Strokectomy for malignant middle cerebral artery infarction: experience and meta‐analysis of current evidence

Strokectomy means surgical excision of infarcted brain tissue post-stroke with preservation of skull integrity, distinguishing it from decompressive hemicraniectomy. Both can mitigate malignant middle cerebral artery (MCA) syndrome but evidence regarding strokectomy is sparse.


Autoimmune encephalitis in a South Asian population

Autoimmune encephalitis (AE) is now considered a main, potentially curable cause of encephalitis, but remains conspicuously underreported from South Asia. We studied the clinical characteristics in relation to their antibody status and outcomes of patients presenting with AE in Sri Lanka.

Stroke in Sri Lanka : How Can We Minimize the Burden?

The burden of stroke in Sri Lanka is high and steadily increasing. Accurate estimation of the burden is hampered by a paucity of epidemiological data. More neurologists, stroke units, facilities for modern treatments and multi-disciplinary rehabilitation services are urgently needed. Essential drugs for risk factor control and secondary prevention are available in many hospitals. Aggressive preventive strategies and promoting stroke awareness are the best ways to minimise the stroke burden in Sri Lanka.

Anterior interosseous nerve palsy caused by Parsonage-Turner syndrome

A 58-year-old man presented with difficulty in moving his left hand. Three weeks before this presentation, he had symptoms of an upper respiratory tract infection, which resolved spontaneously in several days. And 1 week after that, he experienced a severe stabbing pain in his entire left upper arm, which resolved in several days. At that time, he also developed difficulty in moving the thumb and index finger of his left hand.

Second intravenous immunoglobulin dose in patients with Guillain-Barré syndrome with poor prognosis (SID-GBS): a double-blind, randomised, placebo-controlled trial

Treatment with one standard dose (2 g/kg) of intravenous immunoglobulin is insufficient in a proportion of patients with severe Guillain-Barré syndrome. Worldwide, around 25% of patients severely affected with the syndrome are given a second intravenous immunoglobulin dose (SID), although it has not been proven effective. We aimed to investigate whether a SID is effective in patients with Guillain-Barré syndrome with a predicted poor outcome.

A rare mutation in the COLQ gene causing congenital myasthenic syndrome with remarkable improvement to fluoxetine: A case report

Congenital myasthenic syndromes (CMS) are genetically determined heterogenous disorders of neuromuscular transmission. We report a rare mutation of COLQ causing CMS in an Asian man that remarkably improved with fluoxetine. A 51-year-old Sri Lankan man with slowly progressive fatigable muscle weakness since eight years of age, presented with type 2 respiratory failure that required mechanical ventilation in the acute crisis and subsequent home-based non-invasive ventilation. His birth and family histories were unremarkable. On examination, he had limb girdle type of muscle weakness with fatigability and normal tendon reflexes with no ocular or bulbar involvement. DNA sequencing revealed a pathogenic homozygous mutation in COLQ gene: ENST00000383788.10:exon16:c.1228C>T:p.R410W, the first report in an Asian. Treatment with fluoxetine resulted in remarkable improvement and regain of muscle power and independence from assisted ventilation.

Effective treatment of osmotic demyelination syndrome with plasmapheresis: a case report and review of the literature

Rapid correction of hyponatraemia is associated with osmotic demyelination syndrome (ODS), which is a demyelinating disorder of the central nervous system (CNS). Brain adapts to chronic hyponatraemia by extracellular movement of osmotically active organic and inorganic particles. During rapid correction of hyponatraemia, organic osmolytes cannot re-enter the intracellular compartment as rapidly as ionic movement creating an osmotic disequilibrium. This causes shrinkage of brain cells including astrocytes and oligodendrocytes causing accelerated apoptosis leading to disruption of the blood brain barrier and demyelination. Consequently, symptoms related to pontine and extra-pontine demyelination typically occurs after two to six days of rapid sodium correction. Traditionally, established ODS is considered to be associated with a poor prognosis. Apart from supportive therapy, sodium re-lowering therapy has shown to be beneficial in the acute stage. However, successful outcome of chronic ODS is limited to a few case reports. Out of the experimental therapies, plasmapheresis alone or in combination with other treatment modalities has shown variable benefit. We report a case of complete clinical and radiological recovery of ODS with plasmapheresis, initiated twenty-two days after rapid sodium correction.

Acute Cerebrovascular Events With COVID-19 Infection

Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known. COVID-19 has been associated with an increased incidence of thrombotic events, including severe cerebrovascular events in young patients. However, some centers have reported a decline in acute cardiovascular and cerebrovascular cases and low rates of such events among hospitalized COVID-19 patients during the pandemic. We sought to summarize the characteristics and short-term outcomes of patients admitted to a large multi-hospital health system in New York City with acute cerebrovascular disease during the COVID-19 pandemic. We hypothesized that patients with stroke and confirmed SARS-CoV-2 infection would have fewer traditional vascular risk factors, poorer outcomes, and an embolic or cryptogenic stroke cause more commonly than those without confirmed infection.

Effects of Flickering Seizures on Road Drivers and Passengers

The road environment includes many factors that, due to the repetitions of light signals within a limited area of the field of vision, can cause discomfort and in some cases flickering seizures amongst drivers and passengers. These potentially dangerous factors may occur when driving along an open road and in tunnel. The authors develops an experimental program in order to deepen the main factors of the road environment able to trigger seizures due to the flickering effect and to provide useful indications for the designing and maintaining of roads that are safe for all types of user, including photosensitive subjects.