Manjari Tripathi

: Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis, carrying the highest mortality among all forms. This multicentric prospective cohort study conducted in North India aimed to determine the incidence of complications, functional outcome (modified Rankin scale [mRS]), and mortality in TBM. Patients 12 years old and older with TBM were followed up until completion of 9 months of antitubercular treatment. Patients with concomitant HIV infection, other infections causing meningitis, or multidrug-resistant tuberculosis were excluded. The primary outcome was mRS at 9 months. Secondary outcomes included mRS at 6 months, poor mRS (>2), Barthel Index, and mortality at 6 and 9 months. Between October 1, 2019 and March 31, 2024, 585 eligible patients were enrolled, of whom 495 (84.6%) completed follow-up. The median age was 24.0 years old, and the majority were female ( n = 304/495; 61.4%). Complications were present in 377 patients (76.2%): focal neurological deficits (41.6%), seizures (38.6%), immune reconstitution inflammatory syndrome (32.7%), hydrocephalus (24.8%), and drug-induced liver injury (14.1%). Complications were associated with worse mRS on unadjusted analysis (odds ratio [OR]: 2.5 [1.7–3.7]; P P = 0.30). The median mRS improved from 4.0 at presentation to 2.0 at 6 months and 1.0 at 9 months. Death occurred at a median of 91.0 days after presentation. Mortality at 6 months was 9.3% and at 9 months was 10.7%.

Introduction: Vogt-Koyanagi-Harada (VKH) syndrome is an idiopathic immune-related disorder that affects multiple organ systems, particularly targeting melanocytes in the uvea, ear, and meninges. It can sometimes present as subacute vision loss and or headache without other systemic features mimicking optic neuritis or Idiopathic intracranial hypertension, leading to an initial misdiagnosis. Case Report: A 36-year-old male presented with an acute onset and progressive diminution of vision in both eyes for 5 days. Fundus examination revealed papillitis. Brain MRI and CSF examination were normal. Serum NMO and MOG were negative. Considering bilateral optic neuritis, he was started on intravenous methylprednisolone therapy, following which his vision showed initial improvement, followed by deterioration after 3 days. The MRI was reviewed again and showed a subtle FLAIR hyperintensity just lateral to the optic nerve entry in the posterior pole, suggestive of choroidal thickening. Optical coherence tomography showed bilateral large Neurosensory retinal detachment and intraretinal fluid. Fundus fluorescein angiography showed multifocal pinpoint hyperfluorescent spots due to leakage from the retinal pigment epithelium and dye pooling in the subretinal space, suggestive of VKH syndrome. Visual acuity improved after 3 cycles of plasma exchange to 6/6 in the right eye and 6/12 in the left eye. Conclusion: VKH should be considered in the differential diagnosis of any patient presenting with a history and examination suggestive of bilateral seronegative optic neuritis, even in the absence of characteristic extraocular manifestations of the disease.

Background and ObjectivesObesity is a key risk factor underlying both obstructive sleep apnea (OSA) and cardiovascular disease (CVD). The objective of this study was to determine differential stren...

Objective: Invasive presurgical evaluation plays a key role in pediatric epilepsy surgery, particularly in magnetic resonance imaging (MRI)‐negative cases, by guiding resective, disconnective, or ablative procedures. This International League Against Epilepsy (ILAE) Pediatric Epilepsy Surgery Taskforce study provides an updated global overview of current invasive evaluation practices. Methods: Group‐level data were collected from 61 epilepsy surgery programs (49 pediatric‐only) in 29 countries across six continents. Included were children and adolescents who underwent presurgical evaluation and epilepsy surgery in 2023. The study was designed to enable comparison with the similar ILAE survey conducted in 2004. Results: A total of 2427 patients were included. Invasive evaluations were performed in 21.1% of cases, most frequently in North America (33.7%, higher than Europe: 18.0%, p = .003). Among invasive cases, 32.3% had no detectable MRI abnormalities. The main indication for invasive evaluation was seizure onset localization (88.1%), followed by motor or sensory mapping (17.2%) and language mapping (14.2%). Stereoelectroencephalography (SEEG) was the predominant technique (19.8% overall, 93.6% of invasive cases), more common in North America (30.0%, p = .021) and less common in South America (7.4%, p < .001). Subdural electrodes were used in only 3.2% of invasive cases, and combined depth and subdural approaches in 3.2%. SEEG‐guided radiofrequency thermocoagulation (RF‐TC) was performed in 40.9% of SEEG cases, most commonly in Asia (63.8%). In 16.2% of invasive evaluations, patients did not proceed to resection, disconnection, or ablation, with the highest rate in Europe (28.5%). Significance: This global survey provides the first broad overview of invasive evaluation practices in pediatric epilepsy surgery across participating centers worldwide. It highlights the widespread adoption of SEEG, declining use of subdural electrodes, and increasing application of SEEG‐guided RF‐TC. The high proportion of MRI‐negative cases and the considerable proportion of patients not proceeding to resection, disconnection, or ablation underscore the complexity of contemporary surgical candidates and the need for further refinement of selection strategies.

Objective: Pediatric epilepsy surgery is well established, but contemporary global data on referral and presurgical evaluation practices are lacking. This International League Against Epilepsy (ILAE) Pediatric Epilepsy Surgery Task Force study provides an updated overview of current trends and regional differences. Methods: Group‐level data were collected from 61 epilepsy surgery programs (49 pediatric‐only) across 29 countries and six continents, identified through ILAE networks, and included all children and adolescents treated in 2023 who underwent presurgical evaluation/epilepsy surgery. Results: Group‐level data were available for 2427 patients. Mean age at surgery was 9.1 ± 4.9 years; mean epilepsy duration was 5.3. At surgery, 3.2% were 5 years. Reoperations are common, with resection more frequent than neuromodulation. Genetic testing in nearly half of patients reflects its growing relevance, and the high rate of DEEs underscores the complexity of surgical candidates.

Seronegative autoimmune encephalitis (AE), characterized by the absence of known neuronal autoantibodies despite meeting clinical criteria, presents significant diagnostic and therapeutic challenges. Although immunotherapy is frequently used, long-term outcomes in this population remain poorly characterized. This systematic review and meta-analysis aims to synthesize evidence on long-term outcomes in seronegative AE, focusing on functional status, seizure burden, cognitive impairment, relapses, immunotherapy practices, and prognostic indicators. We included studies involving patients 12 years or older diagnosed with antibody-negative probable AE (ANPRA), possible AE, or definite limbic encephalitis (LE) with negative neuronal antibodies according to Graus et al. (2016), with a minimum median follow-up of 6 months. Nineteen studies, predominantly retrospective cohorts with moderate risk of bias, met the inclusion criteria. The pooled proportion of patients achieving favorable functional outcomes (modified Rankin Scale 0-2) was 65% (95% CI 51% - 78%; I² = 88.1%; 12 studies, n = 782). Outcomes differed by seronegative subtype, with better functional recovery in seronegative LE (73%; 95% CI 45%-90%; 6 studies, n = 95) compared with ANPRA (47%; 95% CI 38%-55%; 5 studies, n = 277; p = 0.005). When compared with seropositive AE (n = 466), seronegative patients (n = 373) demonstrated comparable odds of favorable functional outcomes (odds ratio 0.50; 95% CI 0.19-1.31; p = 0.16) but had a significantly higher risk of persistent seizures (risk ratio 1.66; 95% CI 1.01-2.72; p = 0.04). The pooled relapse proportion among seronegative patients was 17% (95% CI 11%-26%; 7 studies, n = 350), with no significant difference by serostatus. Residual disability assessed using the Clinical Assessment Scale in Autoimmune Encephalitis suggested mild persistent impairment (mean score 3.11; 95% CI 1.79-4.43; 5 studies, n = 409). Owing to heterogeneity and inconsistent reporting, meta-analysis of cognitive outcomes, immunotherapy strategies, and RAPID (Refractory status epilepticus, Age ≥ 60 years, Probable AE, Infratentorial involvement, Delayed immunotherapy ≥ 1 month) scores was not feasible; narrative synthesis suggested persistent cognitive deficits and lower utilization of second-line immunotherapy in seronegative cohorts. Seronegative AE is associated with heterogeneous outcomes, with antibody-negative LE demonstrating better recovery than ANPRA. Subtype-specific variability and elevated seizure burden highlight the need for individualized management, timely diagnosis, structured follow-up, and well-designed prospective research.