to investigate the association of these manifestations with disease severity and mortality.

Methods: We searched PubMed, Medline, Cochrane library, ClinicalTrials.gov, and EMBASE for studies from December 31, 2019, to December 15, 2020, enrolling consecutive patients with COVID-19 presenting with neurologic manifestations. Risk of bias was examined with the Joanna Briggs Institute scale. A random-effects meta-analysis was performed, and pooled prevalence and 95% confidence intervals (CIs) were calculated for neurologic manifestations. Odds ratio (ORs) and 95% CIs were calculated to determine the association of neurologic manifestations with disease severity and mortality. Presence of heterogeneity was assessed with , meta-regression, and subgroup analyses. Statistical analyses were conducted in R version 3.6.2.

Results: Of 2,455 citations, 350 studies were included in this review, providing data on 145,721 patients with COVID-19, 89% of whom were hospitalized. Forty-one neurologic manifestations (24 symptoms and 17 diagnoses) were identified. Pooled prevalence of the most common neurologic symptoms included fatigue (32%), myalgia (20%), taste impairment (21%), smell impairment (19%), and headache (13%). A low risk of bias was observed in 85% of studies; studies with higher risk of bias yielded higher prevalence estimates. Stroke was the most common neurologic diagnosis (pooled prevalence 2%). In patients with COVID-19 ≥60 years of age, the pooled prevalence of acute confusion/delirium was 34%, and the presence of any neurologic manifestations in this age group was associated with mortality (OR 1.80, 95% CI 1.11-2.91).

Discussion: Up to one-third of patients with COVID-19 analyzed in this review experienced at least 1 neurologic manifestation. One in 50 patients experienced stroke. In those >60 years of age, more than one-third had acute confusion/delirium; the presence of neurologic manifestations in this group was associated with nearly a doubling of mortality. Results must be interpreted with the limitations of observational studies and associated bias in mind.

Systematic Review Registration: PROSPERO CRD42020181867.
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http://dx.doi.org/10.1212/WNL.0000000000012930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8665434PMC
December 2021

Predisposing Factors and Management of Hemodynamic Depression Following Carotid Artery Stenting.

Ann Indian Acad Neurol 2021 May-Jun;24(3):315-318. Epub 2021 Jul 2.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

Carotid artery stenting (CAS) involves dilatation of carotid bulb which can trigger a series of neuronal responses resulting in hemodynamic depression that might influence the outcome of the procedure. This is a frequent but underdiagnosed complication of CAS. Although it is mild, transient and self-limiting in majority of cases, it can result in significant morbidity and mortality if persistent. Neurologists should be aware of the predisposing factors and management of this common complication. In patients who present with stroke following carotid stenting, neurologists should be aware of hypoperfusion secondary to hemodynamic depression as a cause of stroke apart from the stent thrombosis and occlusion.
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http://dx.doi.org/10.4103/aian.AIAN_1299_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370164PMC
July 2021

Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India.

J Neurol Sci 2021 09 16;428:117583. Epub 2021 Jul 16.

Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

Background: As the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected.

Aims: The present study examined differences in the diagnosis, evaluation and management of stroke patients during a defined period in the ongoing pandemic in 2020 when compared to a similar epoch in year 2019.

Methods: The COVID stroke study group (CSSG) India, included 18 stroke centres spread across the country. Data was collected prospectively between February and July 2020 and retrospectively for the same period in 2019. Details of demographics, stroke evaluation, treatment, in-hospital and three months outcomes were collected and compared between these two time points.

Results: A total of 2549 patients were seen in both study periods; 1237 patients (48.53%) in 2019 and 1312 (51.47%) in 2020. Although the overall number of stroke patients and rates of thrombolysis were comparable, a significant decline was observed in the month of April 2020, during the initial period of the pandemic and lockdown. Endovascular treatment reduced significantly and longer door to needle and CT to needle times were observed in 2020. Although mortality was higher in 2020, proportion of patients with good outcome were similar in both the study periods.

Conclusions: Although stroke admissions and rates of thrombolysis were comparable, some work flow metrics were delayed, endovascular stroke treatment rates declined and mortality was higher during the pandemic study period. Reorganization of stroke treatment pathways during the pandemic has likely improved the stroke care delivery across the globe.
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http://dx.doi.org/10.1016/j.jns.2021.117583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282445PMC
September 2021

Recurrent Stroke in Young: Rule Out a Cervical Rib!

Ann Indian Acad Neurol 2021 Mar-Apr;24(2):286-288. Epub 2020 Jul 22.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/aian.AIAN_325_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232511PMC
July 2020

Managing Non-COVID Acute Neurology Amidst the Pandemic: Challenges and Work in Progress.

Ann Indian Acad Neurol 2021 Jan-Feb;24(1):11-14. Epub 2021 Feb 9.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

The ongoing COVID-19 pandemic has precipitated a global health crisis. Non-COVID diseases across specialties have been significantly compromised. The greatest challenge has been to continue providing care to non-COVID cases with minimum transmission risk to health care workers, patients, and caregivers. In this specter, better described as a medical holocaust, we present our experiences of dealing with acute neurological patients who could access our facility. We attempted to work on three key areas - initial screening using a more inclusive, dynamic checklist for COVID suspicion over and above the emergency triage, a mandatory initial holding on a separate floor of our inpatient service equipped with infection control strategies similar to a COVID-designated area, and daily screening of health care workers and caregivers for symptoms and possible exposures. It was a steep learning curve, a couple of close shaves, and many more lessons that went into the development of an algorithm that seems to be working well.
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http://dx.doi.org/10.4103/aian.AIAN_999_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061500PMC
February 2021

Development and validation of a questionnaire for assessing preventive practices and barriers among health care workers in COVID-19 pandemic.

Indian J Med Microbiol 2021 Apr 23;39(2):200-211. Epub 2021 Apr 23.

Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

Objectives: COVID-19 has affected thousands of health care workers worldwide. Suboptimal infection control practices have been identified as important risk factors. The objective of this study was to develop and validate a questionnaire to holistically assess the preventive practices of health care workers related to COVID-19 and identify the reasons for shortcomings therein.

Methods: The development of the questionnaire involved item generation through literature review, focus group discussions and in-depth interviews with health care workers and experts, followed by validation through expert opinion, pilot testing and survey. A cross-sectional survey on 147 healthcare workers was done using an online platform and/or interviews in August 2020 in New Delhi, India. Exploratory factor analysis using principal component extraction with varimax rotation was performed to establish construct validity. Internal consistency of the tool was tested using Cronbach's alpha coefficient.

Results: The developed questionnaire consists of two sections: Section A contains 29 items rated on a five-point Likert scale to assess preventive practices and Section B contains 27 semi-structured items to assess reasons for suboptimal practices. The first section has good validity (CVR = 0.87, S-CVI/Av = 0.978) and internal consistency (Cronbach's alpha coefficient = 0.85) CONCLUSIONS: This questionnaire is a valid and reliable tool for holistic assessment of preventive practices and barriers to it among health care workers. It will be useful to identify vulnerable practices and sections in health care settings which would assist policymakers in designing appropriate interventions for infection prevention and control. This will also be useful in future pandemics of similar nature.
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http://dx.doi.org/10.1016/j.ijmmb.2021.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063603PMC
April 2021

Cognitive impairment in spinocerebellar ataxia type 12.

Parkinsonism Relat Disord 2021 04 13;85:52-56. Epub 2021 Mar 13.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

Introduction: Cognitive impairment has now been recognised to be present in patients with several of spinocerebellar ataxias (SCAs). Cognitive impairment in patients with spinocerebellar ataxia type 12 has not been evaluated.

Objective: To evaluate the cognitive impairment in patients diagnosed with spinocerebellar ataxia type 12 (SCA12).

Methods: We conducted a cross sectional study and enrolled 30 (20 male and 10 female) genetically confirmed SCA12 patients and 30 healthy, age, gender and education matched individuals as controls. Cognitive domains were tested using a battery of validated neurocognitive tests.

Result: Mean age of patients was 51.6 ± 8.0 years and mean disease duration was 5.3 ± 3.0 years. Mean International Cooperative Ataxia Rating Scale (ICARS) score was 29.8 ± 12.5. SCA 12 patients scored significantly lower than controls in executive function and new learning ability. Other tested cognitive domains were also affected but did not reach statistical significance. Age, age at onset, severity of ataxia, disease duration and CAG repeat length did not correlate with cognitive impairment.

Conclusion: Cognitive impairment is a part of the spectrum of SCA12 and is characterized by dysfunction in executive function and new learning ability even early in the course of disease.
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http://dx.doi.org/10.1016/j.parkreldis.2021.03.010DOI Listing
April 2021

Development and validation of a questionnaire to assess preventive practices against COVID-19 pandemic in the general population.

Prev Med Rep 2021 Jun 23;22:101339. Epub 2021 Feb 23.

Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.

Coronavirus Disease 2019 (COVID-19) pandemic has affected millions of people worldwide with far-reaching socio-economic implications in society. The adoption of preventive practices by the public remains the mainstay in reducing the spread of COVID-19 but there is a dearth of validated tools to assess such infection prevention practices related to pandemics. This study was conducted to develop and validate a questionnaire for the assessment of preventive practices against COVID-19 in the general population. It was done following a standardized protocol involving questionnaire development through literature review, focused group discussions, in-depth interviews, expert opinion, and pre-testing. This was followed by the validation of the questionnaire through a cross-sectional survey on 108 individuals from diverse backgrounds in New Delhi, India in July 2020. Exploratory factor analysis was used to evaluate construct validity. Internal consistency was assessed by Cronbach's alpha coefficient. The developed questionnaire for assessing preventive practices consists of two sections: the first section of 18 items to evaluate preventive practices and the second section of 19 items for assessing various reasons for deficiencies in the preventive practices. The first section has good content validity (CVR = 0.81 and S-CVI/Av = 0.97) and internal consistency (Cronbach's alpha coefficient 0.82). Thus, this questionnaire is a valid and reliable tool for the comprehensive assessment of preventive practices and barriers related to the COVID-19 pandemic. It will be useful in assessing the preparedness of the public and will be helpful to policymakers in designing appropriate interventions for protection against COVID-19.
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http://dx.doi.org/10.1016/j.pmedr.2021.101339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899917PMC
June 2021

Low Back Pain and Foot Drop Associated with Dog Tapeworm Infection.

Am J Trop Med Hyg 2021 01;104(1)

2Department of Neuroradiology, AIIMS, New Delhi, India.

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http://dx.doi.org/10.4269/ajtmh.20-1011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790067PMC
January 2021

Classification and comparative analysis of psychogenic nonepileptic seizures (PNES) semiology based on video-electroencephalography (VEEG).

Epilepsy Behav 2021 02 28;115:107697. Epub 2020 Dec 28.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

Background: Multiple classification systems for psychogenic nonepileptic seizures (PNES) based on semiological features have been described. We sought to compare the efficiency of four PNES classification systems.

Methods: We retrospectively analyzed medical and video-electroencephalography (VEEG) records of patients with PNES with at least one typical event recorded on VEEG. Semiology of PNES events was stringently classified using Hubsch, Dhiman, Wadwekar, and Asadi-Pooya's classification systems.

Results: We studied 248 patients with PNES (78% females, mean age 23.1 ± 10.3 years) and reviewed 498 PNES events. Using Hubsch's scheme, we classified events into: dystonic attacks with primitive gestural activity (5.2%), paucikinetic attacks with preserved responsiveness (9.7%), pseudosyncope (59.8%), hyperkinetic prolonged attacks (16.2%) and axial dystonic prolonged attacks (1.6%), and unclassified (7.5%). Using Dhiman's classification, events were: abnormal motor (hypermotor [10.4%]/ partial motor [12.7%]), dialeptic type (58.6%), mixed patterns (17.3%), and unclassified (1%). Using Wadwekar's classification: dystonic attacks with primitive gestural activity (5.2%), paucikinetic attacks with preserved responsiveness (9.6%), pseudosyncope with/without hyperventilation (65.1%), hyperkinetic prolonged attacks involving limbs ± trunk (18.5%), and axial dystonic prolonged attacks (1.6%). Using Asadi-Pooya's classification, events were: hypermotor (30.1%), non-motor (62.9%), and mixed (7.0%). All events could be classified via Wadwekar and Asadi-Pooya systems.

Conclusion: In our study, pseudosyncope/dialeptic/non-motor semiology emerged as most frequent. Most of our patients with PNES had stereotyped semiology. All events could be classified using the schemes by Asadi-Pooya and Wadweker et al. Dhiman et al. scheme could classify 99% and 7.5% remained unclassified using Hubsch et al. scheme.
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http://dx.doi.org/10.1016/j.yebeh.2020.107697DOI Listing
February 2021

An Acquired Neuro-Nephrology Syndrome.

J Clin Rheumatol 2020 Dec 14. Epub 2020 Dec 14.

From the Departments of Neurology.

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http://dx.doi.org/10.1097/RHU.0000000000001663DOI Listing
December 2020

Are health care workers following preventive practices in the COVID-19 pandemic properly? - A cross-sectional survey from India.

Diabetes Metab Syndr 2021 Jan-Feb;15(1):69-75. Epub 2020 Dec 6.

Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India.

Background And Aims: Health care workers (HCWs) are at increased risk of getting infected with Coronavirus disease 2019 (COVID-19) and suboptimal preventive practices have been identified as an important risk factor in this regard. This study was done to evaluate the preventive practices being followed by health care workers and identify reasons for suboptimal compliance.

Methods: A cross-sectional survey was done in HCWs belonging to various occupational roles and socio-cultural backgrounds across India through online platforms and telephonic interviews from July 30, 2020 to August 30, 2020. A scientifically designed and pre-validated questionnaire with good validity (CVR = 0.87, S-CVI/Av = 0.978) and internal consistency (Cronbach's alpha coefficient = 0.85) was used.

Results: The responses of 956 participants were analysed. Various suboptimal practices like touching outer surface of masks, lack of social distancing in cafeteria and duty rooms, inability to wash hands for adequate duration and properly follow steps of hand hygiene, inability to don and doff PPE properly, carrying PPE to duty rooms before completely doffing, use of personal mobile phones during duty and improper sleep were identified. Lack of knowledge, long duty hours, shortage of PPE, high patient workload, and casual attitude regarding own safety were identified as important barriers. Resident doctors and paramedical staff in the age group 18-30 years reported lower adherence.

Conclusions: Suboptimal compliance in preventive practices like handling PPE, distancing in cafeteria/duty rooms and hand hygiene is not uncommon in HCWs. Certain barriers are identified which should be addressed to ensure adequate safety of HCWs against COVID-19.
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http://dx.doi.org/10.1016/j.dsx.2020.12.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719197PMC
March 2021

Cysticidal Therapy for Diffuse Parenchymal and Calcific Neurocysticercosis.

Am J Trop Med Hyg 2020 Nov 16. Epub 2020 Nov 16.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

Antiparasitic treatment improves the prognosis for neurocysticercosis (NCC)-induced seizures. However, patients with high lesion loads are typically denied the possible benefit of cysticidal therapy because of fear of complications, and such patients are not represented in clinical trials involving cysticidal therapy. We provide proof of concept for combination treatment with dual antiparasitic therapy and corticosteroids in patients with diffuse lesions, including starry sky patterns, or calcific NCC. The safety and efficacy of treating patients with high lesion loads or calcific NCC should be tested in a randomized controlled trial.
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http://dx.doi.org/10.4269/ajtmh.20-1124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866306PMC
November 2020

Primary Central Nervous System Vasculitis Presenting with Isolated Headache.

J Neurosci Rural Pract 2020 Oct 4;11(4):678-679. Epub 2020 Sep 4.

Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1055/s-0040-1715999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595778PMC
October 2020

Letter by Agarwal et al Regarding Article, "Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era".

Stroke 2020 11 26;51(11):e342. Epub 2020 Oct 26.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1161/STROKEAHA.120.031678DOI Listing
November 2020

Meandering pulmonary vein: A case report.

J Radiol Case Rep 2020 Mar 31;14(3):7-13. Epub 2020 Mar 31.

Department of Radiology, Maulana Azad Medical College & LNJP Hospital, New Delhi, India.

Anomalies of the pulmonary venous circulation are extremely uncommon. We report a case of an anomalous unilateral single pulmonary vein also referred to as a meandering pulmonary vein. A single large tortuous pulmonary vein was seen on the right side draining into the left atrium with associated ipsilateral absence of the middle lobe bronchus and interlobar fissures. This is considered a variant of the classical scimitar syndrome. The venous anatomy was depicted with considerable accuracy using multidetector computed tomography (MDCT) non-invasively.
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http://dx.doi.org/10.3941/jrcr.v14i3.3799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535996PMC
March 2020

Blood pressure targets for young adults: are we being too stringent?

BMJ 2020 10 9;371:m3910. Epub 2020 Oct 9.

Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.

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http://dx.doi.org/10.1136/bmj.m3910DOI Listing
October 2020

De novo nose-pinching stereotypy with somnolence: Clues to autoimmune encephalitis.

J Neuroimmunol 2020 10 30;347:577348. Epub 2020 Jul 30.

Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.

Autoimmune encephalitis (AE) is being increasingly recognized as a cause of new-onset movement disorders. Movement disorders in AE are diverse and range from hyperkinetic conditions such as oromandibular dyskinesias, tremors and chorea to hypokinetic ones such as bradykinesia and parkinsonism. Stereotypies have been described in association with anti-NMDAR encephalitis. Similarly, sleep dysfunction is an underrecognized feature in many AE subtypes, prominently anti-IgLON5 although the correlation of phenotype of sleep dysfunction with a particular antibody subtype in AE is unclear. Despite the recognition of both these features as part of an overreaching spectrum in any patient with AE, seldom are they the sole presenting manifestations. Additionally, the challenge is further compounded in a patient who has seronegative AE since neither sleep disturbances nor stereotypies have been well characterized with this condition yet, and the diagnosis is conditional to exhausting a list of ancillary supportive features. In this brief communication, we describe the case of a young man who presented with hypersomnolence and an unusual focal nose-pinching stereotypy of subacute onset who lacked the presence of other typical clinical characteristics such as cognitive/memory impairment and seizures and had negative autoimmune antibodies but responded to immune therapy dramatically. We propose that the presence of de novo hypersomnolence and stereotypy should inform a potential diagnosis of AE.
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http://dx.doi.org/10.1016/j.jneuroim.2020.577348DOI Listing
October 2020

Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS): Case Report of a Novel Nonsense Mutation in the Gene.

Ann Indian Acad Neurol 2020 May-Jun;23(3):395-397. Epub 2020 May 9.

Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/aian.AIAN_670_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313614PMC
May 2020

Intracerebral Hemorrhage and SARS-CoV-2: Association or Causation.

Ann Indian Acad Neurol 2020 May-Jun;23(3):261-264. Epub 2020 Jun 5.

Department of Neurology, AIIMS, New Delhi, India.

Background: Recent respiratory infection including SARS-CoV-2 is an independent risk factor for acute cerebrovascular disease.

Purpose: There have been reports linking haemorrhagic strokes to SARS-CoV-2 infection during this pandemic, which lead us to evaluate if SARS-CoV-2 infection could be associated with increased risk of intracerebral haemorrhage (ICH).

Methods: A retrospective observational study evaluating all stroke cases admitted in our centre in the past one month.

Results: More than half (56%) had ICH, compared to 22% last year. Two patients with ICH were SARS-CoV-2 positive and they had no or mild respiratory symptoms and had higher occurrence of renal dysfunction.

Conclusion: There could be possible association between ICH and SARS-CoV-2 infections. However, a prospective study with larger sample size is needed to elucidate the pathogenesis.
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http://dx.doi.org/10.4103/aian.AIAN_362_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313569PMC
June 2020

Undulating Tongue: A Window for Diagnosing Wilson's Disease.

Mov Disord Clin Pract 2020 May 31;7(4):475-476. Epub 2020 Mar 31.

Department of Neurology Dr RML Institute of Medical Sciences Lucknow India.

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http://dx.doi.org/10.1002/mdc3.12930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197316PMC
May 2020

Undulating Tongue: A Window for Diagnosing Wilson's Disease.

Mov Disord Clin Pract 2020 May 31;7(4):475-476. Epub 2020 Mar 31.

Department of Neurology Dr RML Institute of Medical Sciences Lucknow India.

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http://dx.doi.org/10.1002/mdc3.12930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197316PMC
May 2020
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