Shashank Nagendra

University of Calgary

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Kamlesh Jagiasi

Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals

Pawan Ojha

Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals

Abhijit Gaikwad

Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals

Avinash Gutte

Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals

Rakesh K. Singh

Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals

M. N. Subhash

Vaidyaratnam P.S. Varier Ayurveda College

V. Aglave

Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals

Sumit Kharat

Government Medical College

K. Taranath Shetty

M S Ramaiah University of Applied Sciences

Christian H. Nolte

Charité - Universitätsmedizin Berlin

Cooperative Institutions

Boston University

461

Boston Medical Center

456

University of Thessaly

195

Hospital de Egas Moniz

194

Hospital de Clínicas de Porto Alegre

Grady Memorial Hospital

Universidade Federal do Rio Grande do Sul

University of Calgary

McMaster University

University of Toronto

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Dural AV fistula - A cause of reversible dementia

Journal of the Neurological Sciences (2021)

Shashank Nagendra Avinash Gutte Pawan Ojha Kamlesh Jagiasi Abhijit Gaikwad

10.1016/j.jns.2021.118704

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Myelin Oligodendrocyte Glycoprotein (MOG)-IgG Associated Demyelinating Disease

Annals of Indian Academy of Neurology (2020)

Shripad Pujari Rahul Kulkarni Dattatraya Nadgir Pawan Ojha Shashank Nagendra

Discovery of serum myelin oligodendrocyte glycoprotein (MOG) antibody testing in demyelination segregated MOG-IgG disease from AQ-4-IgG positive NMOSD.To study clinico-radiological manifestations, pattern of laboratory and electrophysiological investigations and response to treatment through follow up in MOG-IgG positive patients.Retrospective data of MOG-IgG positive patients was collected. Demographics, clinical manifestations at onset and at follow up and relapses, anti AQ-4-IgG status, imaging and all investigations were performed, treatment of relapses and further immunomodulatory therapy were captured.In our 30 patients, F: M ratio was 2.75:1 and adult: child ratio 4:1. Relapses at presentation were optic neuritis {ON}(60%), longitudinally extensive transverse myelitis {LETM}(20%), acute disseminated encephalomyelitis {ADEM}(13.4%), simultaneous ON with myelitis (3.3%) and diencephalic Syndrome (3.3%). Salient MRI features were ADEM-like lesions, middle cerebellar peduncle fluffy infiltrates, thalamic and pontine lesions and longitudinally extensive ON {LEON} as well as non-LEON. Totally, 50% patients had a relapsing course. Plasma exchange and intravenous immunoglobulin worked in patients who showed a poor response to intravenous methylprednisolone. Prednisolone, Azathioprine, Mycophenolate and Rituximab were effective attack preventing agents.MOG-IgG related manifestations in our cohort were monophasic/recurrent/simultaneous ON, myelitis, recurrent ADEM, brainstem encephalitis and diencephalic Syndrome. MRI features suggestive of MOG-IgG disease were confluent ADEM-like lesions, middle cerebellar peduncle fluffy lesions, LETM, LEON and non-LEON. Where indicated, patients need to go on immunomodulation as it has a relapsing course and can accumulate significant disability. Because of its unique manifestations, it needs to be considered as a distinct entity. To the best of our knowledge, this is the largest series of MOG-IgG disease reported from India.

Myelin oligodendrocyte glycoprotein

Acute disseminated encephalomyelitis

Neuromyelitis Optica

Demyelinating disease

Optic neuritis

10.4103/aian.aian_627_19

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Spontaneous obliteration of a spinal perimedullary fistula

Interventional Neuroradiology (2023)

Shashank Nagendra Syed Uzair Ahmed Timo Krings

We herewith report a young patient who had an incidental spinal vascular malformation of the cervicomedullary junction discovered during a work-up for anosmia. Angiography demonstrated a perimedullary spinal arteriovenous fistula with supply from lateral spinal arteries arising from bilateral V3 level segmental arteries. It was decided to manage the patient conservatively with magnetic resonance imaging monitored biannually. On a recent follow-up magnetic resonance, nearly 10 years later, we noted a subtle change in caliber and imaging characteristics at the posterior margin of the cervical medullary junction. Repeat digital-subtraction angiography showed no evidence of early venous filling from the previously involved branches. Microcatheter exploration of the right lateral spinal artery confirmed spontaneous occlusion of the spinal perimedullary arteriovenous fistula, without any persistent shunting. Spontaneous resolution of a spinal vascular malformation is rare; this case demonstrates the dynamic nature of shunting vascular malformations and that spontaneous obliteration of arteriovenous shunts is possible.

Digital subtraction angiography

Arteriovenous malformation

Shunting

Magnetic resonance angiography

10.1177/15910199231184522

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Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events

Neurology (2022)

Thanh N. Nguyen Muhammad M. Qureshi Piers Klein Hiroshi Yamagami Robert Mikulík

Background and Objectives

Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020).

Methods

We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.

Results

There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1–6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1–4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4–5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6–0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31–1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82–2.97], 5,656/195,539) of all stroke hospitalizations.

Discussion

There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.

Trial Registration Information

This study is registered under NCT04934020.

Pandemic

Stroke

2019-20 coronavirus outbreak

10.1212/wnl.0000000000201426

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Citations (33)

Isolated Subclavian Artery Thrombosis.

PubMed (2015)

S G Jadhav Neetu Agarwal Nitin Sarate Avinash Gutte Sagar Walinjkar

We presume this case to highlight the importance of underestimated percutaneous angioplasty with stent in isolated subclavian artery thrombosis.

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Patterns of hand drift in parietal lobe lesion

Journal of the Neurological Sciences (2019)

Shashank Nagendra G. Soni Kamlesh Jagiasi

Parietal lobe

Lobe

10.1016/j.jns.2019.10.433

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Plasma Total Amino Acids, Plasma Glutamate and Alanine Levels in Diabetic Subjects

Journal of medical research/The journal of medical research (2014)

R T Kashinath Shashank Nagendra G. Rudrappa.

Transamination

Alanine

Gluconeogenesis

Transaminase

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DWI-FLAIR Mismatch-guided IVT is Safe and Effective in Treatment of AIS Beyond 4.5 Hours

Journal of Stroke Medicine (2020)

Pawan Ojha Shashank Nagendra Shripad Pujari Rakesh K. Singh Rakesh Lalla

Background: Perfusion or clinical mismatch imaging is useful in selecting patients with acute ischemic stroke (AIS) for reperfusion therapies beyond 4.5 hours. These techniques are expensive, technically difficult, and therefore unavailable in most settings. The diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch pattern has been studied only in wake-up stroke/stroke with unclear time of onset but not in AIS patients with clear time of onset of more than 4.5 hours. This study assesses routinely available magnetic resonance imaging (MRI) DWI-FLAIR sequences for selecting AIS patients for intravenous thrombolytic therapy (IVT) beyond 4.5 hours of the witnessed onset of symptoms. Aim: To study the clinical spectrum and outcome of patients with AIS who received IVT based on the DWI-FLAIR mismatch seen beyond 4.5 hours of symptom onset. Methods, Observation, and Results: Retrospective analysis was performed on 10 patients who received IVT for AIS beyond 4.5 hours and had an MRI DWI-FLAIR mismatch. In cohort study, 60% patients were males, with the median age of 59 years, the median baseline National Institutes of Health Stroke Scale (NIHSS) score of 10 (range 7 to 15), and the median time from the onset to imaging of 412.5 minutes. Within 24 hours of thrombolysis, improvement of >4 points in NIHSS was seen in 7 out of 10 (70%) patients, and at the modified Rankin scale, the score of 0 to 1 was noted at 3 months in 8 out of 10 (80%) patients. Neuroimaging at 24 hours showed no intracerebral bleed. Discussion and Conclusion: DWI-FLAIR mismatch-guided IVT is safe and effective in patients with AIS beyond 4.5 hours of the onset of symptoms. More studies are recommended to confirm these findings.

Fluid-attenuated inversion recovery

Stroke

10.1177/2516608520953721

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Citations (1)

Atypical Optic Neuritis

Neurology India (2022)

Pawan T Ojha Prachi P Barvalia Rakesh K. Singh Girish Soni Nikhil Kadam

Many potential causes of optic nerve inflammation exist, including typical and atypical causes, which require different management strategies.The objective of this study is to identify red flags that help differentiate typical from atypical optic neuritis (ON).This prospective study included 66 patients (100 eyes) with immune-mediated ON from January 2016 to June 2019, carefully excluding the nonimmune causes. The clinico-radiological features, investigations, therapy, and outcome were analyzed.We evaluated 33 cases each of typical and atypical ON. The typical group included 29 idiopathic ON and four associated with multiple sclerosis. Atypical ON included 19 neuromyelitis optica (NMO), seven MOG-associated ON (MOG-ON), and others due to Sjogren's syndrome, granulomatous polyangiitis, sarcoidosis, and IgG4 disease. Atypical ON occurred significantly and more frequently with extremes of ages (<10 or >70 years), bilateral simultaneous or severe vision loss with early disc pallor, multiple attacks, symptoms/neuro-imaging indicating non-MS disease e.g., long segment ON/myelitis, large confluent lesions, the involvement of optic tract, chiasma, area postrema or diencephalon, and (pachy) meningitis. Systemic involvement and poor outcomes despite steroids and second-line immunosuppression were observed more often in the atypical ON.The red flags indicating atypical ON are onset at extremes of age, multiple attacks, bilateral simultaneous or severe to very severe vision loss, early disc pallor, neurological symptoms, or imaging abnormalities suggesting non-MS disease, systemic involvement, and poor steroid responsiveness. The awareness might help the clinician promptly identify and escalate therapy to ensure a better outcome.

Optic neuritis

Neuromyelitis Optica

Pallor

10.4103/0028-3886.359189

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Citations (1)

Gradient Echo-Additional Track Sign for Easy Detection of Vertebral Artery Dissection

Journal of Stroke Medicine (2018)

Pawan Ojha Shashank Nagendra Sarika Patil Rakesh K. Singh Akash Chheda

Vertebral artery dissection (VAD), a well-recognized cause of stroke in young, can be easily missed on magneto resonance angiography of the brain. Computed tomography and catheter−based angiography are often used to detect arterial dissection, but they have their limitations. Here, we discuss cases of stroke in young where the presence of the additional track sign on a gradient echo sequence provided the clue to VAD being the etiology of stroke. This sign observed on the routine magnetic resonance imaging brain might be of great help to clinicians and radiologists for the easy detection of VAD.

Vertebral artery dissection

Stroke

Magnetic resonance angiography

Gradient echo

10.1177/2516608518773001

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