Publications by authors named "Hoskote Chandrashekar"

Background: Stroke is the second leading cause of disability worldwide. Stroke results in focal neurological deficit and often leads to auditory problems due to its impact on the auditory pathway. Altered connections in the auditory pathway, caused by stroke, can result in hearing difficulties ranging from impaired sound detection to altered auditory perception.

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Background: Patients with suspected encephalitis continue to represent a diagnostic and therapeutic challenge, even in highly resourced centres. In February 2018, we set up a monthly in-person multidisciplinary team meeting (MDT). We describe the experience and outcomes of the MDT over three years.

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Although neurological complications of SARS-CoV-2 infection are relatively rare, their potential long term morbidity and mortality have a significant impact, given the large numbers of infected patients. Covid-19 is now in the differential diagnosis of a number of common neurological syndromes including encephalopathy, encephalitis, acute demyelinating encephalomyelitis, stroke, and Guillain-Barré syndrome. Physicians should be aware of the pathophysiology underlying these presentations to diagnose and treat patients rapidly and appropriately.

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Article Synopsis
  • POEMS syndrome is a rare and complex condition often misdiagnosed, leading to a significant delay in treatment and potential disability for patients.
  • There are no consensus guidelines for managing POEMS, but this text offers a comprehensive plan for diagnosis and treatment, emphasizing the need for a multidisciplinary team of specialists.
  • Treatment primarily focuses on addressing the underlying plasma cell issues, alongside supportive care for various complications, with a strong call for more clinical trials due to the current lack of robust evidence.
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The histiocytoses are a group of rare disorders characterised by the accumulation of neoplastic or non-neoplastic activated histiocytes in various tissues. Phenotypes vary widely from cutaneous lesions or lymphadenopathy that regress spontaneously to disseminated disease with poor prognosis. Neurological symptoms can be a presenting feature or appear during the course of disease.

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Objectives: Japanese encephalitis virus (JEV) and dengue virus (DENV) represent important causes of encephalitis in Asia. Brain imaging may provide diagnostic clues about the etiology of infectious encephalitis. We performed a systematic review of brain imaging findings in Japanese encephalitis (JE) and DENV neurological infection (dengue) to identify characteristic lesions.

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  • * Researchers analyzed data from 209 glioma cases, finding that IDH mutations were associated with longer overall survival (OS) and progression-free survival (PFS), while other factors like age, extent of resection, and EGFR amplification also influenced outcomes.
  • * Key findings indicate that in IDH-wild type gliomas, older age and a lesser extent of tumor removal correlate with worse OS, highlighting the need for a more nuanced approach in prognosis beyond just IDH mutation status.
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Background: Multimodal monitoring of intracranial pressure and brain tissue oxygen tension (PbtO) have been increasingly used to detect delayed cerebral ischemia (DCI) after subarachnoid hemorrhage. At our center, patients who cannot be easily assessed clinically will undergo intracranial pressure and PbtO monitoring via a NEUROVENT-PTO bolt. We aimed to determine whether the Lindegaard ratios (LRs) computed from transcranial Doppler ultrasonography (TCDU) would correlate with, or can predict, the simultaneously recorded PbtO value.

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We investigated auditory processing in a young patient who experienced a single embolus causing an infarct in the right middle cerebral artery territory. This led to damage to auditory cortex including planum temporale that spared medial Heschl's gyrus, and included damage to the posterior insula and inferior parietal lobule. She reported chronic difficulties with segregating speech from noise and segregating elements of music.

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  • * In a study of 43 patients, most were confirmed or probable COVID-19 cases, revealing five main categories of neurological disorders: encephalopathies, inflammatory central nervous system syndromes, ischemic strokes, peripheral neurological disorders, and other central disorders.
  • * Treatment outcomes varied, with many patients showing full or partial recovery, particularly those with encephalopathy and inflammatory CNS syndromes, while some experienced severe conditions like stroke or Guillain-Barré syndrome.
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Objective: To assess the prevalence of brain MRI abnormalities in people with epilepsy in rural China and to compare it with that of individuals in the United Kingdom.

Methods: Brain MRI scans were obtained in people with epilepsy who participated in a rural community-based program in China between July 2010 and December 2012. Individual epileptogenic lesion types were reviewed and their associations with seizure control examined.

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Objective: To find the covert patterns of abnormality in patients with unilateral temporal lobe epilepsy (TLE) and visually normal brain magnetic resonance images (MRI-negative), comparing them to those with visible abnormalities (MRI-positive).

Methods: We used multimodal brain MRI from patients with unilateral TLE and employed contemporary machine learning methods to predict the known laterality of seizure onset in 104 subjects (82 MRI-positive, 22 MRI-negative). A visualization approach entitled "Importance Maps" was developed to highlight image features predictive of seizure laterality in both the MRI-positive and MRI-negative cases.

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Objective: To summarise the incidental findings detected on brain imaging and blood tests during the first wave of data collection for the Insight 46 study.

Design: Prospective observational sub-study of a birth cohort.

Setting: Single-day assessment at a research centre in London, UK.

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Article Synopsis
  • POEMS syndrome is a rare disease that can affect many parts of the body and is linked to problems with certain blood cells.
  • Researchers studied brain and spine MRI scans of patients with POEMS to see how it affects them compared to patients with a similar condition called CIDP.
  • They found that many POEMS patients had thickening in the protective layers of the brain (meninges), while this was not the case for CIDP patients, showing a key difference between the two diseases.
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Compressive lesions of the spinal cord usually cause a syndrome of upper motor neurone weakness, spasticity and sensory loss below the level of the lesion. It has long been recognised that compressive cervical cord lesions may present as isolated lower motor neurone weakness of the upper limbs, a syndrome termed cervical spondylotic amyotrophy. We describe two patients presenting with isolated lower motor neurone weakness of the lower limbs in association with a compressive cord lesion at T11/12, a condition we have termed thoracic spondylotic amyotrophy.

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We present a validation study comparing results from a patient-specific lattice-Boltzmann simulation to transcranial Doppler (TCD) velocity measurements in four different planes of the middle cerebral artery (MCA). As part of the study, we compared simulations using a Newtonian and a Carreau-Yasuda rheology model. We also investigated the viability of using downscaled velocities to reduce the required resolution.

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It is recognized that IDH mutation negative, low-grade epilepsy associated tumors (LEAT) can show diffuse growth patterns and lack the diagnostic hallmarks of either classical dysembryoplastic neuroepithelial tumors (DNT) or typical ganglioglioma. "Nonspecific or diffuse DNT" and more recently "polymorphous low-grade neuroepithelial tumor of the young" have been terms used for these entities. There are few reports on the MRI recognition of these diffuse glioneuronal tumors (dGNT), which is important in planning the extent of surgical resection.

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Peripheral neuropathy is a common finding in patients with complex inherited neurological diseases and may be subclinical or a major component of the phenotype. This review aims to provide a clinical approach to the diagnosis of this complex group of patients by addressing key questions including the predominant neurological syndrome associated with the neuropathy, for example, spasticity, the type of neuropathy and the other neurological and non-neurological features of the syndrome. Priority is given to the diagnosis of treatable conditions.

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Background: Stroke survivors may suffer from a range of hearing impairments that may restrict their participation in postacute rehabilitation programs. Hearing impairment may have a significant impact on listening, linguistic skills, and overall communication of the affected stroke patient. However, no studies sought to systematically characterize auditory function of stroke patients in detail, to establish the different types of hearing impairments in this cohort of patients.

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Article Synopsis
  • Increasing age is a major risk factor for dementia, with changes related to Alzheimer's disease potentially developing years before symptoms appear.
  • Molecular imaging techniques like PET and MRI help to identify these changes, allowing for earlier detection and intervention before cognitive symptoms manifest.
  • The "Insight 46" study is monitoring 500 individuals from the 1946 British birth cohort to examine the progression of dementia-related changes over time, collecting data through various methods and aiming to identify preclinical stages of Alzheimer's.
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