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Neurology in Tropics (E-book)
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Cover | Cover | ||
| Title Page | iii | ||
| Copyright Page | iv | ||
| Foreword | v | ||
| Preface to the Second Edition | vii | ||
| List of Contributors | ix | ||
| Editorial Advisory Board | xvii | ||
| Dedication | xix | ||
| Contents | xxi | ||
| Section I - CNS Infections | 1 | ||
| Chapter 1 - HIV Infection in the Tropics | 3 | ||
| Epidemiology | 3 | ||
| Neuropathogenesis | 4 | ||
| Clinical manifestations | 5 | ||
| Intracranial Disorders | 5 | ||
| HIV-Associated Neurocognitive Disorder (HAND) | 5 | ||
| Clinical Features | 5 | ||
| Neuromuscular Disorders | 5 | ||
| Classification of Neuromuscular Disorders | 5 | ||
| Distal Symmetric Polyneuropathy | 6 | ||
| Clinical manifestations | 6 | ||
| Mononeuropathy Multiplex | 6 | ||
| Inflammatory Demyelinating Polyneuropathies | 7 | ||
| Lumbosacral Polyradiculopathy | 7 | ||
| Myopathy | 7 | ||
| Clinical Manifestations | 7 | ||
| Spinal Cord Disorders | 7 | ||
| Sub-Acute Vacuolar Myelopathy | 7 | ||
| Human T-Lymphotropic Virus-1–Associated Myelopathy | 7 | ||
| Acute Myelopathies | 7 | ||
| Intracranial Opportunistic Infections | 7 | ||
| Toxoplasma Gondii | 7 | ||
| Cryptococcus Neoformans | 8 | ||
| Aseptic Meningitis | 8 | ||
| Progressive Multifocal Leukoencephalopathy | 8 | ||
| Viral Encephalitis | 8 | ||
| Cytomegalovirus | 8 | ||
| Neurosyphilis | 9 | ||
| Neoplasms | 9 | ||
| Central Nervous System Lymphoma | 9 | ||
| Complications of systemic diseases | 9 | ||
| Metabolic Encephalopathy | 9 | ||
| Stroke | 9 | ||
| Conclusion | 9 | ||
| References | 9 | ||
| Chapter 2 - HTLV-1 Infection in the Tropics | 11 | ||
| Introduction | 11 | ||
| Epidemiology | 11 | ||
| Transmission | 12 | ||
| HTLV-2 | 12 | ||
| HTLV-3 and HTLV-4 | 12 | ||
| Immunology and pathogenesis | 12 | ||
| HAM/TSP | 13 | ||
| Co-infection with HIV-1 and Hepatitis C | 14 | ||
| Clinical characteristics | 14 | ||
| HTLV-1 and Non-Neurological Disease | 14 | ||
| Clinical Characteristics of HAM/TSP | 14 | ||
| Other Neurological Complications Reported in Association with HTLV-1 Infection | 15 | ||
| Diagnosis | 16 | ||
| Laboratory Diagnosis | 16 | ||
| Treatment | 16 | ||
| Prognosis | 16 | ||
| References | 17 | ||
| Chapter 3 - Neurological Complications of Acute Haemorrhagic Conjunctivitis | 19 | ||
| Introduction | 19 | ||
| Epidemiology | 19 | ||
| Predisposing Factors | 20 | ||
| Aetiology | 20 | ||
| Pathogenesis | 20 | ||
| Clinical features | 21 | ||
| Stage of Ophthalmic Infection | 21 | ||
| Latent Stage | 22 | ||
| Pre-paralytic/Prodromal Stage | 22 | ||
| Paralytic Stage | 22 | ||
| Spinal Cord Form | 22 | ||
| Cranial Neuropathy Form | 22 | ||
| Investigative abnormalities | 23 | ||
| Cerebrospinal Fluid | 23 | ||
| Virological Markers | 23 | ||
| Neurophysiology | 23 | ||
| HLA Studies | 24 | ||
| Histological Studies | 24 | ||
| Differential diagnosis | 24 | ||
| Management | 24 | ||
| Prognosis | 26 | ||
| References | 26 | ||
| Chapter 4 - Herpes Simplex Encephalitis | 28 | ||
| Introduction | 28 | ||
| Epidemiology | 28 | ||
| Clinical features | 28 | ||
| Pathology (by S.K. Shankar, NIMHANS, Bangalore) | 29 | ||
| Investigations | 30 | ||
| Cerebrospinal Fluid | 30 | ||
| Magnetic Resonance Imaging (MRI) | 31 | ||
| Electroencephalogram (EEG) | 31 | ||
| Immunodiagnosis | 31 | ||
| Brain Biopsy | 32 | ||
| Differential diagnosis | 32 | ||
| Treatment | 33 | ||
| Prognosis | 33 | ||
| Neonatal HSE | 33 | ||
| HSE in AIDS | 34 | ||
| References | 34 | ||
| Chapter 5 - Japanese Encephalitis | 36 | ||
| Introduction | 36 | ||
| Epidemiology | 36 | ||
| Human infection and pathogenesis | 37 | ||
| Pathology (Professor Susarala K. Shankar, Nimhans, Bangalore, India) | 38 | ||
| Clinical features | 40 | ||
| Investigations | 40 | ||
| Laboratory diagnosis | 41 | ||
| Treatment and prevention | 42 | ||
| References | 43 | ||
| Chapter 6 - Dengue Fever: Neurological Complications | 45 | ||
| Introduction | 45 | ||
| Epidemiology | 45 | ||
| Aetiology | 46 | ||
| Pathogenesis | 46 | ||
| Immunology and Molecular Biology | 46 | ||
| Neuropathogenesis | 46 | ||
| Neurotropism and Neurovirulence | 46 | ||
| Post-Infectious Autoimmune Process | 47 | ||
| Metabolic Disturbances and Haemorrhagic Complications | 47 | ||
| Clinical characteristics | 47 | ||
| Diagnosis | 48 | ||
| Dengue Infection | 48 | ||
| Cerebrospinal Fluid Analysis | 49 | ||
| Diagnosis Imaging | 50 | ||
| Pathology | 50 | ||
| Differential diagnosis | 50 | ||
| Treatment and prognosis | 50 | ||
| References | 50 | ||
| Chapter 7 - Nipah Encephalitis | 53 | ||
| Introduction | 53 | ||
| Epidemiology | 53 | ||
| Why is IT not JE | 53 | ||
| Nipah and hendra viruses: similar, yet different | 53 | ||
| Bats as reservoir | 54 | ||
| Outbreaks in Bangladesh and India | 54 | ||
| Clinical manifestations | 54 | ||
| Laboratory testing | 55 | ||
| Radiological findings | 56 | ||
| Histopathological findings | 57 | ||
| Prognosis, relapses and late-onset nipah encephalitis | 57 | ||
| Treatment | 58 | ||
| Indications of future outbreak | 58 | ||
| References | 59 | ||
| Chapter 8 - Chikungunya – Neurological Complications | 60 | ||
| Introduction | 60 | ||
| Virology | 60 | ||
| Epidemiology | 60 | ||
| Pathogenesis | 61 | ||
| Clinical features | 62 | ||
| Severe and Atypical Forms | 63 | ||
| Ocular Manifestations | 63 | ||
| Neurological Complications | 63 | ||
| Mother-to-Child Transmission | 64 | ||
| Laboratory diagnosis | 65 | ||
| Treatment | 65 | ||
| Mortality and Morbidity | 65 | ||
| Conclusions | 65 | ||
| References | 65 | ||
| Chapter 9 - Poliomyelitis | 68 | ||
| Introduction | 68 | ||
| Epidemiology | 68 | ||
| Causative agent | 68 | ||
| Pathogenesis | 68 | ||
| Diagnosis | 68 | ||
| Clinical features | 69 | ||
| Treatment | 71 | ||
| Poliovirus vaccines | 71 | ||
| Post-polio syndrome (PPS) | 71 | ||
| References | 72 | ||
| Chapter 10 - Rabies | 73 | ||
| Introduction | 73 | ||
| Epidemiology | 73 | ||
| Rabies in Asia | 73 | ||
| Rabies in Europe | 74 | ||
| Rabies in America | 74 | ||
| Rabies in Africa | 74 | ||
| Rabies in Australia | 74 | ||
| Symptomless Carrier | 74 | ||
| Infectious agent | 74 | ||
| Pathogenesis and pathophysiology of rabies | 75 | ||
| Mode of Transmission | 75 | ||
| Uptake of Virus after Peripheral Inoculation | 75 | ||
| Route of Centripetal Spread of Virus Uptake | 76 | ||
| Replication of Virus in Inoculated Muscle | 77 | ||
| Propagation of Virus Occurs only at Chemical Synapses | 77 | ||
| Centrifugal Spread of Rabies Virus | 77 | ||
| Neuronal Receptors for Rabies Virus | 77 | ||
| Relevance of Neuropathogenesis to Incubation Period | 78 | ||
| Furious Versus Paralytic Rabies: What is the Underlying Mechanism? | 78 | ||
| Specific Viral Variants | 78 | ||
| Extent of Immune Response | 78 | ||
| Brainstem Inflammation | 78 | ||
| Poor Immune Response in Rabies-Infected CNS | 78 | ||
| Preservation of Neuronal Integrity | 79 | ||
| Pathogenesis of Paralytic Rabies | 79 | ||
| Pathology | 79 | ||
| Clinical features | 80 | ||
| Incubation Period | 80 | ||
| Prodrome and Early Symptoms | 80 | ||
| Acute Neurological Involvement | 81 | ||
| Encephalitic Type | 81 | ||
| Paralytic Rabies | 81 | ||
| Coma | 82 | ||
| Recovery | 82 | ||
| Laboratory diagnosis of rabies | 82 | ||
| Conventional Diagnostic Tests | 82 | ||
| Direct Microscopy | 82 | ||
| Demonstration of Viral Antigen | 82 | ||
| Isolation of Virus | 83 | ||
| Demonstration of Antibodies | 83 | ||
| Newer Diagnostic Tests | 83 | ||
| Demonstration of Viral Antigen | 83 | ||
| Detection of Nucleic Acid | 84 | ||
| Conclusions | 84 | ||
| Demonstration of Antibodies | 84 | ||
| Practical Application of Available Tests in Current Era | 84 | ||
| Neuroimaging of Rabies | 84 | ||
| Prevention of rabies | 85 | ||
| History of Rabies Vaccines | 85 | ||
| Post-Exposure Prophylaxis (PEP) | 86 | ||
| Local Wound Care | 86 | ||
| Estimation of Risk | 86 | ||
| Different Types of Rabies Vaccines | 86 | ||
| PEP for Previously Unvaccinated Patient | 87 | ||
| PEP in Previously Vaccinated Patients | 88 | ||
| PEP Failures | 89 | ||
| Pre-Exposure Prophylaxis | 89 | ||
| Management of rabies | 89 | ||
| Therapy for Rabies | 89 | ||
| New Approaches | 90 | ||
| References | 90 | ||
| Chapter 11 - Measles Pathobiology and Central Nervous System Complications | 93 | ||
| Measles complications | 93 | ||
| Pathogenesis | 94 | ||
| Viral Entry into Brain | 95 | ||
| PIE or ADEM | 95 | ||
| Measles Inclusion Body Encephalitis (MIBE) | 95 | ||
| Subacute sclerosing panencephalitis (SSPE) | 97 | ||
| Epidemiology | 97 | ||
| Pathogenesis | 98 | ||
| Pathology | 99 | ||
| Clinical features | 100 | ||
| Long-term survivors | 101 | ||
| Fulminant SSPE | 101 | ||
| Diagnosis and treatment of SSPE | 101 | ||
| CSF findings | 102 | ||
| EEG | 103 | ||
| Neuroimaging | 104 | ||
| Treatment | 104 | ||
| Prognosis | 104 | ||
| Acknowledgements | 105 | ||
| References | 105 | ||
| Chapter 12 - Ebola Virus Disease | 109 | ||
| Epidemiology | 109 | ||
| Aetiology | 109 | ||
| Transmission | 110 | ||
| Immounology and pathogenesis | 110 | ||
| Clinical characteristics | 110 | ||
| Diagnosis and differential diagnosis | 111 | ||
| Differential Diagnoses of EVD | 111 | ||
| Treatment | 112 | ||
| Prognosis | 112 | ||
| References | 113 | ||
| Chapter 13 - Leprosy | 114 | ||
| Epidemiology | 114 | ||
| Aetiology | 115 | ||
| M. lepromatosis | 116 | ||
| Pathogenesis of Leprosy | 116 | ||
| Pathogenesis of Nerve Involvement in Leprosy | 116 | ||
| Stages of Nerve Involvement | 117 | ||
| Clinical features of leprosy | 118 | ||
| Classification of leprosy | 118 | ||
| Other Forms of Leprosy | 120 | ||
| Neuropathy in leprosy | 121 | ||
| Chronic Neuropathic Pain | 122 | ||
| Diagnosis | 122 | ||
| Differential Diagnosis | 122 | ||
| Neurological Disorders | 122 | ||
| Laboratory diagnosis | 122 | ||
| Slit-Skin Smears | 123 | ||
| Skin/Nerve Biopsy | 123 | ||
| Immunohistochemistry | 123 | ||
| Serology and PCR | 123 | ||
| Reactions in Leprosy | 123 | ||
| Type 1 Reaction | 123 | ||
| Pathogenesis of Type 1 Reaction | 124 | ||
| Type 2 Reaction | 124 | ||
| Pathogenesis of Type 2 Reaction | 124 | ||
| Systemic involvement | 124 | ||
| Treatment | 125 | ||
| Other regimens for special situations | 125 | ||
| Immunotherapy | 125 | ||
| Management of Lepra Reactions | 125 | ||
| Treatment and Prophylaxis for Nerve Damage | 126 | ||
| Prognosis | 126 | ||
| References | 126 | ||
| Chapter 14 - Leprosy in Africa | 128 | ||
| Introduction | 128 | ||
| Epidemiology | 128 | ||
| Clinical features | 130 | ||
| Tuberculoid Leprosy | 130 | ||
| Lepromatous Leprosy | 130 | ||
| Borderline Leprosy (Borderline Tuberculoid, Mid-Borderline and Borderline Lepromatous) | 131 | ||
| Disabilities | 131 | ||
| Diagnosis | 132 | ||
| Treatment of leprosy | 132 | ||
| Stigmatization | 133 | ||
| Rehabilitation | 133 | ||
| Prevention and Control | 133 | ||
| References | 133 | ||
| Chapter 15 - Pyogenic Meningitis | 134 | ||
| Introduction | 134 | ||
| Epidemiology | 134 | ||
| Aetiology | 134 | ||
| Neonatal | 135 | ||
| Infancy and Childhood | 135 | ||
| Adults | 135 | ||
| Pre-Disposing Factors | 135 | ||
| Pathogenesis | 136 | ||
| Pathology (by Bishen D. Radotra Professor of Neuropathology, PGIMER, Chandigarh) | 136 | ||
| Clinical features | 139 | ||
| Investigations | 139 | ||
| Differential diagnosis | 140 | ||
| Management | 140 | ||
| Empirical Antibiotic Therapy | 140 | ||
| Meningococcal Meningitis | 142 | ||
| Fulminant Meningococcemia | 143 | ||
| H. influenzae Meningitis | 143 | ||
| Antibiotic Therapy | 143 | ||
| Seizures | 143 | ||
| Pneumococcal Meningitis | 143 | ||
| Alternative Antibiotics | 144 | ||
| Streptococcal and Staphylococcal Meningitis | 144 | ||
| Gram-Negative Bacillary Meningitis33 | 144 | ||
| Listeria Meningitis | 144 | ||
| Neonatal Meningitis | 144 | ||
| Role of Corticosteroids | 145 | ||
| Raised Intracranial Pressure | 145 | ||
| Non-Antibiotic Aspects of Therapy | 145 | ||
| Circulatory and Electrolyte Changes | 145 | ||
| Partially Treated Pyogenic Meningitis37 | 145 | ||
| Recurrent Bacterial Meningitis38,39 | 145 | ||
| Prophylaxis | 146 | ||
| Prognosis | 146 | ||
| References | 146 | ||
| Chapter 16 - Neurobrucellosis | 148 | ||
| Introduction | 148 | ||
| Epidemiology | 148 | ||
| Aetiology | 148 | ||
| Immunology and pathogenesis | 149 | ||
| Clinical characteristics | 149 | ||
| Clinical Features of Brucellosis | 149 | ||
| Common Neurological Clinical Features | 149 | ||
| Rare Neurological Clinical Features | 150 | ||
| Diagnosis and differential diagnosis | 150 | ||
| Treatment | 152 | ||
| Prognosis | 152 | ||
| References | 152 | ||
| Chapter 17 - Neuroleptospirosis | 155 | ||
| Introduction | 155 | ||
| History | 155 | ||
| Aetiological agents | 155 | ||
| Epidemiology | 156 | ||
| Transmission of infection | 156 | ||
| High-risk groups | 156 | ||
| Pathogenesis | 156 | ||
| Clinical manifestations | 157 | ||
| Neurological manifestations | 158 | ||
| Leptospiral Meningitis | 159 | ||
| Encephalitis and Encephalomyelitis | 159 | ||
| Transverse Myelitis | 159 | ||
| Intracranial Haemorrhage | 159 | ||
| Ocular Manifestations | 159 | ||
| Peripheral Nerves | 159 | ||
| Other Neurological Manifestations | 159 | ||
| Investigations | 160 | ||
| Differential diagnosis | 161 | ||
| Treatment | 161 | ||
| Prognosis | 161 | ||
| Prevention | 161 | ||
| Summary | 161 | ||
| References | 162 | ||
| Chapter 18 - Neurological Manifestations of Syphilis | 164 | ||
| History and epidemiology | 164 | ||
| Overview of neurosyphilis | 164 | ||
| Early manifestations of syphilis | 165 | ||
| Introduction | 165 | ||
| Case Report 1 | 165 | ||
| Case Report 2 | 166 | ||
| Case Report 3 | 166 | ||
| Case Report 4 | 167 | ||
| Asymptomatic Neurosyphilis and Early Meningeal Syphilis | 167 | ||
| Case Report 5 | 167 | ||
| Case Report 6 | 168 | ||
| Meningovascular syphilis | 168 | ||
| Late neurosyphilis | 170 | ||
| General Paresis of the Insane (Dementia Paralytica) | 170 | ||
| Tabes Dorsalis (or Locomotor Ataxia) | 171 | ||
| Other Spinal Manifestations | 171 | ||
| Other Ophthalmological Problems | 172 | ||
| Syphilitic Osteitis and Gummas | 172 | ||
| HIV and syphilis | 172 | ||
| Congenital syphilis | 173 | ||
| Early Manifestations | 173 | ||
| Late Manifestations | 174 | ||
| Diagnosis | 174 | ||
| Interpretation of Serological Testing for Syphilis | 174 | ||
| False-Positive Syphilis Serology Tests | 174 | ||
| Future Tests | 175 | ||
| Treatment | 175 | ||
| Recommended Treatment Regimens | 175 | ||
| Key messages | 175 | ||
| References | 176 | ||
| Chapter 19 - Neurological Manifestation of Enteric Fever | 177 | ||
| Introduction | 177 | ||
| Epidemiology | 177 | ||
| Transmission and Risk Factors | 177 | ||
| Global Burden of Disease | 177 | ||
| Asia and the Indian Subcontinent | 177 | ||
| Pathogenesis | 179 | ||
| Clinical manifestation | 179 | ||
| Neurological Complications of Enteric Fever | 179 | ||
| Typhoid Delirium | 179 | ||
| Meningitis | 180 | ||
| Specific Neurological Syndromes | 180 | ||
| Focal Cortical Dysfunction | 180 | ||
| Cerebellar Ataxia | 181 | ||
| Psychiatric Disorder | 181 | ||
| Myelopathy | 181 | ||
| Peripheral Neuropathy | 181 | ||
| Extrapyramidal Syndrome | 181 | ||
| Outcome | 182 | ||
| Conclusions | 182 | ||
| References | 182 | ||
| Chapter 20 - Tuberculous Meningitis | 183 | ||
| Section A: Introduction and Epidemiology | 183 | ||
| Introduction | 183 | ||
| Epidemiology | 183 | ||
| Section B: Pathophysiology and Pathology | 184 | ||
| Pathophysiology | 184 | ||
| Pathology | 185 | ||
| Section C: Clinical Features and Diagnosis | 188 | ||
| Clinical features | 188 | ||
| Diagnosis | 189 | ||
| Microscopy | 189 | ||
| Bacteriology | 190 | ||
| CSF examination and other diagnostic aids | 191 | ||
| Section D: Role of Imaging | 192 | ||
| Imaging features | 192 | ||
| CT | 192 | ||
| MRI | 193 | ||
| Differential diagnosis | 194 | ||
| Imaging of Complications | 194 | ||
| Clinical algorithms | 195 | ||
| Treatment | 196 | ||
| Antituberculosis Treatment | 196 | ||
| Adjunctive Immunomodulatory Treatment | 198 | ||
| Antiretroviral Therapy | 198 | ||
| Managing hyponatrAemia | 199 | ||
| Section E: Role of Surgery in TBM | 199 | ||
| Managing hydrocephalus | 199 | ||
| Management | 199 | ||
| Surgical Management | 199 | ||
| Role of endoscopy | 200 | ||
| Endoscopic Third Ventriculostomy | 200 | ||
| Septum Pellucidotomy | 201 | ||
| Adhesiolysis | 201 | ||
| Prognostic factors and outcome | 201 | ||
| Prevention – vaccination | 202 | ||
| Summary | 202 | ||
| References | 202 | ||
| Chapter 21 - CNS Tuberculomas | 206 | ||
| Section A: Epidemiology and Clinical Features | 206 | ||
| Introduction | 206 | ||
| Epidemiology | 206 | ||
| Section B: Pathology of Tuberculomas | 207 | ||
| Pathogenesis | 207 | ||
| Pathology | 208 | ||
| Clinical features | 209 | ||
| Appearance of New Lesion and Paradoxical Expansion of Intracranial Tuberculomas During Chemotherapy | 210 | ||
| Diagnosis | 211 | ||
| Section C: Brain Imaging | 211 | ||
| CT | 211 | ||
| MRI | 212 | ||
| Role of Advanced Imaging | 214 | ||
| Section D: Surgery in Tuberculomas | 214 | ||
| Indications for surgery | 215 | ||
| To Obtain a Definitive Diagnosis | 215 | ||
| Stereotactic Biopsy | 216 | ||
| Stereotactic Craniotomy | 217 | ||
| Microsurgery | 217 | ||
| Intracranial Pressure | 217 | ||
| Tissue for Culture and Sensitivity Studies | 217 | ||
| Tuberculomas with Intractable Epilepsy | 217 | ||
| Complications of surgery | 217 | ||
| Microbiological studies | 218 | ||
| Section E: Medical Management | 218 | ||
| Antitubercular therapy | 218 | ||
| Role of steroids | 219 | ||
| Prognosis | 219 | ||
| References | 219 | ||
| Chapter 22 - Amoebic Infections of Central Nervous System | 222 | ||
| Introduction | 222 | ||
| Acanthamoeba | 222 | ||
| Epidemiology and Life Cycle | 222 | ||
| Human Infections | 224 | ||
| Granulomatous amoebic encephalitis | 224 | ||
| Epidemiology | 224 | ||
| Pathogenesis and Pathology | 224 | ||
| Clinical Features | 224 | ||
| Laboratory Diagnosis | 224 | ||
| Neuroimaging | 224 | ||
| Microscopic Methods | 225 | ||
| Culture Methods | 225 | ||
| Serology | 225 | ||
| PCR | 225 | ||
| Management | 226 | ||
| B. mandrillaris | 226 | ||
| Epidemiology and Life Cycle | 226 | ||
| Human Infections | 226 | ||
| Balamuthia amoebic meningitis | 226 | ||
| Epidemiology, Pathogenesis and Pathology | 226 | ||
| Clinical Features | 227 | ||
| Laboratory Diagnosis | 227 | ||
| Neuroimaging | 227 | ||
| Microscopic Method | 227 | ||
| Culture Methods | 227 | ||
| Serology | 228 | ||
| PCR | 228 | ||
| Treatment | 228 | ||
| N. fowleri | 229 | ||
| Epidemiology and Life Cycle | 229 | ||
| Primary amoebic meningoencephalitis | 230 | ||
| Epidemiology | 230 | ||
| Pathogenesis and Pathology | 230 | ||
| Clinical Features | 230 | ||
| Laboratory Diagnosis | 230 | ||
| Light Microscopy | 230 | ||
| CSF | 230 | ||
| Brain tissue | 230 | ||
| Neuroimaging | 230 | ||
| Culture methods | 230 | ||
| PCR | 230 | ||
| Management | 230 | ||
| Conclusions | 231 | ||
| References | 231 | ||
| Chapter 23 - Neurological Complications of Malaria | 233 | ||
| Introduction | 233 | ||
| Epidemiology | 233 | ||
| Biology | 233 | ||
| Clinical features | 234 | ||
| Cerebral Malaria | 234 | ||
| Definition | 234 | ||
| Clinical Presentation | 234 | ||
| Pathogenesis | 236 | ||
| Brain Pathology (by Bishen D. Radotra, Professor of Neuropathology, PGIMER, Chandigarh) | 237 | ||
| Diagnosis and assessment | 238 | ||
| Neuroimaging | 238 | ||
| Management | 239 | ||
| Adjunctive Therapy | 239 | ||
| Malaria Vaccine | 240 | ||
| Future research | 240 | ||
| References | 240 | ||
| Chapter 24 - Human African Trypanosomiasis | 241 | ||
| Introduction | 241 | ||
| Epidemiology | 241 | ||
| History | 241 | ||
| Parasites | 242 | ||
| Vectors | 242 | ||
| Reservoirs | 242 | ||
| Geographical Repartition | 243 | ||
| Immunology and pathogenesis | 243 | ||
| General Features | 243 | ||
| Pathological Manifestations in the CNS | 244 | ||
| Clinical characteristics | 244 | ||
| Lymphaticosanguine Stage or Stage 1 | 245 | ||
| Meningoencephalitic Stage or Stage 2 | 245 | ||
| Clinical Forms | 246 | ||
| Diagnosis | 246 | ||
| Diagnosis of HAT (Screening) | 247 | ||
| Diagnosis of Stage (Staging) | 247 | ||
| Treatment | 247 | ||
| Treatment of Stage 1 | 248 | ||
| Treatment of Stage 2 | 248 | ||
| Post-Treatment Follow-Up | 248 | ||
| References | 248 | ||
| Chapter 25 - Neurocysticercosis | 251 | ||
| Introduction | 251 | ||
| Life cycle of T. solium | 251 | ||
| Evolutionary stages of cysticercus | 252 | ||
| Clinical presentations | 253 | ||
| Classification and Diagnostic Criteria | 254 | ||
| Seizures and Epilepsy | 255 | ||
| Meningeal–Subarachnoid NCC | 256 | ||
| Heavy Multilesional Parenchymal Cysticerci | 256 | ||
| Cysticercotic encephalitis | 256 | ||
| Heavy non-encephalitic NCC | 256 | ||
| Disseminated cysticercosis | 256 | ||
| Intraventricular NCC | 258 | ||
| Solitary Cysticercus Granuloma | 258 | ||
| Uncommon Manifestations | 260 | ||
| Serological diagnosis of NCC | 260 | ||
| Radiology and imaging | 260 | ||
| Treatment of NCC | 260 | ||
| Anticysticercal Agents | 260 | ||
| Corticosteroids | 261 | ||
| Antiepileptic Drugs | 261 | ||
| Overview of Treatment Decisions | 262 | ||
| Treatment of SCG | 262 | ||
| References | 262 | ||
| Chapter 26 - Hydatid Disease of the Central Nervous System | 264 | ||
| Introduction | 264 | ||
| Aetiopathogenesis | 264 | ||
| E. granulosus Infection | 265 | ||
| Structure of the Intracranial E. granulosus Hydatid Cyst | 265 | ||
| E. multilocularis Infection | 266 | ||
| Intracranial hydatid cysts | 266 | ||
| Clinical Presentation | 267 | ||
| Radiological Diagnosis | 267 | ||
| Skull X-Ray | 267 | ||
| CT | 267 | ||
| Magnetic Resonance Imaging | 267 | ||
| Magnetic Resonance Spectroscopy | 268 | ||
| Serological Diagnosis | 268 | ||
| Differential Diagnosis | 269 | ||
| Treatment | 269 | ||
| Surgical Considerations | 271 | ||
| Pitfalls in Management and their Avoidance | 271 | ||
| Complications | 271 | ||
| Medical Treatment | 273 | ||
| Prognosis | 273 | ||
| Prophylaxis | 273 | ||
| Spinal and vertebral hydatid cysts | 273 | ||
| Clinical Presentation | 274 | ||
| Radiological Diagnosis | 274 | ||
| Treatment | 274 | ||
| Extradural Lesions | 274 | ||
| Intradural Lesions | 276 | ||
| Calvarial and intracranial epidural hydatid disease | 276 | ||
| Orbital hydatid cyst | 276 | ||
| Acknowledgements | 277 | ||
| References | 277 | ||
| Chapter 27 - Neurofilariasis | 279 | ||
| Introduction | 279 | ||
| Epidemiology | 280 | ||
| Global Scenario | 281 | ||
| Indian Scenario | 281 | ||
| Aetiology | 281 | ||
| Immunology and pathogenesis | 282 | ||
| Host–Parasite Interaction and Mode of Invasion | 283 | ||
| Immunobiology and Typical Immune Signalling | 283 | ||
| Molecular biology | 284 | ||
| Clinical characteristics | 284 | ||
| Diagnosis and differential diagnosis of NF | 284 | ||
| Direct Visualization Using Microscopic Technique | 284 | ||
| Microscopic Detection of mf | 285 | ||
| Electroclinical Techniques | 285 | ||
| Neuroimaging (Especially MRI, electroencephalography (EEG)) | 285 | ||
| Cerebrospinal Fluid Analysis | 285 | ||
| Immunodiagnosis | 286 | ||
| Serodiagnosis | 286 | ||
| Antigen Test | 286 | ||
| Mazzotti or Patch Test (Inflammation After DEC Administration) | 286 | ||
| Antibody Test | 286 | ||
| Western Blotting and Immunoprecipitation | 286 | ||
| Histopathology | 286 | ||
| Molecular diagnosis | 286 | ||
| PCR | 286 | ||
| Differential Diagnosis of NF | 287 | ||
| Metabolomics-Based Diagnosis | 287 | ||
| Treatment | 287 | ||
| Anthelmintics | 287 | ||
| Antibiotics | 288 | ||
| Vaccines | 288 | ||
| Prognosis | 288 | ||
| Concluding remarks and future perspectives | 289 | ||
| References | 289 | ||
| Chapter 28 - Neuroangiostrongylosis | 291 | ||
| Introduction | 291 | ||
| Epidemiology | 291 | ||
| Aetiology | 292 | ||
| Agent | 292 | ||
| Incubation Period | 292 | ||
| Immunology and pathogenesis | 292 | ||
| Life Cycle of A. cantonensis | 292 | ||
| Hosts of A. cantonensis | 293 | ||
| Intermediate Hosts | 293 | ||
| Paratenic Hosts | 293 | ||
| Definite Hosts | 293 | ||
| Accidental Hosts (Infection of Humans) | 293 | ||
| Immunological Aspects | 295 | ||
| Molecular biology | 295 | ||
| Clinical characteristics | 295 | ||
| Eosinophilic Meningitis/Encephalitis | 295 | ||
| Adults | 295 | ||
| Children | 295 | ||
| Ocular Angiostrongylosis | 296 | ||
| Diagnosis and differential diagnosis | 296 | ||
| Probable Diagnosis | 297 | ||
| Definite Diagnosis | 297 | ||
| Neuropathology | 297 | ||
| Treatment | 298 | ||
| Prevention | 298 | ||
| Medication | 298 | ||
| Applicable to Humans | 298 | ||
| Experimental | 298 | ||
| Prognosis | 298 | ||
| References | 298 | ||
| Chapter 29 - Neuroschistosomiasis | 301 | ||
| Introduction | 301 | ||
| Epidemiology | 301 | ||
| Aetiology | 301 | ||
| Immunology and Pathogenesis | 302 | ||
| Molecular Biology | 304 | ||
| Clinical characteristics | 304 | ||
| Diagnosis and differential diagnosis | 306 | ||
| Routine laboratory diagnosis | 306 | ||
| Treatment | 306 | ||
| Prognosis | 307 | ||
| References | 307 | ||
| Chapter 30 - Neurognathostomiasis | 309 | ||
| Introduction | 309 | ||
| Epidemiology | 309 | ||
| Aetiology | 309 | ||
| Pathogenesis | 310 | ||
| Immunity | 311 | ||
| Clinical features | 311 | ||
| Diagnosis | 312 | ||
| Differential diagnosis | 313 | ||
| Treatment | 313 | ||
| Prognosis | 313 | ||
| References | 313 | ||
| Chapter 31 - Onchocerciasis and its Potential Association with Epilepsy | 315 | ||
| Introduction | 315 | ||
| Prevalence of Onchocerciasis | 315 | ||
| Life Cycle of O. volvulus | 315 | ||
| Clinical Manifestations of Onchocerciasis | 315 | ||
| Onchocerciasis and Epilepsy: Epidemiology | 318 | ||
| Onchocerciasis and Nodding Syndrome: Epidemiology, Clinical Description and Classification | 318 | ||
| Onchocerciasis and Epilepsy/Nodding Syndrome: Suggested Pathomechanisms | 319 | ||
| Diagnosis of Onchocerciasis | 321 | ||
| Treatment of Onchocerciasis and its Potentially Associated Epilepsy/Nodding Syndrome | 322 | ||
| Acknowledgement | 323 | ||
| References | 323 | ||
| Chapter 32 - Fungal Infections of Central Nervous System in Tropics | 327 | ||
| Introduction | 327 | ||
| Epidemiology | 327 | ||
| Pathogenesis | 327 | ||
| Clinical syndromes | 328 | ||
| Meningitis | 328 | ||
| Focal Mass Lesions | 328 | ||
| Rhinocerebral Syndromes | 328 | ||
| Stroke Syndromes | 328 | ||
| Spinal Syndromes | 328 | ||
| CNS fungal infections common in tropical countries | 328 | ||
| Cryptococcal Meningitis | 328 | ||
| CNS aspergillosis | 330 | ||
| Mucormycosis | 331 | ||
| Other Rare CNS Fungal Infections in Tropical Countries | 332 | ||
| References | 334 | ||
| Section II - Nutritional disordersand neurotoxicology | 337 | ||
| Chapter 33 - Malnutrition and Nervous System in Children | 339 | ||
| Introduction | 339 | ||
| Epidemiology | 339 | ||
| Nature and evolution of malnutrition | 339 | ||
| Scenario in South Asia | 341 | ||
| Nutritional deficiency | 343 | ||
| Classification | 343 | ||
| Protein energy malnutrition | 343 | ||
| Malnutrition and nervous system | 345 | ||
| Malnutrition and Brain Development | 345 | ||
| Clinical features | 346 | ||
| Radiology | 346 | ||
| Electroencephalographic Findings | 347 | ||
| Evoked Potentials | 347 | ||
| Visual-Evoked Potentials | 347 | ||
| Brainstem Auditory-Evoked Potentials (BAEP) | 348 | ||
| Somatosensory-Evoked Potentials | 348 | ||
| Motor-Evoked Potential | 348 | ||
| Endogenous Event-Related Potentials | 348 | ||
| Malnutrition and PNS | 348 | ||
| Nerve Conduction Studies and Electromyography | 348 | ||
| Malnutrition and Autonomic Nervous System | 348 | ||
| Micronutrient deficiencies associated with malnutrition | 349 | ||
| Management of malnutrition | 349 | ||
| Prevention | 349 | ||
| Dietary Management of Malnutrition | 350 | ||
| Conclusions | 350 | ||
| References | 351 | ||
| Chapter 34 - Nutrition Rehabilitation of Children with Protein Energy Malnutrition (PEM) in Developing Countries | 353 | ||
| Introduction | 353 | ||
| Epidemiology | 353 | ||
| Aetiology | 353 | ||
| Classification of Protein Energy Malnutrition | 355 | ||
| Diagnosis of PEM | 355 | ||
| Moderate Malnutrition | 356 | ||
| Severe Malnutrition | 356 | ||
| Management of PEM | 357 | ||
| Assessment of Children with PEM | 357 | ||
| Weight for Height | 358 | ||
| Height for Age | 358 | ||
| Weight for Age | 358 | ||
| Practical Guidelines for Management of Children with SAM in India at the Community/Family Based Level | 360 | ||
| Prevention of PEM | 360 | ||
| Key Messages | 361 | ||
| References | 361 | ||
| Chapter 35 - Infantile Tremor Syndrome | 362 | ||
| Introduction | 362 | ||
| Epidemiology | 362 | ||
| Aetiopathogenesis | 363 | ||
| Clinical features | 364 | ||
| Mental and Physical Retardation or Regression | 364 | ||
| Tremor | 364 | ||
| Hair Changes | 364 | ||
| Skin Pigmentation | 364 | ||
| Pallor | 364 | ||
| Other Features | 364 | ||
| Course of the Disease | 365 | ||
| Investigations | 365 | ||
| Haematologic | 365 | ||
| Radiology | 366 | ||
| Neuro-Radiology | 366 | ||
| Virological Studies | 366 | ||
| Electroencephalography (EEG) | 366 | ||
| Brain Biopsy | 366 | ||
| Liver Biopsy | 366 | ||
| Rectal Biopsy | 366 | ||
| Muscle Biopsy | 366 | ||
| Trace Element Study | 366 | ||
| Differential diagnosis | 366 | ||
| Treatment | 366 | ||
| Prognosis | 367 | ||
| Future Trends | 367 | ||
| References | 367 | ||
| Chapter 36 - Lathyrism | 369 | ||
| Introduction | 369 | ||
| History and epidemiology | 369 | ||
| Aetiology | 371 | ||
| Lathyrus sativus L. | 371 | ||
| Lathyrus Toxins | 372 | ||
| Pathogenesis | 372 | ||
| Nuero Pathology | 372 | ||
| Clinical and electrophysiological features | 373 | ||
| Clinical Presentation of Lathyrism | 373 | ||
| Associated Disorders | 374 | ||
| Diagnosis | 374 | ||
| Prognosis | 375 | ||
| Prevention and treatment | 375 | ||
| Regulatory Aspects | 375 | ||
| Treatment | 375 | ||
| Prevention | 375 | ||
| Utilization | 376 | ||
| Conclusions | 376 | ||
| References | 376 | ||
| Chapter 37 - Konzo: A Permanent, Non-Progressive Motor Neuron Disorder | 379 | ||
| Introduction | 379 | ||
| Epidemiology | 379 | ||
| Aetiology | 381 | ||
| Clinical characteristics | 383 | ||
| Diagnosis | 385 | ||
| Differential Diagnosis | 385 | ||
| Treatment, prognosis and prevention | 385 | ||
| References | 386 | ||
| Chapter 38 - Tropical Ataxic Neuropathy | 389 | ||
| Introduction | 389 | ||
| Historical aspects | 389 | ||
| Nosology | 390 | ||
| Epidemiology | 390 | ||
| Clinical features | 391 | ||
| Demographic Characteristics | 391 | ||
| Neurological Symptoms and Signs | 391 | ||
| Laboratory Findings | 393 | ||
| Diagnosis and Differential Diagnosis | 394 | ||
| Aetiopathogenesis | 394 | ||
| Treatment | 395 | ||
| Conclusions | 395 | ||
| References | 395 | ||
| Chapter 39 - Minamata Disease | 397 | ||
| Introduction | 397 | ||
| Epidemiology | 397 | ||
| Pathology | 398 | ||
| Clinical features | 398 | ||
| Diagnosis | 399 | ||
| Congenital or fOetal minamata disease | 399 | ||
| Treatment | 400 | ||
| References | 400 | ||
| Chapter 40 - Neurotoxins in Tropics/India: An Overview | 401 | ||
| Introduction | 401 | ||
| Classification | 402 | ||
| Non-Biological | 403 | ||
| Others | 404 | ||
| Insects | 406 | ||
| Reptiles | 408 | ||
| Amphibians | 408 | ||
| Marine and Aquatic Creatures | 409 | ||
| Microorganisms (Bacteria) | 410 | ||
| Non-Biological Neurotoxins | 410 | ||
| Lead | 411 | ||
| Mercury | 411 | ||
| Manganese | 412 | ||
| Arsenic | 412 | ||
| Cadmium | 413 | ||
| Tin | 413 | ||
| Gold | 413 | ||
| Man-Made Neurotoxic Chemicals | 413 | ||
| Pesticides | 415 | ||
| Organic Solvents | 416 | ||
| Gases | 418 | ||
| Plastics and Polymers | 419 | ||
| Food Additives Beverages | 419 | ||
| Contaminated Drinking Water in Pune | 420 | ||
| Cosmetics and Related Products | 420 | ||
| Waste from Electrics and Electronics Equipment (WEEE) | 421 | ||
| Mobile Towers and Cell Phone | 422 | ||
| Acknowledgements | 424 | ||
| References | 424 | ||
| Chapter 41 - Marine Neurotoxins | 428 | ||
| Introduction | 428 | ||
| Food chain toxins | 428 | ||
| Ciguatera | 428 | ||
| Ciguatoxin (CTX), Maitotoxin (MTX) and Scaritoxin (SCTX) | 428 | ||
| Palytoxin (PTX) | 430 | ||
| Domoic Acid (DA) | 430 | ||
| Saxitoxin (STX) | 431 | ||
| Neurotoxic (Non-Paralytic) Shellfish Poisoning (NSP) | 431 | ||
| Tetrodotoxin (TTX) | 431 | ||
| Cyanobacterial Neurotoxins | 433 | ||
| Envenomations and Contact Toxins | 434 | ||
| Venomous Fish Toxins | 434 | ||
| Stingray Toxins | 435 | ||
| Scorpionfish Toxins | 436 | ||
| Weeverfish Toxins | 437 | ||
| Catfish Toxins | 437 | ||
| Sea-Snake Toxins | 437 | ||
| Conotoxins | 439 | ||
| Octopus Toxins | 440 | ||
| Coelenterate Toxins | 441 | ||
| Echinotoxins | 443 | ||
| Environmental Interactions | 444 | ||
| References | 444 | ||
| Chapter 42 - Fluorosis | 448 | ||
| Introduction | 448 | ||
| Epidemiology | 450 | ||
| Recent Clinical and Experimental Observations on the Effect of Fluoride on Bones | 450 | ||
| Role of Strontium and Other Trace Elements in the Incidence of Skeletal Fluorosis in Endemic Areas of Fluorosis in Prakasam... | 451 | ||
| Clinical features | 451 | ||
| Dental Fluorosis | 451 | ||
| Pre-Skeletal Stage | 452 | ||
| Skeletal Fluorosis | 452 | ||
| Endemic Genu Valgum | 453 | ||
| Neurological Manifestations of Skeletal Fluorosis | 453 | ||
| Myelopathy | 453 | ||
| Radiculopathy | 453 | ||
| Cranial Nerve Lesions | 454 | ||
| Peripheral Neuropathies | 454 | ||
| Cerebrovascular Accidents | 454 | ||
| Laboratory investigations | 454 | ||
| Electrophysiological Studies | 454 | ||
| Pulmonary Function Tests | 455 | ||
| Scintigraphic Studies | 456 | ||
| Radiology of Fluorosis | 456 | ||
| Computed Tomography | 458 | ||
| Magnetic Resonance Imaging | 459 | ||
| Pathology | 460 | ||
| Histopathology of Bones | 461 | ||
| Muscle and Nerve Pathology | 461 | ||
| Muscle Pathology | 461 | ||
| Conclusion of Muscle and Nerve Studies | 466 | ||
| Differential Diagnosis | 466 | ||
| Treatment | 468 | ||
| Optimum water fluoride concentration | 468 | ||
| Prevention of Endemic Skeletal Fluorosis | 468 | ||
| Medical Therapy | 469 | ||
| Surgical Management of Skeletal Fluorosis with Neurological Manifestations | 469 | ||
| Conclusions | 471 | ||
| References | 471 | ||
| Chapter 43 - Organophosphorous Poisoning | 473 | ||
| Introduction | 473 | ||
| History | 473 | ||
| Epidemiology | 473 | ||
| Pathophysiology | 474 | ||
| Clinical features | 475 | ||
| Laboratory manifestations | 476 | ||
| Clinical Neurophysiology | 476 | ||
| Treatment | 479 | ||
| Decontamination | 480 | ||
| Pharmocological therapy | 480 | ||
| References | 482 | ||
| Chapter 44 - Snake Bites | 483 | ||
| Introduction | 483 | ||
| Prevention of Snake Bites | 483 | ||
| Epidemiology | 484 | ||
| Africa | 484 | ||
| Asia | 484 | ||
| Oceania | 484 | ||
| Americas | 484 | ||
| Europe | 485 | ||
| Snake Bite as an Occupational Disease | 487 | ||
| Aetiology | 487 | ||
| Venomous Snakes: Numbers of Species | 487 | ||
| Classification | 487 | ||
| Distinguishing Snakes from Other Snake-Like Animals | 488 | ||
| Distinguishing Venomous from Non-Venomous Snakes | 488 | ||
| Venom Apparatus | 489 | ||
| Distribution of Venomous Snakes | 489 | ||
| Venomous Snake Bite Without Envenoming (Dry Bites) | 490 | ||
| Immunology and pathogenesis | 491 | ||
| Venom Composition | 491 | ||
| Venom Enzymes | 491 | ||
| Cardiovascular Toxins | 491 | ||
| Neurotoxins | 491 | ||
| Pathogenesis of the Clinical Effects of Envenoming | 492 | ||
| Local Swelling | 492 | ||
| Hypotension and Shock | 492 | ||
| Anti-Haemostatic Disturbances | 492 | ||
| Intravascular Haemolysis | 492 | ||
| Acute Kidney Injury (AKI) | 492 | ||
| Neurotoxicity | 493 | ||
| Descending Flaccid Paralysis | 493 | ||
| Autonomic Nervous System Effects | 493 | ||
| Drowsiness | 493 | ||
| Myotoxicity | 493 | ||
| Clinical characteristics | 493 | ||
| Envenoming by Different Groups of Venomous Snakes | 493 | ||
| Colubrid (Back-fanged Snakes), Families Colubridae and Dipsadidae | 493 | ||
| Atractaspidinae (Burrowing Asps or Stiletto Snakes and Natal Black Snake) | 494 | ||
| Elapidae (Cobras, Kraits, Mambas, Coral Snakes, Sea Snakes) | 494 | ||
| Local Envenoming | 494 | ||
| Systemic Envenoming | 495 | ||
| Neurotoxic Effects | 495 | ||
| Other Features of Systemic Envenoming | 495 | ||
| Viperidae (Old World Vipers and Adders, New World Pit Vipers, Rattlesnakes, Moccasins and Lance-Headed Vipers, Asian Pit Vi... | 497 | ||
| Local Envenoming | 497 | ||
| Antihaemostatic Abnormalities | 497 | ||
| Intravascular Haemolysis | 500 | ||
| Hypotension and Shock | 500 | ||
| Acute Kidney Injury | 500 | ||
| Neurotoxicity and Generalized Rhabdomyolysis | 500 | ||
| Diagonsis and differential diagnosis | 501 | ||
| Immunodiagnosis and PCR | 501 | ||
| Laboratory Investigations Blood Count | 502 | ||
| Twenty-Minute Whole Blood Clotting Test (20WBC) | 502 | ||
| Serum Biochemistry | 502 | ||
| Electrocardiography | 502 | ||
| Radiology and Imaging | 502 | ||
| Histopathology | 504 | ||
| Treatment | 504 | ||
| First Aid | 504 | ||
| Recommendations | 505 | ||
| Methods for Delaying the Onset of Potentially Fatal Systemic Envenoming | 505 | ||
| Pressure-Immobilization Methods | 505 | ||
| Inhibition of the Lymphatic Pump | 505 | ||
| Dangerous and Rejected First-Aid Methods | 505 | ||
| Pre-Hospital Treatment of Early Symptoms | 505 | ||
| Hospital Treatment | 506 | ||
| Clinical Assessment | 506 | ||
| Antivenom | 506 | ||
| Indications | 507 | ||
| Cautions | 507 | ||
| Prediction of Antivenom Reactions | 507 | ||
| Prevention of Antivenom Reactions | 507 | ||
| Specific and Para-Specific Neutralization by Antivenoms | 507 | ||
| Shelf-Life of Antivenoms | 507 | ||
| How Soon to Start Antivenom Treatment | 507 | ||
| Antivenom Administration | 507 | ||
| Dosage | 508 | ||
| Recurrent Envenoming | 508 | ||
| Indications for Second and Subsequent Doses | 508 | ||
| Antivenom Reactions | 508 | ||
| Treatment for Failing Systems and Organs | 508 | ||
| Respiratory Failure | 508 | ||
| Circulatory Failure | 509 | ||
| Renal Failure (AKI) | 509 | ||
| Treatment of Other Complications | 509 | ||
| Wound Infection | 509 | ||
| Intracompartmental Syndrome and Fasciotomy | 509 | ||
| Dangerous and Unproven Treatments | 510 | ||
| Snake Venom Ophthalmia | 510 | ||
| Clinical course and prognosis | 510 | ||
| Risk of Death from Envenoming | 510 | ||
| Interval Between Bite and Death | 510 | ||
| References | 510 | ||
| Chapter 45 - Tetanus | 514 | ||
| Introduction | 514 | ||
| Historical aspect | 514 | ||
| C. tetani and Its Toxin: Chemistry, Biological Action, Transport and Pathogenesis | 514 | ||
| Epidemiology | 515 | ||
| Clinical feature | 516 | ||
| Severity of tetanus | 517 | ||
| Diagnosis | 517 | ||
| Electromyographic studies | 517 | ||
| Differential diagnosis | 517 | ||
| Neonatal tetanus (NT) | 518 | ||
| Management | 519 | ||
| Supportive Intensive Care | 519 | ||
| Control of Rigidly and Spasm | 519 | ||
| Control of Autonomic Dysfunction | 519 | ||
| Neutralizing Circulating Toxin | 520 | ||
| Removal of Source of Tetanospasmin | 520 | ||
| Prevention | 520 | ||
| Complications | 520 | ||
| Prognosis and sequel | 520 | ||
| Conclusions | 521 | ||
| References | 521 | ||
| Section III - Neuromuscular diseases | 523 | ||
| Chapter 46 - Tropical Neuropathies | 525 | ||
| Introduction | 525 | ||
| Nutritional neuropathies | 525 | ||
| Protein Calorie Malnutrition (PCM) | 525 | ||
| Clinical, Electrophysiological and Histological Derangements | 526 | ||
| Histology | 526 | ||
| Vitamin Deficiency | 526 | ||
| Thiamine (B1) | 527 | ||
| Niacin | 528 | ||
| Vitamin B6 (Pyridoxine) | 528 | ||
| Vitamin B12 (Cobalamine) | 529 | ||
| Epidemic neuropathy in Cuba (1992–3) | 529 | ||
| Tropical sprue | 530 | ||
| Tropical myeloneuropathies | 531 | ||
| Tropical Ataxic Neuropathy (TAN) | 532 | ||
| Tropical Spastic Paraparesis (TSP) | 533 | ||
| Acute/Epidemic Spastic Paraparesis | 534 | ||
| Lathyrism | 534 | ||
| Konzo | 534 | ||
| Infections and post-infectiuous neuropathies | 535 | ||
| Directly Infectious Syndromes | 535 | ||
| Leprosy | 535 | ||
| Rabies | 536 | ||
| Enterovirus 70 (EV70) | 536 | ||
| HIV Infection | 537 | ||
| Parasites | 538 | ||
| Infectious Toxin-Mediated Syndromes | 538 | ||
| Diphtheric Neuropathy | 538 | ||
| Tetanus | 539 | ||
| Post-infective polyneuropathy | 539 | ||
| Acute Motor Axonal Neuropathy (AMAN) or Chinese Paralytic Syndrome | 539 | ||
| Toxic neuropathies | 540 | ||
| Clinical features | 540 | ||
| Aetiology of Toxic Neuropathies | 541 | ||
| Heavy Metals | 541 | ||
| Arsenic | 541 | ||
| Lead | 542 | ||
| Drugs | 543 | ||
| Post-Vaccinal Encephaloneuropathies | 544 | ||
| Insecticides | 545 | ||
| Industrial Chemicals | 546 | ||
| Methyl-iso-cyanide (MIC) | 547 | ||
| Plant and Animal Toxins | 547 | ||
| Animal Poisons | 548 | ||
| Neuropathies due to physical injury | 548 | ||
| Entrapment and traumatic neruopathies | 548 | ||
| Conclusions | 549 | ||
| References | 549 | ||
| Chapter 47 - Motor Neuron Disease in Tropics | 553 | ||
| Introduction | 553 | ||
| Environment and MND | 553 | ||
| Diagnostic Criteria for ALS | 553 | ||
| Classification | 554 | ||
| Aetiopathogenesis | 555 | ||
| Pathology | 555 | ||
| Intracellular Inclusions | 556 | ||
| Aetiology | 556 | ||
| SOD1-Mediated Toxicity | 557 | ||
| Inflammatory Responses | 557 | ||
| Excitotoxicity | 557 | ||
| Abnormalities of RNA Metabolism | 557 | ||
| Cytoskeletal Derangements | 557 | ||
| Mitochondrial Dysfunction | 557 | ||
| Viral Infections | 557 | ||
| Apoptosis | 557 | ||
| Growth Factors | 557 | ||
| Clinical features | 558 | ||
| Differential diagnosis | 558 | ||
| Investigations | 559 | ||
| Treatment | 559 | ||
| Symptom-based management | 560 | ||
| Respiratory Management | 560 | ||
| Dysarthria | 560 | ||
| Dysphagia | 560 | ||
| Disease-modifying treatment of ALS | 561 | ||
| Mechanism of Action | 561 | ||
| Other Drugs Tried | 561 | ||
| Current and Future Trials | 561 | ||
| Gene Therapy | 561 | ||
| Monomelic variants of MND | 561 | ||
| Hirayama disease | 563 | ||
| Wasted leg syndrome | 563 | ||
| MND in Western India | 563 | ||
| MND in South India | 563 | ||
| Conclusions | 564 | ||
| References | 564 | ||
| Chapter 48 - Motor Neuron Disease in Africa | 566 | ||
| Introduction | 566 | ||
| Epidemiology | 566 | ||
| Aetiology and risk factors | 567 | ||
| Molecular pathogenesis | 567 | ||
| Pathology | 568 | ||
| Clinical characteristics | 568 | ||
| Diagnosis | 569 | ||
| Differential Diagnoses of MND | 569 | ||
| Treatment | 569 | ||
| Prognosis | 571 | ||
| References | 571 | ||
| Chapter 49 - Tropical Pyomyositis | 573 | ||
| Introduction | 573 | ||
| Epidemiology | 573 | ||
| Aetiopathogenesis | 574 | ||
| Microbiology | 574 | ||
| Role of Trauma | 574 | ||
| Anatomical Distribution | 575 | ||
| Predisposing Factors | 575 | ||
| Age and Sex | 575 | ||
| Malnutrition | 575 | ||
| Parasitic and Viral Myositis | 575 | ||
| Immune Deficiency | 575 | ||
| Pyomyositis and HIV Infection | 575 | ||
| Medical Diseases | 576 | ||
| Pathological features | 576 | ||
| Clinical characteristics | 576 | ||
| Clinical Types of Pyogenic Myositis | 577 | ||
| Tropical and Non-Tropical Pyomyositis | 577 | ||
| Psoas Abscess | 577 | ||
| Piriformis Pyomyositis | 577 | ||
| Diagnosis and differential diagnosis | 577 | ||
| Investigations | 577 | ||
| Routine Laboratory Parameters | 577 | ||
| Imaging Studies | 578 | ||
| Needle Aspiration | 579 | ||
| Treatment | 579 | ||
| Initial Choice of Antibiotics | 579 | ||
| Immunocompetent Patients | 579 | ||
| Immunocompromized Patients | 580 | ||
| Duration of Therapy and Follow-Up | 580 | ||
| Prognosis | 580 | ||
| Conclusions | 580 | ||
| References | 580 | ||
| Section IV - Cerebrovascular diseases | 583 | ||
| Chapter 50 - Epidemiology of Stroke in Tropics | 585 | ||
| Introduction | 585 | ||
| Stroke in Latin American countries | 585 | ||
| Prevalence and Incidence | 585 | ||
| Risk Factors of Stroke in Latin America | 585 | ||
| Stroke from Asian countries: Association of South-East Asian Nations | 586 | ||
| Singapore | 586 | ||
| Other Asian Countries | 586 | ||
| South Asia | 586 | ||
| Indian Scenario | 586 | ||
| Prevalence | 586 | ||
| Incidence Rates | 587 | ||
| Case-Fatality Rates (CFR) | 587 | ||
| Mean Age of Stroke | 587 | ||
| Risk Factors | 587 | ||
| Subtypes of Stroke | 588 | ||
| Long-term sequel of stroke survivors | 589 | ||
| Stroke Awareness | 589 | ||
| Stroke in countries other than India | 589 | ||
| Stroke in Africa | 590 | ||
| Stroke in Australia, New Zealand and French West Indies | 590 | ||
| Disease Burden | 591 | ||
| References | 591 | ||
| Chapter 51 - Transient Ischaemic Attack (TIA): Recent Concepts | 594 | ||
| Epidemiology | 594 | ||
| Definition of transient ischaemic attack | 594 | ||
| Stroke risk after TIA | 595 | ||
| TIA mimics | 596 | ||
| Management | 596 | ||
| Lifestyle Modifications | 597 | ||
| Antiplatelet Therapy | 597 | ||
| Anticoagulation Therapy | 597 | ||
| Antihypertensive Therapy | 597 | ||
| Statins | 597 | ||
| Control of Diabetes Mellitus | 598 | ||
| Carotid Endarterectomy | 598 | ||
| Conclusions | 598 | ||
| References | 598 | ||
| Chapter 52 - Current Concepts of Ischaemic Stroke | 600 | ||
| Introduction | 600 | ||
| Pathology | 600 | ||
| Subacute and Chronic Infarcts with Glial Scar | 602 | ||
| Lacunar Infarcts and Multi-Infarct Dementia | 602 | ||
| Arterial Vasospasm and Delayed Cerebral Ischaemia | 602 | ||
| Pathobiology of Ischaemic Lesions of the Brain | 603 | ||
| Stroke imaging | 606 | ||
| Imaging in Hyperacute Ischaemic Stroke | 606 | ||
| CT Scan | 606 | ||
| MRI | 607 | ||
| Imaging in Ischaemic Stroke – Beyond the Hyperacute Stage | 609 | ||
| Diagnosis and management | 609 | ||
| Triage and Initial Evaluation | 610 | ||
| History | 611 | ||
| Physical Examination | 611 | ||
| Neurological Examination | 611 | ||
| Hyperacute Thrombolysis with Recombinant Tissue Plasminogen Activator | 612 | ||
| Other New Interventions | 613 | ||
| Aspirin | 613 | ||
| General Treatment Recommendations | 613 | ||
| Brain Oedema and Increased Intracranial Pressure | 614 | ||
| Management in a Stroke Unit | 614 | ||
| Stroke Outcome | 614 | ||
| Stroke Mortality and Disability | 615 | ||
| Stroke Recurrence | 615 | ||
| Thrombolysis in Tropical Countries | 615 | ||
| Asia | 615 | ||
| Africa | 615 | ||
| Latin America | 616 | ||
| Australasia | 616 | ||
| Acknowledgements | 616 | ||
| References | 616 | ||
| Chapter 53 - Uncommon Causes of Ischaemic Stroke | 618 | ||
| Introduction | 618 | ||
| Moyamoya disease | 618 | ||
| Clinical Features | 618 | ||
| Other Symptoms | 618 | ||
| Diagnosis | 619 | ||
| Medical Management | 619 | ||
| Surgery | 620 | ||
| Treatment of Acute Symptoms | 620 | ||
| Prognosis | 620 | ||
| Takayasu arteritis | 620 | ||
| Clinical Features | 620 | ||
| Diagnosis | 620 | ||
| Non-Invasive Imaging | 621 | ||
| Treatment | 621 | ||
| Medical Management | 621 | ||
| Surgical Treatment | 621 | ||
| Follow-Up | 621 | ||
| Arterial dissection | 621 | ||
| Stroke Mechanisms of Dissection | 622 | ||
| Clinical Manifestations | 622 | ||
| Diagnosis | 623 | ||
| Treatment | 623 | ||
| Fibromuscular dysplasia | 623 | ||
| Pathology | 624 | ||
| Diagnosis | 624 | ||
| Management | 624 | ||
| Infections and stroke | 624 | ||
| Tuberculosis | 624 | ||
| Diagnosis of TBM | 626 | ||
| Imaging | 626 | ||
| Management | 626 | ||
| Bacterial Infections | 626 | ||
| Fungal Infections | 626 | ||
| Parasitic Infections | 627 | ||
| Viral Infections | 627 | ||
| Varicella Zoster Virus Vasculopathy | 627 | ||
| HIV | 628 | ||
| CADASIL | 628 | ||
| Hypercoagulable states | 629 | ||
| References | 630 | ||
| Chapter 54 - Secondary Prevention of Transient Ischaemic Attack and Ischaemic Stroke | 633 | ||
| Introduction | 633 | ||
| Events in ischaemic brain injury | 633 | ||
| Symptoms of ischaemic brain injury (TIA/early stroke) | 633 | ||
| Risk factors | 634 | ||
| Differential Diagnosis | 634 | ||
| Key Points on Guidelines | 635 | ||
| Therapeutic considerations in stroke prevention | 636 | ||
| Secondary Prevention Strategies of Ischaemic Stroke (TIA and Early Infarct) | 636 | ||
| Antiplatelet Agents in Prevention of Non-Cardioembolic Stroke/TIA | 636 | ||
| Aspirin | 636 | ||
| Aspirin and Dipyridamole | 637 | ||
| Aspirin Plus Clopidogrel | 638 | ||
| Thienopyridine | 638 | ||
| Antiplatelet Agents for Secondary Prevention of Stroke | 638 | ||
| Key Points | 638 | ||
| Anticoagulation Therapy in Cerebral Ischaemia | 638 | ||
| Trials with New/Novel Oral Anticoagulants | 638 | ||
| Cardioembolic Strokes – Anticoagulation in Prevention | 639 | ||
| Non-Cardioembolic Stroke – Anticoagulation Therapy | 639 | ||
| Concluding remarks | 640 | ||
| Antithrombotic Agents in Cerebral Ischaemia | 640 | ||
| Raised Homocysteine (tHcy) Level –‘An Independent Risk Factor’ for Vascular Disease | 640 | ||
| Statins and Stroke – Current Views | 640 | ||
| Recommendations | 640 | ||
| Stenting and Angioplasty in Symptomatic Carotid Stenosis | 640 | ||
| Summary/recommendations | 641 | ||
| Acknowledgements | 641 | ||
| References | 641 | ||
| Chapter 55 - Intracerebral Haemorrhage | 644 | ||
| Introduction and epidemiology | 644 | ||
| Aetiology | 644 | ||
| Pathophysiology and cascade of brain damage | 644 | ||
| Clinical features | 644 | ||
| Management of ICH | 646 | ||
| Emergency Department and In-Hospital Care | 646 | ||
| Laboratory Investigations | 646 | ||
| Monitoring | 646 | ||
| Immediate Management | 647 | ||
| Neuroimaging | 647 | ||
| Haematoma Size Estimation | 647 | ||
| Predicting Haematoma Expansion and the Spot Sign | 648 | ||
| Prognostic ICH Scoring System | 650 | ||
| Treatment | 650 | ||
| Raised Intracranial Pressure | 650 | ||
| Oral Anticoagulant–Associated ICH | 651 | ||
| Heparin-Induced ICH | 653 | ||
| Post-Thrombolytic ICH | 653 | ||
| Glucose Monitoring | 653 | ||
| Seizure | 653 | ||
| BP Management | 654 | ||
| Evidences Towards Lowering BP in ICH | 654 | ||
| Surgical Management of ICH | 655 | ||
| To Do Surgical Intervention or Not and Which Patient? Major Craniotomy Trials | 655 | ||
| Minimally Invasive Surgical Removal | 656 | ||
| Timing of Surgery | 657 | ||
| Intraventricular Haemorrhage | 658 | ||
| Non-Neurological Complications of ICH | 660 | ||
| GI Haemorrhage | 660 | ||
| Temperature | 660 | ||
| Prognosis | 660 | ||
| End-of-Care Issues | 661 | ||
| Rehabilitation and Recovery | 661 | ||
| ICH future therapies | 661 | ||
| References | 661 | ||
| Chapter 56 - Cerebral Venous Sinus Thrombosis | 665 | ||
| Introduction | 665 | ||
| Epidemiology of CVT in Asia | 665 | ||
| Aetiology | 666 | ||
| Genetic Causes of CVT | 666 | ||
| Factor V | 666 | ||
| Factor V Leiden | 666 | ||
| Factor V A4070G | 666 | ||
| Prothrombin | 667 | ||
| Factor XII | 667 | ||
| Protein Z | 667 | ||
| Plasminogen Activator Inhibitor-1 | 667 | ||
| Tissue Factor Pathway Inhibitor 1 | 667 | ||
| Methylene Tetrahydrofolate Reductase | 668 | ||
| Janus Kinase-2 | 668 | ||
| Factor VIII | 668 | ||
| Protein C, Protein S and Antithrombin | 668 | ||
| Clinical features and presentation | 668 | ||
| Syndrome of Raised Intracranial Hypertension without Focal Deficit | 669 | ||
| Syndrome of Focal Motor Deficit with or without Raised Intracranial Hypertension | 669 | ||
| Syndrome of Early Altered Consciousness with Involuntary Movements | 669 | ||
| Syndrome of Cavernous Sinus Thrombosis | 669 | ||
| Pathology | 669 | ||
| Gross Pathology | 670 | ||
| Histology | 671 | ||
| Pathogenesis | 672 | ||
| Investigation and diagnosis | 673 | ||
| MRI and Angiography | 673 | ||
| Management | 675 | ||
| Chemical and Mechanical Thrombolysis | 676 | ||
| Decompressive Craniectomy | 676 | ||
| Outcome | 677 | ||
| References | 678 | ||
| Chapter 57 - Stroke Unit in the Tropics | 680 | ||
| Introduction | 680 | ||
| Rising Burden of Stroke in Tropics | 680 | ||
| Why Stroke Unit Care? | 680 | ||
| What is a stroke unit? | 681 | ||
| Key Components of a Stroke Unit | 681 | ||
| Inside a Stroke Unit | 681 | ||
| Development (history) of stroke units | 683 | ||
| What are the different types of stroke units? | 683 | ||
| Efficacy of stroke unit care in developed nations | 683 | ||
| Applicability of Stroke Units in Low-/Middle-Income Countries | 683 | ||
| Challenges of stroke unit care delivery (barriers to implementation) in low-/middle-income countries | 686 | ||
| Lessons learnt – summary | 687 | ||
| Areas where further studies are needed | 687 | ||
| Hope for tomorrow | 688 | ||
| References | 688 | ||
| Chapter 58 - Stroke in the Young | 689 | ||
| Introduction | 689 | ||
| Epidemiology | 689 | ||
| Vascular risk factors in young adult stroke | 689 | ||
| Smoking | 690 | ||
| Alcohol Consumption | 690 | ||
| Oral Contraceptives | 690 | ||
| Illicit Drugs | 690 | ||
| Migraine | 690 | ||
| Differential diagnosis | 690 | ||
| Aetiology | 690 | ||
| Diagnosis of Cardioembolism | 691 | ||
| Diagnosis of Extracranial or Intracranial Large Vessel Arterial Disease | 691 | ||
| Diagnosis of Small Vessel Disease | 692 | ||
| Diagnosis of Other Identifiable Causes | 692 | ||
| Infections | 692 | ||
| Arterial Dissection | 692 | ||
| Primary and Secondary Vasculitis and Connective Tissue Disorders | 693 | ||
| Other Rare Non-Inflammatory Arteriopathies | 693 | ||
| Monogenic Diseases | 693 | ||
| Pregnancy and Puerperium | 693 | ||
| Undetermined Cause or Cryptogenic Stroke | 693 | ||
| Treatment | 694 | ||
| Acute Treatment | 694 | ||
| Secondary Prevention | 694 | ||
| Prognosis | 694 | ||
| Stroke in the young: Indian perspective | 695 | ||
| Risk Factors | 695 | ||
| References | 696 | ||
| Section V - Epilepsy | 699 | ||
| Chapter 59 - Epilepsy in the Tropics | 701 | ||
| Introduction | 701 | ||
| Epidemiology | 701 | ||
| Aetiology | 703 | ||
| Pathogenesis | 703 | ||
| Clinical Characteristics, Diagnosis and Differential Diagnosis | 704 | ||
| Pharmacological treatment | 705 | ||
| The Treatment Gap and Social Aspects | 705 | ||
| Surgical Treatment | 705 | ||
| Prognosis | 706 | ||
| References | 706 | ||
| Chapter 60 - Central Nervous System Infections and Epilepsy | 707 | ||
| Introduction | 707 | ||
| Burden of epilepsy with CNS infections | 707 | ||
| Pathophysiological considerations | 708 | ||
| Anatomical Compartmentalization of the Infection | 708 | ||
| CNS infections | 709 | ||
| Bacterial Meningitis | 709 | ||
| Viral Encephalitis | 709 | ||
| Malaria | 709 | ||
| Neurocysticercosis | 710 | ||
| Uncommon CNS Infections | 710 | ||
| Association between CNS infections and epilepsy | 713 | ||
| Prevalence Studies | 713 | ||
| Incidence Studies | 714 | ||
| Therapeutic considerations in relation to CNS infections, seizures and epilepsy | 714 | ||
| Optimal Choice of Antiepileptic Drugs in the Treatment of Epilepsy Associated with CNS Infections | 715 | ||
| References | 716 | ||
| Chapter 61 - Hot Water Epilepsy | 718 | ||
| Introduction | 718 | ||
| Epidemiology | 718 | ||
| Clinical features | 718 | ||
| Pathogenesis | 720 | ||
| Genetics | 720 | ||
| Electroencephalography (EEG) findings | 723 | ||
| Autonomic changes | 724 | ||
| SPECT observations | 724 | ||
| fMRI study and network alterations | 724 | ||
| Management | 724 | ||
| Conclusions | 725 | ||
| Acknowledgement | 725 | ||
| References | 725 | ||
| Chapter 62 - Reflex Seizures and Reflex Epilepsies in Tropical Countries | 727 | ||
| Introduction | 727 | ||
| Definition | 728 | ||
| Classification | 729 | ||
| Pathophysiology | 730 | ||
| More frequently encountered reflex epilepsy syndromes in tropics | 730 | ||
| Hot Water Epilepsy | 730 | ||
| Epidemiology | 730 | ||
| Clinical Features | 731 | ||
| EEG Characteristics | 731 | ||
| Pathophysiology | 733 | ||
| Eating Epilepsy | 733 | ||
| Startle Epilepsy | 734 | ||
| Prevalence of Photosensitivity in Tropics | 734 | ||
| Conclusions | 735 | ||
| References | 735 | ||
| Chapter 63 - Surgery for Epilepsy in Tropical Countries | 737 | ||
| Introduction | 737 | ||
| Challenges in establishing epilepsy surgery programs in tropics | 737 | ||
| Identification of Potential Surgical Candidates | 738 | ||
| Pre-Surgical Evaluation | 738 | ||
| Present state of epilepsy surgery in tropical countries | 742 | ||
| Epilepsy Surgery in Tropical Asia | 742 | ||
| Epilepsy Surgery in Tropical Latin America | 742 | ||
| Epilepsy Surgery in Tropical Africa | 744 | ||
| Regionally Prevalent Lesional Epilepsy Syndromes | 744 | ||
| Surgical Treatment Gap | 745 | ||
| Temporal Trends in Epilepsy Surgery | 745 | ||
| Epilepsy Surgery Outcome | 745 | ||
| Is Epilepsy Surgery Cost-Effective? | 746 | ||
| Pragmatic Epilepsy Surgery Models for Tropical Regions | 746 | ||
| Conclusions | 748 | ||
| References | 749 | ||
| Section VI - Demyelinationand degeneration | 751 | ||
| Chapter 64 - Multiple Sclerosis in Tropics | 753 | ||
| Introduction | 753 | ||
| Epidemiology | 753 | ||
| Aetiology | 753 | ||
| MS and Genes | 753 | ||
| MS and the Environment | 754 | ||
| EB Virus and MS | 754 | ||
| Vitamin D Intake and MS | 755 | ||
| Cigarette Smoking | 756 | ||
| Pathology | 756 | ||
| Clinical characteristics | 756 | ||
| Diagnosis | 757 | ||
| Differential Diagnosis of MS | 757 | ||
| Treatment | 758 | ||
| Disease-Modifying Therapies (DMT) | 759 | ||
| Interferon Beta (IFN-beta) | 759 | ||
| Glatiramer Acetate | 759 | ||
| Natalizumab | 760 | ||
| Oral Drugs | 760 | ||
| Fingolimod | 760 | ||
| Teriflunomide | 760 | ||
| Dimethyl Fumarate | 760 | ||
| Mitoxantrone | 760 | ||
| Oral Immunosuppressant Agents | 760 | ||
| Symptomatic Therapy | 761 | ||
| Statins in MS | 761 | ||
| References | 761 | ||
| Chapter 65 - Neuromyelitis Optica Spectrum Disorders | 764 | ||
| Introduction | 764 | ||
| Original Concepts, Evolution of Diagnosis and Diagnostic Criteria | 764 | ||
| Epidemiology | 764 | ||
| Aetiology | 765 | ||
| Clinical features | 765 | ||
| Extra-Optico Spinal Manifestations of NMO | 766 | ||
| Co-existing autoimmune disease and autoantibodies | 766 | ||
| Clinical course and outcome | 766 | ||
| Paediatric NMO | 766 | ||
| Pathogenesis | 767 | ||
| Pathology | 767 | ||
| Histopathology | 767 | ||
| Immunopathology | 767 | ||
| Diagnosis | 767 | ||
| Imaging of NMO | 767 | ||
| Anti-Aquaporin Antibodies | 769 | ||
| Cerebrospinal Fluid | 769 | ||
| Differential Diagnosis | 770 | ||
| Treatment | 770 | ||
| Management of Acute Attacks | 770 | ||
| Intravenous Steroids | 770 | ||
| Plasma Exchange | 770 | ||
| Attack Prevention | 770 | ||
| General Principles | 770 | ||
| Other Immunosuppressants | 771 | ||
| Prognosis | 771 | ||
| Acknowledgements | 772 | ||
| References | 772 | ||
| Chapter 66 - Post-Infectious and Post-Vaccine Acute Disseminated Encephalomyelitis | 775 | ||
| Introduction | 775 | ||
| Epidemiology | 775 | ||
| Aetiology | 775 | ||
| Viral Aetiologies | 775 | ||
| Bacterial Aetiologies | 777 | ||
| Non-Microbial Aetiologies | 777 | ||
| Post-Vaccinal Acute Disseminated Encephalomyelitis | 777 | ||
| Pathogenesis | 778 | ||
| Clinical features | 778 | ||
| Diagnosis | 779 | ||
| Laboratory Diagnosis | 779 | ||
| Cerebrospinal Fluid | 779 | ||
| Electroencephalography | 779 | ||
| Neuroimaging | 779 | ||
| Brain Biopsy | 780 | ||
| Differential diagnosis | 781 | ||
| Treatment | 782 | ||
| Prognosis | 783 | ||
| References | 783 | ||
| Chapter 67 - Neurological Manifestations of Behçet Disease | 788 | ||
| Introduction | 788 | ||
| Epidemiology | 788 | ||
| Neuropathology | 789 | ||
| Pathogenesis | 789 | ||
| Clinical manifestations | 790 | ||
| Parenchymal or Intra-Axial NBD | 790 | ||
| Brainstem Syndrome | 790 | ||
| Psychiatric and Cognitive Disorders | 790 | ||
| Headache | 791 | ||
| Epilepsy | 791 | ||
| Isolated Spinal Cord Involvement | 791 | ||
| Other rare manifestations | 791 | ||
| Acute Meningeal Syndrome | 791 | ||
| Movement Disorders | 791 | ||
| Peripheral Nervous System Involvement | 791 | ||
| Optic Neuropathy | 791 | ||
| Subclinical Neuro-Behçet Syndrome | 791 | ||
| Non-Parenchymal NBD | 792 | ||
| Cerebral Venous Thrombosis | 792 | ||
| Arterial Neuro-Behçet Syndrome | 792 | ||
| Diagnosis of NBD | 792 | ||
| Neuroimaging | 792 | ||
| Cerebrospinal Fluid | 793 | ||
| Other Diagnostic Methods | 794 | ||
| Neurophysiological Tests | 794 | ||
| Differential diagnosis | 794 | ||
| Prognosis | 795 | ||
| Management | 795 | ||
| Treatment of Parenchymal NBD | 795 | ||
| Treatment of Non-Parenchymal NBD | 795 | ||
| References | 796 | ||
| Chapter 68 - Dementia in Tropics | 798 | ||
| Introduction | 798 | ||
| Epidemiology | 798 | ||
| Prevalence of Dementia: India | 798 | ||
| Incidence of Dementia in India | 798 | ||
| Causes of dementia | 799 | ||
| Reversible dementias | 799 | ||
| Clinical features | 799 | ||
| Alzheimer Disease | 799 | ||
| Frontotemporal lobar degeneration | 801 | ||
| Frontotemporal Dementia | 801 | ||
| Semantic Dementia | 802 | ||
| Progressive Non-Fluent Aphasia (PNFA) | 802 | ||
| Mixed Dementia (MD) | 802 | ||
| Dementia with Lewy Bodies (DLBD) | 802 | ||
| Vascular Dementia (VAD) | 802 | ||
| Creutzfeldt–Jakob Disease | 803 | ||
| Genetic factors in dementias | 803 | ||
| Genetic Factors in AD | 803 | ||
| Genetics Factors in FTLD | 804 | ||
| Genetic Forms of Vascular Dementia | 804 | ||
| Neuroimaging of dementias | 804 | ||
| CT and MRI | 804 | ||
| Magnetic Resonance Spectroscopy (MRS) | 804 | ||
| Functional Activation Using MRI | 805 | ||
| Functional Imaging | 805 | ||
| Management of Dementia | 807 | ||
| Pharmacological treatment | 807 | ||
| Cholinesterase Inhibitors (ChEIs) | 807 | ||
| Cholinesterase Inhibitors in Severe Alzheimer Disease | 808 | ||
| Memantine in Alzheimer Disease | 808 | ||
| Vascular Dementia | 808 | ||
| Dementia with Lewy Bodies (DLBD) and Parkinson Disease Dementia | 808 | ||
| Conclusions | 809 | ||
| References | 809 | ||
| Chapter 69 - Vascular Dementia | 812 | ||
| Introduction | 812 | ||
| Disease burden associated with vascular dementia | 812 | ||
| Risk factors for vascular dementia | 813 | ||
| Stroke and Vascular Dementia | 813 | ||
| Vascular Risk Factors and Dementia | 814 | ||
| Genetics and Vascular Dementia | 814 | ||
| Subtypes of Vascular Dementia | 814 | ||
| Large-Vessel Dementia or Multi-Infarct Dementia | 814 | ||
| Small-Vessel Dementia or Subcortical Vascular Dementia | 815 | ||
| Strategic Infarct Dementia | 815 | ||
| Pathology and pathogenesis of vascular dementia | 815 | ||
| Relation of vascular dementia with alzheimer’s disease | 816 | ||
| Uncommon Causes of Vascular Dementia | 816 | ||
| Diagnosis of vascular dementia | 816 | ||
| Diagnostic Criteria for Vascular Dementia | 816 | ||
| Clinical Assessment of Vascular Dementia | 819 | ||
| Neuropsychology of Vascular Dementia | 819 | ||
| Multi-Infarct Dementia | 820 | ||
| Subcortical Vascular Dementia | 820 | ||
| Strategic Infarct Dementia | 820 | ||
| Behaviour in Vascular Dementia | 821 | ||
| Investigations for Vascular Dementia | 822 | ||
| Treatment of vascular dementia | 824 | ||
| Prognosis for vascular dementia | 825 | ||
| Conclusions | 825 | ||
| References | 825 | ||
| Chapter 70 - Rapidly Progressive Dementia | 830 | ||
| Introduction | 830 | ||
| Definition | 830 | ||
| Epidemiology | 830 | ||
| Aetiology | 830 | ||
| Clinical characteristics | 831 | ||
| Creutzfeldt–Jakob Disease (CJD) | 832 | ||
| Degenerative Diseases | 833 | ||
| Infections | 834 | ||
| Bacterial Infections | 834 | ||
| Neurosyphilis | 834 | ||
| Tuberculosis | 835 | ||
| Whipple Disease | 835 | ||
| Viral infections | 835 | ||
| Human Immunodeficiency Virus (HIV) | 835 | ||
| Fungal infection | 836 | ||
| Parasitic infections | 836 | ||
| Neurocysticercosis | 836 | ||
| Vascular Causes | 837 | ||
| Autoimmune Disorders | 837 | ||
| Hashimoto’ Encephalopathy | 837 | ||
| Neurosarcoidosis | 838 | ||
| Behcet Disease | 838 | ||
| Metabolic Causes | 838 | ||
| Normal Pressure Hydrocephalus | 838 | ||
| Psychiatric Causes | 838 | ||
| Neoplastic | 838 | ||
| Diagnosis and differential diagnosis | 838 | ||
| Clinical Assessment | 838 | ||
| Laboratory Testing | 839 | ||
| Electroencephalography | 840 | ||
| Cerebrospinal Fluid | 840 | ||
| Neuroimaging | 840 | ||
| Brain Biopsy | 840 | ||
| Differential diagnosis | 840 | ||
| Treatment | 841 | ||
| Prognosis | 841 | ||
| Acknowledgement | 841 | ||
| References | 841 | ||
| Chapter 71 - Dementia in Africa | 844 | ||
| Introduction | 844 | ||
| Epidemiology | 844 | ||
| Prevalence of Dementia in Africa | 844 | ||
| Prevalent Dementia Subtypes | 846 | ||
| Incidence of Dementia in Africa | 846 | ||
| Analytic Studies of Dementia | 847 | ||
| Aetiology | 847 | ||
| Clinical characteristics | 848 | ||
| Diagnosis and differential diagnosis | 848 | ||
| Treatment | 848 | ||
| Prognosis | 848 | ||
| Conclusions | 849 | ||
| References | 849 | ||
| Chapter 72 - Hereditary Ataxia in the Tropical World | 850 | ||
| Introduction | 850 | ||
| Spinocerebellar ataxia | 850 | ||
| SCA 1 | 850 | ||
| SCA 2 | 851 | ||
| SCA 3 | 851 | ||
| SCA 6 | 852 | ||
| SCA 12 | 852 | ||
| Autosomal dominant episodic ataxia | 853 | ||
| Friedreich ataxia | 853 | ||
| Ataxia telangiectasia | 853 | ||
| Ataxia with vitamin E deficiency | 853 | ||
| Acknowledgements | 854 | ||
| References | 854 | ||
| Section VII - Miscellaneous | 857 | ||
| Chapter 73 - History of Tropical Neurology | 859 | ||
| Introduction | 859 | ||
| Nutritional disorders and tropical neurology | 861 | ||
| Notable features of some neurological disorders in India | 863 | ||
| Degenerative and Demyelinating Disorders | 863 | ||
| Congenital disorders | 866 | ||
| The epilepsies | 866 | ||
| Peripheral neuropathies | 867 | ||
| Tuberculosis and other infections | 867 | ||
| Study of tropical neurology in Africa and South America | 869 | ||
| History of neurology in India | 870 | ||
| References | 877 | ||
| Chapter 74 - Neuroepidemiology for Planning of the Health Structure of the Country | 881 | ||
| Introduction | 881 | ||
| Common uses of epidemiology in general | 881 | ||
| Role of Epidemiologist | 881 | ||
| Epidemiological Framework for the Delivery of Health Care Services | 881 | ||
| Epidemiological Transition | 882 | ||
| Causation Framework | 882 | ||
| Social Determinants of Health | 882 | ||
| Environmental Challenges | 882 | ||
| Challenges in neuroepidemiological researches | 882 | ||
| Delivery of Neurological Services in Developing Countries | 883 | ||
| Prevention | 884 | ||
| Primary Prevention | 884 | ||
| Secondary Prevention | 885 | ||
| Tertiary Prevention | 885 | ||
| References | 885 | ||
| Chapter 75 - Headache Peculiarities in the Tropics | 887 | ||
| Introduction | 887 | ||
| Epidemiology | 888 | ||
| Epidemiology of Headache in Africa | 888 | ||
| Epidemiology of Headache in India | 890 | ||
| Ophthalmoplegic Migraine | 890 | ||
| Treatment | 892 | ||
| Factors Influencing Headache Care in Tropics | 892 | ||
| Management of Headache in Tropics | 893 | ||
| Disability Impacts of Headaches | 894 | ||
| Conclusions | 894 | ||
| References | 894 | ||
| Chapter 76 - Heat Stroke | 896 | ||
| Introduction | 896 | ||
| Epidemiology | 896 | ||
| Aetiology | 897 | ||
| Clothing and Equipment | 897 | ||
| Environment | 898 | ||
| Wet Bulb Globe Temperature | 898 | ||
| Work Facilities | 898 | ||
| Peer or Organizational Pressure | 898 | ||
| Lack of Medical Personnel | 898 | ||
| Dehydration | 898 | ||
| Inappropriate Work-to-Rest Ratio | 898 | ||
| History of Heat Stroke | 898 | ||
| Predisposing Medical Condition, Illnesses and Fever | 898 | ||
| Age | 899 | ||
| Personality | 899 | ||
| Poor Physical Fitness and Body Composition | 899 | ||
| Lack of Heat Acclimatization | 899 | ||
| Delayed Recognition of Warning Signs | 900 | ||
| Sleep Loss | 900 | ||
| Supplements | 900 | ||
| Pathogenesis | 900 | ||
| Normal Response to Heat Stress | 900 | ||
| Thermoregulatory Failure Leading to Heat Stroke | 900 | ||
| Influence of Hydration | 901 | ||
| Clinical characteristics | 902 | ||
| Recognition and diagnosis | 902 | ||
| Treatment | 902 | ||
| On-Site Treatment | 902 | ||
| In-Hospital Treatment | 904 | ||
| Vital Sign Assessment and Initial Management | 904 | ||
| Cooling | 904 | ||
| Haemodynamic Management | 904 | ||
| Complications and Treatments | 905 | ||
| Prognostic Indicators | 905 | ||
| Emerging Treatment Options | 906 | ||
| Prognosis | 906 | ||
| Return to Participation and Work Considerations | 906 | ||
| Recommendations for Heat Stroke Recovery | 906 | ||
| Heat Tolerance Testing | 907 | ||
| References | 907 | ||
| Chapter 77 - Movement Disorders in Tropics | 909 | ||
| Introduction | 909 | ||
| Parkinson disease and parkinsonism | 909 | ||
| Epidemiology | 909 | ||
| Indian Scenario | 909 | ||
| X-linked dystonia parkinsonism (Lubag syndrome) | 910 | ||
| Toxin-induced parkinsonism (manganese-induced) | 910 | ||
| Infectious causes of parkinsonism | 910 | ||
| Common Infections | 910 | ||
| Viral Infections | 910 | ||
| Parasitic Infections | 910 | ||
| Prion Disease | 910 | ||
| Bacterial Causes | 910 | ||
| Bacterial Infection | 910 | ||
| Tubercular Meningitis | 910 | ||
| Viral Infections | 911 | ||
| SSPE | 911 | ||
| Japanese B Encephalitis | 911 | ||
| HIV and AIDS | 911 | ||
| Parasitic Infections | 912 | ||
| Malaria | 912 | ||
| Neurocysticercosis | 912 | ||
| Prion Diseases | 912 | ||
| CJD and Other Prion Diseases | 912 | ||
| Dystonia | 912 | ||
| Wilson Disease | 912 | ||
| Chorea | 912 | ||
| Sydenham Chorea | 912 | ||
| AIDS | 913 | ||
| Wilson Disease | 914 | ||
| Tremor | 914 | ||
| Infantile Tremor Syndrome | 914 | ||
| SCA12 | 914 | ||
| Myoclonus | 914 | ||
| Myoclonus in SSPE | 914 | ||
| Myoclonus in Wilson Disease | 915 | ||
| Tics | 915 | ||
| References | 915 | ||
| Chapter 78 - Future Developments in Tropical Neurology | 918 | ||
| Introduction | 918 | ||
| Disease pattern of neurological diseases in tropics | 918 | ||
| Infective and Communicable Diseases Affecting Nervous System | 918 | ||
| Non-Communicable Diseases Affecting Nervous System | 919 | ||
| Development in diagnosis | 919 | ||
| Future developments in treatment of tropical diseases | 920 | ||
| Scope of Rehabilitation | 921 | ||
| Prevention of tropical diseases | 921 | ||
| Communicable Diseases | 921 | ||
| Non-Communicable Disease | 921 | ||
| Neurogenetics | 921 | ||
| Improvement of Social Determinants of Health | 921 | ||
| Conclusions | 922 | ||
| Acknowledgement | 922 | ||
| References | 922 | ||
| Chapter 79 - Climate Change: What Neurologists Should Know | 923 | ||
| Introduction | 923 | ||
| The climate | 923 | ||
| What Are Climate Change and Global Warming? | 923 | ||
| Has Climate Change Begun? | 924 | ||
| What About Regional Climate Change Effects? | 924 | ||
| How Does the Climate System Work? | 924 | ||
| What Is the Greenhouse Effect? | 924 | ||
| What Are Greenhouse Gases? | 924 | ||
| What Are the Causes of the Global Warming? | 925 | ||
| Why Is Fossil Fuel Combustion Such an Important Factor? | 925 | ||
| Environmental neurology | 925 | ||
| Overview | 925 | ||
| What Are the Neurological Outcomes of Climate Change? | 925 | ||
| Stroke Impacted by Air Pollution and Climate Change | 926 | ||
| CNS Infections: Encephalitis and Meningitis | 927 | ||
| Hypertension and Salinity of Drinking Water | 928 | ||
| Nervous System Responses to Toxic Factors | 928 | ||
| Fungi and Mycotoxins | 928 | ||
| Seafood Poisoning and Algal Blooms | 928 | ||
| Myelopathies from Dietary Dependence on Neurotoxic Plants | 929 | ||
| Neurodegenerative Diseases | 929 | ||
| Conclusions | 930 | ||
| Acknowledgements | 930 | ||
| References | 930 | ||
| Chapter 80 - Craniovertebral Junction Anomalies | 933 | ||
| Introduction | 933 | ||
| Anatomy | 933 | ||
| Atlanto-Occipital Joints | 933 | ||
| Atlanto-Axial Joints | 933 | ||
| Ligamentous Connections | 933 | ||
| Blood Supply of the Odontoid | 934 | ||
| Atlas | 934 | ||
| Axis | 935 | ||
| Genetics | 936 | ||
| Hox Genes: The Control of Rostrocaudal Specification | 936 | ||
| Pax-1: The Resegmentation Gene | 936 | ||
| CV junction anomalies | 936 | ||
| Classification | 936 | ||
| Radiological Measurement | 936 | ||
| Kinematics | 938 | ||
| Rotation | 938 | ||
| Flexion–Extension | 939 | ||
| Lateral Bending and Translational Movements | 939 | ||
| Coupling | 939 | ||
| Basilar Invagination | 939 | ||
| Topographic Types of Basilar Invagination | 939 | ||
| Clinical features | 940 | ||
| Basilar Impression (Secondary Basilar Invagination) | 940 | ||
| Atlanto-Axial Dislocation (Atlanto-Axial Instability) | 940 | ||
| Classification | 940 | ||
| Greenberg’s classification | 940 | ||
| Wadia’s classification | 941 | ||
| Congenital Odontoid Anomalies | 941 | ||
| Os Odontoideum | 941 | ||
| Clinical Features of Atlanto-Axial Instability | 942 | ||
| Radiological Diagnosis of AAD | 943 | ||
| Tuberculosis of the Craniovertebral Junction | 943 | ||
| Clinical Presentation | 943 | ||
| Aetiopathogenesis | 944 | ||
| Investigations and diagnosis | 944 | ||
| Management of CVJ TB | 944 | ||
| Rheumatoid Arthritis | 945 | ||
| Pathology (Rheumatoid Arthritis) | 945 | ||
| Down Syndrome | 945 | ||
| Inborn Errors of Metabolism | 946 | ||
| Occipitalization or Assimilation of Atlas | 946 | ||
| Klippel–Feil Syndrome | 946 | ||
| Anomalies of Ring of Atlas | 947 | ||
| Occipito-Atlantal Instability | 947 | ||
| Traumatic Lesions Involving the Occipito-Atlanto-Axial Complex | 947 | ||
| Clinical features of craniovertebral anomalies | 949 | ||
| Age | 949 | ||
| Familial Incidence | 949 | ||
| Precipitating Factors | 949 | ||
| Clinical Presentations | 949 | ||
| Associated Congenital Malformations | 951 | ||
| Skeletal Traction | 951 | ||
| Reducible Lesions | 951 | ||
| Posterior Decompression | 951 | ||
| Management of Atlanto-Axial Dislocation and Basilar Invagination | 952 | ||
| References | 957 | ||
| Index | 961 | ||
| Back Cover | Back Cover |