Animesh Das

: 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: Foslevodopa-foscarbidopa (LDp/CDp) is a soluble formulation of levodopa/carbidopa delivered as a continuous subcutaneous infusion for the treatment of motor fluctuations in people with Parkinson’s disease. No real-world use data exist regarding its efficacy and safety from a high-volume Canadian center. Methods: This is an ambispective longitudinal study (with the second visit at 1 month of enrollment) in patients with advanced Parkinson’s disease from a tertiary care movement disorder center in Canada. Objectives: The primary objective of the study was to examine the efficacy of LDp/CDp in improving MDS UPDRS III scores, EURO-Q Index, EURO Q VAS score and ON time while reducing OFF time. Secondary objectives focused on safety. Results: The study was conducted from April 2024 to August 2025, with the prospective part comprising 11 patients and the retrospective part 53 patients. There was a significant ( p < 0.05) improvement in clinical efficacy parameters like the MDS UPDRS III (−11.37), OFF hours (−2.77), ON time without dyskinesias (+2.07), ON time with troublesome dyskinesias (−0.74 hours) and quality of life-related parameters like EURO Q Index (+0.10) and PDQ-39 (−10.78). One-fourth (26.5%) of the patients discontinued treatment, mostly due to infusion-site reactions or infections. Conclusion: LDp/CDp can be an effective treatment option for carefully selected patients with advanced Parkinson’s disease and disabling motor complications. Appropriate hygiene measures may reduce the proportion of infusion site reactions, thereby improving patient retention on LDp/CDp infusion.

Introduction Reperfusion Treatment(RT) options for Acute Ischemic Stroke(AIS) within 24 hours include: intravenous thrombolysis(IVT)(within 4.5 hours) and/or mechanical thrombectomy(MT). The utilization of benefits in ‘real world’ scenario, especially in Lower-Middle Income countries(LMICs) is not known. We aimed to determine the ‘real-world’ utilization and effectiveness of RT. Patients and methods In a single-center prospective cohort study, we collected data of all AIS patients coming within 24 hours. Patients receiving RT(IVT/MT/both) and those who were ineligible and received medical management (MM) were compared for the clinical, radiological characteristics and outcomes at 90-days assessed by modified Rankin Scale (mRS). The secondary outcomes were poor outcome at 90 days(mRS 3-6), Barthel Index(BI), Caregiver Strain Index(CSI), Stroke Specific Quality of Life(SSQoL) and mortality. Results In the study period (January 2022-September 2023), there were 302 patients. The mean age was 55.9(SD:15.7) years and majority were males (64.9%). Patients who underwent RT (42.7%(129/302)) had similar clinical characteristics, except for lesser time to presentation, better Glasgow Coma Scale(GCS), and better median ASPECTS. IVT was given to 33.4%(101/302) and MT in 14.6%(44/302). The mRS at 90-days was significantly better in the RT group (RT:1(0;3), MM:3(1;5);P <0.001). RT was an independent protective factor (OR: 0.3(0.2;0.4); p-value:<0.001) for worse outcome (mRS 3-6). Other factors associated with mRS 3-6 at 90-days in multivariate analysis were high NIHSS and low ASPECTS at presentation. Conclusions RT is feasible and effective in LMICs. Since the burden of stroke is increasing in LMICs and mean age of stroke is lower, post-stroke disability prevention by RT is an important intervention.

CNS involvement in hepatitis B virus (HBV) infection is rare. We report a 27-year-old woman with HBV infection presenting with headaches and seizures, whose imaging and brain biopsy confirmed acute hemorrhagic leukoencephalitis. She responded well to steroid and tenofovir therapy.

Background: DYT‐ VPS16 is a rare monogenic form of dystonia caused by pathogenic variants in the vacuolar protein sorting 16 homolog ( VPS16 ) gene. Although increasingly recognized, the clinical spectrum and therapeutic responsiveness, particularly to deep brain stimulation (DBS), remain incompletely defined. Cases: We report six affected individuals (5 males, 1 female) from five unrelated Indian families harboring VPS16 variants. The median age at onset was 16.5 years (range, 8–18 years). Dystonia began in the cervical ( n = 2), upper limb ( n = 2), or laryngeal ( n = 2) regions. Additional features included tremor ( n = 2) and sleep disturbances ( n = 1). Literature Review: A structured literature review identified 34 previously reported DYT‐ VPS16 cases treated with DBS. Pooled analysis revealed a responder rate (defined as ≥30% improvement in BFMDRS‐M) of 0.57 (95% CI: 0.31–0.81; I ² = 22.9%) suggesting a favorable therapeutic response in this subgroup. Conclusion: Our findings broaden the genotypic and phenotypic landscape of DYT‐ VPS16 , suggesting a more motor‐predominant and potentially milder expression in South Asian patients. DBS appears to confer meaningful clinical benefit in selected cases, highlighting the importance of early genetic diagnosis in guiding treatment.

Introduction/Aims: About two‐thirds of patients with Guillain‐Barré Syndrome (GBS) have autonomic dysfunction. The aim of this study was to characterize autonomic system involvement in various subtypes of GBS and its association with electrophysiological parameters. Methods: This was a prospective cross‐sectional study in which patients with GBS underwent autonomic function testing and nerve conduction studies along with the routine clinical history and examination. Involvement of various domains of the autonomic system was recorded by the Composite Autonomic Symptom Score‐31 (COMPASS‐31) at admission. Patients were classified into Miller Fisher syndrome (clinically) or demyelinating and axonal subtypes. Results: Between June 2021 and December 2022, 68 patients completed the study. At baseline, 79% had dysfunction on laboratory autonomic function tests, while only 25% had abnormal scores on COMPASS‐31. Sympathetic dysfunction was the predominant abnormality, accounting for 85.7% of patients in the acute inflammatory demyelinating polyneuropathy group and 68.2% (15/22) of patients in the axonal group (acute motor axonal neuropathy and acute motor sensory axonal neuropathy). There was no association of any pattern of autonomic dysfunction with the subtype of GBS or degree of axonal involvement. Discussion: Autonomic dysfunction detected by standardized autonomic function tests can be present even in GBS patients with no dysautonomic symptoms. These tests can be done as early as first week after admission. Such patients may require close monitoring in intensive care units for clinical dysautonomia. Further longitudinal studies on this group of patients may help to identify the incidence of clinically significant autonomic dysfunction and their long‐term prognosis.

Background: Normal Pressure hydrocephalus (NPH) is treated by ventriculoperitoneal shunting. The cerebrospinal fluid tap test (CSF-TT) is widely used to identify candidates for shunt surgery in idiopathic NPH (iNPH). This study aimed to compare the CSF tap test responses and 24-week functional outcomes between patients with probable iNPH who underwent surgery and those who did not. Methods: This Ambispective cohort study included 40 patients with probable iNPH, as defined by the 2019 Japanese guidelines, from 2019 to 2024. All patients underwent a large-volume CSF-TT, and they were offered surgery based on the clinico-radiologic profile. Results: Twenty-four patients underwent ventriculoperitoneal shunt surgery, and 16 did not for various reasons. No significant differences were found in the baseline or 24-hour post-CSF tap test parameters between the groups. However, at 24 weeks, 62.5% of the operated patients showed at least a 1-point improvement in mRS. In contrast, only 14.3% in the non-operated group did, indicating the beneficial role of VP shunting in NPH. Those who were operated had a 10 times higher odds (95% CI 1.6-105) of achieving at least one point improvement in mRS at 24 weeks. Interestingly, 46.7% of patients whose mRS did not improve after CSF-TT but who underwent surgery still benefited from shunting. Conclusion: Shunt surgery leads to a favorable short-term functional outcome in patients with probable iNPH. However, the CSF-TT alone lacks sufficient discriminatory power to guide surgical decisions in a cohort of patients with clinico-radiological probable iNPH. A negative tap test should not preclude surgery in patients with supportive clinical and imaging features.