Abstracts - IANCON 2025

32nd Annual Conference of the Indian Academy of Neurology, 29^th October 2025 to 2^nd November 2025: Award Presentations: Abstract ID 1: Clinical and Genetic Spectrum of Developmental Dyskinetic Encephalopathy - Experience from a Tertiary Care Centre

Asish Vijayaraghavan, Syam Krishnan, Soumya Sundaram

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Background and aim: Developmental dyskinetic encephalopathy (DDE) is a recently described clinically and genetically heterogenous disorder characterised by developmental or psychomotor retardation with early onset hyperkinetic movement disorders. This study aimed to analyse the clinical and genetic spectrum of DDE.

Methodology: We defined DDE as neurodevelopmental disorders marked by early-onset dyskinetic movement disorders, typically occurring without or with infrequent seizures. Twenty-one children who met the defined criteria seen in the Pediatric Neurology and Movement Disorder Clinic were included in this retrospective cohort study (2016-2024). We reviewed the prospectively maintained electronic medical records for clinical, imaging, biochemical, and molecular genetic features. The videos of these patients were also reanalysed.

Results: There were 21 patients (16 males) and the mean age of patients with onset of movement disorders was 10.7 months (range 3–24). Chorea was the most common movement disorder (17 patients), followed by dystonia (14 patients), myoclonus (5 patients), stereotypy (2 patients) combination. GNAO1 and ADCY5 variants were most common (3 patients each). Other genes were ATP1A3, GRID2, GRIA2, GRIA4, KMT2B, GTPBP2, GCDH, NGLY1, ZNF142, UFSP2, HECW2, and PDHA1 variants. One patient had chromosome 6q deletion. Most common variant type was a missense variant seen in 14 patients (66.6%). Pathogenic or likely pathogenic variants were seen in 13 patients (61.9%).

Discussion: The study underscores the clinical and genetic heterogeneity of DDE while emphasizing the centrality of movement disorders in guiding diagnostic approaches. Early recognition of movement disorder complexes can prioritize genetic testing expediting diagnoses and enabling tailored management. For instance, ADCY5-related dyskinesias may respond to caffeine, while deep brain stimulation has shown promise in GNAO1-related or KMT2B-related dystonia.

Conclusion: The study highlights the importance of looking beyond seizures and cognitive decline in developmental encephalopathies. The recognition of movement disorder types is key in the early diagnosis and management of patients with DDE.

Abstract ID 2: Yield of Whole Exome Sequencing in Epilepsy

Aishwarya Jirwankar, Aditya Gudhate, Sangeeta Ravat, Neeraj Jain, Mayur Thakkar, Shruti Agrawal

Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India

Background and aim: Studies evaluating the genetic yield of epilepsy patients using next-generation sequencing in the Indian subcontinent are limited. This study aimed to assess the diagnostic yield of genetic testing and determine how often it influenced treatment decisions in affected patients.

Methodology: We conducted a retrospective cross-sectional study of patients presenting to the Neurology OPD and IPD between January 2018 and January 2025. Each patient underwent a detailed neurological evaluation, including clinical history, magnetic resonance imaging (MRI), electroencephalogram (EEG), and routine investigations. Sixty-one patients underwent genetic evaluation via whole-exome sequencing (WES). After obtaining informed consent, DNA was extracted from blood samples and sequenced using the TruSight One Sequencing Panel (Illumina, USA). Identified variants were classified per The Americal College of Medical Genetics and Genomics (ACMG) guidelines into ‘Pathogenic’ and ‘Variants of Unknown Significance’ (VUS). Sanger sequencing was offered for VUS confirmation.

Results: Of the 62 patients, 12 (19.3%) had pathogenic variants, 23 (37%) had VUS, and 27 (43.5%) showed no pathogenic gene. Further testing was recommended for VUS cases. Genetic diagnoses led to drug optimization and a reduction in drug-refractory epilepsy rates in 6 patients.

Discussion: The WES revealed pathogenic variants in 19.3% of epilepsy patients, guiding therapy and improving outcomes in selected cases. The high proportion of VUS highlights the need for ongoing interpretation and family studies. WES offers significant diagnostic value and supports its integration into routine care, especially in underrepresented populations.

Conclusion: The WES is a valuable single-test approach in diagnosing neurogenetic disorders. Diagnostic yield improves with careful patient selection. Even VUS cases may benefit from phenotype correlation and segregation analysis. A confirmed genetic diagnosis helps bring closure to the diagnostic journey, reduce unnecessary investigations, inform prognosis, enable tailored surveillance and treatment, and provide access to support services. Our findings support integrating WES into routine clinical practice and promoting genetic counselling in neurology.

Abstract ID 3: CORE-PD STUDY: Cortical Excitability and Retinal Changes in Early Onset Parkinson’s Disease – Exploring the Conundrum from a Prospective Cohort Study

Subhajit Roy, Vikram Holla, Nitish Kamble, Rohan Mahale, Ravi Yadav, Pramod Pal

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Evaluation of cortical excitability and retinal changes in Early-onset Parkinson’s Disease (EOPD) is extremely crucial. Aim of this study was to investigate the transcranial magnetic stimulation (TMS) and optical computerized tomographic (OCT) parameters in EOPD patients compared with age and gender-matched healthy controls and to study any correlation with clinical parameters of EOPD.

Methodology: EOPD patients (age at onset < 50 years) and age- and gender-matched healthy controls were recruited between November 2023 and May 2025. The evaluation included detailed clinical assessments with Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) scales, TMS (single and paired-pulse) and OCT.

Results: A total of 166 subjects (patients = 83) were recruited. The mean age at onset of the EOPD cohort was 33.5 ± 9.2 years, and the duration was 7.2 ± 5.1 years. A positive family history was noted in 19.3% cases. The MDS-UPDRS scores were part-I: 14.3 ± 5.8, part-II: 16.4 ± 10.0, Part-III-OFF: 56.9 ± 21.1, PartIII-ON: 24.9 ± 14.8. The Total Levodopa Equivalent Daily Dose (TLEDD) was 612.6 ± 277.4, Dyskinesia was noted in 36.14% cases with unified dyskinesia rating scale (UDyRS) score of 40.91 ± 21. Tremor-dominant (TD)-PD phenotype was noted in in 55.4% cases and PIGD-PD in 39.8% cases. The common non-motor symptoms were anxiety (71.08%), depression (68.67%), and pain (68.67%) while RBD was found in 39.75%, constipation in 36.14%, and restless legs syndrome (RLS) in 12.04%. Single pulse TMS showed a significant reduction of resting motor threshold (RMT) (p = 0.001), contralateral silent period (cSP, p = 0.001) and ipsilateral silent period (iSP, p = 0.008) compared to healthy controls. In the paired-pulse paradigm, short interval intracortical inhibition (SICI) was significantly reduced (p = 0.013). The iSP showed negative but non-significant correlation with Motor symptoms, non-motor symptoms (NMS), and Parkinson’s disease questionnaire (PDQ). OCT showed significant thinning of macular parameters including Central macular thickness, CMT (p = 0.001), macular GCC-1mm (p = 0.001), GC-IPL-1mm (p = 0.001) and GC-IPL-nasal-3mm (p = 0.045). Peripapillary retinal nerve fibre layer (RNFL) showed significant thinning in Global (p = 0.0004), Temporo-superior (p = 0.016), Nasal-inferior (p = 0.001), Nasal (p = 0.006) and Nasal-superior (p = 0.025) sectors compared to healthy controls. A negative but non-significant correlation was noted between macular GC-IPL and peripapillary RNFL (Nasal-inferior) thickness with UPDRS and NMS.

Discussion: In our study, EOPD patients showed distinct motor, non-motor, neurophysiological, and retinal changes, with significant difference in TMS (Single & Paired pulse) (RMT, cSP, iSp, SICI) and OCT (Macular and peripapillary) parameters compared to healthy controls.

Conclusion: EOPD patients exhibited reduced cortical inhibition with retinal neurodegeneration, reinforcing the role of cortical and retinal biomarkers in understanding pathophysiology and potentially aiding early diagnosis and disease monitoring.

Abstract ID 4: Genetic Architecture and Predictors in Dystonia: A Phenotypic Analysis of an Indian Cohort

Nishanth Gowda, Nitish Kamble, Vikram Holla, Pramod Pal, Babylakshmi Muthusamy¹, Ravi Yadav

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, ¹Kasturba Medical College, Manipal, Karnataka, India

Background and aim: The clinical heterogeneity of dystonia presents challenges in identifying patients who would benefit from genetic testing. We aimed to characterize the genetic landscape and identify phenotypic predictors of monogenic dystonia in an Indian cohort by utilizing advanced statistical and machine learning approaches.

Methodology: We evaluated 148 patients with idiopathic dystonia over three years at a tertiary neurology center (NIMHANS, Bengaluru). Patients underwent comprehensive clinical phenotyping and targeted or exome-based genetic testing. Based on molecular results, cases were categorized as genetically positive (n = 34), variant of uncertain significance (VUS) (n = 20), and genetically negative (n = 74). Multivariable logistic regression and random forest classification were utilized to identify predictors of genetic positivity. Dimensionality reduction [principal component analysis (PCA), t-distributed Stochastic Neighbor Embedding (t-SNE)] and unsupervised clustering were applied to explore natural phenotypic groupings.

Results: A pathogenic genetic etiology was identified in 23% of patients, with an additional 13.5% harboring VUS. Genetically positive patients had a markedly earlier mean age of onset (~14.6 years) compared to gene-negative patients (~25 years), and more often had a positive family history and significant improvement with levodopa. Generalized or limb-onset dystonia was far more frequent in gene-positive cases, whereas gene-negative cases predominantly had adult-onset focal dystonias. Key predictors of a genetic diagnosis were early age at onset, familial dystonia, and levodopa responsiveness (all p < 0.01). Common genes identified included KMT2B, TOR1A, THAP1, SGCE, and GCH1, each correlating with characteristic phenotypic profiles.

Discussion: This study highlights that clinical features can reliably distinguish genetic dystonias. Patients with childhood-onset or familial dystonia, especially those with generalized distribution or Dopa responsiveness, have high odds of a monogenic cause.

Conclusion: Early-onset generalized dystonia with limb involvement or family history is a strong predictor of genetic positivity. Broad genetic screening in idiopathic dystonia uncovers not just classical DYT syndromes but also treatable metabolic etiologies.

Abstract ID 5: Effect of Pranayama on Non-Motor Symptoms in Parkinson’s Disease: A Randomized Controlled Study

Shreya Verma, B Bajaj

Vardhman Mahavir Medical College, New Delhi, India

Background and aim: Parkinson’s disease (PD) is a chronic neurodegenerative disorder characterized not only by motor symptoms but also by a broad spectrum of non-motor symptoms (NMS), including cognitive impairment, depression, anxiety, autonomic dysfunction, sleep disturbances, etc. These NMS are often inadequately addressed by pharmacotherapy, leading to significant impairment in quality of life. This study aimed to assess the effect of Pranayama, a structured yogic breathing practice, on non-motor symptoms in PD patients.

Methodology: This randomized, unblinded controlled trial was conducted at a tertiary neurology center. Fifty PD patients (Hoehn & Yahr stages I–III, aged 18–65) were randomized into two groups: Group A (n = 25): Standard pharmacotherapy + Pranayama (40 minutes/day, 5 days/week for 12 weeks) Group B (n = 25): Standard pharmacotherapy alone. The baseline and 12-week assessments included the Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Parkinson’s disease questionnaire (PDQ)-39, Hamilton anxiety rating scale (HAM-A), Hamilton depression rating scale (HAM-D), Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III, and P300 cognitive evoked potentials.

Results: Of the 50 patients, 43 completed the study (Group A: 23; Group B: 20). Group A showed significant improvement in NMSS (p < 0.0001), MoCA (p = 0.044), FAB (p < 0.001), HAM-A (p = 0.002), HAM-D (p = 0.0004), PDQ-39 (p = 0.003), and MDS-UPDRS III (p = 0.016). No significant change was observed in P300 latency. Group B showed no significant improvements.

Discussion: Pranayama may modulate autonomic balance, neuroplasticity, and emotional regulation, resulting in improvements in NMS and overall quality of life. Its low cost and non-pharmacological nature make it particularly suited to low-resource settings.

Conclusion: Pranayama is a safe, effective, and low-cost adjunct to standard therapy in Parkinson’s disease, significantly improving non-motor symptoms and quality of life.

Abstract ID 6: Sleep Dysfunction in Essential Tremor and ET Plus: A Clinical and Polysomnographic Analysis

Ravi Prakash Singh, Seshagiri V, Rohan Mahale, Jitender Saini, Bindu Kutty, Pramod Pal, Ravi Yadav

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Sleep disturbances are known in neurodegenerative disorders, but PSG-based studies in Essential Tremor (ET) are scarce, especially distinguishing ET from ET-Plus. This study aimed to compare sleep patterns among ET, ET-Plus, and healthy controls, exploring sleep disturbances as potential clinical markers.

Methodology: We conducted a prospective cross-sectional study (November 2021–October 2023) at NIMHANS, Bengaluru including 45 ET patients (26 ET, 19 ET-Plus) and 45 controls. Tremor severity was assessed using The Essential Tremor Rating Assessment Scale (TETRAS) and Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS); sleep symptoms via Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Mayo Sleep Questionnaire, Restless Leg Syndrome-questionnaire (RLS-Q), Berlin questionnaire (BQ), Generalized Anxiety Disorder (GAD)-7, and Patient Health Questionnaire (PHQ)-9. All underwent overnight video polysomnography (PSG), manually scored per AASM 2022 by a trained sleep researcher and the first author. Data were analyzed using R Studio.

Results: ET patients had earlier onset (30.8 ± 16.7 years) than ET-Plus (46.8 ± 11.1 years), with ET-Plus showing higher TETRAS and FTMRS scores (P < 0.001). Both groups exhibited poorer sleep quality, excessive daytime sleepiness, RBD, and RLS compared to controls. PSG showed higher Apnea-Hypopnea Index (AHI), reduced total sleep time, prolonged REM latency, lower sleep efficiency, increased N1, and reduced N2/N3 durations. Microarchitecture analysis revealed decreased spindle coherence, amplitude, frequency, fewer K complexes, and reduced delta activity, especially in ET-Plus, indicating more disturbed sleep versus controls.

Discussion: Our study highlights significant sleep disturbances and altered polysomnographic architecture in both ET and ET-Plus as compared to controls, with ET-Plus showing greater severity. ET-Plus patients exhibited worse motor impairment and disability, independent of age. These findings underscore sleep dysfunction as a key clinical feature and support ET and ET-Plus as distinct entities. This adds a novel perspective to understanding ET’s clinical heterogeneity and neurodegenerative nature.

Conclusion: Both ET and ET-Plus revealed significant sleep disturbances as compared to controls, especially ET-Plus. PSG confirmed disrupted sleep architecture, underscoring sleep dysfunction as a clinical biomarker and supporting ET’s neurodegenerative nature.

Abstract ID 7: Impact of Deep Brain Stimulation and Medication on Somatosensory Temporal Discrimination in Parkinson’s Disease

S Kumar, Rukmini Kandadai¹, Rupam Borgohain¹, Sandhya Manorenj

Deccan College of Medical Sciences, Hyderabad, Telangana, ¹Yashoda Hospitals Hitech city Hyderabad, Telangana, India

Background and aim: Deep brain stimulation (DBS) of the subthalamic nuclei (STN) is an established treatment for motor symptoms in advanced Parkinson’s disease (PD), but its effects on sensory processing, particularly somatosensory temporal discrimination threshold (STDT), remain underexplored. This study investigated the impact of DBS and levodopa on STDT in PD patients.

Methodology: We assessed 30 PD patients with bilateral STN-DBS (implanted between January–December 2021) and 30 age- and sex-matched healthy controls. STDT was measured on both hands under four conditions: DBS Off/Medication Off, DBS Off/Medication On, DBS On/Medication Off, and DBS On/Medication.

Results: Patients with PD showed significantly higher somatosensory temporal discrimination thresholds (STDT) than healthy controls, indicating impaired sensory processing. Controls averaged ~74 ms, while the lowest STDT in PD patients occurred in the DBS Off/Medication On condition (~109 ms), suggesting levodopa improves sensory function. The highest STDT (~130 ms) was seen in the DBS On/Medication On state, indicating DBS may worsen sensory processing, especially when combined with medication. DBS alone showed minimal effect.

Discussion: The study revealed that PD patients exhibit significantly impaired somatosensory temporal discrimination compared to healthy controls, reinforcing the basal ganglia’s role in sensory timing. Dopaminergic therapy alone improved STDT values significantly, aligning with existing literature that links STDT abnormalities to dopamine deficits. However, STN-DBS alone did not improve STDT, and when combined with medication, appeared to negatively affect sensory temporal discrimination, contrasting with its beneficial effects on motor symptoms. This suggests that DBS may interfere with somatosensory pathways, either through local stimulation effects, altered cortical-subcortical connectivity, or disruption in signal processing.

Conclusion: Patients with PD showed impaired sensory processing. Levodopa improved STDT, while DBS worsened it, suggesting that the dopamine aids in sensory integration, whereas DBS may disrupt somatosensory pathways. Further research is needed.

Abstract ID 8: Development of Severity Scale for Spinocerebellar Ataxia 12 patients

Sahaj Agrawal, Achal Srivastava, Awadh Pandit, Roopa Rajan, Divya MR, Ayush Agarwal, Divyani Garg, Prachi Mohopatra

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Spinocerebellar Ataxia Type 12 (SCA 12) is a rare autosomal dominant neurodegenerative disorder predominantly affecting the Agrawal community in India. Existing severity scales like SARA, FTM TRS, and MoCA are not tailored for SCA 12, limiting their clinical utility. The study aimed to develop a comprehensive, disease-specific severity scale for SCA 12.

Methodology: A cross-sectional study involving 81 genetically confirmed SCA 12 patients was conducted at a tertiary neurology centre in India. Potential scale items were identified from existing validated tools and finalized through a three-round Delphi consensus among neurology experts. Psychometric validation included internal consistency analysis and exploratory factor analysis to determine the scale’s domain structure.

Results: The final 34-item composite scale showed excellent internal consistency (Cronbach’s α = 0.924). Exploratory factor analysis identified six domains: Activities of Daily Living, Fine Motor Skills, Coordination, Limb Tremor, Non-Limb Tremor, and Cognitive Abilities, explaining 69.9% of the total variance. The new scale did not show significant correlation with CAG repeat length. Cognitive impairment appeared independent of disease duration or severity.

Discussion: The finalized 34-item scale demonstrated excellent internal consistency (Cronbach’s α = 0.924). Exploratory factor analysis yielded six distinct domains: Activities of Daily Living, Fine Motor Skills, Coordination, Limb Tremor, Non-Limb Tremor, and Cognitive Abilities, collectively explaining 69.9% of the total variance. The severity of disease showed a moderate correlation between tremor and ataxia scales but no significant correlation with CAG repeat length. Cognitive impairment was independent of disease duration or genetic load.

Conclusion: This is the first study to propose a multidimensional severity scale specifically for SCA 12. It offers clinicians and researchers a holistic tool to better assess disease progression and patient disability. Further validation through confirmatory factor analysis and multicenter studies is recommended for broader clinical adoption.

Abstract ID 9: CVT and SAH: Anticoagulant or Not? – A Clinical Challenge Experience from a South Indian Tertiary Care Centre (Retrospective Observational Study)

Sujoy Kabiraj, Ramakrishnan Subasree, Girish Kulkarni

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Cerebral venous thrombosis (CVT) with subarachnoid hemorrhage (SAH), particularly when localized to cortical sulci, poses both diagnostic and therapeutic challenges. The safety of initiating anticoagulation in such scenarios remains a clinical dilemma. This study from a tertiary care hospital in South India aimed to analyze the clinical presentations, radiological patterns, treatment strategies, and functional outcomes of CVT-SAH patients.

Methodology: This retrospective study analyzed 27 patients with imaging-confirmed CVT and concurrent cortical SAH from medical records between January 2022 and December 2024. All patients received subcutaneous unfractionated heparin (5000 IU 6-hourly) titrated to a PTT, followed by acenocoumarol using structured dosing protocols. Primary outcome was functional status at three months using modified Rankin Scale (mRS ≤ 2 indicating favorable outcome).

Results: Mean age was 41.6 ± 12.2 years, with 78% male. Common risk factors were alcohol use (52%), hyperhomocysteinemia (48%), and tobacco use (37%). All patients had superficial sinus thrombosis; 11.1% had additional deep venous involvement. Convexity SAH was universal, and 33% had concomitant intracerebral hemorrhage. No anticoagulation-related rebleed or treatment discontinuation was noted. Only one patient (3.7%) required decompressive craniectomy; none developed hydrocephalus. At 3 months, 74% had favorable outcomes (mRS ≤ 2), and no mortality was recorded.

Discussion: CVT with SAH does not preclude anticoagulation. Early initiation with careful monitoring appears safe and facilitates favorable recovery in most cases.

Conclusion: Despite the presence of SAH, anticoagulation with UFH and Acenocoumarol is safe and effective in CVT. Judicious therapy based on imaging and clinical context ensures excellent outcomes with minimal complications.

Abstract ID 10: A Prospective Observational Study of Clinical and Electroencephalographic Profiles in Cases of Non-Convulsive Status Epilepticus in ICU of a Tertiary Care Hospital in South Gujarat

Chinmay Patel, Anirudha Apte¹, Atma Bansal

Medanta the Medicity, Gurugram, Haryana, ¹Institute of Neurosciences, Surat, Gujarat, India

Background and aim: Non-Convulsive Status Epilepticus (NCSE) is a critical yet underdiagnosed cause of altered mental status (AMS) in ICU. The absence of overt convulsive activity and reliance on electroencephalography (EEG) complicate early identification. Our study aimed to analyze clinical and electrographic features, etiological spectrum, treatment response and prognostic indicators in NCSE.

Methodology: Our prospective observational study enrolled 25 ICU patients with AMS diagnosed as definite NCSE using Salzburg Consensus Criteria (SCC) over one-year. Demographic data, clinical features, neuroimaging, EEG characteristics, treatment response and outcomes including modified Rankin Scale (mRS) and mortality were recorded and analyzed.

Results: Mean patient age was 53.9 ± 8.8 years with a slight female predominance. Mean duration of ICU stay was 9.9+/-3.6 days. 40% of patients developed AMS during hospital stay. 60% had no visible seizures at the onset of AMS. 56% had subtle motor symptoms during AMS. Eighteen (72%) had abnormal brain imaging. On EEG, 15 (60%) had epileptiform discharges of >2.5 Hz, 7 (28%) had epileptiform discharges of less than 2.5 Hz and 3 (12%) patients had rhythmic delta activity. Etiologies included cerebrovascular accidents, metabolic/septic encephalopathy, meningoencephalitis, autoimmune encephalitis, anti-epileptic withdrawal, uncontrolled epilepsy and traumatic brain injury. All patients received initial IV benzodiazepines. Eleven (44%) patients required intravenous anesthetic infusions. Twelve (48%) had status epilepticus severity score (STESS3), out of them 4 were independent, 7 were dependent and 2 died. Out of 2 who died, one was 80 year old male known diabetic, cervical cord injury with right hemiplegia being managed at home, presented with hypoglycemia (RBS-38 mg/dL) and urosepsis. Another was 73 year old male, known advanced Parkinson’s disease presented with aspiration pneumonia and septic shock.

Discussion: The present study emphasizes the high diagnostic complexity of NCSE in ICU patients. Prolonged continuous EEG (cEEG) and early application of SCC on EEG improves diagnostic yield. STESS emerged as a reliable prognostic marker. Etiology-driven therapy, timely stepping up antiepileptics and starting intravenous anesthetics significantly influence outcomes.

Conclusion: Early recognition, etiology-specific treatment and STESS-based prognostication are pivotal in optimizing NCSE outcomes in ICU practice.

Abstract ID 11: Wine Glass Appearance in MRI Brain of a Postpartum Female – A Rare Presentation

Rabia Tinna, Harpreet Mann, Sudesh Prabhakar, J P Singhvi, Amit Singh, Suranjana Basak

Fortis Hospital, Mohali, Punjab, India

Background and aim: Osmotic Demyelination Syndrome (ODS) is a non-inflammatory demyelinating disorder predominantly associated with rapid correction of hyponatremia. However, ODS associated with hypernatremia, especially in the postpartum period, is exceedingly rare. Neuroimaging plays a pivotal role in diagnosis, with the ‘wine glass’ appearance on MRI being a notable radiologic hallmark.

Methodology: This case report presented the clinical profile, imaging findings, and management of a postpartum female diagnosed with hypernatremia-associated ODS. Clinical data, laboratory parameters, neuroimaging, and treatment course were analyzed.

Results: A 31-year-old female, 12 days postpartum following an uneventful full-term vaginal delivery, presented with sudden loss of consciousness, paraparesis, and altered mentation. Examination revealed high-grade fever, tachycardia, and Bilateral lower limb motor weakness (1/5) with preserved upper limb strength and diminished tone and reflexes. Fundus examination – Normal. Laboratory investigations showed serum Na+190 mmol/L. Magentic resonance imaging (MRI) brain revealed T2WI and FLAIR hyperintensities in the bilateral posterior limbs of the internal capsule, splenium of corpus callosum, hippocampi, and bilateral middle cerebellar peduncles, forming a characteristic ‘wine glass’ appearance suggestive of extrapontine myelinolysis. CSF analysis was within normal limits except for HHV-6 positivity. Gradual correction of sodium (190-148 mmol/L) using hypotonic fluids and supportive therapy led to progressive clinical improvement. At discharge, the patient had regained significant lower limb strength (3/5) with intact cognition.

Discussion: This case underscores a rare but important cause of altered sensorium and motor weakness in postpartum patients. Hypernatremia-induced ODS is infrequently reported and may present with characteristic neuroimaging findings. The postpartum state, with associated fluid shifts and possible dehydration, may predispose to such electrolyte imbalances.

Conclusion: This rare case highlights the importance of early recognition of ODS in postpartum in preventing irreversible neurological damage and optimizing recovery.

Abstract ID 12: Spike-Wave Activation in sleep (SWAS) Look-Alikes: Why Pseudo-SWAS Patterns are Common in SeLEAS

Neetha Balaram

Government Medical College Hospital, Kozhikode, Kerala, India

Background and aim: Sleep electroencephalogram (EEG) patterns resembling electrical status epilepticus in sleep (SWAS) can be seen in various childhood epilepsy syndromes. This study aimed to identify SWAS look-alike patterns from our EEG database over a 3-year period and to analyze spatiotemporal propagation patterns in true SWAS cases evolving from self-limited epilepsy with centrotemporal spikes (SeLECTS) and distinguish them from those seen in pseudo-SWAS.

Methodology: We retrospectively analyzed sleep EEGs and clinical data of children aged 2-12 years with SWAS-like patterns. Clinical histories, neurocognitive profiles, and follow-up EEGs were reviewed. Spatiotemporal propagation patterns and dipole stability quotients were assessed to determine involvement of eloquent versus non-eloquent cortex (using Brain Electrical Source Analysis (BESA) research 7.1)

Results: Among 34 children with SWAS-like EEG patterns, 25 were diagnosed with true SWAS associated with developmental and/or epileptic encephalopathy (D/EE-SWAS), while 9 had pseudo-SWAS-all with a diagnosis of self-limited epilepsy with autonomic seizures (SeLEAS). Of the 25 true SWAS cases, 5 had evolved from SeLECTS. Pseudo-SWAS in SeLEAS showed propagation through non-eloquent cortical regions with stable dipole quotients and lacked clinical or cognitive deterioration. In contrast, SWAS patterns in cases evolving from SeLECTS demonstrated propagation through eloquent perirolandic cortex with unstable dipole quotients, clinical correlation, and EEG progression.

Discussion: Pseudo-SWAS patterns in SeLEAS likely represent benign, non-eloquent cortical activation without clinical significance. In contrast, all true SWAS including those evolving from SeLECTS involves eloquent cortex and has clear clinical implications.

Conclusion: SWAS-like patterns in sleep EEGs should be interpreted with careful clinical and electrophysiological correlation. Pseudo-SWAS, frequently seen in SeLEAS, represents a benign condition without adverse developmental outcomes and can be differentiated from true SWAS using advanced EEG metrics. Differentiating these entities is critical for guiding prognosis and

Abstract ID 13: Clinical and Electrophysiological Features of Classic and Overlapping Miller–Fisher Syndrome: A Single-Center Cohort Study

Prashant Bhatele, Aparna Pai

Kasturba Medical College, Manipal, Karnataka, India

Background and aim: This study aimed to explore the relationships between diabetes mellitus (DM) and Guillain–Barré syndrome (GBS) progression and short-term prognosis.

Methodology: This retrospective study analyzed 330 GBS patients, with 31.8% having DM. Disability was measured using the GBS Disability Scale (GDS), where a score of >3 indicated severe disability. At discharge, GDS scores of >3 were linked to a poor short-term prognosis.

Results: Compared with patients with normal glycosylated hemoglobin A1c (HbA1c) and cerebrospinal fluid (CSF) glucose levels, patients in the high HbA1c and high CSF glucose groups were characterized by severe disability (GDS > 3) at admission (52.4 vs. 75.2, P = 0.001; 80 vs. 53.4, P = 0.001), at nadir (63.1 vs. 83.8, P = 0.02; 84.5 vs. 60.6, P = 0.03), and at discharge (52.4 vs. 31.1, P = 0.04; 57.8 vs. 27.8, P = 0.03). Elevated blood levels of HbA1c were significantly correlated with worse disability at admission (OR = 0.64) and at nadir (OR = 0.74) but not at discharge. Elevated CSF glucose levels were significantly correlated with severe disability at admission (OR = 0.68), at nadir (OR = 0.62), and at discharge (OR = 0.72).

Discussion: Older age, gastrointestinal tract infection, and axonal subtype were significantly associated with worse disability at admission, at nadir, and at discharge. High CSF glucose was significantly linked to greater disability in GBS patients upon admission, at nadir, and at discharge. Additionally, elevated blood HbA1c levels correlated significantly with severe disability at both admission and nadir. However, blood HbA1c levels did not significantly correlate with disability severity at discharge.

Conclusion: The present study revealed that elevated glucose levels in the blood and CSF were correlated with disease severity at admission, nadir and discharge and might predict the short-term prognosis of GBS patients. The inclusion of DM in prognostic models for GBS is highly recommended.

Abstract ID 14: Role of Educational Intervention in Improving Diagnosis and Treatment of Central Nervous System Tuberculosis: The RED–TB Trial

Archita Makharia, Aneesha Thomas¹, Anugunj Chaudhary, Jamshed Khan, Neha Singh, Priyanka Sehrawat², Sanjay Mattoo³, R K Gupta⁴, Khushboo Kanojia, Yogita Puri, Roopa Rajan, Rajendra Kumar⁵, Animesh Das, Arunmozhimaran Elavarasi, Ayush Agarwal, Awadh Pandit, Divyani Garg, Sumit Malhotra, Mamta Singh, Rohit Bhatia, Achal Srivastava, MV Padma Srivastava, Divya Radhakrishnan

All India Institute of Medical Sciences, New Delhi, ¹Government Medical College, Kannur, Kerala, ²Neuromed Clinic, Gurugram, Haryana, ³Ministry of HFW, Central TB division, New Delhi, ⁴District Combined Hospital, Sanjay Nagar, Ghaziabad, Uttar Pradesh, ⁵Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

Background and aim: Central nervous system tuberculosis (CNSTB), especially tubercular meningitis (TBM), remains underdiagnosed due to vague symptoms and limited frontline awareness. The RED–TB (Recognition, Education, Diagnosis for TB) trial aimed to assess whether structured educational reinforcement of community health workers (CHWs) could enhance the detection, diagnosis timing, and reporting of CNSTB cases.

Methodology: This cluster-randomised controlled trial was conducted in 14 tuberculosis units (TUs) in Ghaziabad, India (2022–2024). TUs were randomized (7 intervention, seven control). CHWs in intervention clusters received two structured virtual sessions by neurologists, handouts, and ongoing WhatsApp support. Knowledge, attitude, and practice scores were assessed at five intervals. Patient data on CNSTB cases, British Medical Research Council (BMRC) grading, demographics, and diagnosis delays were captured pre- and post-intervention using Nikshay and local TB centre records.

Results: A total of 262 CHWs participated, showing significant improvement in mean awareness scores from baseline (6.29 ± 2.29) to 12 months post-intervention (8.33 ± 2.52; p < 0.0001; Cohen’s d = 0.854). CNS TB notifications rose from 73 pre-intervention to 107 post-intervention, with complete data for 66 cases (54.5% from intervention clusters). While not statistically significant (p = 0.432), this showed a directional benefit. Post-intervention, paediatric (<12 years) and adolescent (13–18 years) diagnoses increased to 15.2% and 30.3%, respectively. Early-stage TBM (BMRC Grade 1) diagnoses were more common in intervention clusters (16.7% vs. 6.7%). The time to diagnosis remained unchanged; however, treatment was initiated promptly once the diagnosis was confirmed. HCWs showed significantly improved CNS TB awareness after educational sessions, with better retention among attendees of both sessions (scores 7.01 ± 2.16 vs 8.3 ± 2.52; P = 0.005).

Discussion: The intervention markedly improved CHW knowledge and case recognition, with emerging trends towards earlier diagnosis and increased identification of younger patients.

Conclusion: This trial demonstrated that structured educational interventions at community level can increase awareness and improve early detection of CNSTB.

Abstract ID 15: Therapeutic Drug Monitoring and Adjunctive Corticosteroids as Precision Strategies to Enhance Clinical Outcomes in Severe Neuromelioidosis

Yara Kandoth, Vivek Mathew, Ajith Sivadasan, Angel T

Christian Medical College, Vellore, Tamil Nadu, India

Background and aim: Neuromelioidosis is associated with high mortality. This study evaluated the impact of precision strategies—therapeutic drug monitoring (TDM), guided meropenem dosing, and adjunctive corticosteroids—on clinical outcomes in severe neuromeliodosis.

Methodology: A prospective cohort study (January 2021–April 2025) included 21 patients with confirmed or clinically suspected neuromelioidosis. All received meropenem (57% empirically) as prolonged high-dose infusions (16–24 g/day), with TDM-guided dose adjustments. Adjunctive corticosteroids were administered in 66% of cases. Outcomes included mortality and functional status (modified Rankin Scale [mRS] ≤2 at 6 months). Predictors of favorable outcomes were analyzed using logistic regression.

Results: The cohort (mean age 35 years, 66% male) had severe disease: 81% required intensive care, and 66% needed mechanical ventilation. Brainstem involvement (85.7%) and spinal cord lesions (47.6%) were common, but microbiological confirmation was achieved in only 33%. Mortality was 23%, lower than historical rates, with 61.9% achieving favourable outcomes (mRS ≤2). TDM-based meropenem dosing (OR 2.6, 95% CI 1.31–5.67, p = 0.031) and corticosteroids were independent predictors of reduced disability.

Discussion: Neuromelioidosis poses a high clinical burden, with frequent ICU admission (81%) and ventilation (66%), and predominant brainstem (85.7%) and spinal cord (47.6%) involvement. Mortality was 23%, lower than historical data, possibly due to early critical care and TDM-guided high-dose meropenem with adjunctive steroids, which significantly improved outcomes (OR 2.6, p = 0.031). Despite low microbiological confirmation (33%), empirical therapy and precision dosing led to 61% favorable recovery at 6 months. Aggressive, protocolized treatment and long-term rehabilitation are essential for optimizing outcomes.

Conclusion: TDM-guided meropenem optimization and adjunctive corticosteroids were associated with improved survival and functional recovery in neuromelioidosis, suggesting synergistic benefits from enhanced CNS drug delivery and immunomodulation. Despite diagnostic limitations, protocolized use of these strategies may reduce mortality. Integration into treatment guidelines is warranted, though larger multicentre studies are needed for validation.

Abstract ID 16: Linking Cerebrospinal Fluid Biomarkers to Neurocognitive Outcomes in Tuberculous Meningitis

Sanchit Chouksey, Rameshwar Nath Chaurasia, Varun Singh

Banaras Hindu University, Varanasi, Uttar Pradesh, India

Background and aim: Tuberculous meningitis (TBM) is a serious type of infection that impacts the central nervous system (CNS). In India, the estimated mortality rate for TBM stands at about 1.5 per 100,000 people, which accounts for nearly 20% of all diagnosed cases. However, there is paucity of data on cognitive and neuropsychological profiles in TBM patients. We aimed to evaluate the cognitive profile of patients with grade 1 and 2 tuberculous meningitis and its correlation with the various biomarkers.

Methodology: This prospective observational study was conducted at the Department of Neurology in BHU, Varanasi. Sixty patients (aged >16 years) with definite and probable TBM (grade 1 and 2) underwent clinical, cognitive (ICMR-NCTB Battery), neuroimaging, and cerebrospinal fluid (CSF) biomarkers evaluation on admission, and at 3-month follow-up. Outcomes were measured by the modified Rankin Scale (mRS) and modified Barthel index scoring system.

Results: Median age of presentation was 26 (Q1-Q3:22-35). The majority were male (63.3%) and from lower-middle socioeconomic backgrounds. Neurocognitive tests revealed Mild to moderate impairment (40%) cases with Modified Trail Complex Figure Test (75%) most impaired test. Mean levels of interleukin (IL)-6, interferon (IFN)-gamma, tumour necrosis factor (TNF)-alpha, S100B, matrix metalloproteinase (MMP)-9 and neuron-specific enolase (NSE) were 18.38 ± 3.86 pg/ml, 305.60 ± 236.43 pg/ml, 375.93 ± 61.69 pg/ml, 2.84 ± 2.84 ng/ml, 0.80 ± 1.50 ng/ml and 2.92 ± 3.98 ng/ml respectively. S100B and NSE, markers of neuronal injury, demonstrated minimal correlation with impairment scores.

Discussion: Deficits were noted across cognitive domains, with significant improvement at 3 months—especially in Grade 1 patients—highlighting the impact of early disease severity on recovery. Inflammatory markers (IL-6, INF-gamma, and TNF-alpha) and neuronal injury markers (S100B and NSE) showed weak, non-significant correlations with outcomes. MMP9 showed a shifting trend, suggesting a possible delayed neuroprotective role.

Conclusion: Neurocognitive impairment is common in TBM. Grade 1 patients show better recovery. Biomarker correlations suggest potential for monitoring severity and recovery.

Abstract ID 17: To Study the Pattern of Neurological Manifestations of HIV in the Era of Highly Active Anti-Retroviral Therapy (HAART)

Chinmay Kumbhar, Rahul Kulkarni, Shripad Pujari, Vishal Deshpande

Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India

Background and aim: We hypothesized that with the widespread use of Highly Active Anti-Retroviral Therapy (HAART), the clinical landscape of neurological manifestations in People Living with human immunodeficiency virus (HIV) (PLHIV) has shifted. While opportunistic infections have declined due to improved immune control, there is a noticeable rise in neurodegenerative, vascular, and treatment-related neurological complications. This study aimed to evaluate the spectrum and pattern of neurological manifestations of HIV in the HAART era and correlate them with immune and virological status.

Methodology: This prospective observational study was conducted over 21 months (January 2021 to November 2022) at a tertiary care hospital in Western Maharashtra. A total of 88 HIV-positive patients presented with neurological symptoms and on HAART were included. Patients were evaluated clinically, radiologically, and through laboratory investigations. Neurological manifestations were classified anatomically and etiopathologically. Patients were stratified into four groups based on virological suppression and CD4 counts.

Results: Brain involvement was most common (85%), followed by peripheral nerves (24%) and spine (9%). Etiologically, 45.5% of patients had neurodegenerative/neurotropic conditions, 43.1% had opportunistic infections, 25% experienced vascular events, and 25% had HAART-related side effects. Opportunistic infections were most prevalent in patients with CD4 < 200 cells/mm³. Neurodegenerative disorders, particularly HIV-associated neurocognitive disorder (HAND), were also common in patients with preserved immune function.

Discussion: Use of HAART has changed the spectrum of neurological manifestations of HIV. Opportunistic infections remain significant in immunocompromised individuals but neurodegenerative, vascular complications and HAART related side effects are increasingly prominent among immunologically and virologically suppressed patients. These observations align with majority Indian and Global literature indicating a changing landscape of HIV neurology in the post-HAART era.

Conclusion: HAART has led to a paradigm shift in neurological manifestations of HIV. Except in patients with low CD4 counts, neurodegenerative and neurotropic effects of HIV are more common than opportunistic infections.

Abstract ID 18: A Lumpy Bumpy Road to Diagnosis: Skull Base Granulomatous Histiocytosis

Akansha Jain, Sanchit Chouksey, Nayana Bhuyan, Vijay Mishra, Abhishek Pathak, Vijay Mishra, Abhishek Pathak

Banaras Hindu University, Varanasi, Uttar Pradesh, India

Background and aim: Rosai-Dorfman Disease (RDD) is a rare non-Langerhans cell histiocytosis characterized by massive lymphadenopathy, most commonly cervical. Although extranodal involvement occurs in 40% of cases, central nervous system (CNS) and skull base involvement are exceedingly rare. Aim of this study included a keen suspicion in a given clinical picture and early diagnosis.

Methodology: A clinical case of 44-year-old male presented with an 8-month history of progressively enlarging, painless right-sided neck swelling, which became bilateral and matted. He also developed a right temporal throbbing headache that became holocranial, bilateral ptosis (right followed by left), horizontal diplopia, complete ophthalmoplegia, sensorineural hearing loss, dysphonia with nasal twang, loss of taste, and dysphagia for both solids and liquids. There was associated weight loss of 8–10 kg over 3–4 months without any other constitutional symptoms, autoimmune features, or signs of systemic illness. He had a remote history of left hemiparesis six years prior, with complete recovery. Neurological examination revealed multiple lower cranial nerve palsies (III, IV, VI, VII, VIII, IX, X, and XII). The Magnetic Resonance Imaging (MRI) brain revealed T2/FLAIR hyperintensities with contrast enhancement at the skull base, involving the cavernous sinus and nasopharynx, suggestive of granulomatous infiltration. Routine labs were unremarkable. Cervical lymph node biopsy showed numerous large histiocytes with emperipolesis and congested vascular channels on Hemoatoxyline and Eosin (H & E) staining, diagnostic of Rosai-Dorfman Disease.

Results: The patient is still undergoing treatment.

Discussion: Skull base involvement in RDD is exceptionally rare, often mimicking meningiomas or granulomatous diseases. MRI findings are nonspecific, making histopathology crucial for diagnosis. Surgical resection, sometimes combined with steroids or radiotherapy, remains the primary treatment approach.

Conclusion: This case highlights a rare presentation of RDD with extensive skull base involvement leading to multiple cranial neuropathies. In patients presenting with atypical cranial nerve syndromes and neck masses, RDD should be considered in the differential diagnosis. Early neuroimaging and histopathological confirmation are essential for accurate diagnosis and timely intervention.

Abstract ID 19: Transcranial Doppler in Tuberculous Meningitis: Diagnostic, Prognostic, and Therapeutic Implications in Vasculopathy

Akansha Jain, Vijay Mishra, Abhishek Pathak

Banaras Hindu University, Varanasi, Uttar Pradesh, India

Background and aim: Tuberculous meningitis (TBM) is the most severe form of central nervous system tuberculosis, characterized by high mortality and long-term neurological sequelae. Cerebral vasculopathy is a major complication, often resulting in ischemic strokes and poor outcomes. Transcranial Doppler (TCD) ultrasonography has emerged as a non-invasive tool to assess intracranial hemodynamics and detect vasculopathy in TBM. Aim of the current study was to evaluate TCD parameters across different stages of TBM, correlate them with functional outcomes and neuroimaging findings, and determine the clinical utility of TCD in prognostication.

Methodology: In this prospective observational study conducted at a tertiary care center in India, 80 adult patients diagnosed with TBM based on standard criteria were enrolled. Serial TCD assessments were performed at admission, during clinical deterioration, and at 3-month follow-up. Parameters such as mean flow velocity (MFV), pulsatility index (PI), and Lindegaard ratio (LR) were analyzed. Magnetic Resonance Angiography (MRA) was used to validate TCD findings. Functional outcomes were assessed using the modified Rankin Scale (mRS), Glasgow Coma Scale (GCS), and MRC sum score at discharge and 3-month follow-up.

Results: Abnormal TCD findings suggestive of vasculopathy were observed in over 30% of patients, with MCA involvement being the most frequent. High MFV and LR values were significantly associated with infarctions on MRA and poor functional outcomes (p < 0.05). PI reduction post-ventriculoperitoneal shunt correlated with clinical improvement in hydrocephalus cases.

Discussion: The study highlights TCD ultrasonography as a vital bedside tool for early detection and dynamic monitoring of cerebral vasculopathy in tuberculous meningitis. TCD abnormalities correlated with infarcts, poor outcomes, and intracranial pressure dynamics, offering predictive value and aiding real-time intervention, especially in resource-limited settings where MRI access is constrained.

Conclusion: TCD is a reliable bedside modality for detecting TBM-associated vasculopathy, guiding therapeutic decisions, and predicting outcomes. Its integration into clinical protocols can enable earlier intervention and personalised monitoring in TBM management.

Abstract ID 20: To Develop a Machine Learning Model to Diagnose Acute Ischemic Stroke, Large Vessel Occlusion and Cerebral Collaterals

Dulari Gupta, Shankar Gorthi, Dhiraj Dhane¹, Sumit Kharat, Chetna Patil, Shreehari Dinesh, Aditya Ghadge¹, Soham Sant¹, Priscilla Joshi, Vivek Murumkar

Bharati Vidyapeeth Medical College, Pune, Maharashtra, ¹Bharati Engineering College, Pune, Maharashtra, India

Background and aim: Acute ischemic stroke (AIS) is a major cause of morbidity and mortality with limited access to advanced treatments like thrombolysis and mechanical thrombectomy in resource-constrained settings. We aimed to develop a machine learning (ML) model to detect AIS, large vessel occlusion (LVO), and cerebral collateral status using non-contrast computed tomography (CT) (NCCT) and CT angiography (CTA).

Methodology: This prospective observational study enrolled patients with suspected anterior circulation AIS at a University Medical College in Maharashtra (Oct 2022–May 2025). NCCT and CTA were segmented semi-automatically using ITK SNAP. Cerebral collaterals were classified (TAN, MAAS, MITEFF, Multiphase CTA scores). Seven ML models were trained.

Results: Of 156 patients, 67.7% were male, with prevalent risk factors including hypertension (56.6%) and diabetes (36.4%). Median NIHSS was 8 (IQR 4-14), CT ASPECTS 9 (IQR 8-10), and 55.8% had good collaterals. The best ML model achieved [insert sensitivity, specificity, e.g., 85% sensitivity, 90% specificity] for AIS detection.

Discussion: This study developed an ML model achieving 85% sensitivity and 90% specificity for AIS detection, comparable to prior models. A multicentric Chinese study used Deep Learning to improve CT ASPECTS reporting and reduce reporting time by radiologists). A ML model was developed based on 499 patients from the ESCAPE-NA1 Trail using NCCT Brain and CT Angiography with good sensitivity 94.12% and specificity of 97.96% in classifying LVO (Present vs absent). Another Chinese study found NCCT and CTA comparable to CT Perfusion in detection of AIS when DL Models were used amongst 345 subjects. Our integration of NCCT and CTA for LVO (82% sensitivity) and collateral status (78% accuracy) is novel, addressing a gap in resource-limited settings.

Conclusion: This ML model is a promising tool for aiding physicians in remote areas to decide on thrombolysis and refer patients for thrombectomy, potentially saving billions of neurons by expediting care.

Abstract ID 21: Predictors and Outcome of Symptomatic Intracranial Haemorrhage in Patients with Acute Ischaemic Stroke Undergoing Intravenous Thrombolysis

Athira P, Chithra P

Government Medical College, Trivandrum, Kerala, India

Background and aim: Symptomatic intracerebral hemorrhage (sICH) following intravenous thrombolysis can lead to life-threatening and debilitating outcomes. Identifying radiological predictors and integrating them with clinical predictors, particularly in populations where limited studies exist, is crucial. Primary objective was to study the predictors and secondary to assess outcome of sICH.

Methodology: In this prospective cohort study at Government Medical College, Trivandrum, between June 2023 to June 2024, patients with AIS undergoing IVT were recruited. sICH was defined as per the ECASSIII criteria and the cohort was followed up, clinicoradiological parameters and outcome were compared between groups with and without sICH. Risk factors were identified using a logistic regression analysis. Predictive efficacy of risk prediction models – HAT, SEDAN, THRIVE, SPAN100 also analysed.

Results: The study found that the incidence of sICH was 9.17%. The intrahospital mortality rate from sICH was 63.64%, with all patients having a modified Rankin Scale (mRS) score greater than 2 at three months.

Discussion: Significant risk factors for sICH identified include vascular risk factors: Previous cerebrovascular accident (CVA), transient ischemic attack (TIA), and coronary artery disease (CAD), blood pressure parameters: Highest diastolic blood pressure, mean diastolic blood pressure, the need for four antihypertensive medications within 24 hours post-thrombolysis, and the median dose of nitroglycerin (NTG), stroke severity: A National Institutes of Health Stroke Scale (NIHSS) score greater than 15, and TOAST etiology: Cardioembolic origin.

Conclusion: After multivariable analysis, three parameters emerged as independent predictors of sICH in this study: 1. Higher mean diastolic blood pressure 2. Stroke severity [NIHSS > 15], and 3. Poor CT ASPECTS (≤8). The study also highlighted that existing bedside sICH risk prediction models—HAT, SEDAN, THRIVE, and SPAN-100—did not effectively identify patients at high risk of sICH in this population. This underscores the need to develop more accurate and tailored risk prediction models

Abstract ID 22: Insights into IgG4-Related CNS Inflammatory Disease and Role of Immunotherapy in Managing IgG4-Related CNS Disorders

Karthik Survi, Kamlesh Jagiashi

Grant Medical College and JJ Hospital, Mumbai, Maharashtra, India

Background and aim: Neurological involvement of immunoglobulin G4-related disease (IgG4-RD) has limited data and treatment strategies has been still a gray area for clinicians, especially in case of relapses. Aim of this study was to evaluate clinical features, diagnostic approaches, treatment outcomes, and prognosis in 24 patients with central nervous system (CNS) IgG4-RD.

Methodology: Inclusion Criteria included the confirmed diagnosis of CNS IgG4-RD based on clinical, radiological, and serological findings with elevated serum IgG4 levels or biopsy-proven IgG4-positive plasma cell infiltration fulfilling the comprehensive diagnostic criteria or Lindstrom criteria. Exclusion Criteria was the other concurrent CNS inflammatory or autoimmune diseases.

Results: In our single center retrospective cohort of 24 patients, mean age of participants was 35.5 years with males (n = 10, 42%) and females (n = 14, 58%). As per institution protocol all patients have been treated with pulse dose of steroids followed by oral steroids tapper to minimal dose over 8 weeks. In our study, we documented retrospectively analyzed patients into 2 groups— steroid responders vs non responders after 8 weeks of therapy.

Discussion: The primary aim of this study was to characterize the neurological disorders of IgG4RD in the Indian cohort. Of the 24 patients, the diagnosis was probable in 7 patients. In 17 patients, the level of certainty was treatment response, which was comparable to a previous study, where 19 (79%) patients has shown objective improvement in visual acuity and cranial nerve palsy. In 5 (21%) patients, there wasn’t complete resolution of symptoms after 8 weeks of steroid therapy and required steroid sparing agent like rituximab. Of 24 patients, 7 (29%) relapsed and required long term immunotherapy.

Conclusion: IgG4RD should be considered in the differential diagnosis of chronic relapsingremitting disease of the CNS along with systemic disorders. It is potentially controllable with tailored therapy with steroids and rituximab. Early diagnosis and prompt ruling out potentially close differential like infective CNS disorders to be done.

Abstract ID 23: Evaluating the Therapeutic Effect of Supervised Mindfulness of Breathing on Chronic Migraine: A Randomized Double-Blind Study

Kumari Archana, Naresh Chinthala, Jyoti Garg, Ashish Duggal

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Chronic migraine (CM) is a debilitating condition with significant impact on quality of life. With conventional therapies benefiting only half of patients, and many discontinuing due to adverse effects, complementary strategies are important. This study evaluated “Mindfulness of Breathing” (Anapana Meditation) as adjuvant therapy for CM.

Methodology: In this double-blind, randomized trial, 80 adults with chronic migraine [International Classification of Headache Disorders (ICHD)-3 criteria] were randomly assigned to either a supervised or unsupervised meditation group. The supervised meditation group attended five supervised sessions and received audio guides and WhatsApp support for home practice. The unsupervised group practiced without guidance. All participants logged their meditation, headache patterns, and medication use, while following lifestyle modifications.

Results: The intention-to-treat analysis (n = 80) showed that the primary outcome of Monthly Headache Days (MHD) decreased from 22.78 ± 6.03 to 18.23 ± 8.73 in the unsupervised group. In the meditation group, MHD reduced from 22.7 ± 6.09 to 10.88 ± 7.15, resulting in a mean difference of 8.19 MHD between the 2 groups. Mixed-effects ANOVA revealed significant differences between groups with a substantial intervention-time interaction (F (3, 234) = 14.64, p = <.001). Monthly Migraine Days (MMD) also showed a significant difference of 6.24 days between 2 groups at three months and a significant intervention – time interaction (F (3, 234) = 10.01, p < .001.

Discussion: Supervised Anapana Meditation enhanced compliance and effect size was greater when compared to previous trials. Mindfulness-based therapies necessitate consistent supervision, but Anapanasati meditation is more convenient for home practice. Compliance was enhanced by WhatsApp groups where instructors constantly motivated the participants, thus showing telemedicine’s value in mindfulness-based therapies.

Conclusion: This study showed that supervised Anapanasati-based mindfulness of breathing meditation significantly improved multiple migraine-related outcomes compared to unsupervised control as an add-on therapy for CM.

Abstract ID 24: The Clinical and Radiological Features in Spontaneous Intracranial Hypotension - A Retrospective Study

Kiren Koshy, Asish Vijayaraghavan

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Background and aim: To describe the clinical and radiological features of patients diagnosed with Spontaneous Intracranial Hypotension (SIH) by the International Classification of Headache Disorders (ICHD)-3 criteria in a tertiary care centre in South India.

Methodology: We studies 34 patients with spontaneous intracranial hypotension diagnosed using ICHD3 criteria and recorded their clinical and radiological features. This was a retrospective study and the electronic medical record was searched using the keywords ‘spontaneous csf hypotension, ‘spontaneous intracranial hypotension, ‘intracranial hypotension’, ‘csf hypotension’, ‘low pressure headache’, ‘orthostatic headache’ and ‘epidural blood patch’.

Results: 34 patients (25 female and 9 male) with a mean age of 41.71 years were included. The mean duration of headache leading to the diagnosis was 74.88 days. The common clinical features were orthostatic headache (97%), nausea/vomiting (38.2%), photophobia (17.6%), phonophobia (14.7%), tinnitus (8.8%), neck pain (26.5%) and double vision (14.7%). The headache pattern was intermittent in 32.4% of cases, continuous in 55.9% and mixed in 11.7% of cases. The radiological features observed were diffuse pachymeningeal enhancement (82.4%), subdural collection (47.1%), tonsillar ectopia (67.6%), drooping of the splenium of corpus collosum (47.1%), pituitary engorgement (52.9%), venous sinus engorgement (50%), spinal epidural collection (73.5%), reduced mamillopontine distance (<6.5 mm) in 76.5%, reduced pontomesencephalic angle (< 50) in 61.8% and reduced interpeduncular angle (<40.5) in 14.7%. The mean pontomesenphalic angle (PMA) was 40.74 degrees and the mean mamillopontine distance (MPD) was 4.66 mm.

Discussion: This is the largest study on SIH from the Indian subcontinent. The study patients were predominantly female, a trend that has been seen in most series of SIH, but remains unexplained. Compared to previous studies, we noted a higher frequency of tonsillar herniation and brainstem descent.

Conclusion: A high index of suspicion is needed to diagnose cases of SIH. Orthostatic headache and pachymeningeal enhancement remain the commonest features and quantitative indices can aid in the diagnosis.

Abstract ID 25: Long-term Seizure Freedom and Resolution of Epilepsy in Patients with Drug-Resistant Epilepsy and Focal Cortical Dysplasia – Comparison of Surgical Versus Medical Management

Pachipala Sudheer, Sita Jayalakshmi, Sudhindra Vooturi, Anuja Patil, Manas Panigrahi

KIMS Hospital, Hyderabad, Telangana, India

Background and aim: Focal malformations of cortical development (MCD), including focal cortical dysplasia (FCD), are prominent causes of drug-resistant epilepsy in children and adults. Studies on comparative data on long-term results of surgical versus medical management in focal MCDs are limited. This study aimed to evaluate the long-term seizure remission, resolution of epilepsy, mortality, and predictors of outcome in patients with focal cortical dysplasia and drug-resistant epilepsy who underwent surgery versus those who received best medical management.

Methodology: A retrospective review was conducted on prospectively collected data from patients with FCD and drug-refractory epilepsy treated between 2003 and 2022 at a tertiary referral centre. Patients were categorized into two groups: surgical and medical. Primary outcomes included seizure freedom (≥2 years) and epilepsy resolution (≥10 years seizure-free and ≥5 years off ASMs). Secondary outcomes included mortality and predictors of seizure

Results: Of the 613 patients, 204 (33.28%) underwent epilepsy surgery, and 409 (66.72%) received medical management. Follow-up ranged from 2-20 years. Among surgical patients, 67% achieved favourable outcome (Engel I and II) while 62.2% were seizure-free at the last follow-up. Significantly, more patients in the surgical group had seizure freedom (62.2% vs. 30.8%, p < 0.001) and resolution of epilepsy (3.9% vs. 0%), when compared to those on medical management. Type 3 FCD and older age at seizure onset predicted better surgical outcomes, while cognitive impairment, Type 1 FCD, and multiple seizure types were predictors of poor outcome across both groups. The mortality was low and similar between groups.

Discussion: Surgical intervention offers superior seizure control and long-term resolution compared to continued medical therapy. Type and localization of FCD significantly influence outcomes.

Conclusion: Seizure freedom was achieved in nearly 62% of patients with FCD and DRE compared to 30% with best medical management. Type 3 FCD and older age at seizure onset were predictors of seizure freedom in the surgical group.

Abstract ID 26: Creating a Composite Score for Prediction of Presence of Seropositivity and Immune Responsiveness in Cases of Autoimmune Seizure and Epilepsy Syndromes

Vedang Desai, Manjari Tripathi, Madhavi Tripathi, Deepti Vibha, Rajesh Singh, Jasmine Parihar, A Elavarasi, Animesh Das

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Immune mediated seizure and epilepsy syndromes are rarer subtypes of syndrome complexes comprising of seizures as a core feature, with numerous other neurological symptoms. However, absolute paradigms in diagnosis, subtypes of antibodies and treatment guidelines still remain a grey area in the expanding field of epilepsy and neuro-immunology. The aim of the study was to create a composite score for prediction of seropositivity for Immune responsiveness in a case of autoimmune seizure/epilepsy syndrome.

Methodology: Patients with Antibody-positive and antibody-negative (Antibody Prevalence in Epilepsy and Encephalopathy (APE2) score >=4) cases fulfilling the inclusion criteria were included. The study was an ambispective cohort with retrospective cases with point analysis and prospectively enrolled observed for at-least 6 months duration.

Results: Seropositivity Prediction Score (SPS) Parameters were specifically selected based on their statistical association with antibody detection, representing disease characteristics that have demonstrated significant odds ratios for predicting antibody positivity in multivariate analyses. Immunotherapy Response Prediction Score (IRPS) parameters were selected based on their proven association with favourable treatment outcomes (defined as >50% reduction in seizure frequency). A final composite score, was developed and demarcated by high, moderate and low likelihood of antibody positivity and treatment responsiveness in a patient.

Discussion: The determinant factors carrying a role in the composite score were as follows - SPS (seropositivity score) - Age at onset, Movement disorders, cerebrospinal fluid (CSF) while blood cells (WBC) count, status epilepticus, acute to subacute duration of illness, magnetic resonance imaging (MRI) and positron emission tomography (PET) computed tomography (CT) abnormality, cognitive impairment and neoplasm association, with varying Normalised weight for each parameter. The IRPS - Seizure reduction in 1st week, ICU stay, duration of illness, age at onset, Steroid responsiveness, hospitalisation length, CSF protein, status epilepstius, neoplasm and cognitive impairment.

Conclusion: The composite score demarcates the likelihood for seropositivity and immune responsiveness with a demarcation of high, moderate and low likelihood, guiding clinicians for a pragmatic clinical approach.

Abstract ID 27: Awareness and Impact of Educational Intervention on Driving Regulations in Persons with Epilepsy and Their Caregivers: A Prospective Interventional Study

Jasmine Parihar, Divya MR, Achal Srivastava, Vinay Goyal, Awadh Pandit, Elavarasi Parihar, Deblina Biswas

All India Institute of Medical Sciences, New Delhi, India

Background and aim: The Motor Vehicles Act (MVA), 1939 in India prohibits persons with epilepsy (PWE) from driving if they have ever experienced a seizure, given their heightened risk of road traffic accidents. Despite this, awareness about these legal restrictions remains low among PWE and caregivers. We aimed to assess baseline awareness and evaluate the impact of a structured educational intervention on knowledge and driving practices in PWE and caregivers.

Methodology: This prospective interventional study was conducted at a tertiary care institute in North India from June 2020 to October 2022. A structured questionnaire was administered to 355 PWE and 351 caregivers to evaluate their awareness of legal driving restrictions. Following a single-session educational intervention about epilepsy and driving laws, participants were reassessed at 3 months for changes in awareness and self-reported driving behavior.

Results: The mean age of PWE was 29.74 ± 10.87 years, and that of caregivers was 41.29 ± 12.69 years. At baseline, only 49.86% of PWE and 56.67% of caregivers were aware of the legal prohibition of driving for PWE. Post-intervention, awareness significantly improved in PWE (49.86% to 93.52%, p < 0.001) and caregivers (56.67% to 95.15%, p < 0.001). Awareness of the legal implications of driving with epilepsy increased from 64.23% to 93.24% (p < 0.001). The proportion of PWE who were actively driving reduced significantly from 45.07% at baseline to 24.51% at follow-up (p < 0.001). Multivariate analysis revealed that daytime seizures (p < 0.01) and absence of aura (p < 0.05) were independently associated with adherence to driving restrictions. These factors may contribute more due to fear of accidents than due to enhanced legal awareness.

Discussion: This study highlights the substantial gaps in knowledge regarding legal driving restrictions among PWE and caregivers in India. Educational interventions significantly enhance awareness and positively modify driving behavior.

Conclusion: Educational interventions and physician counselling improve knowledge and promote safer driving practices.

Abstract ID 28: Evaluation of Social Determinants of Health and Drug Adherence in People with Epilepsy

Vyshnavi Jamalapuram, Sita Jayalakshmi S, Anuja Patil, Sudhindra Vootori, Adhithy Devi

KIMS Hospital, Hyderabad, Telangana, India

Background and aim: Social determinants of health (SDoH) significantly influence anti-seizure medication (ASM) adherence in people with epilepsy (PWE). Low socioeconomic status, unemployment, financial insecurity, and limited education can hinder access to care, medication affordability, and appointment attendance. This study evaluated the relationship between SDoH and anti-seizure medication (ASM) adherence among PWE.

Methodology: This retrospective cohort study analyzed SDoH data and ASM adherence in PWE aged 18 and above, who visited the neurology OPD of a tertiary hospital in India from January 2023 to March 2025. Informed consent and institutional ethics committee approval were sought. Demographic and epilepsy-related data were obtained from participants’ outpatient records. Patient-reported questionnaires were used to assess SDoH using the AAFP Social Needs Screening Tool and medication adherence using the Morisky Medication Adherence Scale (MMAS). SDoH were evaluated across multiple domains, including their relationship to drug adherence.

Results: A total of 1,124 PWE with an SDoH assessment were included (mean age of 31.21 ± 11.81 years, 47.3% female). One hundred and ninety six (17.4%) participants reported significant social needs, 757 (67.3%) had moderate social needs, whereas 171 (15.2%) had no social needs. Four hundred and sixty two (41%) participants had high ASM adherence, 432 (38.4%) had medium adherence, whereas 226 (20.0%) had low adherence. PWE with moderate and significant social needs had low ASM adherence (p < 0.001).

Discussion: This study emphasizes that among PWE, moderate to significant social needs are associated with reduced adherence to ASMs, consistent with findings from previous research. This study underscores a paradigm shift, with a growing number of PWE exhibiting moderate to high drug adherence—a likely result of enhanced awareness and patient engagement.

Conclusion: This SDoH assessment highlights the critical role of individual social needs in epilepsy care and helps identify high-risk individuals, uncovering treatment gaps that may benefit from targeted psychosocial support.

Abstract ID 29: Imaging Markers Predict the Short-Term and Long-Term Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Disease

Anagha Rajiv, Adarsh Anil, Rinta Paul, Kesavadas C, Sapna Sreedharan, Sankara P¹, Sylaja P N

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, ¹Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India

Background and aim: Symptomatic intracranial atherosclerotic disease (ICAD) is associated with high risk of stroke recurrence despite medical management. The study evaluated the clinical and imaging markers in identifying the high-risk group of symptomatic ICAD patients.

Methodology: This was a single center, hospital-based, prospective study (January 2011-March 2024) of patients with symptomatic ICAD within one month of onset. The study was approved by the Institutional Ethics Committee. The baseline images were reviewed by a neuroradiologist blinded to clinical information. The intracranial arterial stenosis, infarct patterns, white matter hyperintensities (WMH) and collateral flow were documented. The primary outcome was the recurrent stroke/transient ischemic attack within 3 months and 1 year.

Results: Of 229 patients enrolled, the mean age was 59.69 ± 10.18 years (men, 72.9%). At one-year follow up, 55 (24.02%) patients had recurrent stroke; 20.5% within 3 months and 6.11% beyond 3 months. The territorial and cortical infarct pattern (27.3% vs 15.8%, p = 0.04), moderate-severe WMH (32.6% vs 17.7%, p = 0.03), hypertension (23.8% vs 11.5%, p = 0.04), diabetes (24.7% vs 3.3%, p = 0.04) and coronary artery disease (35.7% vs 18.4%, p = 0.03) predicted early stroke recurrence. The territorial and cortical infarct pattern (31.8% vs 18.8%, p = 0.02), length of stenosis (8.03 ± 6.47 vs 6.25 ± 5.51, p = 0.04), diabetes (28.8% vs 15.7%, p = 0.02) and coronary artery disease (39.3% vs 21.9%, p = 0.04) predicted later recurrence. On multivariate analysis, the territorial and cortical infarct pattern (OR, 2.134; 95% CI, 1.08-4.23; p = 0.03) independently predicted early stroke recurrence.

Discussion: The stroke recurrence was highest during the early weeks after stroke onset. The correlation of territorial and cortical infarct pattern with early stroke recurrence implies the role of artery-to-artery embolism and the plaque instability in causing stroke recurrence.

Conclusion: The territorial and cortical infarct pattern predicts early stroke recurrence in symptomatic ICAD.

Abstract ID 30: Clinical and Videofluoroscopic Profile of Post-Stroke Dysphagia Beyond 1 Month of Stroke– An Ambispective Study

Lakshmi Nair, Sapna Sreedharan

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Background and aim: Dysphagia is a common complication after stroke, leading to increased risk of aspiration pneumonia, dehydration and chronic malnutrition thereby increasing morbidity and mortality. This study aimed to systematically assess swallow function using bedside screening and videofluoroscopic swallow studies (VFS) in patients with dysphagia persisting beyond one-month post-stroke, its associations, and to evaluate the impact of feeding interventions percutaneous endoscopic gastrostomy (PEG) on functional outcomes.

Methodology: This was an ambispective study conducted at a comprehensive stroke care centre from June 2023 to December 2024. Data from 50 consecutive patients with persistent post-stroke dysphagia and undergoing VFS were studied. Clinical and demographic data, imaging findings, and VFS results were collected. Patients were classified into high-risk (PAS > 6) and low-risk (PAS < 6) aspiration groups. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 3 months and 1 year with scores 0-2 taken as good outcome.

Results: Of the 50 patients with persistent post-stroke dysphagia, 62% were at high risk for aspiration. Cardioembolic strokes tended to have significant post-stroke dysphagia in our cohort. Recurrent strokes tended to show more severe dysphagia, while features such as aphasia, dysarthria, or stroke severity, territory involved, presence of chronic infarcts and white matter hyperintensities were not significantly different between the 2 groups. VFS revealed that pharyngeal stage impairment and cough response were significantly more common in the high-risk group. Only a small proportion of persistent severe dysphagia group underwent PEG placement. No significant differences in functional outcomes were observed between patients with or without PEG at 3- and 12-months post-stroke.

Discussion: Our cohort showed a high prevalence (62%) of aspiration risk among stroke patients, consistent with previous reports of persistent dysphagia in both acute and chronic phases. Demographic and stroke subtype profiles were similar between high- and low-risk groups, though males trended higher in the high-risk category. Ischemic stroke predominated, and bulbar symptoms with higher NIHSS scores were more frequent in the high-risk group, though not statistically significant, underscoring the multifactorial nature of post-stroke dysphagia. The VFS revealed significantly greater pharyngeal stage impairment and poor cough response in the high-risk group, highlighting VFS’s value for risk stratification and intervention planning. Despite identifying many high-risk patients, only a third underwent PEG placement, reflecting patient and caregiver hesitancy and emphasizing the need for individualized, patient-centered dysphagia management.

Conclusion: Persistent dysphagia and aspiration risk remains significant post-stroke, more in cardioembolic strokes. VFS findings like pharyngeal phase impairment and cough response are more predictive of aspiration in addition to PAS scores. PEG placement did not independently improve long-term outcomes highlighting the need for individualized, multidisciplinary management.

Abstract ID 31: Bleeding but not Broken: Outcomes of Anticoagulation in 27 Cases of Cerebral Venous Thrombosis with Subarachnoid Hemorrhage

Sujoy Kabiraj, Subasree Ramakrishnan, Girish Kulkarni

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Cerebral venous thrombosis (CVT) presenting with subarachnoid hemorrhage (SAH) is rare and diagnostically challenging. Management is often complicated by the dilemma of initiating anticoagulation in the presence of hemorrhage. We aimed to evaluate the clinical, radiological spectrum, treatment strategies, and outcomes in CVT-SAH, with a special focus on anticoagulation safety.

Methodology: This retrospective observational study included 27 patients with imaging-confirmed CVT and sulcal convexity SAH, admitted between January 2022 and December 2024 at a tertiary stroke center. Clinical data, neuroimaging, risk factors, venous sinus involvement, treatment details, and outcomes [modified Rankin Scale (mRS)] were extracted from discharge records. All patients received therapeutic anticoagulation (subcutaneous heparin followed by nicoumalone with INR-guided titration). Surgical interventions and complications were noted.

Results: Mean age was 41.6 ± 12.2 years; 78% were male. Alcohol use was present in 52%, tobacco in 37%, and hyperhomocysteinemia in 48%. Superficial venous sinus thrombosis (SSS, transverse, sigmoid) was noted in all, while deep venous involvement occurred in 11.1%. All had convexity SAH, with 33% also exhibiting intracerebral hemorrhage. Despite SAH, anticoagulation was initiated and continued in all patients without interruption. No patient deteriorated due to anticoagulation. One patient (3.7%) underwent decompressive craniectomy; no cases of hydrocephalus or VP shunting were observed. At 3 months, 74% had favorable outcomes (mRS ≤2). Mortality was 0%.

Discussion: CVT with SAH, particularly when limited to the cortical sulci, presents a therapeutic challenge due to perceived bleeding risks. However, our findings reaffirm that anticoagulation should not be withheld in such cases. Heparin followed by nicoumalone was well tolerated, with no anticoagulation-related clinical worsening or new hemorrhagic events observed.

Conclusion: Anticoagulation in CVT-associated cortical SAH appears to be safe and effective. Early diagnosis, INR-guided therapy, and consistent clinical monitoring can lead to favorable neurological outcomes and reduce the need for invasive interventions.

Abstract ID 32: Barriers to Acute Stroke Management: Pre-Hospital and in-Hospital Delays and Their Impact on Outcomes

Saurav Raja, Jyoti Garg, Ashish Duggal

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Stroke management is time-sensitive, and it is important to recognise the underlying barriers. This study aimed to identify the factors contributing to pre-hospital and in-hospital delays in acute stroke management.

Methodology: This prospective observational study was conducted at the Department of Neurology, ABVIMS & Dr. RML Hospital, New Delhi, from July 2023 to December 2024. A total of 100 patients having ischemic or hemorrhagic stroke were included. National Institute of Health Stroke Scale (NIHSS) and baseline modified Rankin Scale (mRS) were calculated. Standard medical management was done. The caregiver was interviewed with a pre-structured questionnaire. The mRS at 30 days was done.

Results: A total of 29 patients (29.0%) had hemorrhagic strokes, whereas 71 patients (71.0%) suffered from ischemic strokes. Thirty eight patients went to other hospitals before presenting to RML hospital. At RML, 90 patients underwent non-contrast computed tomography (NCCT) head. Among them, 41 patients (45.5%) had their scans within 15 minutes, while 49 patients (54.5%) had it within 30 minutes. Door-to-Treatment Time- (40.0%) received treatment within 60–90 minutes after arrival, followed by (28.0%) within 90–120 minutes, (24.0%) within 120–150 minutes, and 8 (8.0%) within 30–60 minutes. Twenty patients underwent thrombolysis, 18 (90.0%) had a door-to-needle time of 75 minutes.

Discussion: This study showed that the major prehospital barriers in the management of acute stroke are delay in the recognition of symptoms by the attendant, delay in time from onset to calling for assistance, and delay in bringing the patient to a tertiary care facility. The in-hospital barriers were delays in the NCCT time and its availability, and delays in door-to-treatment time.

Conclusion: This study identifies the major barriers leading to delay in acute stroke management. If we can significantly reduce these delays, it should positively affect acute stroke care and improve outcomes.

Abstract ID 33: Study of Risk factors of Cerebral Small Vessel Disease and it’s Correlation with Obstructive Sleep Apnea

Drishti Khatri, Joy Desai, Arun Shah, Manish Chhabria

Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India

Background and aim: This study aimed to determine the prevalence of obstructive sleep apnea (OSA) in patients with cerebral small vessel disease (CSVD), assess the impact of OSA severity on radiological and functional outcomes, and evaluate the contribution of traditional vascular risk factors to CSVD burden.

Methodology: We conducted a single-centre, observational study at Sir H. N Reliance Foundation Hospital and Research Centre over 12 months, enrolling 83 adults (>18 years) with magnetic resonance imaging (MRI)-confirmed CSVD. Participants underwent comprehensive clinical assessment, Epworth Sleepiness Scale (ESS) scoring, and overnight polysomnography to diagnose and grade OSA severity. The MRI findings were interpreted according to STRIVE criteria, and white matter hyperintensity (WMH) burden was quantified using the Fazekas scale. Functional outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at discharge. Statistical analyses were performed with STATA 15.

Results: The cohort had a mean age of 66.6 years, with a predominance of males (69%). OSA was identified in 76.2% of CSVD patients, with varying severity. The WMH was observed in 97.6% of cases. Notably, moderate-to-severe OSA was significantly associated with higher Fazekas scores and increased white matter burden (p < 0.05). Severity of OSA also correlated with poorer functional outcomes, as reflected by higher NIHSS and modified Rankin Scale (mRS) scores at discharge. These associations persisted independently of conventional vascular risk factors such as hypertension and diabetes.

Discussion: The findings underscore OSA as a prevalent and potentially modifiable risk factor in CSVD, contributing to both radiological and clinical deterioration. The observed associations suggest pathophysiological mechanisms related to intermittent hypoxia and impaired glymphatic clearance.

Conclusion: OSA is highly prevalent among CSVD patients and is independently associated with increased radiological burden and worse functional outcomes. Early identification and management of OSA may represent a critical strategy to attenuate CSVD progression and improve neurological prognosis.

Abstract ID 34: A Prospective Study to Evaluate the Role of Post Stroke Inflammation in both Ischemic and Hemorrhagic Stroke

Sidharth Sharma, Ajai Singh

Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background and aim: Stroke is a systemic disease wherein it has been postulated that stroke related systemic inflammatory response and immune dysregulation play an important role in brain injury, recovery, and outcome. A novel index, Systemic Immune-inflammation Index (SII) has been shown to be associated with outcomes of cancer patients. However, its application in acute stroke has rarely been reported. Therefore, we examined the relationship between SII levels at hospital admission and the outcome of patients 3 months after onset to predict the probability of adverse outcomes.

Methodology: 103 patients diagnosed with acute stroke within 72 hours were enrolled and evaluated at admission along with follow up by modified Rankin Scale (mRS) 3 months later.

Results: Receiver operating characteristic curve analysis indicated the best cut-off value of SII as 713.21 with it being 737.05 for ischemic and 731.35 for hemorrhagic stroke, respectively. Higher SII was significantly associated with poor outcome. Analysis showed SII level of the poor outcome and moderate-severe stroke group was higher than that of the good outcome and minor stroke group, respectively.

Discussion: In the study, four factors were found to significantly influence the outcome of patients after an acute stroke namely age, gender of the patients, initial National Institute of Health Stroke Scale (NIHSS) score and SII. Hence, binary logistic regression analysis was applied for these variable wherein age (OR = 1.045), initial NIHSS (OR = 1.388) and SII (OR = 1.135) was found to be individually associated with outcome of the patients.

Conclusion: To the best of our knowledge, this is a first prospective study to look at the link between SII and clinical outcomes in stroke patients. Treating this inflammation might be a viable treatment strategy for limiting brain damage, further emphasizing the point that post stroke inflammation might be the missing cog in the wheel of stroke management.

Abstract ID 35: Assessing Clinical, Radiological, and Biochemical Predictors of PIRA in Rituximab-Treated Cohort of Multiple Sclerosis Patients: A Real-World Study from India

Pritam Majumdar, Thomas Mathew, Shagun Bharadwaj, Surabhi Garg, Sudheeran Kannoth, ¹Sharath GG, Sai Deepalam, Uday Murgod, Vikram Kamath, Sagar Badachi, Sonia Shivde, Akshatha Huddar, Sindhu Nambiar, Gosala Sarma, Raghunandan Nadig

St. Johns Medical College, Bengaluru, Karnataka, ¹Amrita School of Medicine, Kochi, Kerala, India

Background and aim: Progression independent of relapse activity (PIRA) significantly contributes to disability in multiple sclerosis (MS), even among patients on high-efficacy therapies like rituximab. The aim was to evaluate PIRA-related disability in rituximab-treated MS patients and identify clinical, radiological, and biochemical predictors.

Methodology: MS patients on rituximab 2 years were included. Confirmed disability accumulation (CDA) was defined as a 12-week sustained EDSS increase of 1.0 (baseline EDSS =5.5) or 0.5 (>5.5). PIRA was CDA without relapse in the prior 90 days. Pre-treatment magnetic resonance imaging (MRI) were assessed for lesion topography: perivenular (central vein sign/anatomical location) or meningeal (subpial, cortical/juxtacortical). Spinal lesions were central (all quadrants) or segmental (2 quadrants). Brain volumes were compared with age-matched healthy Indian controls. Serum neurofilament light chain (NfL) was measured via Enzyme-Linked Immunosorbent Assay (ELISA) in patients with no relapses in the previous 3 months. Statistical tests included Chi-square, ANOVA, Kruskal-Wallis, Bonferroni correction, and Mann-Whitney U.

Results: Ninety-one patients (76% female, median age 35 [IQR 33–37], median follow-up 6 years) were included. PIRA occurred in 39 patients (43%). Mean EDSS rose from 2.2 ± 1.7 to 3.7 ± 1.8. ARR significantly decreased post-rituximab (0.45 to 0.03, p = 0.002). Clinical predictors of PIRA were older age (p = 0.006) and motor onset (p = 0.022). Radiological predictors included higher lesion volume (p = 0.01), mixed lesion topography—i.e., involvement of both meningeal and perivenular regions (meningeal-to-perivenular ratio 0.5–1.0, p = 0.01), central-to-segmental spinal lesion ratio 1 (p = 0.01), paramagnetic rim lesions (p = 0.01), and reduced volumes of the caudate, putamen, and thalamus (all p = 0.02). Elevated NfL (0.41 ± 0.06 ng/ml, p = 0.01) also correlated with PIRA.

Discussion: PIRA was the main driver of disability despite rituximab.

Conclusion: Older age, motor onset, mixed lesion topography involving both meningeal and perivenular regions, central spinal lesions, deep grey matter atrophy, and elevated NfL may help predict progression.

Abstract ID 36: Eyes, Spines and Minds: The Spectrum of Mog Antibody Disease and its Outcomes

Raj Prabhakar, Mugundhan Krishnan, Thamil Pavai, Uma Maheswari, Natarajan E

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune demyelinating disorder with diverse central nervous system manifestations, including optic neuritis, myelitis, and encephalitis. This study aimed to describe the clinical spectrum, disability impact, and outcomes in patients with MOGAD from a tertiary care hospital in South India

Methodology: We retrospectively analyzed 21 patients with MOGAD confirmed by serum MOG-IgG positivity using a cell-based assay from January 2024-March 2025. Data on demographics, phenotype, immunotherapy (acute and maintenance), relapse profile, and outcomes were extracted. Disability and neuropsychiatric status were assessed using the Modified Fatigue Impact Scale (MFIS), Hamilton Anxiety (HAM-A), Hamilton Depression (HAM-D) scales, and Montreal Cognitive Assessment (MoCA)

Results: The median age was 26 years (range: 14–57), with a female predominance (62%). Bilateral optic neuritis was the most frequent phenotype (57%), followed by encephalitis, myelitis, and mixed presentations. High-dose methylprednisolone was used acutely in 95% of cases. Azathioprine was the most common maintenance therapy (81%), followed by mycophenolate mofetil and rituximab. Four patients (19%) had relapses, mainly optic neuritis. Most had preserved cognition (mean MoCA: 27.2), and mild anxiety/depression (mean HAM-A: 5.5, HAM-D: 5.7), but fatigue varied (mean MFIS: 12.4)

Discussion: The spectrum of MOGAD in this South Indian cohort was heterogeneous, with optic neuritis as the predominant manifestation. Despite some relapses, immunosuppressive therapy led to good cognitive and psychiatric outcomes

Conclusion: MOGAD presents mainly as bilateral optic neuritis. All cases confirmed via serum MOG antibody testing. Early recognition and long-term immunosuppression yield favorable neurological and cognitive outcomes

Abstract ID 37: Cognitive Assessment in Patients of Neuromyelitis Optica Spectrum Disorder (NMOSD) at a Tertiary Care Hospital in North India

Atrikumar Patel, Jyoti Garg, Ashish Duggal

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory antibody-mediated disease of the central nervous system. NMOSD shows high rates of comorbidity with other physical & psychological conditions, including cognitive Impairment. This study aims to evaluate cognitive function in NMOSD patients using standardized neuropsychological tools (BICAMS - Brief International Cognitive Assessment for MS).

Methodology: This is a cross sectional observational study. Age, gender and education matched 30 controls were selected.

Results: Total 30 cases & 30 controls enrolled with 28 females in each group. The clinical phenotype was optic neuritis (6), myelitis (11), both (5). Median EDSS was 2.5 between cases. There was no statistical significant difference for SDMT (Symbol Digit Modalities Test) and CVLT2 (California Verbal Learning Test-II) between cases and controls, however a statistical significant difference for BVMT-R (Brief Visuospatial Memory Test-Revised) was found. Age, duration of illness, EDSS shows negative correlation with SDMT, CVLT2 and BVMT-R while years of education shows positive correlation with all 3 components. 6 patients had cognitive impairment in our study. Linear regression analysis shows years of education has significant impact on all 3 components while age has significant impact on SDMT and EDSS has significant impact on CVLT2.

Discussion: This study demonstrates domain-specific cognitive impairment in NMOSD, with BVMT-R showing significant differences between patients and controls, unlike SDMT and CVLT2. Age, duration of illness and disability negatively correlated with cognitive performance, while education showed a positive impact, highlighting their influence on BICAMS scores. These findings show the need for targeted cognitive assessments in NMOSD patients.

Conclusion: Patients with longer duration of disease and higher EDSS perform poorly on cognitive tests but did not have a significant impact on cognition. Age & education emerged as critical factors influencing cognitive outcomes and BVMT-R can be used to detect cognitive impairment but further studies with larger cohorts are warranted.

Abstract ID 38: Living With Demyelination: Assessing Quality of Life Using the Msqol-29 Scale

Naresh Chinthala, Ashish Duggal, Jyoti Garg

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Primary demyelinating conditions of the central nervous system, such as Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum Disorders (NMOSD), and Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease (MOGAD), can profoundly affect patient’s quality of life. The study aimed to evaluate health related quality of life (HRQOL) in these patients and analyse how sociodemographic and clinical variables influence HRQOL outcomes.

Methodology: This cross-sectional observational study was conducted at the Department of Neurology, ABVIMS & Dr. RML Hospital, New Delhi, from July 2023 to December 2024. A total of 60 patients were included. HRQOL was evaluated using the MSQOL-29, which yields eleven subscales and two composite scores: Physical Health Composite (PHC) and Mental Health Composite (MHC). Statistical analyses assessed differences between disease groups and correlations with clinical and demographic variables.

Results: MOGAD patients reported the highest PHC scores (70.96 ± 15.64), whereas NMOSD patients had the lowest (59.76 ± 18.95). Regarding MHC scores, MS patients showed the highest scores (70.59 ± 16.84), followed by MOGAD (68.48 ± 17.71) and NMOSD (63.05 ± 19.53); these differences did not reach statistical significance.

Discussion: The findings suggest that MOGAD patients have better physical health outcomes. Meanwhile, MS patients demonstrated greater psychological well-being, as indicated by higher mental health scores. NMOSD patients showed lower physical and mental health scores. Key factors influencing quality of life includes severity of symptoms, degree of disability, cognitive issues, anxiety, and depression. These variables were strongly associated with both physical and mental composite scores.

Conclusion: This study emphasizes the value of incorporating quality of life assessments into the clinical management of demyelinating disorders. Considering psychological and cognitive factors such as anxiety, depression, and cognitive dysfunction alongside standard clinical measures can provide a more holistic understanding of patient well-being.

Abstract ID 39: Parallel Paths, Divergent Diagnoses: Clinical and Radiological Profile of NMOSD and MS Patients at a Tertiary Care Centre in South India

Pavithira Annamalai

Government Siddhartha Medical College, Vijayawada, Andhra Pradesh, India

Background and aim: Neuromyelitis Optica Spectrum Disorder (NMOSD) and Multiple Sclerosis (MS) are immune-mediated demyelinating disorders of the central nervous system with overlapping phenotypic features but distinct pathophysiological mechanisms, prognoses, and therapeutic implications. Accurate differentiation is crucial, particularly in resource-limited settings, to prevent misdiagnosis. To delineate and contrast the clinical characteristics and neuroimaging profiles of patients diagnosed with NMOSD and MS, with a view to enhancing diagnostic precision and guiding optimal management.

Methodology: A prospective observational study was conducted at the Department of Neurology, SMC, Vijayawada, from January 2024 to April 2025. Patients meeting the 2015 IPND criteria for NMOSD and the 2017 McDonald criteria for MS were enrolled. Detailed demographic, clinical, serological, and radiological data were collected and analyzed. Magnetic resonance imaging (MRI) brain and spine findings were reviewed for lesion morphology, distribution, and enhancement patterns.

Results: Unilateral optic neuritis (50%) and asymmetric limb weakness (50%) were the most common clinical presentations in MS. Myelitis (75%) and bilateral optic neuritis (75%) were the most common presentations in NMOSD. Short segment optic neuritis was observed in 50% of MS patients. Long segment optic neuritis (37.5%) and chiasmal involvement were seen in NMOSD. MS patients (33.3%) had radiological evidence of myelitis, out of which 16.7% had Longitudinally Extensive Transverse Myelitis (LETM). 75% of NMOSD patients had myelitis and all of them had LETM. Cerebellar and brainstem lesions more common in MS.

Discussion: NMOSD patients had severe and more frequent relapses, bilateral optic neuritis with chiasma and LETM. MS had more relapsing disease pattern with LETM occasionally and predilection to infratentorial and Dawson finger lesions. AQP4 Ab positivity and CSF OCB were diagnostic markers.

Conclusion: Despite clinical overlap, NMOSD and MS exhibit distinct syndromic and radiological signatures. Integration of clinical acumen with targeted neuroimaging and serological testing remains pivotal in ensuring diagnostic accuracy and tailoring disease-specific therapies.

Abstract ID 40: A Prospective Observational Study on the Clinical Profile and Treatment Response in Patients Diagnosed with Autoimmune Encephalitis in Eastern India

Devidutta Dash, Ajit Mishra, Lulup Sahoo, Srimant Pattnaik, Lohitha Jasthi, Monica Karan, Srikant Sahoo

IMS and Sum Hospital, Bhubaneswar, Odisha, India

Background and aim: Autoimmune encephalitis (AE), an inflammatory brain disorder with marked neuropsychiatric symptoms, accounts for ~20% of adult encephalitis cases. The 2016 Graus et al. criteria enable early diagnosis, even in antibody-negative patients. Aim of the study included 1. To study the clinical and radiological profile of patients diagnosed with AE, 2. To assess the clinical response and outcome after treatment.

Methodology: This prospective study (Oct 2024–Apr 2025) included 22 AE patients diagnosed per Graus et al. (2016) criteria. Exclusions were terminal illness, recent infection, malignancy, or no consent. Evaluations included magnetic resonance imaging (MRI), electroencephalogram (EEG), cerebrospinal fluid (CSF) antibody panels, and neuropsychiatric tests. Treatment followed standard immunotherapy protocols; outcomes were tracked using modified Rankin Scale (mRS) and Montreal Cognitive Assessment (MOCA).

Results: In the studied cohort (mean age 40.8 years; 63.6% female), altered sensorium (95.5%), seizures, and abnormal movements (86.4%) were the most frequent symptoms. Anti-NMDAR encephalitis (27%) was the most common subtype, primarily affecting young females and associated with psychosis, dyskinesias, and poor outcomes (p = 0.006). LGI1 encephalitis (13%) occurred in older males, presenting with FBDS (p < 0.001) and temporal lobe MRI changes (p = 0.013), all showing favorable recovery. Seronegative AE (59%) also had good, though not statistically significant, outcomes. Early immunotherapy improved prognosis. One patient with Hashimoto’s Encephalopathy responded well to corticosteroids. Two patients died.

Discussion: The epidemiological and clinic-radiological pattern of AE in this study was consistent with previous studies; notably, even antibody-negative patients exhibited characteristic clinical features, supporting a diagnosis of possible AE and demonstrating a favorable response to treatment.

Conclusion: To our knowledge, this will be the first study from eastern India to highlight subtype-specific clinical features and treatment responses in different types of AE. Timely clinical diagnosis and empirical treatment are crucial, especially in resource-limited settings like India.

Abstract ID 41: A Rare Case of Muscle Rippling and Myoedema in a CAVIN 1 Related Congenital Generalized Lipodystrophy Type 4

Aishwarya Jirwankar, Shailina Ali, Neeraj Jain, Sangeeta Ravat, Mayur Thakkar, Shruti Agrawal, Darshan Vitalkar

Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India

Background and aim: Congenital Generalized Lipodystrophy (CGL) is a rare autosomal recessive disorder characterized by a near-total absence of adipose tissue and severe metabolic complications. CGL type 4 (CGL4), caused by mutations in the PTRF/CAVIN 1 gene, is the least common subtype and is distinguished by skeletal muscle abnormalities, including rippling muscle disease, percussion-induced myoedema (PIMM), and proximal myopathy. Early recognition is critical due to potential cardiac arrhythmias and systemic complications. We described a rare case of CGL4 in an Indian child, emphasizing its distinctive neuromuscular features and the importance of early diagnosis and monitoring.

Methodology: To describe a rare case of CGL4 in an Indian child, emphasizing its distinctive neuromuscular features and the importance of early diagnosis and monitoring.

Results: The child showed classical lipodystrophic features with muscle stiffness, rippling, and percussion-induced mounding. He had left ankle contracture, undetectable serum leptin, low adiponectin, and elevated CK levels. EMG/NCS revealed sensorimotor polyneuropathy and bilateral carpal tunnel syndrome. Cardiac evaluation was normal. Whole-exome sequencing (WES) confirmed a homozygous recessive mutation in CAVIN1 gene.

Discussion: This case highlights the diagnostic significance of muscle findings like PIMM and rippling in CGL4, which are often overlooked. Although the child lacked overt metabolic or cardiac complications, literature shows these may develop later, reinforcing the need for longitudinal follow-up. Unlike CGL1 and CGL2, CGL4 uniquely combines lipodystrophy with myopathy and potential arrhythmias. This case highlights the importance of careful neuromuscular assessment in diagnosing atypical presentations of CGL4.

Conclusion: This case highlights the importance of careful neuromuscular assessment in diagnosing atypical presentations of CGL4

Abstract ID 42: The spectrum of Idiopathic Inflammatory Myopathies and their Treatment Outcomes - A Retrospective Observational Cohort Study

Sri Sai Srujana Puppala, Jemini George, Sruthi Nair, Rajalakshmi Poyuran, Deepti Narasimhaiah

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Background and aim: The idiopathic inflammatory myopathies (IIMs) classification has undergone a paradigm shift with the application of muscle specific antibodies (MSAs) and immunohistochemical stains. The treatment outcomes and prognosis can be different in these subgroups. This study aimedto study the spectrum of subtypes in IIMs, especially the role of clinical, pathological and serological evaluation on the therapeutic outcomes

Methodology: Electronic medical records between April 2017- March 2024 were screened for IIM patients on follow up for ≥ 1 year. European Neuromuscular Centre criteria used classified patients into dermatomyositis (DM), immune- mediated necrotising myopathy (IMNM), antisynthetase syndrome (ASyS) and sporadic inclusion body myositis (sIBM), overlap myositis (OM) and unclassified. Descriptive analysis of these subcategories was done.

Results: Total 67 IIM patients (54% females) were included for analysis. The mean age at onset was 42.1 (± 16.9) years with paediatric onset in 7 (10.4%). Extra-muscular features were seen in 19 (28.4%). The patient subclassification was DM in 14 (20.9%), IMNM in 11 (16.4%), ASyS in 3 (4.5%), sIBM in 15 (22.4%), OM in 6 (8.9%) while 18 (26.9) were unclassified. Six of the 61 patients with muscle biopsy had classical DM pathology. Among DM, majority (42.9%) were Mi2+. IMNM had 2 SRP+ and 3 HMGCR+ while ASyS had 2 Jo1+ and 1 PL-7+. Glucocorticoids were given in 97%, oral immunotherapies in 87.9%, and 25.3% received cyclophosphamide or rituximab. While DM (78.6%), IMNM (91%), and ASyS (100%) showed good outcomes, IBM (20%) and OM (16.7%) groups had poor responses.

Discussion: While DM, IMNM, and ASyS showed good outcomes, IBM and OM groups showed poor responses.

Conclusion: Nearly three-fourths of the cohort were classified into a specific IIM subcategory with judicious application of the criteria. Higher therapeutic options were needed in a quarter. Treatment response was strongly associated with IIM subtype. While DM, IMNM, and ASyS showed good outcomes, IBM and OM groups had poor responses.

Abstract ID 43: From Biceps Lump to a Superior Predictive Paradigm: Introducing the Biceps Tendon-to-Belly Ratio (bTBR)

Abhijeet Gadhave, Satish Khadilkar, Darshan Pandya, Jharna Bhanushali

Bombay Hospital, Mumbai, Maharashtra, India

Background and aim: “Biceps lump” is a qualitative clinical observation which points to dysferlinopathies. We designed a method for quantifying the biceps lump and applied it to a group of genetic myopathies.

Methodology: A new diagnostic tool was designed, calculating the biceps tendon-to-belly ratio (bTBR). Biceps TBR ratio was assessed in 70 patients with genetically confirmed myopathies and 70 age and sex-matched controls.

Results: A bTBR cut-off of 0.8 had a 100% positive predictive value and 70.2% negative predictive value for dysferlinopathy and calpainopathy.

Discussion: bTBR was superior to the biceps lump as it helped predict the diagnosis of dysferlinopathy and calpainopathy in patients who did not have the biceps lump. The biceps lump was newly observed in the calpainopathy group.

Conclusion: This novel bTBR-based objective method helps to point to the diagnosis of dysferlinopathy and calpainopathy (bTBR 0.8), even when the biceps lump is not evident.

Abstract ID 44: The Karnataka Brain Health Initiative (KaBHI): A Statewide Neurological Public Health Model for Integrated, Multidisciplinary, and Referral-Based Care in India

Suvarna Alladi, Inbaraj Ganagarajan, Suvarna Alladi, Rajani Parthasarathy¹, Girish Rao, Faheem Arshad, Selva Ganapathy, Yamini B K, Priya Thomas, Jamuna Rajeswaran, Ravikesh Tripathi

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, ¹Department of Health and Family Welfare, Government of Karnataka, Bengaluru, Karnataka, India

Background and aim: Neurological disorders significantly contribute to global disability and mortality, disproportionately affecting low- and middle-income countries (LMICs) due to fragmented healthcare and limited specialized care. In India, underserved populations face heightened disparities from inadequate integrated neurological services. Addressing this critical gap, the Karnataka Brain Health Initiative (KaBHI) was launched collaboratively by the Government of Karnataka, NIMHANS, and NITI Aayog. KaBHI established India’s first state-wide public health model integrating neurological services through systematic screening, standardized diagnosis, multidisciplinary management, structured rehabilitation, referrals, digital tracking, and policy formulation, ensuring sustainable, equitable care across Karnataka’s 33 districts.

Methodology: KaBHI established Brain Health Clinics (BHCs) across Karnataka’s 33 districts, offering screening, diagnosis, treatment, and rehabilitation by multidisciplinary teams. A validated neurological risk assessment tool facilitated community screening. Patient data were maintained in a centralized, real-time digital registry, supported by a robust referral system connecting district BHCs to NIMHANS tertiary care. Extensive capacity building included training over 16,951 health workers. Telerehabilitation and telemonitoring services complemented clinic-based care, while public awareness initiatives and medication mapping enhanced community engagement.

Results: From January 2024 to May 2025, KaBHI screened 3,66,015 individuals, diagnosing 69,822 with conditions including headache (n = 32,271), stroke (n = 10,585), epilepsy (n = 9,437), dementia (n = 328), and other disorders (n = 17,201). Functional disabilities (moderate-severe) were noted in 33.25% of patients. Multidisciplinary services provided comprised nursing (55,096 sessions), psychological consultations (42,561), physiotherapy (31,929), and speech-language therapy (10,294). The referral framework achieved a 59.1% conversion rate for neurology/neurosurgery referrals from NIMHANS. Telehealth services delivered substantial remote care, notably 1,132 tele-neurology consultations and 1,606 psychological follow-ups. Public outreach reached approximately 1.69 lakh individuals through extensive community campaigns.

Discussion: KaBHI offers a scalable model for integrating neurological care in resource-limited settings through clinical services, digital tools, referrals, and training.

Conclusion: Recognized by World Health Organization (WHO), it serves as a replicable framework to strengthen public health systems and address neurological disease burden in LMICs.

Abstract ID 45: A study on Understanding the Pathways to Care in Children with Neurological Disorders: A Karnataka Brain Health Initiative (Kabhi) Perspective

Aradhya Bagchi, Hansashree Padmanabha, Rupam Mandal, Harshini Manohar, Thomas Kishore, Priya Thomas, Senthil Amudhan, Raghavendra Kenchaiah, Suvarna Alladi

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: To understand the pathways to care in children with neurological disorders seeking healthcare services at tertiary care hospital from Karnataka state.

Methodology: This cross-sectional, exploratory study included pediatric patients (<18 years) from the state of Karnataka, India, diagnosed with a neurological disorder, attending the Neurology department of NIMHANS. The provisional diagnosis was noted and the disease classified into either of neurodevelopmental (I)/cerebral palsy (II)/metabolic and genetically mediated disorders (III)/neuroinfections and immune mediated disorders (IV)/miscellaneous disorders (V). Data on their demographics, time taken to visit neurologist/pediatric neurologist and tertiary healthcare centre, and details of consultation with each healthcare provider prior to arrival at NIMHANS, was collected, and analysed using appropriate statistical methods.

Results: A total of 164 patients were recruited, of which 40.9% were females. The median age of the subjects was 10 years. The most common group of disorders was neurodevelopmental (40.2%), followed by metabolic /genetically mediated (25.6%). The number of healthcare visits before reaching our centre ranged from 0-8, with 62.2% having >1 visit. Out of a total of 31 districts in Karnataka, district with maximum representation was Bangalore urban (32.31%), followed by Tumkur (6.09%). The most commonly visited specialist in the first visit was pediatrician (65.8%), followed by general neurologist (7.3%). In 50.6% of the population, a delay of >6 months after symptom onset in accessing tertiary health care/neurology/pediatric neurology services was noted. The median time taken to reach neurologist and tertiary healthcare centre were 150 and 67.5 days respectively. Among the delayed, the maximum delay was noted among metabolic/genetically mediated (71.4%) while the least was with neuroinfections and immune mediated disorders (13.8%).

Discussion: There is a need to focus on strengthening the referral policies of primary healthcare.

Conclusion: This first-of-its-kind study holds the potential to significantly influence child neurology healthcare policy, drive early intervention strategies, and improve overall pediatric neuro-care delivery in India.

Abstract ID 46: Comparative Effectiveness of Mechanical Thrombectomy Techniques for Large Vessel Occlusion Stroke: A Network Meta-Analysis of RCTs

Pradeep Kumar, Adila Jawaid, Manbesh Nath, Annu Gulia

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Mechanical thrombectomy (MT) is a key intervention for acute ischemic stroke due to large vessel occlusion (LVO). Various MT strategies—stent retriever (SR), aspiration (Asp), and their combination (SR + Asp)—are widely used, but the optimal approach remains unclear. This network meta-analysis (NMA) aimed to compare the efficacy and safety of these techniques using evidence from randomized controlled trials (RCTs).

Methodology: A Bayesian network meta-analysis was conducted, including RCTs evaluating different MT techniques in LVO-related stroke. The primary outcome was successful recanalization (TICI ≥ 2b). Secondary outcomes included good functional outcome (modified Rankin Scale [mRS] ≥ 2 at 90 days), all-cause mortality at 90 days, and symptomatic intracranial hemorrhage (sICH) within 24 hours. Odds ratios (ORs) with 95% credible intervals (CrIs) were calculated using a Bayesian random-effects model.

Results: Twenty-seven RCTs were analyzed. SR showed the highest odds for good functional recovery (OR = 2.76; 95% CrI: 1.72–3.02) and successful recanalization (OR = 13.6; 95% CrI: 3.12–75.0) compared to Asp or SR + Asp. The SR + Asp technique demonstrated the lowest 90-day mortality (OR = 0.77; 95% CrI: 0.63–0.92), whereas Asp alone had the highest. sICH rates were similar across techniques, though Asp showed a slightly lower risk (OR = 1.53; 95% CrI: 0.66–3.59).

Discussion: These findings indicate that IAT may result in better clinical outcomes than IVT in appropriately selected patients with AIS. However, due to differences in patient populations and variability in therapeutic protocols, the results should be interpreted with caution.

Conclusion: The present study suggests that SR remains the most effective MT strategy in terms of recanalization and functional outcome, while the SR + Asp combination offers the best balance between efficacy and mortality benefit. Future RCTs with standardized device reporting, protocol harmonization, and long-term follow-up are warranted to validate these findings and refine treatment algorithms for acute LVO stroke.

Abstract ID 47: Extracellular Vesicle-derived Surrogate Biomarkers for Monitoring Disease Progression and Therapeutic Response in Duchenne Muscular Dystrophy

Archana Rajavel, Narayanan Essakipillai¹, Jayasree Kumar², Viswanathan Venkataraman³, Vairamani Mariappan, Ramajayam Anbazhagan, Rajapandiyan Panneerselvam², Raja Natesan Sella

SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, ¹Indian Institute of Information Technology, Pune, Maharashtra, ²SRM University, Andhra Pradesh, ³Apollo Children Hopsital, Chennai, Tamil Nadu, India

Background and aim: Duchenne Muscular Dystrophy (DMD) is a progressive X-linked neuromuscular disorder caused by mutations in the dystrophin gene, leading to ongoing muscle damage, inflammation, and impaired regeneration. While multiplex ligation-dependent probe amplification (MLPA) remains the diagnostic gold standard, neurologists continue to face challenges in objectively monitoring disease progression and response to emerging therapies such as exon skipping and gene therapy. This study aimed to profile extracellular vesicles (EVs) from plasma and urine across various DMD stages to identify minimally invasive surrogate biomarkers that can aid clinicians in evaluating disease severity and therapeutic outcomes.

Methodology: In this ethically approved, prospective study, plasma and urine samples were collected from genetically confirmed DMD patients (ambulant and non-ambulant) and age-matched controls. Informed consent was obtained for all participants. EVs were isolated using a TEI precipitation kit and characterized by nanoparticle tracking analysis (NTA), transmission electron microscopy (TEM), and Western blotting. Proteomic profiling was performed using Fourier-transform infrared spectroscopy (FTIR), surface-enhanced Raman spectroscopy (SERS), matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and nano-liquid chromatography tandem mass spectrometry (nano-LC- MS/MS). Gene ontology and pathway enrichment were conducted using the DAVID and FunRich platforms.

Results: Urine EVs showed strong proteomic overlap with plasma EVs, capturing key molecular signatures related to inflammation, immune activation, and muscle regeneration. Stage- specific patterns of dysregulated pathways—such as the complement cascade, cytoskeletal remodeling, and IL-1 signalling—were evident and consistent with recent therapeutic trials. These findings suggest urine EVs can serve as reliable liquid biopsies for longitudinal disease monitoring.

Discussion: EV-based proteomic profiling represents a powerful strategy for monitoring DMD progression and therapeutic efficacy. Urine EVs, due to their accessibility and protein overlap with plasma EVs, hold strong potential as non-invasive surrogate biomarkers.

Conclusion: This approach provides neurologists with a novel adjunct to clinical evaluation, improving disease management and enabling evidence-based therapeutic decision-making.

Abstract ID 48: High Sensitivity C-Reactive Protein Predicts Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Disease

Rinta Paul, Deepa Damayanthi, Madhusoodanan UK, Srinivas G, P S Sarma¹, P N Sylaja

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, ¹Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India

Background and aim: Inflammation plays a significant role in increasing the risk of stroke recurrence in symptomatic intracranial atherosclerotic disease (ICAD) even on medical management. The study evaluated the inflammatory biomarkers in predicting the stroke recurrence and functional outcome in symptomatic ICAD.

Methodology: This prospective, hospital-based, observational study enrolled symptomatic ICAD patients, three months after onset (September 2022 - January 2025). The institutional ethics committee approved the study. The blood-borne biomarkers measured were high sensitivity C-reactive protein (hs-CRP), Lipoprotein associated phospholipase A2 (Lp-PLA2) activity, intercellular adhesion molecule 1 (ICAM-1) and neutrophil-to-lymphocyte ratio. The clinical characteristics, ankle brachial index, cognition, and post-stroke depression were documented. The primary outcome was the recurrent stroke/transient ischemic attack within three months of onset. The secondary outcome was the functional outcome assessed at three months (modified Rankin scale >2: unfavorable).

Results: Of the 110 patients (age, 59.20 ± 10.21 years), 33 (30%) patients had recurrent stroke and 23 (20.9%) had unfavorable outcome at three months. On univariate analysis, elevated hs-CRP (3.47 ± 5.83 vs 1.59 ± 1.78 mg/l, p = 0.01) and ICAM- 1 (411.14 ± 280.62 vs 321.19 ± 179.71 ng/ml, p = 0.04) predicted stroke recurrence; elevated hs-CRP (3.49 ± 5.98 vs 1.77 ± 2.44 mg/l, p = 0.04) and neutrophil to lymphocyte ratio (2.29 ± 1.51 vs 1.74 ± 0.63, p = 0.009) predicted unfavorable outcome. On multivariate analysis, hs-CRP (OR, 1.21; 95% CI, 1.01-1.44; p = 0.03), coronary artery disease (OR, 3.95; 95% CI, 1.11-14.08; p = 0.03) and physical activity (OR, 0.24; 95% CI, 0.09-0.68; p = 0.007) predicted stroke recurrence. The higher stroke severity (OR, 0.82; 955 CI, 0.73-0.93, p = 0.002) predicted unfavorable outcome.

Discussion: The elevated hs-CRP in patients with early stroke recurrence supports the role of circulating inflammatory mediators involved in the plaque destabilization and further ischemic events in ICAD.

Conclusion: The hs-CRP can predict the stroke recurrence in symptomatic ICAD. The combination of hs-CRP with clinical markers might be useful to identify a high-risk group of symptomatic ICAD.

Abstract ID 49: Flanked and Frazzled: Muscle Functions in Cognitive Control and Strength-Linked Inhibitory Collapse in Parkinson’s Disease

Harshdeep Singh, Kuljeet Anand¹

Neuronal Fix Clinic, C8H11N Solutions, Ghaziabad, Uttar Pradesh, ¹Department of Neurology, Kailash Hospital, Noida, Uttar Pradesh, India

Background and aim: Cognitive impairment in Parkinson’s disease (PD) is often seen as separate from motor symptoms. These traditionally distinct domains, motor (rigidity, weakness) and cognition (executive function, memory), may be deeply interwoven, as recent data suggests. This study explored muscle function predicting inhibitory collapse via Flanker Task, aiming to reveal a neuronal convergence point redefining the motor-cognitive divide.

Methodology: A cross-sectional study of 92 PD patients (HY- I–III) was conducted in a controlled lab, assessed muscle functions using MRC for strength and MAS for tone and inhibitory control through Flanker Task focusing on congruent and incongruent stimuli. Later on a Multivariate Regression and ANCOVA revealed significant motor-cognitive links suggesting an integrated neuronal mechanism underlying PD.

Results: Lower muscle strength (MRC) predicted slower Flanker reaction times (β= -0.38, p < 0.05) indicating the Strength-Inhibition Link, while higher muscle tone (MAS) reduced accuracy (F = 4.87, p = 0.03) evincing Tone-Accuracy Trade-off. Strength inversely correlated with errors (r = -0.37), and positively (r = -0.35). Combined high tone and low strength created a neural bottleneck, worsening inhibition dramatically.

Discussion: This study establishes a quantitative, predictive link between muscle function and cognitive inhibition in PD. The results offer experimental evidence for a shared control system that governs both movement and executive filtering together in one model. These findings disrupt traditional silos and redefine inhibitory failure not as a purely cortical or dopaminergic symptom, but as a peripheral-neural interaction.

Conclusion: This study uncovers a novel motor-cognitive convergence in PD, muscle tone and strength, once seen as “motor-only,” actively drive inhibitory breakdown simultaneously. These findings redefine PD management, urging dual-system correction that links peripheral tone-strength with executive control, paving the way for targeted interventions in neurophysiology, neurorehabilitation, and cognitive-motor retraining.

Abstract ID 50: Learning From Our Elders: Understanding Cognitive Trajectories in Aging- A Comparative Study between Superagers, Typical Agers and At-risk Individuals in India

Thomas Issac, Sandhya G¹

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, ¹Center for Brain Research, Indian Institute of Science, Bengaluru, Karnataka, India

Background and aim: Superagers are older adults whose cognitive abilities are preserved and their memory is comparable to those 20-30 years younger than them. Some people show a steeper decline in cognition when compared with peers of the same age. This depends on many factors, including lifestyle, physical and mental health. The present study aims to compare the profile of superagers, typical agers and at-risk groups.

Methodology: The study included 238 participants aged 75 years and above from Tata Longitudinal Study of Aging (TLSA) based in Bengaluru. The participants were classified into superagers and typical agers based on the Northwestern criteria using Addenbrooke’s Cognitive Examination III (ACE-III) subdomains and Trail Making Test B (TMT-B). Those who did not meet either of these criteria were classified as the at-risk group. All participants underwent detailed clinical and biochemical assessments. Statistical analysis was performed using SPSS 30.0.0.

Results: The participants included in the study had mean age and education of 77.87 ± 3.81 and 15.57 ± 4.47 years, respectively. Seventy-nine participants (33.2%) were females. Of the total of 238 participants, 98 superagers, 42 typical agers and 98 at-risk participants were identified. The superagers, typical agers and at-risk groups differed in anxiety scores (p = 0.019), depression scores (p = 0.037), social network size (p = 0.003), number of embedded networks (p < 0.001) and physical activity (p = 0.002).

Discussion: Groups classified based on cognitive performance were seen to differ with respect to physical, mental and social characteristics. Among those, depression, social networking and physical activity have been cited as dementia risk factors by the Lancet Commission’s report 2024. This study reaffirms the role of these factors in preserving cognition and preventing dementia.

Conclusion: The results imply that overall well-being, in terms of physical, mental and social aspects, is important for preserved cognitive functioning. Hence, in the aging population, in addition to managing physical comorbidities, attending to and addressing mental health problems, maintaining a good social life and engaging in age-appropriate physical activities should be advocated.

Abstract ID 51: Awareness, Knowledge, and Stigma Associated with Sleep Disorders: A Cross-Sectional Study Among the General Population

Sachin, Archana Verma

All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India

Background and aim: Sleep disorders such as insomnia and obstructive sleep apnea (OSA) are prevalent yet underdiagnosed due to limited public awareness and persistent social stigma. This study aimed to assess the general population’s awareness, knowledge, and stigma associated with sleep disorders.

Methodology: A cross-sectional survey was conducted among 231 individuals from varied demographic backgrounds. A structured questionnaire evaluated participants’ awareness of sleep disorders, sources of information, symptom recognition, knowledge of treatment options, and personal experiences with societal stigma.

Results: Most participants (77.05%) were aged 26–35, with 67.09% residing in urban areas. Awareness was highest for disorders such as narcolepsy, restless legs syndrome (RLS), and REM sleep behavior disorder (RBD) (38.52%), followed by OSA (28.57%) and insomnia (17.31%). Friends and relatives were the most common information sources (34.63%). Over half (55.84%) could identify insomnia symptoms, and 47.18% recognized OSA symptoms (p = 0.0407). Awareness of treatment options was relatively high (77.92%, p = 0.3243). However, 68.83% believed that people with sleep disorders are misunderstood by society. Negative stereotypes such as overthinking (30.30%) and laziness (17.74%) were frequently associated with those affected (p = 0.0053). Furthermore, 49.35% reported feeling judged or misunderstood, primarily by friends (42.42%), while 38.52% experienced social exclusion or discrimination.

Discussion: Despite reasonable knowledge of treatment options, the findings highlight significant gaps in symptom awareness and persistent stigma linked to sleep disorders. Misconceptions and negative stereotypes continue to impact individuals’ social experiences and may deter timely diagnosis and treatment.

Conclusion: This study emphasizes the urgent need for targeted educational initiatives and public health campaigns to raise awareness, dispel myths, and reduce stigma surrounding sleep disorders in the general population.

Platform presentations: Abstract ID 121: Advancing Autoimmune Encephalitis Diagnosis and Treatment: A Comprehensive Clinical and Imaging Study

Rajesh Singh

Sir Ganga Ram Hospital, New Delhi, India

Background and aim: Autoimmune encephalitis (AIE) is a complex, immune-mediated neurological disorder presenting with diverse clinical manifestations. Early recognition is critical as timely immunotherapy leads to favorable outcomes, particularly in cases associated with underlying malignancies.

Methodology: This study analyzed 37 patients diagnosed with AIE based on clinical symptoms, anti-neuronal antibody presence, imaging features, and cerebrospinal fluid (CSF) biomarkers. Comprehensive assessments included magnetic resonance imaging (MRI) brain imaging, fluorodeoxyglucose positron emission tomography (18-FDG PET) scans, electroencephalogram (EEG) findings, CSF studies, and treatment responses to various immunotherapies.

Results: The median age at onset was 56 years, with a male predominance (67.6%). The most frequent symptoms included altered mental status (67.6%), behavioral changes (51.4%), seizures (45.9%), and sleep disturbances (40.5%). Antibody profiling revealed LGI1, N-methyl-D-aspartate receptor (NMDAR), and myelin oligodendrocyte glycoprotein (MOG) as predominant, differing from earlier studies reporting NMDAR encephalitis as most prevalent. Notably, PET imaging exhibited higher sensitivity (81%) for detecting inflammatory encephalitis compared to MRI (16.2%). Whole-body FDG PET also uncovered occult malignancies (19%), reinforcing its utility in paraneoplastic syndromes. Immunotherapy showed promising results, with methylprednisolone plus IVIG being the most common regimen (48.6%).

Discussion: This study highlights the significance of multimodal diagnostics in autoimmune encephalitis (AIE), emphasizing the superiority of FDG-PET (81%) over MRI (16.2%) for detecting inflammatory changes. Antibody profiling revealed LGI1, NMDAR, and MOG as predominant markers. Whole-body FDG PET uncovered occult malignancies in 19%, reinforcing its role in paraneoplastic screening. Immunotherapy significantly improved outcomes, with modified Rankin Score (mRS) 0-2 rising from 11% to 54% post-treatment, particularly with methylprednisolone plus IVIG (48.6%). These findings advocate for an integrated approach combining advanced imaging, antibody screening, and aggressive immunotherapy to enhance diagnostic accuracy and optimize recovery in AIE patients.

Conclusion: This study underscores the necessity of multimodal diagnostics, particularly FDG PET, for detecting autoimmune encephalitis and associated malignancies. Our findings suggest for an integrated approach combining advanced imaging, antibody screening, and aggressive immunotherapy to optimize patient outcomes.

Abstract ID 122: A Retrospective Analysis of MER Signals and Anatomical Integration in Refining Subthalamic Nucleus DBS Targeting at a Movement Disorders Comprehensive Care Centre

Reshma Venugopal

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Background and aim: Deep brain stimulation (DBS) is a well-established treatment for advanced Parkinson’s disease (PD), particularly when pharmacotherapy alone no longer provides sufficient symptom control. Although modern high-field imaging allows for detailed anatomical visualization of the subthalamic nucleus (STN), individual variations necessitate intraoperative electrophysiological verification through Modulation Error Ratio (MER). This study retrospectively examines the interplay between MER signals, anatomical integration, and macrostimulation to identify key factors that influence targeting accuracy. The ultimate goal is to establish a refined, evidence-based protocol that enhances precision for targeting subthalamic nucleus in DBS. To identify the channel that consistently provides the most robust electrophysiological signals for precise DBS targeting. Correlate imaging data including middle cerebellar peduncle (MCP), AC-PC distance, and red nucleus morphology with intraoperative electrophysiological recordings to assess their combined impact on electrode targeting.

Methodology: Retrospective observational study in advanced PD patients who underwent STN DBS during the time period 2015- 2025 at SCTIMST was carried out with the approval of the Institutional Ethics committee.

Results: The central channel offer the most reliable MER signal for STN targeting. Cases with robust central channel MER exhibited minimal deviation from the intended target. Suboptimal central channel MER may be associated with increased target deviation and a higher likelihood of adverse effects, supporting the rationale for supplementing with additional channels.

Discussion: This study integrates electrophysiological and anatomical assessments to address key challenges in STN DBS targeting. By focusing on the central channel as the primary source of MER while also evaluating additional channels, when necessary, this study provides a comprehensive analysis of the factors influencing electrode placement accuracy.

Conclusion: The incorporation of anatomical parameters, MER recordings & intraoperative macrostimulation will ensure accurate and safe STN DBS lead placement.

Abstract ID 123: Uncovering the Curable-A review of Vitamin Dependent Epilepsies Highlighting the Importance of its Early Diagnosis and Management

Sonia Martina, Leema Pauline, Neeraj Elango, Jered Livingston

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Vitamin-dependent epilepsies—including pyridoxine-dependent epilepsy (PDE), biotinidase deficiency (BTD), and folinic acid-responsive seizures—are rare but treatable causes of pediatric drug-resistant epilepsy. This study reviews their clinical profiles and outcomes to emphasize the significance of early recognition and intervention.

Methodology: A two-year retrospective study of children with drug-resistant seizures responsive to vitamin therapy, with clinical, investigational, and outcome data analyzed in cases confirmed by biochemical or genetic testing, which was conducted at a tertiary paediatric Neurology centre.

Results: A total of 25 children with vitamin-dependent epilepsy were reviewed. Thirteen (52%) had BTD gene mutations (Biotinidase deficiency), and 12 (48%) had pyridoxine-dependent epilepsy (PDE) with mutations in Aldehyde dehydrogenase 7A1 (ALDH7A1) (36%), Pyridoxal Phosphate-Binding Protein (PLPBP) (8%), and pyridox(am)ne 5’-phosphate oxidase (PNPO, 4%). Presenting complaints included seizures (88%), developmental delay (8%), and spastic diplegia (4%). Seizure onset was neonatal (20%), infantile (70%), and childhood (8%). Seizure types were generalized (84%), focal (4%), myoclonic jerks (4%), and spasms (8%). Developmental delay was seen in 64%, microcephaly in 28%, hearing loss in 8%, and optic atrophy in 12%. TMS showed elevated C5OH in 76% of tested patients and all had profound enzyme deficiency among BTD. EEG findings included generalized epileptic form activity (32%) and hypsarrhythmia/burst suppression (4% each). Magnetic Resonance Imaging (MRI) was normal in 68%; others had cerebral atrophy, white matter changes, or gliosis. All BTD cases received biotin; PDE cases received pyridoxine or pyridoxal-5-phosphate. On follow-up, all but 1 BTD patients were seizure-free with improved milestones and skin hair changes. Among PDE, 75% were seizure-free, and most showed developmental gains.

Discussion: Early recognition of vitamin-dependent epilepsies is crucial due to their varied presentations. In drug-resistant seizures, prompt vitamin trials and targeted genetic or metabolic testing can significantly improve outcomes.

Conclusion: Vitamin-dependent epilepsies are reversible causes of seizures. Early vitamin trials should be standard in refractory or early-onset epilepsy, especially when genetic testing is delayed.

Abstract ID 124: Clinical, Etiological and Radiological Profile of Patients with Optic Neuritis at a Tertiary Care Hospital – An Ambispective Observational Study

Priyanka Kashyap

All India Institute of Medical Sciences, Bhopal, India

Background and aim: Optic neuritis (ON) is an inflammatory condition of optic nerve characterized by acute vision loss, often with pain. It may signify underlying demyelinating diseases like multiple sclerosis (MS), autoimmune conditions, infections, granulomatous, or paraneoplastic disorders. Given the varied etiologies and lack of consensus diagnostic criteria, detailed clinical, etiological, and radiological profiling is crucial for accurate diagnosis and optimal management. This study aimed to comprehensively profile ON patients, emphasizing clinical presentations, etiologies, radiological features, and treatments administered.

Methodology: This ambispective observational study was conducted at AIIMS Bhopal from January 2023 to May 2025. Patients of 18 years above, diagnosed with ON were included. Demographic data, clinical characteristics, visual evoked potentials (VEP), Magnetic Resonance Imaging (MRI) brain and orbital imaging, autoimmune and infectious workups, and treatments were documented.

Results: Forty-eight patients (75% female; mean age 32.0 ± 8.5 years) were analyzed. Unilateral predominated (70%), Retrobulbar ON (81.3%) was common than papillitis type. Etiologically, demyelinating conditions accounted for 75% of the cases with Neuromyelitis Optica Spectrum Disorder (NMOSD) being most common (43.8%), followed by MS (Multiple Sclerosis) (16.7%) and Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD) (14.6%). MRI identified optic nerve enhancement in 72.9%. Intravenous Microcurrent Point Stimulation (MPS) pulse therapy was the primary treatment modality used in acute phase, with adjunctive plasmapheresis or IVIG utilized in severe or steroid-refractory cases. Maintenance immunotherapy (80% cases)-Rituximab was the most used agent.

Discussion: The findings are consistent with established epidemiological trends that highlight demyelinating disorders as the predominant cause. However, NMOSD was the most common etiology, as compared to MS being the leading cause of optic neuritis in ONTT trial. MRI imaging emerged as an essential tool for both diagnosis and etiological classification. Early, aggressive corticosteroid treatment remains standard care for acute ON, reflecting current guidelines and best clinical practices.

Conclusion: Optic neuritis predominantly presents with acute unilateral vision loss and pain, especially in young females. Comprehensive clinical, etiological, and radiological profiling significantly aids in timely diagnosis and appropriate management.

Abstract ID 125: Spectrum of Movement Disorders in Malaria: A Systematic Review of Case Reports, Case Series, and Cohort Studies

Sneh Jain, Raza Mahdi¹, Sanjay Singhal², Shweta Pandey, Ravindra Garg³

King George’s Medical University, Lucknow, Uttar Pradesh, ¹Post Graduate Institute of Medical Education and Research, Chandigarh, ²Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, ³Era Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background and aim: Although malaria is a well-known cause of febrile illness, its neurological complications, particularly movement disorders, are under-recognized. This review aimed to comprehensively evaluate the types, timing, and outcomes of movement disorders reported in association with malaria.

Methodology: We systematically searched major databases for case reports, case series, and cohort studies till 1st may 2025 describing movement disorders in malaria patients. Data were extracted on demographics, Plasmodium species, clinical presentation, imaging, treatment, and outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout.

Results: A total of 86 individual cases were identified from 72 case reports/series, along with 12 cohort studies were also reviewed. Among individual cases, Plasmodium falciparum was implicated in 75%, and P. vivax in 20% cases. Cerebellar ataxia was the most common movement disorder, reported in 52% of cases, often appearing 7–21 days after fever resolution. Tremor (16%), dystonia (9%), and chorea (7%) were also documented. Extrapyramidal symptoms, including acute dystonia and rigidity, were observed in 43 children and adolescents treated with artesunate-amodiaquine, with a median onset of 2 days post-treatment. Neuroimaging was normal in 68% of cases, while Cerebrospinal fluid (CSF) findings were nonspecific. Most patients recovered completely within 1–4 months; however, 4 cases required prolonged rehabilitation. Twelve cohort studies linked malaria, especially P. falciparum, to movement disorders like cerebellar ataxia. Most cases were immune-mediated with full recovery. Extrapyramidal effects and posturing also occurred, highlighting the importance of drug monitoring and tailored treatment in malaria-endemic regions.

Discussion: This review emphasizes the need for clinicians in malaria-endemic areas to be aware of movement disorders, particularly those presenting after resolution of the acute illness. Timely recognition is crucial for optimal management.

Conclusion: Movement disorders in malaria are rare but clinically significant. They may occur during acute illness or weeks later, often linked to P. falciparum or antimalarial drugs. Early identification and supportive care usually lead to favorable outcomes.

Abstract ID 126: A Restrospective Study on Optic Neuritis (Inflammatory Optic Neuropathy)- its Clinical Profile, Diagnostic Evaluation, Radiological and Neurophysiological Findings, and Aetiology- with A Prospective Follow-Up in A Tertiary Care Centre in South India

Shreyashi Ganguly, Divya Nagabushan, Rashmi Devaraj

Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India

Background and aim: Optic Neuritis (ON) is an inflammatory, demyelinating condition that causes acute, usually monocular visual loss. This study evaluates the clinical, aetiological, radiological, and neurophysiological profile in ON.

Methodology: This ambispective study was conducted at VIMSRC from January 2021 to January 2024. The study comprised of ON patients. They were subjected to clinical assessment, perimetry, Optic Coherence Tomography (OCT), Visual Evoked Potential (VEP), and Magnetic Resonance Imaging (MRI). Aetiological workup, treatment response, visual outcomes, recurrence, and neuraxial involvement were assessed. Visual outcomes were reassessed on follow-up. The data was recorded using a pre-tabulated proforma and analysed using appropriate statistical methods.

Results: A total of 70 optic neuritis patients were studied. Male-to-female ratio was 1:1. Vision was affected in all; sudden onset (51.4%), painful eye movements (70%), colour vision dysfunction (61.4%) and Relative Afferent Pupillary Defect (RAPD) (45.7%). MRI showed anterior optic nerve involvement in all. Perimetry and VEP abnormalities indicated bilateral dysfunction in 27.7% unilateral cases. Idiopathic ON 31.4%. Inflammatory demyelination was the leading aetiology (40%) cause, with MOGAD (n = 10, 35.71%) most common. Rest was tuberculous (8.5%), para-infectious (8.5%), 4.2% autoimmune (SLE, Behcets), 4.2% neoplastic, 2.8% sarcoidosis. Treatment included steroids (95.7%), rituximab (35.7%), plasma exchange (15.7%), and natalizumab (n = 1). At a mean follow-up of 16 months significant improvements in vision were noted (p < 0.0005), and final outcomes correlated with OCT findings- Retinal Nerve Fibre Layer (RNFL) thickness (p < 0.05) and Ganglion Cell–Inner Plexiform Layer (GCIPL) thickness (p < 0.005). Recurrence occurred in 4 patients. Thirty-three and four tenth percentage had persistent visual loss, parainfectious 8.57% being the leading aetiology.

Discussion: This study highlighted the diverse aetiological aspects of optic neuritis, with inflammatory demyelinating being most common. Multimodal assessments like OCT, VEP, and MRI detected subclinical involvement. Significant correlations were found between initial structural changes in OCT and long-term visual outcomes irrespective of aetiologies.

Conclusion: Results indicated high incidence of inflammatory demyelination. Multimodal assessments facilitated early diagnosis. Significant correlation was found between initial structural changes in OCT and long-term visual outcomes.

Abstract ID 127: Prevalence, Clinical and Electrophysiological Features of Peripheral Neuropathy in Idiopathic Parkinson’s Disease

Shreejeet Kumar, Munindra Goswami

Gauhati Medical College and Hospital, Guwahati, Assam, India

Background and aim: Peripheral neuropathy is an under-recognized non-motor feature of Parkinson’s Disease (PD), linked to both levodopa-induced hyperhomocysteinemia and synuclein pathology. This study aimed to assess the prevalence and clinical profile of peripheral neuropathy in idiopathic PD (IPD) patients, and its association with levodopa exposure, serum vitamin B12, and homocysteine levels.

Methodology: This cross-sectional observational study enrolled 100 consecutive patients with IPD (UK Brain Bank criteria, age 40–80 years) at Gauhati Medical College. Clinical assessments included disease duration, UPDRS-III, Hoehn & Yahr staging, and cumulative levodopa dose. Neuropathy was evaluated through clinical signs, nerve conduction studies (large fiber), and stimulated skin wrinkling (small fiber). Serum vitamin B12 and homocysteine were measured. Secondary causes of neuropathy were excluded.

Results: Peripheral neuropathy was present in 36% of patients. Large fiber neuropathy was seen in 18%, small fiber in 30%, with 17% overlap. Mean disease duration was 4.1 years, and mean cumulative levodopa dose was 482 grams. Homocysteine levels >20 µmol/L were found in 34%, correlating with levodopa exposure. Vitamin B12 levels were normal in most. Neuropathy prevalence was significantly associated with disease duration, H&Y stage, and levodopa dose.

Discussion: Neuropathy is common in PD and linked to longer disease duration and higher levodopa exposure. Hyperhomocysteinemia likely contributes to this risk. The overlap of large and small fiber types suggests the need for broad screening. Findings highlight the role of routine biochemical and electrophysiological monitoring in PD care.

Conclusion: Our findings are in line with recent Indian data, reaffirming that nearly one-third of IPD patients exhibit peripheral neuropathy, with both large and small fibers affected. Levodopa-induced hyperhomocysteinemia and disease severity appear to be key contributors. Routine screening using simple clinical, electrophysiological, and biochemical tools may facilitate early detection and improve quality of care in PD.

Abstract ID 128: A MR Imaging Study of Pure Neuritic Leprosy Beyond Peripheral Nerves

Sanjeev Bhoi, Yuvraj Lahre, Menka Jha, Suprava Naik, Priyanka Samal

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Background and aim: Pure neuritic leprosy (PNL) is uncommon form of leprosy involving peripheral nerves alone. Some isolated case reports and observational studies have shown imaging changes in the central nervous system (CNS) in leprosy patients. This prospective observational study evaluated the involvement of nervous system beyond peripheral nerve among PNL patients with magnetic resonance imaging (MRI).

Methodology: We screened patients presenting with features of neuropathy and/or thickened nerves. Patients were subjected to detailed clinical examination, routine tests along with nerve conduction study (NCS) and biopsy of peripheral nerve, usually the sural nerve. MRI of brachial and lumbar plexus, dorsal root ganglia, spinal cord and brain were evaluated in patients with Hansen’s neuritis on nerve histopathology.

Results: Out of 86 patients screened for PNL, 52 were positive on nerve biopsy. Most of patients were male (86.53%) and mean age was 45.72 ± 15.25 years. Asymmetrical polyneuropathy was most common NCS pattern in 55.76% (29/52) patients. We found abnormal imaging findings in twenty-one (40.38%) patients. Ganglionitis was most common finding seen in 14 (26.92%) patients followed by plexitis (15.38%) and myelitis (11.53%). Patients with MRI lesions were younger and were found to have more functional impairment and raised cerebrospinal fluid (CSF) protein.

Discussion: In this MRI study we demonstrate a high frequency of brachial plexus, lumbosacral plexus, DRG, and spinal cord abnormalities in patients with pure neuritic leprosy. Diagnosis of PNL challenging in the present era where this disease has been declared eradicated. Imaging may play a supportive role.

Conclusion: In PNL, many patients have subclinical involvement of dorsal root ganglion, brachial plexus, lumbar plexus and spinal cord. Exact pathophysiology of CNS involvement is not clear; however, imaging of the above-mentioned regions may help in early diagnosis and prevent complications. Also, these findings in PNL should be kept in mind while evaluating patients presenting with peripheral neuropathy to avoid misdiagnosis.

Abstract ID 129: Trapped by Profession: How Jobs Maim the Ulnar Nerve (A Neurologist’s Casebook)

Satya Sravani Nyayapathi, Aishwarya Menon, Sakthi Velayutham, Kannan V, Velusamy S

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Ulnar neuropathy, often attributed to trauma, Hansen’s disease, vasculitis or dysimmune etiology as causes, can arise from occupational or recreational activities. This case series aimed to elucidate the diverse etiologies, anatomical localizations, and clinical presentations of ulnar neuropathies secondary to repetitive strain or compression in distinct professions.

Methodology: We presented eight documented cases of ulnar neuropathy evaluated at the Neurology Department, Government Stanley Hospital. Clinical, electrophysiological (Nerve conduction studies and Electromyography), and imaging [magnetic resonance imaging (MRI)] findings were analysed to correlate nerve injury patterns with mechanistic causes.

Results: The cohort (ages 17–52 years) included a weightlifter (flexor carpi ulnaris hypertrophy), a cricket coach (cubital tunnel syndrome), a cottage industry worker (deep palmar branch compression), a desk worker (elbow compression), a mosaic polisher (motor-only Guyon’s canal involvement-zone 2), a gamer (sensory only Guyon’s canal involvement), a mobile phone user (funny bone) and a cyclist (handlebar neuropathy). Motor deficits (intrinsic hand weakness, clawing) predominated, with sensory loss variably present. Electrodiagnostics revealed axonal degeneration ± demyelination, while MRI localized structural compressions. Occupational tasks—ranging from repetitive elbow flexion (bowling) to sustained palmar pressure (murukku making)—were implicated in nerve injury.

Discussion: This series underscores the interplay between biomechanical stress and neuroanatomical vulnerability. Unique mechanisms included: (1) muscle hypertrophy compressing the ulnar nerve (weightlifting), (2) dynamic joint stress (cricket), and (3) isolated motor neuropathy from deep palmar branch compression (tool use). The absence of sensory deficits in Cases 3 and 5 highlighted the diagnostic challenge of mimicking anterior horn cell pathology. Early recognition of activity-related triggers is critical to prevent irreversible axonal loss.

Conclusion: Occupational and recreational ulnar neuropathies demand meticulous history-taking and anatomic localization to guide targeted interventions—ergonomic modifications, activity cessation, or surgical decompression. Heightened awareness of these etiologies can mitigate morbidity in high-risk professions.

Abstract ID 130: Study of the Spectrum of Neuro-ophthalmic Manifestations of Tuberculous Meningitis

Partha Saha, Arun Koul

Govind Ballabh Pant Institute of Postgraduate Medical Education, New Delhi, India

Background and aim: Tuberculous meningitis is the most devastating form of tuberculosis. Neuro-ophthalmic manifestations in TBM are mostly due to visual pathway involvement and/or ocular motor and other cranial nerve involvement. Visual impairment is a devastating outcome of Tuberculous meningitis (TBM), occurring in 26-72% whereas the frequency of cranial neuropathies is 20-52%.

Methodology: We did a prospective longitudinal study of 108 cases of TBM, aged more than 12 years over 18 months. All patients underwent detailed neuro-ophthalmological examination and data were analyzed using the SPSS software. Variables were analyzed using Mann-Whitney test, Kruskal Wallis test and Chi-Square test.

Results: Out of 108 patients, 72.2% were female. 71% of the patients were between 12 years to 30 years age. Seventy-two two tenth percentage of patients were presented in either stage 2 or stage 3 disease. The prevalence of disseminated TB was 38%. 46.3% and 27.7% of patients presented with altered sensorium and seizures respectively, whereas diplopia and hemiparesis were present in 12.9 and 8.3%. Mean Cerebro spinal fluid (CSF) total count was 216.13 cells/cumm and protein levels were 224.1 mg/dl. In magnetic resonance imaging (MRI), vasculitic infarct and basal exudates were detected in 25.9% and 7.4% respectively. Optochiasmatic arachnoiditis were present in 12%. 24.2% patients had CSF Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) positivity.

Discussion: Neuro-ophthalmic manifestations were found in 64.8%. Visual impairment was found in 55.5% whereas 28.7% developed blindness. Bilateral visual field defect was found in 23.15%. Optic atrophy and papilledema was found in 21.3% and 25.2% respectively. Bilateral Retinal Nerve Fiber Layer (RNFL) loss was found in 25.6%. Visual Evoked Potential (VEP) was abnormal in 30.5%. Abducens nerve palsy was found in 24%. 51.8% patients had abnormalities in pupillary size and reactivity. The proportions of mortality and morbidity were 13.8% and 41.9% respectively.

Conclusion: Neuro-ophthalmic manifestations were strongly correlated with CSF total counts, CSF protein levels, and hydrocephalus. The advanced TBM, CBNAAT positivity and presence of neuro-ophthalmic manifestations had significant positive correlation with poor outcome of TBM patients.

Abstract ID 131: Repetitive Transcranial Magnetic Stimulation in Migraine. Comparison of the Efficacy and Impact on Quality of Life of Two Protocols of Repetitive Transcranial Magnetic Stimulation in Chronic Migraine Patients

Pranjali Batra, Rameshwar Chaurasia, Varun Singh

Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background and aim: The present study was a randomized open labelled study to determine the efficacy of repetitive transcranial magnetic stimulation as adjunctive therapy in chronic migraine without aura. The aim of the study was to investigate the efficacy and impact of repetitive Transcranial Magnetic Stimulation (rTMS) therapy on the quality of life in patients with chronic migraine.

Methodology: The patients with migraine without aura were randomised to either of 2 groups using computer generated random number table. One group of patients were subjected to three sessions delivered alternate day every month for 3 months and other group received 3 sessions in one month for 3 months.

Results: Fifty-four patients were included in the study. Both the groups were comparable with the respect to baseline demographic and clinical profile. All the patients in the study were on prophylactic treatment. There was significant improvement in Visual Analogue Scale (VAS) score, Migraine Disability Assessment (MIDAS) scores, and Migraine-Specific Quality of Life Questionnaire (MSQ) scores at the end of three months. There was no significant difference between the VAS scores, MIDAS and MSQ scores between the patient groups subjected to alternate day rTMS therapy and 3 sessions delivered alternate day and repeated every month for 3 months.

Discussion: Transcranial magnetic stimulation targets the altered synaptic plasticity which is observed in migraine with and without aura. The rTMS therapy may be tailored as per patients convenience as each rTMS session exerts synergistic effect on the previous one irrespective of the time period intervening between the first and last session

Conclusion: High frequency rTMS is effective as adjunctive therapy in patients with chronic migraine without aura and no difference in benefit of treatment was found between both the groups at final follow up- Alternate day group (9 sessions) Vs. monthly sessions (3 sessions in a month) was carried out over a period of 3 months.

Abstract ID 132: A Study on Safety and Efficacy of Tenecteplase as Bridging Therapy iIn Large Vessel Occlusions

Molugu Samhitha, Ranjith G, Radhakrishna Hari, Vikram Kishore Reddy Peri

Medicover Hospitals, HiTech City, Hyderabad, Telangana, India

Background and aim: Clinical trials showed a higher recanalization rate of tenecteplase (TNK) over alteplase in large vessel occlusion (LVO) and better functional independence at the end of 3 months without increasing the risk of systematic intracranial haemorrhage (SICH). Indian studies are scarce. We aimed to review the outcomes and safety of tenecteplase upto 4.5 hours in LVO patients who were taken for mechanical thrombectomy (MT).

Methodology: A singlecenter, retrospective, observational study done over 2 years on Inpatients of Neurology department of Medicover hospitalwho were enrolled between April1,2023, and March 30,2025. A cohort of patients who received tenecteplase as bolus dose for Acute Ischemic Stroke (AIS) secondary to LVO before MT were studied. Informed consent was taken from patients or their close relatives. Institutional ethical committee approval was taken.

Results: 54 patients were included in this study. Mean age of presentation was 61 years. Males were 59.25%. Hypertension was most common risk factor seen in 38 (70.37%) of patients. About 22 patients (40.74%) had M1 occlusion, 12 (22.22%) patients had M2 occlusion, 16 (29.62%) patients had internal carotid artery occlusion, and 4 (7.4%) subjects had basilar occlusion. Early recanalization with IV thrombolysis (IVT) with tenecteplase in 10 (18.51%) patients. Functional independence (modified Rankin Scale (mRS):0–2) was achieved in 30 (55.55%) patients. SICH was seen in 2 (3.7%) patients and death within 90 days is noted in 6 (11.11%) patients.

Discussion: The recanalization rates in present study are 18.51% compared to recanalization rates with alteplase in ESCAPE trial 5.1% (7/118) and MR-CLEAN-NO IV 3.7% (9/245). Symptomatic intracranial hemorrhage in the ESCAPE trial was 6/165 (3.6%), in MR-CLEAN-NO IV 14/266 (5.3%), with alteplase, present study is 2 (3.7%). In the MR-CLEAN-NO IV trial, death within 90 days in 42/266 (15.8%, in alteplase), ESCAPE trial, death within 30 days is 44/233 (18.9%), in present study, death within 90 days is 6/54 (11.11%). Higher recanalization rates in present study is attributed to higher fibrin specificity, potent clot dissolution with tenecteplase.

Conclusion: Tenecteplase appears to be effective bridging agent before MT in LVOs considering its ease of administration, low cost, effective recanalization rates and good functional recovery.

Abstract ID 134: Spectrum of Neurotransmitter-Related Disorders in Children- A Single Centre Observational Study in A Tertiary Care Hospital in South India

Shree Badrinath, Leema C, Jered Livingston, Neeraj Elango, Leema Pauline

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: The study aimed to analyse the spectrum of neurotransmitter-related disorders in children less than 12 years of age and to evaluate the outcome after appropriate treatment.

Methodology: This study was conducted in the Pediatric Neurology Department of a tertiary care hospital, over one year between January and December 2024. Inclusion criteria were children aged less than 12 years with a proven neurotransmitter-related disorder.

Results: Of the 23 children included in the study, the mean age at presentation was 1.39 years, ranging from day one of life to two years. Seizure was the primary complaint in 15 (65.2%) children. The study showed that 15 (65.2%) children were born out of consanguineous marriage and 7 (30.4%) had a significant family history. Among the study participants, 13 (56.5%) children had global developmental delay. A total of 11 children had movement disorders, including dystonia 9 (39.1%), chorea 1 (4.3%), and ataxia 1 (4.3%). Oculogyric crisis was noticed in 6 (26%) children and dysmorphism in 7 (30.4%). Diurnal variation of symptoms and autonomic involvement was not present in any child. Microcephaly was noted in 12 (52.1%) and hypotonia in 12 (52.17%). Tandem Mass Spectroscopy showed elevated phenylalanine in 1 (4.3%) case. Imaging of the brain showed non-specific abnormalities in 6 (26%). Genetic analysis showed deficiency of Aromatic aminoacid decarboxylase in 3 (13%) followed by tyrosine hydroxylase in 2 (8.6%), sepiapterin reductase deficiency in two and one each (4.3%) of tetrahydrobiopterin deficiency, GABA transaminase deficiency, serine synthetic defect while the rest 13 (56.5%) were pyridoxine cofactor defects. Seizure was responsive to pyridoxine in 14 (93.3%) and abnormal movements responsive to levodopa in 8 (72.7%) cases.

Discussion: Neurotransmitter-related disorders are under-recognized and often misdiagnosed as cerebral palsy. These conditions are amenable to treatment making early diagnosis paramount.

Conclusion: Children presenting with unexplained developmental delay and red flag signs like oculogyric crisis, dystonia or mixed movement disorders, especially with normal imaging, should prompt the suspicion of neurotransmitter-related disorders.

Abstract ID 135: A Study on Spectrum of Seizure in First Ever Acute Stroke and Development of Post Stroke Epilepsy in A Tertiary Care Centre

Rimjhim Basak, Arijit Roy, Atanu Biswas, Biman Ray

SSKMH, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Background and aim: Stroke is the most common cause of seizures and epilepsy in older adults; 6% of the stroke affected patients eventually develop post stroke epilepsy. In spite of that studies or national guidelines to start anti-epileptic drugs (AED) for primary or secondary prophylaxis of seizure in stroke patients are scarce. This study explored the spectrum of management of Epilepsy in stroke and aims to provide a standardised protocol.

Methodology: This is a prospective observational study, conducted in the Department of Neurology, BIN and Hyper Acute Stroke Unit over one year taking 1000 patients, who had first ever stroke (ischaemic/ haemorrhagic/ sub arachnoid haemorrhage) within 7 days and they were followed up for the next 6 months. Demographics of the population, type of seizure, comorbid conditions, relevant history, findings of clinical examination, neuroimaging, electrophysiological tests, Fluorodeoxyglucose Positron Emission Tomography (FDG PET) scan (in selected patients) were noted. Disability, morbidity and mortality were assessed.

Results: Three-hundred data were collected and 65% was male and 35% was female; 92% was discharged, 8% expired. 48% had modified Rankin Scale (mRS) <2, 52% had mRS > 2%. Forty-two percentage focal and 26% bilateral, 23% tonic-clonic and 9% undetermined seizures were observed. Acute symptomatic seizure - 10.5%, Seizures were most frequently associated with Total Anterior Circulation Infarct (TACI)/ Partial anterior circulation infarct (PACI) Territory site, temporal and frontal lobe involvement, and vascular risk factors were present in all cases of acute symptomatic seizures (ASS). Seizure interval was <3 days in 68% and 3-7 days in 32% of them. Electroencephalogram (EEG) findings had epileptiform discharges in 48% of seizure patients. Seven and five tenth percentage of the patients developed post stroke epilepsy at 3 month follow up. Sixty-one percentage of patients needed one AED and 39% needed more than one to control the seizures.

Discussion: With further structured data collection, we can reach to a definitive conclusion.

Conclusion: The study reinforces the need of judicious and individualized prescription of AEDs in acute symptomatic stroke and post stroke epilepsy.

Abstract ID 136: A Study of Visual Evoked Potential in Type 2 Diabetes Mellitus without Retinopathy and Optic Neuropathy

Yogeshvar G, Anirban Mahanta

Gauhati Medical College and Hospital, Guwahati, Assam, India

Background and aim: Type 2 Diabetes Mellitus (T2DM) is associated with both microvascular and neurofunctional complications, often preceding overt clinical signs such as diabetic retinopathy or optic neuropathy. Visual Evoked Potential (VEP), a non-invasive neurophysiological test, can detect early functional changes in the visual pathway. This study aimed to assess VEP abnormalities in T2DM patients without retinopathy or optic neuropathy and compare them with healthy controls, while evaluating correlations with disease duration and glycemic control.

Methodology: This is a hospital-based observational case-control study conducted at Gauhati Medical College and Hospital from April 2024 to March 2025. The study included 40 patients with T2DM aged 40–60 years without clinical evidence of retinopathy or optic neuropathy, and 40 age- and sex-matched non-diabetic healthy controls. All participants underwent a detailed clinical examination, fundus evaluation, and pattern-reversal VEP testing. VEP parameters including P100 latency, N75 and N145 latency, and P100–N75 amplitude are recorded and statistically analyzed using SPSS.

Results: Preliminary findings, in line with the study suggest that diabetic patients exhibit significantly prolonged P100 latencies (mean ~106.96 ms) compared to controls (mean ~100.16 ms), even in the absence of fundoscopic abnormalities (p < 0.05). P100 latency shows significant correlation with both disease duration and HbA1c levels, while amplitude differences remain statistically insignificant.

Discussion: These results reinforce existing evidence that VEP changes can precede clinical retinopathy. Delayed P100 latency reflects early involvement of the visual pathway, likely due to metabolic or ischemic insults affecting retinal ganglion cells. The correlation with poor glycemic control underlines the importance of metabolic regulation.

Conclusion: VEP is a sensitive tool for early detection of subclinical optic pathway dysfunction in T2DM. Routine electrophysiological screening in high-risk patients may enable timely intervention and prevent irreversible visual impairment.

Abstract ID 137: Study of Clinical and Radiologic Characteristics of Transient Global Amnesia: A Case Series from A Teritiary Care Centre in South India

Abhinay Gattu, J M K Murthy, Muralidhar Reddy Yerasu, Lalitha Pidaparthi, Subhendu Parida

Renova Century Hospital, Renova Institute of Neurological Sciences, Hyderabad, Telangana, India

Background and aim: Transient global amnesia (TGA) is a rare clinical entity characterized by acute onset anterograde amnesia with repetitive questioning lasting for minutes to hours in middle aged or elderly people with gradual recovery leaving behind a period of dense amnesia of the features.

Methodology: This is a retrospective review of case records of consecutive patients with TGA seen over a period of 9 years. Patients who fulfilled the Hodges and Warlow’s diagnostic criteria were included in the analysis. Data collected from the case records included: demographic data, risk factors, duration of amnesia, imaging characteristics and follow-up events.

Results: During the study period, 9 patients fulfilled the diagnostic criteria of TGA. Of the 9 patients, 7 were males (M:F- 3.5:1) and mean age at presentation was 59.88 years (age range 48 to 78 years). The main risk factor migraine was present in 2 patients. Other comorbidities included, hypertension in 5 patients, and diabetes mellitus Type 2 and chronic rheumatic heart disease in one each. Amnesia lasted from 30 min to 24 hours, with mean duration of 316 minutes. Neuroimaging (Magnetic Resonance Imaging (MRI)) showed punctate infarcts in hippocampus in 3 (33.33%) (bilateral in one), thalamic infarct in 1, and no diffusion restriction (DWI) in 5 patients. Positron Emission Tomography (PET) Computed Tomography (CT) brain was done in 1 patient which showed bilateral mesial temporal hypometabolism. The mean duration of follow-up was 88.45 months (range 6-110 months), none had recurrence.

Discussion: The clinical characteristics were similar to reports from the western studies, and none had recurrence of the event during the follow up period. In contrast to western literature, most of our patients (66.67%) had attack during winter. Probably, this is the first report from India.

Conclusion: This study is one of the first case series from Indian subcontinent detailing the clinic-radiological characteristics which are similar to that of western literature.

Abstract ID 138: Diagnostic Accuracy of Combined Arterial and Venous Grade (CRISP Grade) in Predicting the Functional Outcome at 3 Months in Acute Ischemic Stroke in Anterior Circulation Territory in a Tertiary Care Centre

Hareesh V, Chitra P

Trivandrum Government Medical College, Thiruvananthapuram, Kerala, India

Background and aim: Early & accurate prediction of outcomes in acute ischemic stroke is essential for guiding therapeutic decisions. While individual arterial or venous imaging markers provide prognostic information, the CRISP (Combined Arterial and Venous Grading) score integrates both components, potentially enhancing predictive accuracy. This study was aimed to evaluate the diagnostic accuracy of the CRISP grade at admission in predicting 3-month functional outcomes in anterior circulation ischemic stroke and to compare it with the Alberta stroke programme early CT (CT-ASPECT) score. Secondary objectives included assessing the association between CRISP grade and infarct volume and identifying determinants of poor outcomes.

Methodology: This prospective cohort study was conducted in the Department of Neurology, GMC, Thiruvananthapuram. Fifty-five patients with acute ischemic stroke and CT angiography-confirmed internal carotid artery (ICA) /middle cerebral artery (MCA) (M1/M2) occlusion were enrolled. CRISP grade, CT-ASPECTS, National Institute of Health Stroke Scale (NIHSS), and 24-hour infarct volume were recorded. Functional outcome at 3 months was assessed using the modified Rankin Scale (mRS).

Results: CRISP grade had a sensitivity of 72% and specificity of 58% in predicting good outcomes (mRS 0–2), while CT-ASPECTS (>7) showed higher sensitivity (90%) but similar specificity (54%). Poor CRISP grade was significantly associated with larger infarct volume (p = 0.011). Significant predictors of poor outcome included higher NIHSS scores (p < 0.001), infarct volume >50 mL (p < 0.001), mechanical ventilation (p = 0.0097), and in-hospital mortality (p = 0.004).

Discussion: The CRISP grade demonstrated moderate sensitivity and specificity in predicting outcomes, with significant correlation to infarct volume. Although CT-ASPECTS was more sensitive, CRISP provided additional prognostic value by integrating both arterial and venous imaging components.

Conclusion: The CRISP grade is a reliable tool for early prognostication in anterior circulation strokes. It correlates well with infarct size and functional outcomes and offers diagnostic accuracy comparable to CT-ASPECTS.

Abstract ID 139: Role of Procalcitonin Value in Cerebrospinal Fluids for the Differential Diagnosis of Bacterial and Viral Meningitis

Patel Girishkumar Jivabhai, Shubhakaran Khichar

Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India

Background and aim: Timely and accurate differentiation between bacterial meningitis (BM) and viral meningitis/encephalitis (VM/E) is critical for guiding therapy and improving outcomes. However, traditional diagnostic methods like CSF Gram stain and culture are often rendered unreliable due to prior empirical antibiotic use, especially in developing regions. This study aimed to evaluate the diagnostic accuracy of cerebrospinal fluid (CSF) procalcitonin (PCT) in distinguishing BM from VM/E.

Methodology: This cross-sectional study included 60 adult patients presenting with clinical features of meningitis. Group A (n = 30) comprised of patients with BM confirmed via positive CSF Gram stain or culture. Group B (n = 30) included VM patients. CSF PCT was measured using Rapid Quantitative Enzyme-Linked Immunosorbent Assay (ELISA). Clinical features, routine CSF parameters, serum CRP, and total leukocyte count (TLC) were recorded. Statistical analysis was conducted using SPSS v24. ROC analysis determined diagnostic accuracy.

Results: Cerebrospinal fluid procalcitonin (CSF PCT) levels were markedly elevated in patients with bacterial meningitis (mean: 4.34 ng/mL) compared to those with viral or aseptic meningitis (mean: 0.094 ng/mL), with the difference being statistically significant (p < 0.01). Notably, CSF PCT retained its diagnostic accuracy even in patients who had received prior empirical antibiotic therapy—unlike serum PCT, which was more susceptible to treatment-related suppression.

Discussion: This study highlights CSF procalcitonin as a highly sensitive and specific biomarker for bacterial meningitis. Compared to serum markers and other CSF parameters, CSF PCT offers more robust diagnostic yield. These findings are consistent with prior work, supporting its integration into early diagnostic algorithms.

Conclusion: CSF procalcitonin is a valuable biomarker for the differential diagnosis of bacterial vs. viral meningitis. Its inclusion in diagnostic algorithms could improve early identification and targeted treatment of BM.

Abstract ID 140: A study on Understanding the Pathways to Care in Children with neurological Disorders: A Karnataka Brain Health Initiative (KaBHI) Perspective

Aradhya Bagchi, Hansashree Padmanabha, Rupam Mandal, Harshini Manohar, Thomas Kishore, Priya Thomas, Senthil Amudhan, Raghavendra Kenchaiah, Suvarna Alladi

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: To understand the pathways to care in children with neurological disorders seeking healthcare services at tertiary care hospital from Karnataka state.

Methodology: This cross-sectional, exploratory study included pediatric patients (<18 years) from the state of Karnataka, India, diagnosed with a neurological disorder, attending the Neurology department of NIMHANS. The provisional diagnosis was noted and the disease classified into either of neurodevelopmental (I)/ cerebral palsy (II)/ metabolic and genetically mediated disorders (III)/ neuroinfections and immune mediated disorders (IV)/ miscellaneous disorders (V). Data on their demographics, time taken to visit neurologist/pediatric neurologist and tertiary healthcare centre, and details of consultation with each healthcare provider prior to arrival at NIMHANS, was collected, and analysed using appropriate statistical methods.

Results: A total of 164 patients were recruited, of which 40.9% were females. The median age of the subjects was 10 years. The most common group of disorders was neurodevelopmental (40.2%), followed by metabolic /genetically mediated (25.6%). The number of healthcare visits before reaching our centre ranged from 0-8, with 62.2% having >1 visit. Out of a total of 31 districts in Karnataka, maximum representation was Bangalore urban (32.31%), followed by Tumkur (6.09%). The most commonly visited specialist in the first visit was pediatrician (65.8%), followed by general neurologist (7.3%). In 50.6% of the population, a delay of >6 months after symptom onset in accessing tertiary health care/ neurology/pediatric neurology services was noted. The median time taken to reach neurologist and tertiary healthcare centre were 150 and 67.5 days respectively. Among the delayed, the maximum delay was noted among metabolic/genetically mediated (71.4%) while the least was with neuroinfections and immune mediated disorders (13.8%).

Discussion: There is a need to focus on strengthening the referral policies of primary healthcare.

Conclusion: This study holds the potential to significantly influence child neurology healthcare policy, drive early intervention strategies, and improve overall pediatric neuro-care delivery in India.

Abstract ID 141: Age-Stratified Clinical and Treatment Profiles of Acute Ischaemic Stroke in Elderly: A Prospective Study

Japleen Kaur, Gagandeep Singh, Monika Singla

Dayanand Medical College, Ludhiana, Punjab, India

Background and aim: Acute ischaemic stroke in elderly (>60 years) is rising; the “very old” (>80 years) face greater stroke severity, comorbidity burdens, and mortality. While reperfusion therapies are effective regardless of age, evidence shows underuse in the very old. This study prospectively compares clinical profiles, treatment decisions, short-term outcomes, and reperfusion efficacy between 60–80 and >80 years.

Methodology: Patients aged >60 with acute ischaemic stroke admitted to Dayanand Medical College & Hospital, Ludhiana (July2024–June2025) were enrolled (n = 310). Collected data: demographics, vascular risk factors, National Institute of Health Stroke Scale (NIHSS), modified Rankin Score (mRS), TOAST classification, treatment type, and all-cause mortality. Chi-square tests (SPSS, p < 0.05).

Result: The cohort comprised 212 younger elderly (68.4%) and 98 very elderly patients (31.6%) with male predominance (55.8%). Hypertension was the leading risk factor (75.8%), while atrial fibrillation was significantly more prevalent in very elderly patients (57.1% vs 29.2%, p<0.001). Very elderly patients presented with greater stroke severity (mean NIHSS 18.7 vs 12.4, p<0.001). Conservative management was utilized in 74.2% of patients, intravenous thrombolysis in 18.4%, and mechanical thrombectomy in 7.4%. Overall functional independence (mRS 0-2) was achieved in 66.5% of patients, with conservative treatment yielding 64.3% good outcomes and thrombolysis achieving 77.2% success rates. Mortality was 18.1% overall, significantly higher in very elderly patients (26.5% vs 14.2%, p=0.012).

Discussion: Consistent with meta-analyses, IV thrombolysis remains safe and effective in 80 years, without increased hemorrhage risk, improving functional outcomes. Although thrombectomy offers lower efficacy (OR 0.40) and higher mortality in the very old, it still achieves meaningful recovery and recanalization benefits

Conclusion: Reperfusion in elderly stroke patients improves outcomes and remains safe; age alone shouldn’t limit treatment. In elderly stroke patients, including those >80, reperfusion therapies—IV thrombolysis and selected mechanical thrombectomy—are safe and beneficial when clinically indicated. Stroke protocols must prioritize eligibility over age to ensure effective care.

Abstract ID 142: Clinical Subtypes and Radiological Patterns in Progressive Supranuclear Palsy (PSP): A Prospective Study

Kartika Gulati, Sanjay Pandey

Amrita Institute of Medical Sciences, Faridabad, Haryana, India

Background and aim: The 2017 International Parkinson and Movement Disorder Society (MDS) PSP study group sub classified PSP into 8 variants: 4 cortical (PSP-F, PSP-CBS, PSP-SL, PSP-RS) and 4 subcortical (PSP-P, PSP-PGF, PSP-PI, PSP-OM).1 PSP-RS remains the most common subtype.2,3 Midbrain-to-pons ratio (M:P) and magnetic resonance parkinsonism index (MRPI), differentiates PSP-RS from Parkinson’s disease.4-6 This study was conducted to subclassify PSP into cortical and subcortical types and to identify the clinical and radiological correlation in PSP.

Methodology: This prospective study was conducted at our tertiary care teaching institute, Amrita Institute of Medical Sciences, Faridabad, India, from April 2024 to February 2025. Patients clinically diagnosed with PSP were included after giving informed consent. Age at onset, disease duration, PSP subtype, and Magnetic Resonance Imaging (MRI) findings were recorded and then statistically analysed.

Results: 88 patients were included (34% females, 66% males). Mean age at onset was 65.9 ± 7.4 years (range 50-85), with symptom duration of 3.8 ± 2.3 years. The most common subtype was PSP-RS (39.8%, n = 35), followed by PSP-P (26.1%, n = 23), PSP-CBS (23.8%, n = 21), PSP-F (n = 4), PSP-C (n = 2), PSP-PGF (n = 2) and PSP-SL (n = 1). The most common presentation was akinetic-rigid syndrome (73.8%), while limb/cranio-cervical dystonia occurred in 55.7%.

Discussion: In this prospective PSP study, PSP-RS was the most common subtype (39.8%), while other subtypes, including PSP-P and PSP-CBS, accounted for 49.9% of the cases, highlighting their under-recognition. Besides the typical akinetic-rigid presentation, dystonia was commonly seen (55%). PSP-RS patients had the lowest M:P ratio and highest MRPI when compared to the other PSP subtypes, suggesting that non-RS variants may be overlooked with subjective visual assessment.

Conclusion: Non-RS PSP subtypes are often under-recognized. Limb and craniocervical dystonia are common and should be actively assessed. PSP sub classification by clinical and radiological features improves patient management.

Abstract ID 143: Late Window Thrombectomy in Anterior Circulation Stroke Patients without Using Perfusion Studies: A Stitch in Time Saves Nine! - A Single Centre Case Series

Sohini Chakraborty, Manoj Mahata¹

All India Institute of Medical Sciences, New Delhi, ¹Apollo Hospital Chennai, Tamil Nadu, India

Background and aim: The DAWN and DEFUSE 3 studies have transformed the care of acute stroke patients in the extended time window. While advanced imaging with CT-Perfusion or magnetic resonance imaging (MRI) is recommended in the selection of anterior circulation large-vessel occlusion patients presenting between 6 and 24 hours from last well known, selection of patients based on non-contrast CT (NCCT) or CT angiography collaterals may be a reasonable alternative, particularly in cases where access to advanced imaging is unavailable or could incur significant delay. We are describing three such unique extended-period thrombectomy patients, presenting in our centre beyond 12 hours and followed up over a period of 90 days.

Methodology: Our aim was to study the outcome of acute ischemic stroke patients presenting in our centre with anterior circulation-large vessel occlusion who underwent mechanical thrombectomy beyond 12 hours of ictus, over a period of 90 days.

Results: All patients underwent successful thrombectomy (mTICI3), improved post-procedure and remained independent at three months from ictus. Overall, our findings indicate that NCCT +/- CTA (without CTP or MRI) could be used to select patients who present between 6 to 24 hours from stroke onset for endovascular thrombectomy (EVT), with net treatment benefit and comparable safety outcomes. Although advanced imaging (CTP or MRI) in the late window may reliably select ‘slow progressors’ with a higher chance of achieving improved functional outcomes following EVT compared to ‘fast progressors’, our findings suggest that a proportion of patients with a limited ischaemic core and adequate collateral supply may also be feasibly selected with NCCT +/- CTA alone.

Discussion: The DAWN and DEFUSE-3 trials provide compelling evidence that (at least in late time windows) tissue is more important than time.

Conclusion: Thrombectomy for anterior circulation LVO after 6 hours of symptoms onset seems to be as safe and effective as the standard thrombectomy within 6 hours from symptoms onset.

Abstract ID 144: Prevalence of Non Motor Symptoms in Parkinson’s Disease and their Association with Laterality of Motor Symptoms in Patients Presenting to A Tertiary Care Hospital in India

Basundhara Saha, Amitabha Ghosh

Apollo Multispecialty Hospital Kolkata, West Bengal, India

Background and aim: Non Motor Symptoms (NMSs) are increasingly recognized as a major cause of disability in Parkinson’s Disease (PD) and contribute prominently to declining quality of life in Parkinson’s. The laterality of motor symptoms in PD is a well-known phenomenon with asymmetry of resting tremor, bradykinesia, and rigidity. But studies correlating NMSs with the side of onset of PD symptoms are few. Our aim was to study the prevalence of NMSs in PD and see their association, if any, with side of onset of motor symptoms of Parkinson’s.

Methodology: We included 80 patients 50 years or older with clinical diagnosis of idiopathic PD following the MDS Clinical Diagnostic Criteria for PD. They underwent 1.5T/3T Magnetic Resonance Imaging (MRI) and clinical examination according to the Motor Examination section (Part 3) of the Movement Disorder Society-Unified Parkinson’s Disdeases Rating Scale (MDS-UPDRS). Side of Onset of motor symptoms of PD was determined from patient history, and Hoehn and Yahr grading was done. NMSs present in each patient were assessed using a 30 item NMSQ questionnaire. Cognitive assessment of a subset of patients was done using MOCA. Chi Square test of significance was applied when comparing items of NMSQ in Right Vs. Left onset PD.

Results: There were no significant differences seen when we compared the prevalence of NMSs within the 10 domains of NMSQ between Left Onset (LPD) and Right Onset PD (RPD) in this study. MOCA scores also did not show any difference in average between LPD and RPD.

Discussion: A study performed by Cubo E et al, found that LPD was associated with greater motor symptoms, FOG, and NMS impairment. Rodriguez et al found significant differences in the frequency of hallucinations (P = 0.04) and sleep behaviour disorder (P < 0.01) in subjects with RPD compared to LPD.

Conclusion: The present study did not find any significant correlation between side of onset of motor symptoms of PD with prevalence of NMSs.

Abstract ID 145: Genetic Testing in Indian Neurology: Current Practices, Knowledge Gaps, and Future Directions

Tejaswini Shanubhogue, Soaham Desai

Shree Krishna Hospital and Pramukhswami Medical College, Karamsad, Anand, Gujarat, India

Background and aim: This study assessed Indian neurologists’ knowledge, attitudes, and practices (KAP) regarding genetic testing amid advancing technologies and increased awareness of genetics in neurology, aiming to understand how these innovations are being incorporated into clinical practice across the country.

Methodology: A cross-sectional online survey of Indian neurologists (January–June 2023) assessed demographics, genetic knowledge, testing practices, attitudes, and educational needs. Data analysis involved descriptive statistics and multiple logistic regression to identify trends and associations.

Results: Out of 256 neurologists surveyed, 91.4% had ordered genetic tests in the past year, with whole exome sequencing (76.6%) most commonly used. Neuromuscular and movement disorders were leading indications. Despite positive attitudes, key barriers included financial constraints (94.1%), limited access to genetic counselling (70.7%), and self-reported knowledge gaps. Notably, over 90% expressed a strong need for further training in ordering and interpreting genetic tests, highlighting the importance of educational support to improve genetic testing practices in neurology.

Discussion: The high rate of genetic test ordering and predominance of whole exome sequencing (WES) in testing practices mirrors global trends. Lower testing rates for epilepsy and stroke may reflect differing clinical practices or evidence levels. The overwhelming demand for training in genetic test ordering (90.6%) and interpretation (94.5%) align with global studies identifying genetic literacy as a universal challenge in medical education. Study limitations include selection bias, reliance on self-reported data potentially affected by social desirability bias, and a cross-sectional design that limits causal inferences about knowledge, attitudes, and practices.

Conclusion: This study reveals progress and challenges in integrating genetic testing into Indian neurology practice. Identified knowledge gaps and resource limitations suggest opportunities for targeted education and policy efforts to enhance genetic testing use and improve patient care outcomes.

Abstract ID 147: Effectiveness of Cannabidiol In Pediatric Drug Resistant Epilepsy: Initial Experience from A Tertiary Care Hospital in Eastern India

Sananda Majumder, Devlina Roy, Gouranga Mondal, Ramesh Bhattacharya

Calcutta National Medical College, Kolkata, West Bengal, India

Background and aim: Refractory epilepsies in children are a major burden for patients and parents. Cannabidiol has emerged as a promising therapy. The aim of this study was to evaluate the effectiveness of add-on cannabidiol for treatment of childhood refractory epilepsies.

Methodology: A single-center, prospective observational study was done for a period of 12 months. 23 consecutive patients with epilepsy refractory to at least 2 drugs in the age group of 1-12 years, formed the study population. Cannabidiol was initiated at 5 mg/kg/day and escalated weekly, up to 15 mg/kg/day. Outcome was evaluated by the reduction in seizure frequency at 3 months.

Results: Mean age of study population was 5.108 years with 52% being males. 20 patients had a follow up of at least 3 months when this analysis was done. All patients had a seizure reduction of at least 25%, 65% had a > 50% reduction, and 10% had a > 75% reduction. The mean monthly seizure frequency was reduced from 180.45 to 81.4 (median decrease from 180 to 75; median decrease 41%; p = 0.00008). Atonic seizure responded best (mean decrease 82%). Commonest adverse effect was drowsiness in 6 patients.

Discussion: The present interim analysis with half the estimated sample size and follow-up period, shows statistically significant (p < 0.05) reduction in overall seizure frequency. Unlike other studies, none of our patients had significantly elevated transaminases possibly owing to the fact that maximum dosage of 25 mg/kg was not reached. Drowsiness was mainly reported in those with concomitant Clobazam therapy. No statistically significant relationship of response with imaging abnormality was recorded.

Conclusion: The present study shows that cannabidiol can be an effective therapy in wide range of refractory epilepsies apart from the FDA-approved Lennox-Gastaut Syndrome (LGS) spectrum. Large scale studies are required to further quantify the effects. Notwithstanding, high therapeutic cost remains a significant challenge in developing countries.

Abstract ID 148: Combining Smartphone-Delivered and Clinician-Delivered Intervention: A Plausible Model for Service Delivery for People with Aphasia?

Apporva Pauranik, Rajath Shenoy¹, Gopee Krishnan¹

Pauranik Academy of Medical Education, Indore, Madhya Pradesh, ¹Manipal Academy of Higher Education, Manipal, Karnataka, India

Background and aim: Word-finding difficulties in aphasia are amenable to some forms of speech therapy, using a wide range of tasks. New technologies have been incorporated to facilitate the self-practice of traditional therapy tasks. However, some tasks are less easily adapted for self-practice. For example, while repetition in the presence of a picture (RIPP) can be relatively easily implemented, semantic feature analysis (SFA) is more challenging due to the need for feedback and adaptation depending on the participant’s response. We examined a plausible model for clinical service delivery using two modes of service delivery with two different therapy approaches: a smartphone-based home program using RIPP, and clinician-delivered therapy using SFA

Methodology: We employed a single-case methodology with six individuals with chronic aphasia who primarily experienced difficulty with picture naming. Following background testing, participants were given a set of 300 pictures for naming. 120 items that were difficult to name were selected for treatment and divided into four matched lists (30 each). These lists were randomly allotted to four conditions: smartphone-delivered treatment, clinician-delivered treatment, untreated but probed, and untreated pre-post only. We had three treatment orders with two participants per order: clinician-delivered treatment (using SFA) followed by smartphone-delivered treatment (using RIPP); smartphone-delivered treatment followed by clinician-delivered treatment; simultaneous provision of both treatment modes. We analysed the picture naming results using Weighted Statistics (WEST).

Results: Of the six participants, four showed significant item-specific improvements in naming following smartphone-delivered treatment, with three of these participants also showing improvement with the clinician-delivered treatment. There was no significant difference between the tasks for any participant.

Discussion: This is a proof-of-concept study.

Conclusion: This study reinforces the potential for technology-based home practice to improve word retrieval through the use of simple tasks. Such technology-based intervention has advantages over pen and paper ‘homework’ as it allows for (remote) monitoring by clinicians.

Abstract ID 149: Impact of Order Sets on Outcome of Acute Ischemic Stroke in a Tertiary Care Rural Hospital in India

Sarang Videkar, Tushar Patil

Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India

Background and aim: Acute ischemic stroke is a leading cause of disability and death, especially in rural settings where access to standardized treatment protocols is limited. Structured order sets, may enhance adherence to clinical guidelines and improve patient outcomes. However, their role in rural Indian hospitals remains insufficiently studied.

Methodology: This prospective observational study was conducted at Acharya Vinoba Bhave Rural Hospital, Wardha. A total of 200 patients diagnosed with acute ischemic stroke were enrolled—100 prior to (pre-implementation phase) and 100 after (post-implementation phase) the introduction of standardized order sets. Functional outcome assessment using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) was performed only in the post-implementation group at admission, discharge and one-month post-discharge.

Results: In post-implementation group (n = 100), mean NIHSS scores showed progressive improvement from admission (11.8 ± 3.6) to discharge (6.2 ± 3.4), and further at one month (3.5 ± 2.2). Similarly, mRS scores improved from 3.6 ± 1.3 at discharge to 1.9 ± 0.9 at one-month follow-up, indicating better functional independence. No comparable outcome measures were recorded for the pre-implementation group.

Discussion: Implementation of structured order sets significantly enhanced in-hospital efficiency for AIS care in a resource-constrained rural setup.

Conclusion: The implementation of standardized order sets in acute ischemic stroke management was associated with significant improvement in NIHSS and mRS scores, reflecting enhanced neurological recovery and functional outcomes.

Abstract ID 150: A Study on Behavioral and Psychological Symptoms in Patients with Various Neurocognitive Disorders at Medical College, Kolkata

Arghabrata Singha, Sandip Pal, Asutosh Pal

Kolkata Medical College, Kolkata, West Bengal, India

Background and im: Behavioral and Psychological Symptoms of Dementia (BPSD) are integral to the clinical presentation of neurocognitive disorders (NCDs) and significantly affect the quality of life of patients and caregivers. In India, where dementia care is still developing and shaped by unique cultural contexts, understanding the prevalence and patterns of BPSD is crucial. This study aimed to assess the prevalence, types, and severity of BPSD in patients with various neurocognitive disorders attending a tertiary care centre in Kolkata.

Methodology: This hospital-based cross-sectional observational study was conducted over one year (September 2023 to September 2024) at the Dementia Clinic of Medical College & Hospital, Kolkata. Fifty patients diagnosed with dementia were included. Cognitive function was assessed using Addenbrooke’s Cognitive Examination III (ACE-III), dementia severity was evaluated using the Clinical Dementia Rating (CDR) scale, and BPSD was assessed using the 12-item Neuropsychiatric Inventory (NPI-12).

Results: Among the 50 patients, 66% were male. The mean age was 62.94 ± 9.10 years. Alzheimer’s Disease (AD) was the most prevalent diagnosis (46%), followed by Vascular Cognitive Impairment (24%), Frontotemporal Dementia and Mild Cognitive Impairment (10% each), Dementia with Lewy Bodies (8%), and Normal Pressure Hydrocephalus (2%). BPSD was present in 90% of patients. Irritability (60%) was the most common symptom, followed by apathy (40%), and depression and sleep disturbances (32%). Subtype-specific symptoms included hallucinations in DLB (100%) and disinhibition in FTD (60%). ACE-III scores showed a significant moderate negative correlation with total BPSD scores (r = -0.34, p = 0.016) and caregiver distress scores (r = -0.33, p = 0.019).

Discussion: The findings suggest a high burden of BPSD in dementia patients, with distinct patterns observed across different NCD subtypes. Cognitive decline was associated with greater behavioral symptoms and caregiver distress.

Conclusion: Recognizing BPSD and their subtype-specific presentations is vital for comprehensive dementia care and for developing culturally tailored interventions in the Indian context.

Abstract ID 151: Neurotoxoplasmosis Reimagined: Diagnostic Dilemmas in Atypical Presentations

Soorya K, Thamilpavai N, Ravi N, Prakash V, Mugundhan K

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Toxoplasmosis is an opportunistic infection caused by Toxoplasma gondii (TG), an intracellular protozoan parasite that disseminates and persists in humans, particularly in immunocompromised hosts. The central nervous system (CNS) is a common site of involvement, typically presenting with multifocal necrotizing, hemorrhagic lesions with ring enhancement on imaging, especially in individuals with advanced human immunodeficiency virus (HIV) infection. However, atypical presentations pose significant diagnostic challenges. This study highlighted three such atypical cases of CNS toxoplasmosis in HIV-positive patients to underscore the variability in clinical and radiological features, and the importance of maintaining a high index of suspicion.

Methodology: We presented a case series of three patients with HIV infection who developed CNS toxoplasmosis with atypical clinical and imaging features

Results: Case 1: A 44-year-old female with untreated HIV presented with a 6-month history of progressive headache, behavioral changes, and memory disturbances. She was drowsy but arousable, with preserved motor responses. Magnetic Resonance Imaging (MRI) showed multiple T2/FLAIR hyperintensities with open-ring enhancement, mimicking demyelination. CD4 count was <200 cells/mm³. Positive Toxoplasma IgG (>400 IU/mL) and a good therapeutic response to anti-toxoplasma therapy confirmed the diagnosis. Case 2: A 36-year-old male on ART with a CD4 count of 312 cells/mm³ presented with headache and focal seizures. MRI revealed a solitary left frontal lesion with surrounding edema. Initially treated as tuberculoma, he re-presented with altered sensorium. Repeat imaging showed multiple ring-enhancing lesions with eccentric nodules and mass effect. Positive Toxoplasma immunoglobulin G (IgG) and clinical improvement with trimethoprim-sulfamethoxazole supported the diagnosis of toxoplasmosis, despite a relatively preserved CD4 count. Case 3: A 37-year-old female with rheumatic heart disease presented with acute right hemiplegia, cranial nerve palsies, and midbrain signs, initially suspected to be a stroke. MRI revealed multiple rim-enhancing lesions in basal ganglia, cerebrum, and cerebellum. HIV ELISA and Toxoplasma IgG were positive. Her clinical signs were due to perilesional edema compressing the midbrain. She improved with toxoplasmosis treatment.

Discussion: These cases illustrate the protean manifestations of CNS toxoplasmosis in HIV-infected individuals, including presentations mimicking demyelination, neoplasm, or cerebrovascular events. Diagnosis is often delayed in atypical cases or in patients with higher CD4 counts.

Conclusion: CNS toxoplasmosis should be considered in the differential diagnosis of atypical neurological presentations in HIV-positive patients, regardless of CD4 count. Early recognition and empirical treatment based on imaging and serology can significantly improve outcomes.

Abstract ID 152: Mind Over Mineral: Unraveling a Familial Mystery” A Rare Case of Fahr’s Disease Presenting with Choreo-Dystonic Movements and a History of Seizure Disorder

Shiny Thomson, Ravi L A, Tamilpavai N, Mugundhan K

Madras Medical College, Chennai, Tamil Nadu, India

Background andim: Fahr’s disease (also called Primary Familial Brain Calcification, PFBC) is a rare, inherited neurodegenerative disorder characterized by abnormal, bilateral, symmetrical calcifications in areas of the brain such as Basal ganglia, Thalamus, Dentate nucleus, Cerebral cortex, Cerebellum. These calcifications are visible on CT brain scans and are associated with a range of neurological and psychiatric symptoms like Movement disorders (parkinsonism, tremor, chorea, dystonia), Cognitive decline, Neuropsychiatric symptoms (psychosis, mood disorders) Seizures (less commonly). This case highlighted an early-onset presentation with significant family history, emphasizing the importance of early neuroimaging and genetic evaluation.

Methodology: A 20-year-old female presented with childhood-onset focal seizures progressing to generalized tonic-clonic seizures by age 14, which later remitted. After a symptom-free interval, she developed recent-onset involuntary backward neck movements, dystonia, and difficulty raising her left arm. Family history revealed a sibling with mutism and intellectual disability and another sibling deceased at 1 year. Clinical, neurological, biochemical workup including serum calcium, phosphorus, vitamin D, parathyroid hormone (PTH), Computed Tomography (CT), Magnetic Resonance Imaging (MRI) Brain, and genetic testing for familial brain calcification were performed.

Results: Examination showed extrapyramidal signs without cranial nerve, cerebellar, or pyramidal involvement. Blood investigations showed low vitamin D with normal calcium and PTH. Neuroimaging revealed bilateral symmetrical calcifications in the basal ganglia, thalami, dentate nuclei, and right frontal subcortical region, characteristic of Fahr’s disease. Given the family history, a genetic analysis was sent to evaluate for familial primary brain calcification, with results awaited at discharge. The patient was managed symptomatically with significant improvement.

Discussion: Although typically presenting in the third to fifth decade, Fahr’s disease can occur in young individuals, often with early seizure history. In such cases, familial clustering necessitates prompt neuroimaging and genetic workup to establish diagnosis and counsel families. This case underscores the utility of multidisciplinary care and genetic screening.

Conclusion: Early recognition of atypical movement disorders, particularly with seizure history and positive family history, warrants neuroimaging and genetic testing to confirm Fahr’s disease. Supportive therapy and genetic counselling improve long-term outcomes.

Abstract ID 153: A Prospective Study of the Clinical & Radiographic predictors of Outcomes in Spontaneous Intracerebral Hemorrhage in a Tertiary Care Center

Ayush Jain, Shri Ram Sharma, Baiakmenlang Synmon, Mahendra Thakre

North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India

Background and aim: Spontaneous intracerebral hemorrhage (ICH) is a critical stroke subtype with high morbidity and mortality, necessitating the identification of clinical and radiographic predictors for effective risk stratification. This study evaluated these predictors in ICH patients at a tertiary care center in Northeast India.

Methodology: A prospective observational study (Thesis No. T147/2023/147) was conducted at NEIGRIHMS, Shillong, from June 2023 to November 2024, following IEC approval (NEIGR/IEC/M12/T27/2023). This study enrolled 185 patients (66.5% male, mean age 54.61 ± 12.41 years) with spontaneous ICH, confirmed by non-contrast CT, from the Departments of Neurology and Neurosurgery. Informed consent was obtained from participants or their representatives. Clinical variables (e.g., blood pressure, Glasgow Coma Scale [GCS], ICH score) and radiographic features (e.g., hematoma volume, intraventricular hemorrhage [IVH], blend sign, satellite sign) were recorded at presentation. Outcomes were assessed using the Modified Rankin Scale (mRS) at discharge, 30, and 90 days, with good outcome defined as mRS 0–3 and poor outcome as mRS 4–5 or death. Statistical analysis was performed using SPSS version 26.

Results: Mortality rose from 16 (8.6%) at discharge to 25 (13.5%) at 90 days, while good outcomes (mRS 0–3) increased from 23 (13.6%) to 116 (62.7%). Hypertension (72.4%) and diabetes (33.0%) were prevalent, with irregular hypertension treatment (p = 0.04) linked to worse outcomes. Significant predictors of poor outcomes included higher systolic blood pressure (p = 0.0004), diastolic blood pressure (p = 0.0063), ICH score (p = 0.0008), hematoma volume (p = 0.0009), IVH (p < 0.001), hydrocephalus (p < 0.001), herniation (p < 0.001), satellite sign (p < 0.001), blend sign (p = 0.022), spot sign (p = 0.012), and hematoma homogeneity (p < 0.001).

Discussion: Larger hematoma volumes and radiographic signs like IVH (64.9% poor outcomes) and herniation (65.6%) strongly predict poor prognosis, reflecting their role in exacerbating neurological damage. Heterogeneous hematomas (48.9% poor outcomes) also indicate worse prognosis.

Conclusion: Early assessment of clinical and radiographic predictors can guide targeted interventions, emphasizing the need for tailored ICH management to improve outcomes.

Abstract ID 154: Balancing Out the Odds

Samik Ghosh, Alak Pandit, Atanu Biswas, Biman Ray, Souvik Dubey, Debaleena Mukherjee

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Background and aim: Sensory ataxia is commonly encountered in clinical practice. Aim of this study was to describe the clinical, electrophysiological and therapeutic profiles of cases of sensory ataxia in an Eastern Indian tertiary care centre.

Methodology: An ambispective study was conducted on patients admitted between January, 2024-January, 2025. Cases were defined as those with ataxia suggestive of sensory neuropathy/neuronopathy/dorsal column abnormality, without any suggestion of predominant cerebellar, vestibular, pyramidal or extrapyramdial pathology.

Results: Among 33 total cases, male:female was 2.3:1. Median age was 43.2 ± 13.1 years. Seven cases presented acutely, while 26 were chronic. As per substrate, 90.9% cases were of large fibre sensory neuropathy, 6% myeloneuropathy, 3% sensory neuronopathy. Etiologically, 6% cases were Vitamin B12 deficiency -one such case showed elevated methylmalonic acid (MMA) levels with normal Vitamin. B12; 15% cases-Primary Sjogren’s (ACR/EULAR Classification Criteria), 60% large fibre seronegative neuropathy, 10% nodal antibody positive neuropathy, rest were paraneoplastic neuropathy and neuronopathy. Nerve conduction study (NCS) showed both sensory and motor (subclinical) changes in 21% cases. Interestingly, 2 of those cases had relapses, and 1 had nodal antibody positivity. Only 2 patients improved significantly (modified Inflammatory Neuropathy Cause and Treatment Sensory Scale (mISS) change ≥2) without therapy. Two patients required Vitamin B12 supplementation, while 24 cases required IVIG, among which 12 required Rituximab/Azathioprine.

Discussion: Some interesting take-away points gathered. Not all B12 deficiency cases will have subnormal B12 levels, clinical suspicion should be high if there is relevant history/examination findings (eg. knuckle hyperpigmentations). Cases with Motor NCS abnormalities and nodal antibody positivity may have a more sinister course; but not always - as 1 case of concurrently detected Vitamin B12 deficiency and NF186+ showed significant improvement in mISS (18 to 15) with B12 supplementation ONLY. Two cases could partially satisfy the ACR/EULAR criteria initially, but did latter. Whether pure sensory neuropathic presentation can predict fullblown Sjogren’s, needs extensive study.

Conclusion: Sensory ataxia can have an extensively heterogenous spectrum of clinical presentation and thus early detection of above features may help to guide therapeutic decisions in cases of sensory ataxia.

Abstract ID 155: An Ambispective Cohort Study of Patients with Autoimmune seizure and Epilepsy Syndromes

Vedang Desai

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Immune mediated seizure and epilepsy syndromes are rare subtypes of syndrome complexes comprising of Seizures as a core feature, with numerous other neurological symptoms. However, absolute paradigms in diagnosis, subtypes of antibodies and treatment guidelines still remain a grey area in the expanding field of Epilepsy and Neuroimmunology. The primary aim was to ‘study the seizure reduction in patients with clinically definite Vs. probable and possible (Seronegative) autoimmune seizures/epilepsy syndromes, with targeted therapy.

Methodology: Patients with Antibody-positive and antibody-negative (probable and possible - APE2 score ≥4) cases of immune mediated seizure and epilepsy syndromes, fulfilling the criteria were included in the study. It was an ambispective cohort study.

Results: Clinically meaningful seizure reduction (>50% of baseline) was achieved in most patients across definite AE (92.85%), and in 72.41% of cases of seronegative AE. This did not reveal any statistically significant difference between two groups.

Discussion: Definite and Seronegative subgroups had a higher proportion of female participants. The mean modified Rankin Scale (mRS) at presentation was much worse in Definite AE compared to Seronegative AE, which meant that the patients presenting with definite AE had a worse overall general condition compared to the other arms. The Definite AE subgroup also had the highest mean duration of hospitalisation, which probably reflects the overall worse general condition and higher complications encountered. As in the case of pre analysis hypothesis, the Definite AE subgroup had a higher mean APE-2 and RITE-2 score, thus advocating a high sensitivity of the scores in predictability for detection of Anti-neuronal antibodies. PET CT seemed to be a better radiological method compared to MRI for predicting the primary outcome seizure reduction > 50%.

Conclusion: The difference between clinically meaningful seizure reductions is showing a trend towards significance with better trends in definite cases. Positron Emission Tomography (PET) Computed Tomography (CT) seemed more sensitive than Magnetic Resonance Imaging (MRI).

Abstract ID 156: Comparative Analysis of Clinical Profile, Treatment Strategies, and Long Term Outcomes in Seropositive and Seronegative Pediatric Autoimmune Encephalitis – A single Tertiary Center Study

Mohinish S, Neeraj Elango, Jered Livingston, Leema Pauline

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: In pediatric autoimmune encephalitis (AIE), neurological manifestations are prominent initial presentation as compared to behavioral or psychiatric symptoms. Early diagnosis and prompt treatment leads to improved outcomes with reduced relapses. The aim of this study was to analyze the clinical profile and treatment options in seropositive and seronegative patients; and long-term motor and neurocognitive outcomes in both groups.

Methodology: Prospective observational study of AIE patients admitted in the center from January 2022 to December 2023.

Results: A total of 36 children were included. Twenty-five (70%) were positive for cerebrospinal fluid (CSF) autoimmune panel (NMDAR), in which 5 (20%) were HSV triggered, 10 (28%) probable, 1 (2%) possible AIE. The mean age of onset was 6.1 years (1.2 years-12 years). The clinical features were seizures (83%), encephalopathy (72%), movement disorders (52%), behavioral disturbances (48%), sleep disturbances and speech disturbances (43%) and autonomic (16%). Mean duration of PICU stay was 23 days. Neuroimaging was normal in 66.7% cases. Mean time to initiate immunotherapy 13 days. Twenty-three (96%) seropositive cases and 3 (28%) seronegative cases received 2nd line immunotherapy. Among seropositive cases, 78% received Rituximab, 18% both Rituximab and Cyclophosphamide. Overall mortality was 2 (5.5%). Mean duration of follow up 18 months (6 – 42 months). Three cases had relapse during follow up and 2 cases noted to have autoimmune epilepsy. 60% seropositive, 18% seronegative cases had residual deficits in term of modified Rankin Scale (mRS), cognitive and behavior outcome scales. All HSV triggered cases had residual defects and poor outcomes. No underlying tumor was identified in our cohort.

Discussion and Conclusion: Though autoimmune encephalitis has a stormy acute phase, it usually remains monophasic in children. Outcomes are favorable in the large majority of affected children. Those with HSV encephalitis and evidence of structural brain lesions fare poorly.

Abstract ID 157: Evaluation of Clinical, Electrophysiological, and Radiological Profile of Carpal Tunnel Syndrome

Akankshi Agarwal, Papori Borah

Gauhati Medical College and Hospital, Guwahati, Assam, India

Background and aim: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy, typically seen in middle-aged women. Diagnosis relied on clinical symptoms and nerve conduction studies (NCS), while high-resolution ultrasonography (USG) was gaining popularity. This study aimed to evaluate and correlate clinical features, electrophysiological parameters, and ultrasonographic (USG) findings in CTS.

Methodology: This prospective, cross-sectional study was conducted in the Department of Neurology, GMCH over 1 year. Patients aged >12 years with CTS features underwent structured evaluation including history, neurological examination, standardised NCS (motor, sensory, F-wave studies, and median-ulnar comparisons), and high-resolution sonography of both wrists. Data was analysed using SPSS.

Results: Fifty patients (78.8% female) were enrolled, with peak incidence between 30–50 years. Paresthesias (82.8%), nocturnal symptoms (61.8%), and numbness (33.3%) were prevalent. NCS demonstrated bilateral CTS in 69.3% of cases and subclinical contralateral involvement in 48.3% of unilaterally symptomatic individuals. The most sensitive NCS parameter was digit 4 median-ulnar sensory latency comparison (90.1%), followed by F-wave comparison (82.6%) and median sensory distal latency (81.9%). Ultrasonographic and electrophysiological characteristics correlated well. Median nerve anomalies were found in 63.5% of individuals with moderate to severe CTS on ultrasonography. USG also found tenosynovitis in certain RA patients.

Discussion: Combining clinical, electrophysiological, and radiological assessments provided comprehensive CTS understanding. While NCS remained the diagnostic gold standard, USG offered valuable structural insights and could serve as an effective screening tool in resource-limited or NCS-contraindicated settings.

Conclusion: Multimodal evaluation enhanced CTS diagnosis accuracy. Ultrasonography could complement or substitute NCS in appropriate contexts, particularly for early detection, monitoring treatment response, and identifying structural compression causes.

Abstract ID 158: An Observational Study of Clinical Profile and Electrophysiological Assessment of Peripheral Neuropathy in Newly Diagnosed Plasma Cell Disorder

Akshay Bhutada, Marami Das

Gauhati Medical College and Hospital, Guwahati, Assam, India

Background and aim: Peripheral neuropathy is a common and often debilitating complication associated with plasma cell disorders (PCDs), including multiple myeloma, monoclonal gammopathy of undetermined significance (MGUS), and Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin abnormalities (POEMS) syndrome. These neuropathies may be subclinical or overt and significantly impact quality of life. Electrophysiological studies (EPS), especially nerve conduction studies (NCS), aid in early detection and characterization. This study aims to examine the clinical profile of peripheral neuropathy in newly diagnosed PCD patients, categorize neuropathy types based on NCS findings, and evaluate their response to treatment.

Methodology: This observational cross-sectional study was conducted at the Departments of Neurology and Hematology, Gauhati Medical College and Hospital, from March 1, 2024, to February 28, 2025. Thirty-five patients newly diagnosed with plasma cell disorders and presenting with neuropathic symptoms were enrolled. Detailed clinical history, neurological examination, and baseline NCS were performed. Follow-up NCS was conducted three months post-treatment. Data were documented in a structured proforma and analyzed using SPSS software.

Results: Among 35 patients (mean age 61 ± 8 years; 60% male), axonal neuropathy was the predominant electrophysiological pattern (65.7%), followed by demyelinating (25.7%) and mixed-type neuropathy (8.6%). The most common symptoms included paresthesia (85.7%) and distal weakness (68.6%). Patients with axonal neuropathy showed partial improvement on follow-up, while those with demyelinating patterns demonstrated better response to treatment.

Discussion: Axonal neuropathy emerged as the major subtype in newly diagnosed PCD patients, indicating a likely direct toxic or ischemic effect of monoclonal proteins on nerves. The limited reversibility of axonal damage compared to demyelinating types underscores the importance of early detection. These findings align with prior studies, suggesting a need for aggressive management of underlying plasma cell dyscrasias to prevent progression

Conclusion: This study highlights the high prevalence of axonal neuropathy in plasma cell disorders. Early electrophysiological assessment aids in neuropathy characterization, which is essential for prognosis and management. Recognizing neuropathy patterns can guide clinicians in timely intervention, potentially improving patient outcomes.

Abstract ID 159: A Study of Correlation of Levetiracetam Drug Levels with Seizure Control in Cases of Epilepsy

Srinath R, Shamala Shravan¹

Military Hospital, Gangtok, Sikkim, ¹Armed Forces Medical College, Pune, Maharashtra, India

Background and aim: This study investigates the relationship between levetiracetam drug levels and seizure control in epilepsy patients. Primary objective of this study was to correlate the adequacy of seizure control with the measured drug levels of levetiracetam. This secondary objective was to study the effect of drug titration and drug levels of Levetiracetam with seizure control among patients with poor seizure control.

Methodology: This was a prospective cross-sectional observational Study for a period of two years from January 2021 to December 2022. INCLUSION CRITERIA: 1. Adult patients with diagnosed Epilepsy who are drug-naïve started on Levetiracetam as monotherapy. 2. Patient giving written informed consent for study. EXCLUSION CRITERIA: 1. Patients with diagnosed refractory epilepsy. 2. Patients with psychiatric illness, unable to give proper history.

Results: A total of 72 patients were evaluated, eight patients were rejected due to exclusion criteria and four patients refused consent for the study. A total of 60 adult patients were included in the study. The serum level of levetiracetam stem was significantly different between patients with good control and poor control with a p-value less than 0.0001. The mean values for patients with good control was 16.9 ± 9.1 as compared to 4.4 ± 4.8 in patients with poor control.

Discussion: Levetiracetam is an effective monotherapy for seizure control. The patients refractory to seizure control on monotherapy require drug monitoring to achieve therapeutic control.

Conclusion: Levetiracetam is an effective monotherapy for seizure control. The patients refractory to seizure control on monotherapy require drug monitoring to achieve therapeutic control.

Abstract ID 160: Randomized Controlled Trial on Supervised Aptitude-based Cognitive Retraining Intervention in MCI and Early Dementia due to AD –Validation Protocol and Interim Analysis of the ‘SACRED’ Study

Ramshekhar Menon, Parvathy PK, Rajesh PG, Chaithanya NC, Asish Vijayaraghavan

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Background and aim: Cognitive retraining (CRT) is a non-pharmacological intervention aimed at sustaining or improving impaired cognitive abilities. While prior studies suggest benefits of CRT in persons with dementia (PwD), randomised control trial (RCT) evidence is lacking in literature.

Methodology: Inclusion criteria mandated age > 60 years and a diagnosis of MCI/early dementia- AD with clinical dementia rating (CDR) scale performance <2. The present RCT (CTRI 2023/06/053884) design involved a validated aptitude-based CRT intervention-arm (n = 18) focusing on domains – Memory, Attention, Language, Emotion Processing, and Visuo-spatial orientation administered by a neuropsychologist in hourly sessions for 10-12 weeks. The manual-guided Home-based Rehabilitation (HBR) arm (n = 32) served as the internal control arm. Pre and post-intervention assessments included neuropsychological tests CDR-sum of boxes (SB), short-form-survey (SF-36), and Instrumental Activities of Daily Living (IADL).

Results: Interim results at 1 year follow-up was available in 8 participants in CRT and 6 in HBR arm. Baseline Vs post-interventions in CRT group exhibited significant improvement with p = 0.013 for ACE –III (memory), p = 0.031 for recognition memory on list learning, p = 0.01 on confrontation-naming, p = 0.029 on depression scale and p = 0.033 for SF-36 (role limitation due to emotional-problems). Baseline vs Post-interventions in HBR-group also showed improvement with p value = 0.008 on CDR-SB, p = 0.011 & p = 0.039 on WMS logical memory immediate and delayed recall respectively, p = 0.027 on trail-making, p = 0.031 and p = 0.008 for IADL cognitive disability and physical disability indices respectively. Between arm analysis did not reveal any significant differences between baseline and post-intervention results between the groups.

Discussion: Interim analysis of our RCT shows significant benefits of CRT and HBR on various cognitive domains for MCI/PwD.

Conclusion: Results of this study support holistic intervention strategies to stabilize/improve cognitive test performance and ADL in MCI and PwD due to AD for the first time from the Indian subcontinent. Studies with larger sample size and longer duration of follow-up are necessary.

Abstract ID 161: Impact of Moderate-High Intensity Statin Use on Secondary Stroke Prevention: A Retrospective Cohort Analysis from India

Veena Surendran, Sapna Sreedharan

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Background and aim: High-intensity statins, especially Atorvastatin at 80 mg is recommended for secondary prevention after non-cardioembolic ischemic stroke. But, some reports suggest poor tolerability of high intensity statins in Asian population, leading to medication non-compliance and suboptimal lipid targets. This study aimed to evaluate the impact of moderate-high intensity statin (Atorvastatin 40 mg) use on changes in lipid profile at 3 months after stroke and outcome.

Methodology: The current study was a retrospective review of all non-cardioembolic stroke patients admitted to our tertiary care centre between 2021-2023 (3 years) with lipid levels available at stroke onset and prescribed Atorvastatin 40 mg/day for 3 months after the event. Demographics, vascular risk factors, lipid profiles, prior statin use and stroke etiology and 3 month modified Rankin scale (mRS) were extracted from medical records. Correlations were made between changes in lipid levels at 3 months and outcome.

Results: We had 208 subjects of which 147 (70.7%) were males. Mean Cholesterol and LDL-C at admission were 185.9 mg/dL and 118 mg/dL. At 90 days post-stroke, ideal LDL targets (<70 mg/dL) was achieved in 52/109 (47.7%) and good target (<100 mg/dL) in 91/109 (83.5%) patients; none reported discontinuation of statin due to adverse effects. Good functional outcome (MRS 0-3) was observed in 132/154 (86.8%). There was no significant correlation between the each lipid parameter at baseline or at 90 days with good functional outcome.

Discussion: In a retrospective Indian study by Sridharan P. et al (2021) of 100 patients with acute ischemic stroke involving anterior circulation, the patients were divided into those who received low-dose (Atorvastatin 20 mg/dL) vs. high-dose (Atorvastatin40 mg/dL), mRS≥3 was observed in 90.9% of patients, similar to our study (86.8%).

Conclusion: Our findings indicate that moderate-high intensity statin can result in achieving LDL-C targets in over 80% of our stroke population without significant adverse effects though it did not impact short-term functional outcome.

Abstract ID 162: Reproductive Health in Men and Women with Wilson’s Disease

Jalumuri Anjusha, D Seshagiri, Sanjib Sinha, Madhu Nagappa, E Sinu

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: To assess the fertility and pregnancy outcome in patients with Wilson’s Disease (WD) To assess the effects of the disease status on the responsible good fertility outcome

Methodology: Patients with WD, aged 18–45 years, were recruited based on modified Leipzig criteria. Both men (MeWD) and women (WoWD) completed a questionnaire on reproductive health and fertility. Data on disease status, medication use before, during, and after conception, and clinical history were obtained from medical records. Hormonal profiles were reviewed, and disability was assessed using the modified Rankin Scale.

Results: The study included 55 men MeWD cases, 18 of whom were married to women without WD. Among these, 14 couples conceived—2 had abortions and 12 had live births, with no congenital anomalies reported. Six conceived within a year of trying, while four experienced delays over a year. At conception, 3 MeWD were in the presymptomatic, 6 in the symptomatic, and 17 in the maintenance phase. Among 46 women with WD (WoWD), 26 were married to men without WD. These women had 56 conceptions: 19 abortions and 38 live births. Fifteen conceived within a year of planning pregnancy. Abortions occurred in 7 presymptomatic, 7 symptomatic, and 5 in the maintenance phase. Live births followed 11 presymptomatic, 6 symptomatic, and 21 maintenance phase conceptions. Irregular menstrual cycles were reported in 3 presymptomatic and 2 symptomatic-phase women.

Discussion: Patients with WD can have favorable reproductive outcomes. In men, fertility was preserved with no congenital anomalies. In women, live births were more common during the maintenance phase, while abortions were frequent in earlier disease stages. Irregular cycles were noted but did not hinder conception. Stable disease and proper management support better outcomes.

Conclusion: Reproductive outcomes in WD cases are favorable with good disease control, with better fertility and outcomes during the maintenance phase.

Abstract ID 163: Adrenaline’s Dark Side; Phaechromocytoma Presenting as Hemmorhagic Stroke

Nayana Bhuyan, Abhishek Pathak¹, Vijay Mishra¹

Banaras Hindu University, Varanasi, Uttar Pradesh, ¹Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background and aim: Pheochromocytomas are catecholamine-secreting tumours that arise from chromaffin cells of the adrenal medulla. The present case is a 35 years female who presents with intra-cerebral hemorrhage, which is quite an unusual presentation at such a young age.

Methodology: A 35 years female presented with sudden onset left-sided hemiparesis with history of persistent throbbing headache for one year, localized to the bilateral frontotemporal region. There was no significant past, family or personal history. On examination Pulse -80/min, regular, BP-140/100 in right upper limb, and no significant difference in all 4 limbs, the Glasgow Coma Scale (GCS) was E4V5M6, power 0/5 on left upper and lower limb.

Results: All routine examination, lipid profile, HBA1C, routine urine was normal. The computed tomography (CT) Brain was suggestive of hemmorhagic stroke in right temporoparietal cortex. Magnetic Resonance Imaging (MRI) brain with SWI sequence was not suggestive of microbleeds. CT Brain Angiography was normal. Serum free metanephrine and plasma metanephrine was raised and serum 8 am cortisol was normal. Patient was advised abdominal CT which revealed a 4.6 x 4.0 x 4.3 cm Phaechromocytoma. Sixty-eight Gallium dotanoc whole body positron emission tomography (PET) CT confirmed it to be a benign phaeochromocytoma. Patient was operated and excised tumour was sent for biopsy which revealed benign phaechromocytoma. Patient is doing well on follow up.

Discussion: Pheochromocytomas are rare neoplasms, probably occurring in less than 0.2 percent of patients with hypertension. Pheochromocytoma may have a myriad of presentations. This case presented with persistent bilateral headache without palpitation and diaphoresis which is rare.

Conclusion: Pheochromocytoma must be ruled out as the cause of Intra-cerebral hemorrhage in a young patient with hypertension. Early diagnosis and management can reduce the morbidity associated with the potentially fatal disease of pheochromocytoma.

Abstract ID 164: A Case Series of Varied Presentations of Neuromelioidosis in a Tertiary Care Center

Vignesh Kumar, Rajegembeeran V, Sivaji M, Mugundhan Krishnan

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Neuromelioidosis, a rare but severe manifestation of Burkholderia pseudomallei infection, accounts for approximately 5% of melioidosis cases. It is often underdiagnosed due to its protean neurological manifestations and poor culture positivity rates. This case series highlights five patients with neuromelioidosis, emphasizing varied clinical presentations and the critical role of radiological suspicion, particularly in cases like Case 1, which presented as acute flaccid paralysis—a highly unusual form of neuromelioidosis.

Methodology: Five patients diagnosed with neuromelioidosis were analyzed retrospectively. Clinical presentation, laboratory data, neuroimaging, and outcomes were reviewed. All underwent Magnetic Resonance Imaging (MRI) brain and spine, Cerebrospinal Fluid (CSF) analysis, and systemic workup. While culture positivity was low, diagnosis was supported by radiological findings and clinical context. Treatment included high-dose IV meropenem followed by oral co-trimoxazole.

Results: Only one patient had a positive culture, underscoring the diagnostic limitations of microbiology. MRI findings consistently demonstrated rim-enhancing microabscesses and tract-specific hyperintensities. Presentations varied from encephalopathy, cranial neuropathies, and seizures to the rare occurrence of acute flaccid paralysis in a 46 year old male, with spinal and brainstem lesions. Four patients improved significantly on follow-up; one succumbed.

Discussion: The poor sensitivity of cultures in Central Nervous System (CNS) melioidosis (20–30%) necessitates high clinical and radiological suspicion for early diagnosis. In endemic regions, fever with neurological deficits—especially those with atypical features like acute flaccid paralysis—should raise suspicion. Imaging signatures like tract-based abscesses and cranial nerve involvement are crucial for differentiation from tuberculosis or autoimmune mimics.

Conclusion: Neuromelioidosis must be a differential in subacute neurological illnesses with systemic symptoms in endemic zones. Despite its varied presentations, characteristic MRI features and early empirical treatment can improve outcomes. Case 1 exemplifies how rare presentations like acute flaccid paralysis demand heightened clinical awareness despite negative cultures.

Abstract ID 165: Magnetic Resonance Guided Focused Ultrasound (MRgFUS) for Essential Tremor and Tremor Dominant Parkinson’s Disease: Case Series

Jayasree Manikinda, Manas Panigrahi, Gopala Gorrepati

KIMS Hospital, Hyderabad, Telangana, India

Background and aim: Magnetic Resonance guided focused ultrasound (MRgFUS) ventral intermediate nucleus (VIM) thalamotomy is an FDA approved treatment for medically refractory and debilitating tremor for patients with essential tremor (ET) since July 2016 and tremor dominant Parkinson’s disease (TDPD) since December 2018.

Methodology: Patients with medication refractory, debilitating ET and TDPD who regarded their tremor as disabling in daily life activities were treated with MRgFUS. All patients were offered both deep brain stimulation and MRgFUS as treatment options and patients who preferred MRgFUS as their first choice were included. Patients were eligible for MRgFUS only after a movement disorders neurologist verified that they were given optimal medication trial for tremor relief. MRgFUS treatment consisted of multiple sonications, where ultrasound waves were focused on a predefined small target inside the brain repeatedly for different lengths of the time while gradually increasing the energy.

Results: A total of 12 patients were treated since December 2024, out of which 3 patients had ET and 9 patients had TDPD. Treatment resulted in immediate complete cessation of the rest tremor and the action tremor at the end of the procedure, in the treated arm in all the three ET patients and the arm and leg tremors, rigidity and bradykinesia in all TDPD patients.

Discussion: We confirm that MRgFUS is safe and effective treatment option for control of tremor in ET, and tremor, rigidity and bradykinesia in TDPD patients. Persistence of beneficial effects need to be confirmed over long term follow-up. Adverse effects were mild and resolved significantly within one week in most of the patients.

Conclusion: MRgFUS is an effective and safe procedure for patients with ET, and TDPD who are not eligible or willing for DBS. It is a good non-invasive treatment option with minimal side effects for patients who do not want to undergo surgery.

Abstract ID 166: Clinical and Etiological Profile of Childhood Movement Disorders: - Experience from A Tertiary Care Hospital in Eastern India

Sananda Majumder, Devlina Roy, Gouranga Mondal, Ramesh Bhattacharya

Calcutta National Medical College, Kolkata, West Bengal, India

Background and aim: Movement disorders (MD) are a developing field in child neurology, being quite common in everyday practice. They have distinctive characteristics that are determined by the metabolic, physiologic or environmental insults to the developing brain. Consequently, this study was conducted with an aim to 1) delineate the spectrum of movement disorders in children, 2)evaluate the underlying etiology of movement disorders, and 3) record short-term outcome at 3 months.

Methodology: A single-center, prospective observational study was done for a period of 12 months. Total of 89 consecutive patients attending the Neurology ward and OPD in the age group of 1 year to 18 years were taken. Detailed history with video aids helped diagnose the movement phenotype and relevant investigations were carried out to delineate the etiology. Treatment was initiated according to institutional protocol and followed up at 3 months. Statistical analysis was done using SPSS 26.

Results: Dystonia (29.2%) was the predominant MD followed by tics (23.5%), chorea (13.4%), ataxia (12.3%), myoclonus (10%) and tremor (5.6%). Mean age of onset was 8.19 years with 56% of the patients being males. Imaging abnormality was found in 56% of patients. Infection (24.7%) and structural brain abnormality (23.6%) were the commonest underlying etiology. 19 patients were lost to follow-up. 32% of remaining, recovered fully.

Discussion: Infections and structural lesions were the leading underlying causes, with sequelae of hypoxic ischaemic damage being the predominant structural anomaly, which is expected in our population. Similar to few other Indian studies, dystonia was the predominant type. Improvement is seen occurring in 32% of patients indicating that early diagnosis may improve outcome although rheumatic chorea and infantile tremor syndrome usually resolve spontaneously.

Conclusion: This study displays a wide spectrum of childhood movement disorders. Although, response to therapy in MDs is variable, timely diagnosis and initiation of therapy may help reverse treatable conditions.

Abstract ID 167: Acute Amnestic Syndrome Secondary to Fornix Infarct: A Comprehensive Literature Review

Kanika Suri, Gourav Goyal

Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India

Background and aim: Background Fornix infarction is a rare cerebrovascular event characterized by isolated memory impairment, primarily presenting as acute amnestic syndrome. Due to its small size and deep location, infarction of the fornix often goes unrecognized, posing diagnostic challenges. This review aimed to synthesize existing evidence on the clinical presentation, neuroimaging features, risk factors, and outcomes of fornix infarction. It also seeks to highlight diagnostic difficulties and inform better recognition and management of this condition.

Methodology: A systematic review of 35 studies published between 2000 and 2024 was conducted. Inclusion criteria were acute or subacute amnestic syndrome within one month, predominant amnesia as the primary symptom, and neuroimaging-confirmed fornix infarction. Cases with fornix injury due to surgery or extensive limbic damage were excluded. Data on demographics, clinical presentation, imaging, vascular territory, TOAST classification, and outcomes were extracted and analyzed by two independent reviewers

Results: Patients of age ranged from 20 to 80 years, with a mean age of 58. Bilateral fornix infarction was observed in 32 cases, with anterograde amnesia as the main symptom in most. Etiology was undetermined in 23 cases, indicating diagnostic complexity. Diffusion-weighted Magnetic Resonance Imaging (MRI) was the key diagnostic tool.

Discussion: Fornix infarction disrupts limbic memory pathways, resulting in isolated amnesia, most often anterograde. Bilateral involvement aligns with fornix anatomy. Due to the lesion’s size and location, infarcts may be overlooked, emphasizing the importance of diffusion-weighted MRI. Etiologies vary, often remaining unclear, requiring comprehensive workup. Clinical outcomes range from full recovery to persistent deficits, highlighting the need for early diagnosis and cognitive rehabilitation.

Conclusion: Fornix infarction should be considered in acute amnestic syndromes, especially with isolated fornix lesions on MRI. Awareness and thorough evaluation improve diagnosis and management. Further research is needed to better understand mechanisms and treatment.

Abstract ID 168: A Study on the Outcomes of Acute ischemic Stroke Patients Undergoing Thrombolysis at a Tertiary Care Centre - An Observational Prospective Study

Kalingi Teja, Evangelin Gera

Government Siddhartha Medical College, Andhra Pradesh, India

Background and aim: Ischemic stroke remains a leading cause of mortality and long-term disability. Timely thrombolytic therapy with agents like alteplase has improved outcomes. Tenecteplase, a genetically modified variant with greater fibrin specificity and ease of administration, is emerging as a viable alternative in acute ischemic stroke (AIS) management. This study aimed to evaluate the 3-month functional outcomes, safety, and efficacy of tenecteplase in AIS patients presenting within the thrombolysis window at a tertiary care center.

Methodology: This prospective observational study was conducted over 18 months, enrolling 51 AIS patients eligible for thrombolysis; 47 completed follow-up. Tenecteplase was administered at 0.25 mg/kg as a single IV bolus. Clinical parameters, National Institute of Health Stroke Scale (NIHSS) scores, and modified Rankin Scale (mRS) outcomes were recorded at baseline, 24 hours, discharge, 1 month, and 3 months.

Results: The mean age was 59.6 years; 70% were male. At 3 months, 55.3% achieved functional independence (mRS 0–2), and 42.6% had excellent outcomes (mRS 0–1). Early neurological improvement (≥40% NIHSS improvement at 24 hours) was observed in 17%. Mortality was 21.3%. Intracranial hemorrhage occurred in 10.6%, but there were no cases of symptomatic ICH. Favorable outcomes were significantly associated with thrombolysis within 2 hours of symptom onset (p = 0.026) and milder stroke severity (NIHSS < 16; p = 0.020).

Discussion: Favorable outcomes were significantly associated with thrombolysis within 2 hours of symptom onset (p = 0.026) and milder stroke severity (NIHSS < 16; p = 0.020).

Conclusion: Tenecteplase is a safe and effective thrombolytic agent in AIS, showing promising functional outcomes and a low risk of symptomatic hemorrhage. Early presentation and lower stroke severity are key predictors of favorable outcomes. These findings support tenecteplase as a practical alternative to alteplase, especially in real-world tertiary care settings.

Abstract ID 169: Expanding the Clinical Gamut of Autoimmune and Paraneoplastic Encephalitis: Challenging Case Scenarios

Mridula Singh, Rashmi Mishra, Aabhasha Parotra, Siddharth Maheshwari, Rajinder Dhamija, Pooja Shakya

Institute of Human Behaviour and Allied Sciences, Delhi, India

Background and aim: The autoimmune and paraneoplastic encephalitis comprises of disorders characterised by symptoms of limbic and extra-limbic dysfunction sometimes associated with antibodies against synaptic and intracellular antigens. Since majority respond well to immunosuppressive treatment, the recognition of these disorders is of utmost importance.

Methodology: A series of five cases with autoimmune encephalitis with detailed clinical and diagnostic workup.

Results: A 62 year old male with subacute progressive spastic ataxia with dysarthria came out anti SOX 1 antibody positive without any evidence of malignancy. Still, a trial of IVIg was given in anticipation of paraneoplastic syndrome (PNS score - 4). A 38 year old female with history of Herpes Simplex Virus (HSV-1) encephalitis two months prior then presented with behaviour change. Her autoimmune panel showed gamma-aminobutyric acid-B (GABA-B) antibody but she lacked seizures and malignancy Third patient, a 35/F diagnosed as a case of unclassified schizophrenia for 15 years, controlled on valproate and ECT earlier, came with abrupt onset of aggression and visual hallucinations. She came out strongly N-methyl-D-aspartate receptor (NMDAR) positive thus raising serious queries regarding management of NMDAR encephalitis. The fourth case was 14/M with depression for one year, presented with abrupt onset psychosis with seizure turned out to be NMDAR positive and on maintenance rituximab. The fifth case 15/F with acute onset psychosis of 15 days duration was referred from Psychiatry unit after she developed neurolept malignant syndrome. She also came out strongly NMDAR positive and now on rituximab.

Discussion: So these five cases showcase the unusual presentation of autoimmune syndromes. Recently updated criteria for paraneoplastic disorders gives an idea about the association of malignancy with these antibodies and thus imparting more wisdom regarding the appropriate management.

Conclusion: The broad field of symptoms and syndromes associated with autoantibodies poses a great challenge. The prompt diagnosis and treatment is the most relevant step in the their management

Abstract ID 170: Immediate Effect of Coupling Inhibitory and Facilitatory rTMS with Neuromuscular Electrical Stimulation on Motor Recovery in Chronic Stroke

Sudhindra Vooturi, Panem Sumanth, Subhash Kaul, Sita Jayalakshmi

KIMS Hospital, Hyderabad, Telangana, India

Background and aim: In chronic stroke patients, combination of repetitive transcranial magnetic stimulation (rTMS) with peripheral neuromuscular electric stimulation (NMES) could result in significantly more improvement in motor function than either of the treatments alone. Efficacy of such combination depends greatly on the sequencing of both interventions. We evaluated the efficacy of a sequence of contralesional inhibitory rTMS, ipsilesional excitatory rTMS followed by NMES in patients with chronic ischaemic stroke.

Methodology: Thirty-four chronic stroke survivors received combination of low frequency rTMS and NMES sessions, for 10 sessions over two weeks. Each contra-lesional inhibitory session included 150 pulses at 120% resting motor threshold (MT) for 150 seconds, followed ipsilesional excitatory stimulus at 120%MT, with 300 pulses delivered over 10 trains at three pulses per train. This was followed by Faradic NMES for motor-function training. Assessment of outcome was done using Functional Independent Measure (FIM) scoring done at Baseline & immediately after 10 sessions.

Results: The average age of the study population was 47.91 ± 15.41 years with 10 (29.4%) women. The average duration after ischaemic stroke was 18.94 ± 9.81 months. 26 (76.5%) patients showed neurological improvement immediately after 10 sessions. There was a significant improvement in FIM score (97.46 ± 27.07 vs. 101.46 ± 29.18; p < 0.001).

Discussion: All patients showed functional improvement immediately after 10 sessions and no adverse events were reported.

Conclusion: Combination of rTMS with conventional rehabilitation therapies like NMES may show immediate improvement in motor functions in chronic stroke. Our findings should be validated in larger trials.

Abstract ID 171: Effect of Social Determinants of Health on Physical Activity in People with Epilepsy

Sudhindra Vooturi, Panem Sumanth, Anuja Patil, Sita Jayalakshmi

KIMS Hospital, Hyderabad, Telangana, India

Background and aim: People with epilepsy (PWE) have unique social barriers to physical activity. Identifying these barriers may help design suitable interventions. We evaluated influence of social determinants of health (SDoH) on physical activity in PWE.

Methodology: In this prospective observation study of 706 PWE between January 2024 and May 2025, we collected self-reported data on physical activity (150 minutes per week). SDoH data included – Epilepsy stigma scale, Modified Morisky Medication Adherence scale, Liverpool adverse events questionnaires, and assessment of social needs. The study population was divided into two groups – those who met 150 minutes a week of structured physically activity and those who did not meet the criteria.

Results: The mean age of the study population was 31.21 ± 11.81 years with 334 (47.3%) women and 172 (24.3%) reported to be physically active. PWE who were physically active were older (34.62 ± 13.68 vs. 30.58 ± 10.5 years; p < 0.001) than PWE who were not active. Although PWE who were active had lesser number of anti-seizure medications (2.00 ± 1.06 vs. 2.19 ± 1.08; p = 0.039) but they scored higher on medication related adverse events like weight gain (27.70 ± 6.67 vs. 26.64 ± 5.93; p = 0.034). There was no significant difference between the groups for social stigma (38.56 ± 24.52 Vs. 36.44 ± 23.68; p = 0.283) and adherence to ASMs (6.20 ± 2.06 Vs. 6.46 ± 2.43; p = 2.03). There were no differences between the groups for gender, employment and socio-economic status measured by social needs (2.06 ± 1.98 Vs. 2.36 ± 2.31; p = 0.100).

Discussion: Clinical implications of our findings should be evaluated in future studies.

Conclusion: Adherence to prescribed physical activity guidelines in PWE is highly influenced by adverse events to ASMs like weight gain than any other social determinant.

Abstract ID 172: Atypical Idiopathic Intracranial Hypertension: A Collection of Cases from a Tertiary Care Centre In Hyderabad

Sandhya Manorenj, Sara Kumar

Deccan College of Medical Sciences, Hyderabad, Telangana, India

Background and aim: Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that results in elevated intracranial pressure. Classic symptoms and signs of IIH include headache, papilledema, diplopia, transient visual obscuration, and pulsatile tinnitus. Atypical presentations include IIH without papilledema, other cranial nerve involvement, seizures, spontaneous skull base defects, and cerebrospinal fluid (CSF) leaks. Atypical presentation raises a red flag for an alternative diagnosis, and a CSF study with opening pressure is missed and a diagnosis is not established.

Methodology: Here, we present cases with an atypical presentation of IIH, their demographic and radiological profiles, and their outcomes. A Prospective cohort study conducted over two years confirmed the diagnosis of IIH using magnetic resonance imaging (MRI) brain and CSF opening pressure.

Results: 64 cases of IIH were diagnosed during the study period. Among those eleven cases, 12.9% had an atypical presentation. All were female. The mean age was 37.4 ± 4 years. IIH without papilledema was observed in one case. Two cases had no involvement of the 6th nerve. The atypical presentations were trigeminal neuralgia, unilateral brachial seizure with Todd’s palsy, CSF rhinorrhoea, acute headache with unilateral 12th nerve palsy, migraine-like headache, cervical radiculopathy and orthostatic intolerance with giddiness. Obesity was observed in four cases (57.1%). All cases responded to medical therapy except one that required correction of a skull base defect.

Discussion: An atypical IIH presentation is rare. Our series showed 12th nerve palsy, spontaneous CSF leak, seizures mimicking transient ischemic attack (TIA), cervical radiculopathy, IIH without papilledema, migraine-like headache, and spontaneous CSF leaks. A headache not responding to medical treatment, the CSF opening pressure will aid in accurate diagnosis

Conclusion: Clinicians should be aware of the atypical presentation of IIH. Strong suspicion and evaluation for CSF opening pressure help confirm the diagnosis and avoid unnecessary investigation and medication. Weight reduction is an important and cost-effective disease-modifying therapy.

Abstract ID 173: Risk Factors and Mechanisms of Recurrence after Ischemic Strokes

Srivarsha Tanneru, Subhash Kaul

KIMS Hospital, Hyderabad, Telangana, India

Background and aim: The main challenge after the ischemic stroke is the risk of recurrence. The aim of this study was to identify the risk factors and mechanisms associated with recurrence in ischemic stroke with a larger aim to prevent stroke recurrence

Methodology: Consecutive patients of recurrent stroke were prospectively enrolled from inpatient and outpatient department of Neurology in KIMS Hospital Secunderabad, a teritiary referral centre in south Indian State of Telengana and their risk factors were analysed.

Results: Among 120 recurrent stroke patients, 100 (83.3%) were men and 20 (16.7%) were women with age ranging from 26-88 years; mean 60.08 years. The recurrence occurred from 1 week to 30 years after index stroke. Large vessel disease was seen in 44 (36.7%) out of which Intracranial Atherosclerotic Disease (ICAD) was seen in 11 (13.5%), lacunar strokes in 31 (25.85%) and cardioembolic source in 17 patients (14.2%). Recurrence with same mechanism as index stroke was seen in 110 (91.7%) and different mechanism in 10 patients (8.3%). Uncontrolled DM-2 was seen in 57 (47.5%), uncontrolled HTN in 43 (35.8%), dyslipidemia in 33 (27.5%) and noncompliance of drugs in 50 (41.7%) patients. Uncontrolled diabetes mellitus (DM) and hypertension (HTN) together was seen in 37 (30.8%), whereas only smoking and alcohol together was seen in 11 (9.1%). One recurrence was seen in 91 (75.85%) and 2 or more recurrences were seen in 29 (21.7%) patients for which uncontrolled DM and hypertriglyceridemia were found to be significant risk factors. In 11 (9.1%) patients, the recurrence occurred despite excellent drug compliance and controlled risk factors.

Discussion: Uncontrolled DM, HTN, low-density lipoprotein (LDL) and persistent smoking and alcoholic consumption were major factors associated with recurrence even when the drug compliance was good. Non-compliance of drugs contributed significantly, although in small number of patients recurrence occurred despite good drug compliance and controlled risk factors

Conclusion: Stroke recurrence is major reason for long term morbidity and mortality. Uncontrolled DM, HTN, dyslipidemia and poor drug compliance remain the major risk factors.

Abstract ID 174: Unmasking Atypical Presentations in Subacute Sclerosing Panencephalitis (SSPE)

Shimpy Priya, Ashwin Panda, Mridula Rustogi, Suman Kushwaha, Aldrin Antony, Ankita Bansal, Aditya Singh, Harsha Burgula, Rashmi Mishra, Zuber Sheikh, Aabhasha Parotra, Ritesh Kumar, Siddharth Maheshwari, Rajinder Dhamija

Institute of Human Behaviour and Allied Sciences, Delhi, India

Background and aim: Subacute Sclerosing Panencephalitis (SSPE) is a rare, fatal complication of the measles virus typically presenting in children and young adults. It is characterized by progressive cognitive decline, myoclonus, behavioural changes and gait abnormalities. However, SSPE can occasionally manifest with atypical clinical features leading to delay in diagnosis and mismanagement. This study aims to 1 Describe case series of atypical presentations of SSPE 2. Emphasize the importance of maintaining a high index of suspicion for SSPE even in non-classical presentations.

Methodology: It is a case series of patients admitted in a tertiary care centre in neurology department from January 2024 to May 2025 with atypical presentations of SSPE. Diagnosis of SSPE was confirmed by clinical features, EEG findings, and elevated anti-measles antibody titre in cerebrospinal fluid (CSF), according to Dyken Criteria.

Results: During the study period, 21 patients were diagnosed with subacute sclerosing panencephalitis (SSPE), comprising 16 males and 5 females. Several presented with atypical features, including hemiparesis, catatonia, epilepsia partialis continua (EPC) with hemimyoclonus, psychiatric symptoms with forgetfulness and visual blurring, rapidly progressive vision loss with ataxia and altered sensorium, recurrent paroxysmal dyskinesia-like movements, and behavioral abnormalities. One patient with EPC and hemimyoclonus was 13 years old; others were older than 15 years. Magnetic Resonance Imaging (MRI) findings revealed periventricular white matter hyperintensity with a leukodystrophy-like pattern in two patients, right frontotemporooccipital hyperintensity with cerebral atrophy in one, bilateral parieto-occipital and thalamic hyperintensity with diffuse cerebral atrophy in one, and hydrocephalus and normal imaging in one patient each, reflecting varied radiological profiles.

Discussion: Atypical presentations posed diagnostic challenges in above cases. This emphasizes the need for high clinical suspicion, especially in regions with measles exposure. Our study highlights that atypical SSPE can mimic diverse neurological conditions.

Conclusion: SSPE can have varied atypical presentation.

Abstract ID 175: A Study of Clinical Variants of Guillain-Barre Syndrome (GBS) and its Long Term Outcome Measures in Children Less than 12 Years of Age in A Tertiary Care Hospital

Mohinish S, Neeraj Elango, Jered Livingston, Leema Pauline

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Guillain-Barré syndrome (GBS) is characterized by acute progressive weakness, areflexia, and maximal motor disability that occur within 4 weeks of onset. Various clinical subtypes have been described since the original description of the syndrome. To study the demographic variables, clinical features and Electrophysiological findings and outcomes in patients with various subtypes of GBS.

Methodology: Prospective Observational study done in the centre from January 2023 to June 2024.

Results: 54 patients based on clinical criteria, aged 9 months to 12 years were enrolled. Thirty one (57%) girls and twenty three (43%) boys. Highest incidence occurred in age group 5 – 12 years (63%) In the classic ascending group, twenty eight patients (52%) manifested acute inflammatory demyelinating polyradiculoneuropathy, nine (17%) manifested acute motor axonal neuropathy, and three (5.5%) manifested acute motor sensory axonal neuropathy. In the atypical presentation group of fifteen cases (28%), seven (13%) with Miller Fisher syndrome, two (3.6%) with Bickerstaff brainstem encephalitis, two (3.6%) with the pharyngo-cervical-brachial variant, and four (7.5%) with polyneuritis cranialis. The time from onset to illness to nadir was shorter in variant group. Twenty six (48%) required PICU admission and 34% required mechanical ventilation. Fourteen (25%) cases had autonomic manifestations during the stay. No change in treatment protocol. Mortality one (1.8%) During follow up, 47 (87%) recovered satisfactorily, 6 (11.2%) remained with residual paresis. Poor outcomes were attributable to respiratory distress, ventilator support and autonomic manifestations.

Discussion and conclusion: At the earliest stage, differentiating clinical variants from typical Guillain-Barré syndrome was difficult. Children with clinical variants of Guillain-Barré syndrome are more likely to manifest rapid onset from disease onset to nadir, increasing the severity of disability, cranial nerve involvement, and need for ventilator support than in typical Guillain-Barré syndrome.

Abstract ID 176: Characterization of Voice in Persons with Bulbar and Spinal ALS

Naveen Masaraddi, B Yamini, Atchayaram Nalini, Seena Vengalil, Aishwarya Y

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: To compare the acoustic cepstral measures of voice between spinal and bulbar amyotrophic lateral sclerosis (ALS) patients. To describe the perceptual characteristics of voice in ALS using the Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale. To assess voice quality using the Voice Handicap Index-10.

Methodology: Case-control study was conducted in the Department of Neurology and Speech Pathology at NIMHANS. Inclusion criteria included patients meeting the El Escorial criteria for Definite ALS. All patients underwent laryngoscopy, Acoustic measurements of voice, including cepstral peak prominence (CPP) and its related parameters, Perceptual assessment of voice using the GRBAS scale and self-rating assessment of voice using the Voice Handicap Index-10 completed.

Results: 21 patients included in the study, 9 with bulbar onset ALS, 12 with spinal onset ALS. The mean age of patients with bulbar ALS was 49.56, with spinal ALS was 58.20. The mean duration of illness was 12.11 months in the bulbar group, 9.67 months in the spinal group. The Voice Handicap Index (VHI) was significantly impaired in the bulbar group. CPP for sustained vowels was significantly impaired in the bulbar group compared to the spinal group. Other acoustic parameters, including CPP standard deviation, showed higher values in the bulbar group for vowels I but not for vowel A. Both CPP fundamental frequency (F0) and CPP F0 standard deviation were significantly impaired for all three vowels. Perceptual analysis of voice using the GRBAS scale revealed significant impairment in the bulbar group, with the most affected parameter being voice asthenia. A significant correlation was found between GRBAS scores and CPP values in the bulbar group.

Discussion: The study demonstrated a significant difference in acoustic voice measures, specifically CPP, between bulbar and spinal onset ALS patients. There was also a correlation between patient-rated VHI and examiner-rated perceptual measures of voice quality

Conclusion: CPP showed to be a good objective measure of voice impairment in ALS patients

Abstract ID 177: From Psychosis to Recovery: A Case Series on Autoimmune Encephalitis Presentation

Juhina PP, K. Mugundhani, Shanmugasundaram, Marian Vijay

Madras Medical College, Chennai, Tamil Nadu, India

Background and Aim: Autoimmune encephalitis (AIE) is a group of immune-mediated inflammatory brain disorders caused by antibodies against neuronal cell surface or synaptic antigens. It presents with altered mental status, seizures, memory deficits, psychiatric manifestations, and movement disorders, frequently mimicking infectious or primary psychiatric illnesses and leading to diagnostic delay. Early diagnosis is essential, as most patients respond well to immunotherapy. This case series highlights the clinical spectrum, diagnostic challenges, and therapeutic outcomes of AIE at our center.

Methodology: We present a case series of 10 patients with autoimmune encephalitis managed at a tertiary care center, evaluating clinical presentation, antibody profile, treatment, and outcomes.

Results: Ten patients aged 14–61 years were included, with female predominance (6/10). Anti-NMDA receptor antibodies were identified in five patients, CASPR2 in four, and LGI1 in three, with some showing dual CASPR2/LGI1 positivity. Seizures and neuropsychiatric symptoms were the most common presentations. One patient had an associated ovarian teratoma, and one presented during early pregnancy. All patients received immunotherapy, including corticosteroids, IVIG, plasmapheresis, and rituximab for refractory disease. Eight patients improved, six achieving good recovery and two partial recovery. One patient with refractory anti-NMDA receptor encephalitis succumbed despite aggressive treatment.

Discussion: The study underscores the importance of early antibody identification and aggressive immunotherapy in improving outcomes in autoimmune encephalitis.

Conclusion: This series highlights the clinical heterogeneity of autoimmune encephalitis, with anti-NMDA receptor encephalitis more common in younger females and CASPR2/LGI1-associated encephalitis in older patients. Early diagnosis and prompt immunotherapy resulted in favorable outcomes in most cases, while severe or refractory disease carried a poorer prognosis. A high index of suspicion and multidisciplinary management are crucial for optimal outcomes.

Abstract ID 178: Outcomes of Endovascular Treatment in Medically Refractory Cerebral Venous Thrombosis: A Prospective Observational Study

Arpit Agrawal, Hemant Verma¹, Chandradev Sahu¹, Abhijeet Kohat²

Ramkrishna Care Hospital, Raipur, Chhattisgarh, ¹Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, ²Dau Kalyan Singh Postgraduate Institute and Research Centre (DKSPGI), Raipur, Chhattisgarh, India

Background and aim: Despite anticoagulation, a subset of cerebral venous thrombosis (CVT) patients demonstrate the progression of thrombosis, clinical deterioration or persistent coma. The present study was aimed to evaluate clinical efficacy of endovascular intervention in refractory CVT cases. The primary objective was to assess functional outcomes utilizing the modified Rankin Scale (mRS).

Methodology: A prospective observational study was conducted over a 12-month period at the Department of Neurology, DKS Superspeciality Hospital and Department of Radiodiagnosis, J.N.M. Medical College, Raipur (Chhattisgarh). Twenty-eight patients with severe, medically refractory CVT—confirmed through MR venography, CT venography, or digital subtraction angiography—were enrolled. Endovascular procedures, including catheter-directed thrombolysis, mechanical thrombectomy, and balloon venoplasty, were performed based on clinical and radiological assessment. Post-procedural outcomes were evaluated after a 3-month follow-up.

Results: Of the 28 participants, 89.3% were male, with a predominant age group below 30 years. Headache was universally reported, followed by seizures (71.4%) and focal neurological deficits (57.1%). All patients underwent balloon angioplasty; 35% received additional thrombolysis, and 21% underwent aspiration thrombectomy. Technical success was 100%, with no major complications. Mean mRS improved significantly from 2.9 to 0.8 (p < 0.001). Right sigmoid sinus thrombosis was significantly associated with complications (p = 0.041).

Discussion: Mechanical disruption or removal of thrombus offers the advantage of rapid vascularization and has been a valuable adjunct in patients presenting with encephalopathy or impending herniation. Rapid restoration of venous flow likely prevented irreversible parenchymal injury, supporting the notion that early intervention could significantly influence outcomes

Conclusion: Endovascular therapy constitutes a viable and effective therapeutic modality in the management of CVT refractory to standard medical treatment, offering substantial neurological recovery in appropriately selected patients. Further multicenter trials are warranted to standardize indications and protocols

Abstract ID 179: Clinical Spectrum and Outcomes in Agrin and LRP4 Antibody-Positive Patients

Yadlapati Venkata Sai Suhas, Gampa Nikhil Kumar, Lakshmi Narasimhan Ranganathan, Sundar Shanmugam, Philo Hazeena, Rithvik Ramesh, Deepa Avadhani

Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

Background and aim: Agrin is a synaptic glycoprotein essential for neuromuscular junction formation and immune modulation. Low density lipoprotein receptor-related protein 4 (LRP4) acts as a receptor for Agrin and activates MuSK signaling. Both are critical in neuromuscular junction (NMJ) stability and are implicated in autoimmune neuromuscular disorders. This study aims to evaluate the clinical profile, antibody associations, treatment responses, and outcomes in patients with anti-Agrin and/or anti-LRP4 seropositivity in tertiary care centre

Methodology: An prospective observational study was conducted on patients testing seropositive for anti-Agrin antibodies between March 2024 and March 2025. Clinical features, laboratory parameters, antibody profiles, treatment details, and outcomes were recorded and analyzed.

Results: Among 12 patients included, nine presented with NMJ phenotypes predominantly bulbar onset, and three showed anterior horn cell-like presentation. Isolated Agrin positivity: 4 patients. Isolated LRP4 positivity: 2 patients. Agrin + LRP4 positivity: 3 patients. Co-positivity with striational muscle antibody and LRP4: 1 patient. Co-positivity with titin, and LRP4: 1 patient. Co-positivity with titin, and Agrin:1 patient SIX patients received IVIG, two of patients underwent plasma exchange, two of the patients received IVIG followed by plex, and two of the patients were treated with pyridostigmine alone. Thymoma was detected in one of the patient. One of the patients died, and six had recurrent admissions.

Discussion: This study highlights the clinical heterogeneity of patients with anti-Agrin and anti-LRP4 antibodies, with presentations ranging from classic Myasthenia phenotypes to anterior horn cell-like features. Dual Agrin and LRP4 positivity was associated with more severe disease, increased relapses, and higher treatment requirements, especially when co-occurring with other autoantibodies like titin or striational antibodies. Immunotherapy was often necessary.

Conclusion: Extended antibody testing in seronegative MG and patients with atypical or ALS Like features and timely immunotherapy can improve the outcomes

Abstract ID 180: Prevalence, Predictive Phenotypes, Outcomes, and Prognosis of patients with Nodal, Paranodal antibodies in a cohort with Autoimmune neuropathy: Real World Experiences from a Tertiary Care Centre

Tiruvayapadi Bhargav Sumanth, Ajith Sivadasan

Christian Medical College, Vellore, Tamil Nadu, India

Background and aim: Autoimmune neuropathies are diverse, with nodal and paranodal antibodies emerging as important biomarkers. However, the prevalence and clinical significance of these autoantibodies remain unclear. Moreover, there is limited testing availability. This study aimed to determine the prevalence of these antibodies, associated clinical features, outcomes, and prognostic value in patients with “autoimmune neuropathies”.

Methodology: A prospective cohort of 101 consecutive patients diagnosed with autoimmune neuropathy over 2 years was analyzed. Clinical, electrophysiological, laboratory, neuroimaging, and antibody testing for nodal isoform NF140 and paranodal NF155 were performed “in-house” using ELISA. Clinical features and outcomes were analyzed to identify patterns linked to antibody positivity.

Results: 58 patients (57.4%) tested positive for nodal/paranodal antibodies: NF140 (16, 15.8%), NF155 (14, 13.9%), and double positive (28, 27.7%). No significant differences in demographics or overall clinical severity were found between antibody-positive and negative groups. However, NF antibody-positive patients more commonly presented with chronic inflammatory demyelinating polyneuropathy (CIDP) and variants (p = 0.031), had greater extents of demyelination, slower conduction velocities, and prolonged F-wave latencies (all p < 0.05). Distinct phenotypes included severe hyperacute Guillain-Barré syndrome (GBS)-like illness with autonomic dysfunction in NF140-positive patients, and recurrent GBS-like episodes responsive to IVIG were noted. Treatments included IVIG, plasma exchange, corticosteroids, and rituximab, with 49/58 (84.5%) of NF-positive patients showing substantial improvement. Severe disease at nadir predicted poorer recovery (p 0.001). There were no significant differential treatment responses.

Discussion: Nodal/paranodal antibodies are highly prevalent in autoimmune neuropathies and associate with specific clinical and electrophysiological features, especially CIDP variants and more severe demyelination. No clear differential treatment responses were identified, probably attributable to the multimodal immunotherapy, which was overall effective.

Conclusion: Further research on antibody subtypes and broader panels is needed in a larger cohort of patients. Integrating antibody testing into clinical algorithms will improve the diagnosis and management of autoimmune neuropathies.

Abstract ID 181: Development of a Validated Multilingual Educational Assessment Instrument for Measuring School Personnel’s Epilepsy Literacy, Attitudes, and Classroom Interventions: A Cross-Cultural Study

Pooja Pathak, Marami Das, Sulena¹, Rajni Sharma², Khushboo Bhagat¹, Prasenjit Patil³

Gauhati Medical College and Hospital, Guwahati, Assam, ¹Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, ²Post Graduate Institute of Medical Education and Research, Chandigarh, ³All India Institute of Medical Sciences (AIIMS), Nagpur, Maharashtra, India

Background and aim: Epilepsy is one of the most common neurological disorders among children and adolescents. Assessing school teachers’ Literacy, Attitudes, and Classroom Interventions regarding epilepsy is vital for fostering a supportive and inclusive learning environment for these students who spend 40% of their developing life in school. Aim of this study was to develop and validate a multilingual Educational Assessment Instrument for measuring School Personnel’s Epilepsy Literacy, Attitudes, and Classroom Interventions

Methodology: This mixed-methods study developed and validated a Knowledge, Attitude, and Practice (KAP) scale for school teachers managing children with epilepsy across Punjab, Maharashtra, and Assam on May 2025. Informed written consent was taken for each subject and Ethical clearance was taken from the respective Institutional Ethics committee. A four-phase process, consisting of item development, translation, pilot testing, and psychometric validation, was followed. The Delphi method, expert panels, and cognitive interviews guided the refinement of items. The scale was translated into Hindi, Punjabi, Marathi, and Assamese. Reliability was confirmed using EFA, CFA, Cronbach’s alpha and ICC.

Results: The study included 455 teachers, with a mean age of 42 ± 7 years, predominantly female (87.91%), comprised of 78.9% aged 31–50 years, and 55.16% married. The KAP questionnaire showed strong content validity (S-CVI = 0.94) and high internal consistency (Cronbach’s alpha = 0.88–0.94). Test-retest reliability was confirmed with ICCs ranging from 0.72 to 0.91

Discussion: This study developed a culturally adapted multilingual Educational Assessment Instrument to assess school teachers’ knowledge, attitudes, and practices on epilepsy across three Indian states. The tool showed strong validity (S-CVI = 0.94), high reliability (Cronbach’s alpha = 0.88–0.94), and stable test-retest scores (ICC = 0.72–0.91).

Conclusion: The validated multilingual Educational Assessment Instrument reliably assesses teachers’ understanding of epilepsy and supports culturally sensitive, targeted interventions for inclusive education.

Abstract ID 182: Sight Under Seize: Clinico-Opthalmological Manifestations of idiopathic intracranial hypertension (IIH)

Nayana Bhuyan, Abhishek Pathak¹, Vijay Mishra¹

Banaras Hindu University, Varanasi, Uttar Pradesh, ¹Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background and aim: Patients with elevated intracranial pressure (ICP) who show no signs of cerebral disease are typically defined as having idiopathic intracranial hypertension (IIH), also known as primary pseudotumor cerebri. In this study we aim to study the clinical as well as ophthalmological spectrum of IIH.

Methodology: This was a case control study conducted over a period of 12 months from April 2024 to April 2025 which included 36 cases and 36 controls above 18 years of age. Cases were diagnosed by modified Dandy Criteria.

Results: The study included 36 cases and 10 controls, 35.8 years in cases and 39.0 years in controls was the mean age, (p = 0.480). Gender distribution indicated a female predominance in both groups (69.4% in cases, 60% in controls) (p = 0.573). Cases had an average BMI of 26.6. Nuchal headaches were the most common (58.3%). The headache character was pulsatile in 75% of cases and dull aching in 27.8%. Vision loss was unilateral in 38.9% and bilateral in 16.7% of cases. The average thickness of retinal nerve fiber layer (RNFL) was 203 µm in right and 207 µm in the left eye which was elevated. Papilledema grading indicated that Grade II papilledema was the most common stage, affecting 50% of cases.

Discussion: In this study, the mean age was 35.8 years in cases and controls was 39.0 years (p = 0.480), aligning with global trends in IIH. Headache character was pulsatile in 75% of cases with nuchal headaches being the most common (58.3%) in comparision to IIHT which reported that the pain was pressure-like (47%) with the frontal region (68%) being most common site. Our data revealed RNFL (retinal nerve fiber layer) thickening on OCT during active papilledema (~205 µm), Average RNFL thickness was 159 ± 45 µm in IIHT

Conclusion: To summarize, our study explored the clinical and ophthalmological manifestations of IIH and served as a platform for studying the clinical spectrum of IIH

Abstract ID 183: Exploring the Role of Carcinoembryonic Antigen Level in the Outcome of Acute Ischemic Stroke

Archana Verma, Divyata Sachan¹, P A Hemash Ashok, Ashutosh K Mishra, Sachin

All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, ¹Yashoda Hospitals, Malakpet, Hyderabad, Telangana, India

Background and aim: - Carcinoembryonic antigen (CEA) levels have been implicated in atherosclerosis, its role as a prognostic biomarker in acute ischemic stroke (AIS) remains underexplored. To determine the correlation between the CEA levels and infarct volume and the outcome of ASI at 3 months.

Methodology: We conducted a hospital based, prospective follow up study and all the consecutive patients of ASI (>18 years of age) presenting within 72 hours was enrolled. Detailed clinical examination, investigation, imaging and CEA level were done.

Results: Ninety –eight consecutive AIS cases were recruited. The mean age was 61.33 ± 13.68 years. Mean CT scan volume was 12.860 ± 14.325 and CEA level was 4.605 ± 3.135 ng/mL. The mean mRS at the time of admission was 3.75 ± 0.67 and at 90 days was 3.56 ± 0.85. CEA had an area under curve (AUC) of 0.379 (p = 0.477) to predict stroke severity (as per mRS) at admission, indicating poor discriminative ability. CT infarct volume showed AUC of 0.351 (p = 0.381), also reflecting poor predictive value. Neither CEA levels nor CT infarct volume demonstrated significant accuracy in predicting stroke severity at admission, as reflected by low AUCs and poor specificity. CEA had an AUC of 0.552 (p = 0.577) for stroke outcome based on mRS score after 90 days, indicating poor to marginal discriminative power. Suggesting it may be more useful in ruling in severe cases than ruling them out. CT infarct volume had an AUC of 0.531 (p = 0.736), also reflecting poor predictive value.

Discussion: One study has reported CEA as a promising novel biomarker for assessing the severity of ASI.

Conclusion: Neither biomarker demonstrated strong overall predictive power for 90-day stroke outcome. However, CEA was highly specific, and CT infarct volume was highly sensitive, which may suggest complementary roles depending on clinical context

Abstract ID 184: Severity of Dementia Predicts Burden of Behavioural and Psychological Symptoms of Dementia: an Indian Cohort Study

Atri Chatterjee, Sanghamitra Laskar, Sonali Aggarwal

Vardhman Mahavir Medical College, New Delhi, India

Background and aim: Behavioural and psychological symptoms of dementia (BPSD) affect ~90% of dementia patients, worsening quality of life and increasing caregiver distress. While some studies report BPSD severity evolves independently of dementia severity, this relationship is not well-documented in diverse populations like India. This study examined the association of BPSD severity with dementia severity in Indian patients.

Methodology: Ethical approval was obtained from the Institutional Committee of Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi. This study used baseline data from an ongoing project at the VMMC & SJH Cognitive Neurology Clinic. Participants underwent Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and Neuropsychiatric Inventory Questionnaire (NPI-Q) assessments. Baseline NPI-Q scores were compared across global CDR stages (Kruskal-Wallis test), and the CDR Sum of Boxes (CDR-SB) relation with NPI-Q scores was assessed using univariate and multivariate analysis.

Results: Data from 65 participants (44 male, 21 female; mean age 64.9 ± 9.5 years) were analyzed. 29 participants were diagnosed with Alzheimer’s disease, 20 with vascular cognitive impairment and 16 with other causes of dementia. Median global CDR was 1 (mean CDR-SB 7.3 ± 4.8). Mean total NPI-Q score was 11.3 ± 12.4. NPI-Q scores significantly differed across global CDR stages (P = 0.01), mainly driven by increased NPI-Q in CDR 3 participants (post-hoc Dunn’s test). CDR-SB showed a significant positive correlation with NPI-Q (Kendall’s tau 0.26, P = 0.003). Adjusted linear regression (for age, sex, diagnosis) showed CDR-SB was a significant positive predictor of NPI-Q (β = 1.2, P = 0.0004).

Discussion: In this Indian cohort, increasing severity of dementia estimated by CDR-SB predicts a significant increase in the burden of BPSD in all-cause dementia. A longitudinal is required to further analyze the relationship between dementia severity and BPSD.

Conclusion: Our study provides definitive evidence that increasing severity of dementia is associated with increasing burden of BPSD.

Abstract ID 185: A Study on Spectrum of Non Motor Symptoms in Isolated Dystonia

Subhajit Das, Atanu Biswas, Samar Biswas¹, Sumanta Sarkar

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, ¹NRS Medical College and Hospital, Kolkata, West Bengal, India

Background and aim: Emerging evidence has demonstrated that non-motor symptoms are frequent in isolated dystonia and little is known about the frequency, severity of such presentations. Here, we investigated motor and non-motor symptoms in Indian patients with isolated dystonia and find out the prevalence of non-motor symptoms. Objectives— 1. Explore the spectrum of non-motor symptoms in patients with isolated dystonia. 2. To find relationship between specific non-motor symptom and different forms of dystonia. 3. To look for association of non-motor symptoms with motor symptoms burden.

Methodology: In this observational study, subjects will be enrolled from ward, OPD, movement disorder clinic of Department of Neurology, B.I.N, Kolkata from January 25 - June 26 and analyzed with standardized scales. The study was approved by the Institute Ethics committee and written informed consent was taken from participants.

Results: Till now 8 patients has been included in the study (5 males,3 female). [Further subjects will be included]. In terms of non-motor symptoms, anxiety determined by HARS >17 was observed in 2 (25%), depression [HDRS > 18] in 3 (37.5%), fatigue [FSS > 36] in 1 (12.5%), excessive day time sleepiness [ESS > 10] in 4 (50%), poor sleep quality [PSQI > 5] in 2 (25%), cognitive decline [ACE III < 83 ] in 4 (50%). Among the autonomic dysfunction, dry mouth, decreased sweating have been observed in 5 (62.5%).

Discussion: The present study highlighted high frequency of non-motor symptoms in patients with isolated dystonia. To date, the pathophysiology underlying non-motor symptoms remains to be poorly understood, but considered to be related to the disruption in cortical-limbic-striatal circuits.

Conclusion: Isolated dystonia appeared to be no longer solely motor manifestation, but a disturbance in many non-motor domains including anxiety, depression, sleep disturbances, excessive daytime sleepiness, cognitive decline and autonomic dysfunction.

Abstract ID 186: COVID-19 Vaccination Associated Neurological Complications: A Cross-Sectional Observational Study from a Tertiary Care Centre of North India

Vikas Lakhanpal, Bhawna Sharma, Priyank Upadhay

All India Institute of Medical Sciences, Bathinda, Punjab

Background and aim: World Health Organization declared COVID-19 infection a global health emergency on 30th January 2020, against which COVID-19 vaccines have shown protective and beneficial effects. Mild to severe neurological events have been reported due to covid vaccines. Hence, a detailed assessment of any serious neurological event after COVID-19 vaccination is needed urgently to analyze such correlations. We designed our study to look for any adverse neurological effects of COVID-19 vaccination and to search for any predisposing risk factors and to determine whether vaccination precipitates such pre-existing neurological illness. We also looked at the socioeconomic impact of any adverse neurological effects after COVID-19 vaccination, limitations in activities of daily living (ADLs) and mobility limitations.

Methodology: The present research was an observational study on 1000 adult persons (>18 years, <65 years) for determining the neurological adverse effects within six months of COVID-19 vaccination. Limitations in the activity of daily living (ADL) were assessed by questionnaires consisting of five questions.

Results: No major neurological complications were found; the only side-effect was of transitory headache in 15% of the participants

Discussion: Several underlying mechanisms have been suggested to explain adverse effects after COVID-19 vaccination, viz. involvement of vaccine adjuvants, the role of anti-idiotype autoantibodies, molecular mimicry, and persistence of spike protein. Whilst vascular spasm, stress and intracerebral or subarachnoid hemorrhage have been claimed to be reasons for post-vaccination headaches, we could not verify this as we observed no such event. If post-vaccination headache is indeed more frequent after the second dose, this could be explained by expression of CD4+T-cell with Th1 cytokines (TNF-α), which can further sensitize meningeal nociceptors and the synthesis of a migraine-associated calcitonin gene-related peptide.

Conclusion: Though the possibility of a severe adverse neurological reaction related to COVID-19 vaccination has not been ruled out by our study, it appears to be significantly rare (<0.1%).

Abstract ID 187: Caregiver Burden in Epilepsy and Quality of Life of People Living with Epilepsy Patients

Rashma P, Firosh S, Aswathy Sasidharan, Ahamed Humyun Kabir, Fazal Ghafoor, Ahamed Humyun, Firosh Khan

MES Medical College Hospital, Kolathur, Kerala, India

Background and aim: Caregiver burden (CGB) in Epilepsy is a significant challenge. Epilepsy affects over 100 million people worldwide. It diminishes the quality of life through loss of control, depression increases stress and emotional burden on caregivers. This study aimed to identify prevalence of caregiver burden in epilepsy, and to identify factors contributing to caregiver burden in epilepsy.

Methodology: This study involved 139 caregivers of epilepsy patients who attended neurology department of tertiary care hospital in Kerala. Socio-demographic data were collected using a semi-structured questionnaire, along with clinical details like diagnosis duration and epilepsy type. Caregiver burden was assessed using the Zarit Burden Scale, while depression with the Beck’s Inventory. Inclusion criteria: Caregivers of Patients diagnosed with epilepsy according to ILAE criteria. Exclusion criteria: Caregiver less than 18 years. The data were categorized & entered into Excel, and analyzed using SPSS software version 22. Chi-square tests and Pearson correlation were used. Statistical significance was set at p < 0.05. Tabulation was done by principle investigator and statistical analysis was done with SPSS software.

Results: Caregivers averaged 38.8 ± 9.3 years, with 82.7% being women, primarily mothers (65.5%) and 43.2% having only primary education. Overall, 61.9% experienced caregiver burden, especially those caring for patients with refractory seizures. The prevalence of depression among caregivers was 38.85%, with 25.1% reporting mild and 9.35% severe depression. A strong correlation existed between the Zarit Burden Score, depression scores, and the ages of both patients and caregivers.

Discussion: Caregiver Burden showed a strong correlation with depression scores, age of patient, caregiver, and hospital anxiety depression score. Factor alleviation will improve Caregiver burden and improve quality of life of caregiver and epilepsy patient.

Conclusion: This is the largest study to date. Factors identified include refractory seizure, longer duration, and stigma of epilepsy. Targeted interventions and future research is needed to provide more understanding of the factors of Caregiver burden

Abstract ID 188: Comparison of Efficacy of Oral Naproxen and Ibuprofen for Management of Acute Headache in Children with Migraine Aged 5-18 Years: A Single Blind, Randomized Controlled Trial (NIM-C Trial)

Prateek Panda, Indar Sharawat, Swati Gupta

All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Background and aim: Naproxen and Ibuprofen are the two most common NSAIDs used for aborting an acute attack of migraine, both drugs found to be efficacious in various previous clinical studies, but no study has previously compared these medications directly in children with migraine.

Methodology: This single-blind RCT (CTRI/2022/11/047712) compared number of children aged 5-18 years with migraine achieving pain freedom at 2 hours with oral naproxen (7 mg/kg, single dose) and oral ibuprofen (10 mg/kg, single dose), when used for acute management of headache. It also compared number of participants achieving pain relief (at least 2-point reduction in numerical rating scale for pain) at 2-hours, 24-hour sustained pain freedom, complete relief of functional disability at 2-hours, requirement for use of rescue medication, relief of associated symptoms of migraine at 2-hours of receiving the drugs, change in Headache Impact Test-6 (HIT-6) score and quality of life (Migraine specific QOL-MSQOL) at 4-weeks and adverse effects. They were followed every 2-weeks and headache diary was reviewed.

Results: Total 132 (66 in each group) were enrolled. While incidence 2-hour pain freedom was comparable between naproxen and ibuprofen groups (36 (54%) vs 31 (47%), p-0.48), 2-hour pain freedom was more frequent in naproxen group (62 (94%) vs 51 (71%), p-0.01). Other variables were comparable in both groups (p = 0.98, 0.38, 0.16, 0.39,0.43 and 0.16 for 24-hour pain freedom, relief of associated symptoms at 2-hours, relief of functional disability, quality of life and HIT-6 score, respectively). Only one participant in each group complained of epigastric pain.

Discussion: Both naproxen and ibuprofen can be safely used in pediatric migraine for aborting acute attacks with 70%-90% efficacy in achieving pain relief and about 50% efficacy in pain freedom at 2-hours.

Conclusion: Naproxen is better than Ibuprofen for achieving pain relief at 2-hours in pediatric migraine, but comparable to ibuprofen in all other variables assessing efficacy and safety

Abstract ID 189: Sensitivity of Carotid Artery Doppler Ultrasonography in Moderate to Severe Carotid Artery Stenosis among Patients with Ischemic Stroke in A Tertiary Care Centre

Ibtisam Mohammed, Chithra P

Trivandrum Government Medical College, Thiruvananthapuram, Kerala, India

Background andim: Ischemic stroke from large artery atherosclerosis poses a significant risk for early recurrence. Management of carotid artery stenosis is determined by degree of stenosis. While digital subtraction angiography (DSA) is the gold standard for diagnosis, carotid Doppler is preferred as it is non-invasive. Estimating sensitivity of carotid Doppler is crucial for managing carotid stenosis thereby preventing stroke recurrence. Aims: To estimate sensitivity of carotid artery Doppler in detecting moderate to severe carotid artery stenosis in ischemic stroke. To estimate diagnostic accuracy of carotid artery Doppler in differentiating moderate and severe carotid artery stenosis.

Methodology: This cross-sectional observational study conducted at Trivandrum Government Medical College recruited patients >18 years with transient ischemic attack (TIA) and/or acute ischemic stroke in anterior circulation with >50% carotid artery stenosis on CT angiogram in whom carotid artery Doppler and DSA are done. Data related to baseline characteristics and clinical presentation were collected. Sensitivity, specificity, positive, and negative predictive values of moderate and severe carotid artery stenosis were estimated.

Results: This study assessed 150 ICAs from 75 patients. Compared to DSA, DUS exhibited sensitivity of 85.90% and specificity of 98.61% for identifying moderate to severe stenosis, with positive and negative predictive values of 98.53% and 86.59%, respectively, yielding an overall diagnostic accuracy of 92.00%. For specific stenosis categories, sensitivity was 26.67% for 50-69% stenosis and 33.33% for 70-99%, while maintaining excellent sensitivity for complete occlusions.

Discussion: High sensitivity, specificity, and overall diagnostic accuracy of DUS support its use as a reliable initial screening tool for patients suspected to have moderate to severe carotid artery stenosis. This is crucial in Indian scenario as varying access to advanced imaging such as DSA can be a barrier to timely diagnosis.

Conclusion: Accurate diagnosis of hemodynamically significant stenosis is imperative for identification of patients who may benefit from surgical intervention.

Abstract ID 190: Association of Collateral Flow Pattern in Transcranial Doppler with Functional Outcome among Patients with Acute Ischemic Stroke with Large Vessel Occlusion in A Tertiary Care Centre

Athira K, Sunil D, Chitra P

Government Medical College, Thiruvananthapuram, Kerala, India

Background and aim: Transcranial Doppler (TCD) ultrasonography gives bed side, non-invasive, real-time measurement of blood flow characteristics. Study aims to determine the association of collateral flow pattern in TCD with functional outcome among patients with acute ischemic stroke with large vessel occlusion and to estimate the diagnostic accuracy of TCD in assessment of collateral flow patterns in comparison to Computed Tomography (CT) angiography.

Methodology: In this Prospective observational study, patients Age >18 years with first ever acute ischemic stroke with large vessel occlusion confirmed by CT angiography, thrombolysed and not thrombolysed were included. After Data pertaining to demographics and co-morbidities, CT angiography Collateral grading (Tan et al grading) and TCD were done within 24 hrs. TCD parameters were correlated with the CT angiography grading and its association with 90 days functional outcome assessed by modified Rankin Scale (mRS). Sample size calculated was 56 for a study period of 1 year.

Results: TCD showed the indirect evidence of leptomeningeal collateral flow as the flow diversion (FD:I/L MFV 30% greater than the contralateral artery) in 23 out of 56 (41%) patients as significantly faster MFV in ipsilateral ACA (40%) and PCA (35%) of the occluded MCA/ICA side compared to contralateral ACA and PCA measured within mean duration of 6 hrs of symptom onset, showed statistically significant association with good collateral on CT angiography (odds ratio (OR) 9.7 p value < 0.001) and significant positive correlation with Ipsilateral MFV of ACA with collateral status (r = 0.68, p < 0.001). The likelihood of good functional outcome was higher in those with flow diversion (odds ratio (OR) 11.2 p < 0.001) and independently predict 90 day outcome. Sensitivity of FD was 80% and specificity 76%.

Discussion: There were few studies conducted till now among which Similar observation were obtained by H Zareie et al (retrospecticve study), also ACA asymmetry index used by Zanette et al and CLOTBUST trial, also one comparison study was done with DSA by Na wang et al.

Conclusion: TCD can assess leptomeningeal collaterals by mechanism of flow diversion in patients with MCA/ICA occlusion and significantly correlated with CT angiography and 90 day outcome with a diagnostic accuracy of 78%.

Abstract ID 191: Subtype-Specific Risk Factor and Outcome Analysis in Isolated Cerebellar Strokes: A 2-Year Observational Cohort Study

Naren Polavarapu, Mugundhan Krishnan, Sivaji M, Thamil Pavai Arulnambi, Raja Gambeeran V

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Isolated cerebellar strokes are uncommon but clinically significant due to their potential for mass effect, hydrocephalus, and rapid neurological deterioration. This study aimed to compare ischemic and hemorrhagic cerebellar stroke subtypes in terms of clinical profiles, risk factors, surgical management, and functional outcomes.

Methodology: A prospective observational cohort of 120 patients with imaging-confirmed isolated cerebellar strokes was studied over 2 years at a tertiary care center. Patients were classified as ischemic (n = 92) or hemorrhagic (n = 28). Baseline data included age, sex, vascular risk factors, anticoagulant use, and admission Glasgow Coma Scale (GCS). Imaging was reviewed for hydrocephalus and mass effect. Surgical interventions (suboccipital decompression/ventriculostomy) were documented. Functional outcome at 3 months was assessed using the modified Rankin Scale (mRS). Statistical comparisons were made using chi-square tests and multivariate logistic regression.

Results: Hemorrhagic strokes were associated with older age (67.5 vs 58.2 years, p < 0.01), hypertension (78.6% vs 50.0%, p = 0.014), lower GCS (10.8 vs 13.8, p < 0.001), and hydrocephalus (50% vs 16%, p < 0.01). Ischemic strokes showed higher prevalence of smoking (76.1% vs 25.0%) and dyslipidemia (56.5% vs 25.0%) (both p < 0.01). Surgery was more common in hemorrhagic strokes (50% vs 8%), but ischemic patients had better surgical outcomes (67% vs 42%). Poor outcome (mRS > 3) was more frequent in hemorrhagic strokes (53.6% vs 26.1%, p < 0.01). Hemorrhagic subtype, older age, and GCS < 11 were independent predictors of poor outcome.

Discussion: These findings align with prior studies (Kumral et al., Amarenco et al.) highlighting the severity of cerebellar hemorrhage and the importance of early surgical triage. Literature supports better outcomes with prompt decompression in ischemic mass-effect strokes. Subtype-specific management is essential as underlying risk factors vary between them.

Conclusion: Hemorrhagic cerebellar strokes carry worse outcomes, as do older age and low GCS at presentation. Early identification of high-risk features and tailored surgical triage—particularly in ischemic strokes—may improve prognosis.

Abstract ID 192: Longitudinal Regression Based Estimates of Evolutionary Trends in Inflammatory Myositis (IIM)

Prashanth Poulose, Seena Vengalil, Karthik Kulanthaivelu, Ravi Shanker, Deepak Menon, Saraswati Nashi, Nalini Atchayaram, Anita Mahadevan

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Study longitudinal evolution trends and predict regression based treatment response in a large Indian cohort

Methodology: Ninety-two M:F-38:54 with clinical & immunological diagnosis of IIM according to ACR/EULAR criterion 2017, between 2014 -2020 were included in this retrospective study

Results: Mean age of presentation & follow up are 38 yrs & 15 months, respectively. MMT-8 baseline (54), 6m -69, final follow up-74. Dermatomyositis and overlap myositis were 37% each, necrotising myositis 19% and anti-synthetase syndrome 7%. Positive MSA 66% & MAA 58%. Pelvis and adductors muscle Magnetic Resonance Imaging (MRI)showed fatty replacement in 83.6% (41/49), edema 85%(42/49). Anterior thigh FR-81.6%, edema 85.7%, posterior thigh FR-89.7% and edema 81.6%. FDG uptake showed good correlation with HPE & muscle oedema in MRI.SUV mean, SUV max ratio were higher among non-responders. Muscle biopsy 36% showed muscle necrosis (28%) perimysial infiltrates (20%), endomysial infiltrates (22%), perifasicular atrophy (11%) & fibrosis (23%). Outcomes showed best treatment responders (36%), satisfactory responders (39%), unsatisfactory responders (13%) and non-responders (11%). Non-responders had higher ICU admissions (30.4%), endotracheal intubations (13%), infections (39.1%), multiple immunomodulators, severe & rapidly progressive weakness (n = 20, 87%), chronic continuous course (n = 19, 82.6%) and higher number of relapses. Multivariate logistic regression showed that lower score of MMT-8 at baseline (p < 0.01) and higher number of relapses (p < 0.05) were independent predictors of non-response. These parameters could predict non-response with a sensitivity of 30.4% and specificity of 91.2% with ROC-0.775

Discussion: Non-responders had rapid progression with higher relapse rates & grades of MSA positivity, higher edema & fatty replacement on MR, higher SUV mean and max ratio on PET, more florid necrosis & inflammation on biopsy. They required higher doses and duration of immunomodulatory. Regression showed low MMT-8 scores at baseline, higher number of relapses were independent poor response predictors

Conclusion: Identifying distinctive trajectories creates predictive models and future precision based treatments. Highly specific model was another major highlight which aligns with focussed diagnostic frameworks in tertiary care settings

Abstract ID 193: Study to Evaluate the Clinical, Radiological and Electrophysiological Spectrum of Neurological Manifestations of Sjogren Syndrome

Debtanu Banerjee, Sumanta Sarkar, Biswadip Ghosh, Samar Biswas¹, Arijit Roy

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, ¹NRS Medical College and Hospital, Kolkata, West Bengal, India

Background and aim: Neurological disorders are a common extra-glandular complication of Sjogren syndrome (SS), with prevalence ranging from 8.5% to 70%. Peripheral neuropathy, particularly sensory polyneuropathy, is the most frequent complication, while Central Nervous System (CNS) involvement is less common. This study aimed to comprehensively evaluate the clinical, radiological, and electrophysiological spectrum of neurological manifestations in symptomatic SS patients.

Methodology: This ongoing observational, cross-sectional study is being conducted from August 2024 to March 2026 on around 180 patients attending the Department of Neuromedicine, Bangur Institute of Neurosciences, and the Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata. Both newly diagnosed patients and individuals presenting new-onset symptoms who have met the inclusion criteria and have given consent have been included

Results: Among 180 patients, 73 (40.56%) exhibited neurological symptoms, with a female predominance (80.82%) and peak prevalence in ages 21-30 (31.51%) and 51-60 (26.03%). Symptoms included quadriparesis (10.96%), tingling/numbness (9.59%), and sensory ataxia (8.22%). Diagnoses comprised large fibre neuropathy (12.33%), small fibre neuropathy (10.96%), and bilateral carpal tunnel syndrome (8.22%), along with rare cases like ADEM, CNS vasculitis, cranial neuropathy, periodic paralysis, and stroke.

Discussion: The findings reveal a significant female predominance and a peak in neurological symptoms among young to middle-aged adults. The varied sensory, motor, and central nervous system manifestations underline the complexity of neurological involvement in SS. The study confirmed the predominance of peripheral neuropathy, with large fibre neuropathy (12.33%) and small fibre neuropathy (10.96%) rates consistent with prior research. Similarly, bilateral carpal tunnel syndrome occurred in 8.22%. Central nervous system issues like stroke (5.48%) and CNS vasculitis (2.74%) also corroborated previous findings, despite some literature variability on cerebrovascular event risks.

Conclusion: Neurological manifestations in SS are varied and predominantly affect females. Peripheral neuropathies are the most frequent complication. Continued research will aid in earlier diagnosis and targeted management strategies for symptomatic patients.

Abstract ID 194: A Study on the Outcomes of Acute Ischemic Stroke Patients Undergoing Thrombolysis at A Tertiary Care Centre - An Observational Prospective Study

Kalingi Teja, Evangelin Gera

Siddhartha Medical College, Vijayawada, Andhra Pradesh, India

Background and Aim: Ischemic stroke remains a leading cause of mortality and long-term disability. Timely thrombolytic therapy with agents like alteplase has improved outcomes. Tenecteplase, a genetically modified variant with greater fibrin specificity and ease of administration, is emerging as a viable alternative in acute ischemic stroke (AIS) management. The study evaluated the 3-month functional outcomes, safety, and efficacy of tenecteplase in AIS patients presenting within the thrombolysis window at a tertiary care center.

Methodology: This prospective observational study was conducted over 18 months, enrolling 51 AIS patients eligible for thrombolysis; 47 completed follow-up. Tenecteplase was administered at 0.25 mg/kg as a single IV bolus. Clinical parameters, NIHSS scores, and modified Rankin Scale (mRS) outcomes were recorded at baseline, 24 hours, discharge, 1 month, and 3 months.

Results: The mean age was 59.6 years; 70% were male. At 3 months, 55.3% achieved functional independence (mRS 0–2), and 42.6% had excellent outcomes (mRS 0–1). Early neurological improvement (≥40% NIHSS improvement at 24 hours) was observed in 17%. Mortality was 21.3%. Intracranial hemorrhage occurred in 10.6%, but there were no cases of symptomatic ICH. Favorable outcomes were significantly associated with thrombolysis within 2 hours of symptom onset (p = 0.026) and milder stroke severity (NIHSS<16; p = 0.020).

Discussion and conclusion: Tenecteplase is a safe and effective thrombolytic agent in AIS, showing promising functional outcomes and a low risk of symptomatic hemorrhage. Early presentation and lower stroke severity are key predictors of favorable outcomes. These findings support tenecteplase as a practical alternative to alteplase, especially in real-world tertiary care settings. Small sample size, single-center design, and reliance on patient recall for symptom onset time may limit generalizability. Further multicentric studies with larger cohorts and long-term follow-up are needed.

Abstract ID 195: Spectrum of Neuroinfections in A Teritiary Care Centre

Sirisha Yasa

KIMS Hospital, Hyderabad, Telangana, India

Background and aim: In the wake of increasing metabolic syndrome and related disorders we tropical countries still struggling with persistent and resurfacing infectious diseases. This study focused on understanding the epidemiological patterns of neuro-infections, risk factors and determine predictors of outcomes. Presentation, early initiation of steroids were associated with good outcomes.

Methodology: Single centered, prospective data analysis of all cases admitted with neuroinfections. Total 117 cases were analysed. Most of the cohort were between 41-50 years (22%), (10.3%) were over 60 years age, (55.56%) were males. Cerebrospinal Fluid (CSF) analysis was done in 82% of the total cases. Neuroimaging (CT/MRI) was done for all cases.

Results: Forty-one and eighty-eight hundredths percentage were viral, 29.91% were bacterial, 14.52% were fungal, and 13.67% were tubercular infections. Associated risk fctors were diabetes (40.17%), hypertension (38.46%), hypothyroidism (23.08%), chronic liver diseases (5.98%), and chronic kidney diseases (3.42%). Among these, 10.26% were immunocompramised (HIV, other immunomodulators). Acute presentation (<week) was seen in 72.65%. Nearly 6.84% presented comatose (GCS < 8). Bacterial and viral infections were associated with the most favorable outcomes with 86% having mRS < 4 at discharge, improving to 94% at 6 months. TB infections also showed late recovery with MRS improving at 6 months (69% to 94%). In contrast, fungal infections had the poor outcomes of 35% achieving modified Rankin Scale (mRS) < 4 at discharge (59% at 6 months). By 6 months nearly 5.12% of cohort succumbed. Age, gender, hypoglycorrhachia, CSF cellularity and empirical usage of antibiotics were not significantly associated with outcomes.

Discussion: Diagnostic positivity rate are meningitis panel (2.56%), staining (9.28%), CSF culture (25%), gene x pert (68.75%), CSF culture (2.06%), biopsy (55.56%), montoux test (31.25%). Imaging features when compared, meningeal, parenchymal involvement were associated with type of infection but vascular involvement did not show much association.

Conclusion: There is notable shift in incidence of infection compared to prior studies available. Diabetes, hypertension, immuno-compromised state, low Glasgow Coma Scale (GCS) at presentation, need for mechanical ventilation, presence of multi-organ dysfunction, elevated CSF proteins were associated with poor outcomes.

Abstract ID 196: Predictors of Early Recurrent Stroke in an Indian Cohort: Clinical, Laboratory, and Lifestyle Correlates from a Ambispective-Observational Study

Vignesh Kumar, Jude Vijay, Sivaji M, Mugundhan Krishnan

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Stroke recurrence remains a formidable challenge in neurovascular care, with rates as high as 53% over five years despite adherence to guideline-based secondary prevention. In low- and middle-income settings, the contribution of non-traditional risk factors—such as systemic inflammation, hematologic indices, and subclinical dysmetabolism—remains underexplored. This study aimed to identify clinical, biochemical, and lifestyle predictors of recurrent ischemic stroke, emphasizing real-world, blood-based biomarkers to enable precision risk stratification in a South Indian cohort.

Methodology: We conducted an ambispective observational study at Madras Medical College, enrolling 200 patients with documented recurrent ischemic stroke between January 2023 and December 2024. Detailed demographic, clinical, lifestyle, and radiological profiles were collected alongside comprehensive laboratory parameters, including neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), mean platelet volume (MPV), HALP score, lipid ratios (LDL/HDL, TGL/HDL), and the TyG index. Multivariate logistic regression was used to identify independent predictors of early recurrence (<1 year) and stroke severity (NIHSS).

Results: Hypertension (94%) and diabetes (70%) were nearly universal, but recurrence occurred despite antiplatelet compliance in 88.5% of cases. MPV (OR = 4.60) and TGL/HDL ratio (OR = 2.56) were the strongest independent predictors of early recurrence. Low hemoglobin (OR = 0.13) and HALP score (OR = 0.46) conferred protective effects. Inflammatory indices (NLR, PLR, SII) showed moderate associations. Atrial fibrillation, though infrequent (2.5%), predicted recurrence in different vascular territories (80%).

Discussion: Findings of the present study underscore the pivotal role of pro-inflammatory, nutritional, and metabolic indices in recurrent stroke pathogenesis. Composite biomarkers derived from routine labs demonstrated superior predictive value over conventional parameters.

Conclusion: This study advances the paradigm of stroke recurrence risk assessment by integrating easily accessible yet powerful laboratory markers. Incorporating indices such as MPV, HALP, and TGL/HDL into discharge protocols may enable cost-effective, precision-guided secondary prevention—especially in resource-constrained environments.

Abstract ID 197: Genetic Heterogeneity of Charcot-Marie-Tooth Disease in an Indian Cohort

Meera Ramkumar, Seena Vengalil, Atchayaram Nalini, Saraswati Nashi, Gautham Arunachal

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Charcot-Marie-Tooth (CMT) is a clinically and genetically heterogenous group of inherited neuropathies More than 100 causative genes have been identified. This study was conducted to address the scarcity of Indian CMT research and to define the clinical and genetic profile of patients in this population. To describe the phenotypic and genotypic profile of a large cohort of CMT patients from India.

Methodology: A retrospective study of genetically confirmed cases of CMT was done. Demographic, history and examination noted. Details of nerve conduction study (NCS) and other investigations were collected. Clinically relevant mutations were annotated using published variants in literature and a set of databases.

Results: 120 genetically confirmed CMT cases (M:F = 1.8:1) were analyzed. Mean age at onset was 16.2 ± 14.9 years, mean illness duration 7 ± 7.3 years. Consanguinity was present in 17.7%. Distal limb weakness predominated; 21.9% had both proximal and distal involvement, and 34.3% had upper-limb weakness. Foot deformities occurred in 37.5%, sensory ataxia in 10.4%, facial weakness in 10.4%, tongue fasciculations in 12.5%. NCS (n = 83) revealed axonal (32.5%), demyelinating (24.6%). Predominant mutations were SH3TC2 (n = 16), MFN2 (14), GDAP1 (13), and PMP22 (9); 58% were missense variants. Early onset was linked to mutations in PRX, GDAP1, MFN2, MTMR2, PLEKHG5, SBF2, and GJB1. Demyelinating phenotypes correlated with PMP22, GJB1, SH3TC2; axonal with MFN2, MTMR2, GDAP1.

Discussion: This study—one of the largest genetically characterized Indian CMT cohorts—identifies SH3TC2, MFN2, GDAP1, and PMP22 as the most common genes, with high rates of consanguinity and homozygosity. Additionally, multisystemic features including hearing loss, glaucoma, ptosis, and bulbar signs expand clinical recognition of CMT in the Indian context.

Conclusion: This study delivers a comprehensive genetic and phenotypic profile of Indian CMT, highlighting diverse sensory, cranial, and ocular involvement that warrants broader clinical screening, and recommends future efforts toward functional characterization of novel variants.

Poster presentations: Abstract ID 501: Impact of Betahistine along with Canalith Repositioning Maneuvers on Benign Paroxysmal Positional Vertigo in Real-World Settings

Ashish Sharma

All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India

Background and aim: Benign paroxysmal positional vertigo (BPPV) is a vestibular disorder caused by otoconia displacement, leading to episodic vertigo. While Canalith repositioning maneuvers (CRMs) are the primary treatment, recurrence and residual dizziness remain concerns. Betahistine, a histamine analog, improves inner ear microcirculation and vestibular compensation, potentially enhancing symptom resolution and reducing BPPV recurrence. This study aimed to evaluate the efficacy of betahistine 48 mg/day for 3 months as an adjunct to CRMs in improving symptom resolution, recurrence prevention, and residual dizziness reduction in BPPV patients.

Methodology: This real-world, retrospective study analyzed adult BPPV patients receiving either CRMs alone (Group B, n = 112) or CRMs + betahistine 48 mg/day (Group A, n = 112) for 3 months. The primary outcome was monthly vertigo incidence, while secondary outcomes assessed symptom severity, attack duration, recurrence, and residual dizziness, at 30, 60, and 90 days of treatment compared to the baseline.

Results: At 90 days, Group A showed a greater reduction in monthly vertigo attacks (92.2% vs. 89.1%, p = 0.034) and severity, with consistent improvements observed at 30 and 60 days. Group A also demonstrated significantly faster symptom resolution, with greater reductions in unsteadiness (50% to 8.04%), nausea (58.93% to 9.83%), and vomiting (41.97% to 3.58%) (all p < 0.001) than Group B. Reduction in nystagmus was only significant in Group A at all time-points (p < 0.05) highlighting the adjunctive benefits of betahistine with CRM therapy. Additionally, residual dizziness was absent in Group A, whereas moderate residual dizziness persisted in 7.1% of Group B patients (p = 0.002). Furthermore, no cases of recurrence were observed in Group A throughout the treatment period, compared to 0.89% in Group B. Both treatments were well tolerated, with no reports of serious or severe adverse events.

Discussion: In the primary outcome of this study, both treatment groups showed significant improvements in vertigo incidence with every visit (p < 0.001). From baseline to 90 days, the reduction in the number of monthly vertigo attacks was significantly greater in Group A (22.03) compared to Group B (19.34) (p = 0.034). This suggests that while CRMs are effective at repositioning otoconia, additional supportive therapy with Betahistine enhances long-term BPPV stabilization and prevent recurrence.

Conclusion: Betahistine 48 mg/day for 3 months significantly enhances BPPV management, providing greater symptom relief, recurrence prevention, and residual dizziness reduction than CRMs alone. These findings support its integration as an adjunctive therapy for sustained vestibular stabilization.

Abstract ID 502: Identifying Genetics-Proven Unique MRI Features in the Diagnosis of GFAP Astrocytopathy: A Rare Autoimmune Neuroinflammatory Disorder

Vamsi Mudamanchu

Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India

Background and aim: Glial Fibrillary Acid Protein (GFAP) astrocytopathy is a rare autoimmune disorder that causes inflammation in the central nervous system, impacting the meninges, brain parenchyma, and spinal cord.

Methodology: A key Magnetic Resonance Imaging (MRI) finding associated with this condition is distinctive periventricular radial and linear contrast enhancement.

Results: The MRI findings revealed enhancing t2w/flair hyperintensities in bilateral frontal periventricular white matter, sparing the U-fibers involving the bilateral caudate, lentiform nucleus, rostrum of corpus callosum centrum semiovale, thinning of the rostrum, genu & anterior half of body of corpus callosum, enhancing lesions of varying sizes in the pons, medulla oblongata, vermis and bilateral cerebellar hemispheres.

Discussion: This case report details a 23-year-old female who presented with, ataxia, dysphagia, dysphasia, with vestibular dysfuncion. Notably, the whole genome exome sequence is postive for GFAP gene. GFAP is an intermediate filament protein expressed in astrocytes that regulates its shape and motility and is involved in synaptic plasticity and reactive gliosis. The imaging hallmark of GFAP astrocytopathy is a linear and radial type of periventricular enhancement on MRI. It is reported in both adults (44%–53%, 32%–100%) and pediatric patients (53.8%, 8%–20%). Pathologically, it is due to inflammation around the perivascular region originating from GFAP-enriched areas and disruption of blood-brain barrier (BBB). Pathologically, it is due to inflammation around the perivascular region originating from GFAP-enriched areas and disruption of blood-brain barrier (BBB).

Conclusion: GFAP astrocytopathy presents with nonspecific symptoms, leading to delayed diagnosis and management. Autoimmune GFAP astrocytopathy encompasses an expanding clinical spectrum and should be considered in the context of ataxia, dysphagia, dysphasia, with truncal ataxia with vestibular dysfuncion, myelitis, optic neuritis, ataxia, papillitis, seizures, autonomic dysfunction occurring in isolation or more commonly in varying combinations. Characteristic periventricular radial and linear types of contrast enhancement and whole genome exome sequence, positive anti-GFAP antibodies in CSF are highly specific for diagnosis. Our case to establish a diagnosis, further stressing the need for a predictive diagnostic algorithm.

Abstract ID 503: Aggression and Headache in a Young Male: A Neurobehavioral Storm Unveiling Cushing Syndrome

Mohit Mann

Shree Aggarsain International Hospital, New Delhi, India

Background and aim: Cushing’s syndrome (CS) is a rare endocrine disorder characterized by prolonged exposure to elevated cortisol levels. While classical features include central obesity, hypertension and striae, psychiatric and neurobehavioral symptoms may be early or predominant, often leading to diagnostic delays.

Methodology: We report a case of a 27-year-old male presenting with severe headache, episodic aggression, insomnia, and cognitive impairment. Initial workup revealed classic features of CS including hypertension, hypokalemia, and Cushingoid appearance. Biochemical investigations confirmed ACTH-dependent hypercortisolism with markedly elevated serum and urinary cortisol levels and a lack of suppression on high-dose dexamethasone testing. Imaging revealed bilateral adrenal hyperplasia and a suspicious pulmonary nodule, raising the possibility of ectopic ACTH secretion, likely from a bronchial carcinoid. Initiation of ketoconazole therapy led to significant clinical and biochemical improvement.

Results: The patient was initiated on ketoconazole 200 mg three times daily, resulting in significant clinical improvement—normalization of blood pressure, serum potassium levels, and reduction in serum cortisol.

Discussion: Cushing’s syndrome may present with subtle or atypical neuropsychiatric symptoms, often delaying diagnosis. In ACTH-dependent cases, ectopic sources like bronchial carcinoids should be considered when pituitary imaging is negative. This case highlights the importance of recognizing early psychiatric features and initiating prompt treatment with steroidogenesis inhibitors like ketoconazole, which can lead to significant clinical improvement. A multidisciplinary approach is crucial for timely diagnosis and optimal outcomes.

Conclusion: This case underscores the importance of considering CS in young patients presenting with neuropsychiatric symptoms and treatment-resistant hypertension. Early recognition and a multidisciplinary approach are critical for timely diagnosis and improved outcomes in atypical presentations of CS.

Abstract ID 504: Peripheral Neuropathy as a Presenting Complaint of IgG4 Related Disease

Pratibha Prasad

All India Institute of Medical Sciences, Patna, Bihar, India

Background and aim: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibro-inflammatory condition characterized by high serum IgG4 concentrations and tissue infiltration by IgG4-positive plasma cells. Though IgG4-RD affects various organs, including the pancreas, kidney, lung, thyroid, and lacrimal and salivary glands, however, the peripheral neuropathy involvement is unusual as a presenting complaint.

Methodology: A 27 year old male presented with LMN quadriparesis since 12 days. Power was 3/5 in all four limbs. Cerebrospinal fluid (CSF) was normal and nerve conduction studies (NCS) showed axonal neuropathy. He was given IVIG but did not respond after one month. Rather his illness progressed and he presented with nausea, severe weight loss with power 1/5 in all four limbs. He was again re admitted

Results: Routine investigation showed raised OT/PT, amylase and lipase. The magnetic resonance imaging (MRI) whole abdomen and magnetic resonance cholangiopancreatography (MRCP) showed diffuse pancreatic swelling with loss of pancreatic cleft giving rise of sausage appearance. NCS was non recordable. The antinuclear antibody (ANA) profile, IgA TTG was negative, cANCA p ANCA was negative. Thus, autoimmune pancreatitis was diagnosed. He underwent 5 cycles of plasma exchange where he showed improvement. Repeat LFT showed a decreasing trend of lipase and amylase and OT/PT. Serum IgG4 was sent, which came out to be positive. At present, he is on oral steroids and steroid sparing agents.

Discussion: IgG4-RD can be diagnosed based on histological features and high serum IgG4 levels. However, IgG4-RD with neuropathy in the extremities is easily misdiagnosed with POEMS syndrome, paraneoplastic syndrome and Churg-Strauss syndrome. IgG4 related disease must be kept as differential diagnosis.

Conclusion: IgG4-RD is a relatively recently reported systemic fibrous inflammatory disease caused by the infiltration of IgG4-positive plasma cells in various organs. In the nervous system, symptomatic peripheral nerve invasion is very rare. However, as demonstrated in our case, IgG4-RD may present with primarily peripheral nerve disease.

Abstract ID 506: Acute Sarcoid Myopathy -A Rare Case Report

Mohammed Fahad, Kamlesh Kumar

National Institute of Medical Sciences, Jaipur, Rajasthan, India

Background and aim: Sarcoidosis myopathy is a rare condition affecting the muscle leading to weakness and myalgia. It can manifest as chronic or acute myopathies with chronic form being most common Sarcoidosis: characterized by non-caseating granuloma that can form in various organs including muscles. Only a small percentage of sarcoidosis patients experience symptomatic muscle involvement 0.5-2.5%) we are presenting a rare case report in which 62-year-old female presented with acute onset bilateral lower limb weakness, myalgia, seizure, confusion, shortness of breath and latter mediastinal lymph node biopsy suggestive of sarcoidosis.

Methodology: A 62 year old female came with insidious onset myalgia and bilateral progressive proximal weakness, one episode of seizure, vomiting, pain in abdomen, on examination patient is irritable confused, power in both lower limb 3/5 at hip joint, lab finding suggestive of increase calcium -14.5 and angiotensin converting enzyme (ACE) level high creatine phosphokinase (CPK) NAC normal vitamin D3 6 iPTH 29 magnetic resonance imaging (MRI) brain and MRI whole spine normal PET scan suggestive of enlarged mediastinal lymph nodes. A biopsy of an intrathoracic lymph node showed noncaseating granulomas. Muscle biopsy was done suggestive of non-caseating granuloma infiltrate. Patient was given steroid and hypercalcemia treatment, patient improved significantly.

Results: Corticosteriod used, the patient improved dramatically in clinically.

Discussion: Sarcoidosis is a multisystem inflammatory noncaseating granulomatous unknown etiology disorder. Acute Myopathy is a rare neurological disorder characterized by proximal lower limb weakness with myalgia.

Conclusion: Sarcoidosis myopathy is a rare disorder. Diagnosis requires comprehensive clinical examination, laboratory finding and radiological evaluations with histopathology findings. Management often involves a combination of corticosteroids and immunosuppressive drugs.

Abstract ID 507: Beyond the Scan: Unveiling IIH’S Radiological Clues

Nayana Bhuyan, Abhishek Pathak¹, Vijay Mishra¹

Banaras Hindu University, Varanasi, Uttar Pradesh, ¹Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background and aim: The primary purpose of magnetic resonance imaging (MRI), the neuroimaging modality of choice for Idiopathic Intracranial Hypertension (IIH), is to rule out other conditions. The pathologies seen on MRI in cases of chronic IIH include an empty Sella, flattening of the posterior globes, protrusion of the optic nerve head, distention of the optic nerve sheath, tortuosity of the optic nerve, meningoceles, herniated cerebellar tonsils, leakage of cerebrospinal fluid (CSF), and stenosis of transverse sinuses.

Methodology: This was a case control study conducted over a period of 12 months from April 2024 to April 2025, which included 36 cases and 36 controls above 18 years of age. Cases were diagnosed by modified Dandy Criteria.

Results: MRI findings were strongly suggestive of IIH, with 75% of cases showing tortuosity of optic nerve and 69.4% exhibiting partial empty sella. Other common findings including optic nerve sheath distension (52.8%), posterior globe flattening (52.8%), and stenosis of transverse sinus (63.9%), highlighting structural changes associated with raised intracranial pressure.

Discussion: Arhem Barkatullah et al. detailed the same findings as probable radiological markers of IIH, emphasizing their reversibility after treatment. Portelli et al. reviewed imaging from >50 cases and noted that partial empty sella and optic nerve changes were highly sensitive, although not specific to IIH. Magnetic resonance venography (MRV) studies have consistently shown transverse sinus stenosis (TSS) in 30–60% of IIH patients. Hence, the present radiological data reflects the typical imaging spectrum seen in IIH, further substantiating the diagnosis.

Conclusion: The radiological data of this study reflects the typical imaging spectrum seen in IIH, further substantiating the diagnosis.

Abstract ID 508: Syringomyelia and Syringobulbia Presenting with Unilateral Optic Neuropathy

MD Zamin Ahsan, Kamlesh Kumar, Rohit Kumawat

National Institute of Medical Sciences, Jaipur, Rajasthan, India

Background and aim: Syringomyelia is a chronic and progressive disease affecting the spine or craniovertebral junction in which long cavities form within the spinal cord. Neurological manifestations of syringomyelia include pain, motor symptoms, sensory disturbances and brainstem signs. Common ocular features are downbeat nystagmus and oscillopsia. Papilloedema and optic atrophy have been described as rare signs. Herein, we present a rare case of optic neuropathy in patients with syringomyelia.

Methodology: A 13-year-old boy presented to NIMS Medical College with progressive diminution of vision in left eye for 3 month. Patient had burning sensation and weakness in all 4 limbs since 1 year. On evaluation his visual acuity was 6/6 in the right eye and perception to light was absent in the left eye. There was a relative afferent pupillary defect in her left eye. His extraocular muscle movements were normal. The Magnetic resonance imaging (MRI) of spine showed syringomyelia in cervical and dorsal cord and even syringobulbia.

Results: Intravenous corticosteroids are beneficial in the treatment of early optic neuropathy in syringomyelia.

Discussion: Syringomyelia is a chronic disease, in which fluid-filled cavities in the spinal cord called syrinx expand and elongate over time. In this process, they destroy the nerve fibers of the spinal cord that lead to a variety of neurological manifestations, depending on the size and location of the syrinx. Optic neuritis is an extremely rare neuro-ophthalmic manifestation in syringomyelia. Herein, we report a case of optic neuritis in a patient with syringomyelia and synringobulbia. Due to the underlying anatomical basis of the diagnosis of this condition, it is almost impossible to diagnose it when patients present with visual complaints in the absence of neurological symptoms.

Conclusion: Optic neuropathy is a rare neuro-ophthalmic manifestation in patients with syringomyelia. Prompt diagnosis and timely management are essential to avoid a poor visual outcome.

Abstract ID 509: Unusual Etiology of Transient Ischemic Attacks (TIA) - 2 Case Reports

Molugu Samhitha

Medicover hospitals, Hyderabad, Telangana, India

Background and aim: Carotid webs are intraluminal shelf like filling defects that could be mistaken for focal dissection or ruptured plaque. Female preponderance of 63%- 91%. Age at diagnosis is 30-70 years with prevalence of 0.7%. They are non-atherosclerotic fibrous bands that arise along the posterior margin of the carotid bulb.

Methodology: Case1- A 28 year old male presented with weakness of right hand, lasted 2 minutes after waking up. One more similar episode during bath, for 2 minutes and subsided. Had difficulty in buttoning his shirt with right hand and difficulty in holding pen which persisted. Central nervous system (CNS) examination- Right pronator drift+, Right hand grip- 80% (mild grip weakness), ABCD2 score-3. Magnetic Resonance Imaging (MRI) brain suggestive of left high parietal and high frontal patchy infarctions. Magnetic resonance angiography (MRA) intracranial was normal. Computed tomography (CTA) and Digital subtraction angiography (DSA) were suggestive of left proximal carotid large thrombus. He was diagnosed as acute ischemic stroke with recurrent transient ischemic attack (TIA) and was started on anticoagulation. Repeat DSA done after 2 months showed carotid web in left proximal carotid artery. Carotid stenting was done, no new symptoms in follow-up.

Case 2- 74 year old male, with left upper limb and lower limb weakness, subsided within 24 hours, 6 months ago. Had similar complaints for 3 more times, had left hemiparesis with symptoms subsiding within 24 hours. No focal deficits during examination. ABCD2 score- 5. MRI Brain, MRA s/o Normal. DSA s/o Carotid web at right proximal carotid artery.

Results and Discussion: Disease process affects the innermost layer with foci of marked fibroelastic thickening of intima. Diagnosed by DSA, gold standard investigation for carotid webs. CT Angiography shows carotid artery structures, degree of stenosis, characterization of lesion, calcified plaques, webs, ulcerations. Medical management includes use of anticoagulants, antiplatelets. Invasive management is by carotid endarterectomy and carotid artery stenting.

Conclusion: Carotid webs are rare causes of TIA which should be considered in cases of multiple TIAs.

Abstract ID 510: Critical Appraisal of Guidelines for Evaluation and Certification of Specified Neurological Disabilities as Per Newer Disability Guidelines- 2024

Bhawna Sandhir, Inder Puri

Sardar Patel Medical College and Hospital, Bikaner, Rajasthan, India

Background and aim: India passed the Rights of Persons with Disabilities (RPWD) Act, 2016. In March, 2024 new gazette notification PART II—Section 3 came with advancements, newer inputs in older guidelines. The study aims to contribute to the ongoing evolution of disability evaluation frameworks toward greater precision, fairness, and inclusivity. AIMS: To critically acclaim newer disability guidelines, highlights the newer additions and deletions in comparison to older guidelines.

Methodology: 1995 Persons with Disabilities (PwD, Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 was presented to give effect to the Proclamation on the Full Participation and Equality of the people with Disabilities in the Asian and Pacific Region. India was signatory to that and hence disability protocols were implemented though they were restricted to certain diseases. In 2006 National policy for persons with Disability was formed. In continuation to it Rights to PwD was formed, it added more diseases for the assessment as well scoring methods for Permanent Physical Impairement (PPI). The recent revision of disability assessment guidelines by the Government of India in March 2024 marks a pivotal advancement. This paper critically examines the newly instituted guidelines, offering an analytical discourse on the efficacy of disability scoring methodologies compared to previous ones.

Results: The updated guidelines now integrate additional disorders such as Chorea, Dystonia, thereby enhancing the comprehensiveness of disability evaluation. The framework has incorporated objective, standardized scales for quantifying disability levels in complex neurological conditions, including Ataxia, Parkinson’s disease, Multiple Sclerosis, Amyotrophic Lateral Sclerosis, Chorea, and Dystonia, ensuring a more precise and clinically grounded assessment mechanism.

Discussion: While the 2024 disability assessment guidelines demonstrate considerable progress in neurological disorder inclusion and disability quantification, scope remains for refinement in grading precision, classification clarity, and scale integration.

Conclusion: A dynamic approach—incorporating international best practices, objective assessment tools, and detailed stratifications—will ensure that PwDs receive equitable recognition of impairments while benefiting from streamlined assessment methodologies.

Abstract ID 511: Wobble and Jerk: A Neurological Tale of Sialidosis

Jayaram S, Saranya Gomathy, Ramkumar Sugumaran, Manoj Manyem, Sunil Narayan

Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Background and aim: Sialidosis is a rare lysosomal storage disorder caused by NEU1 gene mutations, leading to neuraminidase deficiency. It manifests as two phenotypes: type I (milder, late-onset) and type II (severe, early-onset). Type I typically presents with myoclonus, ataxia, and cherry red spots, though the latter is absent in some cases. We report a genetically confirmed case of sialidosis type I with classic neurological features but no cherry red spot.

Methodology: A 29-year-old woman presented with a 5-year history of progressive gait ataxia, bilateral limb myoclonus, slurred speech, and seizures. Examination revealed truncal ataxia, cortical myoclonus (action-induced, stimulus-sensitive), and impaired coordination without cherry red spots. Differentials considered were SSPE, CJD, storage, PMA spectrum disorders, metabolic and mitochondrial disorders. Investigations included routine blood tests (normal complete blood count (CBC), liver function test (LFT), renal function test (RFT), ceruloplasmin, vitamins), electroencephalogram (EEG) (right central/temporal spikes, giant SSEPs), axillary skin biopsy (no Lafora bodies), and whole-exome sequencing (WES).

Results: WES identified a pathogenic NEU1 mutation (exon 5, c.880C > T, p.Arg294Cys), confirming sialidosis type I. EEG demonstrated epileptiform discharges, and SSEPs revealed high-amplitude cortical potentials. Fundoscopy showed no cherry red spot. The patient exhibited a pure neurological phenotype without cognitive decline or systemic involvement.

Discussion: This case highlights the diagnostic challenge of sialidosis type I when the cherry red spot is absent (reported in 25% of cases). The presence of cortical myoclonus, ataxia, seizures, and giant SSEPs is highly suggestive. Genetic testing is crucial for confirmation, as biochemical assays for neuraminidase activity are often unavailable. Unlike type II, type I spares visceral and skeletal systems but progresses relentlessly, necessitating symptomatic management (e.g., antiepileptics for myoclonus/seizures).

Conclusion: Sialidosis type I should be considered in young patients with progressive ataxia, cortical myoclonus, and seizures, even without cherry red spots. Genetic testing (e.g., WES) is pivotal for diagnosis, enabling appropriate counselling and palliative care. Early recognition can avoid redundant investigations and guide targeted therapy.

Abstract ID 512: Guillain Barre Syndrome with Hyper-IgE-Emia: Pure Coincidence or a Real Connection?

Ajay Emani, Ramakant Yadav, Roopesh Kirar, Midhun Mohan

Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India

Background and aim: Hyper IgE syndrome (HIES), also known as Job’s syndrome, is a rare primary immunodeficiency disorder marked by elevated serum IgE levels, recurrent skin and lung infections, and eczema. Guillain-Barré Syndrome (GBS) is an acute autoimmune condition affecting the peripheral nervous system, causing muscle weakness and paralysis. This case report discusses a unique instance of a 24-year-old male diagnosed simultaneously with HIES and GBS, detailing the clinical presentations, diagnostic challenges, and treatment strategies.

Methodology: The patient presented with sudden onset weakness in both upper and lower limbs, progressing over 12 days and resulting in hoarseness of voice and difficulty swallowing solids and liquids. Two months prior, he experienced periorbital puffiness and redness indicative of eczema, which improved with medical treatment. Physical examination revealed flaccidity in the limbs, absent reflexes including plantar reflex, and weakened gag and cough reflexes. His single breath count was 20.

Results: The patient was treated with intravenous immunoglobulin (IVIG) for GBS, which led to a gradual improvement in muscle strength.

Discussion: The coexistence of HIES and GBS is remarkably rare, complicating diagnosis and therapy. The clinical overlap of immunodeficiency and autoimmune neuropathy necessitates a nuanced approach to treatment, addressing both immune modulation and supportive care for neurological deficits.

Conclusion: This report aims to shed light on the complexities involved in managing such dual diagnoses and emphasizes the importance of a multidisciplinary approach in addressing the therapeutic challenges posed by these intersecting conditions.

Abstract ID 513: Cerebral Sinus Venous Thrombosis Presenting as Isolated Ipsilateral Trigeminal Neuralgia: An Unusual Reversible Phenomenon

Sandhya Manorenj, S Kumar

Deccan College of Medical Sciences, Hyderabad, Telangana, India

Background and aim: Cerebral sinus venous thrombosis (CSVT) is an uncommon yet potentially fatal condition that presents with a variety of clinical symptoms. Neurological deficits, headaches, and seizures are frequently observed, while isolated involvement of cranial nerves is rarely seen. The occurrence of trigeminal neuralgia (TN) as the only symptom indicative of CSVT is an extremely rare phenomenon.

Methodology: We describe the case of a 48-year-old male with no significant medical history who reported a sudden onset of intense right-sided facial pain typical of trigeminal neuralgia, specifically affecting the maxillary (V2) branch.

Results: The patient characterized the pain as electric shock-like, episodic, and exacerbated by facial movements. No other neurological deficits or systemic symptoms were present. Initial evaluations indicated a newly diagnosed case of diabetes mellitus. A Magnetic Resonance Imaging (MRI) scan accompanied by Magnetic Resonance Venography (MRV) of the brain identified cerebral venous sinus thrombosis affecting the right transverse and sigmoid sinuses. There were no signs of infarction or mass effect. The patient began treatment with low molecular weight heparin for anticoagulation, which was subsequently switched to oral anticoagulants. Notably, the facial pain completely resolved within a week of starting treatment, without requiring standard anti-neuralgic medications.

Discussion: This case emphasizes an atypical manifestation of CSVT presenting solely as ipsilateral trigeminal neuralgia. The close anatomical relationship between the trigeminal nerve pathways and the affected venous sinuses may elucidate the underlying mechanism, potentially related to venous congestion or inflammation.

Conclusion: Healthcare providers should remain vigilant for secondary causes when encountering atypical presentations of trigeminal neuralgia. Although rare, CSVT should be considered in cases of acute, unilateral trigeminal pain, especially when imaging indicates venous sinus involvement

Abstract ID 514: ALADIN and the 6 A’s

Vignesh Kumar, Prakash V, Sivaji M, Mugundhan Krishnan

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Allgrove Syndrome (Triple A Syndrome) is a rare autosomal recessive disorder due to mutations in the AAAS gene on chromosome 12q13. It classically presents with alacrima, achalasia, and adrenocorticotropic hormone (ACTH)-resistant adrenal insufficiency, but frequently includes neurological manifestations such as motor neuropathy, autonomic dysfunction, cognitive impairment, and ataxia. This case aims to highlight an expanded phenotype of the syndrome, emphasizing neurological and cognitive involvement.

Methodology: A 22-year-old male, born of third-degree consanguineous parentage, presented with progressive dysphagia (solids > liquids), nasal voice, distal upper limb weakness with polyminimyoclonus, proximal lower limb weakness, and unsteadiness during movement. Examination revealed dysmorphic facies, tongue wasting with fasciculations, decreased palatal movement and gag reflex, generalized muscle wasting, distal hypotonia, spasticity, exaggerated reflexes, and clawing of fingers and toes. Cerebellar signs included impaired finger–nose and heel–knee tests. Cognitive testing showed deficits in executive function, sequencing, and abstraction. Schirmer’s test confirmed alacrima (<5 mm B/L). Serum cortisol was 0.05 µg/dL with ACTH at 520.3 pg/mL. Esophageal manometry indicated impaired lower esophageal sphincter relaxation. Nerve conduction studies showed demyelinating motor neuropathy. MRI brain was normal. Genetic testing for AAAS mutation was initiated.

Results: The patient fulfilled the diagnostic triad of Allgrove Syndrome and demonstrated prominent neurological involvement, including motor neuronopathy, limb ataxia, and cognitive impairment. Autonomic dysfunction was evident from orthostatic hypotension and an abnormal 30:15 ratio. Sensory and cranial nerve examinations were normal.

Discussion: This case illustrates the neurodegenerative spectrum of Allgrove Syndrome, where neurological signs such as polyminimyoclonus, limb ataxia, and cognitive dysfunction may precede or overshadow classical endocrine features. The multisystemic nature of the disorder reflects dysfunction of the ALADIN protein at the nuclear pore.

Conclusion: Allgrove Syndrome should be considered in young patients with adrenal insufficiency, alacrima, achalasia, and neurological features including ataxia. Early recognition and multidisciplinary care are critical for improving long-term prognosis.

Abstract ID 515: Unmasking a Rare Reversible and Treatable Causes of Status Epilepticus in a School-Going Child

Paras Gulati

Deccan College of Medical Sciences, Hyderabad, Telangana, India

Background and aim: To identify, investigate and describe a rare, reversible and treatable cause of status epilepticus in a school going child.

Methodology: A prospective case report with clinical and radiological profile.

Results: Investigation and management FEVER Panel: suggestive of leucocytosis, raised C-reactive protein (CRP), raised erythrocyte sedimentation rate (ESR) levels, pus cells and bacteria in urine. Cerebrospinal fluid (CSF) analysis: two cells of 100 percent lymphocytes, with proteins and glucose within normal limits, no acid-fact bacilli (AFB), no growth in fungal cultures. Magnetic resonance imaging (MRI) brain: cytotoxic edema in bilateral basal ganglia symmetrical. Treatment: high doses of biotin and thiamine were given with antiseizure medications antibiotics.

Discussion: Prevalence of biotin-thiamine-responsive basal ganglia disease (BTBGD): 2,15,000-10,00,000. It is an autosomal recessive neurometabolic disorder, which is caused by mutations in SLC19A3 gene, leading to impaired thiamine transport across cell membranes, resulting in thiamine deficiency, primarily affecting the basal ganglia. It often presents with symptoms of Sub acute encephalopathy, seizures, developmental delay, dysphagia, movement disorders such as dystonias, rigidity or tremors. Identification of SLC19A3 gene confirms the diagnosis.

Conclusion: Early intervention with high doses of biotin and thiamine in BGBTD cases, especially following fever is crucial to prevent permanent neurological damage and manage status epilpticus.

Abstract ID 516: Missing Link Between Connections & Motivation

Rojina Choudhury, Siddharth Anand, Mona Tiwari, Sidharth Anand

Institute of Neurosciences, Kolkata, West Bengal, India

Background and aim: There are different types of disconnection syndrome related to white matter tracts in brain. Among all Inferior longitudinal fasciculus (ILF) is related to visual processing & structurally different from optic radiation fibres & U-shaped fibres. Disconnections syndrome following lesion in ILF has been well described by Marco catani et al. ILF originate from extra- striate cortex of occipital lobe & run parallel to optic radiation fibres & a direct fast connection of visual information to anterior temporal structure & from anterior temporal structure to occipital lobe. Here we are presenting two such cases.

Methodology: Case 1: Eighteen years old male had history of febrile seizure since 3 years of age, later developed focal seizure with secondary generalization, and came to our institute for surgery since he was not able to focus on his study & not able to track ongoing videos without sound in class like his peer group. No visual field defect. Acuity of vision was intact. The electroencephalogram (EEG) did not show any epileptiform discharge. Formal cognitive assessment showed deficit in sustained attention & visual memory. Diffusion Tensor Imaging-Magnetic Resonance Imaging (DTI-MRI) showed thinning of ILF (right) and not able to trace the ILF up to occipital lobe. Case 2: A 37 years old female had suffered from posterior reversible encephalopathy syndrome in 2023 & later came with a case of inability to drive despite being a well skilled driver previously. She has normal field of vision and acuity of vision. DTI-MRI showed thinning of left ILF & breach in continuity of ILF towards occipital lobe.

Results: Both had lesion in ILF & suffering from occipito-temporal disconnection syndrome.

Discussion: They were not able to learn novel non-verbalize visual stimuli due to lesion in ILF and also there is a lack of motivation possibly due to lack of neuro-modulatory effect of amygdala on extra-striate visual cortex.

Conclusion: Never neglect patient complaints related to attention & motivation.

Abstract ID 517: A Rare Diagnosis Behind a Common Symptom: CLN8-Related NCL in a 7-Year-Old Boy

Aditi Jain, Bhawna Sharma

S.M.S. Medical College, Jaipur, Rajasthan, India

Background and aim: Neuronal Ceroid Lipofuscinosis (NCL) is a group of rare autosomal recessive lysosomal storage disorders characterized by progressive neurodegeneration, seizures, and vision loss. The disease is classified into subtypes based on the age of onset and associated gene mutations (CLN1–CLN14). Variant late-infantile NCL due to CLN8 mutations is uncommon and often underrecognized. This case report aimed to highlight the clinical presentation, diagnostic pathway, and importance of early recognition of CLN8-related NCL

Methodology: A 7-year-old male born to consanguineous parents presented with a history of developmental regression beginning at age 4, along with motor decline, loss of speech and vision, generalized tonic-clonic seizures, and continuous myoclonic jerks. Detailed clinical evaluation, neurological examination, brain Magnetic Resonance Imaging (MRI), and genetic testing were conducted to reach a definitive diagnosis.

Results: The patient initially developed gait instability and tremulousness in the lower limbs, followed by progressive loss of ambulation, mutism, visual deterioration, and intractable seizures. MRI brain revealed cerebellar and cerebral atrophy. Genetic analysis identified a pathogenic mutation in the CLN8 gene, confirming the diagnosis of variant late-infantile NCL.

Discussion: CLN8-related NCL is a rare form of late-infantile neuronal ceroid lipofuscinosis presenting between ages 2 and 5. It manifests with seizures, motor and cognitive regression, and visual loss. Cerebellar atrophy on MRI and confirmatory genetic testing are key to diagnosis. Early identification is essential for genetic counselling and supportive care. The variability in presentation often delays diagnosis, underscoring the need for heightened clinical suspicion in regressing children with seizures.

Conclusion: This case emphasizes the importance of considering NCL in the differential diagnosis of childhood neuroregression. Early MRI and genetic testing facilitate timely diagnosis. Awareness of CLN8-related NCL is crucial for improved outcomes through early intervention and family counseling.

Abstract ID 518: Cerebral Storm in a Young Male with Primary Antiphospholipid Syndrome

Vipul Phogat

S.M.S. Medical College, Jaipur, Rajasthan, India

Background and aim: Antiphospholipid antibody syndrome (APLA) is a prothrombotic autoimmune disorder that may rarely present with central nervous system (CNS) vasculitis. CNS involvement can mimic a wide spectrum of neurological disorders and may present diagnostic challenges, especially in male patients without comorbidities.

Methodology: A 35-year-old male with no known comorbidities presented with a 4-day history of acute-onset headache, vomiting, and gait imbalance. He had a past history of superior sagittal sinus thrombosis with right frontal and left occipital hemorrhagic infarcts 2 years prior, followed by focal motor seizures with impaired awareness, mild memory impairment, and behavioral changes. Neurological examination revealed gaze-evoked right-beating nystagmus, bilateral lower limb spasticity, exaggerated deep tendon reflexes, flexor plantar responses, intact sensation, right-sided cerebellar signs, and swaying to the left.

Results: Investigations showed elevated C-reactive protein (CRP), prolonged International Normalized Ratio (INR), cerebrospinal fluid (CSF) with raised protein and normal cytology and glucose, and magnetic resonance imaging (MRI) evidence of right cerebellar hemorrhage with multiple cortical and subcortical blooming areas. MR vessel wall imaging showed multifocal small vessel enhancement, while cerebral digital subtraction angiography (DSA) was normal. Lupus anticoagulant was persistently positive over 3 months; other autoimmune markers were negative. A diagnosis of primary APLA-associated CNS vasculitis was established.

Discussion: This case highlights a rare neurological manifestation of primary APLA in the form of CNS vasculitis, presenting with both acute thrombo-hemorrhagic events and chronic neurobehavioral changes. The diagnostic process emphasized the utility of advanced neuroimaging modalities, particularly MR vessel wall imaging, in identifying small vessel vasculitis where computed totmography (CT) angiography and DSA may be unrevealing. Persistent lupus anticoagulant positivity supported the diagnosis, even in the absence of systemic autoimmune features.

Conclusion: Primary APLA can present with CNS vasculitis leading to both acute and chronic neurological deficits. High clinical suspicion, comprehensive imaging, and targeted serological testing are crucial for diagnosis. Early recognition is essential to initiate appropriate immunosuppressive and anticoagulation therapy to prevent further neurological deterioration.

Abstract ID 519: Early Neurological Deterioration Following Thrombolysis in Patients with Acute Ischemic Stroke in a Tertiary Care Centre in Kerala

Sobhitha Abraham, Shaji C V, Haris A A

Government TD Medical College, Alappuzha, Kerala, India

Background and aim: Early Neurological Deterioration (END) has been reported to occur in a proportion of stroke patients. END has been consistently linked with increased rates of death and dependency at 2 months after stroke onset. Aim of this study was to estimate the proportion of patients with early neurological deterioration following thrombolysis in acute stroke and to find out the risk factors associated with it.

Methodology: Study design: Prospective observational study. Study setting: Stroke unit and Neurology OP, Government Medical College, Alappuzha. Study Population: Patients undergoing thrombolysis for acute ischemic stroke Sample size: 74. Study Procedure: Patients thrombolysed for acute ischemic stroke were monitored for the development of END defined as worsening of National Institute of Health Stroke Scale (NIHSS) ≥ 2 in 24 hours and the causes were classified as hemorrhagic, ischemic and others. Association between factors like age, blood pressure, blood sugar, pre lysis NIHSS score, stroke characteristics and END were assessed. They were followed up for 2 months to assess the relationship between END and neurological disability assessed by modified Rankin Scale (mRS).

Results: END occurred in 16 patients (21.6%). Lower Pre lysis ASPECTS, higher systolic BP, posterior circulation stroke were risk factors for END while small vessel etiology was negatively associated with END. There was a statistically significant association between END and mRS at 2 months.

Discussion: Early neurological deterioration occurred in 21% of patients which was similar to previous studies. Appropriate monitoring and search for risk factors can help us to predict end and treat it to prevent morbidity and mortality.

Conclusion: END occurs in one fifth of patients after intravenous thrombolysis. Prevention and Early detection can reduce further progression. This can aid in improving functional outcomes after stroke thrombolysis.

Abstract ID 520: The Efficacy and Safety of Remote Electric Neuromodulation (REN), via Neuromodulation Device Nerivio™, for the Acute and Preventive Treatment of Migraine: A Real-World Evidence (RWE) Study from India

Ashish Sharma

All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India

Background and aim: To establish the safety and effectiveness of Nerivio™, a neuromodulation device, in reducing migraine burden in chronic and episodic migraine patients over a 60-day retrospective observational period.

Methodology: This was a retrospective monocentric study that included 141 patients aged between 12 and 75 years meeting ICHD-3 criteria for chronic and episodic migraine administered with Nerivio™ for acute and preventive treatment. Efficacy outcome measures included reduction in monthly migraine days, number of attacks, pain intensity, attack duration, and Migraine Disability Assessment (MIDAS) scores from baseline to 60-day follow-up period. Safety outcomes included the proportion of patients reporting adverse events while using the REN device. Data was analyzed using SPSS software.

Results: Out of 141 most patients (98%) were of chronic migraine. The average number of migraine attacks decreased significantly from 9.26/month at baseline to 2.40/month at 60 days follow-up (p < 0.0001), and migraine days reduced from 15.54 to 2.67 per month (p < 0.0001). MIDAS Score decreased from 23.33 to 6.87 (<0.0001), showing a significant reduction in migraine-related disability, with a change in grade from severe disability to mild disability.

Discussion: Attack duration at 60 days follow-up was significantly lower after Nerivio™ uses (Z = -6.081, p < 0.001) and a statistically significant reduction was seen in typical pain levels at 2 hours after using Nerivio™ at 60 days, compared to the rescue medication taken at baseline (Z = -7.518, p < 0.001). All patients experienced a greater reduction in headache and migraine days with Nerivio™ uses at 60 days compared to baseline preventive medication (Z = -9.851, p < 0.000). Most patients (98%) tolerated Nerivio™ well. Four (2.8%) patients experienced mild adverse effects (redness and itching at the device uses site).

Conclusion: The Real-world study demonstrated that the REN device Nerivio™ is highly effective in reducing migraine frequency, severity, duration, and related disability without any moderate or severe adverse effects after 60 days of use.

Abstract ID 521: The Fungal Impostor: How Invasive Infections can Simulate Stroke

Hrishikesh Kulkarni

S.M.S. Medical College, Jaipur, Rajasthan, India

Background and aim: Stroke due to fungal infections is rare. Cerebral invasive fungal infection may present with meningism, focal neurological signs, and hemiplegia & cranial nerve deficits depending on the type of fungus.

Methodology: Case Presentation: We report a case of 18-year-old male with no known comorbidities who presented with 1 month history of right eye progressive blurring of vision which was treated by ophthalmologist with oral steroids, 10 day history of headache, vertigo and vomiting, acute left hemiparesis due to pontine infarct on presentation. Clinical findings include right eye perception of light+, left power 3/5, neck rigidity+ Initial magnetic resonance imaging-diffusion-Wweighted imaging (MRI-DWI) showed bilateral multiple acute posterior circulation infarcts. The computed tomography (CT) angiography of the brain & neck revealed thrombosis of the basilar artery. Patient was febrile with signs of meningism on admission. Hence, cerebrospinal fluid (CSF) analysis was done, which showed lymphocytic pleocytsosis with raised protein & glucose ratio <0.6. CE-MRI showed invasive fungal sinusitis, meningitis with fungal mass in sphenoid sinus which was confirmed with CECT PNS- 43 X 42 X 45 mm sphenoid sinus mass causing bony erosion & extending into parasellar, suprasellar region, breach into pituitary fossa and encasing right ICA along with right superior orbital fissure & optic foramen. Diagnosis was confirmed with biopsy which showed Aspergillus flavus.

Results: The patient was initially managed medically with intra venous (IV) liposomal amphotericin-b 10 mg/kg/day and later in combination with IV voriconazole 4 mg/kg q12hr combination with dual antiplatelets. He underwent paranasal sinus debridement surgery after which liposomal amphotericin was stopped after confirming voriconazole therapeutic trough levels. Thorough evaluation for immunodeficiency states was negative for any. Patient had improvement in right eye visual acuity to 6/12, power was 5/5 in all 4 limbs. Plan for lifelong voriconazole therapy in view of bony invasive disease

Discussion: Angioinvasion is known to occur in all cases of Aspergillus. Hence, stroke & stroke-like syndromes are most likely to occur with Aspergillus.

Conclusion: Invasive aspergillosis presenting as stroke in immunocompetent adult

Abstract ID 522: Clinical Profile and Outcomes of 20 Consecutive Patients with Non Convulsive Status Epilepticus

Jayashree Dahiphale

Fortis Hospital, Mulund, Mumbai, Maharashtra, India

Background and aim: Non-convulsive status epilepticus (NCSE) is a challenging neurological emergency often underdiagnosed due to its subtle clinical manifestations. Timely recognition and management are crucial to improve outcomes. AIM is to evaluate the clinical features, etiologies, diagnostic approaches, treatment strategies, and outcomes of 20 consecutive patients diagnosed with NCSE.

Methodology: A retrospective observational study was conducted on 20 patients diagnosed with NCSE. Diagnosis was based on clinical assessment and confirmed with continuous electroencephalographic (EEG) monitoring. Data collected included demographics, presenting symptoms, EEG findings, treatment regimens, response to therapy, and outcomes.

Results: The average age of patients was 50 years, with more females than males (12 females and 8 males). The most common symptom was altered consciousness, seen in 8 out of 20 patients. Seizures were present in 4 patients at the time of admission. Metabolic disturbances were the most frequent cause found in 50% of the cases. Most patients responded well to first line treatment with benzodiazepines, but some needed additional antiepileptic medications. The overall mortality rate was 30%.

Discussion: The diagnosis of NCSE can be challenging, as subtle clinical signs may be present, and EEG monitoring is often necessary for confirmation. Early intervention with anticonvulsants was associated with improved outcomes. Future research should focus on developing strategies for optimizing treatment in this patient population.

Conclusion: Patients with advanced age, those with multiple comorbidities, post cardiac arrest, sepsis or worsening sensorium and those post neurosurgery tend to have an adverse outcome.

Abstract ID 523: Real World Utilization and Effectiveness of Remote Electrical Neuromodulation in treatment of Migraine in India

Deepak Arjundas, Akshay Deepak, Tamanna Deepak Rattha

Vijaya Group of Hospitals, Chennai and Mercury Institute of Neuro Sciences, Chennai, Tamil Nadu, India

Background and aim: Nerivio, is a Remote electrical neuromodulation (REN) device, cleared by CDSCO for acute and/or preventive treatment of migraine with or without aura for patients aged 12+ years in India. There is limited real world experience reported from India and this study highlights the real world utilization and patient reported efficacy outcomes with Nerivio in India.

Methodology: Patients > 12 years old, diagnosed with migraine according to ICHD-3 criteria, using Nerivio for preventive treatment of migraine between Sept 2024 to April 2025 were included in the study. At the end of each REN device usage, patient feedback data were collected over a phone call. De identified patient data was collected from the Portea Medical patient support program for analysis.

Results: One hundred and twenty-nine patients used Nerivio for prevention of migraine. Of these, 78% (n = 101) patients were between the age group of 21-50 years. ~3 out of 4 patients were female and majority were non-working and had chronic migraine (72%). Eighty three of 129 patients used single device only whereas 46 patients used ≥2 devices. Patients used an average intensity of 45.23% (75% sessions were between 20%- 60% intensity). Average duration per session was 44.4 minutes. Two out of 3 patients reported relief in their migraine (n = 92). Greater number of patients reported relief when they used ≥2 devices (72% vs 60%). 38/129 patients provided feedback regarding reduction of headache days and pain intensity. Twenty-nine of 38 patients had > 14 headache days before using Nerivio, 25/ 29 patients reported reduction in headache days. Using Nerivio also resulted in reduction in headache intensity (baseline VAS score 8.7 Vs follow up VAS score 5.7).

Discussion and conclusion: Two out of 3 patients using Nerivio reported relief in their migraine. Using Nerivio resulted in reduction of headache days and pain intensity. Greater percentage of patients report relief in migraine with usage of ≥2 devices.

Abstract ID 524: Clinical Efficacy of Intravenous Ferric Carboxymaltose in Restless Leg Syndrome Patients: An Observational Study

Agrata Sharma, Ruchi Singh, Nirendra Rai

All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Background and aim: Restless leg syndrome (RLS) is a sensory-motor disorder. The time course of the effect of IV iron with its exact dosing to be used for its response in RLS is not yet proven. Present study was done to determine impact of single dose of 500 mg IV ferric carboxymaltose (FCM) on RLS severity, sleep and quality of life.

Methodology: Individuals were assessed for RLS on International RLS Study Group (IRLSSG) diagnostic criteria and those having low ferritin (<100 nanogm/l) were invited to participate. Single dose of IV FCM was administered to 50 RLS individuals and change in RLS severity was evaluated using International RLS severity scale, improvement in sleep (nocturnal and daytime) by Pittsburgh Sleep Quality Index (PSQI) and Epworth sleepiness Scale (ESS), while quality of life was assessed using RLSQoL (Quality of Life Scale) questionnaire at baseline, 1 month and 3 month.

Results: Significant improvement was observed in IRLS severity score (p < 0.0001). IRLS severity score reduced from 29.9 ± 8.19 at baseline to 10.31 ± 11.54 and 9.11 ± 11.28 at the end of 1st and 3rd months, respectively. Similar improvement was noticed in sleep quality and quality of life. Majority 90% (45) were poor nocturnal sleepers at baseline and after treatment 59.57% (28) were good sleepers at third visit. Quality of life also registered significant improvement (p = 0.0001) with an RLSQoL score of 59.05 ± 23.88 at baseline, increasing to 86.28 ± 21.58 at the third visit.

Discussion: Single dose 500 mg IV ferric carboxymaltose not only improves symptoms of RLS but also enhances the sleep quality and quality of life of individuals having RLS. Secondly, the improvement continues to occur even after 3 months of a single dose 500 mg IV ferric carboxymaltose.

Conclusion: Single dose of 500 mg of IV FCM is effective in improving the severity of RLS with significant improvement in quality of sleep, daytime sleepiness as well as Quality of life of individuals of RLS.

Abstract ID 525: Osteomalacic Myopathy

Anugu Rao, Radhakrishna Hari¹

Medicover Hospitals, Hitech City, Hyderabad, Telangana, ¹Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

Background and aim: Osteomalacia, a disease ensuing from inadequate mineralization of the skeleton, caused mainly by calcium and vitamin D deficiency. Osteomalacic myopathy is a pure proximal motor weakness because of type 2 muscle fibre atrophy, because of vitamin D deficiency, hypocalcemia occurs-it affects excitation contraction coupling, low phosphorus results in impaired adenosine triphosphate (ATP) production. There will be secondary hyperparathyroidism that results in muscle catabolism-leading to symmetrical proximal muscle weakness. Aim of this study was to identify osteomalacic myopathy early in cases presenting with symetrical proximal muscle weakness, as it has some non-specic features, which delays the diagnosis.

Methodology: Presenting 2 cases which presented to our hospital OPD, follow up period was 6 months.

Results: First case was a 29 year-old female presented with symetrical proximal weakness, tightness, difficulty in getting up from ground. On examination,-proximal weakness, with hyperreflexia was present. Serum calcium -8.2 mg/dl, Alkaline phosphatase -156, Vitamin D -7, Magnetic Resonance Imaging (MRI) lumbar spine-flexion, extension is normal. MRI hip joints suggestive of partial fractures in both femoral neck. X-Ray pelvis s/o looser’s zones. Second case- presented with difficulty in getting up from bed. On examination-power in proximal upper and lower limbs was 4-/5, knee, ankle power-5/5 DTR-UL-2+, B/L LL –Knee, ankle -3+, truncal weakness+ X ray pelvis done s/o looser’s zones, Serum alkaline phosphatase was 838 iu/ml, serum calcium was 8 mg/dl, vitamin D was 10. Patients were treated with calcium and vitamin D -showed improvement

Discussion: Osteomalacia is often asymptomatic in its early stages; with progression, it presents with non-specific symptoms such as bone pains, diffuse arthralgia and myalgia, muscle spasms, muscle weakness and/or tenderness, and difficulty walking. pseudofractures/Looser zones) appear as a radiolucent, transverse bands. Treatment with adequate doses of calcium and vitamin D has shown to improve symptoms and increase muscle power, improving the activities of daily living and general wellbeing of the patient.

Conclusion: Proximal myopathy and gait changes are completely reversible with adequate treatment-so identifying early helps as it is reversible.

Abstract ID 526: A Rare Manifestation of Chikungunya Infection: Meningo Myeloradiculoneuropathy

Rohith P, Jagadish Agadi, Sujit Kumar

Apollo Hospitals, Sheshadripuram, Bengaluru, Karnataka, India

Background and aim: Neurological complications in chikungunya is uncommon.

Methodology: Case report

Results and Discussion: We present a 67-year-old gentleman with known comorbidity of idiopathic generalised seizure disorder who presented with complaints of fever and joint pains, initially tropical fever panel work up was positive for chikungunya. He went home after 03 days of hospitalisation, returned back within 48 hours with complaints of altered sensorium and urinary retention. Cerebrospinal fluid (CSF) sample for Chikungunya PCR sent to NIMHANS-tested positive. Magnetic Resonance Imaging (MRI) Brain with contrast and whole spine screening was done, which showed, multiple tiny diffusion-weighted imaging (DWI) hyperintense lesions, suggestive of Chikungunya encephalitis, subtle T2/STIR cord hyperintensity without contrast enhancement seen in the posterior aspect of the cervical cord at C3-C4 level and dorsolumbar conus medullaris. Diagnosed as a case of Meningo myeloradiculoneuropathy, managed with pulse methylprednisolone followed by 05 days of IVIG. During follow-up 02 weeks later, developed paraplegia with bowel incontinence, managed with 05 cycles of plasmapheresis. On 6 months follow up, he is ambulant independently with minimal ataxia. We shall review literature on rare neurological manifestations of chikungunya infection and similar cases reported from India in the poster presentation.

Conclusion: The case highlights importance of early recognition of infective neurological complications, and prompt treatment with immunomodulation in early stage is beneficial.

Abstract ID 527: Clinical and Radiological Profile of a Cohort of Anti-HMGCR Myopathy

Seena Vengalil, Sabha Ahmed, Saraswati Nashi, Deepak Menon, Anita Mahadevan, Atchayaram Nalini

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Anti-HMGCR myopathy is an immune-mediated necrotizing myopathy. We undertook this study to know the clinical and radiological features of a cohort of anti-HMGCR myopathy.

Methodology: Retrospective study of 10 patients of anti-HMGCR myopathy, seen in NIMHANS, India, from March 2023-March 2025. Details of clinical features and lab investigations were collected. Magnetic resonance imaging (MRI) muscle was done using 3T Aera MRI (axial T1, T2, and T2-weighted fat-saturated images). Edema was scored in STIR using Modified Stramare scoring and fatty infiltration in T1 using Mercuri scoring.

Results: Ten patients. Mean age at evaluation-34.8+20.7 years. Male: female 8:2. Mean duration of illness was 20.8+36.2 months (8 patients’ onset within a year). Initial clinical feature was proximal lower limb (LL) weakness in 9, upper limb in 1. History of statin exposure noted in one. Neck flexor weakness (7), facial weakness (5), exertional myalgia (3), bulbar involvement (3), distal LLweakness (3) and respiratory muscle weakness (1) were the other features. One patient was wheel chair bound. None had cardiac involvement. Mean creatine kinase (CK) was 10499+3787 IU/L. Biopsy (n = 6) showed necrosis in 5, myophagocytosis in 2, perifascicular atrophy 2, sparse endomysial inflammatory infiltrate in 1. The computed tomography (CT) chest (n = 8) –no Interstitial lung disease. MRI muscle showed that Hip/Gluteus region had highest fatty infiltration (mean score 0.85), followed by Thigh Posterior (0.73) and Obturator (0.73). The Leg region had lowest level (0.41). 60% of all muscles had normal muscle tissue (Score 0), while 30% had mild fatty infiltration (Score 1). Severe (score 3) and complete fatty replacement (Score 4) were less common. Posterior leg muscles had mean edema score of 2.33 while the obturator group had the least score of 1.25. 70% of muscles in each group had scores of 2 and 3.

Discussion: Our patients had a subacute onset compared to other studies.

Conclusion: Anti-HMGCR Myopathy may have subacute onset, high CK. Cardiac and respiratory involvement are rare. MRI muscle showed distinct patterns.

Abstract ID 528: Association of Sleep Disorders with Neuromyelitis Optica (Nmo), Myelin Oligodendrocyte Glycoprotein (Mog) Antibody Associated Diseases and Nmo/Mog Negative Disorders

Abhinav Mohindra, Birinder Paul, Monika Singla, Gagandeep Singh

Dayanand Medical College, Ludhiana, Punjab, India

Background and aim: Demyelinating diseases include Multiple Sclerosis, Neuromyelitis Optica (NMO), Myelin oligodendrocyte glycoprotein (MOG)-associated diseases (MOGAD) and NMO/ MOG negative disorders. Various researchers argue that sleep disorders may occur as a prodrome or may occur secondary to the symptoms of demyelinating disorders, while some have found neurobiological associations between sleep disorders and demyelinating disorders. This study aimed to investigate association of sleep disorders with NMO, MOG and NMO/MOG negative disorders.

Methodology: This observational cross-sectional study was conducted in Department of Neurology in a tertiary care hospital of Ludhiana. Individuals meeting the diagnostic criteria of NMO, MOG, or NMO/MOG negative diseases were included. Expanded Disability Status Scale (EDSS) for severity of demyelinating disorders, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) for screening, the Insomnia Severity Index, and International Restless Leg Syndrome Rating Scale (IRLS) for assessing the severity of sleep disorders were used. Statistical analysis was done to establish the association of sleep disorders with demyelinating disorders. Later, correlation of severity of sleep disorder and severity of demyelination was done.

Results: A total of 77 patients were studied (39 NMO, 29 MOG, 9 NMO/MOG-negative). In NMO patients, EDSS positively correlated with IRLS scores (r = 0.273, p = 0.043), indicating greater disability linked to more severe RLS. Moderate and mild RLS-related sleep disturbances were common. PSQI and ISI scores also showed weak but significant positive correlations with EDSS, suggesting disease severity is associated with poorer sleep quality and increased insomnia symptoms

Discussion: This study demonstrates a significant relationship between neurological disability and sleep-related disturbances in patients with demyelinating diseases, particularly among those with NMO. NMO-related lesions disrupt dopamine pathways and spinal circuits, increasing RLS severity and symptoms.

Conclusion: Addressing sleep disturbances may not only improve functional outcomes and well-being but could also play a role in modulating disease progression and rehabilitation response.

Abstract ID 529: A Rare Case of Vrk 1 Mutation Related Motor Neuron Disease with Atypical Presentation

Nitish Balla, Prashant Bhatele

Kasturba Medical College, Manipal, Karnataka, India

Background and aim: Vaccinia-related kinase 1 (VRK1)-related disease is an extremely rare autosomal recessive disorder primarily affecting the peripheral and/or central nervous system. VRK1 variants have been segregated with motor neuron diseases including spinal muscular atrophy (SMA) phenotypes or hereditary complex motor and sensory axonal neuropathy (HMSN), with or without pontocerebellar hypoplasia or microcephaly. To describe the genetic and clinical aspects of a 10-year-old male with distal hereditary motor neuropathy with brisk reflexes caused by a unique homozygous VRK 1 mutation.

Methodology: A 10-year-old male, born out of non-consanguineous marriage with normal birth and developmental history, presented with history of dragging of bilateral foot, more on climbing steps, for past 6 months. HMF, cranial, sensory and cerebellar examination were unremarkable. Bilateral Pes cavus was present. Motor examination revealed normal tone and power in all four limbs except for dorsiflexion and plantarflexion at B/L ankle was 3/5 and 4+/5 respectively. B/L Brisk knee reflex were present with B/L plantar equivocal. High stepping gait noted. No atrophy and fasciculations were present. No history of similar complaints in family. Clinically Differentials of hereditary neuropathies (CMT vs hereditary motor neuropathy) and distal spinal muscular atrophy were considered.

Results: The magnetic Resonance Imaging (MRI) brain and spine were normal. Mildly elevated creatine kinase (CK) levels. Nerve Conduction Studies (NCS) revealed generalized motor axonal neuropathy (LL > UL). Electromyography (EMG) shows Neurogenic MUs. Genetic analysis was done by performing singleton exome sequencing found to have splice site variant, c.1159+1G>A in intron 12 of VRK-1 in homozygous state in proband. Variant in Heterozygous state is found in his parents.

Discussion: Novel VRK1 mutations associated with mild, and slowly progressive form of ALS-like MND (distal hereditary motor neuronopathy with brisk DTRs) of childhood onset. Various phenotypes of VRK 1 mutation were associated with MND.

Conclusion: Motor neuron disease phenotype caused by VRK1 mutations should be considered in atypical cases of juvenile-onset and slowly progressive types of motor neuron disease.

Abstract ID 530: Early Post Stroke Seizures Following Acute Ischemic Stroke: A Cross Sectional Study from a Tertiary Care Centre in Kerala

Nithya Jose, Shaji C V

Government TD Medical College, Alappuzha, Kerala, India

Background and aim: Stroke is the most common cause of epilepsy in the adult population. Post-stroke seizures can significantly affect the clinical outcome and duration of hospital stay. Studies report that 5-20% of stroke patients develop post stroke seizures. Post stroke seizures are classified as early (ES) and late (LS). ES were classified as spontaneous seizures, occurring within 1 week of the stroke event. This study was aimed to describe the clinical profile of patients with early post stroke seizures, and assess the risk factors for early post stroke seizures.

Methodology: Inclusion criteria included all consecutive patients admitted under neurology department during the study period with acute ischemic stroke. Exclusion criteria was patients with a previous stroke, transient ischemic attack (TIA), cerebral venous thrombosis (CVT), prior history of seizures, or any other epileptogenic comorbidity. All patients who met the inclusion criteria were grouped into as those with early post stroke seizures (within one week of stroke event) and those without. National Institute of Health Stroke Scale (NIHSS) score was used to assess the severity of stroke. Stroke subtype was classified based on the TOAST classification.

Results: Patients with ES were younger, had a more severe stroke at presentation, had a cortical location of the infarct, and underwent lesser recanalization procedures. Large artery disease and cardioembolic subtypes were more common in patients with ES.

Discussion: Early seizures occurred in 20 (10.0%) of acute ischemic stroke patients in our cohort. Significant risk factors revealed in our study were cortical location, modified Rankin Scale (mRS) at admission, anticoagulant use.

Conclusion: We seek to determine those individuals who would be at high risk for ES, and therefore, can be given prophylactic anti-seizure drugs (ASD) along with the standard of care. By preventing a seizure, we will not only decrease their infarct volume but also reduce the morbidity, mortality and duration of hospital stay for the patient

Abstract ID 531: Tubercular Meningitis (TBM) Presenting as TOBA Syndrome: A Therapeutic Triumph

Ritesh Kumar, Mridula Singh¹, Siddharth Maheshwari, Deepika Dalal

Institute of Human Behaviour and Allied Sciences, Delhi, ¹S.M.S. Medical College, Jaipur, Rajasthan, India

Background and aim: Tubercular meningitis (TBM) sometimes can be a complex and challenging condition in endemic zones like India, where it manifests in diversified clinical forms. We report an unusual case of TBM presenting with TOBA syndrome in a young female patient.

Methodology: A 27-year-old female with no prior medical history presented with a three-month history of intermittent fever, holocranial headache, non-projectile vomiting, and significant weight loss. Over the subsequent 1.5 months, she experienced progressive cognitive decline and decreased sensorium. On neurological examination, she exhibited agitated delirium with reduced movements on the right side, preserved reflexes, and withdrawal response in planter reflex bilaterally. Notably, she also had ocular signs including vertical gaze restriction, impaired convergence, lid retraction (Collier’s sign). These constellation of symptoms pointed to significant involvement of the rostral midbrain, pretectum and thalamus. Her cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, raised protein and markedly low glucose level. Brain imaging demonstrated vasculitis infarcts in the midbrain, pons and bilateral thalami, and portions of the temporal and occipital lobes.

Results: The LANCET Consensus score for tuberculous meningitis was calculated at 19, indicating a probable diagnosis of TBM. Based on these findings, she was initiated on anti-tubercular therapy, corticosteroids and other supportive measures. Her presentation and clinical findings aligned with the clinical spectrum of TOBA Syndrome, a rare clinical neurological syndrome caused by ischemic lesions in the distal branches of the basilar artery.

Discussion: Posterior circulation strokes account for only 15% of all in TBM, and basilar artery occlusion is extremely rare, occurring in less than 1% of strokes.

Conclusion: The occurrence of TOBA syndrome in TBM is exceedingly rare, with only a few cases documented in the literature. Early recognition and timely initiation of anti-tubercular therapy are crucial to prevent long-term neurological sequelae.

Abstract ID 532: Spinal Cord Infarct as a Delayed Complication of Subarachnoid Haemorrhage

Abhimanyu Reddy

Continental Hospital, Hyderabad, Telangana, India

Background and aim: Subarachnoid hemorrhage (SAH), often resulting from ruptured intracranial aneurysms, is a critical neurological event associated with significant morbidity and mortality. While cerebral vasospasm and delayed cerebral ischemia are well-documented, complications of SAH, spinal cord infarction leading to acute quadriplegia remains an exceedingly rare and underrecognised complication.

Methodology: To present a rare case of spinal cord infarction manifesting as acute quadriplegia following aneurysmal SAH, highlighting the diagnostic challenges and emphasising the importance of considering spinal vasospasm in the differential diagnosis of delayed neurological deficits post-SAH, with vasospasm of spinal arteries causing spinal infarct.

Results: A 44-year-old woman presented with a sudden-onset severe headache. CT brain revealed SAH extending into the perimedullary cisters and upper cervical intraspinal spaces, and subsequent computed tomography (CT) angiography showed a fusiform aneurysm in left posterior inferior cerebellar artery (PICA). She was managed conservatively and planned for coiling on a later date. Twenty-four days later, she returned for endovascular flow diverter placement with coiling of the aneurysm, which was performed without immediate complications. However, 12 hours after the procedure, she developed sudden-onset quadriplegia, with preserved consciousness, normal cranial nerves examination and decreased sensation in the right side of the body. A CT stroke protocol showed irregular restricted diffusion in C3-C4 vertebral levels and T2 hyperintense in cervical cord extending from the cervicomedullary junction to C7 vertebra, suggestive of spinal cord ischemia (Left >Right) and small multiple infarcts in the left cerebellum. Repeat CT angiography showed patent flow diverted in left PICA with no bleed, and proximal anterior spinal artery (ASA) was visualised and distal not visualized. The cause of the infarct was attributed to delayed vasospasm of ASA secondary to the initial SAH.

Discussion and Conclusion: Clinicians should maintain a high index of suspicion for spinal vasospasm in patients presenting with new-onset motor deficits following SAH. Early identification and intervention are crucial to mitigate long-term neurological sequelae.

Abstract ID 533: Beyond the Basal Ganglia: Rare Cortical Involvement in a Case of Wilson’s Disease

Kanika Suri, Amit Agarwal

Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India

Background and aim: Wilson’s disease (WD) is a rare autosomal recessive disorder of copper metabolism, leading to pathological copper accumulation primarily in the liver and brain. While basal ganglia and brainstem involvement is typical in neurological WD, less is known about the extent of white matter pathology. This study presents a unique case of a 16-year-old male with severe generalized dystonia and atypical neuroimaging findings, highlighting the need to consider broader neuroanatomical involvement in WD.

Methodology: A 16-year-old boy, previously diagnosed with hepatic WD in 2019, was re-evaluated after the resurgence of neurological symptoms following treatment discontinuation. Clinical examination revealed severe dystonia, dysarthria, and dysphagia. Brain magnetic resonance imaging (MRI), including T2-weighted, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI), was performed to assess neurological involvement.

Results: MRI revealed symmetrical hyperintensities in the bilateral caudate and lentiform nuclei on T2 and FLAIR sequences, consistent with classical WD involvement. Notably, additional hyperintense lesions were observed in the frontoparietal cortical and subcortical white matter, which are atypical for WD. DWI demonstrated restricted diffusion in the bilateral frontoparietal gyri, indicative of cytotoxic edema. These findings suggest a more widespread neuroinflammatory or toxic process, potentially linked to uncontrolled copper accumulation after treatment cessation.

Discussion: This case underscores the expanding neuroimaging spectrum of WD. While basal ganglia changes are well-documented, involvement of cortical and subcortical white matter is rare and may reflect severe or prolonged copper toxicity. The presence of cytotoxic edema in the frontoparietal gyri suggests acute cellular injury, likely due to excessive copper-induced oxidative stress and inflammation.

Conclusion: WD may involve more extensive neuroanatomical regions than traditionally recognized, including cortical and subcortical white matter. Clinicians and radiologists should maintain a high index of suspicion for widespread brain involvement in WD patients, especially those with treatment nonadherence or severe neurological relapse. Early identification of atypical imaging patterns may guide timely intervention and improve outcomes.

Abstract ID 534: Genetic, Phenotypic and Radiological Diversity in Hereditary Spastic Paraparesis; A Case Series

Swarup Hange, Sangeeta Rawat, Neeraj Jain, Mayur Thakkar, Shruti Agrawal, Manali Chaudhari

Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India

Background and aim: Hereditary spastic paraparesis (HSP) encompasses a spectrum of genetic disorders with variable clinical presentations characterized by spasticity and weakness of the lower limb. We describe a case series of patients with HSP, evaluating their clinical features, family history, radiological findings and genetic testing results to identify disease spectrum and address diagnostic challenges. Also, we report a new magnetic resonance imaging (MRI) brain finding in SPG 15 mutation positive HSP.

Methodology: The present study is a retrospective analysis of patients having HSP phenotype with genetically proven mutation at a tertiary care centre in western India.

Results: We report 7 patients presenting with spastic paraparesis with or without additional neurological or non-neurological features. Most common inheritance pattern seen in our study was autosomal recessive and mutations were SPG 11, KIF5A, SPAST, SPG7, ZYFEV26 (SPG15), and NFU1. Two patients from our study had abnormal MRI Brain, of which one with SPG11 mutation showed classic “Ear of Lynx” sign. Other patient with SPG15 showed “Tigroid pattern” on MRI Brain which has never been reported in literature earlier.

Discussion: Most common pattern for HSP is autosomal dominant in 75 -80% patients as described by P Hedera et al. However, we got 50% patients with autosomal recessive inheritance pattern. Average age of presentation was less in our study as compared to reported literature. Unique finding was “Tigroid pattern” on MRI brain in patient with SPG15 mutation which has not been reported in literature. Tigroid pattern has been reported in several other conditions e.g. metachromatic leukodystrophy, Krabbe disease, Pelizaeus-Merzbacher disease, autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). This new MRI brain finding in HSP patient may help in adding to the literature of differentials in such scenario.

Conclusion: HSP is not so uncommon disease even in adolescent age group. Neuro-Imaging can aid in diagnosis of HSP, Tigroid pattern can be seen in SPG 15 mutation positive, which is relatively new finding.

Abstract ID 535: Middle Meningeal Artery Embolization in Chronic SDH Patients

Kunal Suri, Gourav Goyal, Amit Aggarwal, Rajendra Jain

Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India

Background and aim: Middle meningeal artery embolization (MMAE) is a relatively new treatment modality for chronic subdural hematoma (cSDH), even though surgical management with burr-hole or craniectomy is the current treatment of choice. Recurrence rates following burr-hole irrigation or craniotomy range from 5% to 30%, often requiring a rescue re-operation. MMAE is an emergent adjunctive or alternative therapy. To ascertain if MMAE is an appropriate alternative to conventional surgical treatment in cSDH patients and to assess its ability to prevent reoccurrence.

Methodology: From January 2024 till January 2025, 46 patients with cSDH underwent surgery in our hospital. Recurrence of cSDH was observed in 5 (11%), which underwent MMA embolization. No patient was taken up for primary MMAE.

Results: Five patients out of total 46 (11%) presented with both clinical and radiographic recurrence with clinical symptoms attributable to chronic SDH with an increase in size from the postoperative Computed Tomography (CT) and were previously operated (burr-hole). Four men (80%) and 1 female (20%) within the age group (54 -70 years) were included. Clinical symptoms in all 5 were significantly improved or resolved by latest follow-up. All 5 (100%) had significantly reduced cSDH in size. For the 5 patients with MMAE alone, 3 achieved significant reduction at 6 weeks and 2 achieved complete resolution at 3 months. There were no procedure related complications and there was no recurrence.

Discussion: In this case series cSDH, postoperative recurrence was 11%. Large craniotomy or subdural-peritoneal shunt have been proposed as a treatment modality for recurrent cSDH. MMAE has been emerging as a safe and effective modality to manage cSDH as reported in a number of other case series.

Conclusion: In the present case series of 5 patients with postoperative recurrent chronic SDHs, all 5 were successfully treated with MMAE and thus avoiding surgery for re-evacuation. No complications were observed suggesting that MMAE may represent an effective alternative to surgery.

Abstract ID 536: Neurofascin 140 Positive Autoimmune Neuropathy: A Case Report

Swarup Hange, Sangeeta Rawat, Neeraj Jain, Mayur Thakkar, Shruti Agrawal, Dnyashwar Asole

Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India

Background and aim: Recently antibodies targeting node and paranode of myelinated nerves are increasingly detected. These patients have phenotype similar to GBS and CIDP with some additional atypical neurological and systemic features, respond poorly to intravenous immunoglobulin (IVIG). We report a case of neurofascin 140 positive autoimmune neuropathy and aim to describe clinical presentation, diagnostic findings, treatment and outcome.

Methodology: A case report on patient with nf140 positive autoimmune nodopathy at a tertiary care centre in western India.

Results: A 61-year-old male, diabetic with acute onset progressive for 3 days sensorimotor weakness in both lower and distal upper limbs without bladder bowel, cranial nerve involvement, with autonomic dysfunction without any history of preceding infection was admitted and evaluated in a tertiary care hospital. His nerve conduction studies (NCS) done was suggestive of acute motor axonal neuropathy affecting both lower >upper limbs. Patients’ cerebrospinal fluid (CSF) studies were suggestive of protein 90 mg/dl, sugar 110 mg/dl, 45 cells all lymphocytes.in view of acute history, NCS findings ANS albuminocytological dissociation patient was thought to be a case of GBS and started on IVIG. Patient had marked autonomic dysfunction and pain in lower limbs disturbing his sleep. In view of no response to ivig and autonomic dysfunction and severe pain patient’s nodopathy panel was sent. His neurofascin antibody titre by elisa came out to be 265 ng/ml (0 t0 233). He was given inj mps 5 days, oral steroids and first dose of inj rituximab. Currently patient is stable.

Discussion: Neurofascin 140 IgG is associated with pan neurofascin disease spectrum characterized by fulminent disease course resulting in profound sensorimotor tetraplegia, severe cranial nerve involvement, and autonomic dysfunction. Cases are mistaken as GBS; they poorly respond to IVIG.

Conclusion: patients presenting as GBS and CIDP with additional atypical neurological and systemic features and responding poorly to ivig should be evaluated for nodopathies.

Abstract ID 537: Diverse Clinical Profiles and Therapeutic Responses in Inflammatory Myopathies: A Case Series from a Tertiary Neurology Centre

Rimjhim Basak, Atanu Biswas, Biman Ray, Alak Pandit, Arijit Roy, Souvik Dubey

Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India

Background and aim: Inflammatory myopathies are a heterogeneous group of muscle disorders with varied clinical presentations, autoantibody profiles, and treatment responses. This case series presents four female patients, diagnosed with different subtypes of inflammatory myopathy, each with distinct phenotypic features and immunological findings, different response to treatment.

Methodology: This is a case series of 4 different cases of inflammatory myopathy patients, admitted in Department of Neuromedicine, Bangur Institute of Neurosciences. Routine blood tests, specialised investigations - extended mysoitis profile, antinuclear antibody (ANA) & ANA profile, nerve conduction studies (NCS) & electromyography (EMG), Magnetic Resonance Imaging (MRI) - Muscle protocol (3T) were performed in our institute. For further work up, in some cases muscle biopsy were sent outside (NIMHANS). Patients were managed conservatively either with oral or injectable immunomodulators in our institute and they were followed up in BIN - NM OPD.

Results: There were 4 different cases of myopathies, among which 3 patients responded with immunotherapy (steroid/cyclophosphamide/rituximab) dramatically but in one patient, treatment with immunomodulators did not give optimal response.

Discussion: With masterly clinical examination and judicial use of investigations we can reach to a proper diagnosis. In this case series, the patient who did not show optimal response to immunomodulator therapy, we sent for genetics study for whole-exome sequencing suspecting an acute presentation of LGMD variant. Report awaiting.

Conclusion: This series highlights the clinical diversity in inflammatory myopathies, from seropositive necrotizing myopathy to dermatomyositis-like features with negative immunologic markers. A multidisciplinary diagnostic approach—combining clinical evaluation, imaging, serology, EMG, and histopathology—is essential. Personalized immunotherapy based on subtype and severity yielded variable but encouraging responses.

Abstract ID 538: Atypical Neuroimaging Presentation in a Case of MOGAD

Mandadi Prathyusha, Animesh Das

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) is an immune-mediated central nervous system disorder characterized by optic neuritis, transverse myelitis, brainstem encephalitis and ADEM accompanied by the presence of MOG IgG antibodies in serum/cerebrospinal fluid (CSF). Corpus callosum lesions are frequent in primary CNS demyelinating lesions like multiple sclerosis and susac syndrome, but callosal involvement in MOGAD has not been described.

Methodology: A 44-year-old female presented with fever followed by acute onset decrease in vision in both eyes associated with pain during eye movements and colour desaturation. She had past history of recurrent episodes of optic neuritis since 20 years involving both eyes, transverse Myelitis improved with intravenous and oral steroids by around 50-60%. Since then, the patient is on maintenance dose of steroid and azathioprine 150 mg/day. On examination, the patient’s vision perception of light-negative in both eyes with pale optic disc. In view of recurrent focal neurological deficits involving optic nerves, brain stem and spinal cord, demyelinating etiology was thought of.

Results: The Magnetic Resonance Imaging (MRI) Brain shows Multiple T2 flair hyperintense lesions in b/l Periventricular region, corpus callosum, callosal septal interface, B/l MCP, Pons, dentate nucleus and medulla. Viral markers constituting anti-HbSAg, Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV) were negative. Serum Angiotensis-Converting Enzyme (ACE), Antinuclear antibody (ANA), Extractable Nuclear Antigen (ENA), Neuromyelitis Optica (NMO)- antibodies were unrevealing. Serum MOG antibodies measured by Indirect Immunoflourescence method were positive.

Discussion: A Few primary demyelinating lesions of the CNS affect corpus callosum of which multiple sclerosis and susac’s syndrome are relatively common with contrast enhancement in acute changes. Secondary demyelinating lesions with corpus calosum involvement- include PML and Tumors like Lymphoma, Glioma no or minimal contrast enhancement in PML. In CNS lymphoma, lesion cross over midline to involve other lobe, causing butterfly appearance with mild homogenous enhancement.

Conclusion: Corpus callosal involvement in MOGAD is variable, usually large and involving the sagittal midline. Extracallosal extension is frequent, bilateral spread to parasagittal frontoparietal cortices. Callosal lesion resolution was more frequent compared to other Demyelinating disorder.

Abstract ID 539: Thrombolysis in Acute Ischemic Stroke-Is it Always Safe?

Mummadi Rajashekar, Rajesh Reddy

Apollo Hospital, Jubilee Hills, Hyderabad, Telangana, India

Background and aim: Acute ischaemic stroke and aortic dissection are infrequent concurrent medical crises associated with elevated fatality rates. Aortic dissection, particularly affecting the ascending aorta, may manifest atypically without conventional chest discomfort, hindering prompt diagnosis and treatment. This example underscores the clinical difficulties of thrombolysis in a patient experiencing acute ischaemic stroke due to severe aortic dissection

Methodology: A 50-year-old male patient with hypertension, managed with Amlodipine, experienced left-sided weakness and dysarthria within 60 minutes of symptom onset. He was transported to the emergency hospital, where he showed sleepiness and dyspnoea. Clinical examination revealed a Glasgow Coma Scale score of E1V1M4, sinus tachycardia, and desaturation. Magnetic resonance imaging confirmed bilateral ischaemic infarcts, and intravenous thrombolysis was delivered. Two-dimensional echocardiography showed a dilated aortic root with an ascending aortic flap corroborated by CT aortogram as DeBakey Type I aortic dissection.

Results: Mechanical thrombectomy was postponed due to the aortic dissection. Antiplatelet and anticoagulant agents were excluded to reduce the risk of haemorrhage. The patient’s health worsened due to thrombocytopenia and sepsis, exacerbated by a diagnosis of Dengue fever. Notwithstanding rigorous medical intervention, encompassing tracheostomy and inotropic support, the patient experienced cardiac tamponade and ultimately succumbed to cardiac arrest on Day 6 of hospitalisation

Discussion: This case highlights the intricacies of handling acute ischaemic stroke in the context of undetected aortic dissection. Thrombolysis, although life-saving in standard stroke scenarios, may worsen outcomes in the presence of aortic dissection. A heightened suspicion for aortic dissection in unusual stroke presentations, along with timely imaging, is crucial for optimising outcomes.

Conclusion: Literature says Aortic Dissection presentation- Chest pain or interscapular pain, but absent in 10 to 55% patients. Stroke occurs right more than left hemispheric infarcts. Mortality is 50% if dissection involves Ascending aorta and root.

Abstract ID 540: The Professor Who Wouldn’t Stand

Ananya Sengupta, Jayanta Roy, Subhadeep Bannerjee, Avik Mukherjee

Manipal Hospital, Karnataka, India

Background and aim: Focal myositis is a rare and benign immune-mediated localised muscle inflammation, most commonly presenting as a benign pseudotumor restricted to skeletal muscle. We present an unusual case of a gentleman presenting with acute onset unilateral leg weakness with no palpable pseudotumor.

Methodology: A 51-year-old college professor presented with acute onset inability to stand for 1 day. On examination, he was found to have isolated right quadriceps weakness with tenderness in anterior hip region and sensory loss in right femoral distribution.

Results: Nerve conduction was suggestive of right femoral motor axonal neuropathy. Muscle Magnetic Resonance Imaging (MRI) showed edema in right iliopsoas with contrast enhancement extending into the floor of right femoral triangle, along with elevated creatine phosphokinase (CPK) and inflammatory markers. The patient was treated conservatively with oral analgesics, antibiotics and physiotherapy. He showed significant clinical improvement after two weeks with complete pain relief and normalization of inflammatory markers.

Discussion: Focal myositis may be secondary to viral infection, muscle denervation, neoplasms or autoimmune diseases; or may be associated with an ischaemic condition secondary to atheromatous emboli, diabetic angiopathy, and vascular malformation. It typically presents as an inflammatory pseudotumor restricted to one or more skeletal muscles with pain, erythema, and fever without muscle weakness. MRI with fat suppression images is the diagnostic modality of choice. It is usually a self-limiting condition and responds well to steroid or nonsteroidal anti-inflammatory drugs. The present case was unique because the patient presented acutely without any palpable mass and with definite quadriceps weakness in presence of typical radiological features

Conclusion: Focal myositis is often misdiagnosed as tumors resulting in excessive treatments, and may induce joint contracture with progression if not diagnosed in time. It may have an atypical presentation without any swelling and requires a high index of suspicion for diagnosis

Abstract ID 541: Beyond the Usual Bite: Neurological Sequelae of Dengue in Pregnancy

Bhargav Prajapati, Chintan Prajapati¹

Shalby Hospital, ¹SGVP Hospital, Ahmedabad, Gujarat, India

Background and aim: Dengue virus, a common arboviral infection in endemic regions, rarely presents with central nervous system (CNS) involvement. Dengue encephalitis, though uncommon, is an emerging neurotropic manifestation. Diagnosis is challenging, especially in pregnancy, due to overlapping symptoms with other infections and altered immune responses. We present a rare case of dengue encephalitis in a pregnant woman to highlight clinical presentation, diagnostic approach, and maternal-neurological implications.

Methodology: A 28-year-old female, gravida 2 para 1, at 30 weeks gestation, presented with a 7-day history of high-grade fever followed by one episode of generalized tonic-clonic seizure and altered sensorium. On examination, Glasgow Coma Scale was E3M5V2 with preserved extraocular movements and withdrawal to pain in all limbs. Laboratory investigations showed thrombocytopenia (platelets 80,000/µL), leukocytosis (TLC 15,000/µL), and mildly elevated liver enzymes. Dengue NS1 antigen was positive; other viral markers including Human Immunodeficiency Virus (HIV), HBsAg, and Hepatitis C Virus (HCV) were negative. CRP was 20 mg/L. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis (10 cells/µL), elevated protein (60 mg/dL), and normoglycorrhachia. Neuroimaging showed T2/FLAIR symmetrical hyperintensities in bilateral thalami with restricted diffusion on DWI/ADC and no hemorrhage on GRE.

Results: The clinical, laboratory, and radiological findings were consistent with a diagnosis of dengue encephalitis, a rare but increasingly recognized entity. She was managed conservatively in the ICU with antipyretics, antiseizure medication, and supportive care. No obstetric complications occurred during hospitalization. Neurological status gradually improved over 7 days.

Discussion: Dengue encephalitis remains underdiagnosed due to its nonspecific neurological presentation and the lack of confirmatory CSF PCR in many settings. In pregnancy, it poses a dual threat to maternal and fetal outcomes. Recognition requires a high index of suspicion in endemic areas.

Conclusion: This case underscores the importance of considering dengue encephalitis in pregnant women presenting with fever and altered sensorium. Early recognition and supportive management can lead to favorable neurological and obstetric outcomes.

Abstract ID 542: Comparative Effectiveness and Safety of Stem Cell Therapy Versus Standard Care in Spinal Cord Injury: A Systematic Review and Meta-Analysis

Awadh Pandit, Poorvi Tangri, Bhoomika Arora, Manabesh Nath

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Spinal cord injury (SCI) leads to significant motor, sensory, and autonomic impairments, often resulting in long-term disability. While stem cell therapy has emerged as a potential treatment, questions remain regarding its clinical safety and effectiveness. This systematic review and meta-analysis aimed to evaluate how stem cell therapy compares to standard care in terms of safety and neurological recovery in individuals with SCI.

Methodology: Following PRISMA guidelines, a comprehensive search of PubMed, EMBASE, Web of Science, and Cochrane Central databases was conducted up to November 17, 2024. Randomized controlled trials (RCTs) comparing stem cell therapy with usual care in SCI patients were included. Two independent reviewers extracted data. Key efficacy outcomes included improvements in the American Spinal Injury Association Impairment Scale (AIS), ASIA motor and sensory scores, and the Spinal Cord Independence Measure (SCIM). Safety outcomes were adverse events, tumor development, and mortality.

Results: Twelve RCTs involving 256 patients treated with stem cells and 203 control subjects were analyzed. Patients receiving stem cell therapy had a significant improvement in AIS grades (Risk Ratio [RR] = 4.53; 95% Confidence Interval [CI]: 2.74–7.47; I² = 0%). Subgroup analyses showed benefits in both acute (RR = 3.60; 95% CI: 2.15–6.03) and chronic (RR = 11.23; 95% CI: 2.38–53.11; I² = 0%) SCI cases. Intrathecal (RR = 4.04; 95% CI: 2.43–6.72) and local injections (RR = 19.00; 95% CI: 1.18–305.88) were associated with favorable neurological outcomes. Importantly, the incidence of adverse effects, tumor formation, and mortality did not significantly differ from the control group.

Discussion: Stem cell therapy appears to enhance neurological recovery in SCI without elevating the risk of adverse events.

Conclusion: However, further large-scale, well-designed RCTs are necessary to confirm these findings and establish optimal treatment protocols.

Abstract ID 543: Spectrum of Genetically Confirmed Spinocerebellar Ataxia: A One-Year Observational Study at a Tertiary Care Center in Eastern India

Anand Rai, Pratibha Prasad, Basauraj Bannigidad

All India Institute of Medical Sciences, Patna, Bihar, India

Background and aim: Spinocerebellar ataxias (SCAs) are a group of autosomal dominant, progressive neurodegenerative disorders. Despite being rare, SCAs cause significant disability. This study aims to document the confirmed cases of SCA diagnosed at Tertiary care centre, AIIMS Patna over a one-year period and describe their clinical features.

Methodology: An observational study was conducted in the Department of Neurology at AIIMS, Patna, over a one-year period. Inclusion criteria required genetically confirmed SCA diagnoses. Demographic data, clinical presentation, family history, and subtype classification were collected and analyzed descriptively.

Results: During the study period, 58 patients presented with progressive cerebellar ataxia. Out of these, 2 cases were genetically confirmed as Spinocerebellar Ataxia. The first was a patient with SCA2, with a positive family history involving his father. The second case was a 44-year-old male diagnosed with SCA1, with positive family history. His younger sister; aged 40 yr was also having similar illness and also diagnosed with SCA TYPE 1. Both subgroups of SCA type 1 and type 2 were presented with gradually worsening gait ataxia, dysarthria, and impaired coordination. Genetic analysis confirmed trinucleotide repeat expansions consistent with their respective subtypes.

Discussion: The low number of confirmed cases reflects the rarity of SCAs, but may also indicate underdiagnosis due to limited access to genetic testing or late referrals. The presence of both familial and apparently sporadic cases underlines the clinical variability of SCAs and the importance of genetic confirmation in ataxia diagnosis.

Conclusion: Over one year at AIIMS Patna, three genetically confirmed cases of SCA (2 SCA1 and 1SCA2) were identified. Strengthening genetic diagnostic services and increasing clinical awareness are essential for improving early detection and management of SCAs.

Abstract ID 544: Clinical Spectrum and Genetic Profile of Pediatric Hyperhomocysteinemia: A Case Series from a Tertiary care center

Hansashree Padmanabha, Raghavendra K, Gautam Udupi, Maya Bhat

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, Inida

Background and aim: Hyperhomocysteinemia is a condition that is characterized by increase in plasma homocysteine levels due to nutritional causes (B12 deficiency) and genetic causes most notable the MTFHR mutation. It contributes to neurodevelopmental, vascular, and musculoskeletal complications. This case series presents the clinical presentation and genetic profiles of children diagnosed with the condition at a tertiary care centre.

Methodology: A retrospective study of 11 pediatric patients below the age of 15 years with genetically confirmed hyperhomocysteinemia was conducted. Data on age, gender, age at onset, clinical features, biochemical markers, neuroimaging, and genetic mutation identified and treatment outcomes were collected and analysed.

Results: In the group of 11 patients (M: F = 4:7), the average age was 11.2 years. The median age of presentation was 1.5 years with four children showing symptoms before reaching 1 year of age. The most frequently found mutation was in the MTHFR gene (n = 7) followed by CBS (Cystathionine Beta synthase) (n = 2). Variants of Uncertain significance included mutations in MMUT (Methyl malonyl CoA mutase) and MMACHC (Methyl malonyl aciduria (MMA) cobalamin deficiency type C (cblC) with homocystinuria). Intellectual disability, developmental delay, spasticity, visual impairment, and seizures were common neurological features. MRI findings included cerebral atrophy, white matter changes, and corpus callosal thinning. The treatment included pyridoxine, folic acid, betaine and dietary modifications with varying treatment response.

Discussion: The case series highlights the varying clinical manifestations of a treatable metabolic disorders of genetically confirmed patients of hyperhomocysteinemia. Vitamins like pyridoxine, folic acid and betaine can help in reducing the homocysteine levels.

Conclusion: This case series emphasizes the phenotypic diversity of hyperhomocysteinemia in children, with a majority of mutations linked to MTHFR. Timely intervention depends on early diagnosis through clinical and biochemical suspicion, backed by genetic testing. Early management can aid in reducing long-term neurological morbidity, even though therapeutic responses differ from patient to patient.

Abstract ID 545: The Still Ventricles That Spoke- Perinaud Syndrome as a Harbinger of Arrested Hydrocephalus

Sonia Martina, Leema Pauline, Neeraj Elango, Jered Livingston

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Arrested hydrocephalus is a form of compensated hydrocephalus where ventricular enlargement remains stable without progressive intracranial hypertension. Usually asymptomatic but may present with macrocephaly and mild motor deficits. This case report aims to highlight the unusual presentation of dorsal midbrain syndrome/Perinaud syndrome in a patient with previously undiagnosed arrested hydrocephalus.

Methodology: A 7-year-old male child with a normal perinatal transition and intellectual disability, presented with an abnormal gait in the form of a frontal gait, difficulty in looking upward and intermittent diplopia. His Neurological examination revealed a vertical gaze palsy with convergence retraction nystagmus consistent with dorsal midbrain syndrome. His MRI brain revealed dilated lateral and 3rd ventricles.

Results: The patient was diagnosed with dorsal midbrain syndrome secondary to arrested hydrocephalus. Since there were no signs of active raised intracranial pressure, neurosurgical intervention was deferred. The patient was managed conservatively with close follow-up. Over a 3-month period, the symptoms remained stable without progression.

Discussion: This case emphasizes that arrested hydrocephalus, although typically considered benign and non-progressive, can result in localized neurological syndromes such as Parinaud syndrome due to chronic dilatation of 3rd ventricles and enlargement of suprapineal recess causing pressure on posterior commissure. Decision between surgical versus conservative management must be individualized, considering symptom severity, evidence of intracranial pressure, and the risk-benefit ratio.

Conclusion: Arrested hydrocephalus, while often asymptomatic, can present with subtle but significant neurological signs such as dorsal midbrain syndrome. Clinicians should maintain vigilance in assessing vertical gaze abnormalities and consider neuroimaging to exclude structural causes. Conservative management may be appropriate in stable cases, but careful monitoring is essential to detect progression.

Abstract ID 546: Case Series of Concave Intraparenchymal Hemorrhage- The Cashew Nut Sign and its Role as Predictor of Outcome

Agrata Sharma, Vaibhav Pandey

All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Background and aim: Cerebral venous thrombosis is the presence of a blood clot in the dural venous sinuses, the cerebral veins, or both. Apart from few clinical features which may predict the diagnosis of CVT namely, headache or seizures at onset and the presence of provoking factors like dehydration, pregnancy etc., there are a few radiological signs as well that help foresee the diagnosis of CVT and thus help start early therapeutic measures. The cranial imaging could range from only minimal cerebral parenchymal changes to frank intracerebral hemorrhage. Of particular note, the presence of a concave juxtacortical intraparenchymal hemorrhage not following any particular arterial territory which although not very sensitive, is very specific for the diagnosis of CVT particularly involving the superior sagittal sinus named as the Cashew Nut sign. It arises from the collection of blood in sulcal spaces. We aim to study the clinical presentation and outcomes of CVT patients with the Cashew nut sign.

Methodology: Patients with sudden onset neurodeficits with NCCT brain suggesting CVT with Cashew Nut sign were included in this study and were followed up.

Results: Patients were treated with standard anticoagulation regime. Follow up visits showed an improved mRS as well resolution of bleed on interval imaging.

Discussion: This case series may establish possible link of CVT patients’ better clinical outcome of CVT with the presence of this sign.

Conclusion: Our case series highlights the importance of early detection of CVT on the basis of this unique sign with the subsequent early institution of anticoagulation and a favourable clinical outcome.

Abstract ID 547: Clinical, Investigational and Genetic Profiles of Seven Patients with PARK-SYNJ1: An Experience from a Tertiary Care Center in India

Subhajit Roy, Vikram Holla, Nitish Kamble, Rohan Mahale, Ravi Yadav, Pramod Pal, Ravi Yadav

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Synaptojanin-1 (SYNJ1) is a phosphoinositide phosphatase critical for synaptic vesicle recycling and membrane dynamics. Biallelic disease causing variants involving the SYNJ1 gene is associated with a spectrum of neurological disorders, primarily due to disrupted synaptic transmission and neuronal homeostasis. The aim of our study was to describe the clinico-demographical, investigational and genetic profiles of patients of PARK-SYNJ1 and to draw correlation between clinical features with genetic variants.

Methodology: In this retrospective study, from our database of Parkinsonism, patients who had undergone exome sequencing and were confirmed to have biallelic SYNJ1 variants were selected and detailed demographic, clinical, biochemical, radiological and genetic details of these selected patients were extracted through a chart review.

Results: Seven cases (4 females) were recruited from 5 families. The median age at presentation was 31 (IQR: 24-36) years and age at symptom onset was 18 (IQR :4-30) years. All presented with features of early-onset Parkinsonism (EOP) with dystonia, while 4/7 had developmental delay, intellectual disability and seizures. Three of six patients, who received levodopa, had good improvement and all 6 had dopa-induced dyskinesia. Median UPDRS-III (6 cases) OFF was 49.5 (IQR-25-54) and ON was 39 (IQR-20-45). MRI brain showed GPi mineralization in 4 and cerebral atrophy in 1 and cerebral and cerebellar atrophy in 1 patient.

Discussion: Exome-sequencing revealed 5 unique variants of which 4 are novel. All 3 patients with c.656G>A homozygous missense variant, had atypical EOP presentation with seizures, intellectual disability and psychosis suggesting a possibility of clinical-genetic correlation. In contrast, the 2 patients with homozygous frame shift duplication (c.3339_3351dup) had typical EOP presentation. Thus, the genetic basis of the patients also helped us in characterization of their presentation and having possible clinico-genetic correlation.

Conclusion: PARK-SYNJ1 is an important cause of early onset PD. The presentation can be both typical and atypical with additional symptoms of seizures, cognitive and behavioural abnormality. Despite having a suboptimal response to levodopa, they are prone to develop levodopa induced dyskinesia.

Abstract ID 548: A Rare Case of Young Onset Dementia

Antony Martin Charles, Ravi Kumar V, Rajasekaran M

K.A.P. Viswanatham Government Medical College, Trichy, Tamil Nadu, India

Background and aim: Adrenoleukodystrophy is a rare cause of young onset dementia which has x linked recessive inheritance with seven phenotypes. Here I present a case of Adrenoleukodystrophy with young onset dementia.

Methodology: A 35-year-old male presented with insidious onset slowly progressive illness of five year duration with forgetfulness involving immediate and recent memory, apathy, social disinhibition, food preferences, hypersexuality, behavioural disturbances, and visual hallucinations. He had significant family history of his two siblings had psychiatric illness. On examination his MOCA was 20, Attention and memory was impaired, FAB score 9, Apraxia testing - unable to do sequential actions. Other neurological examination findings were normal

Results: Routine investigations, complete blood count (CBC), Blood sugar, renal function test (RFT), liver function test (LFT), homocysteine, B12 were normal. Copper and ceruloplasmin levels were normal. Thyroid functions were normal, Human Immunodeficiency Virus (HIV), HbsAg and Hepatitis C Virus (HCV) were negative. Autoimmune, para-neoplastic and IgLon5 panels were negative. The Magnetic Resonance Imaging (MRI) brain showed cerebral and cerebellar atrophy with frontal predominant Periventricular white matter changes, and atrophy of genu of corpus callosum. LP-CSF showed nil cells, with elevated protein 109.9, normal glucose and lactate. Hence the possibilities of X linked adrenoleukodystrophy and Adult onset Leukoencephalopathy were considered. Electroencephalogram (EEG) was done which showed diffuse slowing without any IED or periodic complexes. Genetic test was positive with ABCD1 gene mutation in exon 1 suggestive of adrenoleukodystrophy.

Discussion: Adult onset ALD can be presented with adrenal, gonadal, neurological, psychiatric manifestations. In neuropsychiatric manifestation patient may have cognitive decline, urinary incontinence, UMN signs, cerebellar dysfunction, visual defects, peripheral neuropathy, disinhibition, emotion lability, hypersexuality, perseveration, irritability and psychosis. Our patient had rapidly progressive dementia with psychiatric manifestations and his MRI findings also suggestive of adrenoleukodystrophy. Whole-exome sequencing confirms ABCD1 gene mutation with adrenoleukodystrophy.

Conclusion: Adrenoleukodystrophy should also be considered one of the differential diagnosis of rapidly progressive young onset dementia with neuropsychiatric manifestations.

Abstract ID 549: Unusual Clinical and Radiological Presentation of HHV-6 Encephalitis in an Adult with Intellectual Disability: A Case Report

Shalini S, Kavya B K, Pradeep R, Mahendra Javali, Lakshmi Priya, Prabhudev Hiremath, Purushottam Acharya, Anish Mehta

MS Ramaiah Medical College, Bengaluru, Karnataka, India

Background and aim: Human Herpesvirus 6 (HHV-6) commonly causes roseola in children but may rarely cause encephalitis in adults, particularly in the immunocompromised. We report an unusual case of HHV-6 encephalitis in an intellectually disabled adult without overt immunosuppression, presenting with atypical parieto-occipital involvement on magnetic resonance imaging (MRI), aiming to highlight diagnostic challenges and therapeutic considerations.

Methodology: A 36-year-old male with intellectual disability and epilepsy presented with fever, vomiting, visual blurring, agitation, and seizures. Neurological examination revealed impaired visual tracking and neck stiffness. MRI brain showed bilateral temporo-parieto-occipital cortical hyperintensities with diffusion restriction, sparing the mesial temporal lobes. Laboratory tests indicated thrombocytopenia, elevated aspartate aminotransferase (AST), and rising creatine phosphokinase (CPK). The cerebrospinal fluid (CSF) analysis demonstrated mildly elevated protein without pleocytosis; HHV-6 PCR was positive. Other viral and autoimmune panels were negative. The patient received intravenous ganciclovir and supportive care.

Results: The patient exhibited gradual clinical improvement with resolution of seizures and partial recovery of visual disturbances following antiviral therapy. The radiological findings remained atypical for classical HHV-6 encephalitis, which generally involves mesial temporal structures

Discussion: This case demonstrates an uncommon presentation of HHV-6 encephalitis in a non-immunosuppressed adult, characterized by predominant parieto-occipital involvement and visual symptoms. The initial differential diagnosis included posterior reversible encephalopathy syndrome and autoimmune encephalitis. Positive CSF HHV-6 PCR was pivotal for diagnosis. Early initiation of antiviral therapy contributed to favorable outcomes.

Conclusion: Clinicians should consider HHV-6 encephalitis in adults presenting with acute encephalopathy, seizures, and atypical parieto-occipital MRI changes, even in the absence of classical risk factors. Timely polymerase chain reaction (PCR) testing and antiviral therapy are essential for improving prognosis in such atypical cases.

Abstract ID 550: When HIV Decides to Invite Every Infection to the Party - A Confluence of Opportunistic Infections

Kolluru Karthik

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Human Immunodeficiency Virus (HIV) significantly compromises the immune system, predisposing patients to multiple opportunistic infections. Co-infections involving Cryptococcus neoformans, Cytomegalovirus (CMV), and John Cunningham Virus (JCV) are rare but can occur simultaneously in severely immunocompromised individuals. This case aims to highlight the complex interplay of opportunistic infections in an HIV-positive individual and the diagnostic and therapeutic challenges in managing such presentations

Methodology: Patient Profile: A 47-year-old male from New Delhi Daily wage laborer, educated up to 12th standard retropositive status confirmed upon admission Clinical Course: Initial Presentation: High-grade fever, profuse sweating, holocranial headache, polyarthralgia Progression: Developed right leg weakness progressing to dragging gait, altered mental status (confusion, agitation), and new-onset urinary retention with lower abdominal pain Examination Findings: Spastic paraparesis in right leg, complete sensory loss below the inguinal region, right-sided paresthesia

Results: Investigations: magnetic resonance imaging (MRI) brain: diffuse leptomeningitis, bilateral basal ganglia enhancing lesions with fluid-attenuated inversion recovery (FLAIR) hyperintensity and diffusion restriction; left cerebellar and middle cerebellar peduncle (MCP) atrophy; MRI Spine: mild lumbar nerve root enhancement; cerebrospinal fluid (CSF) analysis: elevated protein (165 mg/dL), lymphocytic pleocytosis (50 cells), low glucose (48.4 mg/dL); microbiology: India ink stain and fungal culture positive for Cryptococcus neoformans; CSF polymerase chain reaction (PCR): high levels of CMV DNA (38,453 copies/mL) and JC virus detected. Treatment: Cryptococcal Meningitis: liposomal amphotericin B (4 mg/kg) + flucytosine (1.25 mg QID) for 2 weeks; CMV Radiculitis: ganciclovir 250 mg BID for 2 weeks. Follow-up CSF: lowered opening pressure (14 cm H₂O), negative India ink stain, but positive cryptococcal antigen (>1:256) Discharge Medications: Fluconazole, Sulfamethoxazole-trimethoprim, Ganciclovir. Advised follow-up for CD4 count, repeat CSF studies.

Discussion: This case underscores the multifaceted challenges of managing advanced HIV with multiple CNS opportunistic infections. The patient exhibited classical and atypical features of cryptococcal meningitis complicated by CMV-associated radiculitis and JCV-related encephalopathy. The imaging findings supported widespread CNS involvement, and the presence of co-infections significantly increased the diagnostic burden. Timely identification via advanced CSF studies, including PCR and fungal culture, was critical to directing appropriate therapy. The role of MRI in detecting basal ganglia lesions and cerebellar atrophy, combined with the presence of JCV in CSF, also raised concerns for possible PML-like features, necessitating vigilant follow-up. Early initiation of liposomal amphotericin B and ganciclovir was pivotal in clinical improvement, though residual neurological deficits persisted at discharge.

Conclusion: This case exemplifies the devastating effects of immune suppression in HIV, where multiple opportunistic infections can coexist and complicate the clinical course. Prompt diagnosis using a combination of imaging, microbiological, and molecular techniques, along with aggressive antimicrobial therapy, is essential. Multidisciplinary management and continuous follow-up are imperative to monitor treatment response and prevent relapse or further complications.

Abstract ID 551: Anti-PM-Scl Antibody (Pathogenic Agent or Innocent Bystander??): Unravelling the Orbital Apex Syndrome Mystery

Deepika Dalal, Mridula Singh¹, Siddharth Maheswari, Rajinder Dhamija

Institute of Human Behaviour and Allied Sciences, Delhi, ¹S.M.S. Medical College, Jaipur, Rajasthan, India

Background and aim: Anti-PM Scl antibody was first described in 1977. This is rarely encountered antibody directed against a nucleolar complex, namely PM/Scl-75 and PM/Scl-100 autoantigen. This antibody mainly reported in idiopathic inflammatory myositis -systemic sclerosis overlap syndromes. Herein we report an unusual case of orbital apex syndrome with strong positivity of this antibody.

Methodology: Case Report

Results: A 45-year-old female patient, known case of Type 2 Diabetes Mellitus and hypertension presented with left eye complete ptosis, binocular diplopia and blurring of vision in left eye for 2 weeks. She also had associated continuous mild holocranial headache. She was not had any associated redness and congestion of eye, facial numbness, facial deviation, hearing loss, dysphagia, dysarthria, limb weakness, fluctuation or any ear and nasal discharge. There was no sensory, cerebellar, gait issues with no systemic complains. On examination, her visual acuity in right eye was 6/12 and in left eye it was finger counting at 1 meter. Left eye pupil was sluggish reactive to light. On extra ocular muscle examination, she was having complete left 3rd and 4th cranial nerve palsy. Other cranial nerve examination was normal. Her motor, sensory, cerebellar and gait examination was normal. Her routine workup and imaging was normal except for antinuclear antibody (ANA) profile, which was strongly (2+) positive for Anti-PM -Scl antibody.

Discussion: In this case report, we presented the unique clinical association of Anti-PM-Scl antibody and Orbital apex syndrome. On literature review, we couldn’t find any association between these two. So, this case is much thought provoking whether this antibody was just incidentally positive in our case or it was pathogenic. As the patient studied responded very well intravenous Methylprednisolone pulse followed by oral prednisolone tapering.

Conclusion: Patient presented with orbital apex syndrome, then under inflammatory etiology, we should consider possibility of overlap syndrome in our differential

Abstract ID 552: Genetic Variants of CD33 and CLU are Associated with Dementia Risk in Indian Cohort

Atri Chatterjee, Aathira N S¹, Arun Kumar¹, Ghulam Dar¹, Nimisha Nimisha¹, Abhay Sharma¹, Pinki Bera¹, Sundeep Saluja¹, Atri Chatterjee, Sonali Aggarwal, Sanghamitra Laskar, Sundeep Saluja¹, Atri Chatterjee

Vardhman Mahavir Medical College, New Delhi, ¹Govind Ballabh Pant Institute of Postgraduate Medical Education, New Delhi, India

Background and aim: Single Nucleotide Polymorphisms (SNPs) linked to neuroinflammation, amyloid, and lipid metabolism are involved in dementia. Studies exploring such SNPs are lacking in India that have potentials in risk prediction and patient stratification in dementia. This case-control study aims to analyse the association of the common genetic variants of CD33 (rs3865444), CLU (rs11136000), ABCA7 (rs3764650), and CR1 (rs6656401) with risk of dementia.

Methodology: The genotype of 43 dementia patients and 40 non-dementia controls were studied using PCR Restriction Fragment Length Polymorphism (RFLP) followed by their statistical associations with the age and risk of dementia by SPSS.

Results: In the present study cohort, around 67% of the cases had early-onset of dementia with major proportion (73%) of male gender. Of all, 42% of dementia cases had Alzheimer’s Disease and 65% cases had moderate-to-severe mini-mental state examination (MMSE) score with a median of 12.00 [0-25.00]. The A allele, particularly the C/A genotype in CD33 has showed significant association with decreased risk of dementia (p = 0.0027). While in CLU, A/A genotype was significantly associated with a reduced risk of dementia (p = 0.0009). Meanwhile, no significant association was observed between genotypes of ABCA7 (p = 0.96) or CR1 (p = 0.75) with the risk of dementia. Linkage disequilibrium analysis revealed significant co-inheritance between CD33–ABCA7 (D?=0.9972, r = –0.1905, p = 0.0181), CD33–CR1 (D?=0.6772, r = 0.3441, p < 0.0001), and ABCA7–CR1 (D?= 0.5677, r = –0.2134, p = 0.006).

Discussion: CD33 and CLU gene variants are significantly associated with dementia where the CD33 C/A genotype and CLU A/A genotype showcased the strongest associations, while ABCA7 and CR1 variants showed no significant association with the disease.

Conclusion: CD33 and CLU gene variants are significantly associated with dementia where the CD33 C/A genotype and CLU A/A genotype showcased the strongest associations, while ABCA7 and CR1 variants showed no significant association with the disease.

Abstract ID 553: Unravelling Stroke in Erdheim-Chester Disease with Optic Nerve Glioma: A Rare Clinical Challenge

Justin C, Thuslim Banu K, Murugan P K

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Erdheim-Chester Disease (ECD) is a rare non-Langerhans cell histiocytosis characterized by xanthogranulomatous infiltration of multiple organ systems. Central nervous system (CNS) involvement occurs in up to 50% of cases; however, ischemic stroke is an exceptionally rare manifestation. The coexistence of optic nerve glioma adds complexity to both diagnosis and management. We present a rare case of ischemic stroke in a patient with ECD and optic nerve glioma, post-chemotherapy, highlighting the diagnostic challenges and therapeutic approach.

Methodology: A middle-aged male with ECD and optic nerve glioma on chemotherapy presented with progressive right-sided hemiparesis over one month. Neurological examination revealed spastic quadriparesis. MRI brain, systemic imaging, and laboratory work-up were performed to assess the extent of disease and rule out conventional causes of stroke.

Results: The Magnetic Resonance Imaging (MRI) of the brain revealed acute infarcts in the left posterior temporo-occipital lobe, left thalamus, and hypothalamus. The pons was expanded, with bilateral T2 FLAIR hyperintensities in the optic chiasma, thalamocapsular region, and optic radiation. Additional findings included retrobulbar soft tissue swelling in the bilateral optic sheath complex and thickening of the pituitary stalk. No traditional vascular risk factors were present. The stroke was attributed to histiocytic vascular infiltration and possible chemotherapy-induced endothelial injury. The patient was treated with intravenous corticosteroids, antiplatelet therapy, and low molecular weight heparin.

Discussion: Stroke in ECD with optic nerve glioma is exceedingly rare. CNS histiocytic infiltration and treatment-related vascular injury can mimic disease progression. Prompt diagnosis and treatment are critical.

Conclusion: Ischemic stroke is a rare but serious complication of Erdheim-Chester Disease with optic nerve glioma. Early multimodal imaging and a multidisciplinary treatment strategy, including immunosuppression and anticoagulation, are essential for improving outcomes in these complex cases.

Abstract ID 554: A Case of Progressive Myoclonic Epilepsy with KCN1 Mutation in an Adolescent Male: A Rare Presentation of Autosomal Dominant PME

Swati Gupta

S.M.S. Medical College, Jaipur, Rajasthan, India

Background and Aim: Presenting a case of progressive myoclonic epilepsy with KCN1 mutation in an adolescent male.

Methodology: A 14-year-old male with a 6-year history of generalized tonic-clonic seizures, progressive action myoclonus, and cognitive decline was evaluated. Clinical examination, neuroimaging [magnetic resonance imaging (MRI) brain with magnetic resonance spectroscopy (MRS)], neurophysiology [electroencephalogram (EEG]), nerve conduction velocity (NCV)], and metabolic screening were performed. A detailed family history revealed similar symptoms in the father. Genetic evaluation via whole genome sequencing was conducted to determine the etiology.

Results: Neurological findings included: hypotonia in lower limbs, intention tremor, cerebellar signs, and impaired memory. Nerve conduction studies showed axonal sensorimotor polyneuropathy. MRI brain revealed mild cerebral and cerebellar atrophy, with normal MRS (no lactate peak). EEG was normal during this admission but had shown asymmetrical spike-and-wave discharges previously. Laboratory tests including VEP, BERA, serum lactate, and vitamin levels were within normal limits. Genetic testing revealed a pathogenic KCN1 mutation, confirming autosomal dominant PME.

Discussion: This case demonstrates a rare KCN1-related autosomal dominant PME with associated progressive axonal neuropathy, a feature not commonly described. The patient exhibited hallmark PME symptoms: seizures, action myoclonus, cerebellar signs, and cognitive decline. The additional presence of axonal neuropathy broadened the differential diagnosis, initially raising possibilities such as mitochondrial disorders, CIDP, or toxic neuropathies. Comprehensive metabolic and mitochondrial evaluations were non-contributory. The positive KCN1 mutation provided a unifying genetic diagnosis, reinforcing the need to consider genetic testing early in complex progressive neurologic conditions, particularly with a positive family history. Timely identification enabled optimized seizure control and initiated the process of family screening and counselling.

Conclusion: This case highlights a unique presentation of autosomal dominant PME with KCN1 mutation associated with progressive axonal neuropathy. Recognition of this rare phenotype is essential for timely diagnosis, appropriate management, and genetic counseling. It underscores the expanding clinical spectrum of PME and the crucial role of genomic diagnostics in pediatric neurology.

Abstract ID 555: Carotid Web and Fibromuscular Dysplasia: A Rare Cause of Recurrent TIAs in a Young Female

Kapeesh Khanna, Trilochan Srivastav

S.M.S. Medical College, Jaipur, Rajasthan, India

Background and aim: Carotid web is a rare and underrecognized vascular anomaly associated with recurrent transient ischemic attacks (TIAs) and ischemic strokes, often misdiagnosed as atherosclerosis. Fibromuscular dysplasia (FMD), a non-atherosclerotic vascular disorder, may underlie such cases and is characterized by multifocal arterial abnormalities. Aim of this study was to highlight the diagnostic importance of advanced imaging in identifying carotid web and FMD in young patients presenting with cryptogenic strokes or recurrent TIAs.

Methodology: We present a case study of a 38-year-old female with no known comorbidities who experienced multiple TIAs over a three-month period despite dual antiplatelet therapy. Clinical evaluation included: Initial Imaging: MRI-DWI (diffusion-weighted imaging) was unremarkable. Further Imaging: CT angiography revealed an aberrant right subclavian artery, left-sided carotid web above the bifurcation, middle cerebral artery (MCA) occlusion, and absent visualization of the left A1 segment. Confirmatory Test: Digital subtraction angiography (DSA) demonstrated >50% luminal narrowing at the carotid web and M1 stenosis at early bifurcation. Additional Workup: Vasculitis panel (negative), vessel wall imaging (showed intimal thickening).

Results: Identified a left-sided carotid web causing >50% stenosis. Detected M1 segment stenosis and an aberrant right subclavian artery. Collateral circulation from the left anterior cerebral artery (ACA) to the right ACA was observed. Vessel wall imaging suggested fibromuscular dysplasia as the likely cause. Vasculitis was ruled out.

Discussion: The case underscores the need to consider non-atherosclerotic etiologies such as carotid web and FMD in young patients with recurrent TIAs and no conventional risk factors. Carotid web may remain undetected on standard imaging; thus, advanced modalities like CT angiography, DSA, and vessel wall imaging are critical for diagnosis. The co-existence of vascular anomalies such as an aberrant subclavian artery further supports the systemic nature of FMD.

Conclusion: Carotid web and fibromuscular dysplasia are important differential diagnoses in young patients with cryptogenic strokes or recurrent TIAs. Accurate diagnosis using advanced imaging is vital for appropriate management. In this case, continued antiplatelet therapy was maintained with plans for carotid stenting if symptoms recurred. Early recognition and intervention are essential to prevent further ischemic events.

Abstract ID 556: Title: A Case of Carotid Web Presenting with Large Vessel Occlusion and Successfully Treated with Mechanical Thrombectomy

Shikha Agarwal

S.M.S. Medical College, Jaipur, Rajasthan, India

Background and aim: Carotid web (CW) is an uncommon variant of focal fibromuscular dysplasia, characterized by a shelf-like fibrous projection into the carotid bulb. It is an often- overlooked yet significant cause of cryptogenic and recurrent strokes. Misinterpretation of imaging findings, particularly in suboptimal planes, may lead to misdiagnosis as atheromatous plaques or dissection flaps, thereby influencing clinical management and outcomes.

Methodology: We present the case of a 26-year-old female with no known comorbidities who developed sudden-onset slurred speech, facial weakness, and right-sided hemiparesis. She arrived at the hospital within two hours of symptom onset, with a non-contrast CT showing an ASPECTS score of 10. CT angiography revealed left M1 occlusion and a suspected carotid web in the left cervical ICA.

Results: The patient underwent intravenous thrombolysis, followed by digital subtraction angiography (DSA), which confirmed the presence of a carotid web in the left cervical ICA and left M1 segment occlusion. Mechanical thrombectomy was successfully performed, leading to an improvement in National Institute of Health Stroke Scale (NIHSS) score from 16 to 5. Post-procedure, she was managed with dual antiplatelet therapy, and carotid stenting was planned after a 15-day follow-up.

Discussion and conclusion: Accurate diagnosis of a CW is crucial in determining appropriate therapeutic strategies. Medical management alone may not be sufficient in preventing recurrent strokes in such cases. A high level of clinical suspicion and meticulous imaging review are essential, particularly in younger stroke patients.

Abstract ID 557: Cerebral Venous Sinus Thrombosis in Males: A Case Series

Partha Saha, Arun Koul

Govind Ballabh Pant Institute of Postgraduate Medical Education, New Delhi, India

Background and aim: Cerebral venous thrombosis (CVT) is a rare cerebrovascular disease that accounts for 0.5% of all strokes. CVT has a greater incidence in women of childbearing age related to hypercoagulable states. The clinical manifestations of CVT depends on the location of the thrombosis and raised intracranial pressure. The most common symptom is headache, reported in 90% of cases. Other symptoms include seizures, focal neurological deficit and altered sensorium.

Methodology: We performed a retrospective descriptive-analytical study in which 20 male patients, presented with CVT confirmed by imaging were included during September 2022 to November 2024. Their demographic, etiologic, radiological and prognostic characteristics were studied.

Results: The mean age of patients was 32.2 years. Most common comorbidity associated was young hypertension (28.5%). The most frequent clinical manifestations were headache (71.42%) followed by seizures (57.14%). Focal neurological deficits were present in 42% of cases, among them cranial neuropathy was 21%. Transverse sinus (78.57%), sigmoid sinus (64.28%) and Superior sagittal sinus (50%) were the most involved areas (85.71%) and hemorrhage was found in 21.42% cases, venous infarcts in 28.57% cases. Mortality and morbidity rates were 7.14% and 28.57%, respectively. Poor prognostic factors at the time of admission were stupor and coma. Fifty percentage patients received Vitamin K receptor antagonists and 42.85% received NOAC as maintenance treatment. In the assessment of etiology of CVT, we found hyperhomocysteinemia in 2 out of 6 cases, Factor V Leiden mutation was found in 1 case.

Discussion: There are changing trends in terms of increasing overall incidence of CVTs and male incidence of CVT. Hyperhomocysteinemia was present in 18% and 5% in NIMS and ISCVT studies, respectively. Hemorrhage and mortality were 18% and 3.3%, respectively.

Conclusion: CVT in male patients is not uncommon, they have varied clinical presentations and radiological signs. Early treatment with anticoagulants can improve prognosis of them.

Abstract ID 558: Living Through the Guillain Barre Syndrome Outbreak in Pune, India

Shreejita Sengupta, Rahul Kulkarni, Shripad Pujari, Rushikesh Deshpande, Neha Kadamduke, Vishal Deshpande, Viresh Nashte

Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India

Background and aim: The recent outbreak of Guillain Barre Syndrome (GBS) in Pune in 2025 had a total 225 GBS cases which became a matter of rising national concern. The aim was to study their clinical, laboratory and electrophysiological profiles and management.

Methodology: Patients of GBS with onset from 1/1/25 to 28/2/25 who were admitted in our institute were included. Their demographic and clinical characteristics were noted. Laboratory findings including ganglioside antibodies, cerebrospinal fluid (CSF), electrophysiological features and treatment were documented. Functional outcomes in the form of treatment outcome and GBS disability scores were noted.

Results: Out of 225 patients, 31 (14%) patients were admitted in our hospital; 25 adults and 6 children. Cases peaked in the first 2 weeks of January. Preceding gastrointestinal and respiratory symptoms were seen in 38% and 9%, respectively. Albumino-cytological dissociation was seen in 29%. Stool biofire tested positive for Campylobacter Jejuni and Norovirus in 16% and 29%, respectively. Ganglioside antibodies were positive in 78%, majority being GM1 and GQ1b antibodies. IVIG was used in 80%, PLEX done in 16% and 1 patient was managed conservatively. Electrophysiology revealed Acute Motor Axonal Neuropathy (AMAN) variant in 58%, AMSAN in 10% and AIDP in 19%. One patient had Miller-Fischer syndrome while 5 patients had MFS-GBS overlap. Fulminant GBS requiring ventilation within 24 hours of onset was seen in 5 adults and 4 children; all of these were AMAN. Overall 38% required mechanical ventilation. Average hospital stay was 32 days. At time of discharge, GBSDS score of 0-2 (good outcome) was seen in 23% while 3-6 (poor outcome) was seen in 77% There was no mortality in our institute.

Discussion: As on 31/5/25, we have discharged 29 out of 31 cases.1 adult and 1 child are still in the hospital.

Conclusion: With early diagnosis and timely management including efficient ICU care and early rehabilitation, we were able to prevent mortality in these 31 GBS patients.

Abstract ID 559: Clinical and Cerebrospinal Fluid Analysis (CSF) of Patients with Altered Sensorium at a Tertiary Care Center

Manish Bhartiya, Vinny Wilson¹, Satish Barki, Gaurav Yadav

Command Hospital, Southern Command, Pune, Maharashtra, ¹Armed Forces Medical College, Pune, Maharashtra, India

Background and aim: Fever with altered sensorium is a diagnostic challenge. Cerebrospinal fluid (CSF) studies are cornerstone of diagnosis. The aim of the study was to study the clinical and laboratory findings of the patients with altered sensorium admitted to intensive care unit of a tertiary care hospital.

Methodology: This was a retrospective study of 109 patients. The duration of the study was from April 2021 to Mar 2024. The study was carried out at a tertiary care centre. The study included data from the patients admitted in ICU for the said duration which included clinical profile, CSF studies and imaging. Patients with any other cause of altered sensorium were excluded.

Results: The mean age of patients was 74.6 years with male predominance. The most common presentation was headache, fever and altered sensorium. 8.3% patients also had cranial nerve involvement. Forty-one patients were managed as acute pyogenic meningitis. Thirty patients were managed as chronic meningitis (24 as tubercular meningitis and 06 as cryptococcal meningitis). Thirty-eight (34.86%) patients were managed as viral meningoencephalitis out of which 06 were proven HSV encephalitis, two patients tested positive for Chikungunya. The CSF cytology showed Neutrophilic pleocytosis in 56 patients and Lymphocyte predominace in rest. Seventy-three and five-tenth percentage had elevated proteins and 40.8% had decreased glucose. CSF culture was negative in 44.5% of the samples. The CSF cytology and sugar levels were most important parameters in determining the etiology in case the cultures and stains were normal.

Discussion: The present study underscores the importance of Clinical features and CSF findings in patients presenting with altered sensorium and fever. High rate of culture negativity may be due to exposure to empirical antibiotics prior to CSF studies.

Conclusion: In instances where the stains and cultures are unrevealing the CSF proteins, predominant cells and Sugar levels play an important role in empirical treatment.

Abstract ID 560: Aceruloplasminemia Presenting as Neuropsychiatric Syndrome: A Rare NBIA Variant

Vaibhav Bhat

St. Johns Medical College, Bengaluru, Karnataka, India

Background and aim: Aceruloplasminemia is a rare autosomal recessive neurodegeneration with brain iron accumulation (NBIA) disorder due to mutations in the CP gene. It presents variably with diabetes, anemia, hepatic iron overload, and progressive neuropsychiatric manifestations. We report a case of genetically confirmed aceruloplasminemia presenting primarily with mania without any EPS.

Methodology: A 50-year-old male presented with a 5-year history of insidious-onset behavioral changes including irritability, grandiosity, aggression, poor judgment, and social disinhibition with tangentiality suggestive of Mania. Workup for psychosis and recurrent hypoglycemia (brittle pancreatic diabetes) led to neurology referral. Neurological examination revealed inattention, executive dysfunction and episodic memory loss with subtle neck dystonia. Investigations included detailed metabolic, endocrine, hematologic, radiologic, and genetic evaluations.

Results: MRI brain revealed symmetrical T2 hypointensities in bilateral basal ganglia, thalami, substantia nigra, red nuclei, and dentate nuclei with blooming on SWI—suggestive of iron deposition. MRI abdomen showed hepatic iron overload and pancreatic atrophy. Biochemistry showed undetectable ceruloplasmin (<0.07 g/L) and elevated serum ferritin (979 µg/l). Significant anaemia with Hb-9.1 was noted. Whole-exome sequencing identified two likely pathogenic compound heterozygous variants in the CP gene: a frameshift variant (c.2274del; p.Leu758PhefsTer11) and a splice-site variant (c.1349-1G>T), confirming aceruloplasminemia.

Discussion: Neuropsychiatric-onset NBIA syndromes are often underrecognized. Aceruloplasminemia, though classically presenting with diabetes and anemia, can manifest initially with manic and cognitive symptoms. MRI patterns of brain iron deposition and hepatic siderosis, along with undetectable ceruloplasmin, strongly support the diagnosis. Genetic confirmation is crucial for definitive diagnosis and genetic counselling.

Conclusion: This case underscores the need to consider aceruloplasminemia in patients with progressive neuropsychiatric syndromes and systemic features such as diabetes and anemia. Early recognition enables appropriate management, surveillance, and familial screening in this potentially treatable NBIA subtype.

Abstract ID 561: The Pandora’s Box - Case Series of Lafora Body Disease

Abinaya Guru, Thamilpavai A, Mugundhan K, Ravi L A, Prakash V, Rajgokul R, Rajgokul P

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Lafora disease is a rare autosomal recessive, progressive myoclonic epilepsy (PME) characterized by myoclonus, generalized tonic-clonic seizures, visual hallucinations, and rapid cognitive decline. It typically manifests in adolescence and progresses rapidly, often resulting in death within a decade. This case series aims to highlight the clinical presentation, progression, and diagnostic approach in two patients with genetically confirmed Lafora disease, underscoring the importance of early consideration of this condition in the differential diagnosis of PME.

Methodology: A retrospective case review was conducted at MMC and RGGGH, Chennai, involving two adolescent male patients diagnosed with Lafora disease. Detailed clinical histories, seizure progression, cognitive and neurological symptoms, imaging findings [magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET CT)], electroencephalographic (EEG) features, and genetic testing results were analyzed.

Results: Case 1: A 21-year-old male with seizure onset at 15 years presented with tonic-clonic seizures, followed by rapid cognitive decline, visual hallucinations, and generalized tonic-clonic status epilepticus. MRI and PET CT revealed bilateral parieto-temporal and occipital hypometabolism. Genetic testing confirmed Lafora disease. Case 2: A 16-year-old male with seizure onset at 12 years initially managed with valproate and levetiracetam. He subsequently developed hallucinations, emotional lability, cognitive decline, and dysarthria. EEG showed photosensitive generalized discharges, and MRI revealed cerebral atrophy. Genetic analysis confirmed Lafora disease; family history was significant for a similarly affected sibling.

Discussion: Lafora disease is one of the most aggressive forms of PME with hallmark features including visual seizures, rapid cognitive decline, and refractory seizures. The EEG pattern of photosensitive generalized discharges and MRI findings, alongside a supportive genetic background, aid in diagnosis. Given the rarity of the condition, it is often misdiagnosed or diagnosed late, leading to delayed supportive interventions.

Conclusion: Despite its rarity, Lafora disease should be considered early in adolescents presenting with progressive myoclonic epilepsy, especially when accompanied by cognitive regression and visual hallucinations. Timely genetic testing and neuroimaging are essential for diagnosis and family counselling.

Abstract ID 562: Neurosjogren’s Syndrome – A Report of Three Cases

Saravana Sukriya S, Madhumitha S, Girish A S, Joydeep Samanta

All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

Background and aim: Sjogren’s syndrome (SS) is a chronic autoimmune disease characterized by lymphocytic infiltration and inflammation of exocrine glands. SS is notorious for its multifaceted systemic involvement including the nervous system. We report three cases of Neuro-Sjogren’s syndrome (NSS) highlighting the diverse clinical manifestations.

Methodology: Case report of three cases

Results: Case I: A middle-aged female presented with one episode of seizure, right hemiparesis 3 months back followed by progressive cognitive decline. Examination revealed MMSE-8/30 with right spastic hemiparesis. Her serum potassium was low (2.8 mEq/L), and ABG showed non-anion gap metabolic acidosis. MRI brain revealed multiple chronic infarcts and diffuse narrowing of bilateral anterior and posterior cerebral arteries, vertebral arteries, suggestive of vasculitis. Antinuclear antibody (ANA) immunoblot showed strong positive anti-Ro and anti–La antibodies suggestive of NSS. She received intravenous pulse methylprednisolone (IV MPS) and Rituximab.

Case II: A young female presented with progressive quadriparesis and bulbar weakness, recurrent episodes of vomiting, loose stools and syncopal episodes since 2 months. Examination showed bilateral facial and bulbar weakness, flaccid quadriparesis, and orthostatic hypotension. Nerve conduction studies (NCS) revealed demyelinating sensorimotor polyradiculoneuropathy. MRI brain and spine was unremarkable. Cerebrospinal fluid (CSF) examination showed albumin-cytological dissociation, ANA immunoblot revealed strong positive SS-A and SS-B antibodies. With a diagnosis of NSS with acute onset CIDP she received fludricortisone, pulse IV MPS and Rituximab. Case III: A young female presented with progressive quadriparesis and dysarthria since 4 weeks. She had episodes of dryness of mouth for past few years. Examination revealed scanning speech, spastic quadriperesis and cerebellar ataxia. MRI brain showed diffuse cerebellar atrophy. CSF analysis, autoimmune and para-neoplastic panel were unremarkable. ANA immunoblot revealed strong positive anti-Ro antibodies with focus score > 1 on labial biopsy. A diagnosis of NSS with spastic ataxia was considered and she received IV pulse followed by Rituximab.

Discussion and conclusion: A high index of suspicion along with clinical history, serological tests, lip biopsy and parotid gland enlargement establishes diagnosis of NSS.

Abstract ID 563: Common to Uncommon: Unravelling the Reversible Dementia

Hamsa T, Praveen Kumar

Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Background and aim: Most dementias are caused by neurodegenerative disease for which treatment options are limited and management is mainly symptomatic. Currently there is increased awareness of immune-mediated processes that involve brain structures concerning cognition and behaviour. These diseases typically present subacutely with evidence of inflammation and pathologic antibodies, there is a potential role of immunomodulatory agents in the management or treatment of the underlying cancer in case of paraneoplastic disease

Methodology: A 75-year-old male, known hypertensive presented with history of memory impairment from past 2 years, initially episodic recent memory impairment which gradually progressed, to visuospatial & way finding difficulties. His spouse also reported hypersexuality from past 1 year. Examination revealed memory impairment of immediate and recent events, MoCA score of 11 with impairment in attention, vigilance and abstract thinking. In view of rapidly progressive symptoms he was evaluated for secondary causes of dementia. Routine blood investigations were normal. Magnetic Resonance Imaging (MRI) brain showed diffuse cerebral atrophy predominantly bilateral temporal lobe, serum paraneoplastic panel showed anti amphiphysin 2 antibody positivity. He was subjected to Positron emission tomography (PET) scan, which revealed thyroid carcinoma with lungs and skeletal metastasis. Thyroid FNAC unveiled papillary carcinoma of thyroid. He underwent total thyroidectomy and radioiodine ablation for metastasis and is under follow up

Results: Amphiphysin is an intracellular antigen associated with small cell lung cancer or breast cancer, it manifests with paraneoplastic neurological syndromes. Limbic encephalitis and stiff-person syndrome are the most common paraneoplastic syndromes seen in patients with anti-amphiphysin antibodies, association of anti amphiphysin antibodies with thyroid malignancy is very rare.

Discussion and conclusion: Immune-mediated dementias typically require urgent diagnosis and treatment of the underlying etiology and with immunomodulators, awareness about immune-mediated dementias and their associated symptoms should lead to diagnosis and management of these mysterious conditions

Abstract ID 564: Cruciate Paralysis at the Crossroads: A Curious Case of Selective Weakness and Sensory Reversal

Bharath R, Thamilpavai N, Ravi L A, Prakash V, Mugundhan K

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Cruciate paralysis is a rare neurological condition resulting from lesions at the cervicomedullary junction affecting decussating corticospinal fibers, particularly those controlling the upper limbs. It leads to bilateral upper limb weakness with sparing of the lower limbs. Chiari malformation type I (CM-I), defined by herniation of cerebellar tonsils through the foramen magnum, can cause cervicomedullary compression and syringomyelia, contributing to such presentations. We report a rare case of CM-I with cruciate paralysis and reverse dissociated sensory loss.

Methodology: A case report with literature review.

Results: A 30-year-old woman presented with a two-year history of asymmetric distal-to-proximal weakness in both upper limbs, initially right-sided, progressing to bilateral involvement. She noted hand thinning. Examination revealed bilateral upper limb weakness (distal > proximal), muscle wasting, areflexia in upper limbs, and hyperreflexia in lower limbs with right plantar extensor. Vibration and joint position sense were impaired, with preserved pain and temperature—indicative of reverse dissociated sensory loss. Cranial nerves, cognition, and cerebellar functions were normal. MRI showed cerebellar tonsillar descent (9 mm), cervicomedullary kinking at C1, and a syrinx from C2 to D11. Blood tests and nerve conduction studies were unremarkable. Findings supported CM-I with syringomyelia causing cruciate paralysis.

Discussion: Cruciate paralysis involves damage at the pyramidal decussation where upper limb fibers cross rostrally. The reverse sensory dissociation pattern reflects dorsal column dysfunction due to posterior cord syrinx expansion. CM-I is often congenital and asymptomatic until adulthood; syringomyelia frequently dictates symptom onset. This case highlights the diagnostic value of recognizing selective upper limb involvement with preserved lower limb function and dorsal column sensory loss hallmarks of cervicomedullary pathology.

Conclusion: This case underscores a rare manifestation of CM-I with syringomyelia presenting as cruciate paralysis. Bilateral upper limb weakness with reverse sensory dissociation should prompt early cervicomedullary imaging. Timely recognition and neurosurgical referral are crucial to prevent further neurological decline.

Abstract ID 565: Amyloid Myopathy: A Cunning Masquerader

Avni Apte, Ish Anand, Anuradha Batra, Bharat Rastogi

Sir Ganga Ram Hospital, New Delhi, India

Background and aim: Primary systemic amyloidosis is characterized by extracellular deposition of immunoglobulin light chains as amyloid fibrils resulting in organ dysfunction. The most common neurological manifestations are small fibre length dependent neuropathy, carpal tunnel syndrome, and autonomic involvement. Amyloid myopathy although well recognized, is an uncommon manifestation.

Methodology: A 58-year-old male presented with bilateral upper limb weakness x 1.5 years, bilateral lower limb weakness x 1 year, difficulty in swallowing, change in character of voice and polyuria x 6 months. Examination revealed macroglossia, weak gag reflex, wasted proximal upper and lower limbs; truncal, neck flexor and proximal muscle weakness in all 4 limbs, normal deep tendon reflexes. Investigations revealed elevated creatine phosphokinase (CPK), LDH, transaminitis and nephrotic range proteinuria. Workup for Myositis, Vasculitis profile, myasthenia gravis and paraneoplastic syndrome was negative. MRI brain was non-contributory. Nerve conduction studies (NCS) were normal, EMG revealed myopathic pattern. Muscle biopsy revealed inflammatory myopathy pattern. Whole Body Positron Emission Tomography (PET) Computed tomography (CT) showed increased FDG uptake in skeletal muscles. Patient started on intravenous immunoglobulin (IVIg) therapy.

Results: Renal biopsy and bone marrow biopsy showed presence of amyloidosis. SFLC showed elevated predominant lambda light chains with reduced kappa: lambda ratio. Muscle biopsy reviewed with congo red stain revealed amyloidosis. Patient was started on CyborD protocol, after 2 cycles-myeloma panel revealed worsening of kappa: lambda ratio and very low levels of IgG. Hence, patient switched to daratumumab and dexamethasone protocol. Currently his bulbar symptoms have improved and is able to mobilize with support.

Discussion: Primary systemic amyloidosis is a plasma-cell dyscrasia characterized by an autonomous proliferation of plasma cells with an overproduction of a monoclonal Ig protein. Misfolded proteins deposit as amyloid fibrils in the extracellular matrix causing organ dysfunction.

Conclusion: It is important to look for amyloidosis when atypical features of inflammatory myopathy with organ involvement are present.

Abstract ID 566: Spastic Legs, Slowed Mind, and the Lynx Sign: A Diagnostic Trio in SPG11

Santhosh Arepalli, Marian Vijay, Vignesh Anbazhagan, Shanmuga N

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Hereditary spastic paraplegia (HSP) refers to a diverse group of inherited neurodegenerative disorders marked by progressive lower limb spasticity and weakness, primarily due to corticospinal tract involvement. Among its autosomal recessive forms, HSP type 11 (SPG11) is the most prevalent, often presenting with cognitive impairment and characteristic MRI findings such as a thin corpus callosum. We present a case of genetically confirmed SPG11 to highlight its diagnostic features and clinical course.

Methodology: A case report of a 17-year-old male with spastic paraparesis, supported by clinical evaluation, neuroimaging and genetic testing.

Results: The patient presented with a 4-year history of progressive lower limb spasticity and weakness, along with learning difficulties since early childhood. Neurological examination revealed moderate spasticity, bilateral ankle contractures, hyperreflexia, and extensor plantar responses. Gait was spastic with toe-walking; upper limbs and cerebellar function were spared. Magnetic resonance imaging (MRI) brain showed periventricular white matter hyperintensities near the frontal horns—resembling the “ears of the lynx” sign—and a diffusely thinned corpus callosum. Neuropsychological testing indicated a mild intellectual disability (IQ 55). Whole-exome sequencing identified compound heterozygous pathogenic variants in the SPG11 gene, confirming the diagnosis.

Discussion: SPG11 accounts for up to 8% of all HSP cases and often presents with complex features, including intellectual disability, spasticity, and characteristic radiological markers. The presence of the “ears of the lynx” sign in combination with corpus callosum thinning, although not pathognomonic, strongly supports SPG11 when observed alongside compatible clinical findings. Early genetic testing can facilitate timely diagnosis and guide prognosis, surveillance, and genetic counselling.

Conclusion: This case highlights the importance of integrating clinical, radiological, and genetic data for the accurate diagnosis of SPG11. Whole-exome sequencing is an essential diagnostic tool in suspected hereditary spastic paraplegias.

Abstract ID 567: The Role of Meditation in Reducing the Anxiety Component of Migraine Patients - Study of 50 Patients

R Pazhani

Pazhani Neuro Centre, Chennai, Tamil Nadu, India

Background and aim: Some of the migraine patients, additional anxiety component is a troublesome feature. The meditation technique helps in reducing anxiety and it helps to relieve the migraine significantly in addition to regular therapeutic measures.

Methodology: Fifty patients with recurrent migraine, getting two and more episodes per month, with GAD-7 anxiety score of 0-4 were taken for the study. Twenty-four were male and twenty-six were female in the age range of 20-50 years. All of them were given prophylactic medications and acute treatment measures. The anxiety component was one of the precipitating factors in all the patients. All fifty patients were taught four meditation techniques, Om-Ah-Hum, Kechari mudra, Bhramari pranayama and silent breathing meditation techniques. They were practicing it five minutes in the morning and in the evening. The GAD-7 anxiety score was assessed one month and three months after the practice.

Results: Fifty patients of migraine with minimal anxiety the GAD-7 score of 0-4 felt free from anxiety without anxiolytics, one month and three months after the meditation practice. All of them were taking migraine prophylactic medications and the migraine was under significant control.

Discussion: Om-Ah-Hum chanting silently represent body, speech and mind. Kechari mudra is a kind of meditation where the tip of the tongue was touching the roof of the palate and intermittent vibration was given. Bhramari pranayama is also a kind of meditation where humming bee sound was produced with Shanmukhi mudra. The final meditation technique taught was placing one hand in the palm of other hand at navel level and doing slow deep breathing in and out.

Conclusion: The meditation techniques reduced the minimal anxiety score to nil in this study population. It is useful to consider meditation as an additional measure in migraine patients to reduce anxiety.

Abstract ID 568: Cavernous Malformation of The Spinal Cord: A Clinical and Radiological Imposter

Saurav Raja, Jyoti Garg, Ashish Duggal, Iftikar Khadas

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Spinal cord cavernous angiomas are relatively rare vascular malformations, accounting for 5% to 12% of spinal vascular abnormalities. These lesions usually develop in the vertebrae and can extend into the extradural space, but intramedullary cavernomas are rare. This report describes two cases that illustrate the considerable diagnostic difficulties these malformations can pose.

Methodology: Case report

Results: The first case concerns a 47-year-old male who experienced a sudden onset of bilateral lower limb weakness, which peaked within 12 hours. He exhibited a sensory level at T10 and had associated bowel and bladder dysfunction. The initial magnetic resonance imaging (MRI) was reported as an infective granuloma, resulting in an unsuccessful course of anti-tuberculous therapy and steroids. Follow-up MRI showed a T2 hyperintense lesion with a peripheral hypointense rim, which, along with apoplectic onset, led to the diagnosis of intramedullary cavernoma. The second case involves a 66-year-old male who developed radicular pain followed by symmetric, flaccid weakness in his lower limbs over 3-4 days, along with sensory and autonomic deficits. His initial MRI was reported as longitudinally extensive transverse myelitis and was treated with IV steroids. Once again, a repeat MRI revealed a T1 and T2-hyperintense lesion with foci of blooming, which was suggestive of intramedullary cavernoma.

Discussion: The presented cases emphasize that intramedullary spinal cord cavernous malformations can closely mimic inflammatory, demyelinating, and neoplastic conditions. The presence of T1 hyperintensity and blooming on SWI sequences, along with rapidly progressing deficits, is a critical indicator of cavernomas.

Conclusion: Therefore, it is essential to consider cavernous malformations as a primary differential diagnosis when evaluating focal intramedullary lesions of the spinal cord to ensure accurate and timely management.

Abstract ID 569: The Butterfly Effect-From a Miniscule Error to Multisystem Chaos

Rosy Thomas, E Natarajan, E Maheswari, K Mugundhan

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: An 18-year-old boy with prior history of hyperparathyroidism, status post parathyroidectomy with background history of multiple episodes of gastritis presented with headache for 2 weeks prior to presentation.

Methodology: Patient was apparently well 2 weeks prior to presentation when he started having headache which was holocranial, persistent, moderate to severe intensity, associated with nausea and vomiting, without any photophobia, phonophobia, no aggravating factors. There was minimal improvement with pain relieving medications. No history of fever, trauma, seizures. History of hyperparathyroidism 5 years ago, diagnosed in view of recurrent urinary stones with hypercalcemia. Multiple episodes of hospitalization for recurrent gastritis. On examination he was tall with arachnodactyly, with positive wrist sign and thumb sign with high arched palate with dysmorphic features in the form of wide forehead, widely spaced eyes, small jaw and patulous lips. He had bilateral papilledema with minimal proximal weakness of upper and lower limbs without any other focal neurological deficit.

Results: His investigations revealed a superior sagittal sinus occlusion which was partially recanalized with collaterals on MR venogram. Upper gastro-intestinal endoscopy revealed pangastritis. The whole-exome sequencing (WES)- Homozygous mutation in MTHFR gene which was pathogenic for homocystinemia.

Discussion: In view of multisystem involvement with dysmorphic features with a thrombotic episode 2 possibilities were kept - Multiple Endocrine Neoplasia with a prothrombotic state. MTHFR mutation resulting in prothrombotic state and marfanoid habitus. Genetic analysis was sent in view of the above two possibilities which revealed a pathogenic mutation in MTHFR leading on to thrombosis causing CVT, Marfanoid habitus. Associations between MTHFR gene mutation and gastritis has been documented. Associations between MTHFR mutation and hyperparathyroidism has also been noted.

Conclusion: Diagnosing homocystenemia is important therapeutically for further management and in terms of genetic counselling and screening of family members. He was initiated on anticoagulation and B12 and folate substitution and is on regular follow up

Abstract ID 570: Clot or Not? When Stroke Unveils a Hidden Intracranial Infection

Zuber Shaikh, Ashwin Panda, Aldrin Anthony, Suman Kushwaha, Tushar Marbate

Institute of Human Behaviour and Allied Sciences, Delhi, India

Background and aim: Subdural empyema is a rare but critical intracranial infection, often presenting with fever, altered mental status, or seizures. Stroke like symptoms as the initial presentation are highly uncommon. This case highlights an atypical presentation of subdural empyema in a paediatric patient, emphasizing the need for early neuroimaging in acute neurological deficits.

Methodology: A 14-year-old male presented with a 15-day history of headache followed by sudden onset left sided weakness and facial deviation. There was no history of fever, seizures, or trauma. Neurological examination revealed left hemiparesis and upper motor neuron facial palsy. Magnetic resonance imaging (MRI) revealed a right temporoparietal subdural empyema with infarction in the right middle cerebral artery (MCA) territory. Cerebrospinal fluid (CSF) and blood cultures were negative.

Results: The patient underwent emergency decompressive craniectomy along with drain insertion and was started on empirical intravenous antibiotics and later converted to oral antibiotics, which were continued for three months. No causative organism was identified. The patient had an uncomplicated hospital stay and showed neurological improvement with physiotherapy. Follow up imaging confirmed resolution of the empyema and infarct.

Discussion: This case underscores how subdural empyema can mimic acute ischemic stroke, especially in younger patients where fever and classical signs of infection may be absent. Potential mechanisms include mass effect, venous thrombosis, or vasospasm. Timely imaging and intervention are vital for optimal recovery, regardless of microbial confirmation.

Conclusion: Not all strokes are due to a clot. Subdural empyema can present as an ischemic event, masking a deeper pathology. A high index of suspicion, prompt imaging, surgical intervention, and prolonged antibiotics can dramatically improve outcomes in such deceptive presentations.

Abstract ID 571: BIALLELIC SETX Mutations Presenting as Spinocerebellar Ataxia, Autosomal Recessive, with Axonal Neuropathy-2’ (SCAN2) in an Indian Family-A Case Report

Ilakkiya Venu, Ravikumar V, Rajasekharan M, Kannan N

K.A.P. Viswanatham Government Medical College, Trichy, Tamil Nadu, India

Background and aim: We present a patient of SETX Gene associated with autosomal recessive cerebellar ataxia with axonal neuropathy, who had features suggestive of cerebellar ataxia, head tremor, dysarthria with significant family history.

Methodology: Case report

Results: A 24-year-old female presented with insidious onset, gradually progressive neurological illness of 4 years duration in the form of unsteadiness of gait, tremulousness movement of bilateral upper limbs which increased on reaching objects, slurring of speech, tremulousness movement of head normal motor, sensory, cranial nerves, higher mental functions (HMF), ANS with significant family history (brother had similar complaints). General examination: No abnormalities central nervous system (CNS) Examination : HMF : Conscious, oriented mini mental state examination (MMSE) : 29 Speech : Articulation- Scanning and staccato speech CN Examination : 3,4,6 th CN : B/L Horizontal nystagmus Saccades: horizontal slowing Broken pursuit Spinomotor : normal Sensory: Vibration impaired both great toe Cerebellar signs: Head tremor B/L Horizontal nystagmus Speech – Scanning and staccato speech Intentional Tremors Coordination: UL – Finger-Nose Test (FNT), Fast Finger-Nose Test (FFNT) : Past pointing with hyper and hypometria, Dysdiadochokinesia - present Lower Limbs – Heel Knee test – Impaired. Tandem Walking – Cannot be assessed. Gait ataxia present. Routine blood investigations normal. Viral markers negative, Thyroid profile was normal. MRI brain: Bilateral cerebellar atrophy, NCS all 4 limbs : sensory >motor axonal neuropathy VNG : HYPOMETRIC SACCADES. Whole Genome sequencing of patient and her brother shows SETX gene associated with spinocerebellar ataxia, autosomal recessive, with axonal neuropathy-2’ (SCAN2).

Discussion: SCAN2 is a neurodegenerative disorder characterized by juvenile onset of progressive cerebellar ataxia, axonal sensorimotor peripheral neuropathy, and increased serum alpha-fetoprotein. Oculomotor apraxia is a common but inconsistent finding, found in about 50% of patients; hence, this disorder is sometimes referred to as ‘ataxia-oculomotor apraxia-2’ (AOA2).

Conclusion: In the patient studied, gait disturbance started at the age of 20, and oculomotor apraxia was absent. The patient treated with low-cholesterol diet, gait physiotherapy and speech therapy. Patient is under follow up.

Abstract ID 572: “Spastic Ataxia in Siblings: A Case Series of Genetically and Radiologically Characterized ARSACS from Southern India”

Dilip Vangara, Thamilpavai N, Uma Maheswari E, Mugundhan Krishnan

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) is a rare inherited neurodegenerative disorder caused by mutations in the SACS gene on chromosome 13q12.12. Though originally described in Quebec, Canada, ARSACS is now recognized worldwide. Reports from India, particularly with genetic confirmation, remain limited. This case series aims to describe the clinical, neurophysiological, imaging, and genetic features of four patients from two unrelated consanguineous families, two of whom are genetically confirmed to have ARSACS.

Methodology: Four female patients from two sibling pairs were evaluated: Case 1: A 29-year-old woman with early-onset spastic ataxia, distal wasting, and gait disturbance. Genetic analysis showed a homozygous partial deletion of exon 5 of the SACS gene. Case 2: Her 26-year-old sister with similar features declined genetic testing. Case 3: A 23-year-old woman with adolescent-onset gait ataxia and lower limb stiffness. Genetic testing revealed a homozygous frameshift mutation in exon 10 of the SACS gene. Case 4: Her 20-year-old sister also presented with similar symptoms but opted out of genetic testing. All underwent clinical exams, magnetic resonance imaging (MRI) brain, and nerve conduction studies.

Results: All patients exhibited the classical ARSACS triad: spasticity, cerebellar ataxia, and sensorimotor neuropathy. MRI findings included superior vermis atrophy and characteristic pontine linear hypointensities (“tigroid” pattern). Nerve conduction studies showed demyelinating or axonal neuropathy. Fundus and cognition were normal in all.

Discussion: ARSACS may be underdiagnosed in India due to limited genetic access. MRI features and clinical signs can strongly suggest diagnosis even in the absence of genetic confirmation.

Conclusion: ARSACS should be suspected in early-onset spastic ataxia with typical imaging. Clinical and radiological recognition remains crucial in resource-limited settings.

Abstract ID 573: Aicardi Goutières Syndrome: Unlocking the Puzzle of Early Encephalopathy

Janki Makani, Deepika Joshi, Anand Kumar

Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background and aim: Aicardi Goutières syndrome is rare genetic disorder which presents in neonates and infants. It is associated with TREX1 gene mutation. The autoimmunity has been found recently as part of pathophysiology of the disease. Hence, this is to highlight the disease and possible treatment options.

Methodology: A 4-year-old male born out of non-consanguineous marriage and normal birth history presented with global developmental delay and failure to thrive. The mother also noticed dystonic posturing of the limbs with spasticity. The patient was also having stimulus-sensitive myoclonus. On examination, microcephaly was present. With increased tone and dystonic posturing of limbs on walking. Deep tendon reflexes were exaggerated and babinski sign was positive. Magnetic resonance imaging (MRI) brain was suggestive of white matter changes. The patient’s younger brother is also having similar complaints since 10 months of age.

Results: considering the progressive nature of the disease and positive family history, possibility of genetic disease was high. The patient was also screened for any systemic manifestations of the disease. However it was normal. His whole-exome sequencing was sent, which was suggestive of pathogenic variant of TREX1 gene mutation. It also matches the phenotype of the patient.

Discussion: Aicardi Goutières syndrome is a rare autosomal recessive encephalopathy having monogenic autoimmune etiology. The patient may present with neurological as well as other systemic manifestations. Neurological symptoms include seizures, dystonia, myoclonus, poor neck holding, irritability, spasticity. The systemic manifestations include erythema, glaucoma, hypothyroidism, pulmonary hypertension, cardiomyopathy, autoimmune hepatitis, myopathy and arthropathy. Appropriate investigations should be carried out for detecting these rare presentation.

Conclusion: To conclude, recent advances has shown that considering autoimmune etiology, research is ongoing especially with JAK inhibitors. It has role in suppressing interferon activation. However currently symptomatic and supportive management remains the mainstay of the treatment.

Abstract ID 574: Tuberous Sclerosis Complex in an Adolescent Male Presenting with Pulmonary Lymphangioleiomyomatosis and Recurrent Pneumothorax: A Rare Case Report

Valli Priya, A Sita Kanthima, U Kumari, N V Sundara Chary, T Bhnau Prasad, A Sita Kanthima, T Bhanu Chandra

Guntur Medical College, Andhra Pradesh, India

Background and aim: Tuberous Sclerosis Complex (TSC) is a multisystem genetic disorder characterized by benign tumors affecting the brain, skin, kidneys, heart, and lungs. It is most commonly diagnosed in childhood based on dermatological findings, seizures, or developmental delay. Seizures, often caused by cortical tubers, are present in up to 90% of TSC patients. Pulmonary lymphangioleiomyomatosis (LAM), a progressive cystic lung disease, is a rare manifestation of TSC. Here, we report case of a 15-year-old male presenting with recurrent seizures and spontaneous pneumothorax due to LAM with one shagreen patch

Methodology: Chest X-ray: Detection of pneumothorax. High-Resolution CT (HRCT) Chest: Identification of cystic lung changes consistent with LAM. CT Brain: Identification of cortical tubers.

Results: Tuberous Sclerosis Complex (TSC) with pulmonary LAM, seizures secondary to cortical tubers.

Discussion: This case represents a rare constellation of TSC manifestations in a male adolescent. Seizures were the initial neurological manifestation, consistent with cortical tubers, which disrupt normal cortical architecture. LAM involves the proliferation of abnormal smooth muscle-like cells in the lung, leading to cyst formation and recurrent pneumothorax. Cutaneous manifestations in TSC are often a diagnostic clue; however, this patient had only one shagreen patch, emphasizing that TSC may present with minimal dermatological signs.

Conclusion: This case highlights a rare presentation of Tuberous Sclerosis Complex in a male, manifesting with recurrent seizures and spontaneous pneumothorax due to pulmonary LAM. Despite minimal cutaneous findings, the diagnosis was established based on neurological and pulmonary imaging.

Abstract ID 575: An Interesting Case of Recurrent Vision Loss-Vogt Koyanagi Hirada Syndrome

Aswin G, Kishore R, Rajasekharan M, Arun Raj E

K.A.P. Viswanatham Government Medical College, Trichy, Tamil Nadu, India

Background and aim: Vogt-Koyanagi-Harada (VKH) disease is defined as a bilateral granulomatous panuveitis, with or without extraocular manifestations, affecting young adults. It is characterized by chronic pan uveitis, alopecia, vitiligo, and dysacusia with bilateral exudative retinal detachments, accompanied by pleocytosis of cerebrospinal fluid.

Methodology: A 26-year-old female patient presented with recurrent episodes of vision loss alternating with each eye and last episode with sequential involvement of both eyes for a duration of 1.5 years. She was investigated and evaluated for the cause during each admission. She didn’t have any dermatological/neurological manifestations.

Results: Patient’s visual acuity was decreased in each affected eye during the acute episode; fundus examination revealed hyperemic fundus with blurred disc margins and marked obscuration of vessels. VEP was prolonged in each eye during the episode. Magnetic resonance imaging (MRI) brain with optic nerve cuts with contrast was normal for 3 times. Cerebrospinal fluid (CSF) analysis was normal and CSF OCB were negative. Serum myelin oligodendrocyte glycoprotein (MOG), aquaporin 4 were negative. Her antinuclear antibody (ANA) profile was negative. C-ANCA and P- ANCA were negative. Serum angiotensin-converting enzyme (ACE) levels and CT chest were normal. Optical coherence tomography (OCT) showed macular edema with sub retinal pockets of fluid collection. B scan revealed exudative retinal detachments. Her hearing assessment was normal. Patient was treated with intravenous methyl prednisolone during initial 4 episodes and her symptoms drastically improved. Her last episode showed bilateral pan uvetis with optic neuritis with festoon pupils and had a partial recovery after steroid therapy.

Discussion: After investigations become inconclusive, patient was diagnosed with a probable VKH disease as per the diagnostic criteria.

Conclusion: Vogt Koyanagi hirada disease is a rare cause for recurrent uvetis with optic neuritis and it should be considered whenever investigations are inconclusive and a diagnostic dilemma is present. Many cases of VKH syndrome are getting missed due to lack of awareness regarding the condition.

Abstract ID 576: Nummular Headache: Clinical Characteristics and Therapeutic Outcomes from a South Indian Cohort

Sandhya Manorenj

Deccan College of Medical Sciences, Hyderabad, Telangana, India

Background and aim: Nummular headache (NH) is an uncommon, newly identified primary headache disorder characterized by a distinct, coin-shaped region of pain on the scalp. Despite growing awareness, information regarding its clinical features and treatment outcomes is still scarce. This case series seeks to outline the clinical profiles, diagnostic elements, and treatment responses in patients diagnosed with NH over five years.

Methodology: A retrospective analysis of all patients diagnosed with NH at a tertiary care neurology clinic was conducted for the period between January 2020 and December 2024. The diagnosis was established based on the criteria from the International Classification of Headache Disorders (ICHD-3). Collected data included demographic details, headache features, accompanying symptoms, neurological assessments, imaging results, and treatment responses. Patients were followed for a minimum duration of six months

Results: Eight patients were identified (8 females), with an average age of 25.5 ± 5.4 years. Most reported experiencing localized, pressure-like or stabbing pain in the parietal region. Pain intensity varied from moderate to severe, with the majority reporting episodic symptoms. No focal neurological deficits or abnormal findings on neuroimaging were observed. Duration of symptom lasted from 3 months to 12 months Indomethacin and gabapentin were the most frequently administered treatments, with 66.7% of patients reporting substantial relief. Other medications, such as amitriptyline, exhibited varying levels of effectiveness. Underlying associated conditions detected were hyperglycemia and vitamin D deficiency.

Discussion: NH continues to be an under-recognized condition due to its atypical presentation and similarity to other headache disorders. The results confirm the benign nature of NH and emphasize the necessity of clinical diagnosis substantiated by the exclusion of secondary causes. Treatment responses were inconsistent but generally positive with both indomethacin and gabapentin.

Conclusion: Increased recognition and larger prospective studies are essential to develop standardized management approaches.

Abstract ID 577: Forgotten Hours, Lingering Spikes: Distinguishing TGA from its Epileptic Twin

Shamisha Khade, Vibhor Pardasani

Bombay Hospital, Mumbai, Maharashtra, India

Background and aim: Transient Global Amnesia (TGA) and Transient Epileptic Amnesia (TEA) are characterized by sudden-onset transient memory disturbances. While TGA is classically non-epileptic and self-limiting, TEA is a manifestation of temporal lobe epilepsy with recurrence. Differentiating between the two has critical therapeutic implications as managenent differs. TGA is characterized by the sudden onset anterograde amnesia lasting less than 24 hours, without other neurological deficits, does not require anti-seizure medications. Temporal spikes on Electroencephalography (EEG) can complicate the diagnosis. This case series highlights clinical markers to differentiate TGA from TEA in patients with left temporal epileptiform discharges on EEG.

Methodology: We retrospectively reviewed four patients presenting with sudden-onset memory loss. Each underwent a neurological examination, brain magnetic resonance imaging (MRI), EEG, and 6–12 months of follow-up. Presentations were compared with established TGA (Hodges and Warlow) and TEA (Zeman) criteria.

Results: All patients exhibited: Acute amnesia lasting 4–12 hours. Preserved consciousness and identity. No automatisms, olfactory hallucinations, or focal neurological deficits. No history of seizures or similar prior episodes EEG revealed left temporal interictal spikes in all cases. MRI was either normal or showed hippocampal diffusion restriction suggestive of TGA. None received anti-seizure medications. All recovered fully, with no recurrence of symptoms or seizure activity on follow-up.

Discussion: Despite EEG abnormalities, clinical features strongly favoured TGA: Single, prolonged episode. No ictal signs or automatisms. Full spontaneous recovery. No sleep-related onset or early morning episodes. These contrast with TEA, which typically includes brief, recurrent episodes, often on waking, and may involve autobiographical memory loss or sensory symptoms—absent here.

Conclusion: Temporal EEG spikes alone should not confirm the diagnosis of TEA in patients with otherwise classic TGA like presentations. Clinical context is important in differentiating the two. In the absence of recurrence, ictal signs, or behavioral arrest, conservative management without anti-seizure drugs is reasonable.

Abstract ID 578: Sepiapterin Reductase Deficiency: Diagnostic Challenges in DOPA-Responsive Dystonia

Caroline Silvia, Robert Wilson, Kalpana Silvia, Arunan Subbiah, Kalpana Wilson, Kalpana R

SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu, India

Background and aim: Sjogren syndrome is a chronic systemic autoimmune disorder characterised by the presence of dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) due to lymphocytic infiltration into the lacrimal and salivary glands. Additional symptoms can include dryness of skin, nose, throat; arthralgias and myalgias; peripheral neuropathies; pulmonary, thyroid, and renal disorders.

Methodology: A 54-year-old lady, who is hypothyroid, had complaints of tremors in the right upper and lower limb. A diagnosis of Parkinson’s was made and was started on Levodopa. Neuroimaging revealed T2 Flair hyperintense lesions in the periventricular region perpendicular to the corpus callosum, which were characteristic of multiple sclerosis-like lesions. The patient was continued on levodopa and showed improvement. Later, she developed right-sided weakness, sicca symptoms for 3 months and high-grade fever spikes for 5 days. Evaluation revealed raised erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), positive RA factor – 54.4 and Anti-CCP 8.27. Cerebrospinal fluid (CSF) analysis was unremarkable. Serum IgG index was normal. Antinuclear antibody (ANA) was positive 2+ (nucleolar pattern) and profile revealed ssA Ro 60 kd positivity, suggestive of Sjogren’s syndrome.

Results: There is a correlation between PD (inflammation at the onset or progression of PD) and autoimmune disorders, which has emerged as a prominent area of interest. The inflammatory process associated with Sjögren’s gives rise to a range of additional manifestations beyond glandular involvement. Neurological symptoms are reported to be found in 8.5–70%, of which Peripheral Nervous System (PNS) is more commonly involved than Central Nervous System (CNS) – neuronopathy, ganglionopathy, mononeuritis multiplex. CNS (2–25%) symptoms include headache, meningitis, seizures, transverse myelitis, optic neuritis, ataxia, encephalopathy, and multiple sclerosis-like (MS-like) lesions, along with occurrences of Parkinsonism, depression, anxiety and psychosis. Neurological symptoms manifest before the onset of sicca symptoms.

Discussion: In cases of an atypical course of Parkinson’s disease or when there is inadequate response to standard treatment, causes of secondary Parkinsonism must be thought of.

Conclusion: PD, MS-like lesions - Sjogren’s

Abstract ID 579: Unsteady Beginnings- Understanding Early Onset Ataxia- Report on a Case of ARSACS

Sangeetha Nair, Aishwarya Menon, Sowmini R, Sakthi S, Velusamy S

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay is the 2nd-most common cause of recessive ataxia worldwide after Friedrich’s ataxia. It’s characterised by progressive cerebellar ataxia, spasticity& peripheral neuropathy

Methodology: Here, we report the case of a 38-year-old lady from Chennai, 2nd born of consanguinous marriage, who presented with insidious onset unsteadiness and swaying while walking since 1st decade of life, which progressed to requirement of assistance to walk by 4th decade of life, associated with slurred speech with undue pauses between syllables and clumsiness of hands with shaking on reaching for targets. By 4th decade, she was dragging feet while walking due to lower limb stiffness and had numbness of feet (altered perception of floor). Her younger brother also had similar complaints since childhood. On examination, her MMSE was 22/30. She had lower limb spasticity with distal more than proximal weakness of both lower limbs, with exaggerated deep tendon reflexes except absent ankle jerks. She had graded loss of all sensations in lower limbs. She had bilateral gaze evoked nystagmus, dysmetric saccades, broken pursuits, scanning type dysarthria, impaired finger-nose & heel-knee tests bilaterally with stance & gait ataxia. Routine hematological & biochemical & thyroid function tests were normal except for anemia, managed with blood transfusions. Hearing & cardiac evaluation were normal. Fundus showed changes of hypertensive retinopathy. Nerve conduction studies (NCS) showed severe sensorimotor axonal neuropathy of all 4 limbs with secondary demyelinating changes. Magnetic resonance imaging (MRI) brain showed superior vermian atrophy with linear hypointensities in pons.

Results: Whole-exome sequencing revealed homozygous variant of SACS gene on exon10. She was managed with gait training and vitamin supplements and given genetic counselling.

Discussion: While approaching early onset/ recessively inherited ataxias, we must identify a laboratory biomarker or a signature radiologic feature to help narrow the differential diagnosis.

Conclusion: Pontine linear hypointensities on MRI is a sensitive marker of ARSACS

Abstract ID 580: Three Interesting Cases of Ocular Myasthenia Presenting as Blepharospasm

R Pazhani

Pazhani Neuro Centre, Chennai, Tamil Nadu, India

Background and aim: Ocular myasthenia and blepharospasm are seen in the outpatient neurological service. Occasionally ocular myasthenia can present as blepharospasm and three such cases are presented here.

Methodology: Fifty-eight year, forty-year-old gentlemen and sixty-year-old lady presented over a period of six months to the outpatient neurological service with history of bilateral frequent blinking of eyelids with no double vision, no dysphagia and no limb weakness. All of them had a small dose of trihexyphenidyl and clonazepam with no improvement. Clinically on close observation, it was found that some of the some of the blinking was followed by mild drooping of the eyelids which got corrected immediately.

Results: All the three patients were tested for serum acetylcholine receptor antibody, anti-MUSK antibody, chest X-ray (CXR). All three had positive acetylcholine receptor antibody level, 0.7, 0.6 and 0.5 nmol/L with negative anti-muscle-specific kinase (MuSK) antibody test. The CXR was normal in all three patients. The other blood parameters were in the normal range. The trihexyphenidyl and clonazepam was stopped as there was no response and they were started on T Pyridostigmine 60 mgm half tablet three times a day with good response.

Discussion: Frequent blinking can be the presentation in some cases of ocular myasthenia as a compensatory mechanism for fatigue and ptosis. In the background of no double vision and no other myasthenic symptoms, this can lead to the diagnostic and therapeutic error.

Conclusion: Blepharospasm can be the manifestation in some cases of ocular myasthenia. History, clinical examination, suspicion and appropriate investigation will help to diagnose this unusual presentation.

Abstract ID 581: 2 Rare Case Reports of Autoimmune Nodopathy

Sanjana DS, Archana NB, Praveen Kumar, Pramod K, Janardhan DC

Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Background and aim: -Autoimmune nodopathy are diseases where antibodies targeting peptide structures of the node (NF186/140, Gliomedin) and paranode (CNTN1, Caspr1, NF 155) were identified in patients with clinical features of Guillain–Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Patients with positive anti-NF186/140 IgG are rare (<3%) and we highlight 2 such cases.

Methodology: A 39-year-old man presented with distal paresthesia since 4 days and quadriparesis since one day. Examination revealed flaccid quadriplegia with autonomic dysfunction and respiratory failure. Nerve conduction studies (NCS) showed severe motor axonal polyneuropathy. He was treated with IVIG following which his respiratory failure improved. Autoimmune nodopathy panel came positive for NF 140 antibody. Though he received IV Methylprednisolone and Rituximab, there was no further improvement.

Results: A 46-year-old woman presented with progressive sensory ataxia of four months. Examination showed severe large fibre sensory loss. Electrophysiology disclosed pure sensory axonal polyneuropathy. Etiological workup in terms of autoimmune, paraneoplastic, vasculitic, and serological markers were normal. NF186 IgG antibody was positive. Patient received 5 days of IV pulse Methyl prednisolone and 1st cycle of Rituximab. She improved from a completely bedbound state to being able to walk with minimal support.

Discussion: -Though these patients presented as acute motor axonal neuropathy (AMAN) variant of Guillain-Barré syndrome (GBS) and sensory variant of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) both of them didn’t respond to IVIG. -Nodo-paranodopathy should be suspected in patients presenting with acute to subacute onset predominantly distal motor neuropathy with rapid progression and severe nadir disability; associated features- severe sensory ataxia, tremor, autonomic dysfunction or respiratory insufficiency, associated disorders- Nephrotic syndrome; less responsive to IVIG and responsive to PLEX, rituximab, corticosteroids.

Conclusion: -Patients with specific antibodies to NF186/NF 140 are rare. -Their prompt recognition and institution of appropriate therapy can lead to improved outcomes and help in prognostication and conserve costly resources.

Abstract ID 582: Uncommon Unyoked Stroke Presented as Isolated Bilateral INO

Chaitra Gowda, Manasa K

ESIC Medical College and PGIMSR, Rajajinagar, Bengaluru, Karnataka, India

Background and aim: Horizontal gaze coordination is achieved by the yoking of ipsilateral lateral recuts and contralateral medial rectus via the abducens-MLF-oculomotor pathway. The medial longitudinal fasciculus (MLF) is a highly myelinated tract that connects the ipsilateral third nerve nucleus in the midbrain to the contralateral sixth nerve nucleus in the pons. Internuclear ophthalmoplegia (INO) can result from lesions along this pathway. Bilateral INO (BINO) is rare, and the most common cause of BINO is Multiple Sclerosis. This case report highlights Isolated BINO due to ischemic stroke - an uncommon clinical stroke syndrome

Methodology: A 49-year-old male with no comorbidities or risk factors presented with sudden-onset diplopia. At presentation his blood pressure was 160/80 mmHg, with pulse rate of 98 beats per minute. Neurologic examination revealed exodeviation of right eye in primary gaze position. He had bilateral adduction weakness associated with abduction nystagmus on side gaze. On upward gaze upbeating nystagmus was observed. Convergence was unimpaired. Pupillary reflex and palpebral elevation were normal. Other cranial nerves were intact. Rest of the neurological examination was normal. Routine laboratory investigations were normal, except for random blood sugar which was elevated. Magnetic resonance imaging (MRI) brain showed T2/FLAIR hyperintense lesion with diffusion restriction on diffusion-weighted imaging (DWI) sequence in the dorsal median pons suggestive of acute infarct. The possibility of demyelination was still considered. However, cerebrospinal fluid (CSF) biochemistry showed no abnormality and was negative for oligoclonal bands. Serum anti-MOG and anti-AQP4 antibodies were negative. The patient was incidentally diagnosed with diabetes mellitus, with HbA1C- 11%. ECG revealed sinus rhythm. Two-dimensional echocardiography showed global LV hypokinesia with EF of 30%, with no evidence of thrombus

Results: A diagnosis of isolated bilateral INO secondary to infarct of dorsal median pons was made. Patient was initiated on appropriate treatment. He reported improvement in diplopia by the fifth day. The patient on follow up after 24 days after presentation, reported significant resolution of diplopia, and on examination was found to have improvement in ocular motility.

Discussion: Isolated BINO is a unique clinical stroke syndrome caused by dorsal brainstem infarction involving the MLF bilaterally. In a study of 33 patients with INO, it was found that the most common cause of unilateral INO was infarction, and bilateral INO was Multiple sclerosis. One study noted that the cause for BINO was more likely to be infarct in a patients above 45 years of age, and more likely demyelinating disease in the category of patients less than 45 years of age. In a study with 33 patients with INO due to acute stroke, it was shown that patients become asymptomatic in primary position over 2 to 3 months. The presence of other associated neurological deficits correlated with persistent diplopia.

Conclusion: This case underscores the importance of recognizing BINO as a potential isolated manifestation of brainstem infarct, one of the myriad of other presentations of stroke. However the statistically more common cause- demyelination- must be kept in mind, particularly at first presentation. MRI, MRA, cardiovascular investigation, and cerebrospinal fluid analysis with evaluation of oligoclonal bands should aid clinical judgment in the evaluation of a case of BINO. Stroke as compared to demyelination as a cause of BINO has an excellent prognosis, particularly in isolation, when not associated with other neurological deficits.

Abstract ID 583: Masquerading as Myopathy

Rekha Patil, Archana B, Praveen S, Archana Netto, Pramod K, Janardhan C

Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Background and aim: Choreo-acanthocytosis (ChAc) is a rare autosomal recessive syndrome characterized by hyperkinetic movements, cognitive impairment, seizures, neuropsychiatric symptoms and acanthocytes in peripheral smear. It is due to mutations of the gene VPS13A located on 9q21. The average age of onset is 35 years. It poses a serious diagnostic challenge as it takes years to evolve into a classic multisystem syndrome. Here we present a rare initial manifestation of this disease.

Methodology: A 36-year-old male was admitted with progressive waddling gait of six months. On examination, the patient had mild proximal weakness (MRC grade 4) in lower limbs with areflexia. Initial working diagnosis was of acquired myopathy vs radiculopathy. Routine hematological, biochemical, inflammatory/autoimmune parameters were normal except elevated CPK level of 945. Electrophysiology showed sensory axonal polyneuropathy involving lower limbs. Subsequent examination of patient disclosed infrequent episodes of grunting suggestive of vocal tics. After correlating the sensory neuropathy, proximal muscle weakness, elevated creatine phosphokinase (CPK) and the presence of vocal tics, neuroacanthocytosis was suspected and peripheral smear was sent which showed acanthocytes (5%). Magnetic resonance imaging (MRI) brain revealed bilateral caudate atrophy. Whole-exome sequencing identified a novel homozygous deletion of exon 60 variant c. (8211+1_8212-1)(8325+1_8326-1) of VPS13A gene on chromosome 9 confirming the diagnosis of ChAc.

Results: Our patient highlights the uncommon presentation of this rare disease.

Discussion: Neuroacanthocytosis syndromes are exceedingly rare. The current knowledge about the disease is mainly based on the small number of case reports. The clinical features of ChAc are diverse, and there is no common diagnostic standard. Even though patients are detected to have raised CPK in early stages of disease, patients with initial presentation as myopathy have not been reported to the best of our knowledge.

Conclusion: So the patient studied highlights the uncommon presentation and the detection of novel mutation indicates the probable phenotype-genotype associations of this rare disease.

Abstract ID 584: Rituximab in Anti-Mi-2 Antibody-Mediated Refractory Dermatomyositis with Calcinosis Cutis

Sripadma V, Aparna Pai, Sanjay Kordcal, Prashant Bhatele

Kasturba Medical College, Manipal, Karnataka, India

Background and aim: Background: Dermatomyositis is a rare immune-mediated myositis characterized by proximal muscle weakness, cutaneous involvement, and the potential for interstitial lung disease or malignancy.

Methodology: Case: A 19-year-old presented with a progressive history of difficulty climbing stairs and raising arms overhead for 6 months. On examination, she exhibited diffuse hyperpigmentation and hard plaques on the lower back and buttocks. Shawl sign, Gottron’s papules, finger-tip ulcers were not seen. She displayed a pure motor limb girdle pattern of muscle weakness with no cranial nerve, cerebellar, or sensory involvement. Dermatomyositis with calcinosis cutis was considered.

Results: Hemogram, renal, and liver function tests were normal. Creatine phosphokinase was 1337 U/l, and myositis panel was strongly positive for anti-Mi-2 antibodies. X-ray of the back showed calcinosis cutis. Nerve conduction studies were normal, and the electromyogram indicated myopathy. Skin and muscle biopsy showed interface dermatitis and perifasicular inflammation with atrophy consistent with dermatomyositis. Computed tomography of thorax was normal, and a malignancy screen was negative. Steroids and azathioprine were started. At the six-week follow-up, she reported improvement; difficulty in getting out of bed and rising from chairs persisted. Slow steroid taper was planned while continuing azathioprine. In the fourth month of treatment, she developed steroid-induced osteoporosis, and steroids were withdrawn. By the end of the sixth month, clinical improvement had plateaued. She still couldn’t climb stairs. Two doses of Rituximab 1000 mg were administered two weeks apart and repeated after six months. One year into the treatment, she can run and climb stairs, and her cutaneous hyperpigmentation and calcinosis continue to improve.

Discussion: Anti-Mi-2 antibody-mediated dermatomyositis can present with calcinosis cutis in addition to myositis. Rituximab induces remission and is a good alternative to azathioprine and mycophenolate mofetil in these patients.

Conclusion: Rituximab improves not only the myositis but also the cutaneous manifestations in anti-Mi-2 antibody-mediated refractory dermatomyositis.

Abstract ID 585: Overlap Myositis: Bridging Autoimmunity and Muscle Disease

Vaddadi Navya Sri, Sakthi Velayutham, P R Sowmini, Malcom Jeyaraj, S Velusamy, V Kannan

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Overlap syndromes have been defined as at least two connective tissue diseases occurring at same or at different times in same patient. Connective tissue diseases (CTDs) include systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, polymyositis / dermatomyositis and sjogren syndrome. Overlap myositis is a condition where myositis occurs alongside features of other CTDs is a subtype of idiopathic inflammatory myopathy.

Methodology: A 36-year-old male presented with subacute onset and gradually progressive proximal greater than distal weakness of all four limbs, later he developed truncal and neck muscle weakness, cramps over bilateral calf, weight loss, not associated with sensory symptoms, cranial nerve, bowel and bladder involvement. On examination, patient was conscious oriented, hyperpigmentation of skin was present, bilateral temporal hollowing, supraclavicular hollowing, infraclavicular flattening, bilateral deltoid, biceps, triceps, bilateral thigh and calf wasting was present, cranial nerve examination was normal, neck flexor and extensor weakness, proximal greater that distal weakness of all limbs with preserved deep tendon reflexes, plantar flexor, sensory, cerebellum normal.

Results: Routine investigations were showing serum potassium 2.5 mg/dl, CPK – 11200, LDH- 1888, ESR- 32 mm/hr, ANA- POSITIVE, SSA- POSITIVE, nerve conduction study was normal, EMG features suggestive of inflammatory myopathy. Schrimmers test negative, lip biopsy was done –normal. Muscle biopsy of left vastus lateralis -features suggestive of inflammatory myopathy consistent with overlap myositis – vasculitis .whole body PET CT-features of inflammatory myositis. He was treated with 5 days of intravenous methylprednisolone followed by oral steroids and mycophenolate mofetil, patient symptomatically improved.

Discussion: Overlap myositis should be in the differentials in patients presenting with clinical features suggestive of idiopathic inflammatory myositis even if there is no overlap features of CTD.

Conclusion: Prompt diagnosis will help provide adequate treatment to get better response to the therapy and to closely monitor the possible complications.

Abstract ID 586: Unravelling Morvan Syndrome: A Rare Neuro-Immunological Puzzle

Caroline Silvia, Kalpana R, Robert Wilson, Arunan Subbiah

SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu, India

Background and aim: Morvan syndrome (MoS) is a rare and complex disorder of nervous system hyperexcitability. Central nervous system (CNS) hyperexcitability manifests as confusion, behavioral changes, myoclonus, and severe insomnia; hallucinosis and encephalopathy may also occur. Autonomic hyperactivity includes hyperhidrosis, constipation, labile blood pressure, hemodynamic instability, and cardiac arrhythmias. Finally, peripheral nervous system hyperexcitability is typically demonstrated by painful muscle cramps, myokymia and neuromyotonia.

Methodology: A 27-year-old gentleman presented with complaints of low back ache, radiating pain to the buttock and thigh, twitching of muscles in his shoulder, forearm and calf muscles. There was history of sleeplessness, drenching sweats at night with tremors. There was history of ayurvedic medication intake for cholelithiasis for 5-6 months. Examination revealed labile blood pressure, rippling muscle movements - myokymia over the shoulder, forearm and calf muscles. On evaluation, serum voltage-gated potassium channel (VGKC) antibodies were positive. Serum mercury levels were elevated, though not in the toxicity range. The patient was started on intravenous immunoglobulin and continued on steroids. He was supported through physiotherapy. He gradually improved and is on follow up.

Results: MoS is a rare—less than 1 case per million population with a male preponderance. Etiology of this condition is varied – a viral infection, exposure to heavy metals, associated with Siddha/ Ayurveda medication. It is associated to antibodies against the VGKC complex proteins.

Discussion: Contactin-associated protein-like 2 (CASPR2) is expressed predominantly in the peripheral nervous system, whereas LGI1 is found in the central and peripheral nervous systems. Management is by steroids, intravenous immunoglobulin and plasmapheresis.

Conclusion: MoS is a rare disorder due to hyperexcitability of the nervous system. Thorough history, prompt evaluation and timely management are essential for a better prognosis.

Abstract ID 587: Clinical Utility of Electroencephalography in ICU: A Retrospective Audit from Narayani Hospital, a Tertiary Care Center

Anand Diwan, Pankaj Rane, Devikumar Kelkar, Swapnil Sakhala, Gouri Diwan

Narayani Hospital, Nashik, Maharashtra, India

Background and aim: Continuous or routine electroencephalogram (EEG) in the ICU setting provides crucial diagnostic and prognostic information in patients with altered consciousness, seizures, or encephalopathy. This study aimed to analyze the clinical indications and EEG findings in ICU patients referred for EEG monitoring and assess its diagnostic utility in a real-world setting.

Methodology: This retrospective observational study was conducted at a tertiary care center, Narayani hospital, Nashik. EEG records of ICU patients referred between October 2023 and May2025 were reviewed. Demographic details, clinical indications, and EEG findings were extracted from EEG logs. EEGs were classified into normal, generalized slowing, periodic discharges, burst suppression, epileptiform abnormalities, or other findings.

Results: A total of 40 ICU EEGs were analyzed (age range: 8–83 years, mean age: ~50 years; M:F = ~2:1). The most common clinical indications were: 1) Unexplained altered sensorium/drowsiness (45%), 2) Seizures/status epilepticus (20%), 3) Hypoxic-ischemic encephalopathy (HIE) (20%), 4) post-arrest monitoring (15%). EEG findings included: Generalized slowing – 30%, Normal EEG – 25%, Burst suppression pattern – 10%, Bilateral epileptiform discharges – 10%, Triphasic waves/metabolic encephalopathy patterns – 7%, Other patterns (e.g., PLEDs, alpha coma) – 5%.

Discussion: The study highlights the diagnostic yield of ICU EEG, particularly in seizure identification, assessment of encephalopathy, and prognostication in comatose states. Generalized slowing was the most frequent abnormality, reflecting diffuse cerebral dysfunction. Normal EEGs were also informative in ruling out ongoing nonconvulsive seizures.

Conclusion: ICU EEG is a valuable bedside neurophysiological tool. Despite limitations in access and interpretation, it provides critical data influencing diagnosis and management in a significant proportion of ICU patients.

Abstract ID 588: Localisation Riddle: Diplopia, Ataxia with Frontalis Over Activity

Pranjali Batra, Rameshwar Chaurasia, Varun Singh, Ibrahim Hussain, Ankur Vivek

Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background and aim: The importance of detailed history and examination in the patient of stroke cannot be undermined as it helps to localise the artery.

Methodology: We report a case of dilated cardiomyopathy with acute stroke with vertical diplopia and ataxia.

Results: A 57-years-old patient, a known case of dilated cardiomyopathy on treatment for 2 years, presented with history of sudden onset of vertical diplopia that worsened with down gaze. It was associated with swaying to left side while walking. The symptoms were sudden in onset and non-progressive. On examination, BP 90/60 and PR 80/min and regular. On neurological examination, there was tilt of the head towards the left side. There was anisocoria with right side more dilated than left. Light reflex was diminished on both sides. She had impaired adduction, depression and elevation on the right side along with impaired elevation of left side. Asymmetry was noted in the resting position in the wrinkles of forehead which disappeared when she was asked to look up. Finger nose test was impaired on the left side with swaying to left side while walking. Pinprick sensation was impaired on left half of face, left upper limb and lower limb. MRI brain showed T2 flair hyperintensity in the left upper medial midbrain extending into the medial thalamus with diffusion restriction suggestive of acute infarct.

Discussion: The ocular examination revealed restriction in vertical gaze bilaterally and left eye abduction, therefore neck tilt and frontalis overactivity is the compensatory mechanism. Thus, ataxia, diplopia, hemisensory loss is localised to thalamus and midbrain. Thalamic infarction varies in presentation based on the involvement of artery-inferolateral, tuberothalamic, posterior choroidal, paramedian. Inferolateral territory strokes produce contralateral hemisensory loss, hemiparesis, hemiataxia, and pain syndromes.

Conclusion: We learn neurology stroke by stroke and detailed evaluation helps to determine the artery involved.

Abstract ID 589: Expanding the Clinical Spectrum of Deficiency of Adenosine Deaminase 2 (DADA2): A Case of Conus Cauda Syndrome

Shivam Mirg, Ayush Agarwal, Achal Srivastava

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Deficiency of adenosine deaminase 2 (DADA2) is an autosomal recessive disorder characterized by overlapping inflammatory/vascular (skin lesions, stroke), immune dysregulatory (hypogammaglobulinemia, low memory B cells, poor vaccine response), and hematologic (PRCA, neutropenia, pancytopenia) phenotypes. Its clinical spectrum continues to broaden as more cases are recognized.

Methodology: We report a 27-year-old male presenting with a two-week history of acute, progressive, asymmetric lower motor neuron-type paraparesis (left > right), along with bowel and bladder incontinence. Past history included early-onset hypertension, migraine with recurrent painful ophthalmoplegic neuropathy, testicular torsion, Raynaud phenomenon, and livedo racemosa. Examination revealed proximal > distal weakness in the left leg (hip 2/5, ankle 3/5), brisk knee reflexes, absent ankle reflex, extensor plantar on the left, and saddle anesthesia.

Results: Differentials considered included vasculitides (e.g., PAN, lupus, Sjögren’s, ANCA-associated), infections (CMV, HTLV, HSV, syphilis), and malignancy (lymphoma/metastasis). Magnetic resonance imaging (MRI) revealed asymmetric thickening/enhancement of left lumbosacral nerve roots. Cerebrospinal fluid (CSF) was acellular with normal protein/glucose and no malignant cells. PET scan showed no abnormal uptake. Autoimmune and vasculitis profiles were negative. Given a working diagnosis of PAN, the patient received IV methylprednisolone. Whole exome sequencing revealed a homozygous missense mutation in ADA2 (c.139G>A; p.Gly47Arg), confirming DADA2. He was treated with steroids and cyclophosphamide, showing significant improvement at 3-month follow-up.

Discussion: This case expands the known phenotypic spectrum of DADA2 to include conus cauda syndrome, migrainous headaches, and recurrent painful ophthalmoplegic neuropathy—features rarely reported. Genetic testing for DADA2 should be considered in all suspected cases of early-onset or familial cases of PAN.

Conclusion: Given its expanding spectrum, DADA2 should be considered in patients with unexplained immunologic, neurologic, or hematologic features. Increased awareness among specialists is essential for timely diagnosis and management.

Abstract ID 590: Rare Eye Manifestation Seen with Hypokalemic Periodic Paralysis

Chandrashekar G S

Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Background and aim: Hypokalemic paralysis is commonly encountered emergency in neurology, but eye manifestation is not clearly established in these cases. Aim of this study was to establish correlation between hypokalemic paralysis and eye diseases.

Methodology: A young male presented with acute onset quadriparesis secondary to hypokalemia requiring mechanical ventilator. Patient serum showed low potassium. Arterial blood gas (ABG) and urine electrolytes showed proximal tubular acidosis. There was similar episode 12 years back but patient was lost to follow up. Patient was diagnosed to have glaucoma which progressed and resulted in loss of vision in left eye. Literature suggested patient these findings are seen with SCN4A4 gene defect.

Results: With background of proximal tubular acidosis leading to hypokalemic periodic paralysis and glaucoma, the SCN4A4 gene defect was suspected. Genetic study was sent, which was positive for the SCN4A4 gene defect.

Discussion: Here we have a male patient with 2 episodes of quadriparesis Secondary to hypokalemia, on evaluation he was found to have proximal tubular acidosis. Patient was found to have glaucoma 4 years back, but lost to follow up, at presentation he had loss of vision in left eye. Genetics was positive for the SCN4A4 gene defect. The SCN4A4 is responsible for encoding sodium bicarbonate channel (NBC). NBC is found over kidney, cornea. In kidney chanel disfunction leads to proximal tubular acidosis. In cornea it causes glaucoma (precise mechanism not known)

Conclusion: In the current case we could establish the cause for hypokalemia and glaucoma. Defect in the SCN4A4 Gene results in defect in NBC functions in kidney and cornea. One must be vigilant to look for eye defects in patients presenting with hypokalemic paralysis.

Abstract ID 591: Beyond the Grayscale: Re-evaluating the Prognostic Value of CT Density in Cerebral Venous Thrombosis

Perumalla M V S Alekhya, R Subasree, Girish Kulkarni, Hima Pendharkar, R Subasree, Girish B Kulkarni

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Cerebral venous thrombosis (CVT) is a rare stroke subtype resulting from thrombus formation in the dural venous sinuses. Non-enhanced computed tomography (NECT) is commonly used as an initial imaging modality due to its wide availability and speed, although its diagnostic accuracy remains limited (sensitivity 68% and specificity 52%). This study aimed to evaluate whether serial CT density measurements could serve as a simple tool for monitoring thrombus evolution over time. Also, to assess longitudinal changes in CT density within different involved cerebral venous sinuses and see their correlation with recanalization outcomes.

Methodology: Fifty patients with confirmed cerebral venous thrombosis underwent non-enhanced CT scans at admission, within 14 days, and at 3–6 months. CT densities were analyzed using linear mixed models. All received heparin acutely and acenocoumarol for long-term anticoagulation, targeting an INR between 1.5 and 2.0.

Results: A total of 46 patients were followed up for 1 year with a mean age of 33.6 ± 11.2 years, of whom 56% were male. Headache (96%) and seizures (62%) were common presentations. The superior sagittal sinus was most frequently involved (72%). CT density declined significantly over time across all sinuses (p < 0.05), indicating thrombus resolution. Higher baseline CT densities were associated with partial recanalization, whereas lower initial densities with modest declines over time were more often linked to complete recanalization.

Discussion: This study demonstrated a significant decline in CT density over time across all sinuses, consistent with thrombus resolution. Although patients with recanalisation showed a numerically slower decline in density, the interaction between time and recanalisation status was not statistically significant.

Conclusion: Serial reductions in CT density suggest progressive thrombus resolution; however, their relationship with recanalisation is complex and nonlinear, underscoring the need for comprehensive clinical, etiological, and radiological follow-up in CVT management

Abstract ID 592: The Metabolic Trap: Epsiodic Weakness in a Young Man with MADD

Raj Prabhakar, Mugundhan Krishnan, Uma Maheswari, Natarajan E

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Multiple acyl-CoA dehydrogenase deficiency (MADD), also known as glutaric acidemia type II, is a rare, autosomal recessive metabolic disorder affecting fatty acid, amino acid, and choline metabolism. Its adult-onset form may manifest as episodic muscle weakness, often triggered by catabolic stress, and can mimic inflammatory or mitochondrial myopathies. Early recognition is critical to prevent morbidity.

Methodology: We report the case of a 22-year-old male with no prior comorbidities who presented with subacute, crampy bilateral thigh and calf pain progressing to proximal limb weakness and severe neck flexor weakness. The onset followed a period of strenuous physical exertion and fasting. No sensory, cranial, or autonomic features were noted. Clinical evaluation, blood investigations, neuroimaging, and genetic analysis were conducted to arrive at a diagnosis

Results: Neurological examination revealed symmetrical proximal limb weakness and neck flexor weakness with absent reflexes. Creatine kinase was markedly elevated (2876 U/L), with raised transaminases. Magnetic resonance imaging (MRI) brain showed diffuse and nodular T2/FLAIR hyperintensities in frontotemporoparietal and periventricular white matter. Nerve conduction studies were normal. Cerebrospinal fluid (CSF) studies were unremarkable. Whole-exome sequencing revealed mutations consistent with MADD. The patient improved without recurrent symptoms on follow-up.

Discussion: This case underscores the episodic, activity-triggered nature of adult-onset MADD, which may be mistaken for polymyositis or mitochondrial myopathy. The combination of biochemical abnormalities, characteristic imaging findings, and genetic confirmation was critical to diagnosis. Recognizing this treatable condition early can prevent life-threatening metabolic decompensation.

Conclusion: MADD should be considered in young patients presenting with episodic, proximal myopathy, particularly following exertional or fasting stress. Prompt diagnosis supported by MRI and genetic testing can guide effective management and prevent irreversible damage

Abstract ID 593: Lead Exposure Triggered Autoimmunity

Cankatika Choudhury

Govind Ballabh Pant Institute of Postgraduate Medical Education, New Delhi, India

Background and aim: Lead is ubiquitously present in many industries such as paints, automobiles and plumbing. We report the case a 33 year old gentleman presenting with encephalitis and subacute asymmetric distal neuropathy with concomitant Anti -CaspR2 positivity and high blood levels.

Methodology: The patient presented with altered sensorium followed by focal onset motor seizures and progressive acute onset right hand grip weakness. He had pallor and Burtonian lines on his gums, blood pressure was elevated. He had a power of 4-/5 on wrist flexion, pronation 4-/5 and grip was 30% compared to normal. There was wasting in both thenar and hypothenar eminence. Small muscles were weak. Deep Tendon reflexes except for Brachioradialis on the right side were all normal. He was evaluated for infectious, infiltrative, autoimmune, etiologies. Cerebrospinal fluid (CSF) was suggestive of lymphocytic pleocytosis, and elevated protein.

Results: His autoimmune workup came positive for Anti-CaspR2 (2+) on cell based assay. Blood lead levels were high (80 ug/dl). There was basophilic stippling on peripheral blood smear. Magnetic resonance imaging (MRI) Brain was suggestive of bilateral basal ganglia, insular and thalamic T2/ FLAIR hyperintensities. Seizures were aborted with Levetiracetam loading and maintenance doses (20 mg/kg), combination therapy with dimercaprol and CaNa2EDTA along with intravenous methylprednisolone. There was some improvement in sensorium and patient was continued on oral prednisolone for some days. Follow up urine lead levels showed some improvement.

Discussion: Heavy metals like gold, cadmium and Mercury are known to trigger autoimmunity. Children usually present with lead Encephalopathy. Concomitant presentation of encephalitis and distal neuropathy is rare to nil. This might be a manifestation of autoimmunity triggered by chronic lead exposure and needs to be managed differently. Repeat Anti CaspR2 antibody testing after 6 months was also positive

Conclusion: Every atypical feature in multi axial involvement needs to be assessed and the predominant presentation treated.

Abstract ID 594: Channelopathy Chronicles - A Case Series

Deepak K S, Archana NB, Praveen S, Janardhan DC, Pramod K

Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Background and aim: Membrane excitability, which is critical for the function of muscle and nerve is regulated by voltage gated ion channels. It is therefore not surprising that ion channels are involved in the pathogenesis of diseases of these tissues. The aim of the study was to characterize the clinical presentations and genetic profiles of patients presented with periodic paralysis through a comprehensive case series analysis.

Methodology: Here, we present a case series detailing five patients presenting with periodic paralysis and myotonia. Clinical features, family history, electrodiagnostic data, genetic test results, and treatment outcomes were analyzed.

Results: In this case series 5 patients were analysed. Their ages ranged from 20 to 37 years, with three of them having a history of consanguineous parentage. All of them were male. Two patients presented with muscle stiffness which would worsen with initial movements after a state of inactivity. The stiffness would get better when they moved around. Three patients presented with episodic weakness which would worsen with strenuous exercise and carbohydrate intake. One patient had a severe attack with neck flexor weakness requiring intensive care. Their clinical features, family history and electrodiagnostic tests were analysed.

Discussion: Muscle channelopathies are characterized by either transient, membrane hyperexcitability (i.e., myotonia) or hypo excitability (i.e. paralysis) or both. This simple way of distinguishing the main symptoms corresponds quite well to the types of ion channels involved and allows one to discern. 1. Classic congenital myotonia without paralysis (chloride channel) 2. Varying combination of myotonia and paralysis (sodium channel) 3. Paralysis without myotonia. (various cation channels).

Conclusion: The clinical and genetic spectrum of muscle channelopathies is highlighted in this case. Two patients with myotonia who had typical pathogenic mutations of the CLCN 1 gene. Three patients presented with periodic paralysis had mutations in the SCN4A and the CACN1AS genes.

Abstract ID 595: Cognition Beyond Dementia: The Conundrum of White Matter Cognition; A Case Series Analysis

Satyadip Sarkar, Atanu Biswas

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Background and aim: White matter plays a pivotal role in the integration and transmission of neural signals essential for cognitive functioning. Disruptions or developmental abnormalities in white matter have been increasingly linked to impairments in attention, memory, processing speed, and executive functions. This case series investigates the association between white matter microstructure and cognitive profiles in individuals presenting with cognitive deficits with overt structural brain abnormalities on conventional imaging.

Methodology: This case series analyzed six cases with neurocognitive evaluation presented to our outpatient (OPD) with some major neurological complaints. Study area -Bangur institute of neurosciences study period -1 year study population 6 cases presented to our OPD. Study design -observational cross-sectional study.

Results: Major domains affected were mainly frontal subcortical, execution, intraparietal sulcus (IPS), visuospatial, gnosis and social cognition.

Discussion: This case series highlights the potential of white matter microstructural abnormalities to contribute to cognitive dysfunction. The findings support the hypothesis that efficient cognitive functioning depends on the integrity of white matter networks.

Conclusion: These cases underscore the value of advanced neuroimaging techniques, such as DTI, in complementing neuropsychological assessments to guide diagnosis and intervention in unexplained cognitive deficits. White matter is no longer seen as passive wiring but as a dynamic component of cognitive functioning.

Abstract ID 596: A Diagnostic Odyssey in Lower Motor Neuron Disorders: Recognizing Kennedy Disease

Tamil G, Aubin Mathew, Nandakumar Vasudevan, Viveka Saravanan, Mugundhan Krishnan, Aubin Varghese, Viveka R

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Kennedy Disease, or Spinal and Bulbar Muscular Atrophy (SBMA), is a rare X-linked recessive lower motor neuron disorder caused by a CAG repeat expansion in the androgen receptor gene. It typically presents with progressive proximal muscle weakness, bulbar symptoms, and characteristic fasciculations, often misdiagnosed in early stages.

Methodology: Case study with review of literature

Results: A 53-year-old male presented with progressive difficulty in walking for 10 years, followed by proximal upper limb weakness, tremors, and bulbar symptoms including slurred speech and difficulty chewing with twitching of proximal muscles. Neurological examination revealed flaccid quadriparesis with proximal muscle wasting and fasciculations, postural hand tremors, head tremor (no-no type), tongue weakness with fasciculations, and preserved sensory and cerebellar functions with gynecomastia. Laboratory results were unremarkable with mildly elevated creatine phosphokinase (CPK). Electrophysiological studies demonstrated a neurogenic electromyography (EMG) pattern with normal nerve conduction studies. Repetitive nerve stimulation showed a decremental response. Genetic confirmation of expanded cytocine-adenine-guanine (CAG) repeats in the androgen receptor gene established the diagnosis of SBMA.

Discussion: In this case, the combination of progressive proximal weakness, muscle fasciculations, postural tremors, bulbar involvement, and preserved sensory function raised suspicion for SBMA. Normal nerve conduction studies with a neurogenic EMG pattern and decremental response on RNS supported a motor neuron pathology with neuromuscular junction fatigue. Genetic testing confirming CAG repeat expansion in the androgen receptor gene established the diagnosis.

Conclusion: This case underscores the diagnostic challenge of Kennedy Disease due to its overlapping features with myopathy, myasthenia, and motor neuron disease (MND). Key clinical clues like tremor, tongue fasciculations, and androgen insensitivity-related features should raise suspicion. EMG and genetic testing remain the cornerstone for confirmation. Early recognition can guide appropriate management and genetic counseling.

Abstract ID 597: Aortoarteritis as a Presenting Manifestation of Atypical CML in an Elderly

Cankatika Choudhury

Govind Ballabh Pant Institute of Postgraduate Medical Education, New Delhi, India

Background and aim: Atypical chronic myeloid leukemia (aCML) typically presents with symptoms related to increased white blood cell count, including fatigue, weight loss, and splenomegaly. While less common, there have been cases where aCML has presented with signs and symptoms of Takayasu’s arteritis, an inflammatory condition affecting large arteries, including the aorta.

Methodology: A 60-year-old female presented with recurrent strokes despite on optimum therapy. She had radio radial delay. Blood pressure was elevated. Within few months, she came with episodes of limb shaking TIAs. She was treated as Takayasus arthritis but she was non-compliant to therapy. 6 months later, she presented with a flurry of seizures and drowsiness.

Results: Aortogram was suggestive of Takayasu’s arthritis and fulfilled the Ishikawa criteria. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were not elevated. Fluorodeoxyglucose (FDG) PET whole body did not reveal any hotspots. Magnetic resonance imaging (MRI) Brain had extensive small vessel white matter changes. On the third admission, she presented with leukocytosis which on further work up revealed atypical CML.

Discussion: While not a direct causal relationship, there have been reported cases and discussions regarding the potential association between chronic myeloid leukemia (CML) and aortitis. The CML, a cancer of the blood-forming cells in the bone marrow, can sometimes lead to a hyperleukocytosis, which is a very high white blood cell count. This, in turn, can lead to leukostasis, a condition where the blood becomes too thick due to the high number of white blood cells, which can affect blood flow and potentially lead to issues with blood vessels, including the aorta.

Conclusion: Every case of recurrent stroke with seizures should be evaluated thoroughly if patient continues stroking despite treatment optimisation.

Abstract ID 598: Ataxia Oculomotor Apraxia Type I – A Rare Cause of Early-Onset Progressive Ataxia

C Pauline, Neeraj Elango, Jered Livingston

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Ataxia oculomotor apraxia (AOA) type I is a rare cause of autosomal recessive ataxia characterized by early onset progressive ataxia, oculomotor apraxia, axonal neuropathy and hypoalbuminemia. Herewith we present a case of AOA type1

Methodology: Case study

Results: A six-year-old male child presented with progressive unsteadiness while walking since 2 years of age with frequent falls. He also has clumsiness of movements in the upper limbs. There was history of floppiness of limbs present. There was no history of weakness of limbs, sensory disturbances, bladder involvement, cognitive disturbances, or cranial nerve dysfunction. There was no history of recurrent respiratory tract infections or recurrent diarrhoea in the past. No family history of similar illness. He was the second born of third degree consanguineous parents and the elder sibling was normal. Examination revealed a conscious child with oculomotor apraxia, no telangiectasia, intact cranial nerves, generalized hypotonia, power 4/5 in all four limbs, preserved reflexes, flexor plantars, bilateral appendicular ataxia, and gait ataxia. There was no nystagmus, or dysarthria. MRI brain showed cerebellar atrophy. Serum alphafeto protein, immunoglobulins, lipid profile, liver function tests, proteins, creatine kinase were normal. Fundi were normal. Hearing evaluation was normal. Tandem mass spectrometry was normal. Whole exome sequencing revealed a pathogenic homozygous mutation in APTX gene. Nerve conduction study was normal. He was on physiotherapy and occupational therapy.

Discussion: The other differentials to be considered are ataxia telangiectasia, ataxia telangiectasia-like disorder, ataxia oculomotor apraxia types 1-4.

Conclusion: AOA type I should be considered as a differential in early onset progressive ataxia.

Abstract ID 599: Rapidly Progressive Post-Melioidosis Encephalitis with Extensive Brainstem and Corticospinal Tract Involvement: A Rare and Devastating Neurological Complication

Divyaprabha Gurusamy, Mugundhan K, Sivaji M, Rajagembeeran V, Shylaja K

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Melioidosis, caused by Burkholderia pseudomallei, is a potentially fatal infectious disease endemic to Southeast Asia and northern Australia. Neurological manifestations are rare (~4% of cases), but when present, can be severe and rapidly progressive. This case highlights a rare presentation of post-melioidosis neurological syndrome with cerebral, cerebellar, brainstem, and corticospinal tract involvement leading to encephalopathy and eventual death. Aims of this study was to present a rare case of post-melioidosis encephalitis involving the brainstem and bilateral corticospinal tracts, resulting in rapid neurological deterioration, and to emphasize the importance of early recognition and aggressive management of neurological melioidosis.

Methodology: A 35-year-old male with a history of right upper limb cellulitis due to B. pseudomallei underwent fasciotomy and skin grafting, followed by 40 days of intravenous antibiotics. After apparent recovery, he developed neurological symptoms, including dysmetria, right-sided ataxia, left eyelid ptosis, and myoclonic jerks. Rapid progression to respiratory failure necessitated intubation. Magnetic resonance imaging (MRI) brain revealed multiple T2/FLAIR hyperintensities in bilateral middle cerebellar peduncles (MCP), cerebral hemispheres, brainstem, and corticospinal tracts (CST). The patient was managed with IV meropenem and IV levetiracetam. Despite escalation of care and transfer to a tertiary center, the patient developed shock and cardiac arrest, resulting in death.

Results: MRI brain showed multifocal T2/FLAIR hyperintensities involving the bilateral MCP, cerebral hemispheres, brainstem, and CST, consistent with encephalitic changes. Clinically, the patient developed progressive encephalopathy, pyramidal signs, ocular motor dysfunction, and myoclonic jerks. Despite appropriate antimicrobial therapy (IV meropenem and doxycycline) and seizure management (IV levetiracetam), the patient developed cardiorespiratory failure. Laboratory work-up and CSF analysis were planned but could not be completed due to the patient’s rapid clinical decline. The neurological deterioration occurred after completion of initial antibiotic therapy, suggesting a possible post-infectious immune-mediated mechanism or delayed CNS invasion

Discussion: Neurological melioidosis is a rare manifestation with variable presentations including encephalitis, brain abscess, and myelitis. In this case, the delayed onset of CNS symptoms following systemic infection raises suspicion for hematogenous spread or immune-mediated post-infectious encephalitis. The involvement of deep structures such as the brainstem and corticospinal tracts correlates with the patient’s rapidly progressive neurological deficits and poor prognosis. Radiological findings were key in identifying the extent of CNS involvement. Despite the use of high-dose carbapenems and supportive care, the fulminant course underscores the aggressive nature of neuromelioidosis. Early suspicion, prolonged antimicrobial therapy, and neurological monitoring are vital, although mortality remains high in such fulminant cases.

Conclusion: Post-melioidosis encephalitis is a rare but devastating complication. Clinicians should remain vigilant for delayed neurological deterioration in recovered melioidosis patients. Neuroimaging plays a vital role in diagnosis. Prompt identification and tailored antibiotic therapy are essential, but prognosis remains guarded. This case underlines the neurological spectrum and fatal potential of B. pseudomallei, urging the need for improved awareness and early intervention strategies.

Abstract ID 600: Beyond Dry Eyes and Mouth: Cramp Fasciculation Syndrome Revealing Primary Sjögren’s Syndrome

Varun Singh, Abhishek Pathak, Rameshwar Chaurasia, Vijaya Mishra, Deepika Joshi, Anand Kumar, Pratishtha Sengar, Anand Sharma

Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background and aim: Peripheral nerve hyperexcitability (PNH) syndromes are characterized by muscle stiffness, cramps, and fasciculations, often with abnormal spontaneous activity on EMG. Cramp fasciculation syndrome (CFS), a rare PNH variant, may have autoimmune etiologies involving antibodies to voltage-gated potassium channels (VGKC). Primary Sjögren’s syndrome (pSS), an autoimmune exocrinopathy, commonly causes peripheral neuropathy but is rarely associated with CFS as an initial presentation.

Methodology: We describe a 26-year-old male laborer with no known comorbidities, who presented with bilateral lower limb cramping pain and widespread muscle twitching for two months. Fasciculations progressed to involve all limbs, trunk, extraocular muscles, and tongue. There were no other symptoms suggestive of autoimmune etiologies except symptoms of grittiness in the eyes and a history of frequent sips of water since 1 month.

Results: Neurological examination was unremarkable except for continuous fasciculations. Laboratory tests, including metabolic panels, thyroid function, vitamin B12, viral serologies, and autoimmune encephalitis panel (LGI1, CASPR2), were normal. Antinuclear antibody (ANA) profile revealed 2+ Ro-52 antibody positivity. Schirmer’s test was also found to be positive. Nerve conduction studies were normal, while needle electromyography (EMG) showed fasciculation potentials and doublet discharges in multiple muscles, consistent with CFS. The patient was started on immunosuppressant (steroids), and his symptoms subsided completely at 2 months follow up.

Discussion: CFS results from peripheral motor nerve hyperexcitability, often mediated by autoantibodies such as those targeting VGKC complexes. Though VGKC and CASPR2 antibodies were negative, the presence of anti-Ro52 antibodies supports an autoimmune process. It could possibly be the pSS that typically presents with sensory neuropathy, but motor hyperexcitability syndromes like CFS are rarely reported, making this a unique manifestation.

Conclusion: Primary Sjögren’s syndrome can rarely present as cramp fasciculation syndrome and precedes symptoms of sicca symptoms. Clinicians should consider autoimmune etiologies like pSS in patients presenting with CFS after exclusion of more common causes.

Abstract ID 601: A Rare Presentation of Adult-Onset KCNQ2 Encephalopathy in a Young Male with Recurrent Seizures and Encephalopathy

Harsha Burgula, Mridula Singh, Rashmi Mishra, Rajinder Dhamija, Siddharth Maheshwari

Institute of Human Behaviour and Allied Sciences, Delhi, India

Background and aim: The KCNQ2 gene mutations are well-recognized causes of neonatal-onset epileptic encephalopathies and benign familial neonatal seizures (BFNS), typically presenting in early infancy. We present a unique case of a 25-year-old male with recurrent encephalopathy and seizures, later diagnosed with KCNQ2 encephalopathy. The aim is to highlight the under-recognized adult-onset phenotype and emphasize the importance of genetic testing in atypical epilepsy.

Methodology: A Case study of KCNQ2 Encephalopathy.

Results: A 25-year-old male software engineer with normal birth and family history with no prior developmental delays presented with multiple stereotyped episodes of abnormal behavior, seizures, and encephalopathy requiring intubation. Each episode resolved within 7–10 days of supportive care along with multiple anti-seizure medications. Seizure semiology was GTCS, focal motor seizure with impaired consciousness. Frequency of seizures was also very high and was not controlled in spite of being on multiple anti-seizure medications at the maximum tolerable doses. Serial electroencephalograms (EEGs) showed generalized slowing, Neuroimaging and Metabolic parameters were normal. Genetic testing revealed KCNQ2 gene missense mutation, establishing the diagnosis.

Discussion: This case represents an atypical, adult-onset presentation of KCNQ2 encephalopathy, extending the known clinical spectrum of the disorder. While adult KCNQ2 phenotypes are characterized with motor, behavioral and language abnormalities, this report supports emerging evidence of broader variability in presentation with adult onset drug resistant epilepsy with recurrent episodes of encephalopathy prior to the onset of seizures and with normal intellect and without any developmental delay or motor abnormalities. Recognizing such patterns may prompt timely genetic evaluation, reducing unnecessary interventions and therapeutic modification by using Injectable pyridoxine along with various ASM especially Sodium channel blockers which have been found to be effective in KCNQ2 Encephalopathy.

Conclusion: KCNQ2 encephalopathy should be considered in adults with recurrent unexplained seizures and encephalopathy. Early identification through genetic testing facilitates appropriate diagnosis, counseling, and potential for precision treatment.

Abstract ID 602: Primary CNS Angitis: Case Series and Experience from a Single Center In North India

Cankatika Choudhury, Akhil Sahib

Govind Ballabh Pant Institute of Postgraduate Medical Education, New Delhi, India

Background and aim: Primary angiitis of the central nervous system (PACNS) is a rare inflammatory disorder of the blood vessels of the brain and the spinal cord without any evidence of systemic vasculitis. PACNS was first described as a distinct clinical entity in 1959, and since, multiple different clinical presentations have been reported. Clinical manifestations of PACNS at the time of diagnosis are non-specific with various presenting symptoms.

Methodology: Case 1: A 50-year-old man, symptomatic for 20 years (undiagnosed), recurrent sensory symptoms, headache and syncope. Case 2: A 30-year-old male, with first stroke, no vascular risk factors. Case 3: A 17-year-old male presented with a Transient Ischemic Attack (TIA). No systemic features.

Results: Patient 1: Magnetic resonance angiography (MRA) was negative. Digital Subtraction Angiography (DSA) was negative. MR vessel wall imaging (VW-MRI) suggestive of central nervous system (CNS) vasculitis. Cerebrospinal fluid (CSF) lymphocytosis with high protein. Symptom free on CYC + steroids. Patient 2: MRA suggestive, confirmed on VW-MRI. CSF normal. All other causes of vasculitis excluded. Patient 3: MRA suggestive of Moyamoya syndrome. VW-MRI highly suggestive. CSF and other systemic vasculitis negative.

Discussion: CNS vasculitis should be a diagnosis of exclusion after all other causes have been excluded. Before proceeding to brain biopsy, VW-MRI may come in handy. In CNS vasculitis, VW-MRI can reveal characteristic findings, including concentric arterial wall thickening and homogeneous enhancement. VW-MRI can also be used to monitor disease activity and response to treatment, particularly in cases where conventional imaging may be in conclusive.

Conclusion: A high index of suspicion for CNS vasculitis is crucial because it is a rare but potentially devastating condition that can be misdiagnosed, leading to delayed treatment and poor outcomes. Clinicians must be vigilant and consider CNS vasculitis in patients with unexplained neurological symptoms, especially if other more common causes are ruled out.

Abstract ID 603: Marchiafava-Bignami Disease Presenting with Subacute Speech Impairment and Ataxia in a Chronic Alcohol User: A Case Report

Ragul Sen, Mugundhan Krishnan, Viveka Saravanan, Nanda Kumar

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Marchiafava-Bignami Disease (MBD) is a rare demyelinating disorder primarily affecting the corpus callosum, most commonly seen in individuals with chronic alcohol dependence. It presents with varied neuropsychiatric symptoms, often making early diagnosis challenging. Aims and Objectives of this study included highlighting a case of MBD with predominant symptoms of slurred speech, gait unsteadiness, and behavioral changes, and underscoring the importance of early neuroimaging and thiamine therapy.

Methodology: A 55-Year-old male, chronic alcoholic, presented with a one-month history of slurred speech, psychomotor slowing, gait ataxia, poor oral intake, and behavioral disturbances. One day prior to admission, he developed aphonia and tonic posturing of all limbs. Neurological examination revealed dysarthria, apathy, broad-based ataxic gait, and hyperreflexia, with fair comprehension and preserved sensory and cranial nerve functions. Magnetic resonance imaging (MRI) brain showed T2/FLAIR hyperintensities and diffusion restriction involving the rostrum, genu, body, and splenium of the corpus callosum, consistent with MBD. Cerebrospinal fluid (CSF) and routine labs were unremarkable apart from mild electrolyte abnormalities.

Results: Following treatment with high-dose intravenous thiamine, methylcobalamin, folic acid, vitamin B complex, and nutritional support, the patient showed symptomatic improvement. Speech output and cooperation improved, and further neurological deterioration was prevented.

Discussion: MBD is a rare demyelinating disorder seen in chronic alcohol users, primarily affecting the corpus callosum. It presents with neuropsychiatric symptoms such as dysarthria, gait ataxia, and behavioral changes. MRI is crucial for diagnosis, showing characteristic callosal lesions. This case demonstrates a subacute presentation with favorable recovery following early intervention with high-dose thiamine and nutritional support. Timely recognition and treatment of MBD are essential to prevent permanent neurological deficits and improve prognosis.

Conclusion: MBD should be suspected in chronic alcohol users presenting with cognitive decline, speech disturbances, and gait ataxia. MRI is critical for diagnosis. Early initiation of thiamine and nutritional therapy can significantly improve outcomes and reduce morbidity.

Abstract ID 604: Rare Case of IEM

Priyanka Jangam

Guntur Medical College, Andhra Pradesh, India

Background and aim: Worldwide incidence of maple syrup urine disease (MSUD) is 1 case per 185,000 live births. The MSUD is an autosomal recessive inborn error of metabolism caused by defects in the branched-chain α-ketoacid dehydrogenase (BCKAD) complex, which results in elevations of the branched-chain amino acids (BCAAs) in plasma, α-ketoacids in urine, and production of the pathognomonic disease marker, alloisoleucine. Individuals with the classic neonatal form have <2% of BCKAD enzymatic activity and present with maple syrup odor in cerumen shortly after birth and in urine during the first week of life.

Methodology: Ten days old term female baby born out of Non consanguineous marriage, delivered by lower segment caesarean section (LSCS), indication-oligohydramnios, at outside hospital with birth weight of 2.3 Kg, referred to GGH on tenth day of life with complaints of decreased oral acceptance of feeds-since day 3 of life, dull activity-since day 4 of life, no abdominal distention/fever/jaundice/seizures.

Results: On examination: Dull Activity noted, Pallor+.

Discussion: Urine Ketones-Positive ABG- high anion gap metabolic acidosis serum ammonia -313 ug/dl (30-150 ug/dl) serum lactate – 35.9 mg/dl (4.2-20 mg/dl) magnetic resonance imaging (MRI) BRAIN: diffuse symmetrical diffusion restriction seen along corticospinal tracts, Mid brain, pons, medulla, cerebellar hemispheres along white matter tracts suggesting leukodystrophy. Tandem Mass Spectroscopy- increased levels of leucine, Isoleucine, Valine i.e., increased levels of branched chain amino acids Final diagnosis: Inborn errors of metabolism (IEM)- MSUD

Conclusion: The 4,5-dimethyl-3-hydroxy-2[5H]-furanone (sotolone) is thought to be responsible for the characteristic odor of MSUD. Increased BCAA levels within the body causes dysfunction of the immune system, skeletal muscle, and central nervous system Accumulation of leucine is highly neurotoxic. α-Keto isocaproic acid, an intermediate in the metabolism of leucine, is a major neurotoxin contributing to the encephalopathic syndrome. MSUD is unique for the sweet odor of cerumen and a positive urine dinitrophenylhydrazine test.

Abstract ID 605: A Case Report of Combined Central and Peripheral Demyelination with Good Steroid Response

Karthikeyan Sabapathi

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: A case report of combined central and peripheral demyelination with good steroid response

Methodology: A 55 years-old female is a known case of rheumatoid arthritis on treatment for last 4 years. She discontinued her treatment 4 months back and started on native medicine for 3 months. Patient developed pan gastritis, persistent vomiting hyponatremia and was treated in private hospital. She started to have visual and auditory hallucinations. She developed mild difficulty to get up from squatting position which was gradually progressive leading bed bound state in two weeks. She had poor appetite and become dependent for her activities of daily living (ADL). Then, her sensorium started to fall. There was no sensory symptoms, bladder and bowel involvement. She was admitted as a case of subacute encephalitis with flaccid areflexic quadriparesis, lower limb more than upper limb. There was no features suggestive of neuro myotonia. Her cerebrospinal fluid (CSF) protein 77 sugar 89 acellular. All infective work up were negative. Magnetic resonance imaging (MRI) brain showed small vessel disease. Nerve conduction studies (NCS) showed conduction block with no temporal dispersion noted in peroneal and ulnar. SNAP not obtained in bilateral median ulnar and sural nerve. Combined central and peripheral demyelination suspected. Autoimmune panel showed CASPER1 strong positive and LGI1 positive.

Results: She showed good response to steroids. Her sensorium recovered and power improved. She was discharged in stable status ambulating with support

Discussion: Though patient did not have any features of neuromyotonia, with History of native medicine intake and history of hallucinations, we suspected possibility of combined central and peripheral demyelination. NCS showed axonal conduction block. Patient showed good rectory with steroids

Conclusion: Strong suspicion is warranted whenever a patient presents with features suggestive of both central and peripheral involvement with history of native medicine intake.

Abstract ID 606: A Rare Case of Suspected Neurobrucellosis Presenting as Acute Demyelinating Encephalomyelitis

Nithya Periyasamy, Viveka saravanan R, Mugundhan K, Nandakumar V

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Neurobrucellosis is a rare but serious manifestation of systemic brucellosis, frequently mimicking other central nervous system (CNS) pathologies. Aim was to highlight the diagnostic complexity in a patient with suspected neurobrucellosis, and to differentiate it from other inflammatory and infectious CNS disorders

Methodology: A 33-year-old female presented with acute-onset right upper and lower limb weakness, fever, headache, left facial deviation, and slurred speech. Initial neuroimaging and clinical evaluation led to a provisional diagnosis of acute demyelinating encephalomyelitis (ADEM). Investigations included magnetic resonance imaging (MRI) brain and spine, cerebrospinal fluid (CSF) analysis, autoimmune and infective panels which were negative. She was initially treated with pulse steroids with partial response. Subsequently she got readmitted with drop in sensorium and focal seizure. Repeat MRI showed disease progression. She underwent five cycles of plasmapheresis and hospital acquired infections which were managed with broad-spectrum intravenous antibiotics, antiepileptics, and supportive care. MRI showed multiple T2/FLAIR hyperintense lesions in the brainstem, cerebellum, corpus callosum, and spinal cord. Redo CSF analysis was normal. Serum Brucella IgM was positive (1.14), supporting a diagnosis of neurobrucellosis.

Results: Despite immunotherapy and antimicrobial treatment, the patient’s condition deteriorated. She required mechanical ventilation and eventually succumbed to hospital-acquired sepsis.

Discussion: This case underscores the importance of considering neurobrucellosis in the differential diagnosis of atypical demyelinating diseases, particularly in endemic areas.

Conclusion: Early multidisciplinary involvement, aggressive supportive care, and a high index of suspicion are crucial for optimizing outcomes in such rare and complex CNS infections.

Abstract ID 607: A Cohort Study of Patients with Rasmussen’s Encephalitis

Vedang Desai, Manjari Tripathi, P Sarath Chandra, Madhavi Tripathi, Deepti Vibha, Jasmine Parihar, Rajesh Singh, A Elavarasi, Animesh Das

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Rasmussen’s encephalitis (RE) is a rare, chronic, and progressive neurological disorder typically affecting children and young adults. It is characterised by severe, drug-resistant focal seizures, progressive neurological deficits, and unilateral (uncommonly bilateral) cerebral atrophy. Although the precise etiology remains uncertain, current evidence suggests an immune-mediated mechanism, with involvement of cytotoxic T cells leading to inflammation and neuronal loss. Diagnosis is often challenging and relies on a combination of clinical presentation, electroencephalogram (EEG) findings, neuroimaging, and sometimes brain biopsy. We studied a cohort of cases of Rasmussen’s encephalitis, fulfilling the Bien’s Diagnostic criteria and the clinico-radiological as well as treatment parameters.

Methodology: Patients fulfilling Bien’s criteria for diagnosis of Rasmussen’s encephalitis were studied Ambispectively. A total of 22 cases were enrolled after prior informed consent. Their clinical, diagnostic and therapeutic outcomes are studied.

Results: The Median age at onset of symptoms in study population was 6.25 years. However, maximum age at onset was noted at 22 years of age. The gender distribution was nearly equal. Three patients had weakly positive anti-NMDA antibodies, reflecting the ambiguous and possible Auto-antibody mediated disease process. The most common seizure semiology was focal seizures with unto 90% EEGs showing epileptiform pattern. Magnetic resonance imaging (MRI) and positron emission tomography computed tomography (PET CT) were abnormal in all cases evaluated, with 22.73% cases showed bilateral hemispheric involvement and 40% showing caudate atrophy. Forty-five and forty-five hundredths percentage of cases experienced Epilepsia partialis continua during disease course. Forty percentage of cases underwent Epilepsy surgery (Hemispherotomy) and all clinically meaningful seizure reduction (>50% of baseline) was seen in 91% cases.

Discussion: RE is a disabling and chronic disease, however with timely diagnosis and appropriate treatment, the quality of life and resolution of symptoms is a realistic possibility in these cases.

Conclusion: Immune therapy and Epilepsy surgery are cornerstone of treatment of RE. The study helps study the clinico-radiological and treatment paradigm in cases further.

Abstract ID 608: Accelerated Cerebral Atrophy in a Young Indian Male – Delay in Diagnosis of Neuro HIV Disease

Devanshi Rathore, Inder Puri, Jagdeesh Kookna

S P Medical College, Bikaner, Rajasthan, India

Background and aim: Neuro human immunodeficiency viral (HIV) disease can present with a plethora of findings. Accurate and timely diagnosis is important. Centre for Disease Control and Prevention (CDC)-recommended rapid HIV tests generally have high sensitivity, often exceeding 99%, the fourth-generation HIV tests yield of 99.7%. We present a case of false-negative point of care HIV test result leading to delayed diagnosis and treatment of HIV.

Methodology: A 34-year-old male presents with acute onset asymmetric progressive sensorimotor quadriparesis with a past history of multiple joint pains, weight loss and fever and mood instability. No cranial nerve or cognitive involvement. He was found to have demyelinating polyneuropathy with axonal degeneration, cerebrospinal fluid (CSF) lymphocytic pleocytosis with raised protein, hypergammaglobulinemia, global cerebral and cervical cord atrophy with periventricular hyperintensities and nonspecific cervical C4-5 signal. HIV rapid tests were negative. Hence, the suspicion of autoimmune disorders mainly systemic lupus erythematosus (SLE) was kept. Antinuclear antibody (ANA) blot 17 profile was negative. He was treated for autoimmune/ vasculitic neuropathy and drastically improved with iv pulse steroid therapy.

Results: After 7 months patient presented with flu like illness, urine incontinence and paraparesis. Imaging showed global cerebral and cervical cord atrophy. HIV rapid tests now came out to be reactive.

Discussion: If the rapid test result is negative and clinical symptoms persist and clinician has a high index of suspicion, additional follow-up tests using other clinical methods are recommended. A negative result at any time does not preclude the possibility of HIV-1 and/or -2 infections.

Conclusion: It is warranted to screen for HIV more often than is generally done now especially in the context of evaluation of suspected autoimmune disease. False negatives in HIV screening can be reduced by using the fourth-generation test. Physicians should remain vigilant.

Abstract ID 609: Prevalence of Metabolic Syndrome in Idiopathic Intracranial Hypertension – A Retrospective Observational Study

Saravana Sukriya S, Akash Jain, Najiya Nageeb

All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

Background and aim: Idiopathic intracranial hypertension (IIH) refers to an increased intracranial pressure with an unidentified underlying pathology, presenting with papilledema and decreased visual acuity. It commonly affects women of child bearing age group. The other important risk factor being obesity, recent weight gain, medication intake or abrupt withdrawal of corticosteroids, systemic diseases. Aim of this study was to study the prevalence of metabolic syndrome (MetS) in patients diagnosed with IIH.

Methodology: This study was conducted in the department of Neurology, AIIMS, Raipur, Chhattisgarh. During this study period all diagnosed cases of IIH, who attended the neurology outpatient and in-patient services, from December 2022 to November 2024 fulfilling the inclusion and exclusion criteria were included in the study. The data was retrieved from the medical records of the patients.

Results: Our study recruited 20 patients with a notable female predominance (18/20). The median age of the study population is 30.5 years and median duration of disease is one year. Headache was seen in 10 patients, transient visual obscurations (TVOs) were seen in 5 patients, diplopia and tinnitus were seen in 2 patients. The median cerebrospinal fluid (CSF) opening pressure is 28.5 cm of H20. Anemia was seen in 3/20, steroid intake in 5/20, recent weight gain in 6 patients and obesity in 15 patients. All patients had papilledema. Metabolic syndrome was seen in 7/20 patients. Tortuous optic nerves and posterior scleral flattening were seen in magnetic resonance imaging (MRI) optic nerves of all patients.

Discussion: Transverse sinus stenosis was seen in 6 patients and two patients underwent transverse sinus stenting and rest were managed conservatively.

Conclusion: Obesity was more prevalent in patients with IIH followed by metabolic syndrome.

Abstract ID 610: The DOK-7 Decoy: Where Myasthenia Hides in Plain Sight

Navaneethakrishnan Ramasamy, Sivaji M, Mugundhan K, Raj Gokul

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: The DOK-7 is a postsynaptic cytoplasmic protein that activates muscle-specific tyrosine kinase (MuSK), facilitating Rapsyn-associated acetylcholine receptor (AChR) clustering and normal folding of the postsynaptic membrane. The classical DOK-7 congenital myasthenic syndrome (CMS) phenotype includes limb girdle weakness with nonspecific myopathic features. Distinguishing characteristics include onset after infancy, normal walking milestones, sparing of ocular movements, stridor, tongue wasting, poor response to pyridostigmine and 3,4-diaminopyridine, and association with nonspecific myopathy. This case highlights the importance of clinical suspicion in diagnosing DOK-7 CMS.

Methodology: A 35-year-old female presented with progressive proximal upper limb weakness for 13 years, bilateral ptosis for 12 years, and recent onset respiratory difficulty with worsening limb weakness. Examination revealed bilateral ptosis, complete ophthalmoparesis, no tongue wasting, normal tone, and limb power of 3/5. She was tachypneic and required continuous positive airway pressure (CPAP) support. Serum creatine phosphokinase (CPK) was normal. Whole-exome sequencing revealed a DOK-7 mutation. The patient was started on oral salbutamol with subsequent clinical improvement.

Results: The patient exhibited a phenotype of bilateral ptosis, limb girdle weakness extending distally, and respiratory compromise. Differential diagnoses included congenital myopathy, congenital myasthenia, and mitochondrial myopathy. Genetic confirmation of DOK-7 mutation established the diagnosis. Supporting features included post-infancy onset, normal early motor milestones, limb girdle pattern, and favorable response to salbutamol. Atypical features included complete ophthalmoparesis and absence of tongue wasting.

Discussion: DOK-7 CMS is distinct from AChR subunit deficiency and often presents later with spared ocular movements and poor response to anticholinesterases. Stridor and tongue wasting are early clues in some patients. Adult-onset respiratory and bulbar worsening is common. Recognition of DOK-7 CMS is crucial as salbutamol or ephedrine therapy may significantly improve outcomes.

Conclusion: DOK-7 CMS should be suspected in patients with chronic limb girdle weakness, ptosis, and nonspecific myopathic features. Early diagnosis, guided by clinical suspicion and genetic testing, allows effective treatment and improved quality of life.

Abstract ID 611: Creatine Transporter Deficiency – A Treatable Cause of Developmental Delay

C Pauline, Neeraj Elango

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Creatine transporter deficiency (CTD) is a rare inherited metabolic disorder characterized by global developmental delay, intellectual disability, seizures, autistic behaviour, and movement disorder. It is an X-linked recessive disorder due to a mutation in the SLC6A8 gene. Creatine supplementation may be beneficial in improving the motor and cognitive outcomes

Methodology: Case study

Results: A two-year-old male child, second born of nonconsanguineous parents, was brought in for developmental delay. He was a full-term baby, delivered by vaginal delivery with a normal neonatal transition. His early milestones were normal. However, standing and walking independently were delayed. His language milestones were markedly delayed in that he could speak a single word by two years of age. There was no history of seizures, abnormal odor of urine, abnormal startle, or deterioration during intercurrent illnesses. The elder sibling was normal. Examination revealed a conscious child with no dysmorphisms, skin/hair changes, neurocutaneous markers, or micro/macrocephaly. He had mild hypotonia, preserved reflexes, no cerebellar signs, and no involuntary movements. Thyroid profile, serum creatine phosphokinase (CPK), uric acid, ammonia, lactate, liver function test (LFT), renal function test (RFT), and lipid profile were normal. Magnetic resonance imaging (MRI) brain showed mild thinning of the corpus callosum. Tandem mass spectrometry was normal. Unable to find out the cause for his global delay, whole-exome sequencing was done, which revealed a pathogenic mutation in the SLC6A8 gene, confirming the diagnosis of Creatine Transporter Deficiency in this child.

Discussion: CTD accounts for approximately 2% of global delay/intellectual disability in males. The diagnosis is based on clinical findings, absent creatine peak in MRS, increased urinary creatine, and SLC6A8 sequencing. The child studied did not have autistic features, involuntary movements or seizures. He showed developmental gains following creatine supplementation.

Conclusion: CTD should be considered in any male child with global delay and MR spectroscopy should be included in the evaluation protocol.

Abstract ID 612: When Weakness has Two Faces: A Rare Overlap of Myasthenia Gravis and Amyotrophic Lateral Sclerosis

Saranya Gomathy, Manoj Manyem, Amruthavarshani Krishnamoorthy, Jayaram Saibaba, Ramkumar Sugumaran

Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Background and aim: Myasthenia Gravis (MG) is an autoimmune disorder affecting neuromuscular junction, while Amyotrophic Lateral Sclerosis (ALS) is a progressive motor neuron disease. Their coexistence is rare and presents diagnostic and therapeutic challenges. We report a case of this unusual overlap.

Methodology: Case report

Results: A 52-year-old man presented with a 1.5-year history of asymmetric fatigable ptosis (right > left) with diurnal variation. One year prior, he had an acute bulbar crisis that improved after five plasma exchange cycles and Rituximab. Over six months, he developed progressive, asymmetrical pure motor quadriparesis with truncal and neck weakness and bulbar dysfunction. Neurological exam showed hypotonia in upper limbs, normal tone in lower limbs, power 2/5 in upper limbs and 3/5 in lower limbs, absent upper limb reflexes, exaggerated lower limb reflexes with bilateral ankle clonus, limb and tongue wasting, and fasciculations. Ice pack and neostigmine-atropine tests were positive; ocular repetitive nerve stimulation test revealed a decremental response. Serology for acetylcholine receptor (AChR), muscle-specific kinase (MuSK), and LRP4 antibodies was negative. Imaging (contrast enhanced computed tomography (CECT) thorax, magnetic resonance imaging (MRI) brain and spine) was unremarkable. Nerve conduction studies were normal; electromyography (EMG) showed active denervation and chronic reinnervation consistent with motor neuron disease. He received intravenous immunoglobulin (2 g/kg over 5 days), steroids, and two doses of Rituximab. Post-treatment, ptosis and neck weakness improved significantly, and he regained the ability to walk with support.

Discussion: Overlap of seronegative MG and motor neuron disease is rare and diagnostically challenging. Immunotherapy improves MG symptoms, but progression of MND persists. Shared immunological or neuromuscular junction abnormalities may underlie this overlap.

Conclusion: Seronegative MG can coexist with motor neuron disease (MND), complicating diagnosis and management. Thorough clinical and electrophysiological evaluation is essential. Early immunotherapy improves MG symptoms but not MND progression. Awareness of this overlap facilitates timely diagnosis and appropriate care.

Abstract ID 613: Infections to Infarction: An Unusual Suspect!!

Mohinish S, Neeraj Elango, Jered Livingston, Leema Pauline

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: A 9-year-old girl with fever, cough and cold for 9 days. Developed deviation of angle of mouth to right side along with difficulty in using left upper limb and left lower limb noticed on day 7 of illness followed by seizures requiring intubation. Suspected vascular event and emergency magnetic resonance imaging (MRI) showed hyper intensity in Right anterior cerebral artery (ACA)/ middle cerebral artery (MCA) territory with midline shift 6 mm and absent signal in right ACA/ MCA. Child Underwent emergency decompression craniotomy and post-operatively put on ventilator, required higher pressure than normal. Bilateral air entry reduced. Chest x-ray showed Right upper lobe collapse, Left lower lobe consolidation, eventually leading to bilateral pneumothorax requiring intercostal chest drain. Respiratory swab viral panel, tuberculosis workup and vasculitis workup were negative. Persistent high grade fever with internal bleeding noted with sudden drop of haemoglobin. When blood sent for cross matching, it was incompatible. Cold agglutinin test positive (Titre = 1:2048), DCT 3+, Mycoplasma PCR positive. Received 1 course of immunotherapy, dexamethasone and low dose aspirin. Clinical improvement noted after a stormy course.

Methodology: Case report

Results: Stroke with respiratory prodrome - think of mycoplasma. Macrolide resistance is increasing - Consider Doxycycline and initiate early steroids which reduce the morbidity and mortality. Neurological outcome is good if treatment initiated early.

Discussion and conclusion: Stroke in mycoplasma is a Para infectious presentation seen among 3 – 13 years and commonly involves middle cerebral artery territory. Large internal carotid artery involvement is extremely rare. With respiratory prodromal, usually present after 1 week of illness due to severe inflammation causing significant neurological symptoms, where immunotherapy and steroids have a role along with antibiotics.

Abstract ID 614: A Mimic and a Masquerade: Sjogren’s Syndrome

Caroline Silvia, Robert Wilson, Kalpana R, Arunan Subbiah

SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu, India

Background and aim: Sjogren syndrome is a chronic systemic autoimmune disorder characterised by the presence of dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) due to lymphocytic infiltration into the lacrimal and salivary glands. Additional symptoms can include dryness of skin, nose, throat; arthralgias and myalgias; peripheral neuropathies; pulmonary, thyroid, and renal disorders.

Methodology: A 54-year-old lady, who is hypothyroid, had complaints of tremors in the right upper and lower limb. A diagnosis of Parkinson’s was made and was started on Levodopa. Neuroimaging revealed T2 Flair hyperintense lesions in the periventricular region perpendicular to the corpus callosum, which were characteristic of multiple sclerosis-like lesions. The patient was continued on levodopa and showed improvement. Later, she developed right-sided weakness, sicca symptoms for 3 months and high-grade fever spikes for 5 days.

Results: Evaluation revealed raised erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), positive RA factor – 54.4 and Anti CCP 8.27. Cerebrospinal fluid (CSF) analysis was unremarkable. Serum IgG index was normal. Antinuclear antibody (ANA) was positive 2+ (nucleolar pattern) and profile revealed ssA Ro 60 kd positivity, suggestive of Sjogren’s syndrome.

Discussion: There is a correlation between PD (inflammation at the onset or progression of PD) and autoimmune disorders, which has emerged as a prominent area of interest. The inflammatory process associated with Sjögren’s gives rise to a range of additional manifestations beyond glandular involvement. Neurological symptoms are reported to be found in 8.5–70%, of which PNS is more commonly involved than CNS – neuronopathy, ganglionopathy, mononeuritis multiplex. Central nervous system (CNS) (2–25%) symptoms include headache, meningitis, seizures, transverse myelitis, optic neuritis, ataxia, encephalopathy, and multiple sclerosis-like (MS-like) lesions, along with occurrences of Parkinsonism, depression, anxiety and psychosis. Neurological symptoms manifest before the onset of sicca symptoms.

Conclusion: In cases of an atypical course of Parkinson’s disease or when there is inadequate response to standard treatment, causes of secondary Parkinsonism must be thought of.

Abstract ID 615: A Spectrum of Congenital Pontine Anomalies

Mohinish S, Neeraj Elango, Jered Livingston, Leema Pauline

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: A wide spectrum of congenital abnormalities of pons has been demonstrated, including malformations and disruptions. Familiarity with theses spectrum and their well-defined diagnostic criteria is crucial for optimal therapy, an accurate prognosis, and correct genetic counselling.

Methodology: Spectrum 1: An 8-years-old girl presented with restriction of eyeball movements noticed since childhood. Noticed abnormal curving of back since 4 years of age. Bilateral horizontal gaze palsy noted with normal vertical gaze. Progressive neurogenic scoliosis was noted. Magnetic resonance imaging (MRI) showed presence of butterfly shaped medulla with split pons sign suggestive of hypoplasia and malformation of the ventral portion of the pons and medulla oblongata. Diffusion tensor imaging revealed the absence of decussation of the bilateral pyramidal tracts. Genetics revealed the ROBO3 gene homozygous mutation in exon 9 – likely pathogenic variant confirming diagnosis as Horizontal Gaze Palsy with Progressive Scoliosis (HGPPS). Spectrum 2: An 11-months-old baby presented with delayed milestones not able to sit without support. Child had normal head circumference with no neurocutaneous markers. Spastic quadriparesis was noted. MRI showed hypoplastic left hemipons with hypolplasia of middle cerebellar peduncle, molar tooth appearance suggestive of pontine tegmental cap dysplasia. Spectrum 3: A 6–months-old male child with developmental delay had turricephaly, wide-open anterior fontanel, low-set ears, high-arched palate, and inverted V-shaped upper lip. He had bilateral temporal and parietal alopecia, bilateral corneal opacity and was not following the light. MRI showed fused cerebellar hemispheres with absent vermis, small pons and posterior fossa, diamond-shaped IV ventricle. Gómez–López-Hernández syndrome is a triad of rhombencephalosynapsis, trigeminal anesthesia leading to corneal opacity and scalp alopecia.

Discussion and conclusion: Familiarity with theses spectrum and their well-defined diagnostic criteria is crucial for optimal therapy, an accurate prognosis, and correct genetic counselling.

Abstract ID 616: Pediatric Autoimmune Neuropsychiatric Syndrome (PANS) Presenting as Obsessive-Compulsive Behaviour (OCD) in a 12-Year-Old

Jaya Kaushik, Kaushik Raghunathan, Vishnupriya Veeraraghavan

All India Institute of Medical Sciences Guwahati, Assam, India

Background and aim: To describe a 12-year-old boy diagnosed with Pediatric Autoimmune Neuropsychiatric Syndrome, presenting with obsessive-compulsive disorder (OCD).

Methodology: A 12-year-old boy, the first child of non-consanguineous parents from rural Assam, with an unremarkable perinatal and developmental history, presented with new-onset behavioural problems of two weeks’ duration following a brief febrile illness. His symptoms included increased irritability, emotional lability, fearfulness, excessive day time sleepiness and reduced communication. Additionally, he exhibited a decline in academic performance and recent onset staring episodes (mannerisms), and low frustration tolerance. His physical, cardiac and neurological examination were unremarkable. Brain imaging and electroencephalogram (EEG) were normal. His anti-streptolysin-O (ASO) titre was elevated (766 IU/mL), though his throat swab culture did not yield any bacterial growth.

Results: By day three of admission, he began showing symptom resolution, leading his parents to decline cerebrospinal fluid (CSF) evaluation and autoimmune serology workup. He showed improvement with a minimal dose of Aripiprazole, which was continued at discharge. The child remained symptom-free for the next two months. However, he returned with a relapse of symptoms lasting one week with a voracious appetite and new-onset skin-picking behaviour, severe enough to cause bleeding from the nail bed. His mother prompts him whenever he attempts to pick his skin, but he admitted to continuing the behaviour whenever she fails to notice. He also expressed experiencing repetitive thoughts about skin picking and feeling discomfort if prevented from doing so. His symptoms, along with associated neuropsychiatric manifestations, fulfilled the criteria for PANS based on clinical presentation

Discussion: Skin-picking behaviour, a body-focused repetitive disorder, is a well-known, but uncommon symptom in PANS. Further research is needed to elucidate the spectrum of presentation, immunopathogenesis, biomarkers, therapeutic response, and long-term outcomes of PANS.

Conclusion: We report a case of PANS with a rare body-focused repetitive disorder as a clue to diagnosis

Abstract ID 617: A Case of Poly Autoimmunity Anti-MDA5 Associated JDM & NMO Overlap

Neeraj Elango, Mohinish Sundar, Jered Livingston, Leema Pauline

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Poly Autoimmunity is defined as the presence of more than one autoimmune disease in a single patient. Clinically amyopathic form JDM represents less than 2% myositis. Among JDM, prevalence of MDA-5 is 7 - 60%, higher in Asian population (11-60%).

Methodology: Case report

Results: A 10-years-boy presented with history of fever (on and off), arthritis, skin rash for 6 months. Serum creatine phosphokinase (CPK) level was normal. Clinically diagnosed as a case of Amyopathic form of Juvenile Dermatomyositis (JDM) and was started on steroids. Had acute onset of Vomiting, seizures, encephalopathy within 1 week of discharge requiring ventilator support. On examination, severe wasting noted. Patchy non-scarring alopecia, heliotrope rash, gottron papules, pitted scar. Visual acuity of only light perception in both eyes. Spino-motor – Generalized wasting with painful restriction of movements. Serum CPK – 47 U/L, ESR - 88 mm/hour. Magnetic resonance imaging (MRI) brain showed hyper intense lesions involving corpus callosum, right midbrain, pons, cerebellar peduncles, left parietotemporal region, ganglio-capsular regions, thalami, hypothalami, optic chiasm and bilateral optic tracts. Considering the possibilities, we proceeded with myositis panel and serum for neuromyelitis optica (NMO) & Myelin oligodendrocyte glycoprotein (MOG). Both NMO and Anti-MDA5 antibodies were strongly positive, suggestive of poly Autoimmunity. Intravenous methyl prednisolone was given followed by oral steroids. Clinical improvement noted, as he was able to stand, take few steps with support. Visual loss improved from just light perception to 6/12 in both eyes at discharge. He was put on oral cyclosporine and currently under follow up.

Discussion and conclusion: Association of JDM with NMO spectrum diseases (NMOSD) only 3 cases have been reported so far (only 1 in paediatric population). The course of paediatric form of this overlap seems to be monophasic and has a better prognosis after treatment with steroids. CNS involvement in JDM is very rare. If present it’s mainly due to vasculitis / vasculopathy. Presentation includes seizures, psychiatric symptoms, and visual loss. Visual loss in JDM due to retinal vasculitis / NMO. Therapeutics targeting B cells such as Rituximab seems the most satisfactory treatment.

Abstract ID 618: An Interesting Case of Unilateral MRI Changes in a Patient of Hypoxic Brain Injury

Shubham Dubey

Datta Meghe Institute of Higher Education and Research, Wardha, Sawangi, Meghe, Maharashtra, India

Background and aim: Hypoxic-ischemic encephalopathy, also known as global hypoxic-ischemic injury, is seen in many clinical scenarios and often has devastating neurological sequelae. Hypoxic-ischemic cerebral injury occurs at any age, although the etiology is significantly different: Children: drowning and asphyxiation are common causes. Adults: commonly a result of cardiac arrest or cerebrovascular disease, with secondary hypoxemia/hypoperfusion patients typically present to hospital following an acute event (drowning, asphyxia, cardiac/respiratory arrest).

Methodology: Diffusion-weighted MR imaging is generally the earliest imaging modality to become positive, usually within the first few hours after a hypoxic-ischemic event due to early cytotoxic edema. During the first 24 hours, there may be findings of restricted diffusion in the cerebellar hemispheres, basal ganglia, or cerebral cortex (in particular, the perirolandic and occipital cortices). The thalami, brainstem or hippocampi may also be involved. Diffusion-weighted imaging abnormalities usually become normal by the end of the 1st week. T1 and T2 weighted images are often normal or demonstrate only very subtle abnormalities. In the early subacute period (24 hours to 2 weeks), conventional T2 weighted images typically become positive and show increased signal intensity and swelling of the injured grey matter structures.

Results: A 41-year-old male presented to emergency settings with cardiac arrest. He was immediately resuscitated and put on ventilator assistance. He was subjected to magnetic resonance imaging (MRI) next day which showed unilateral diffusion restriction in right cortical and subcortical regions with sparing of the left hemisphere.

Discussion: Patient gradually regained sensorium over the next 10 days and the repeat MRI scan was normal, thus signifying reversal nature of the lesion.

Conclusion: Generally, hypoxic brain injury has got characteristic MRI findings which are often bilateral and symmetrical. In rare cases, such patients can present with unilateral MRI findings also.

Abstract ID 619: Peripheral Neuropathy in a Patient with Poliomyelitis: The Compounding Impact of Disease: A Case Report

Shivam Mirg, Arunmozhimaran Elavarasi, Animesh Das, M Sharma, Manjari Tripathi

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Worsening neurological symptoms in patients with a history of poliomyelitis are frequently attributed to Post-Polio Syndrome (PPS), a well-recognized late complication. However, similar symptoms can also arise from unrelated or superimposed conditions, and misattribution may delay diagnosis and treatment. This case highlights the importance of comprehensive evaluation in such presentations.

Methodology: A 25-year-old male presented with a six-month history of insidious-onset, progressive, asymmetric sensory symptoms, initially affecting the left upper limb, followed three months later by similar complaints in the right lower limb. He had a history of lower motor neuron paraparesis due to poliomyelitis since the age of 2.5 years. Neurological examination revealed sensory loss in the ulnar distribution of the left forearm, involvement of the right deep peroneal and medial plantar nerves, and weakness of ulnar-innervated intrinsic hand muscles on the left side, along with persistent bilateral lower limb weakness. Multiple mononeuropathy was suspected.

Results: Nerve conduction studies showed absent sensory nerve action potentials in the left dorsal ulnar cutaneous, medial antebrachial cutaneous, and radial nerves. Electromyography demonstrated active denervation in the left abductor digiti minimi with evidence of reinnervation in other muscles, suggesting a superimposed insult on prior poliomyelitis. Ultrasound revealed thickening of the left ulnar nerve at the cubital tunnel. A vasculitis workup was negative. Nerve biopsy from the dorsal ulnar cutaneous nerve confirmed lepromatous leprosy, with acid-fast bacilli present. The patient was started on multidrug therapy, including rifampicin, clofazimine, and dapsone, and showed near-complete symptom resolution at one-year follow-up.

Discussion: While Post-Polio Syndrome is often the presumed cause of new symptoms in polio survivors, it remains a diagnosis of exclusion. This case underscores the need to consider alternate causes, especially when symptoms are asymmetric, progressive, or sensory-predominant—features atypical of PPS. Electrophysiological studies, nerve imaging, and biopsy were critical in identifying Hansen’s disease as a treatable, superimposed neuropathy. Early diagnosis allowed for timely therapy and excellent recovery.

Conclusion: Not all new or worsening symptoms in post-polio patients are due to PPS. In cases with atypical features, superimposed conditions such as Hansen’s disease should be considered and thoroughly evaluated

Abstract ID 620: Prodrome and Postdrome Symptoms in Migraine - An Analysis

Ashila R S, Shaji C V

Government TD Medical College, Alappuzha, Kerala, India

Background and aim: Migraine is the second leading cause of disability among neurological illnesses. The prodrome and postdrome in migraineurs are often ignored disabling symptomatology. Understanding the symptoms, targeting them with agents “on time” can treat the symptoms and abort an attack. This study aimed to assess the prevalence of prodrome and postdrome symptoms and their associations with age, gender, aura, migraine severity, and prophylactic treatment.

Methodology: This was a prospective, descriptive study, conducted over 18 months at the Neurology OP Department of Government TD Medical College, Alappuzha. Total of 173 migraine patients >14 years, meeting International classification of headache disorders (ICHD)-3 criteria for migraine, were enrolled. After informed written consent and approval from the Institutional Ethics Committee (IEC), detailed clinical evaluation was performed. Participants completed a questionnaire covering 26 recognized prodrome and postdrome symptoms. Migraine severity was assessed using Migraine Disability Assessment (MIDAS) scale. Statistical analysis - performed using SPSS version 25. Chi-square and McNemar’s tests were used, with significance set at p < 0.05.

Results: Mean age was 33.14 ± 9.45 years, with female predominance (4.24:1). Prodrome symptoms were more frequent in younger patients. Most common prodrome symptoms were phonophobia (48%), anxiety (43.4%), irritability (42.8%), and photophobia (42.8%), while postdrome symptoms included tiredness (31.8%) and asthenia (28.3%). Aura was significantly associated with more prodrome and postdrome symptoms. Higher MIDAS scores correlated with greater symptom burden. Prophylactic therapy showed no statistically significant reduction in symptom frequency.

Discussion: Prodrome and postdrome symptoms contribute significantly to migraine-related morbidity. Their correlation with aura and severity reflects shared underlying neurophysiological mechanisms. The limited impact of prophylactic therapy on these symptoms may indicate the need for improved treatment strategies.

Conclusion: Nonpainful symptoms in migraine are common and clinically significant which adds to morbidity of the disease. The individual prodrome and postdrome symptoms were variably associated with severity of migraine and presence of aura. Routine evaluation of these phases may aid early diagnosis and tailored interventions.

Abstract ID 621: Neurorehabilitation with EMG Biofeedback in an Elderly Parkinson’s Patient: A Case Study

R Anand, Ruchi Shah¹, Karthik Rao¹, Raghavan K¹

Sai Neuro Clinic Chennai, Tamil Nadu, ¹JOGO Health, Chennai, Tamil Nadu, India

Background and aim: Parkinson’s disease (PD) is a progressive neurodegenerative disorder affecting motor function, balance, and gait. Surface electromyography (sEMG) biofeedback-assisted neurorehabilitation is emerging as a novel treatment to enhance motor performance. This study presents an 80-year-old male with PD treated using JOGO digital EMG biofeedback therapy.

Methodology: Diagnosed with PD for 5 years, the patient showed worsening mobility over the past year. He was unable to stand unaided, had poor balance, and an altered gait pattern. Alongside medication, he received JOGO EMG biofeedback-assisted therapy three times weekly for 36 weeks. Interventions included progressive muscle relaxation, lower limb strengthening, balance and gait training and tremor control training. Outcome measures were assessed at baseline and discharge using the Unified Parkinson’s Disease Rating Scale (UPDRS), Berg Balance Scale, Timed Up and Go (TUG) test, 30-second sit-to-stand test, manual muscle testing (MMT), and sEMG recordings.

Results: Post-therapy, UPDRS score reduced from 58 to 42; Berg Balance Scale improved from 4 to 25; sit-to-stand test increased from 1 to 7 repetitions; TUG improved from non-assessable to 30 seconds. MMT for quadriceps and tibialis anterior improved from 3/5 to 4/5 bilaterally. JOGO sEMG recordings (in millivolt second) showed a marked reduction in resting amplitude of wrist extensors: right from 37 mvs to 1 mvs, and left from 15 mvs to 2 mvs

Discussion: JOGO therapy demonstrated improvements in tremor control, muscle strength, and functional mobility. Prior studies have shown similar benefits of EMG biofeedback in PD, improving tremor control and promoting neuroplasticity. A meta-analysis further supports its effectiveness in enhancing motor outcomes across neurological conditions.

Conclusion: JOGO EMG biofeedback offers targeted, non-invasive, precision muscle retraining with real-time audio-visual feedback and objective assessment, positioning it as a superior adjunct to conventional physiotherapy in Parkinson’s Disease management.

Abstract ID 622: An Unusual Neurological Presentation of Coeliac Disease

Sapna Mittal, Lekshmi Hema, Ayush Agarwal, Divyani Garg, Ajay Garg, Achal Srivastava

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Coeliac disease (CD) is an autoimmune condition affecting the intestinal mucosa. The presenting symptoms include diarrhea, weight loss, nausea, etc. It may remain asymptomatic, and extraintestinal symptoms may lead to diagnosis. Thrombotic complications are rare, and hepatic vein thrombosis is the most commonly reported. We report here a case of a young adult with cerebral venous sinus thrombosis (CVST), diagnosed with CD.

Methodology: A 30-year-old male presented with a chronic headache for one and a half years. He had an insidious onset headache associated with photophobia and projectile vomiting. For the past 3 months, he had binocular horizontal diplopia, worsened on far vision. He also had a weight loss of about 10 kgs. On examination, his vital parameters were normal, visual acuity was 6/6 in both eyes, with mild restriction in lateral rectus movements. Fundus showed grade 4 papilloedema. The remaining neurological examination was normal. MRI brain with venography revealed bilateral transverse venous sinus thrombosis. Thrombophilia workup was negative. He was found to have moderate iron deficiency anemia (IDA). The stool examination for occult blood was negative. Anti-TTG IgA titers were elevated >10 times the upper limits of normal. Thus, a duodenal biopsy was done, which was suggestive of CD.

Results: He was diagnosed as a case of CSVT secondary to CD. A gluten-free diet and oral anticoagulants were advised. He showed symptomatic improvement within a week and became asymptomatic at 3-month follow-up.

Discussion: This patient had chronic CVST with weight loss and IDA. The malabsorption of micronutrients and inflammatory milieu can predispose patients with CD to thrombotic events. The neurological complications are rare, and a few case reports have been published concerning this presentation.

Conclusion: CD may have varied manifestations. In cases of CVST of obscure etiology, clinicians’ awareness of possible CD is warranted, especially in the presence of IDA in young adults.

Abstract ID 623: Tracing a Tremor: The Enigma of a Fourteen-Year Journey

Soumya Bhowmik

All India Institute of Medical Sciences, Kalyani, West Bengal, India

Background and aim: Neurodegeneration with Brain Iron Accumulation (NBIA) encompasses a group of genetically diverse disorders characterized by extrapyramidal signs and excessive iron deposition in the basal ganglia. We present a diagnostically challenging case of adolescent-onset, slowly progressive tremor with dystonia and cerebellar signs in a 38-year-old male. The aim was to investigate the clinicoradiological and genetic correlates in this atypical presentation.

Methodology: A 38-year-old male with symptom onset at age 14 was evaluated for chronic right > left upper limb postural and action tremor, dystonia, past pointing, and dyssynergia. Magnetic resonance imaging (MRI) brain revealed paramagnetic substance deposition in the bilateral basal ganglia. Whole-exome sequencing (WES) was performed. Genetic variants were assessed based on ACMG criteria and clinical correlation.

Results: MRI showed bilateral globus pallidus hypointensities on susceptibility sequences, consistent with iron deposition. WES identified heterozygous variants of uncertain significance (VUS) in ITPR1 (associated with SCA15/SCA29) and GIGYF2 (linked to Parkinson disease 11). No pathogenic mutations were detected in classical NBIA genes (PANK2, PLA2G6, FA2H, etc.). No cerebellar atrophy was noted. Clinical features did not align fully with spinocerebellar ataxia or Parkinsonism.

Discussion: This case demonstrates an adolescent-onset extrapyramidal-cerebellar syndrome with iron deposition but no confirmed genetic diagnosis. While ITPR1 mutations may explain the tremor and ataxia, they do not account for basal ganglia changes. The presentation aligns most closely with an NBIA-like phenotype, underscoring diagnostic challenges in genetically unresolved cases. Limitations of WES and the need for advanced genomic methods such as whole-genome sequencing (WGS) or RNA-sequencing are highlighted.

Conclusion: We report a probable NBIA-spectrum disorder with adolescent-onset tremor and dystonia, cerebellar signs, and basal ganglia iron deposition but no identifiable genetic etiology. This case exemplifies the complexity of neurogenetic diagnosis and the need for evolving genomic strategies in atypical NBIA presentations.

Abstract ID 624: Mycophenolate Mofetil-Induced Toxic Encephalopathy in a Patient with CIDP and Crohn’s Disease: A Rare and Reversible Case

Sricharan Alladi, Lakshmi Lavanya Muppalla

Kamineni Hospital LB Nagar Hyderabad, Telangana, India

Background and aim: We report a rare case of mycophenolate mofetil (MMF)-induced toxic encephalopathy in a patient with chronic inflammatory demyelinating polyneuropathy (CIDP) and Crohn’s disease. This case highlights the importance of recognizing this serious adverse effect and the role of timely intervention.

Methodology: A 50-year-old female with known Crohn’s disease and CIDP presented with progressive lower limb numbness, weakness, difficulty in walking, and sensory ataxia. She was started on MMF (500–1000 mg BD) as a steroid-sparing immunomodulator in an outside hospital. Following MMF initiation, she developed progressive neurological symptoms, including confusion, ataxia, slurred speech, and blurred vision. Magnetic resonance imaging (MRI) brain revealed bilateral edematous dentate nuclei with altered signal intensities, after ruling out other causes diagnosed as possible MMF-induced toxic encephalopathy.

Results: After 48 hours of discontinuing MMF, the patient showed significant improvement, with resolution of encephalopathy and gradual recovery of neurological symptoms. Subsequently, to manage CIDP, intravenous immunoglobulin (IVIG) at 0.4 g/kg/day for 5 days was administered. The patient improved steadily and was able to walk independently. Serial follow-up showed no recurrence of symptoms.

Discussion: MMF is widely used as an immunosuppressive therapy in autoimmune disorders, but toxic encephalopathy is a rare yet potentially reversible adverse effect. Early recognition, immediate discontinuation of MMF, and supportive therapy are essential to prevent long-term neurological sequelae. In this case, discontinuation of MMF alone led to significant symptomatic improvement within 48 hours, underscoring the importance of drug withdrawal as the primary step in management. Follow up imaging after a month resolution of previous findings was seen. IVIG therapy was then used to address the underlying CIDP.

Conclusion: Clinicians should remain vigilant for MMF-induced toxic encephalopathy in patients receiving MMF for CIDP or other autoimmune disorders. Prompt diagnosis and withdrawal of MMF can lead to complete recovery and prevent permanent neurological damage.

Abstract ID 625: When the Worm Crawls North: A Rare Tale of Nerve and Gut

Md Karimulla Mondal, Atanu Biswas, Arijit Ray, Uma Singharoy

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Background and aim: Strongyloides stercoralis is a soil-transmitted helminth that typically causes asymptomatic or gastrointestinal disease in immunocompetent hosts. Neurological complications, particularly myeloneuropathy, are rare and usually associated with disseminated disease in immunocompromised individuals. This report presents a rare case of Strongyloides-associated myeloneuropathy in an immunocompetent adult.

Methodology: A 36-year-old previously healthy male presented with progressive bilateral lower limb weakness over two months. There were no sensory, cranial nerve, or autonomic symptoms. Examination, neuroimaging, nerve conduction studies (NCS), cerebrospinal fluid (CSF) analysis, abdominal imaging, colonoscopy with biopsy, stool microscopy, and duodenal biopsy were performed. Strongyloides serology was also obtained. Based on findings, oral ivermectin was initiated, and response was monitored clinically and with repeat CSF analysis.

Results: Neurological examination revealed bilateral lower limb hypotonia, hyporeflexia, wasting, and pyramidal signs with a Medical Research Council (MRC) sum score of 42/60. NCS showed motor axonopathy. CSF revealed lymphocytic pleocytosis and elevated protein. Magnetic resonance imaging (MRI) of the dorsolumbar spine was normal. Colonoscopy showed deep ulcers; biopsies revealed nonspecific colitis. Duodenal biopsy and stool examination identified Strongyloides larvae. Serology for Strongyloides (IgG/IgM) was positive. Routine labs showed hypoalbuminemia, mildly low copper, and raised inflammatory markers. Ivermectin was administered at 200 mcg/kg/day for 14 days. On follow-up, the patient had full neurological recovery (MRC 60/60) with normalized CSF parameters.

Discussion: This case demonstrates an unusual manifestation of strongyloidiasis as myeloneuropathy in an immunocompetent host. The pathophysiology may involve immune-mediated mechanisms or toxin-mediated neuronal injury, given the rarity of larvae detection in CSF.

Conclusion: Strongyloidiasis should be considered in the differential diagnosis of unexplained myeloneuropathy, even in immunocompetent patients. Early diagnosis and treatment are crucial to prevent irreversible neurological damage.

Abstract ID 626: Probable Tolosa-Hunt Syndrome in a Young Female with Balanced Translocation and 4q Deletion: A Rare Intersection of Genetics and Autoimmunity

Sricharan Alladi, Lakshmi Lavanya Muppalla

Kamineni Hospital LB Nagar, Hyderabad, Telangana, India

Background and aim: Probable Tolosa-Hunt Syndrome (THS) in a Young Female with Balanced Translocation and 4q Deletion: A rare intersection of genetics and autoimmunity. THS is a rare cause of painful ophthalmoplegia due to granulomatous inflammation of the cavernous sinus. Atypical presentations may be associated with underlying autoimmune or cytogenetic abnormalities. We present a case of probable THS in a young female with balanced translocation and 4q deletion, highlighting the diagnostic challenges and the importance of a multidisciplinary approach that integrates genetic and autoimmune perspectives.

Methodology: A 27-year-old female presented with a 2-month history of left-sided headache, left eye pain, tingling on the left side of the face, photophobia, phonophobia, and blurring of vision. Clinical examination revealed left lateral rectus palsy with ptosis but no pupillary involvement. Systemic examination showed features of gonadal dysgenesis. Investigations included viral markers, electrocardiogram (ECG), 2D echo, CSF analysis, MRI brain, autoimmune profile, and karyotyping.

Results: MRI brain revealed an ill-defined enhancing lesion in the left petrous apex extending to Meckel’s cave and cavernous sinus, encasing the left internal carotid artery and involving the left 5th and 6th nerves—suggestive of probable THS with differentials including idiopathic hypertrophic pachymeningitis and granulomatous diseases. Karyotyping revealed a normal female karyotype (46, XX) with a balanced translocation between chromosomes 7 and 14 [46, XX, t (7q; 14q)] and a deletion on chromosome 4q. Antinuclear antibody (ANA) screening was positive with antibodies to double-stranded DNA (dsDNA) and histones; the ANA profile is pending. Serum IgG4 levels were mildly elevated.

Discussion: This case highlights the interplay between genetic and autoimmune factors in THS pathogenesis. A comprehensive evaluation, including genetic and autoimmune workup, is essential for accurate diagnosis and effective management.

Conclusion: Probable THS should be considered in young females with painful ophthalmoplegia, particularly when cytogenetic and autoimmune abnormalities are present. Early corticosteroid therapy can lead to significant symptomatic improvement.

Abstract ID 627: Role of White Matter Hyperintensities in Aging and Dementia Spectrum

Sarath G, Nithin Thanissery, Suvarna Alladi, Sunil Khokhar, Faheem Arshad, Bharath Ravindra, Vikram Choudhary, Subasree Ramakrishnan, Jitender Saini, Rose Bharath, Suvarna Alladi

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Among approximately 5.3 million dementia patients in India, nearly 40% are estimated to be due to vascular contribution. White matter hyperintensities (WMHs) indicate small vessel disease and have been increasingly recognized as contributors to cognitive impairment in neurodegenerative disorders. This study aimed to quantify and compare the burden of periventricular (PWMH) and deep white matter hyperintensities (DWMH) among cognitively normal (CN) individuals, patients with Alzheimer’s disease (AD) and frontotemporal dementia (FTD) and examined their association with cognitive performance using the Addenbrooke’s Cognitive Examination-III (ACE-III).

Methodology: The study included 39 CN controls, 49 AD patients and 64 FTD patients for whom FLAIR images were acquired on a 3T MRI scanner. ACE-III was used to access cognition which included a global and sub-scores for attention, memory, fluency, language and visuospatial domains. And the WMHs were graded using Fazekas grading.

Results: Persons with dementia (FTD and AD) had significantly more PWMH (62%) and DWMH (53%) compared to CN individuals (PWMH: 18%; DWMH:10%). In AD, presence of PWMH was associated with higher age (p = 0.027) and duration of illness (p = 0.027). Presence of PWMH in AD was also related to poorer attention (p = 0.005) and memory (p = 0.034) scores after controlling for age, duration of illness and education. In FTD, presence of DWMH was associated with higher age (p = 0.002).

Discussion: The findings reveal a significantly greater burden of PWMH and DWMH in individuals with AD and FTD compared to cognitively normal controls. In AD group, increased PWMH burden was associated with advancing age, longer disease duration, and lower attention and memory scores. DWMH in FTD was significantly associated with older age. The results highlight patterns of WMH distribution and their cognitive correlates in AD and FTD.

Conclusion: This study indeed emphasises the importance of vascular contribution to dementia and its subtypes.

Abstract ID 628: A Dance of Missteps: Echoes of the Cerebellum in the Neuromuscular Cleft

Md Karimulla Mondal, Alak Pandit, Souvik Dubey, Biman Ray

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Background and aim: Lambert–Eaton Myasthenic Syndrome (LEMS) is a rare autoimmune disorder affecting presynaptic voltage-gated calcium channels (VGCCs) at the neuromuscular junction. While cerebellar ataxia is recognized in paraneoplastic LEMS (P-LEMS), its occurrence in non-paraneoplastic LEMS (NP-LEMS) is exceedingly rare. This case highlights the diagnostic approach and therapeutic response in an elderly male with ataxic NP-LEMS.

Methodology: A 63-year-old chronic smoker presented with progressive gait imbalance and recurrent falls over 4 months, worsened in low light and narrow spaces. Clinical examination revealed cerebellar signs (hypometric saccades, broken pursuits, mild limb incoordination, ataxic wide-based gait) and global hyporeflexia with preserved power and sensation. Magnetic resonance imaging (MRI) brain and spine were unremarkable. Nerve conduction studies revealed axonal motor neuropathy. Repetitive nerve stimulation test showed a significant decremental (>10%) and incremental (>100%) response. Routine blood work, autoimmune panel, and CSF studies were normal. Serum anti-VGCC antibodies were positive. Imaging for malignancy (CECT NTAP) was negative. The patient was treated with Intravenous immunoglobulin (IVIg) followed by oral corticosteroids. Results Following IVIg therapy, the patient showed remarkable improvement in gait stability and was able to ambulate independently. The absence of malignancy and a positive autoimmune marker confirmed a diagnosis of ataxic NP-LEMS. The patient continues to improve on oral immunosuppressive therapy.

Results: Cerebellar ataxia in NP-LEMS is infrequent and may obscure the diagnosis of LEMS. Anti-VGCC antibodies may cross-react with cerebellar structures, particularly Purkinje cells, contributing to ataxia. While LEMS symptoms often improve with immunotherapy, cerebellar deficits may be less responsive due to possible irreversible damage.

Discussion: Cerebellar ataxia in NP-LEMS is infrequent and may obscure the diagnosis of LEMS. Anti-VGCC antibodies may cross-react with cerebellar structures, particularly Purkinje cells, contributing to ataxia. While LEMS symptoms often improve with immunotherapy, cerebellar deficits may be less responsive due to possible irreversible damage.

Conclusion: NP-LEMS should be considered in patients with subacute cerebellar ataxia, especially when routine evaluations are inconclusive. Early detection and immunotherapy may improve neuromuscular symptoms and functional outcomes.

Abstract ID 629: Intracranial Epidermoid Cysts with Malignant Transformation: Two Case Reports

Pratishtha Sengar, Vikas Kailashiya, Amrita Ghosh, Nityanand Pandey, Anurag Sahoo

Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background and aim: Intracranial epidermoid cysts (IECs) are rare, benign congenital lesions, comprising about 1% of all intracranial tumors. While typically slow-growing and non-aggressive, malignant transformation into squamous cell carcinoma or other malignancies is extremely uncommon. When it occurs, the prognosis is generally poor due to aggressive tumor behaviour and delayed diagnosis.

Methodology: We present two rare cases of IECs with evidence of malignant transformation. Clinical presentation, radiological findings, surgical outcomes, and histopathological analyses were reviewed retrospectively.

Results: Case 1: A 48-year-old male presented with altered sensorium for one day, along with a 10-day history of intermittent headache and vomiting. He had a prior episode of focal to bilateral tonic-clonic seizures and a history of chronic suppurative otitis media. A computed tomography (CT) imaging revealed multiple conglomerate ring-enhancing lesions in the right temporoparietal region with significant perilesional edema and midline shift. Surgical resection was performed, and histopathology revealed an epidermoid cyst with malignant transformation to squamous cell carcinoma. Case 2: A 23-year-old male had a five-year history of generalized tonic-clonic seizures and headache. MRI revealed a right temporal space-occupying lesion, and histopathology confirmed an epidermoid cyst. Seven months later, he presented with worsening headache and bilateral visual impairment. Examination showed papilledema, and MRI suggested a recurrent lesion, possibly glioblastoma. Surgical resection revealed histopathology suggestive of oligodendroglioma.

Discussion: Malignant transformation of IECs, while rare, may be influenced by chronic inflammation, repeated surgical manipulation, or cyst rupture. Both cases suggest a possible link between chronic irritation or incomplete excision and carcinogenesis, though the pathophysiology remains unclear.

Conclusion: These cases highlight the potential for malignant transformation in IECs, emphasizing the importance of long-term follow-up and thorough surgical management. Early recognition and histopathological confirmation are crucial for timely intervention and improved prognosis.

Abstract ID 630: Effect of Glycosylated Haemoglobin on Early Neurological Deterioration in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis and Functional Outcome in a Tertiary Care Centre

Anantha A, Rammohan K, Chithra P

Trivandrum Government Medical College, Kerala, India

Background and aim: Early Neurological Deterioration (END) following intravenous thrombolysis is a predictor of poor prognosis in acute ischemic stroke (AIS). Chronic glycemic control, as reflected by glycosylated haemoglobin (HbA1c), may influence this outcome. This study aimed to assess the effect of HbA1c and diabetes status on END and functional outcome at 90 days in thrombolysed AIS patients.

Methodology: This was a prospective cohort study conducted at a tertiary care centre. A total of 81 AIS patients who received intravenous thrombolysis were included: 41 diabetics and 40 non-diabetics. HbA1c was measured at admission. END was defined as an increase in NIHSS >1 at 72 hours. Good outcome was defined as modified Rankin Scale (mRS) 0–1 at 90 days. Statistical tests included Fisher’s exact test, chi-square, ROC analysis, and logistic regression.

Results: END occurred in 24.4% of diabetics and 15.0% of non-diabetics (p = 0.404). Good outcome was achieved in 39.0% of diabetics and 62.5% of non-diabetics (p = 0.059). ROC analysis showed HbA1c > 9.2% predicted END with an AUC of 0.71, sensitivity 55%, and specificity 82%. On logistic regression, only national institutes of health stroke scale (NIHSS) at admission was a significant independent predictor of END (p = 0.002); HbA1c and age were not statistically significant.

Discussion: While diabetes status did not independently predict END, poor glycemic control (higher HbA1c) showed moderate predictive value. Baseline stroke severity remained the strongest predictor of early deterioration.

Conclusion: HbA1c > 9.2% may help identify AIS patients at higher risk of END after thrombolysis. Along with NIHSS, it can guide early risk stratification and individualized management strategies.

Abstract ID 631: Segmental Zoster Paresis- Report of 2 Rare Cases

Subramanian Rajendran, Senthur Raja Pandian, Elangovan S, Murugan P K

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Herpes zoster infection, known as shingles, results from reactivation of latent varicella-zoster virus (VZV) that gained access to sensory ganglia. The classical manifestations are rash involving single or multiple dermatomes and acute neuritis. Here, we present 2 cases of peripheral motor neuropathy, called as segmental zoster paresis, a rare complication of Varicella zoster infection.

Methodology: Cases 1: A 58-years-old male patient, uncontrolled diabetic, presented with classical zoster rash over right C6 dermatome with ulceration, complaining of right hand weakness. Examination revealed right wrist drop with weak extensor carpi radialis, triceps, supinator and brachioradialis. Right biceps, triceps and supinator reflexes were hypo. Routine investigations showed elevated renal parameters. Magnetic resonance imaging (MRI) brain / spine (plain) doesn’t show any significant abnormality. NCS shows mild reduction in amplitude of right median and radial nerve, and sensory nerve action potential (SNAP) was normal. Case 2: A 60-years-old male patient, presented with rashes over left T1 dermatome with paresthesia and weakness of left hand. Examination revealed weak left opponens pollicis, lumbricals and interossei. Serum herpes simplex virus (HSV) IgM and IgG was positive. MRI brain/ spine showed left T1 root enhancement suggestive of radiculitis. Nerve conduction studies (NCS) show reduced amplitude over left median, ulnar and radial nerve with impersistent F waves. SNAP of left median and ulnar nerves show reduced amplitude. Electromyography (EMG) over left abductor pollicis brevis, abductor digiti minimi and first lumbrical had fibrillation potentials, suggestive of acute devervation.

Results: We made the diagnosis of segmental zoster paresis in both the cases and started on acyclovir, steroids, physical therapy.

Discussion: Segmental zoster paresis (SZP) develops in approximately 3% of patients with herpes zoster. It may mimic stroke. Peripheral motor weakness results from spread of VZV from the dorsal root ganglia to the anterior root of the spinal cord. 75% of the patients experience gradual recovery of motor strength.

Conclusion: These 2 cases are presented for its rarity.

Abstract ID 632: Post Herpes Simplex Virus 1 Encephalitis (HSV1E) induced N-methyl-D-aspartate Receptors (NMDAR) Autoimmune Encephalitis; A Case Report

Neeraj Kumar, Surekha Dabla

Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Background and aim: Herpes simplex encephalitis (HSE) is the leading cause of severe sporadic encephalitis. Post-herpes simplex virus (HSV) type 1 encephalitis (HSV1E) development of N-methyl-D-aspartate receptor (NMDAR) antibodies resulting in autoimmune encephalitis in the various studies reported from 7.1% to 12.5% in adult patients. Anti-NMDAR develops 1–4 weeks after herpes simplex virus encephalitis (HSVE), manifesting as choreoathetosis and/or orofacial dyskinesia in children and psychiatric symptoms in young adults. We should consider anti-NMDAR encephalitis in the differentials in patients with clinical relapse after improvement of treated acute HSVE.

Methodology: A case report

Results: A 33-year-old previously healthy female presented in March 2025 with history of moderate to high grade fever since 2 days followed by altered sensorium with generalized tonic clonic seizure episode since one day, on evaluation electroencephalogram (EEG) showed generalized slowing, magnetic resonance imaging (MRI) brain findings were suggestive of acute HSV encephalitis, HSV 1 PCR positive in cerebrospinal fluid (CSF), patient was treated with injection acyclovir for 14 days to which responded well. A month later in April 2025, patient had clinical relapse of headache, drowsiness, episodes of perioral movements. Repeat HSV1 PCR done in CSF in view of possibility of relapse of HSV1 but came out to be negative and no fresh MRI brain necrotic or hemorrhagic lesion. Further evaluation in view of post infective autoimmune encephalitis, autoimmune panel detected NMDAR antibody both in CSF and serum. The patient showed poor response to steroids and intravenous immunoglobulin (IVIG) but improved after rituximab therapy.

Discussion: Post HSVE induced NMDAR autoimmune encephalitis is not so common condition to encounter. Exact pathogenic mechanism underlying the biphasic HSE followed by HSV induced anti NMDAR encephalitis remains unknown.

Conclusion: The present case highlights the importance of keeping high clinical suspicion for anti-NMDAR encephalitis in biphasic HSE following HSV, as it responds well to immunotherapy.

Abstract ID 633: The Molar Tooth Mystery: Spotting Joubert Syndrome on MRI

Apsara S, Murugan P K, Justin C, S Elangovan

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Joubert Syndrome (JS) is a rare autosomal recessive ciliopathy characterized by cerebellar vermis hypoplasia, brainstem malformations, and the pathognomonic “molar tooth sign” on neuroimaging. Although typically diagnosed in infancy or early childhood with developmental delay and hypotonia, late presentations are increasingly being recognized due to improved neuroimaging and genetic testing.

Methodology: We report the case of a 20-year-old female who presented with new-onset generalized tonic-clonic seizures and progressive unsteadiness of gait. Neurological examination revealed cerebellar signs including dysmetria, dysdiadochokinesia, and broad-based ataxic gait.

Results: Fundoscopy showed no evidence of retinal involvement. Magnetic resonance imaging (MRI) brain demonstrated the classic “molar tooth sign” suggestive of JS, with hypoplasia of the cerebellar vermis and thickened, elongated superior cerebellar peduncles.

Discussion: This case highlights an atypical adult presentation of JS, which is infrequently diagnosed beyond childhood. Seizures, although not a core diagnostic feature, can occur in up to one-third of JS patients, possibly due to associated cortical dysplasia or structural abnormalities. Cerebellar ataxia may be progressive and disabling. Recognition of the radiological hallmark is crucial in diagnosing JS in adults with unexplained ataxia or seizures.

Conclusion: This case emphasizes the importance of considering JS in the differential diagnosis of adult-onset cerebellar ataxia with seizures. Timely neuroimaging and genetic confirmation are essential for accurate diagnosis, prognostication, and genetic counseling.

Abstract ID 634: Utility of Transcranial Direct Current Stimulation on Cognition in Cases of Alzheimer Disease

Srinath R, Subrat Nanda¹, Manish Sharma², Ankit Mathur, Akshay Rana³

Military Hospital Gangtok, Sikkim, ¹AHRR, New Delhi, ²Armed Forces Medical College, Pune, Maharashtra, ³Command Hospital Airforce, Bengaluru, Karnataka, India

Background and aim: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, mood disturbances, and sleep impairments. This study aimed to assess the impact of transcranial direct current stimulation (tDCS) on cognition, mood, and sleep quality in AD patients.

Methodology: A prospective observational study and 50 subjects were included in the study. It was conducted over a period of two years, from Jan 2023 to Jan 2025.This study involved AD patients who underwent tDCS sessions targeting the dorsolateral prefrontal cortex. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), depressive symptoms were measured using the Beck Depression Inventory (BDI), and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Assessments were conducted at baseline, 6 weeks, and 12 weeks post-treatment.

Results: There was improved cognitive function, sleep quality, and depressive symptoms, with the benefits observed in the first 6 weeks and a continued, improvement at 12 weeks.

Discussion: The results of this study suggest that tDCS is an effective non-invasive intervention for improving cognitive function, mood, and sleep quality in Alzheimer’s disease patients. Significant improvements in MoCA, BDI, and PSQI scores indicate that tDCS enhances neuroplasticity, reduces depressive symptoms, and regulates sleep patterns.

Conclusion: Given its safety, ease of application, and potential as an adjunctive treatment, tDCS may offer a promising approach for managing AD-related cognitive and neuropsychiatric symptoms. Further, large-scale, long-term studies are needed to optimize stimulation protocols and establish its clinical efficacy.

Abstract ID 635: Coexisting Cerebellar Degeneration and Lambert Eaton Myasthenic Syndrome Without Cancer: Insights from a Case and Systematic Literature Review

Prachi Mohapatra, Shikha Priya, Rajesh Singh, Deepti Vibha, Arunmozhiraman Elavarasi, Jasmine Parihar, Manjari Tripathi

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder often associated with small cell lung carcinoma (SCLC). Cerebellar degeneration can coexist with LEMS, although their coexistence without malignancy is uncommon.

Methodology: We present the case of an elderly male with coexistent LEMS and cerebellar degeneration associated with anti-voltage-gated calcium channels (VGCC) antibodies, in whom no malignancy was identified despite extensive evaluation. In addition, we reviewed 56 published cases of this clinical association, highlighting the phenotypic spectrum, antibody profiles, and long-term outcomes.

Results: A 75-year-old male with 30-year history of smoking presented with a three-year history of progressive cerebellar ataxia, followed by one-month history of bilateral ptosis, ophthalmoparesis, and proximal lower limb weakness. Serum P/Q-VGCC antibodies and electrophysiological tests confirmed LEMS, but extensive malignancy screening, including PET-CT, was negative. Immunotherapy led to significant improvement in ocular and motor symptoms and moderate improvement in cerebellar manifestations. We reviewed 56 cases of coexistent LEMS and cerebellar ataxia published since 1991. Mean age at presentation was 59.8 ± 6.8 years, with male predominance (62.5%). Simultaneous onset of LEMS and ataxia occurred in 41.1%, LEMS preceded ataxia in 32.1%, and ataxia preceded LEMS in 26.8%. Malignancy was identified in 75% (42/56), most commonly SCLC (30/56, 53.6%). Median interval from symptom onset to cancer diagnosis was 2 months (IQR, 0.5–6.5 months), with a range from 60 months before to 39 months after. Antibody profiles revealed anti-VGCC in 80.4%, anti-SOX1 in 8.9%, and anti-Hu in 3.6%. 25% (14/56) had no detectable malignancy. Clinical improvement in LEMS and ataxia following treatment was observed in 58.9% and 51.8% respectively. Death occurred in 25%.

Discussion: Coexistence of LEMS and cerebellar ataxia, though rare, highlights a complex spectrum of autoimmune neurological disease with both paraneoplastic and idiopathic autoimmune subsets.

Conclusion: Continued malignancy surveillance along with prompt immunotherapy is needed in such cases.

Abstract ID 636: Case of Progressive Ataxia

Shamili Devi, Murugan K, Justin C, Kishore

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Ataxia-telangiectasia (A-T) is a rare inherited syndrome that primarily presents as ataxia due to cerebellar involvement and dilated capillaries in the oculocutaneous region.

Methodology: We report a case of 10-years-old male child with developmental delay who presented with imbalance while walking and swaying side to side since 7 years of age. History of tremulousness on reaching objects for past 2 years and history of frequent falls for past 4 months. History of recurrent sinopulmonary infections for past 2 years.

Results: Examination shows truncal, stance and appendicular ataxia with telangiectasia over conjunctiva and ear lobes. Magnetic resonance imaging (MRI) shows cerebellar atrophy and genetic study confirms A-T.

Discussion: A-T, also known as Louis-Bar syndrome, belongs to the group of hereditary ataxias that is inherited in an autosomal recessive pattern. It involves multiple systems in the body and results in progressive cerebellar ataxia, oculocutaneous telangiectasias, frequent pulmonary infections, immunodeficiency, increased risk of certain malignancies, and radiation sensitivity.

Conclusion: A young patient presenting with ataxia should be enquired for a family history of similar complaints and thoroughly examined for the presence of telangiectasias, especially in the ocular region. Ataxia associated with immunodeficiency leading to recurrent respiratory infections or associated with malignancies should also raise suspicion about the possibility of A-T.

Abstract ID 637: Efficacy and Safety of Single-Photon Emission Computed Tomography (SPECT) Aided Botulinum Toxin Injection in Writers’ Cramp: A PROBE Study

Animesh Das, Thrupthi KM, Madhavi Tripathi, Jasmine Parihar, Deepti Vibha, Roopa Rajan, Ashish Upadhyay, Anu Gupta, Divya MR, Rajesh Singh, Manjari Tripathi, Achal Srivastava, A Elavarasi

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Writer’s cramp is a focal hand dystonia, a task-specific movement disorder characterized by sustained or repetitive, involuntary contractions of finger, hand, forearm or sometimes even arm muscles that occur during writing. Accurate identification of muscles of interest can often be challenging as the affected muscles are closely spaced, and there’s significant compensatory action to dystonia, which can make even use of electromyography (EMG) ineffective. We would like to conduct a study to determine the efficacy of functional imaging like SPECT CT as an aid for botulinum toxin injection by EMG in writer’s cramp.

Methodology: This is single-centred prospective, randomized, open label, blinded end-point trial analysis (PROBE) study. Patients with writers’ cramp who visit Department of Neurology in our hospital will be randomized into study group (SPECT +EMG) or control group (EMG) in a 1:1 allocation ratio, if they satisfy the inclusion criteria [>18 years, fulfil definition of focal hand dystonia by MDS, on stable doses of anti-dystonic drugs for the last 1 month and not received Botulinum toxin (BoNT) for >4 months]. The primary outcome would be difference in Writer’s Cramp Rating Scale (WCRS) and Unified Dystonia Rating Scale (UDRS) scores at 3 weeks between the study and the control groups.

Results: The data will be presented using mean (standard deviation) or median (range) for continuous variables, and frequency (%) for categorical variables, as appropriate.

Discussion: This is the protocol of the proposed study which has been registered in CTRI: CTRI/2025/04/083788 after it has been approved by the Institutional Ethics Committee.

Conclusion: This study may provide us an idea whether SPECT aided EMG guided BoNT injections are better than only EMG and clinician judgement guided BoNT injections in Writer’s cramp.

Abstract ID 638: Myasthenia Gravis- Anti-Muscle-Specific Kinase (MuSK) Antibody-Positive with type 2 Respiratory Failure in an Elderly man: A Case Report

Priynka Ranga, Surekha Dabla

Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Background and aim: Myasthenia gravis (MG) is an autoimmune disease that results in impaired signal transmission due to the presence of pathogenic autoantibodies to several target antigens on the postsynaptic membrane of the neuromuscular junction. Antibodies against acetylcholine receptor (AChR) and muscle-specific kinase (MuSK) induce myasthenic weakness by inhibiting normal neuromuscular signalling. Although symptoms and response to treatment vary depending on the age of onset and antibodies involved. In this report, we present a case of an elderly patient with MuSK-positive MG, who presented with difficulty in chewing, swallowing, bilateral ptosis with respiratory muscle weakness leading to dyspnea leading to type 2 respiratory failure.

Methodology: Patient hereby presented with generalized weakness with bilateral ptosis, dysarthria with respiratory distress leading to type 2 respiratory distress for which patient intubated, further evaluation patient found to be Anti-AcHR antibody negative with poor response to anti-cholinergic drugs with Anti-MuSK positive and started on plasmapharesis with rituximab therapy. He responded very well to the treatment.

Results: We hereby present a case of a 67-years-old gentleman who presented to us with type 2 respiratory failure, dysphagia, ptosis anti-Achr R antibody negative with anti-Musk antibody positive confirming a diagnosis of MuSK-positive MG who initially responded to anti-cholinergic drugs but further deteriorated due to respiratory failure put on mechanical ventilation. Patient responded well to plasmapharesis and rituxiamb therapy and extubated successful on 23rd day of admission with no neurological deficits and discharged in well condition.

Discussion: Elderly who with neuro-muscularr symptoms with type 2 respiratory failure should undergo for anti-Musk anti-body responded well to plasmapharesis and immuno-suppression therapy.

Conclusion: We conclude here about atypically presentation of MG in elderly with Musk –positive who manifested with type 2 respiratory failure with generalised weakness. Some patients with MG can present with respiratory failure without any apparent ocular and limb weakness symptoms.

Abstract ID 639: Neurofascin (NF) 186 Antibody Positive- Nodopathy Presenting as Guillian Barre Syndrome in Young Female: A Case Report

Vikrant Nehra, Surekha Dabla

Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Background and aim: Nodo-paranodopathies presents as acute Guillian Barre Syndrome (GBS) or chronic inflammatory demyelinating polyneuropathy (CIDP) with atypical features like cranial nerve involvement, Tremors, ataxia and nephrotic syndrome. The electrophysiology study (EPS) in Nodopathies generally shows mixed pattern.

Methodology: Patient with fulminant GBS with multiple Cranial nerve involvement with autonomic dysfunction and respiratory failure - poorly responsive to intravenous immunoglobulin (IVIG), so in view of this, she was evaluated for Nodopathy and Paranodopathy.

Results: Patient was found to be neurofascin (NF) 186 positive.

Discussion: Patients are poorly responsive to IVIG and early introduction of rituximab is helpful for better outcome.

Conclusion: This case highlights the significance of considering NF antibodies in young patients who are poorly responsive to IVIG Therapy.

Abstract ID 640: PLA2G6 Associated Neurodegeneration (PLAN) - From Genotypic to Phenotypic Variability

Ashutosh Tiwari, Nayan Gupta

All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Background and aim: PLA2G6-associated neurodegeneration (PLAN) encompasses a spectrum of neurodegenerative disorders, in which adult onset forms showing significant clinical variability. Although mutations in different domains of the iPLA2 β enzyme are known contributors, the underlying causes of phenotypic differences among individuals with the same mutation remain poorly understood.

Methodology: We analyzed three adult-onset PLAN patients, each carrying the pathogenic mutation in the PLA2G6 gene. Detailed clinical histories, neurological examinations, available neuroimaging and genetic analysis were reviewed.

Results: The three patients, despite harboring the same PLA2G6 mutation, displayed strikingly different clinical phenotypes. One presented primarily in dystonia-parkinsonism and cognition involvement in 3rd decade, second with only with Parkinsonian features and third with psychiatric features followed by early onset Parkinsonism and cognition involvement. These observations highlight the extent of phenotypic diversity in adult-onset PLAN, even in genetically identical setting.

Discussion: The variability in clinical presentation among adult-onset PLAN patients with identical mutations suggests a more complex pathophysiology involving variable expressivity, the influence of epigenetic modifiers like methylation, synergistic genetic processes or environmental factors that may affect enzyme activity.

Conclusion: To better understand underlying genetic and non-genetic modifiers, future research in individuals with PLAN will be crucial for identifying epigenetic mechanism and other modifiers that contribute to the variable clinical presentation.

Abstract ID 641: Small Nerves and Large Vessels: An Uncommon Neurological Manifestation of Takayasu Arteritis

Vikram Khardenavis, K J Venkateshwaran, P K Murugan, D Chezhian, Ramu Sekar

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Vasculitic neuropathy due to Takayasu arteritis is a rare but can cause serious issues, especially in young people. This case shows the difficulties in diagnosing and treating a 19-year-old girl with painful neuropathy and claudication.

Methodology: A 19-year-old nurse presented with a 10 days of history of bilateral knee pain, followed by numbness, burning sensation, and lower limb distal weakness. Symptoms and signs included difficulty in walking, unsteady gait, impaired sensation and hyperaesthesia and distal weakness, absent peripheral pulses, and positive Romberg’s sign.

Results: Investigations: nerve conduction studies (NCS) showed axonal neuropathy; CT aortogram revealed significant narrowing of subclavian, carotid, and abdominal aorta, confirming Takayasu arteritis. Treatment: Managed with intravenous (IV) methylprednisolone followed by oral prednisone and MMF, Gabapentin.

Discussion: The patient’s presentation of subacute painful neuropathy with systemic symptoms points towards a vasculitic etiology. Differential diagnoses included Guillain-Barré syndrome, toxic neuropathies, and diabetic neuropathy. Early recognition and treatment with immunosuppressants are essential in preventing irreversible damage and improving outcomes.

Conclusion: Recognizing vasculitic neuropathy from Takayasu arteritis early is key to avoiding permanent damages. Prompt treatment can enhance life quality in young patients with this rare disease.

Abstract ID 642: Case report: A 32-Year-Old Man with Painless Bilateral Shoulder Girdle Weakness and Atrophy

Dhiraj Kumar, Jayantee Kalita

Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background and aim: Bibrachial amyotrophy is a rare clinical presentation characterized by bilateral, often asymmetric, upper limb weakness and atrophy. While anterior horn cell or root pathologies are commonly implicated, spontaneous cerebrospinal fluid (CSF) leak as an etiology is rarely recognized. We aim to describe a unique case of bibrachial amyotrophy secondary to a cervical CSF leak and outline its clinical evaluation, diagnostic workup, and management.

Methodology: A 32-year-old male presented with a 14-month history of progressive left-sided shoulder girdle weakness followed by similar right-sided symptoms. Clinical examination revealed proximal upper limb wasting, more on the left, with corresponding weakness and reduced tendon reflexes. Sensory loss was noted in the left C5-C8 dermatomes. Diagnostic evaluation included nerve conduction studies, electromyography (EMG), MRI of the brain and spine, lumbar puncture, and CT myelography. Hormonal assays were also performed.

Results: Electrophysiology showed denervation and chronic reinnervation in C5-C8 myotomes with preserved sensory conduction, suggestive of anterior horn cell or motor root involvement. MRI revealed features of intracranial hypotension and CSF leak at the C1–C2 level. CT myelography confirmed CSF extravasation. The patient had elevated serum prolactin and gynecomastia. Initial epidural blood patch was unsuccessful; surgical repair of a 1×1 cm dural rent was performed. Postoperatively, clinical stabilization and mild improvement in muscle bulk were observed with normalization of prolactin levels.

Discussion: This case highlights an unusual manifestation of spontaneous intracranial hypotension. CSF leaks may mimic motor neuron disease or radiculopathies and lack classical features like orthostatic headache. Pathophysiological mechanisms include nerve root traction or cord shift. Imaging and targeted diagnostics are critical for early recognition.

Conclusion: CSF leak should be considered in patients with unexplained bibrachial amyotrophy. Multimodal imaging and timely surgical intervention can lead to neurological stabilization and improved outcomes.

Abstract ID 644: A Headache with Hidden Roots - Revealing the Secret

Chilaka Prasanthi, Sowmini P, Kannan V, Velusamy S, Kancharla Siddhartha, Sowmini PR, Sakthi Velayutham

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Headache is one of the most common neurological complaints and is often considered benign or attributed to primary headache syndromes. However, in rare cases, it may be the initial manifestation of an underlying systemic or neuromuscular disorder. Atypical presentations like these underscore the importance of a thorough clinical evaluation. In this case, a seemingly simple headache led to the unexpected diagnosis of a muscle disorder, highlighting that even common symptoms can have uncommon origins.

Methodology: An 18-year-old female presented with headache of atypical migraine character, more in occipital region, lasting for few hours, from two years. As her symptoms was temporarily subsiding with medications and recurring, neuroimaging was done which revealed Leukodystrophy. When history was retaken, mother revealed that child used to walk slowly compared to her sibling, and had thigh pains while walking fast, standing for a long time and climbing stairs. She also had arm pain while lifting bag and carrying heavy books. Her scholastic performance was good. However symptoms doesn’t affected daily activities, so didn’t seek medical attention for this issue.

Results: On examination she had mild proximal muscle weakness. Based on her symptoms, Nerve conduction study (NCS) was done and it revealed demyelinating peripheral neuropathy. An ECHO was done and it was normal. Serum creatine phosphokinase (CPK) was mildly elevated. Ophthalmological evaluation was normal. Based on this, genetic testing was done.

Discussion: In this case, headache served as the initial clue to an underlying leukodystrophy. Further evaluation revealed associated peripheral neuropathy, prompting genetic testing, which confirmed a muscular dystrophy with LAMA2 mutation, Merosinopathy. This highlights how a common symptom can lead to the diagnosis of a rare genetic disorder.

Conclusion: A seemingly simple headache led to the unexpected diagnosis of merosin-deficient muscular dystrophy (merosinopathy), highlighting the need to consider underlying neuromuscular and genetic disorders in atypical headache presentations.

Abstract ID 645: Isolated Left Hypoglossal Nerve Palsy in a 17-Year-Old Female: A Rare Manifestation of Cervical Tubercular Lymphadenopathy

Pragnya Panda

All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India

Background and aim: While cervical tubercular lymphadenopathy is a common extrapulmonary form of tuberculosis, cranial nerve involvement is exceedingly rare. Isolated 12th cranial nerve (hypoglossal nerve) palsy is particularly unusual. We reported a rare case of isolated left hypoglossal nerve palsy in a young female secondary to compressive cervical tubercular lymphadenopathy.

Methodology: We presented the clinical profile, diagnostic evaluation, imaging findings, and treatment response of a 17-year-old girl with isolated left hypoglossal nerve palsy associated with tuberculous lymphadenopathy.

Results: A 17-year-old female presented with complaints of slurred speech and tongue deviation for 3 weeks. Neurological examination revealed isolated left 12th cranial nerve palsy with tongue deviation to the left and mild atrophy. No other cranial nerves or limb motor functions were involved. A firm, non-tender lymph node was palpable in the left Level 1b (submandibular) cervical region. Magnetic resonance imaging (MRI) of the neck revealed an enlarged necrotic lymph node adjacent to the hypoglossal canal, causing mass effect on the left hypoglossal nerve. Fine needle aspiration cytology (FNAC) of the node showed granulomatous inflammation consistent with tuberculosis, and GeneXpert was positive for Mycobacterium tuberculosis. The patient was initiated on standard 4-drug anti-tubercular therapy. On follow-up after 6 months, tongue deviation persisted with mild improvement in articulation.

Discussion: Compression of the hypoglossal nerve by tubercular lymph nodes is rare and may mimic neurological disorders. In endemic regions, tuberculosis should remain a differential in lower cranial neuropathies, especially with associated lymphadenopathy.

Conclusion: This case highlights an uncommon presentation of cervical tubercular lymphadenopathy with isolated hypoglossal nerve palsy in an adolescent. Early imaging and tissue diagnosis are essential for timely treatment and to prevent permanent neurological sequelae.

Abstract ID 646: Unveiling a Rare Occupational Hazard: Tarsal Tunnel Syndrome Due to Footwear

Akil Reddy V, Daya Varghese, S Sakthi Velayutham, S Velusamy

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Tarsal Tunnel Syndrome (TTS) is an entrapment neuropathy of the tibial nerve, leading to pain, numbness, and paresthesia in the foot. This case study presents a 30-year-old male with progressive sensory symptoms in left foot, later involving the right, likely triggered by prolonged use of tight-fitting safety boots with thick socks. The study aims to highlights diagnostic approach and management strategies for TTS, especially in the presence of co-existing conditions like pulmonary tuberculosis.

Methodology: A quality control worker, presented with insidious-onset burning pain, numbness, and allodynia in sole of left foot, sparing heel, later affecting right foot. Symptoms developed after prolonged use of safety boots weighing 0.75 kg with thick socks. Neurological examination revealed positive Tinel’s sign, triple compression test, TTS score 2 indicating severe type and sensory deficits in the medial and lateral plantar nerve distributions. Investigations included nerve conduction studies (NCS), which confirmed TTS, and magnetic resonance imaging (MRI), which was normal. Additional workup led to the incidental diagnosis of pulmonary tuberculosis via sputum Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) and chest CT.

Results: NCS revealed reduced compound muscle action potential (CMAP) in left medial and lateral plantar nerves with absent sensory nerve action potential (SNAPs) on the left. MRI of foot was unremarkable. Metabolic workup and vasculitis profile were normal. Patient was started on neuropathic pain medications and anti-tuberculosis therapy (ATT).

Discussion: This case highlights the role of tight-fitting footwear and thick socks as trigger for TTS, emphasizing importance of ergonomic footwear in preventing entrapment neuropathies. The normal MRI suggests functional rather than structural compression. The presence of tuberculosis complicates management, necessitating multidisciplinary approach.

Conclusion: Early diagnosis of TTS with electrophysiological studies is crucial in preventing chronic neuropathic pain. Addressing occupational hazards such as improper footwear, along with co-existing conditions like tuberculosis, is essential for holistic patient care.

Abstract ID 647: Kappa Free Light Chains: Enhancing Multiple Sclerosis Diagnosis Beyond Oligoclonal Bands - A Case Series

Kumari Archana, Devavrata Sahu, Saurav Raja, Naresh Chinthala, Iftikhar Khadas, Sowmya Kallu, Prashant Thakur, Jyoti Garg

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Misdiagnosis of multiple sclerosis (MS) is common, with studies reporting a rate of 24% at tertiary MS centres. A high index of suspicion for alternative diagnoses should be maintained in patients with atypical presentations and atypical radiological features. Additional investigations, such as positive oligoclonal bands (OCB), should be explored in such cases. However, the positivity of OCB in the Indian population may be suboptimal. The kappa Free Light Chains (kFLC) assays have gained popularity in diagnosing MS because it is a valid, easier, and rater-independent alternative to OCB detection.

Methodology: Four patients with MS were included in the study, comprising two with primary progressive multiple sclerosis (PPMS) and two with clinically isolated syndrome (CIS). The PPMS cases exhibited progressive myelopathy and cerebellar syndromes, while the CIS patients presented with partial myelitis and optic neuritis. All four patients met the criteria for Dissemination in Space (DIS), although OCB were negative.

Results: All had demyelinating disease suggestive of MS on imaging but were not fulfilling diagnostic criteria for MS. All patients had a raised kFLC index with a median of 14.575 and a range of 6.31 to 34.70.

Discussion: The kFLCs have addressed the challenge of establishing DIT in patients with negative OCBs who do not meet clinical and imaging criteria for DIT. They have facilitated MS diagnosis where OCBs were insufficient. As no single test definitively diagnoses MS, the use of kFLCs alongside OCBs may enhance the sensitivity and specificity of diagnosis.

Conclusion: This small series demonstrates the greater sensitivity and additional value of testing for the kFLC index. Moreover, OCBs provide only a qualitative result and are subject to inter-observer bias. The kFLC index may offer added value in establishing a diagnosis of MS, thereby enhancing the sensitivity and specificity of MS diagnostic criteria.

Abstract ID 648: Investigating the Etiology of Morvan’s Syndrome: A Case Report on Scrotal Antigen Exposure Resulting from Hydrocele Drainage

Kumari Archana, Kumari Archana, Naresh Chinthala, Jyoti Garg, Ashish Duggal

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Morvan’s syndrome (MoS) is a rare autoimmune disorder that affects the central, peripheral, and autonomic nervous systems. MoS is caused by proteins that target the voltage-gated potassium channel complex, particularly CASPR2 and LGI1. Although the triggers for MoS remain poorly understood, various factors influence its onset. We present a rare case in which MoS was triggered following hydrocele drainage and sclerosing agent instillation.

Methodology: A 28-year-old male presented with burning sensation in his lower limbs that progressed to his entire body within three months, along with continuous calf muscle rippling. He experienced anxiety, agitation, insomnia, forgetfulness, behavioural abnormalities, myoclonus, pruritus, increased sweating, heat intolerance, and hypersalivation for three months. Symptoms began 15 days after hydrocele drainage and sclerosing agent instillation by a local practitioner. The patient had hypertension, tachycardia, and multiple scratches on the trunk and limbs. Neurological findings included impaired mental function, myokymia, and exaggerated deep tendon reflexes. Sensory examination was normal except for impaired vibration sense.

Results: Routine investigations and brain imaging yielded normal results. The serum autoimmune profile was positive for CASPR 2 and weakly positive for LGI 1, while other markers of autoimmunity were negative. The electromyography (EMG) revealed neuromyotonic and myokymic discharges. A diagnosis of CASPR2 and LGI1-related Morvan’s syndrome was established, likely triggered by hydrocele drainage. The patient showed minimal improvement with pulse steroids, prompting the initiation of plasmapheresis for five cycles, which led to significant improvement. Additionally, the patient received injection of Rituximab, resulting in notable clinical improvement at the 3-month follow-up.

Discussion: Patients presenting with MoS should be enquired about the history of recent hydrocele drainage.

Conclusion: Morvan’s syndrome represents a rare yet significant complication that can occur due to exposure to scrotal antigens following hydrocele drainage. In conclusion, recognizing this trigger is particularly crucial in the Indian subcontinent to develop effective strategies for prevention and management.

Abstract ID 649: Assessment and Modification of Stroke Risk Factors through Health Education among Nursing Officers in a Tertiary Care Hospital

Naveen Ranga

Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Background and aim: Stroke is a leading cause of mortality and long-term disability worldwide. A significant proportion of strokes are preventable through modification of lifestyle-related risk factors. Nursing officers, due to high occupational stress and lifestyle irregularities, may have an elevated stroke risk. This study aimed to assess stroke risk factors and evaluate the impact of structured health education among nursing officers in a tertiary care setting.

Methodology: This prospective interventional study included 200 nursing officers aged 25-60 years from PGIMS and PGIDS, Rohtak. Baseline assessment was done and risk assessment done with Stroke Riskometer (R) app. Participants received structured health education. Follow-up assessment was conducted after 6 months to evaluate changes in clinical parameters.

Results: At baseline, 23% had hypertension, 5% had diabetes, 51% were overweight/obese, and 32.5% reported high stress levels. Physical inactivity (<30 min/day) was reported in 56% and <2 servings/day of fruits/vegetables in 63%. After 6 months of health education: significant changes seen in physical activity, Fruit/vegetable intake. - Smoking, Alcohol and Mental health parameters (anxiety, stress, and depression) showed modest but statistically non-significant improvement. Mean relative risk score from the Stroke Riskometer (R) app decreased significantly: 5-year risk from 2.81% to 2.35% (p = 0.02), and 10-year risk from 5.68% to 4.94% (p = 0.03).

Discussion: The study demonstrated that targeted health education significantly improved modifiable stroke risk factors, especially physical inactivity, and dietary habits among nursing officers. This highlights the potential of structured interventions using digital tools like the Stroke Riskometer in primary stroke prevention.

Conclusion: Structured health education led to significant improvement in some modifiable stroke risk factors among nursing officers. The use of a mobile-based app and regular reminders proved feasible and effective. In promoting lifestyle changes. Strengths: Targeted an underserved high-risk group; utilized both clinical and digital tools; demonstrated scalable, low-cost intervention. Limitations: Single-center design, short follow-up duration, and reliance on self-reported data.

Abstract ID 650: IgG4-Related Disease Presenting as Hypertrophic Pachymeningitis: A Diagnostic and Therapeutic Challenge

Atrikumar Patel, Naresh Chinthala, Sowmya Kallu, Jyoti Garg, Ashish Duggal

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Immunoglobulin G4-related disease (IgG4-RD) is a systemic lymphoproliferative disorder characterized by its ability to affect multiple organ systems. The most frequently involved sites include the pancreas, salivary glands, retroperitoneum, and lymph nodes. In contrast, central nervous system (CNS) involvement is uncommon and predominantly presents as hypertrophic pachymeningitis (HP) or hypophysitis.

Methodology: We prospectively identified seven patients with Hypertrophic pachymeningitis due to IgG4-related disease and report their clinical, laboratory & radiological data.

Results: Four patients presented with recurrent multiple cranial nerve palsy, one patient exhibited cavernous sinus syndrome, another patient demonstrated orbital apex syndrome, and one patient had involvement of the V and VIII cranial nerves. Contrast-enhanced magnetic resonance imaging (CEMRI) of the brain in all patients indicated HP. Comprehensive investigations were conducted to identify secondary causes, and tuberculosis (TB) and sarcoidosis were excluded. Elevated serum IgG4 levels (median level, IQR and range) were observed in all patients. Positron emission tomography-computed tomography (PET-CT) in two patients revealed increased fluorodeoxyglucose (FDG) uptake in the caecum and ascending colon in one patient, and an FDG-avid lymph node in the left inguinal region in the other. All patients received a pulse dose of intravenous methylprednisolone (IV MPS), followed by a tapering regimen of oral steroids. Significant clinical improvement was noted in all patients. Rituximab was administered to two patients with recurrent multiple cranial nerve palsy.

Discussion: IgG4-related disease should be a diagnostic consideration in patients with multiple cranial nerve palsy, hypertrophic pachymeningitis, and Tolosa-Hunt Syndrome.

Conclusion: Early initiation of corticosteroid therapy, often followed by steroid-sparing immunosuppressants, particularly Rituximab, can lead to significant improvement in symptoms and prevent long-term complications.

Abstract ID 651: Central PRES Mimicking Brainstem Demyelination in Chronic Kidney Disease: A Diagnostic Conundrum

Kumari Archana, Naresh Chinthala, Atri Patel, Jyoti Garg, Ashish Duggal

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Posterior Reversible Encephalopathy Syndrome (PRES) typically manifests with vasogenic edema in the posterior cerebral hemispheres. However, atypical presentations, such as the central variant involving the brainstem and basal ganglia while sparing the cortex, pose a significant diagnostic challenge. This report details a rare case of central PRES in a patient with chronic kidney disease (CKD), highlighting its potential to mimic other neurological disorders.

Methodology: A 25-year-old female with stage 3A CKD was admitted with a one-week history of fever and a five-day history of headache, ptosis, diplopia, dysarthria, and ataxia, which progressed to an altered sensorium over two days. Neurological examination revealed drowsiness, bilateral ptosis, complete ophthalmoplegia with dilated, poorly reactive pupils, as well as generalised hypotonia and areflexia with an extensor plantar response.

Results: Laboratory investigations indicated leucocytosis and elevated sepsis markers, suggestive of a urinary tract infection. Extensive autoimmune and vasculitis screening returned negative results, as did serum NMO/MOG antibodies. Cerebrospinal fluid analysis revealed markedly elevated protein (737 mg/dL) alongside normal glucose (89.6 mg/dL) and cell count (5 cells/µL), while infectious and ganglioside antibody panels were unremarkable. Nerve conduction studies of all four limbs were normal. Magnetic resonance imaging (MRI) of the brain demonstrated diffuse T2-FLAIR hyperintensities in the pons and medulla, with restricted central diffusion within the pons and no contrast enhancement.

Discussion: After a comprehensive exclusion of infectious, autoimmune, and demyelinating etiologies, a diagnosis of central PRES was established. The patient’s neurological deficits resolved completely following multiple sessions of haemodialysis. This case underscores the importance of considering central PRES in the differential diagnosis for patients with risk factors such as accelerated hypertension and CKD who present with brainstem symptomatology and corresponding MRI abnormalities.

Conclusion: Recognising this rare PRES variant is crucial to avoid misdiagnosis and ensure appropriate management.

Abstract ID 652: Unusual Movements with a Breath of Complexity: A Case of Respiratory Dyskinesia

Atrikumar Patel, Ajayrajsinh Gohil, Kumari Archana, Ashish Duggal, Jyoti Garg

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Tardive dyskinesia (TD) is a drug-induced movement disorder caused by medication, characterized by involuntary, repetitive movements that occur during or shortly after discontinuation of neuroleptic treatment. While TD can affect any muscle in the body, it is most frequently observed in the muscles of the mouth, arms, legs, and trunk. In rare cases, it can impact the respiratory muscles, leading to significant disability.

Methodology: Case report

Results: We present a case of a 65-year-old female admitted with involuntary movements involving the trunk, mainly the abdomen and perioral region. The movements allegedly started after the abrupt stoppage of Risperidone. The patient felt respiratory distress because of these movements, which disappeared during sleep. Workup for cardiorespiratory causes was normal (Chest x-ray, pulmonary function test [PFT], arterial blood gas [ABG], electrocardiography [ECG], 2D echo). Workup for Wilson’s disease (serum ceruloplasmin, 24-hour urinary calcium, KF ring) was negative. Ultrasound of the abdomen showed a bilateral ovarian mass. Cerebrospinal fluid (CSF) examination and CSF autoimmune encephalitis panel were negative. The patient was started on clonazepam, and there was significant improvement over the next 4 weeks. A diagnosis of Withdrawal emergent dyskinesia (WE-D) was made based on the clinical profile and exclusion of other causes.

Discussion: WE-D is a reversible dyskinesia and generally improves spontaneously in 1–2 months. If required, the antipsychotic is to be restarted and tapered gradually over 1–3 months.

Conclusion: Tardive dyskinesia can exhibit a variable phenotype and, in rare instances, involve the abdominal and respiratory muscles, resulting in breathlessness. If not identified promptly, this manifestation may lead to unnecessary investigations.

Abstract ID 653: A Rare Case of Hypertrophic Osteoarthropathy Presenting as Cranial Entrapment Neuropathy

Kotha Aravind, Seepana Gopi

Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

Background and aim: Cranio-osteoarthropathy is a rare variant of hypertrophic osteoarthropathy that affect the skull, causing the increased bone growth and decreased ossification, leading to compression of cranial nerves passing through narrow channels, resulting in cranial entrapment neuropathy.

Methodology: An 8-year-old male, born of 3rd degree consanguineous marriage with normal birth and developmental history, presented at 4 years of as deviation of angle of mouth to left, with drooling from right corner of mouth, difficulty to close right eye completely. After 2 months, the child was unable to close the mouth a with drooling from both the corners of the mouth, eyes left half open during sleep, unable to smile, with slurring of speech. After 6 months, he developed hardness of hearing, more in the right compared to left ear. On examination, there was bilateral lower motor neuron (LMN) type facial paresis with bilateral sensorineural hearing loss (SNHL). Other cranial nerves, motor, sensory and cerebellar examination were unremarkable. No history of similar complaints in family.

Results: Serum calcium-9.5 mg%; serum phosphate-5.2 mg%; alkaline phosphatase (ALP)-683 IU/L. Skeletal survey showed increased cortical thickness and density in skull bones base with loss of normal diploic spaces between skull bones. Long bones, ribs, vertebra, wrist and feet bones showed mild increase in cortical density without any fractures. Contrast-enhanced magnetic resonance imaging (CEMRI) brain; 3D FIESTA showed narrowing of bilateral internal acoustic meatus with compression over bilateral vestibulocochlear and facial nerves. The brainstem evoked response audiometry (BERA) -right>left SNHL, Blink - bilateral facial not recordable. Whole-exome sequencing showed SLCO2A1 gene mutation in heterozygous state.

Discussion: The SLCO2A1 gene encodes a prostaglandin transporter. Its mutation leads to elevated levels of prostaglandin E2. Excess PGE2 leads to bone changes causing primary hypertrophic osteoarthropathy, also known as Touraine- Solente- Gole syndrome. Cranio osteoarthropathy is one of the rare manifestations of PHO.

Conclusion: No definite treatment is currently available to halt the progression. Surgical decompression of cranial nerves can be performed to relieve pressure and prevent further potential damage.

Abstract ID 654: A Novel Peripherin Mutation in a Young Indian Male with Sporadic Amyotrophic Lateral Sclerosis

Manoj Manyem, Saranya Gomathy, Vishnu Subramanian, Shamir Sugan, Ramkumar Sugumaran, Sunil Narayan

Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Background and aim: Motor neurons in amyotrophic lateral sclerosis (ALS) have inclusion bodies composed of intermediate filament (IF) proteins. Peripherin is a component of these inclusions and rare mutations in the peripherin (PRPH) gene have been reported in sporadic cases of ALS. We presented the case of ALS with a new heterozygous mutation in the PRPH gene.

Methodology: Not applicable

Results: This is a 36-year-old male with history of chronic, insidious onset and progressive, asymmetrical weakness of both upper limbs, distal > proximal, bulbar dysarthria, with normal higher mental functions, sensory, cerebellar and autonomic functions. On examination, bilateral wasting of intrinsic muscles of hand, deltoid, tongue with fasciculations, Upper limb has hyporeflexia, lower limb reflexes normal with bilateral extensor plantars were present. Nerve conduction study parameters were normal, and electromyography showed active denervation and chronic reinnervation from bilateral C5-T1 myotomes, thoracic paraspinal and genioglossus muscles, consistent with a diagnosis of probable ALS as per the El Escorial criteria. The ALS-functional rating scale score was 45.CECT of abdomen and pelvis and MRI of cervical spine normal. Whole-exome sequencing revealed a heterozygous mutation in the exon 1 (c.490C>T p.Arg164Trp) of the PRPH gene. We started treatment with Riluzole and Edaravone infusions.

Discussion: A hallmark of motor neurons in ALS is the presence of perikaryal and axonal inclusion bodies containing IF proteins, called neurofilament and peripherin. Peripherin is a type III IF usually expressed at low levels in spinal motor neurons, and there is an up-regulation of its expression in ALS.

Conclusion: We present a novel mutation in the PRPH gene causing young-onset ALS. PRPH mutations may be responsible for a very small number of ALS cases. More studies are needed to better understand the disease pathogenesis and progression of ALS patients with these rare mutations.

Abstract ID 655: From Whorls to Neurological Symptoms- A Case Report of Hypomelanosis of Ito

Ammanabrolu Sreekavya, Seepana Gopi

Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

Background and aim: Hypomelanosis of Ito is a rare genetic neurocutaneous disorder, characterized by a distinctive skin lesions, neurological and multisystem abnormalities. Incidence ranges from 1 in 8000- 1 in 80,000, Common in females. Primarily not a genetically inherited condition, rather a disorder caused by genetic mosaicism or sporadic mutations.

Methodology: A 3-year-old girl, born of 3rd degree consanguineous marriage, as a preterm child. She was presented with history of seizures since day 2 of life with multiple semiologies-right focal motor clonic seizures, generalised tonic seizures, excessive laugh followed by Generalized Tonic-Clonic Seizure (GTCS), with frequency of 2-3 times per week while on anti-seizure medications. History of delayed milestones-able to hold neck; able to sit without support by 1.5 years and 2.5 years of age, respectively. Language - only cooing attained, social milestones- no eye contact and doesn’t recognize family members. History of regression of milestones-loss of ability to sit. History of streaks of hypopigmented lines over back, right thigh since birth. No history of similar complaints in family. On examination-macrocephaly, short stature, dysmorphic facial features-prominent forehead, depressed nasal bridge; kyphosis. Whorls of hypopigmentation along the Blaschko lines over back and right thigh. No eye contact, right eye exotropia, no response to sounds, hypotonia of all 4 limbs with bilateral plantar flexor.

Results: Hemogram test results including renal function test (RFT), liver function test (LFT), thyroid profile, etc. were Normal. The electroencephalography (EEG) showed amultifocal epileptiform activity with left occipital region predominance with secondary generalisation. The magnetic resonance imaging (MRI) brain showed hypomyelination at bilateral supratentorial fronto-tempero-parietal white matter, corona radiata, internal and external capsule, pons, medulla oblongata. Brain Evoked Response Auditor (BERA) test showed a bilateral sensorineural hearing loss (SNHL). The findings of whole-exome sequencing (WES) were not significant.

Discussion: Clinical spectrum-hypopigmented whorls along Blaschko lines, seizures, developmental delays, intellectual disability, hypotonia, hemimegalencephaly, retinal hypopigmentation; cataracts, skeletal deformities; hearing loss, dental abnormalities.

Conclusion: Diagnosis-made from pathognomonic streaks of hypopigmentation along Blaschko lines with presence of neurological abnormalities. Genetic testing to check the cellular mosaicism, for confirmation. There is no definite treatment. Symptom management to improve the quality of life. Prognosis depends upon the extent of multisystem involvement.

Abstract ID 656: Eosinophilic Granulomatosis with Polyangiitis Presenting with Mononeuritis Multiplex

Naresh Chinthala, Kumari Archana, Milan Mori, Ashish Duggal, Jyoti Garg, Atri Patel

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of vasculitis associated with antineutrophil cytoplasmic antibody (ANCA). The disease is characterized by asthma, eosinophilia, and systemic vasculitis, with varying degrees of neurological, cutaneous, cardiac, gastrointestinal, and renal involvement. Neurological manifestations may include mononeuritis multiplex, as well as symmetrical and asymmetrical polyneuropathy.

Methodology: The first case was a 64-year-old male with progressive weakness and paresthesia in the right hand, then left hand and right foot. He showed weakness in hypothenar muscles of right hand, thenar muscles of left hand, and right ankle dorsiflexion, with hypesthesia in right ulnar, left median, and right peroneal nerves. He had pulmonary and renal involvement. Second case was a 33-year-old male with asthma presenting progressive weakness and paresthesia of both hands and left eye drooping. Examination showed left third and fourth cranial nerve palsy, right seventh cranial nerve palsy, weakness of hypothenar muscles in right hand, thenar muscles in left hand, and hypesthesia in right ulnar and left median nerves, with cardiac and gastrointestinal involvement.

Results: The aforementioned patients presented with a mononeuritis multiplex pattern accompanied by multiorgan involvement. Investigations revealed moderate eosinophilia and elevated C-reactive protein (CRP). Rheumatoid factor and p-ANCA were positive in the first case. Computed tomography (CT) showed bilateral consolidation, and a two-dimensional echocardiogram indicated global left ventricular hypokinesia in the second case. Nerve conduction studies suggested a mononeuritis multiplex pattern.

Discussion: In light of asthma, eosinophilia, and multiorgan involvement, EGPA was considered, and steroid therapy was administered. Rituximab was administered in the second case.

Conclusion: The diagnosis of EGPA is often challenging due to the diversity of symptoms. A history of asthma, blood eosinophilia, and multiorgan involvement are critical indicators for suspecting EGPA.

Abstract ID 657: KCTD7 in the Spotlight: A Key Player in Progressive Myoclonic Epilepsy

Maheshpandian Mariappan, Murugan P K, Sivarama S

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Mutations in the potassium channel tetramerization domain-containing KCTD 7 gene cause progressive myoclonic epilepsy type 3 (PME 3), a rare but often crippling neurodevelopmental and epileptic disorder. This is a rare report associating KCTD 7 mutation with PME in the Indian population.

Methodology: A 1-and-half-year-old male child, was born of third-degree consanguineous Indian parents presented to neurology clinic with complaints of seizures and regression of milestones. Pregnancy and birth history were uneventful with no indication of intrauterine or perinatal hypoxia or other neonatal complications. Seizures started when the patient was 10 months old after a period of normal development. The seizure types were continuous multifocal myoclonic seizures, affecting all the limbs and the face, and rare tonic and tonic-clonic seizures. Electroencephalogram (EEG) showed multifocal epileptiform abnormalities. Magnetic resonance imaging (MRI) of the brain was normal at this time. The patient was started on valproic acid, pyridoxine, and clobazam, but there was no response. Hence prednisolone was added. After these four medications, seizure frequency decreased.

Results: DNA sequencing with next-generation sequencing platform revealed a pathogenic homozygous KCTD 7 gene mutation, which causes an autosomal PME 3.

Discussion: PME is caused by a wide range of specific etiologies including neuronal ceroid lipofuscinoses, Unverricht-Lundborg disease, Lafora disease, myoclonic epilepsy with ragged red fiber, Tay-Sachs disease, sialidosis, and dentatorubral-pallidoluysian atrophy. The individuals with KCTD 7-related PME had a variable ethnic origin, high rate of consanguinity, and variable phenotypic presentation. Age of onset ranged between five months to three years, after a period of normal or mildly delayed development.

Conclusion: Here, we report a case with PME, in whom next-generation sequencing led to the identification of a homozygous KCTD 7 mutation. This is a rare report associating KCTD 7 mutation with PME in the Indian population.

Abstract ID 658: All that Burns is Not Small Fiber Neuropathy!

Sathish Mathivanan, Madhu Nagappa, Viswanathan Lakshminarayanapuram Gopal, Seshagiri Doniparthi V, Sanjib Sinha

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Even in today’s era, diagnostic accuracy depends on meticulous history taking and detailed clinical examination. We aim to describe how a diligent history & examination established an accurate diagnosis in a patient with a clinical phenotype of ‘small fibre neuropathy’, when extensive laboratory investigations failed.

Methodology: Case review of a 25-year-old lady who presented with painful paresthesias of lower limbs.

Results: The patient presented with asymmetric intermittent pain, numbness, tingling and burning paresthesias of both lower limbs, which extended from mid-leg to toes. Neurological examination revealed impaired touch and pin-prick sensations below mid-leg with antalgic gait. Electroneuromyography, magnetic resonance imaging (MRI) spine and brain were normal, and she was diagnosed with small fibre neuropathy. Workup for the underlying aetiology, such as hemogram, hepatic, renal and thyroid function tests, blood sugar, viral markers and vasculitic profile was negative. Initially, there was a partial response to gabapentin, but later the symptoms became continuous and disabling such that the patient was unable to walk due to the pain. A clinical review and detailed general physical examination revealed cool peripheries and absent distal pulses in both lower limbs. Neurological examination was unchanged. Arterial Doppler and computed tomography (CT) angiography confirmed complete occlusion and non-visualisation of lower limb vessels distal to the femoral arteries. Detailed drug history revealed chronic overuse of ergotamine- caffeine combination, sumatriptan and azithromycin for migraine and sore throat. The final diagnosis was peripheral vascular disease mimicking small fibre neuropathy due to chronic ergotism. She was referred to vascular surgery for angioplasty.

Discussion: Chronic ergotism or St. Anthony’s fire, though rare, can occur with unsupervised use of ergot alkaloids, particularly in combination with CYP3A4 inhibitors, i.e., sumatriptan and azithromycin. Classical skin changes of vascular insufficiency may be absent and masquerade as small fibre neuropathy.

Conclusion: In this artificial intelligence (AI)-driven era, diagnostic accuracy still depends on the clinician’s ability to extract, review, prioritise and interpret the relevant data. History and examination remain paramount.

Abstract ID 659: Case Series of Non Ketotic Hyperglycemia Presenting as Focal Seizures

Naresh Chinthala, Kumari Archana, Atri Patel, Ashish Duggal, Jyoti Garg

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Nonketotic hyperglycemia (NKH) is a rare but serious complication of uncontrolled diabetes mellitus (DM). This condition presents with a clinical syndrome consisting of profound hyperglycemia, hyperosmolality, and dehydration. Infrequently, the patients also present with seizure activity. The most common types of seizures observed in this condition are focal seizures, as opposed to the generalized seizures observed in hypoglycemia-induced seizures.

Methodology: We prospectively identified four patients with NKH presenting with focal seizures and report their clinical, laboratory and radiological data.

Results: Four patients presented with seizures secondary to hyperglycemia, all the patients were presented with focal aware seizures. There is clustering of seizures and associated with Todds palsy in all the patients. No previous history of diabetes in all the four patients and one patient has history of chronic steroids abuse. Serum and urine ketones were negative in all the patients. Magnetic resonance imaging (MRI) brain was done in three patients, out of which two patients has shown symmetrical T1 hyperintensity involving bilateral corpus striatum and one patient has shown small vessel ischemic changes.

Discussion: Patients were treated with adequate hydration, Insulin infusion and short course of anti-epilpetics. Seizures were controlled in all the patients after controlling of sugars.

Conclusion: NKH-related seizures should be suspected in adults with new-onset clustering focal seizures, even in the absence of a history of DM. Typical focal changes on brain MRI, while not pathognomonic, can drive the clinical diagnosis.

Abstract ID 660: From Infection to Infarction: Fungal Sinusitis as Unusual Culprit in CNS Stroke

Saurav Raja, Naresh Chinthala, Jyoti Garg, Ashish Duggal

Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Background and aim: Ischemic events in the central nervous system (CNS) attributable to fungal infections are infrequent, and their clinical characteristics remain largely unexplored. This report presents a case initially diagnosed as a stroke, which was subsequently identified as a fungal infection of the CNS.

Methodology: Case report

Results: A patient with a known case of Type 2 Diabetes Mellitus (T2DM) for 15 years presented with a headache persisting for one week and numbness on the right side of the face for four days. Clinical examination revealed right Horner’s syndrome with V2/V3, and bilateral sixth and eighth cranial nerve involvement. Magnetic resonance imaging (MRI) of the brain showed multiple watershed infarcts. While computed tomography (CT) angiography was normal, digital subtraction angiography (DSA) indicated 90% stenosis at the origin of the left internal carotid artery (ICA). The patient was evaluated for stroke and vasculitis and received intravenous steroids, along with oral steroids. Although symptoms improved with steroid treatment, they did not completely resolve. A repeat MRI of the brain revealed sphenoethmoidal sinusitis with skull base osteomyelitis, left ICA thrombosis, and a border-zone infarct in the left parieto-occipital region. The patient was commenced on intravenous liposomal amphotericin B and Voriconazole, resulting in symptomatic improvement. A contrast-enhanced CT of the paranasal sinuses revealed sinusitis with bone erosion. An endoscopic biopsy from the sinus was inconclusive. The patient achieved complete recovery with antifungal treatment.

Discussion: The relationship between CNS fungal infections and stroke is an under-researched area. The mechanisms by which these infections lead to stroke are multifaceted, potentially involving direct invasion of blood vessels, inflammatory responses, or secondary effects on the coagulation system.

Conclusion: Ischemic stroke secondary to CNS fungal infections should be considered in patients with recurrent or progressive cryptogenic stroke, regardless of immune status and cerebrospinal fluid profile. A comprehensive approach, including spinal fluid analysis and biopsy, should be considered and managed aggressively.

Abstract ID 661: Neuroregression in Early Childhood: A Case of Mitochondrial DNA Depletion Syndrome 9

Noonavathu Krishna, Noonavathu Krishna, P K Murugan, C Justin

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Mitochondrial DNA depletion syndrome-9 (MTDPS9) is a severe autosomal recessive disorder characterized by infantile onset of hypotonia, lactic acidosis, severe psychomotor retardation, progressive neurologic deterioration, and excretion of methylmalonic acid. Mortality is high in early infancy.

Methodology: A 2-years-old female child 1st order of Birth of Non-consanguineous marriage, full term normal delivery, cried immediately after birth with normal developmental milestones up to 1 year of age. Later, mother noticed not responding to oral command for 6 months now presented with fever and altered sensorium since 3 days and history of head lag and decreased attained milestones. On examination, child is drowsy, hypotonia of all 4 limbs and reduced reflexes with bilateral plantar extensor.

Results: All Routine Blood investigations were normal. Arterial blood gas (ABG) – suggestive of metabolic acidosis and magnetic resonance imaging (MRI) brain suggestive of symmetrical T2/ FLAIR hyperintensity with diffuse restriction noted in lentiform nucleus and urine for metabolic screening negative. Genetic testing done and reported as MTDPS9 (encephalomyo pathic type with methylmalonic aciduria).

Discussion and conclusion: The MTDPS9 is a rare autosomal recessive disorder primarily affecting mitochondrial function. It results from mutations in genes essential for mitochondrial DNA maintenance, leading to severe energy production deficits. The neurological deterioration seen in MTDPS9 is attributed to defective oxidative phosphorylation, leading to energy failure in high-demand tissues like the brain and muscles. Methylmalonic aciduria, often associated with this condition, results from disrupted mitochondrial metabolism, further exacerbating neurological decline.

Abstract ID 662: Renal Artery Lesions in Moyamoya Disease

Poornima Nair, Manuraj N, Rinta Paul, Jayadevan R, Jayanand Sudhir, Sapna Sreedharan, Sylaja N

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Background and aim: Moyamoya disease (MMD) is a chronic, noninflammatory, nonatherosclerotic progressive angiopathy characterised by gradual occlusion of terminal intracranial internal carotid arteries and their branches, with collaterals. The prevalence of hypertension (HTN) in MMD ranges from 5% to 38%. However, the incidence of renal artery lesions (RAL) in adult MMD is 8%. Here, we report a case series of MMD patients with RAL.

Methodology: We systematically reviewed the electronic medical records of all patients with MMD at SCTIMST from the year January 2010 to December 2024. The clinical, demographic and radiological data were collected and analysed for the prevalence of HTN and RAL.

Results: Of the 121 adult and 51 paediatric patients evaluated, HTN was seen in 15 adult patients and one paediatric patient. Amongst them, four had RAL- three had renal artery stenosis (RAS) (two adults and one child) and one had renal artery (adult) duplication. Amongst those with RAS, two were hypertensive (1 adult and 1 child). All of them presented with ischemic events and 1 (adult) had symptomatic seizures. Renin and angiotensin levels were elevated and both had severe (grade 3 and grade 4, respectively) disease. Digital subtraction angiography (DSA) showed bilateral RAS (60-90%) soon after origin in all the three patients. All patients underwent revascularisation surgery without complications. The hypertensive child with RAS was positive for RNF 213 polymorphism (p.Arg4062Gln), while the secondary workup for MMD were negative in all the other patients.

Discussion: HTN in MMD patients is not uncommon and therefore all MMD patients must be screened with a renal angiogram to look for RAL. It is worthwhile to look for underlying homozygous RNF 4810K variant and elevated renin levels, especially in pediatric patients.

Conclusion: Early detection of HTN in MMD patients is important to prevent HTN related complications and has implications in management.

Abstract ID 663: Painful Abdomen, Painless Blindness: An Unusual Presentation of Pancreatitis

Udupi Mallya, Raghunandan Nadig

St. Johns Medical College, Bengaluru, Karnataka, India

Background and aim: Neurological complications in systemic illness, particularly renal failure and pancreatitis, are often under-recognized. We present a young male with epilepsy and recurrent pancreatitis, presenting with acute painless bilateral vision loss.

Methodology: A 19-year-old male with a history of childhood seizure disorder, birth asphyxia, hypogonadotropic hypogonadism and recurrent acute pancreatitis presented with abdominal pain, vomiting, and oliguria. He developed sudden bilateral painless vision loss during hospitalization for acute kidney injury with volume overload. Fundus examination was normal. Magnetic resonance imaging (MRI) brain on admission showed restricted diffusion in bilateral medial temporal lobes and lateral geniculate bodies (LGB), raising differentials of Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes (MELAS), Hypoxic-Ischemic Encephalopathy (HIE), or metabolic encephalopathy. A follow-up MRI revealed T2/FLAIR hyperintensities in bilateral parieto-occipital and temporal lobes, suggestive of Posterior Reversible Encephalopathy Syndrome (PRES). Visual prognosis was poor despite supportive care.

Results: MRI findings confirmed bilateral LGB infarcts with subsequent evolution into PRES. The episode was likely secondary to pancreatitis, metabolic derangement in acute kidney injury (AKI) with hypertension. Vision did not recover during hospital stay

Discussion: This case emphasizes the rare occurrence of bilateral LGB infarction in a young patient with pancreatitis. On literature review, the exact mechanism was not found. Several hypotheses, like microangiopathy, hypovolemic shock, osmotic pathology have been mentioned

Conclusion: PRES and bilateral LGB infarction should be considered in AKI patients presenting with acute visual loss. Prompt neuroimaging, multidisciplinary care, and recognition of this rare entity are vital to avoid misdiagnosis and ensure optimal management.

Abstract ID 664: Double Whammy - When Inflammation and Fulminant ICT Strike Together

U Meenakshisundaram

MGM Healthcare, Chennai, Tamil Nadu, India

Background and aim: Bilateral optic neuritis is known to occur in Neuromyelitis optica spectrum disorder (NMOSD) while Fulminant intracranial hypertension, leading to rapid visual deterioration is a rare but dangerous condition. Co-occurrence of the two is extremely rare.

Methodology: A 16-year-old girl was brought to the hospital with sudden onset vision loss in both eyes. Imaging studies (magnetic resonance imaging [MRI] and computed tomography [CT]) showed bilateral optic peri neuritis, tortuous optic nerves bilaterally with prominent peri-optic nerve spaces and indentation of the posterior sclera. Despite initial treatment with intravenous methylprednisolone and immunoglobulin therapy, her vision after mild improvement deteriorated further, and she lost the perception of hand movements and light. She underwent plasmapheresis again with only mild improvement. Tests confirmed very high cerebrospinal fluid (CSF) pressure, leading to the placement of a lumbar drain, and later a lumboperitoneal shunt.

Results: Post-surgical intervention, her vision improved from perception of light to faint perception of hand movements and shadows. The patient completed six cycles of plasmapheresis and was started on oral prednisolone. Follow-up imaging revealed proper shunt function, and the patient demonstrated gradual visual recovery and improvement in neurological status.

Discussion: This rare case highlights the co-occurrence of bilateral optic neuritis and fulminant intracranial tension (ICT) in young patient, likely linked to NMOSD. Despite early immunotherapy, rapid visual decline emphasized the aggressive nature of raised intracranial pressure (ICP). Surgical CSF diversion through a lumboperitoneal shunt led to partial visual recovery, underscoring the importance of early recognition and combined management of both inflammation and raised ICP to prevent irreversible vision loss

Conclusion: Early recognition of both conditions are vital to prevent irreversible vision loss. It also highlights the need for close monitoring, prompt and aggressive treatment in cases of optic neuritis and when complicated by raised intracranial pressure, appropriate measures for the same.

Abstract ID 665: A Comparative Analysis of Neurophysiological Parameters in Acute and Chronic Inflammatory Demyelinating Polyneuropathies

U Meenakshisundaram

MGM Healthcare, Chennai, Tamil Nadu, India

Background and aim: This study aimed to analyze the clinical and neurophysiological profile of 25 patients diagnosed with acute inflammatory demyelinating polyneuropathy (AIDP) and chronic inflammatory demyelinating polyneuropathy (CIDP). By evaluating the parameters, research seeks to elucidate profiles associated with each condition and enhancing the pathophysiological mechanisms and improving diagnostic accuracy.

Methodology: This study employed a retrospective analysis of clinical and neurophysiological data from 25 patients with either AIDP (n = 8) or CIDP (n = 17) from a tertiary care centre. Nerve conduction studies (NCS) had been performed with a Nicolet Viking quest in accordance with recommended guidelines. Measurements were obtained from median, ulnar, tibial, peroneal, sural and superficial peroneal nerves and were compared between patients diagnosed with AIDP and/or CIDP.

Results: In patients under 50 years (n = 8) females included 1 AIDP & 1 CIDP, males included 3 AIDP & 3 CIDP. Over 50 years (n = 17) females had 1 AIDP & 2 CIDP, males had 3 AIDP & 11 CIDP. Males showed a higher prevalence of both conditions across age groups.

Discussion: This study highlights distinct clinical and neurophysiological patterns in AIDP & CIDP, with a higher prevalence of CIDP among older males. Reduced median nerve conduction velocity was the most common abnormality, and 60% of patients had widespread electrophysiological involvement. These findings underscore the importance of age- and gender-based profiling in improving diagnostic precision and tailoring management in inflammatory demyelinating polyneuropathies

Conclusion: This study provides valuable insights into the distinct neurophysiological profiles of AIDP and CIDP among patients below and above 50 years of age, emphasizing a predominance of CIDP in older males. The most common electrophysiological abnormality was reduced median conduction velocity and 60% of patients showed abnormalities in all parameters. Understanding these patterns may facilitate targeted approaches in the diagnosis and management of inflammatory demyelinating polyneuropathies. Further research is needed to explore the underlying mechanisms driving these differences and to enhance patient outcomes.

Abstract ID 666: Unveiled IIH in A Case of Childhood Ophthalmoplegic Migraine- A Hidden Existence or Co-Existence

Sai Gullapalli, Sai Gullapalli, Uma Maheswari E, Mugundhan K, Umamaheswari E

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: The relationship between Ophthalmoplegic migraine (OM)and IIH needs to be deciphered through clinical and investigatory workup to attain maximum remission.

Methodology: A 16-year-old girl with history of migraine episodes since 3 years of age - right sided throbbing headache with photo and phonophobia, abdominal pain, nausea and occasional vomiting lasting for 1 day at the frequency of 1-2 per month. She had 2 episodes of OM at the age of 6 and 7 years. In first episode, she had right eye ptosis, dilated pupil, visual acuity of 6/36 with adduction, elevation and abduction restriction of right eye. Left eye was normal. Her magnetic resonance imaging (MRI) brain, cerebrospinal fluid (CSF), and blood investigation were normal. She was treated with oral steroids for 1 month and continued migraine prophylaxis. Her symptoms and signs improved in 4 months. During second episode at 7 years of age she had similar signs with normal acuity. MRI Brain showed enhanced nodule in cisternal part of right 3rd cranial nerve (CN). She was given symptomatic treatment and her complaints improved in 1 month. She continued migraine prophylaxis with migraine frequency at 1-2 per month. Her mother had left sided migraine since 15 years of age. She was presented to us with complaints of increased frequency of migraine at 4-6 episodes mild predominance at occipital region past 1 and half year.

Results: She had right exotropia with normal fundus. Other examination was normal. Her complete blood count (CBC), renal function test (RFT), thyroid function test (TFT) were normal. MRI Brain with contrast showed features suggestive of IIH and enhancing nodule in cisternal part of roght 3rd CN. Her CSF opening pressure was 29 cm H2O. She was started on acetazolamide with migraine prophylaxis. She improved symptomatically.

Discussion: In rare cases IIH can develop later in a case of OM. Exact mechanism is not known.

Conclusion: MRI findings and recurrence point to possibility of demyelination or other causes.

Abstract ID 667: A Case Report of Association between Serum Copper and Multiple Sclerosis

Sai Gullapalli, Umamaheswari E, Mugundhan K

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Dysregulation of copper homeostasis may be linked to MS pathogenesis.

Methodology: A 31-year-old male born out of non-consanguineous marriage presented with chronic progressive neurological illness past 8 years involving numbness of left upper limb followed by tremulousness of left, followed by right upper limb, persistent blurring of vision in left eye past 4 years. He had progressive memory disturbances – immediate and working past 1 year. For 3 months, he had new onset slurring of speech, double vision more for near objects and deviation of angle of mouth to right with no other complaints, with elder sister having locomotor disability.

Results: On examination he had mild impairment in attention, working and recent memory deficit and mild disinhibitory speech, stance and gait ataxia, action > postural > rest tremors (wing beating) with mild incoordination of left upper limb. He had left Relative afferent pupillary defect (RAPD) with bilateral internuclear ophthalmoplegia (INO) and horizontal and upgaze nystagmus, left upper motor neuron (UMN) facial palsy, mild numbness in left forearm and hand, power normal.

Discussion: Cerebrospinal fluid (CSF) glucose- 77 mg/dl, CSF protein -29 mg/dl with high IgG synthesis index and rate. He had low serum copper, serum ceruloplasmin and high 24-hr urine copper levels. Complete blood count (CBC), renal function test (RFT), liver function test (LFT), thyroid function test (TFT) was normal. Neuromyelitis optica spectrum disorder (NMOSD) panel- negative and CSF oligoclonal banding (OCB) –positive. No Kayser-Fleischer (KF) ring. Genetic test for the ATP7B was negative. Visual evoked potential (VEP) decreased P100 amplitude in both eyes. Magnetic resonance imaging (MRI) brain and spine showed T1 hypointense and T2 hyperintense lesions in cortical subcortical, periventricular (Dawson fingers), cerebellum, optic chiasm and optic tracts involving U- fibres, periphery of cord at the C5-C6 level – possible demyelinating plaque with no contrast enhancement.

Conclusion: This patient probably has Primary progressive MS. He was treated with injection Rituximab twice May 2024 and January 2025. Increased serum copper levels may be detrimental to inflammatory process (oxidative stress) and so, demyelination which might be the cause of severe progression of disease in our patient.

Abstract ID 668: Epilepsy in an Unusual Combination - SeLECTS in a Case of Sturge Weber Syndrome

Swansu Batra, Praveer Sharma

King George’s Medical University, Lucknow, Uttar Pradesh, India

Background and aim: Sturge Weber syndrome is a genetic neurocutaneous syndrome characterized by intellectual disability, skin lesions and epilepsy. Hereby we aim to highlight an unusual combination of epilepsy seen in a case of Sturge Weber syndrome.

Methodology: A 7-year-old boy, presented with chief complaint of recurrent episodes of right focal followed by secondary generalized seizure, multiple times since 3 years of age. He showed poor control with carbamazepine but was under spontaneous complete remission for two years before presentation. He had complete vision loss in the left eye, mild intellectual disability and port wine stain which had regressed to his face. His magnetic resonance imaging (MRI) was suggestive of leptomeningeal angiomatosis in left frontoparietal temporal and occipital lobe. Electroencephalogram (EEG) was suggestive of centrotemporal spikes with a tangential dipole.

Results: This was a unique case of Sturge Weber syndrome with Self Limiting Epilepsy of Childhood with Centrotemporal spikes. Epilepsy in Sturge weber syndrome is secondary to defective blood brain barrier secondary to leptomeningeal angiomatosis and reactive gliosis and secondary dystrophic calcification.

Discussion: Epilepsy in Sturge Weber syndrome depends on various factors. Later, age of onset, unihemispheric involvement, portwine stain regressing to face and no regression of milestones are some of the good prognostic factors. SeLECTS is also one of the epilepsies having good prognosis. However, seizure clustering, poor response to carbamazepine and the presence of Interictal epileptiform discharges suggest bad prognosis.

Conclusion: Self-Limiting Epilepsy with Centrotemporal spikes (SeLECTS), can also be seen secondary to structural MRI brain lesions, as described in the case above.

Abstract ID 669: Debilitating Spasms

Naveen Ashokan, Mugundhan Krishnan

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: First reported by Ornstein, describing the patient as “tin soldier”, stiff person syndrome is a rare disorder.

Methodology: A case report and literature review.

Results: A-60-year-old female, with subacute onset chronic progressive neurological illness, in the form of light headedness followed by unsteadiness while walking, with swaying towards either side with recurrent falls, without speech disturbances/ upper limb incordination with stiffness of all four limbs, with History of paroxysmal, painful, pulling sensation with stiffening and straightening of bilateral lower limbs, 10-12 episodes per day, not present during sleep. No history of specific precipitating factors. On examination, patient had bilateral horizontal gaze palsy, nuchal rigidity, spasticity of all four limbs, exaggerated deep tendon reflexes, with impaired joint position sense in bilateral metatorso phalangeal joint. With bilateral impaired finger nose test and dysdiadochokinesia, with extensor spasms involving bilateral lower limb, causing extension at hip and knee joint+, precipitated by movement/ tactile stimuli + with Continuous brief arrhythmic jerky movement involving left upper limb, proximal muscles, with continuous rhythmic oscillatory movement involving left lower limb, distally, with positive suggestibility distractibility.

Discussion: Stiff person syndrome is characterised by increased tone of axial and limb muscles with superimposed spasms leading to hyperlordosis and stiff gait. It occurs in 4-6th decade. Other features like autonomic dysfunction, opthalmoplegia, down beat nystagmus, myoclonus may be present. Antibodies incriminated are GAD 65, anti amphiphysin, glycin receptor antibody. Treatment options includes intravenous immunoglobulin (IVIG) and rituximab in refractory cases.

Conclusion: This case has been reported for the rarity of the disease and diagnostic conundrum when it is seronegative.

Abstract ID 670: Comparative Efficacy of Endovascular Treatment Alone versus in Combination with Thrombolysis in Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials

Adila Jawaid, Pradeep Kumar, Deepti Vibha, Manabesh Nath

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Acute ischemic stroke (AIS), particularly due to large vessel occlusion (LVO), remains a major global cause of mortality and long-term disability. While both intravenous thrombolysis (IVT) and endovascular treatment (EVT) are established modalities, the clinical benefit of combining thrombolytic strategies with EVT—either via IVT or intra-arterial thrombolysis (IAT)—as opposed to EVT alone, remains uncertain. This meta-analysis aims to evaluate the comparative efficacy and safety of EVT alone versus EVT combined with IVT or IAT in AIS patients.

Methodology: A PRISMA based systematic review and meta-analysis was conducted. Databases including PubMed, EMbase, and Cochrane Library were searched for randomized controlled trials (RCTs) published between January 2013 and December 2023 comparing EVT+IVT/IAT versus EVT alone. The primary outcome was functional independence (modified Rankin Scale [mRS] score of 0–2 at 90 days). Secondary outcomes included successful reperfusion (mTICI 2b/3), 90-day mortality, and spontaneous intracerebral hemorrhage (sICH). Two reviewers independently screened and extracted data; analysis used RevMan 5.4.

Results: A total of 17 RCTs involving 7,428 patients (EVT+thrombolysis: n = 3,876; EVT alone: n = 3,552) were included. The pooled analysis showed that combination therapy significantly increased the odds of achieving functional independence at 90 days (OR: 1. 22; 95% CI: 1.05–1.41; p = 0.008) compared to EVT alone. Rates of successful reperfusion were also higher in the combination group (OR: 1.19; 95% CI: 1.03–1.38; p = 0.017). However, the risk of sICH was modestly elevated with combination therapy (OR: 1.34; 95% CI: 1.01–1.78; p = 0.041). No significant difference was found in 90-day mortality between the groups (OR: 0.96; 95% CI: 0.84–1.10; p = 0.56).

Discussion: This meta-analysis demonstrates enhanced efficacy of adjunctive IVT/IAT with EVT in AIS, notably in early presenters with favourable imaging. Elevated sICH risk necessitates selective eligibility. Stroke severity, occlusion site, and timing influenced outcomes. Heterogeneity moderate, bias minimal.

Conclusion: In Patients with AIS due to LVO, adding thrombolysis to EVT improves functional outcomes and reperfusion but slightly increases hemorrhagic risk. Findings support individualized, evidence-based strategies in acute stroke management.

Abstract ID 671: When the Pressure Drops : Recognizing Postpartum Spontaneous Intracranial Hypotension

Rashmi Rajur

Manipal Hospital, Karnataka, India

Background and aim: Postpartum headache is a common occurrence after childbirth, with a range of potential causes, from benign to serious, including hormonal fluctuations, physical changes, and secondary headache disorders. It’s essential to understand the different types and potential causes to determine appropriate management.

Methodology: A postpartum female presented with headache, neck pain, and stiffness following full-term normal vaginal delivery (FTNVD) with epidural anesthesia. Magnetic resonance imaging (MRI) brain done which showed features of spontaneous intracranial hypotension. Then, she underwent glue patch therapy.

Results: After glue patch therapy, the patient improved symptomatically, and headache subsided.

Discussion: Headaches, nausea, vomiting, and sensitivity to light are symptoms that can easily be attributed to the nature of pregnancy or even be confused with conditions such as migraine and sinus thrombosis, so taking a mindful history can help the diagnosis of sICH

Conclusion: spontaneous intracranial hypotension (sICH) is still a rare disease in pregnancy, but with severe consequences, if not diagnosed correctly and on time. Clinical complaints of the disease, along with brain MRI and other imaging modalities, can help diagnose sICH and the exact location of the cerebrospinal fluid (CSF) leak.

Abstract ID 672: Case Study of Dysferlinopathy: A Clinical Perspective on a 29-Year-Old Woman with Progressive Lower Limb Weakness

Mathakala Aparna

Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India

Background and aim: - Presenting a case study of Dysferlinopathy.

Methodology: A 29-years-old women presented with insidious-onset, progressive difficulty in walking that had been worsening over two years. She reported tingling and numbness in both lower extremities, alongside pain that had persisted for an equal duration. Her symptoms were accompanied by muscle weakness, and she experienced significant difficulty in performing everyday tasks such as walking and climbing stairs. A notable aspect of her history was that she had been walking with difficulty for approximately five years due to progressive muscle weakness.

Discussion: Dysferlinopathy is part of a group of autosomal recessive muscular dystrophies caused by mutations in the DYSF gene located on chromosome 2p13. The DYSF gene encodes dysferlin, a protein essential for repairing muscle fibre membranes. The clinical presentation of dysferlinopathy can vary significantly, with patients developing either a limb-girdle pattern of weakness (LGMD2B) or a distal myopathy affecting the calves, known as Miyoshi myopathy. In this case, the patient exhibited symptoms consistent with both LGMD2B and Miyoshi myopathy. The reported family history of muscular dystrophy further supports the diagnosis of an inherited condition.

Conclusion: This case highlights the complexity of diagnosing and managing dysferlinopathy, a rare and progressive muscle disorder. The patient’s presentation, family history, and diagnostic findings, including elevated CK levels, MRI evidence of muscle atrophy, and genetic testing, all support the diagnosis of dysferlinopathy. The literature reinforces the variability in clinical presentations and the importance of genetic testing for a definitive diagnosis]. While there is no cure, supportive management with physiotherapy, occupational therapy, and regular follow-ups can help improve the patient’s quality of life. Future research into gene therapies offers hope for potential curative treatments.

Abstract ID 673: Saved by the F-Waves: A Surprising Turn in the Diagnosis of Motor CIDP

Tanish Modi, Ikreet Cheema, Reece Hass, Samir Nath, Tapath Wannarong, Lily Dao, Chris Vermeersch, Rafid Mustafa, Michel Toledano, Marcus Pinto

Mayo Clinic Rochester, USA

Background and aim: Nerve conduction studies (NCS) and electromyography (EMG) are instrumental in the diagnostic approach to patients with generalized weakness. Herein we report a case of painless progressive quadriparesis mimicking a motor neuron disorder (MND) who was treated with intravenous immunoglobulin (IVIg) based only on abnormal F-waves.

Methodology: Case report

Results: A 74-year-old male presented with subacute, painless, progressive, flaccid quadriparesis first noticed six months prior. He had no sensory, bulbar, bladder, or bowel involvement. Outside magnetic resonance imaging (MRI) suggested cervical canal stenosis for which, he underwent anterior cervical decompression and fusion five months into illness with no improvement. Weakness worsened until he was wheelchair dependent and had significant upper extremity weakness limiting daily activities. Neurologic examination revealed fasciculations in the lower limbs, diffuse hyporeflexia, and distal predominant asymmetric quadriparesis (medical research council (MRC) scale of 3 to 4), most severely affecting the upper limbs. Sensory testing was normal. Cerebrospinal fluid analysis showed mildly elevated protein at 61 mg/dL (N < 35) with normal cell count and glucose. Autoimmune and paraneoplastic antibodies were negative. Creatine kinase (CK) was mildly elevated at 318 U/L (N: 39-308). NCS revealed normal motor and sensory responses, except for absent F-waves in median, ulnar and peroneal nerves, and prolonged F-wave latencies in the tibial nerves. EMG showed signs of active and chronic denervation in bulbar, cervical, thoracic and lumbosacral segments.

Discussion: Even though needle EMG findings were highly suggestive of a diffuse motor neuron disease (MND), the markedly abnormal F-waves suggested motor nerve root demyelination. Therefore, we started a 12-week IVIg trial (0.4 g/kg weekly) for possible motor chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). At 2-month follow-up, he was essentially back to baseline, walking independently with improvement in Inflammatory Neuropathy Cause and Treatment (INCAT) disability score from 8 to 1.

Conclusion: Marked response to IVIg confirmed the diagnosis of motor chronic inflammatory demyelinating polyneuropathy (CIDP). This case highlights the importance of a thorough electrodiagnostic evaluation in pure motor syndromes to identify treatable disorders.

Abstract ID 674: Caught off Balance: A Rare Neurotoxic Effect of RCVP in Follicular Lymphoma

Edwin Pullan, Dilip Vallathol, Abhinav Menon, Arun Warrier, Hanna Melleth

Aster Medicity, Kochi, Kerala, India

Background and aim: Reversible Acute Cerebellar Toxicity Syndrome (REACT) is potentially severe neurological condition characterized by sudden-onset cerebellar dysfunction. It is often precipitated by chemotherapeutic medications, toxins, infections, or immune-mediated responses, and may occur in both pediatric and adult populations, is extremely rare and lacks standardized diagnostic criteria. Here, we present a case of a 69-year-old male who is a known case of follicular lymphoma on RCVP (Cyclophosphamide, Prednisolone, Rituximab, Vincristine) regimen who came with complaints of slurring of speech and swaying while walking of 2 days duration.

Methodology: Case report

Results and Discussion: A 69-year-old gentleman with a history of systemic hypertension, type 2 diabetes mellitus, and ankylosing spondylitis presented in September 2022 with parotid swelling and a left cervical nodal mass. Biopsy revealed low-grade follicular lymphoma, and he was placed on active monitoring due to low tumor burden. His disease remained stable for three years. In January 2025, he reported a two-week history of shortness of breath. Evaluation revealed a left-sided pleural effusion, and aspiration showed atypical lymphoid cells. He was started on the RCVP regimen. After three cycles of chemotherapy, he developed dysarthria and ataxia. MRI revealed T2/FLAIR hyperintensities in the bilateral cerebellar hemispheres with mild diffusion restriction, suggestive of REACT syndrome in the clinical context. He was managed by a multidisciplinary team involving medical oncology, neurology and physical medicine. He was treated with steroids and rehabilitation following which he improved symptomatically. REACT syndrome is a very rare encephalopathic syndrome, although it has been reported in some cases following administration of cytarabine, Ifosfamide and 5-fluorouracil. It has not been associated with these chemotherapeutic drugs.

Conclusion: REACT syndrome should be considered in all patients receiving chemotherapy who present with cerebellar symptoms. Magnetic resonance imaging (MRI) is the key modality for diagnosis and it has good response to prompt timely treatment.

Abstract ID 675: Prevalence and Impact of Sleep Disorders in Migraine: A Case Control Study

Vaishali Sharma, Rahul Sabharwal, Kamalesh Chakravarty, Sucharita Ray, Ashok Pannu

Post Graduate Institute of Medical Education and Research, Chandigarh, India

Background and aim: Sleep disturbances are frequently reported among individuals with migraine and may contribute to increased headache frequency, chronicity, and disability. This study aimed to assess sleep quality in migraine patients using validated tools and to explore associations with migraine characteristics and psychological comorbidities.

Methodology: In this study, migraine patients were diagnosed as per The International Classification of Headache Disorders (ICHD)-3 criteria. All participants completed validated tools assessing sleep quality (Pittsburgh Sleep Quality Index [PSQI]), daytime sleepiness (Epworth Sleepiness Scale [ESS]), restless legs syndrome (RLS), risk for obstructive sleep apnea (Berlin Questionnaire), depression (Beck Depression Inventory [BDI]), and anxiety (Generalized Anxiety Disorder-7 [GAD-7]). Statistical analyses were conducted using SPSS version 28.

Results: A total of 200 migraine patients and 80 healthy controls were enrolled. The mean age of cases was 34.28 ± 11.06 years, and of controls was 35.19 ± 10.58 years. Overweight or obesity (BMI > 25) was present in 48.2% of patients and 51.8% of controls. Migraine patients had significantly poorer sleep quality (mean PSQI scores, p < 0.001), with 68% of cases having poor sleep quality (PSQI score > 5). Prevalence of RLS (39% vs. 12%), excessive daytime sleepiness (21.2% vs. 9%), and high risk for obstructive sleep apnea (25.5% vs. 12.5%) were also higher in the migraine group. Poor sleep quality was more common in patients with chronic migraine, female sex, and higher headache frequency, duration, and disability. Strong positive correlations were observed between sleep disturbances and depression, anxiety, and body mass index (BMI).

Discussion: Migraine patients demonstrate a markedly higher burden of sleep disturbances and related comorbidities. These findings underscore the need for routine screening of sleep and psychological parameters in migraine care. Addressing these factors through targeted interventions may improve headache outcomes and overall quality of life.

Conclusion: Sleep disturbances are significantly more prevalent in migraine patients, particularly those with chronic migraine and psychological comorbidities such as anxiety and depression.

Abstract ID 676: Association of AQP4 Expression at the Glial Neurovascular Unit with Risk of Idiopathic Intracranial Hypertension: Meta-Analysis

Bhoomika Arora, Poorvi Tangri, Awadh Pandit

All India Institute of Medical Sciences, New Delhi, India

Background and aim: To evaluate the evidence regarding Aquaporin-4 (AQP4) expression and its clinical significance in idiopathic intracranial hypertension (IIH), and to determine the overall effect through meta-analysis. Background Idiopathic intracranial hypertension (IIH) is marked by elevated intracranial pressure in the absence of a structural cause. Aquaporin-4 (AQP4), a water channel protein highly expressed in astrocytic endfeet at the glial-neurovascular interface, regulates brain water homeostasis. Altered AQP4 expression may contribute to impaired cerebrospinal fluid dynamics and increased intracranial pressure in IIH.

Methodology: A systematic review following PRISMA guidelines was conducted across PubMed, EMBASE, Web of Science, and Scopus. Seven eligible studies with observational designs were included, assessing AQP4 expression or markers in IIH patients versus controls. Data were synthesized to compute standardized mean differences (SMDs), risk ratios (RRs), and heterogeneity indices using a random-effects model. Sensitivity analysis using a leave-one-out approach was performed to test result stability.

Results: Seven studies met inclusion criteria. The pooled SMD for AQP4 expression or related markers was 0.21 (95% CI: –0.20 to 0.61), suggesting a small, non-significant effect. Substantial heterogeneity was observed (Q = 43.15, I² = 86.1%, Tau² = 0.26). Sensitivity analysis indicated no single study unduly influenced results. Risk ratio analysis showed that IIH patients were approximately twice as likely (mean RR = 2.12) to exhibit AQP4-related abnormalities compared to controls, although significance varied.

Discussion: High heterogeneity reflects differences in methodologies, biomarkers, and sample sizes. While some studies show AQP4 upregulation, others report decreased or unchanged expression. Larger, standardized investigations are needed to clarify AQP4’s role in IIH.

Conclusion: Altered AQP4 expression may be associated with IIH pathogenesis. However, study variability limits definitive conclusions. There is no consistent evidence supporting AQP4 autoantibodies in IIH.

Abstract ID 677: Subacute Sclerosing Panencephalitis Presenting as Multiphasic Demyelination: A Diagnostic Challenge

Bijayalaxmi Panda, Samhita Panda

All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Background and aim: Subacute sclerosing panencephalitis (SSPE) is a late complication of measles infection. The disease has a progressive course, starts with nonspecific symptoms and signs, later on myoclonic jerks, seizure, pyramidal, and extrapyramidal signs. Eventually, it may progress to a vegetative state and finally to death. Here, we described an adult SSPE case which presented with feature of relapsing and remitting pattern and an aggressive course.

Methodology: This is a descriptive retrospective case study. The patient initially presented with acute neurological symptoms after a febrile illness, with magnetic resonance imaging (MRI) findings consistent with acute disseminated encephalomyelitis (ADEM). He responded well to mucopolysaccharidosis (MPS). Relapse & Progression: Two months later, the patient developed progressive left-sided hemiparesis. Repeat magnetic resonance imaging (MRI) revealed encephalomalacia and gliosis in the right cerebellum and middle cerebellar peduncle, along with new bilateral corticospinal tract hyperintensities. Extensive investigations for demyelinating, autoimmune, and infectious causes were negative at this stage. Given the relapsing course and progressive symptoms, atypical SSPE or central nervous system (CNS) measles-related encephalitis was suspected. Subsequent testing confirmed measles-related pathology.

Results: Due to the multiphasic clinical pattern, progressive deficits, and exclusion of other etiologies, a diagnosis of atypical SSPE was made.

Discussion: This case demonstrates an unusual presentation of adult-onset SSPE. Unlike classical SSPE, this patient had a relapsing-remitting course and lacked hallmark features such as behavioral changes or myoclonus early on. The initial demyelinating pattern mimicked ADEM, complicating early diagnosis.

Conclusion: This case illustrates a rare presentation of suspected SSPE with a multiphasic demyelinating course in an adult. It highlights the diagnostic complexity and potential overlap between post-infectious demyelination, viral encephalitis, and autoimmune CNS disease. Timely immunotherapy and consideration of atypical infectious causes remain critical

Abstract ID 678: Clinical Spectrum of MOGAD Patients with Diverse Phenotypes- A Short Case Series

Mayur Bhat

All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Background and aim: Myelin oligodendrocyte glycoprotein-associated disease (MOGAD) is a rare, antibody-mediated inflammatory demyelinating disorder of central nervous system (CNS) with various phenotypes ranging from optic neuritis, transverse myelitis to acute demyelinating encephalomyelitis (ADEM) and cortical encephalitis. This case series aims to describe the varied clinical spectrum of MOGAD and resulting outcomes with standard therapies.

Methodology: Patients presenting with acute onset neurodeficits, with a positive Myelin oligodendrocyte (MOG) antibody titre and fulfilling the diagnostic criteria of MOGAD were included in this case series.

Results: Clinico-serological and radiological diagnosis of MOGAD was made according to the criteria, and all patients were treated with standard therapy using intravenous pulse steroids (1 gm MPS), and two patients receiving intravenous immunoglobulin (IVIG) due to non-response to pulse therapy for acute treatment. The outcome was favourable with a drop in modified Rankin Scale (mRS) score of 2 or more, and improvement of expanded disability status scale (EDSS) to <4 in three out of five patients.

Discussion: Varied presentation has been described in our case series reflecting the wide spectrum of MOGAD. As per literature, ON is most frequent clinical phenotype in older age patients, and typically bilateral at onset. The patients studied had unilateral ON at onset. Myelitis in MOGAD is longitudinally extensive in approximately 70% to 80% of cases, and conus medullaris is frequently affected. Similar findings were seen in two of the present cases, with a conus myelitis and dorsal cord long segment TM. ADEM is characterized by clinical/magnetic resonance imaging (MRI) evidence of multifocal CNS involvement with or without encephalopathy, more commonly seen in children (>50% cases) than adults (<18%). A young male adult patient of ADEM presented with encephalopathy and was treated using IVIG.

Conclusion: A high clinical suspicion is necessary for the early diagnosis of MOGAD in patients presenting with atypical clinical features, and with standard therapy has good outcomes.

Abstract ID 679: An Unusual Case of Subacute Sclerosing Panencephalitis Presenting as Myoclonus and Cervical Dystonia

Shivani Singh

Sir Ganga Ram Hospital, New Delhi, India

Background and aim: Subacute sclerosing panencephalitis (SSPE) is characterized by progressive deterioration of cognitive and motor function and death within 1-3 years. It often develops in a person who had measles at an age of less than 2 years. It is diagnosed with Dyken’s criteria including clinical features, high titre anti-measles IgG in serum and cerebrospinal fluid (CSF) and electroencephalogram (EEG) pattern. A very few adult onset SSPE cases have been reported in literature.

Methodology: A 17-year-old male with normal birth and developmental history and immunization schedule presented with history of poor scholastic performance and abnormal involuntary movements since 1 year. On clinical examination, patient had cognitive impairment, generalized spontaneous and stimulus sensitive myoclonus. He also had cervical dystonia with occasional tremors with no sensory, autonomic and bowel/bladder involvement. He had CSF/serum quotient positivity (5.16) for measles antibody. His EEG showed periodic long interval diffuse discharges (Radermecker complexes) occurring at 5-20 seconds interval, time locked with myoclonic discharges. His contrast enchanced MRI brain revealed hyperintense signal in bilateral insular cortex, occipito-temporal lobes and subcortical left high frontal lobe. His workup for Wilson’s disease and progressive myoclonic epilepsy was non-contributory.

Results: He was diagnosed with a case of stage III SSPE and was started on treatment with valproate, clonazepam, levetiracetam and trihexyphenidyl.

Discussion: He had history of repeated respiratory tract infections before 2 years of age. Due to the presence of high titre CSF anti-measles antibodies, Radermecker complexes and brain imaging findings, a reasonable diagnosis of SSPE was considered.

Conclusion: SSPE usually results from a measles virus infection acquired earlier in life, which usually develops 7 to 10 years later. It is a chronic progressive neurodegenerative condition resulting in akinetic mutism with persistent vegetative stage.

Abstract ID 680: Kidney-Brain Axis: Identifying the Role of Blood Biomarkers of Kidney Dysfunction in Cognitive Impairment – Insights from LASI-DAD

Aradhana Nayak, Thomas Isaac¹, Dwaiti Roy¹, Sandhya G¹, Aishwarya Ghosh¹

All India Institute of Medical Sciences, Bhubaneswar, Odisha, ¹Centre for Brain Research, Indian Institute of Science, Bengaluru, Karnataka, India

Background and aim: Cognitive impairment (CI) is one of the leading causes of debilitation and disability worldwide, especially in older adults. Patients with Chronic Kidney Disease (CKD) have an elevated risk for developing CI. There is a paucity of research examining the interplay between kidney dysfunction and CI within the Indian population. This study aims to explore the relationship between blood biomarkers of kidney dysfunction and their association with CI in aging Indian population.

Methodology: In this study, 4,096 participants of the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) Wave-1 were included. Estimated glomerular filtration rate (eGFR) was calculated based on Cystatin C levels using the 2012 CKD-EPI formula for Cystatin C. Hindi Mental State Examination (HMSE) score was used as a measure of global cognition. Statistical analyses were performed using Python (version 3.11.12) with relevant libraries including NumPy, SciPy, pandas, and statsmodels.

Results: The study included 1889 males (46.12%) and 2207 females (53.88%) aged 60 and above. Significant positive correlation was found between HMSE and eGFR (p < 0.05), uric acid (p < 0.001), creatinine (within the normal range) (p < 0.001). Significant negative correlation was found between HMSE and BUN (blood urea nitrogen) (p < 0.05), BUN/creatinine ratio (p < 0.001), NT- proBNP (p < 0.001).

Discussion: The association of kidney dysfunction to cognition could be due to various pathophysiological mechanisms – accumulation of uremic toxins, presence of cardiovascular disorders, neuroinflammation and altered electrolyte balance. eGFR is an established marker of kidney function and was found to be decreased with decreasing HMSE. Uric acid, due to its neurostimulatory and antioxidant effects has a positive impact on cognition. Creatinine, in the normal range, indicative of higher muscle mass, increased with increasing HMSE. NT-proBNP (solely excreted by the kidney) is a specific biomarker of renal dysfunction.

Conclusion: eGFR, uric acid, creatinine, BUN, BUN/creatinine ratio and NT-proBNP could be potential markers for cognitive function.

Abstract ID 681: When Seizures Tell a New Story: Autoimmune Encephalitis Imitating Progression of Epilepsy

Anuj Mahendra, Puneet Agarwal, Vasundhara Aggarwal, N M Hrudainag, Ankitha Ann

Max Hospital, New Delhi, India

Background and aim: A case report of a 24-year-old male with a birth history of perinatal hypoxia with long-standing seizure disorder and presented with progressive impairment of speech, walking difficulty, and multiple daily seizure episodes over the past three months. Neurological history and seizure semiology depicted abdominal rising aura with right motor focal seizures with secondary generalization.

Methodology: Magnetic resonance imaging (MRI) brain-a gyral pattern of restricted diffusion in the left temporo-parietal region. Positron emission tomography-computed tomography (PET-CT)-Increased metabolic activity in the left temporal lobe, suggesting acute inflammation. Electroencephalography (EEG)-left temporoparietal intermittent epileptic discharges with background slowing. Cerebrospinal fluid (CSF)-lymphocytic pleocytosis with elevated protein but without evidence of CNS infection; autoimmune encephalitis panel was negative. However, antinuclear antibodies (ANA) was positive with a speckled pattern (1:160), keeping the suspicion of autoimmune etiology most likely. We made the diagnosis of sepsis-associated encephalopathy (SAE) based on his clinical presentation, supportive brain imaging and excluding infectious and neoplastic causes.

Results: Treated with optimal doses of anti-seizure medications, intravenous corticosteroids pulse therapy and immunosuppressants. There was remarkable improvement in his clinical status as seizure episodes stopped and his previous MRI findings on repeat imaging disappeared.

Discussion: One can face diagnostic and therapeutic challenges in diagnosing SAE, particularly in patient with longstanding epilepsy. When new neurological symptoms emerge like language deficits, disturbances in vision, and instability in gait in a previously stable epileptic patient, we must consider an additional ongoing autoimmune process in the brain. The mildly positive ANA titer and a negative CSF autoimmune encephalitis panel, suggests activation of systemic immune response. This may suggest the presence of non-neuronal or unidentified neuronal antibodies not covered by current autoimmune panels.

Conclusion: This case report is unique in many ways, 1) history of chronic epilepsy predating SAE onset which can lead to delay in diagnosis, 2) autoimmune panel-mild positive ANA with negative CSF autoimmune antibody panel reflecting the possibility of autoimmune inflammation in the brain, 3) clinical presentation was consistent with focal findings in MRI, EEG, PET-CT, 4) remarkable radiological and electrophysiological reversal post-treatment, 5) responded to immunotherapy in an exceptional manner, even though he was suffering from chronic epilepsy.

Abstract ID 682: Revisiting Perampanel: A Literature-Based Review on its Role as a First Add-on in Focal Seizure Management

Arthik Shetty, Prashant Devkare, Shruti Dharmadhikari, Chintan Khandhedia, Amey Mane, Suyog Mehta

Sun Pharma Laboratories Ltd, Mumbai, Maharashtra, India

Background and aim: India has an estimated epilepsy prevalence ranging from 3.0-11.9 per 1,000 individuals, with approximately 12 million individuals affected nationwide and almost half of them suffering from focal seizures. Overall, 35% of newly diagnosed patients fail to achieve long-term remission with antiepileptic treatment resulting in severe disability, psychosocial consequences, decreasing life quality, and increasing economic burden. Perampanel, a highly selective, and non-competitive antagonist of AMPA receptor, approved for adjunctive treatment of partial-onset seizures, with or without secondarily generalized seizures in patients aged more than 12 years. The aim was to highlight role of perampanel as first add-on in management of partial onset seizures.

Methodology: To summarize relevant studies, researched on PubMed and Google Scholar.

Results: An Italian consensus statement has mentioned that perampanel can be effective and well tolerated when used as early add-on therapy, even at low doses. Numerous studies have showed seizure freedom rate ranging from 8%-60% with perampanel as first add-on. A study of 30 patients showed that patients treated with perampanel for 6-months had significantly higher seizure free rate when used as first add-on treatment (75.0%) compared to those who used it as late add-on treatment (31.8%) (p = 0.049). In another study in 44 patients, 29.5% of patients in first adjunctive therapy group achieved seizure freedom.

Discussion: Numerous studies have showed perampanel being reliable option in focal seizure management with efficacy parameters being significant in patients, especially as first add-on. A desirable feature of perampanel which is relevant to add-on use is its unique mechanism, which facilitates use in combination with any anti-seizure medication. No significant cardiac or metabolic adverse effects were reported, supporting long-term safety. Its role as add-on is useful in polytherapy settings due to low-interaction potential.

Conclusion: Based on existing evidence, perampanel showed significant efficacy as first add-on in patients with focal seizures.

Abstract ID 683: Virtual Reality-Based Motor Imagery Training for Rehabilitation in Post-Stroke Patients: A Narrative Review

Kajal Goyal, Deepti Vibha

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Stroke is a leading cause of long-term disability, with the acute phase—especially Stage 1 of the Brunnstrom Motor Recovery Stages—being crucial for early motor rehabilitation. Motor imagery, the mental practice of movement, promotes brain reorganization by activating undamaged neural networks, while virtual reality enhances this effect by providing immersive visual feedback and reducing distractions. Combining motor imagery (MI) with virtual reality (VR) enables stroke patients to improve motor function without physical movement, boosting brain connectivity and neuroplasticity. This safe and cost-effective approach shows promise for enhancing post-stroke recovery. This review highlights the potential of VR-based MI training in rehabilitation programs.

Methodology: A literature search was conducted using PubMed, Google Scholar, Scopus, and Web of Science with tailored keywords. Studies from 2017–2025 involving stroke patients (aged 18–90, within two years of onset) were included, excluding those with recurrent stroke or other major conditions. After screening, relevant data were extracted and thematically analyze.

Results: This review included 19 studies- randomized controlled trials (RCTs), quasi-experiments, and pilots examining VR-based MI for post-stroke motor recovery. Most studies reported improved limb function, increased neural activation, and higher patient motivation due to VR’s immersive nature. Real-time sensory feedback and multisensory stimulation in VR enhanced neuroplasticity and motor learning, with VR and MI combined showing a synergistic effect on functional recovery.

Discussion: Stroke patients can activate motor brain areas without movement, supporting neuroplastic recovery. Combining MI with VR enhances neural rewiring through mechanisms like synaptic and Hebbian plasticity. Studies show VR-MI improves motor function, boosts neural activation, and increases patient engagement. Despite limitations such as small sample sizes and varied study designs, evidence supports VR-MI as a safe, effective, and promising tool for post-stroke rehabilitation.

Conclusion: VR-based MI training holds significant potential as an innovative and effective tool in post-stroke rehabilitation, offering new dimension in neurorehabilitative care that can enhance both patients & clinical outcomes.

Abstract ID 684: A Odd Case of GBS

Omprakash Jaiswal, Megha Dhamne

P D Hinduja Hospital, Mumbai, Maharashtra, India

Background and aim: To Report a rare and diagnostically challenging case of thallium poisoning presenting with atypical clinical features.

Methodology: A case report

Results: Nerve conduction studies (NCS) demonstrated a length dependent axonal neuropathy, and cerebrospinal analysis (CSF) analysis were within normal limits, making Guillain-Barré Syndrome (GBS) less likely. The patient exhibited neuropsychiatric symptoms, severe neuropathic pain, and alopecia - features atypical for GBS. Prompting evaluation for toxic neuropathy. Toxicology confirmed markedly elevated blood and urine thallium levels, supporting a diagnosis of thallium induced toxic neuropathy.

Discussion: A 46-years-old male was admitted to an outside hospital with acute gastroenteritis for 3 to 4 days. One week later he developed severe pain followed by a tingling sensation in all four limbs, occurring sequentially in length dependent pattern. Within the next two days, he developed weakness in the lower limbs and difficulty in walking, subsequently becoming bedbound within following 2 to 3 days. He developed difficulty in swallowing and speaking within the next 3 to 4 days. Subsequently, he developed aspiration pneumonia and was intubated in view of respiratory distress. Based on clinical feature, NCS and CSF analysis, diagnosis of GBS was considered. Subsequently started on intravenous immunoglobulin (IVIG), but due to progressive worsening in clinical condition he was transferred to our hospital. On presentation he has alopecia, with severe painful neuropathy with power in upper extremity 3/5 and lower extremity 1/5 and hyporeflexia. Serum and urine thallium levels were high. He was treated with hemodialysis with hemoperfusion and Prussian blue for a month. After completion of treatment marked improvement in overall clinical condition noted.

Conclusion: Thallium toxicity, though infrequent, should be considered in the differential diagnosis of patients presenting with multisystemic symptoms such as painful peripheral neuropathy, gastrointestinal disturbance, and alopecia of unclear aetiology.

Abstract ID 685: Case Report: A case of Subacute Cerebellar Ataxia in a Patient of Prolonged Metronidazole Abuse-Uncommon Manifestation of a Commonly Used Antibiotic

Sayan Malakar

Kolkata Medical College, Kolkata, West Bengal, India

Background and aim: Central nervous system (CNS) complication following long term Metronidazole intake has been rarely reported and the mechanism is poorly understood. We describe a patient who developed subacute onset neurotoxicity, predominantly cerebellar dysfunction following prolonged metronidazole abuse.

Methodology: Detailed history, neurological examination, biochemical parameters, imaging including magnetic resonance imaging (MRI) brain, computed tomography (CT) thorax- abdomen -pelvis, positron emission tomography (PET) CT whole abdomen were done in the patient of ataxia with metronidazole abuse admitted in Medical College, Kolkata.

Results: A 60-years-old male non hypertensive, non-diabetic with history of smoking, alcohol abuse (stopped alcohol for 2 yrs) presented with subacute cerebellar ataxia, intention tremor, ataxic speech for 1 month with 3 episodes of seizures. Considering his age and onset of symptoms, our differentials were immune mediated, paraneoplastic, vascular, post infectious, drugs-toxin mediated. History, clinical examination, investigations helped us to rule out first 4 differentials. There was a history of metronidazole intake on and off due to diarrhoea like episodes and he took metronidazole for 3 weeks at a stretch just before the initiation of illness. MRI brain revealed FLAIR hyperintense lesion in dentate nucleus, vestibular nucleus, pontine tegmentum, splenium along with diffusion-weighted imaging (DWI) restriction in splenium-features suggestive of metronidazole toxicity. The patient improved significantly after stoppage of metronidazole with functional status improving from bed bound state to self-ambulation.

Discussion: Metronidazole being commonly used antibiotic can cause CNS manifestation due to cerebellum and brainstem dysfunction. We should aware of neurotoxicity in patients taking metronidazole especially for prolonged duration.

Conclusion: High index of suspicion with early detection of hallmark brain MRI changes and cessation of metronidazole therapy can lead to great improvement in functional status as it a potentially reversible condition.

Abstract ID 686: The Role of Pramipexole in Early Parkinson’s Disease: A Review of Literature

Arthik Shetty, Prashant Devkare, Shruti Dharmadhikari, Chintan Khandhedia, Amey Mane, Suyog Mehta

Sun Pharma Laboratories Ltd, Mumbai, Maharashtra, India

Background and aim: India has an estimated Parkinson’s disease (PD) prevalence ranging from 52 to 328 per 100,000 individuals, with up-to 2 - 4 million individuals affected nationwide. Early symptoms of PD go undiagnosed, leading to functional decline. Early levodopa use is associated with increased risk of motor complications such as dyskinesias and wearing-off phenomena. Dopamine agonists such as pramipexole are well established in Parkinson’s disease management. The aim was to highlight the role of pramipexole in early Parkinson’s disease.

Methodology: To summarize relevant studies, search was made on PubMed and Google Scholar.

Results: Numerous studies have shown efficacy of Pramipexole in early PD with Unified Parkinson’s Disease Rating Scale (UPDRS) score reduction in the range of 4-6.5 points. In a study of 296 patients, UPDRS motor score decreased by an adjusted mean 4·4 (0·6) points in pramipexole group and 2·2 (0·5) points in placebo group. Another long-term study showed adjusted mean UPDRS Parts II + III scores remained substantially improved from baseline, at -6.6 and -6.3 points amongst ER and IR recipients after 113 weeks of pramipexole (33 double blind plus 80 open label) in early PD. In another study, UPDRS score reduction was comparable among active treatment groups: 0.75 mg bid- 4.7; 0.5 mg bid- 4.4, 0.5 mg tid- 4.4 compared to placebo (p < 0.0001).

Discussion: Clinical trials consistently demonstrate that pramipexole significantly improves motor symptoms in early PD, as evidenced by improvements in UPDRS scores. Pramipexole is generally well tolerated, with dose-dependent side effects such as nausea, somnolence, and impulse control disorders. Pramipexole can be effective option in early PD management as it improves motor symptoms, delay the need for levodopa and address non-motor symptoms like depression and sleep disturbances.

Conclusion: Based on existing evidence, pramipexole remains a well-supported, effective, and tolerable option for management of early PD.

Abstract ID 687: Herpes Simplex Virus Induced Neuromyotonia with Positive GLI1 and CASPR2 Antibodies

Sakshi Verma, Ravi Sarswat

Atal Institute of medical superspecialities, Shimla, Himachal Pradesh, India

Background and aim: We report a patient with Herpes genitalis who simultaneously developed neuromyotonia.

Methodology: A young female with herpes gentalis and pain and twitching in both lower limbs showed evidence of neuromyotonia. Her serum was positive for CASPR2 and anti-GLI1 antibodies. She was diagnosed as Isaac syndrome possibly induced by herpes simplex virus (HSV)-2. She received corticosteroids, intravenous immunoglobulin (IVIG) and acyclovir. The peripheral nerve symptoms improved however herpes infection flared following steroids leading to severe pain only improving after multiple nerve blocks.

Results: This is believed to be the first reported case of neuromyotonia precipitated by herpes.

Discussion: It is suggested that when patients with HSV and neuromyotonia are admitted, an early test be carried out to look for the presence of CASPR2 and LGI1 antibodies in the serum. Treatment that includes corticosteroids and immunoglobulin to acyclovir can improve the patients’ prognosis. On the other hand, corticosteroid therapy may precipitate disseminated HSV infection, which should be looked out for.

Conclusion: Herpes simplex virus may trigger neuromyotonia. Early diagnosis and treatment can prevent progression of the disease and associated comorbidities.

Abstract ID 688: Neurotropic Fungal Invasion Without a Primary Focus: Two Rare Cases of Cerebral Chromoblastomycosis in Immunocompetent Hosts”

Bhaskara Rao Vana, Pritam Raja, Seena Vengalil

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Chromoblastomycosis is a chronic fungal infection typically involving skin and subcutaneous tissue. Central nervous system (CNS) involvement is rare, particularly without a primary cutaneous or pulmonary lesion. Neurotropism of dematiaceous fungi may be related to melanin metabolism. To describe two histopathologically confirmed cases of cerebral chromoblastomycosis (phaeohyphomycosis) in immunocompetent young males, each presenting with distinct clinical syndromes.

Methodology: Review of case records of patients with clinical features and laboratory parameters suggestive cerebral chromoblastomycosis (phaeohyphomycosis) in immunocompetent young males.

Results: Case 1: A 17-year-old presented with acute hemiparesis and altered sensorium. Imaging showed bilateral infarcts and leptomeningeal enhancement. Despite empirical antimicrobial therapy, he deteriorated and succumbed. Autopsy revealed fungal meningitis and arteritis due to Cladosporium cladosporioides. Case 2: A 21-year-old presented with headache, focal deficits, and fever. Magnetic resonance imaging (MRI) revealed a right frontoparietal lesion. Biopsy showed necrotizing granulomatous inflammation with pigmented fungal hyphae. Culture confirmed Cladophialophora bantiana. He improved with voriconazole.

Discussion: These cases illustrate two rare CNS manifestations of chromoblastomycosis—fungal arteritis leading to infarction and a cerebral abscess—both without detectable extracranial foci. Diagnosis relies on high clinical suspicion, neuroimaging, and histopathology. Timely biopsy and targeted antifungal therapy are critical, though prognosis remains poor in diffuse disease.

Conclusion: CNS chromoblastomycosis should be considered in atypical neuroinfectious presentations, even in immunocompetent patients. Early diagnosis and combined antifungal/surgical management may improve outcomes.

Abstract ID 689: Atypical Trigger or Unmasking? Varicella-Zoster Infection Precipitating MOGAD Myelitis

Anush Jain, Amit Agarwal, Balveen Singh

Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India

Background and aim: Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) is a rare, immune-mediated demyelinating disorder of the CNS, which may be unmasked or triggered by preceding infections. Differentiating between primary infectious myelitis and infection-associated autoimmune demyelination remains a clinical challenge but has crucial therapeutic implications.

Methodology: We studied a case of a 30-year-old previously healthy male, who developed acute symmetric sensorimotor paraparesis with bladder and bowel dysfunction, two weeks after recovering from chickenpox.

Results: Magnetic resonance imaging (MRI) spine revealed long-segment cervico-dorsal myelitis, predominantly involving the central grey matter. Cerebrospinal fluid (CSF) analysis was normal and varicella-zoster virus (VZV) polymerase chain reaction (PCR) and antibodies were negative, ruling out direct viral myelitis. Given the extent and pattern of cord involvement, MOGAD was suspected. Serum MOG-IgG returned positive, confirming the diagnosis. The patient was started on immunotherapy with good clinical improvement.

Discussion: This case highlights the importance of recognising MOGAD as a potential post-infectious autoimmune complication following viral illnesses like varicella.

Conclusion: Early testing for MOG antibodies in cases of extensive myelitis, even with an infectious prodrome, can help distinguish primary infection from autoimmune demyelination, allowing timely immunomodulatory treatment and better outcomes.

Abstract ID 690: Nuclear Magnetic Resonance (NMR) Spectroscopy Based Profiling of Lipid Components in Tissue, Serum, and CSF from Primary Brain Tumor Patients: A Diagnostic Perspective

Niraj Srivastava, Vijaya Mishra, Abhishek Pathak

Banaras Hindu University, Varanasi, Uttar Pradesh, India

Background and aim: Primary brain tumors that originate from glial cells are classified as gliomas. Various types of gliomas are distinguished based on imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, as well as through histopathological analysis. The aim of the present study was to identify diagnostic lipid markers and examine their quantitative correlation with tumor grade through NMR spectroscopy-based lipid profiling of surgically excised tumor tissue, serum, and cerebrospinal fluid (CSF).

Methodology: In vitro high-resolution 1H NMR spectroscopy was employed for both qualitative and quantitative analysis of lipid components in the tissue, serum, and cerebrospinal fluid (CSF) of patients with primary brain tumors (including Grade II/III gliomas, glioblastoma, and medulloblastoma) compared to healthy subjects.

Results: A quantitative and statistically significant difference in the levels of phospholipids, cholesterol, and cholesterol esters was observed in the tumor tissue, serum, and cerebrospinal fluid (CSF) of patients with primary brain tumors (including Grade II/III gliomas, glioblastoma, and medulloblastoma) compared to normal subjects.

Discussion: Previous studies have highlighted the significance of lipid metabolism in human brain malignancies. While some research has explored various lipid types within gliomas tissue, similar investigations involving serum or CSF are lacking. In the present study, lipid markers were first identified in brain tumor tissues and subsequently assessed in serum and CSF. The outcomes of this study, potentially distinguish between different subtypes or grades of the brain tumors.

Conclusion: This study highlights the potential role of lipid estimation in CSF and serum as a complementary diagnostic tool for the preoperative evaluation of brain tumors. Additionally, NMR-based lipid profiling of post-surgical tumor tissue may aid in distinguishing between different tumor types.

Abstract ID 691: Efficacy and Safety of Lacosamide in Elderly Patients: A Review of Literature

Navodaya Salwe, Prashant Devkare, Shruti Dharmadhikari, Chintan Khandhedia, Amey Mane, Suyog Mehta

Sun Pharmaceuticals Industries Ltd, Mumbai, Maharashtra, India

Background and aim: Epilepsy management in elderly patients is complex due to presence of multiple comorbidities, which may restrict the use of certain antiepileptic drugs. Partial seizures, particularly complex partial seizures, are of significant concern with prevalence ranging from 49% to 61.3%. Lacosamide, a non-enzyme-inducing antiepileptic drug, offers a predictable pharmacokinetic profile and a low potential for drug interactions. Aim of this study was to review data on efficacy and safety of lacosamide in elderly patients.

Methodology: A literature search was conducted using PubMed and Google Scholar.

Results: A study in elderly patients demonstrated that at 12-months of follow-up, the mean monthly seizure frequency decreased from 4.23 ± 8.53 to 0.33 ± 0.9 (p < 0.001) in lacosamide group and from 2.29 ± 6.11 to 0.2 ± 0.81 (p < 0.001) in levetiracetam group. Another study in elderly patients showed a median percent reduction of 62.5%, 58.2%, and 66.6% in seizure frequency from baseline for 1-, 3-, and 5-year completers, respectively. In a subgroup analysis of patients aged ≥65 years, 78% of patients were seizure-free at 12-months with lacosamide, compared to 83% with carbamazepine-CR. Treatment-emergent adverse events were reported in 82% of patients in lacosamide group and 84% of patients in carbamazepine-CR group. Notably, discontinuations due to treatment-emergent adverse events were numerically lower in the lacosamide group compared to the carbamazepine-CR group (21% vs. 26%).

Discussion: This review indicates that efficacy of lacosamide is comparable to that of levetiracetam and carbamazepine in elderly population. Additionally, long-term treatment with lacosamide was generally well-tolerated. The review also highlights the lower incidence of drug-related adverse events and treatment discontinuations in the lacosamide group.

Conclusion: Lacosamide has favorable efficacy and tolerability profile, along with reduction in seizure frequency. Given the frequent comorbidities and the potential for drug–drug interactions in elderly patients, lacosamide may serve as a valuable treatment option for focal-onset epilepsy due to its favorable pharmacokinetic profile.

Abstract ID 692: Questionnaire-Based Assessment of Neurocysticercosis (NCC) Patients in the North Indian Population and Its Clinical Significance

Niraj Srivastava, Vijaya Mishra, Abhishek Pathak, Arpan Mitra¹, Nidhi Chandra, Neha Srivastava, Arvind Das, Viturv Tripathi, Deepika Joshi, Anand Kumar, Varun Singh, Rameshwar Chaurasia

Banaras Hindu University, Varanasi, Uttar Pradesh, ¹Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background and aim: Neurocysticercosis (NCC) is a widespread parasitic infection of the human nervous system caused by Taenia solium. It represents a major public health concern globally. Utilizing a questionnaire-based assessment for patients with NCC can yield important insights into the disease, particularly its symptomatology, thereby facilitating a more comprehensive understanding of the patient’s clinical condition.

Methodology: The present study was conducted using both qualitative and quantitative approaches and received approval from the Ethics Committee of the Institute of Medical Sciences (IMS), Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India (Approval No.: Dean/2023/EC/6806). A total of 50 patients were enrolled for the study through the outpatient department (OPD) of the Department of Neurology, IMS, BHU.

Results: All patients (N = 50) in the study experienced seizures, with a mean duration of 3.78 ± 4.54 years. Focal seizures were observed in 84% of cases (42/50), while generalized seizures were reported in 16% (8/50). Among the 22 cases with available data, the mean seizure frequency was 1.90 ± 1.57 episodes per year (though the unit was not explicitly specified). Common associated symptoms included dizziness in 96% (48/50), headache in 80% (40/50), and post-seizure vomiting in 24% (12/50). Visual abnormalities were present in 4% (2/50), whereas 96% (48/50) reported no such issues. A positive family history of seizures was noted in 20% of patients (10/50), and a history of head trauma or injury was documented in 12% (6/50).

Discussion: This study highlights that among patients with NCC, focal seizures occur more frequently than generalized seizures. Commonly reported symptoms include dizziness, headaches, and vomiting following seizures. Furthermore, a family history of seizures and a history of head trauma may serve as potential risk factors in certain cases. Overall, the findings provide insight into the clinical profile of NCC in the North Indian population and underscore its clinical relevance.

Conclusion: The outcomes of the questionnaires from patients with NCC in the present study contribute to evaluating the effectiveness of new interventions or combined therapeutic approaches, including Ayurveda, Yoga, and dietary modifications.

Abstract ID 693: Risk Factors for Large Vessel Occlusion in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Amit Kumar, Neetika Katiyar, Dheeraj Khurana, Pradeep Gupta¹

Post Graduate Institute of Medical Education and Research, Chandigarh, ¹Clinical Research Unit, All India Institute of Medical Sciences, New Delhi, India

Background and aim: Large vessel occlusion (LVO) accounts for a significant proportion of acute ischemic strokes (AIS) and is associated with worse clinical outcomes compared to non-LVO strokes. Early identification of individuals at higher risk for LVO can inform stroke triage, imaging decisions, and endovascular preparedness. However, the specific clinical, demographic, and vascular risk factors associated with LVO remain inconsistently reported. This study aims to systematically review and quantitatively synthesize the available evidence on the risk factors associated with LVO in patients presenting with AIS.

Methodology: A comprehensive literature search was conducted across PubMed, EMbase, and Cochrane CENTRAL up to 30th April 2025, identifying observational studies and registries comparing patients with LVO versus non-LVO AIS. Two independent reviewers screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Meta-analyses were performed using random-effects models to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs).

Results: A total of 42 studies encompassing over 65,000 stroke patients were included. Key risk factors significantly associated with LVO included atrial fibrillation (OR: 2.76; 95% CI: 2.18–3.49), cardioembolic etiology (OR: 3.14; 95% CI: 2.40–4.10), older age (mean difference: 4.6 years; 95% CI: 2.9–6.3), and higher baseline NIHSS scores (mean difference: 6.7 points; 95% CI: 5.1–8.2).

Discussion: Hypertension and diabetes were not significantly different between LVO and non-LVO groups. Subgroup analyses confirmed consistent associations across geographic regions and stroke subtypes. Heterogeneity was moderate to high, but sensitivity analyses confirmed the robustness of findings.

Conclusion: Atrial fibrillation, cardioembolic stroke, advanced age, and high stroke severity are strong predictors of LVO in AIS. These findings may support pre-hospital LVO screening tools and aid in rapid triage for mechanical thrombectomy. Future research should explore LVO-specific risk prediction models incorporating clinical and imaging variables.

Abstract ID 694: Role of Ropinirole for the Treatment of Early Parkinson’s disease. A Review of Literature

Navodaya Salwe, Prashant Devkare, Shruti Dharmadhikari, Chintan Khandhedia, Amey Mane, Suyog Mehta

Sun Pharmaceuticals Industries Ltd, Mumbai, Maharashtra, India

Background and aim: Early-onset Parkinson’s disease (EOPD) is defined as PD with an age of onset after 21 years of age but before 50 years. Prevalence of Parkinsonism was found to be 45.82 per 100,000 with 40–45% experiencing the onset of motor symptoms between the ages of 22 and 49. Long term use of L-dopa is limited by the development of motor fluctuations, dyskinesias. In many patients, the response to L-dopa gradually declines after 3 years of therapy. Ropinirole, a non-ergoline D2-receptor agonist, demonstrated effective symptomatic reduction in patients with Parkinson’s disease and was generally well tolerated. Aim of this study was to review the role of Ropinirole for the treatment of early Parkinson’s disease.

Methodology: Literature search was performed on PubMed and Google Scholar.

Results: Adler CH et.al study showed the mean ± SD UPDRS motor examination score in all ropinirole-treated patients improved from 17.9 ± 8.8 at baseline to 13.4 ± 9.5 and in placebo 17.7 ± 9.5 at baseline to 17.9 ± 10.5 at endpoint. Hersh BP et.al study showed the adjusted mean (SE) reduction from baseline for the UPDRS total motor score at Week 4 was 5.2 ± 0.65 points in the ropinirole prolonged release group and 2.2 ± 0.67 points in the placebo group (P < 0.0001). In a long-term five-year study, the cumulative incidence of dyskinesia, was 20 percent in the ropinirole group and 45 percent in the levodopa group.

Discussion: Ropinirole provided effective symptomatic reduction in early Parkinson’s disease patients and was generally well tolerated. Patients treated with ropinirole experienced a significant improvement in motor function compared with placebo, as measured by UPDRS motor score. Ropinirole also demonstrated a favorable safety and tolerability profile.

Conclusion: Ropinirole is an effective and well-tolerated therapeutic option for treatment of early Parkinson’s disease.

Abstract ID 695: Double-Negative, Yet Distinct: Hyperkplexia and Neuromyotonia in VGKC Encephalitis Without LGI1 or CASPR2

Pragnya Panda, Prateek Panda

All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India

Background and aim: Voltage-gated potassium channel (VGKC)-complex antibody encephalitis presents with a heterogeneous spectrum including limbic encephalitis, neuromyotonia, Morvan syndrome, and progressive encephalomyelitis with rigidity and myoclonus (PERM). Antibodies to LGI1 and CASPR2 are typically implicated; however, rare cases are double-negative with atypical features. We report two such cases with unusual phenotypes and therapeutic response to immunotherapy.

Methodology: We are presenting the clinical profile, neuroimaging, electrophysiological findings, serology, treatment, and outcomes of two patients with suspected VGKC-complex encephalitis who tested negative for both LGI1 and CASPR2 antibodies.

Results: Case 1: A 48-year-old male presented with progressive generalized stiffness, exaggerated startle response (hyperkplexia), and action-induced myoclonus for three months. Brain magnetic resonance imaging (MRI) was normal; electroencephalogram (EEG) showed diffuse slowing. LGI1, CASPR2, and glycine receptor antibodies were negative. Case 2: A 22-year-old male developed focal seizures followed by painful spasms, generalized rigidity, insomnia, hallucinations, and features mimicking Morvan syndrome and tetanus. LGI1, CASPR2, and other autoimmune/paraneoplastic panels were negative. Both patients received high-dose intravenous methylprednisolone pulses (1 g/day for 5 days), leading to significant clinical improvement, with reduction in myoclonus, rigidity, and neuropsychiatric symptoms.

Discussion: These cases expand the clinical spectrum of double-negative VGKC-complex encephalitis. Hyperkplexia is classically linked with glycine receptor antibody syndromes but was observed here in the absence of such antibodies. The combination of PERM-like symptoms with neuromyotonia and encephalopathy in antibody-negative cases presents diagnostic challenges. Notably, both cases responded well to corticosteroid therapy.

Conclusion: Double-negative VGKC-complex encephalitis can manifest with atypical features including hyperkplexia and tetanus-like rigidity. Despite negative LGI1, CASPR2, and glycine receptor serologies, immunotherapy with methylprednisolone may yield favorable outcomes. High clinical suspicion remains critical for early diagnosis and treatment.

Abstract ID 696: Atypical Bibrachial Amyotrophic Lateral Sclerosis with Stable Course: A Case of TARDBP-Associated ALS10 in a Young Female

Pragnya Panda, Prateek Panda¹

All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, ¹All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Background and aim: Amyotrophic lateral sclerosis-10 (ALS10) is a rare form of motor neuron disease caused by heterozygous mutations in the TARDBP gene encoding TDP-43. It typically presents in adulthood with rapid progression affecting both upper and lower motor neurons, and may be associated with frontotemporal dementia (FTD). We report an unusual case of bibrachial-onset ALS10 in a young female with a static course on edaravone therapy.

Methodology: We describe the clinical course, neurophysiological findings, imaging, genetic testing, and treatment response of a 31-year-old female diagnosed with TARDBP-associated ALS.

Results: The patient presented with progressive bilateral upper limb weakness over two years, with no bulbar, lower limb, cognitive, or behavioral involvement. Examination revealed symmetrical wasting and weakness in both arms with brisk reflexes. The electromyography (EMG) demonstrated chronic denervation in cervical myotomes, sparing other regions. MRI brain and spine were unremarkable. Genetic analysis revealed a heterozygous missense variant c.1043G>T (p.G348V) in exon 6 of the TARDBP gene (Chr1:11082509), with an allele depth of 170X. This variant is listed in dbSNP (rs1131690782) and ClinVar (VCV000266064.1) and classified as likely pathogenic according to The American College of Medical Genetics and Genomics (ACMG) criteria (PS4, PM2, PP3). The patient has remained clinically stable over 10 months on edaravone therapy.

Discussion: This case represents an atypical, slowly progressive bibrachial form of ALS10 in a young adult, linked to the G348V variant in TARDBP. The absence of bulbar or cognitive features and a static clinical course contrast with previously reported TARDBP mutations, highlighting phenotypic variability. The role of edaravone in disease stabilization warrants further exploration.

Conclusion: TARDBP-related ALS can present with focal motor symptoms and an indolent course. Genetic testing is essential for accurate diagnosis in atypical cases. Early edaravone therapy may contribute to disease stability in selected patients.

Abstract ID 697: Synaptic Dysregulation and Cognitive Deficits in a Mild Traumatic Brain Injury Model

Ankit Kumar, Akash Gautam

Center for Neural and Cognitive Sciences, University of Hyderabad, India

Background and aim: Traumatic Brain Injury (TBI) is a major risk factor for long-term neurodegeneration, including Alzheimer’s disease (AD). Fragile X Mental Retardation Protein (FMRP) and Activity-Regulated Cytoskeleton-Associated Protein (Arc) are key synaptic proteins implicated in memory and learning. This study aimed to (1) establish a rodent model of TBI-induced cognitive impairment and (2) analyze the expression and interaction of FMRP and Arc using behavioral, biochemical, and bioinformatics approaches.

Methodology: TBI was induced in male Sprague-Dawley rats via the weight-drop method. Behavioral assessments included the Morris Water Maze (MWM) and Novel Object Recognition (NOR) tests. Biochemical assays measured oxidative stress markers (SOD, MDA) and inflammatory cytokines (IL-1b, IL-6). Western blotting was standardized for FMRP and Arc expression in the hippocampus and prefrontal cortex. Bioinformatics analyses utilized protein-protein interaction networks to explore regulatory pathways.

Results: Significant memory impairment was observed 24 hours post-injury in rats subjected to 300 g TBI, as indicated by reduced time in the target quadrant during MWM probe trials. Biochemical assays showed increased MDA levels and altered SOD activity in 300 g TBI groups, indicating oxidative stress. No significant anxiety-related behavioral changes were found in the Open Field Test. Western blotting for FMRP and Arc remains in optimization stages. Initial bioinformatic analysis suggests potential co-regulatory roles in synaptic function and neuroinflammatory signaling.

Discussion: A 300 g weight drop reliably induced acute cognitive deficits and oxidative stress, validating the model. Recovery effects were evident in 30-day post-TBI animals, underlining the importance of time-point selection. FMRP and Arc may modulate injury response through shared molecular pathways, warranting further investigation.

Conclusion: This study establishes a reliable mild TBI model with measurable cognitive and biochemical outcomes. Further analysis of FMRP-Arc interaction may reveal novel targets for intervention in TBI-related neurodegeneration.

Abstract ID 698: Comparing Machine Learning Models for Differentiating Stroke Subtypes Using Biomarkers and Imaging Modalities

Manabesh Nath, Deepti Vibha, Rajesh Singh, Pradeep Kumar, Awadh Pandit, Deepti Vibha

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Accurate and rapid stroke subtype differentiation is crucial for effective treatment. This study evaluates machine learning (ML) models in differentiating ischemic stroke (IS) from hemorrhagic stroke (HS) and classifying IS subtypes: large artery atherosclerosis (LAA), cardioembolic (CE), and small vessel occlusion (SVO), using integrated genomic, proteomic, transcriptomic, microRNA, and neuroimaging data. We also compare the ML model’s performance with standard CT and MRI.

Methodology: Data from 7500 patients (4500 IS, 3000 HS) were obtained from public databases (GEO, ArrayExpress, Human Protein Atlas) and neuroimaging studies. IS subtypes included LAA (n = 1750), CE (n = 1500), and SVO (n = 1250). We analyzed single nucleotide polymorphisms (SNPs) (APOE, CETP, MTHFR, F5), protein levels (CRP, IL-6, D-dimer, fibrinogen, NSE, S100B), gene expression (MMP9, TIMP1, VEGFA, BDNF), microRNAs (miR-124, miR-21, miR-145, miR-155), and neuroimaging features (lesion volume, location, ADC values). Three ML models (RF, SVM, GBM) were trained and evaluated using 5-fold cross-validation. Performance was assessed using accuracy, sensitivity, specificity, F1-score, and AUC and compared with CT and MRI diagnostic accuracy reported in the literature

Results: For IS vs. HS differentiation, GBM achieved the highest accuracy (94.2%), sensitivity (95.1%), and specificity (93.0%). In IS subtyping, RF performed best (accuracy: 89.2%, sensitivity: 88.4%, specificity: 94.1%, F1-score: 0.87, AUC: 0.92). Key differentiators included APOE ?4 in CE, elevated CRP and MMP9 in LAA, reduced miR-124/miR-21 in CE, deep white matter lesions in SVO, and cortical lesions with elevated D-dimer in LAA. Literature indicates that non-contrast CT has limited sensitivity (~16%) for early ischemic stroke detection, while magnetic resonance imaging (MRI) (diffusion-weighted imaging [DWI]) offers high sensitivity and specificity (>90% and >95%, respectively).

Discussion: ML models, especially RF and GBM, demonstrate accuracy, sensitivity, and specificity superior to CT and comparable or better than MRI in differentiating stroke subtypes by integrating multi-omics and imaging data.

Conclusion: This integrative approach holds significant promise for improving diagnostic accuracy and enabling faster, more personalized stroke treatment strategies.

Abstract ID 699: Pre-Stroke Physical Activity and Post-Stroke Outcomes: A systematic review and meta-analysis

Manabesh Nath, Deepti Vibha, Pradeep Kumar, Rajesh Singh, Awadh Pandit

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Regular physical activity improves cardiovascular health, but its relationship with post-stroke outcomes remains unclear. This study provides an updated quantitative evaluation of this relationship. This meta-analysis investigates the association between pre-stroke physical activity and post-stroke outcomes, including stroke severity and functional recovery.

Methodology: A systematic search of PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library was conducted up to April 15, 2024. Studies reporting pre-stroke physical activity and post-stroke outcomes (NIHSS scores at 3 months and modified Rankin Scale (mRS) at 3 and 6 months) were included. Data extraction and quality assessment were performed independently by two reviewers. Random-effects models were used to calculate pooled mean differences (MD) for NIHSS and odds ratios (OR) for mRS, with 95% confidence intervals (CI).

Results: Twenty-three studies, encompassing 98,765 stroke patients, were included. Pre-stroke physical activity was associated with significantly lower NIHSS scores at 3 months (MD: -2.45, 95% CI: -3.10 to -1.80; I² = 88%; 12 studies, n = 15,672). Patients with pre-stroke physical activity had significantly better functional outcomes at 3 months (OR: 1.85, 95% CI: 1.52 to 2.26; I² = 76%; 15 studies, n = 68,540) and at 6 months (OR: 2.10, 95% CI: 1.75 to 2.52; I² = 68%; 10 studies, n = 45,289) as assessed by mRS. Subgroup analysis indicated moderate to vigorous physical activity (>150 minutes/week) conferred the greatest benefit.

Discussion: This meta-analysis demonstrates that pre-stroke physical activity significantly reduces stroke severity and improves functional recovery at 3 and 6 months. Promoting physical activity is crucial for stroke prevention and better post-stroke outcomes.

Conclusion: Pre-stroke physical activity is significantly associated with reduced stroke severity and improved functional outcomes at 3- and 6-months post-stroke. These findings underscore the importance of promoting physical activity for stroke prevention and improved post-stroke recovery. Further research is needed to elucidate the underlying mechanisms and optimal pre-stroke activity levels.

Abstract ID 700: OPA1-Related Optic Neuropathy Masquerading as Ethambutol Toxicity

Prabhjit Kaur, Basavaraj Tigari, Karthik Mahesh, Aastha Kapila, Vivek Lal

Post Graduate Institute of Medical Education and Research, Chandigarh, India

Background and aim: Ethambutol-induced Optic Neuropathy (EtON) is a severe adverse effect of ethambutol, a key component of anti-tubercular therapy. Although its exact mechanism remains unclear, mitochondrial dysfunction has been long suspected. Identifying genetic predisposition may help in recognizing at-risk individuals. During follow-up of a patient cohort with EtON, one case revealed a pathogenic OPA1 mutation.

Methodology: A 27-year-old female with extra-pulmonary tuberculosis on weight-based anti-tubercular treatment (FDC as per NTEP) presented with sudden, progressive bilateral visual loss, photophobia, glare, and color desaturation. Visual acuity was reduced (RE 6/60, LE 5/60), with bitemporal hemianopia, bilateral temporal pallor on fundus exam, and Optical Coherence Tomography (OCT) showing superior and inferior RNFL thinning. Gadolinium-enhanced (Gd)-magnetic resonance imaging (MRI) revealed left optic nerve enhancement; all blood and CSF investigations were normal. Suspecting EtON, treatment was started.

Results: A possibility of ethambutol-induced optic neuropathy was considered and patient was given high dose vitamin B12 (1500 mcg) for five days, high dose pulse methylprednisolone (1000 mg) was given for five days followed by oral vitamin B-12, co-enzyme Q and vitamin E. Based on examination, she underwent mitochondrial mutation analysis and OPA1 mutation came out to be positive. After genetic confirmation, she was continued on idebenone 900 mg/day. On follow-up after six-months, her vision minimally improved and but the fundus showed optic atrophy.

Discussion: This case highlights a potential link between ethambutol-induced optic neuropathy and mitochondrial dysfunction, particularly OPA1 mutations. In patients presenting with atypical or severe visual loss during ethambutol therapy, underlying mitochondrial pathology should be considered. Early recognition and targeted treatment may help mitigate long-term visual damage, although routine genetic screening remains impractical in current clinical settings.

Conclusion: EtON may be associated with underlying mitochondrial mutations like OPA1. Identifying such cases early can aid in timely intervention and potentially limit irreversible vision loss.

Abstract ID 701: When Therapy Turns Toxic: Lessons from a Dalfampridine Overdose Case

Pooja Jain

All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Background and aim: Dalfampridine is a broad-spectrum potassium channel blocker which improves ambulation in multiple sclerosis (MS) and spinal cord injury (SCI) patients by enhancing conduction in demyelinated axons. Aim of this study was to provide an in-depth discussion of clinical manifestations and management strategies for a case of 4-aminopyridine intoxication.

Methodology: We report a 23-year-old lady with history of SCI and psychiatric illness who ingested a quantity of dalfampridine approximately tenfold recommended daily dose. Approximately 2 hours later, relatives found her diaphoretic and vomiting, followed by multiple episodes of Generalized Tonic-Clonic Seizure (GTCS) without regaining consciousness in between. She was brought to AIIMS emergency, got intubated and commenced on mechanical ventilation due to profoundly low Glasgow Comma Scale (GCS) and impending respiratory failure.

Results: Initial management comprised aggressive fluid resuscitation; however, persistent hemodynamic instability necessitated initiation of inotropic support. She was being managed as a case of refractory status epilepticus, with concurrent correction of underlying metabolic derangements, yet her seizures have remained unresponsive to multiple anticonvulsant drugs. Gastric lavage was done, and laxative was administered to enhance drug elimination. Electroencephalogram (EEG) revealed epileptiform activity. After 36-hour stay in the Intensive Care Unit (ICU), she achieved seizure control and was successfully extubated following hemodynamic stability.

Discussion: To date, only 20 cases of 4-aminopyridine overdose have been documented, with status epilepticus being a rare but severe complication. The clinical features observed in this case—autonomic instability, cholinergic manifestations, pulmonary edema and refractory seizures—align with the anticipated toxicological profile of dalfampridine overdose. The Naranjo probability scale confirmed a definite causal relationship between drug and observed clinical syndrome.

Conclusion: Dalfampridine is a potent neurofunctional agent. However, overdose can lead life-threatening complications, most notably status epilepticus. Management is primarily supportive emphasizing airway protection, hemodynamic stabilization and controlling central nervous system (CNS) hyperexcitability with sedatives. Collaboration with toxicology experts is essential for optimal outcomes.

Abstract ID 702: Fading Strength, Unbreakable Ties: A Legacy of Muscle Loss

Abi Gokhale, P K Murugan, Justin C, Elangovan S, Chezian D, Murugan P K

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant myopathy characterized by progressive, often asymmetric weakness of the facial, scapular, and upper limb muscles. Though globally recognized, FSHD remains underdiagnosed in India due to limited awareness and restricted access to genetic testing. This case highlights the clinical features and diagnostic approach in a young adult with a strong multigenerational family history, emphasizing the role of detailed clinical assessment in early identification of hereditary muscle disorders.

Methodology: A 22-year-old male presented with a 1.5-year history of progressive, asymmetrical proximal upper limb weakness (left > right), resulting in difficulty performing overhead activities. There were no sensory complaints. Neurological examination revealed selective muscle wasting with Polyhill sign, Popeye arm appearance, prominent anterior axillary folds, scapular winging, bilateral facial weakness, lumbar lordosis, and a positive Beevor’s sign. Serum CPK was mildly elevated. Electromyogram (EMG) demonstrated mild myopathic potentials. Family history revealed multiple similarly affected maternal relatives across four generations, none of whom had undergone prior evaluation. Genetic testing for D4Z4 repeat contraction was initiated.

Results: The clinical phenotype, classic examination findings, and a compelling maternal lineage strongly supported a working diagnosis of FSHD. The pattern was consistent with autosomal dominant inheritance and variable penetrance, suggestive of FSHD1.

Discussion: FSHD remains an underrecognized condition in the Indian context, where limited access to specialized diagnostics can delay identification. Hallmark signs—such as facial diplegia, scapular winging, and selective shoulder girdle muscle wasting—should prompt early suspicion. The value of thorough clinical evaluation and family history cannot be overstated, especially when molecular testing is unavailable.

Conclusion: Early diagnosis allows timely genetic counselling, family screening, and future access to targeted therapies such as DUX4-inhibition strategies. Greater clinical awareness and improved diagnostic infrastructure are essential to improve outcomes for patients with hereditary myopathies like FSHD.

Abstract ID 703: Interesting Case of Multiple Cranial Nerve Palsy in an Immunocompetent Patient

Vignesh Subramanian

Kanyakumari Government Medical College, Kanyakumari, Tamil Nadu, India

Background and aim: Multiple cranial nerve palsies are uncommon and can result from neoplastic, inflammatory, or infectious etiologies. Cryptococcal infection typically affects immunocompromised individuals; however, involvement in immunocompetent patients is rare. This report highlighted a case of cryptococcal infection presenting as multiple cranial neuropathies in an immunocompetent individual.

Methodology: A 60-year-old right-handed male with diabetes, hypertension, and depressive disorder presented with sudden-onset facial asymmetry, dysphagia, dysphonia, ataxia, and weakness in shoulder elevation and head turning. Neurological examination revealed left-sided lower motor neuron facial palsy, glossopharyngeal, vagus, and accessory nerve involvement, and ipsilateral cerebellar signs. All routine blood investigations including complete blood count (CBC), liver function test (LFT), renal function test (RFT), electrolytes, antistreptolysin O (ASO), C-reactive protein (CRP), rheumatoid arthritis (RA) factor, hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV), enereal Disease Research Laboratory (VDRL), and human immunodeficiency virus (HIV) were normal or negative. Chest X-ray, electrocardiogram (ECG), ECHO, and ultrasound abdomen were normal. MRI brain was initially normal. Cerebrospinal fluid (CSF) analysis revealed high protein (96 mg/dL), normal glucose (70 mg/dL), and 0–1 lymphocytes. India ink and Gram stain of CSF showed capsulated yeast; culture confirmed Cryptococcus. MRI with contrast showed meningeal enhancement; CT chest revealed alveolitis. Ethical approval was obtained from the Institutional Ethics Committee, and written informed consent was taken from the patient. Statistical analysis was not applicable as this is a single case report.

Results: Clinical findings and imaging supported the diagnosis of cryptococcal meningoencephalitis with multiple cranial nerve involvement in an immunocompetent host. Appropriate antifungal therapy was initiated.

Discussion: While Cryptococcus neoformans infection is classically associated with immunocompromised states, it may also present in immunocompetent individuals. The localization of lesions and cranial nerve involvement pointed to brainstem and meningeal inflammation. Early diagnosis via CSF India ink preparation remains crucial.

Conclusion: Cryptococcal infection should be considered in the differential diagnosis of multiple cranial nerve palsies, even in immunocompetent patients, particularly when CSF analysis and imaging support the diagnosis.

Abstract ID 704: An Interesting Case Report of Brick Kiln Worker Palsy

Sagaya James

Thanjavur Medical College, Thanjavur, Tamil Nadu, India

Background and aim: Compression neuropathy of the common peroneal nerve (CPN) at the fibula head is the most common type occurring in the lower limb. A prolonged squatting posture is one cause of this type of compression neuropathy in the CPN, but there has been little research in the working environment. Here, we report a brick kiln worker who presented with right CPN palsy following prolonged squatting posture.

Methodology: A case report here we report a case of 33-year-old female who worked as a labourer in a brick kiln, in a village near Thanjavur, city in Tamilnadu. She presented with complaints of tripping of toes and dragging of right foot for past 3 days. She also had numbness in lateral aspect of right leg since then, she had given history of prolonged squatting for 12 hours per day for 3 days at her work in brick kiln.

Results: On examination, patient had right foot dorsiflexion and inversion weakness and reduced sensation over the dermatomal distribution of common peroneal nerve palsy. All of these made us to arrive the diagnosis of right foot drop due to right common peroneal nerve palsy. Nerve conduction studies (NCS) showed right CPN.

Discussion: The fibula head is the most common site of compression neuropathy in the CPN because the nerve runs superficially at this site. Crossing of the legs, sitting and lying down, cause compression neuropathy at the fibula head. NCS is a useful tool to determine the location of compression, NCS usually shows conduction block.

Conclusion: Compression neuropathy of the CPN at the fibula head is a common condition, but it has not attracted attention in working environments. So, we hereby presented this case to throw light on such workers to create awareness among them to avoid prolonged squatting to prevent its occurrence and to reduce morbidity.

Abstract ID 705: Visual Imagery and Spatial Memory: Behavioural and Pilot EEG Correlates of Cognitive Mapping in Medical Students

Saumya Singh

Baba Raghav Das Medical College, Gorakhpur, India

Background and aim: Spatial memory and visual mental imagery rely on overlapping neural substrates, notably the hippocampus and parietal cortex, which are vulnerable in neurological disorders such as Alzheimer’s disease and temporal lobe epilepsy. Although individual differences in imagery vividness exist, their relationship with spatial memory and associated neural oscillations remains underexplored in healthy adults. This study aims to investigate whether visual imagery vividness predicts subjective navigational ability and objective spatial memory performance in medical students, while piloting resting-state electroencephalogram (EEG) theta amplitude as a neural correlate.

Methodology: Fifty healthy medical students (ages 18–40) will complete the Vividness of Visual Imagery Questionnaire (VVIQ), the Santa Barbara Sense of Direction Scale (SBSOD), and a brief image-based spatial memory task. Following installation of EEG equipment, pilot resting-state EEG recordings will be obtained from a subset (~10 participants). Spectral analysis will quantify theta-band (4–8 Hz) amplitude to explore its relationship with behavioural measures. Correlational and regression analyses will assess these associations.

Results: Behavioural data collection is ongoing. We hypothesise that higher imagery vividness will correlate positively with both self-reported navigational ability and spatial memory task performance, reflecting hippocampal-dependent cognitive functions. Pilot EEG data acquisition will begin soon, allowing exploratory analysis of resting-state theta amplitude as a neurophysiological marker linked to imagery and memory.

Discussion: If supported, these findings may establish subjective imagery vividness and resting-state theta amplitude as accessible behavioural and neural markers of spatial cognition. This has implications for early detection of navigation-related cognitive deficits in neurological disorders and suggests potential for scalable cognitive and neurophysiological screening tools.

Conclusion: This study investigates a novel cognitive-behavioural relationship in a healthy population, with potential relevance for early detection of spatial memory dysfunction. The findings may contribute to the development of accessible, behaviour-based assessments to support clinical screening and cognitive profiling in neurology.

Abstract ID 706: A Young Lady with Abnormal Movement

Regia Sultana

Kolkata Medical College, Kolkata, West Bengal, India

Background and aim: Niemann pick disease type C is an autosomal recessive lipid storage disorder characterized by progressive selective neurodegeneration and visceral involvement. Considering its heterogeneous clinical presentation, unspecific findings and complex diagnostic approach this diagnosis is often delayed or missed.

Methodology: Detailed history, general and neurological examination, family history, imaging were done to reach the diagnosis of this case.

Results: A 27-years-old female presented with upper limb onset twisting, repetitive abnormal movement, subsequently involved other part of the body including trunk and cranio-cervical area for last 2 years. Phenomenology of this movement disorder is hyperkinetic abnormal, repetitive, twisting movement with posturing of both hand, feet, trunk, jaw, facial muscle with backward and lateral deviation of neck. Along with intermittent fixed upward deviation of both eyeball like oculogyric crisis. There was sensory trick present but no urge or suppresibility. She had history of antipsychotic drug intake.

Discussion: This hyperkinetic movement disorder is dystonia which was action induced and even present at rest. There was temporal association with antipsychotic drug intake and onset of the disorder. But, odd was presence of vertical gaze palsy and it was limb onset and later involved craniocervical area unlike drug induced movement disorder which has predilection for craniocervical area. So, our other differential were Niemann pick disease type C as there was vertical gaze palsy and presence of splenomegaly. Bone marrow biopsy showed lipid laden macrophage and blue histiocyte, also genetic test confirmed the disease.

Conclusion: Diagnosis of Niemann pick disease type C depends on positive family history and clinical findings indicating visceral, neurological and psychiatric involvement. Light microscopy of bone marrow specimen also gives diagnostic clue but genetic testing is mandatory to confirm the diagnosis.

Abstract ID 707: Study of Hormonal and Coagulation Profile in Patients with Idiopathic Intracranial Hypertension

Shalaj Jain

All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Background and aim: Idiopathic intracranial hypertension (IIH) predominantly affects obese women of reproductive age. Emerging evidence suggests hormonal and coagulation abnormalities may contribute to its pathogenesis, warranting comprehensive profiling in affected individuals. We aimed to study hormonal and coagulation profile in patients with IIH.

Methodology: This prospective observational study was conducted at AIIMS Jodhpur. Patients with IIH, diagnosed using modified Dandy criteria, were evaluated for hormonal and coagulation parameters. Clinical, ophthalmological, radiological, and biochemical assessments were performed.

Results: A total of 38 participants, predominantly female, were enrolled. Headache was the most common presenting symptom (89.5%), followed by photophobia, phonophobia, and blurring of vision. Female gender and obesity were the primary risk factors. Grade 2 bilateral papilledema was most frequent on examination; only 8–18% had abnormal perimetry in right and left eye respectively. The mean body mass index (BMI) was 26.99 kg/m². Imaging revealed partial empty sella in over half the patients, complete empty sella in 18.4%, and transverse sinus stenosis in 76.3%. Cerebrospinal fluid (CSF) opening pressure averaged 30.80 cm H₂O. Hormonal profiling showed elevated insulin (mean 17.68 mIU/mL), with most other hormones within normal ranges. Vitamin D was deficient in 92% of patients. Hyperprolactinemia was present in 10%, and 44.7% had elevated leptin levels. Coagulation abnormalities included increased fibrinogen (31.6%), low protein C (18.4%) and S (47.4%), and low antithrombin III (36.8%). More than half had homocysteinemia.

Discussion: This study reinforces emerging evidence linking IIH to metabolic, hormonal, and coagulation disturbances, suggesting a multifactorial pathogenesis and supporting integrated therapeutic strategies beyond intracranial pressure management.

Conclusion: Research highlights associations with insulin resistance, hyperleptinemia, vitamin D deficiency, and coagulation abnormalities. These findings suggest that IIH’s pathogenesis extends beyond intracranial pressure dynamics, implicating broader metabolic and hormonal dysregulations. Consequently, comprehensive management strategies addressing these systemic factors are essential for effective treatment and improved patient outcomes.

Abstract ID 708: Mystery Behind Movement Identified and Treated in a Tertiary Care Hospital

Allwyn A, Sethuram A, Kalpana P

Kanyakumari Government Medical College and Hospital, Kanyakumari, Tamil Nadu, India

Background and aim: Whipple’s disease, a rare systemic illness caused by the bacterium Tropheryma whipplei. Symptoms include gastrointestinal disturbances, weight loss and neurological manifestations such as oculo masticatory myorhythmia, a condition characterized by rhythmic eye and jaw movements. Recognizing oculo masticatory myorhythmia is crucial in diagnosing central nervous system manifestations of Whipple’s disease, as it serves as a pathognomonic indicator.

Methodology: Case report

Results: A 75-years-old male with complaints of involuntary movements involving oro-facial region for 6 months. Examination revealed rhythmic myoclonus or spasm occurring in synchronous bursts involving jaw and face. Upper gastrointestinal endoscopy with D2 biopsy was done. With Periodic Acid Schiff (PAS) staining showed chronic duodenitis with features suggestive of Whipple’s disease.

Discussion: A 75-years-old male came with involuntary movements involving oro-facial region for 6 months. No history of limb weakness/ cranial nerve dysfunction/ incoordination/ features of increased intracranial pressure (ICP). There was abdominal pain with loose stools and loss of appetite which was managed symptomatically 1 year ago. He had past history of coronary artery disease, type 2 diabetes mellitus, systemic hypertension and chronic kidney disease, currently on regular medical management. Examination revealed rhythmic myoclonus or spasm occurring in synchronous bursts involving jaw and face. Whipple’s disease was suspected and upper gastrointestinal endoscopy with D2 biopsy was done. Biopsy with PAS staining showed chronic duodenitis with features suggestive of Whipple’s disease. He was started on IV antibiotic Ceftriaxone OD for 2 weeks, followed by oral antibiotic Cotrimoxazole DS BD for 1 year. Patient is under regular follow up.

Conclusion: Prompt recognition of myorhythmia can lead to timely interventions because many cases of central nervous system (CNS) Whipple’s disease remain undiagnosed until autopsy. Furthermore, the diagnostic process may involve rigorous testing, including tissue biopsy, with findings of myorhythmia providing critical guidance for effective treatment management. Hence, understanding the implications of this disorder can greatly influence both diagnostic clarity and therapeutic outcomes.

Abstract ID 709: Total Paralysis in a Dancing Child - A Rare Case Report

Sagaya James, Arunraj E

Thanjavur Medical College, Thanjavur, Tamil Nadu, India

Background and aim: Movement disorders in a child are very interesting and difficult to diagnose. Though Chorea is common secondary to rheumatic heart disease, severe form of Sydenham’s chorea is very rare nowadays. Here, we are reporting a child presented with quadriparesis, which turned to be rare cause.

Methodology: A 9-years-old male child, first born, non-consanguineous marriage, with normal birth and developmental history, presented with acute onset flaccid symmetrical quadriparesis with inability to speak without bulbar, cranial and respiratory weakness. No history of bladder and autonomic involvement. On examination, child is alert, obeying commands with normal cranial nerve examinations and flaccid symmetrical quadriparesis with global areflexia. On investigation, serum electrolytes are normal, electrophysiological study also normal. Neuroimaging of brain and spinal also found to be normal. On further enquiring, mother gave a history of dancing like movements with slurring of speech were present for 1 week. Then, patient suspected to have Sydenham chorea with severe form of chorea paralytica. On further examination, echocardiogram showed findings suggestive of rheumatic heart disease (RHD), and antisense oligonucleotides (ASO) was also positive. Child treated with antibiotics and haloperidol’ and sodium valproate. At discharge, child was neurologically stable.

Results: Child was treated with penicillin and low dose steroids. For chorea, patient treated with haloperidol and sodium valproate. Child showed full recovery with neurologically stable.

Discussion: Sydenham chorea is a major manifestation of rheumatic fever in up to 40% of patients. It is autoimmune mediated process resulting from molecular mimicry. Anti-basal ganglia antibodies from molecular mimicry damaging the dorsal and ventral striatum responsible for the pathological findings and symptoms. Chorea paralytica is severe form of Sydenham chorea, which presents as flaccid quadriparesis. In a child with flaccid quadriparesis, chorea Mollis should be considered as differential diagnosis.

Conclusion: Chorea mollis is a severe form of Sydenham chorea, characterised by extreme hypotonia and weakness, which is treatable.

Abstract ID 710: Limb Hypertrophy – An Atypical Clinical Association

Alagarasi G

Thanjavur Medical College, Thanjavur, Tamil Nadu, India

Background and aim: The occurrence of hypertrophy confined to one limb is uncommon, diagnostically perplexing leading to potentially unwarranted treatment. The link between syringomyelia and limb enlargement is rarely recognized; it is often attributed to heightened sympathetic activity.

Methodology: A 56-year-old right-handed male, with history of cervical syringomyelia operated 10 years before, presented as clawing of left little finger and ring finger with associated numbness below elbow. Examination showed hypertrophy in the left upper limb. On examination, there was ulnar clawing, and weakness was noted in small hand muscles of left upper limb. Ulnar nerve was thickened. Reflexes were normal, and there was dissociated sensory loss impaired pain and temperature sensation, with light touch preserved. Magnetic resonance imaging (MRI) showed cervicodorsal spinal cord syrinx with hypertrophic Charcot’s joint of left shoulder and elbow joints, Bulky osteophytes causing ulnar nerve entrapment at the level of cubital tunnel in left elbow. Nerve conduction studies (NCS) showed axonal sensory-motor neuropathy affecting the left ulnar nerve. Surgery was advised and nerve transposition was done. Patient was given rehabilitation

Results: This is a case report of a patient with limb hypertrophy, a rare association with syringomyelia has been highlighted.

Discussion: Syringomyelia associated with Limb hypertrophy is a rare presentation and is postulated to result from particularly due to sympathetic overactivity. There was hyperhidrosis in the left upper limb, and sympathetic skin response studies showed higher amplitude responses on the left side. There was hypertrophic Charcot arthropathy which leads to compression of nerve, and it was diagnosed and surgically addressed to prevent further nerve damage.

Conclusion: Syringomyelia, however uncommonly, can present as limb hypertrophy and rarely can involve and stimulate the sympathetic neurons of intermediolateral column. Syringomyelia presenting as hypertrophy should be tested for sympathetic overactivity.

Abstract ID 711: Nitrazepam Versus Topiramate in Resistant Infantile Epileptic Spasms Syndrome: An Open-Label, Randomized Controlled Trial

Parth Lal, Kiran Prakash¹, Sandeep Negi, Jitendra Sahu, Naveen Sankhyan, Naveen Sankhyan, Jitendra Sahu

Post Graduate Institute of Medical Education and Research, Chandigarh, ¹Government Medical College and Hospital Sector 32, Chandigarh, India

Background and aim: There is a lack of consensus among physicians regarding antiseizure medication choice in resistant infantile epileptic spasms syndrome (IESS) after failure of hormonal and vigabatrin therapy. This study aimed to assess whether oral nitrazepam is superior to oral topiramate in achieving complete cessation of spasms in children with resistant IESS.

Methodology: In this open-label, randomized controlled trial (RCT) with a superiority hypothesis and masked end-point assessments, children with resistant IESS were randomized to receive oral nitrazepam (0.5–3 mg/kg/day; n = 20) or topiramate (2–12 mg/kg/day; n = 20). The primary outcome was sustained spasm cessation for four weeks, assessed at 10 weeks post-randomization. Secondary outcomes included electroclinical remission, quality of life (Hi-QUALIN), autonomic tone (heart rate variability [HRV]), and adverse events.

Results: Nitrazepam was superior to topiramate in achieving complete spasm cessation (55% vs. 15%, p = 0.019) and electroclinical remission (45% vs. 10%, p = 0.031), with better quality of life scores (p = 0.023). Sedation was more common with nitrazepam, while irritability predominated with topiramate. HRV analysis showed significantly higher parasympathetic parameters among nitrazepam responders compared to topiramate, indicating better autonomic recovery.

Discussion: Nitrazepam demonstrated superior efficacy with favorable electroclinical and autonomic outcomes. This is the first RCT in resistant IESS to incorporate HRV analysis, highlighting its role as a biomarker of treatment response. The study employed stringent eligibility criteria, had zero attrition, and followed Prospective Randomized Open, Blinded Endpoint (PROBE) standards, ensuring methodological rigor.

Conclusion: Nitrazepam is more effective than topiramate in short-term management of resistant IESS, with added benefits of improved quality of life and autonomic stability. HRV may serve as a potential biomarker for treatment efficacy and autonomic recovery.

Abstract ID 712: When Immunotherapy Backfires: A Case Report of Progressive Multifocal Leukoencephalopathy in a Patient with NMOSD on Rituximab & Review of Literature

Akshay Soni, Bhupender Bajaj, Sumirini Puppula, Saloni Gupta

Vardhman Mahavir Medical College, New Delhi, India

Background and aim: Progressive multifocal leukoencephalopathy (PML) is usually a fatal demyelinating disorder most commonly associated with HIV positive patients and patients on immunosuppressive or immunomodulatory treatment. We present a rare case of rituximab associated PML in a patient with Neuromyelitis Optica Spectrum Disorder (NMOSD) and review available literature on the subject.

Methodology: Case Summary: A 45-year-old non-hypertensive, non-diabetic female, a known case of anti-aquaporin-4 antibody positive NMOSD with cervical longitudinally extensive transverse myelitis on rituximab maintenance treatment for past around 4 years, presented to us with subacute onset progressive neurocognitive impairment including worsening memory, attention, language functions, calculation and praxis. She had received corticosteroids and azathioprine for an unconfirmed duration and was on l-thyroxin for hypothyroidism for 12 years. Her blood examination revealed lymphopenia, with absence of CD 19 and CD 20 cells. Magnetic resonance imaging (MRI) brain showed T2/FLAIR hyperintensity without contrast enhancement in bilateral parietal and right frontal lobe.

Results: Lumbar puncture revealed normal cytology and biochemistry with positive polymerase chain reaction for JC virus. She was seronegative for human immunodeficiency virus (HIV) and had normal serum vitamin B12. All the immunosuppressive drugs were stopped. Patient was given course of intravenous Immunoglobulin infusion.

Discussion: PML is a rare critical demyelinating disease caused by reactivation of JC virus in immunosuppressed patient. The condition is known to be adverse effect of rituximab and has poor prognosis. It is managed by stopping the immunosuppression and attempting to reconstitute the immune status. No evidence-based therapy is known for the condition but interferons, interleukins and monoclonal antibodies like pembrolizumab have been tried.

Conclusion: All patients on rituximab treatment must be meticulously followed up for the earliest clinical and radiological signs of PML.

Abstract ID 713: Exploring The Clinicopathological Correlates In Frontotemporal Dementia : A Case Series From India

Gagan B H, Suvarna Alladi, Faheem Arshad Arshad, Yasha T C, Anita Mahadevan, Saraswathi Nashi, Faheem Arshad, Yasha T C

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Frontotemporal dementia (FTD) spectrum disorders are clinically and pathologically heterogeneous, characterized by frontal and temporal lobe degeneration, leading to behavioral or language alterations and functional deficits. This study examines clinical-pathological subtypes of FTD in a tertiary centre of India.

Methodology: We defined clinical subtypes of FTD based on the standard criteria. A structured informant questionnaire was used to assess the severity scale using Clinical Dementia Rating Scale (CDR). All brains have been collected following informed consent from closed relatives of the deceased in medico-legal and clinical autopsies. The brain tissue was analysed using various techniques, including beta amyloid, phospho-tau (Cortical or subcortical) immunohistochemistry, to assess the morphology, regional involvement, and severity of abnormal proteins.

Results: Patient I: A 72-year-old male with a 15-year history of apathy, neglect of personal hygiene, lack of empathy, and cognitive impairments in recent memory and executive functions. Diagnosed with behavioural variant frontotemporal dementia (bvFTD). Patient II: A 70-year-old male with progressive motor and behavioral symptoms over three years, including slowness of speech, micrographia, and reduced activity engagement. Later symptoms included right foot dragging, tremors, gait slowness, festination, imbalance, auditory hallucinations, occasional forgetfulness, and urgency in bowel and bladder functions. Diagnosed with frontotemporal dementia (FTD)-progressive supranuclear palsy (PSP). Patient III: A 66-year-old female with chronic rheumatoid arthritis, progressive behavioral disturbances over 2.5 years, severe apathy, distractibility, and inappropriate public behaviors. Diagnosed with bvFTD, with a retrospective CDR score of 3 in all cases, indicating advanced dementia.

Discussion: Gross pathological findings revealed diffuse cortical atrophy, most pronounced in the prefrontal regions in three cases. One case exhibited atrophy confined to the frontal pole. Thinning of the corpus callosum, dilated frontal horns, and periventricular white matter softening were noted. Histological evidence of tau-positive neuronal cytoplasmic inclusions, seen in affected cerebral cortices, basal ganglia, were represented either by diffuse cytoplasmic immunoreactivity, often with appearances of pretangles. Fine tau-positive neuropil threads were seen in the grey matter structures.

Conclusion: This case series highlights the clinical and pathological diversity of FTD, including p-tau and TDP-43 pathologies, frontotemporal atrophy, neuronal inclusions, p-tau reactivity, and pre-tangles, correlating with behavioral and motor symptoms in bvFTD and FTD-PSP subtypes.

Abstract ID 714: A Rare Presentation of Dermatomyositis

Sushil Kumar Sharma, Dinkar Kulshreshtha

Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background and aim: Dermatomyositis is one of the idiopathic inflammatory myopathies. It presents with symmetric proximal muscle weakness, skin rash, and extramuscular manifestations, such as esophageal dysfunction and interstitial lung disease. We present a case of married middle-aged female with left sided monoparesis along with dysphagia

Methodology: Clinical examinations and Investigations: antinuclear antibody (ANA) profile, creatine phosphokinase (CPK) level, myositis panel, electromyography (EMG), muscle biopsy, computed tomography (CT) thorax and abdomen.

Results: Her CPK total was slightly elevated at 422.99 IU/L and muscle biopsy findings suggestive of inflammatory pathology. ANA profile and myositis panel showed positive ANA along with Anti Mi-2 Ab and Anti Jo-1 Ab positive status which were consistent with the pattern seen in Dermatomyositis..

Discussion: Dermatmyositis is one of the inflammatory myopathyies which usually presents with skin rash along with insidious onset of progressive weakness. It is rare in Dermatomyositis to present solely with weakness of limbs without any skin manifestations. Muscle weakness is usually more pronounced in proximal muscle groups - typically in the neck, pelvic, thigh, and shoulder muscles—with a symmetric distribution. Females are uaually more affected than males (2:1). The average age at diagnosis is middle age, with prevalence of 1 per lakh in the general population. The pathognomonic skin manifestations are Gottron’s papules, heliotrope rash, erythematous rash over the neck, shoulders and back, hip. All these skin signs were lacking in our patients. In Dermatomyositis as compared to other inflammatory myopathies there is also increased incidence of malignant conditions like ovarian cancer, breast cancer, melanoma, colon cancer, and non-Hodgkin lymphoma. Muscle biopsy findings which can be diagnostic are perivascular and perimysial inflammatory infilterate, perifascicular atrophy (hall mark) and microangiopathy.

Conclusion: In absence of characteristic rash and muscle weakness, a high reservation is needed for patients presenting as monoparesis for early diagnosis and management of dermatomyositis.

Abstract ID 715: A Rare Case of Callosal Tuberculoma with Bilateral Tubercular Optic Neuritis

Ratna Bhustali, Abdul Qavi

Dr Ram Manohar Lohia Institute ofMedical Sciences, Lucknow, Uttar Pradesh, India

Background and aim: Tuberculosis of Central Nervous system (CNS) results from hematogenous dissemination of Mycobacterium tuberculosis. Intracranial manifestations of Tuberculosis are wide and can affect different anatomic sites – meningeal/parenchymal. It can cause meningitis, tuberculoma, tuberculous abscess, focal cerebritis, vasculitis and strokes. Tuberculomas are the 2nd most common manifestation of CNS tuberculosis. Within the CNS, they can occur at various sites, including the cerebral hemispheres, basal ganglia, cerebellum, and brainstem. Spinal cord tuberculomas can be intradural extramedullary or intramedullary, with the intradural extramedullary form being the most unusual. Corpus callosal Tuberculomas are very rare with only a handful cases reported in literature. We presented a rare case of Callosal Tuberculoma with Tubercular Optic Neuritis.

Methodology: A 25-year-old female presented with `fever and headache since 1 month, altered sensorium since 10 days. On admission, patient was drowsy, arousable. Patient was not following command, had reduced movements of right upper and lower limbs. She had b/l LR palsy. Fundus examination revealed papilledema.

Results: Cerebrospinal fluid (CSF) analysis revealed normal cell count with elevated protein, low glucose. Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) was positive. Magnetic resonance imaging (MRI) brain showed leptomeningeal enhancement with T2hyperintense lesion in body of Corpus Callosum. Ocular B scan revealed Bilateral papilledema with left > right optic neuritis. Patient was also evaluated with neuromyelitis optica (NMO) myelin oligodendrocyte glycoprotein (MOG) – found to be negative

Discussion: Patient was started on 1st line antitubercular treatment (ATT), Steroids and Antiplatelets along with supportive care. Patient condition gradually improved. Patient was then started on rehabilitative therapy. On follow up after 2 weeks, patient again developed worsening of symptoms in the form of irrelevant talking, b/l LR palsy + B/l upgaze restriction. Patient was started on pulse steroids considering paradoxical reaction. Patient condition gradually improved. Patient was started on rehabilitative therapy and discharged.

Conclusion: Patient presented with history suggestive of Chronic meningitis. MRI Brain revealed Callosal Tuberculoma, B scan showed Bilateral Optic neuritis which is a rare manifestation of CNS Tuberculosis.

Abstract ID 716: Transient Quadriplegia in Craniovertebral Junction Anomaly

M Reddy

Thanjavur Medical College, Thanjavur, Tamil Nadu, India

Background and aim: The severity of spinal cord injury can range from transient to permanent injury. On this spectrum, the least severe injury is known as neuropraxia, which is defined as a transient loss of motor or sensory function that can last from less than 15 mins to 48 hours. This is a case of 32-years-old female presented with transient quadriplegia which recovered in 24 hours.

Methodology: Observational study.

Results: This is a case of craniovertebral junction anomaly presented with transient quadriplegia which recovered in 24 hours.

Discussion: The pathophysiology of transient quadriplegia involves a non-neutral cervical position in addition to an axial force. It is theorized that the compression causes a prolonged depolarization of the neural tissue, thus inhibiting further action potentials. Patients at risk for transient quadriplegia are those with a smaller ratio of spinal cord to vertebral body diameter. In patients, who presented to the emergency department with transient quadriplegia, they do not commonly experience neck pain and loss of cervical range of motion around the time of injury.

Conclusion: When this patient population presents to the emergency department, appropriate assessment, clinical decision making, and imaging is of great importance to reduce prolonged disability. In the case discussed, the patient recovered within 24 hours of onset of quadriplegia in which magnetic resonance imagig (MRI) showed craniovertebral junction anomaly.

Abstract ID 717: An Interesting Atypical Presentation of PRES (Posterior Reversible Encephalopathy Syndrome)

Arya Satheesh

Thanjavur Medical College, Thanjavur, Tamil Nadu, India

Background and aim: Primi came for safe confinement with no known comorbidities, developed generalised tonic clonic seizures with hypertension, patient taken for emergency lower segment caesarean section (LSCS), postpartum 1 more episode of generalised tonic clonic seizures, intubated and was on mechanical ventilator outside and referred here. Patient was found to have right hemiplegia. Patient evaluated found to be atypical posterior reversible encephalopathy syndrome (PRES). Aim was to study atypical presentation of PRES.

Methodology: Computed tomography (CT) brain showed hypodense region with area of hemorrhage in right occipital lobe. Hemorrhage with surrounding edema of left gangliocapsular region causing squishing of left lateral ventricle extension of hemorrhage into ventricular system. Midline shift of 4 mm towards right. Patient started on MgSO₄ regimen and antihypertensives, antiedema, antiepileptics and other supportive care given. Patient gradually improved and was weaned off from ventilator, weakness improved and became symptomatically better.

Results: CT brain showed hypodense region with area of hemorrhage in right occipital lobe. hemorrhage with surrounding edema of left gangliocapsular region causing squishing of left lateral ventricle extension of hemorrhage into ventricular system. Midline shift of 4 mm towards right. Patient started on MgSO₄ regimen and antihypertensives, antiedema, antiepileptics and other supportive care given. Patient gradually improved and was weaned off from ventilator, weakness improved and became symptomatically better.

Discussion: CT findings were not typical of PRES and had improvement of symptoms with antihypertensives and antiedema measures.

Conclusion: PRES may not always have typical imaging findings of bilateral hypodensity in parietooccipital region but may present as bleed as well and if identified early could be reversible.

Abstract ID 718: Ornidazole-Induced Ataxia and Encephalopathy in an Indian Woman: A Case Report

Bharat Sharma

SP Medical College Bikaner, Rajasthan, India

Background and aim: Nitroimidazole derivatives such as metronidazole, tinidazole, and ornidazole are frequently used for treating protozoal and anaerobic bacterial infections. Though gastrointestinal side effects are common, neurological complications such as cerebellar ataxia and encephalopathy are rare. Ornidazole, due to its longer half-life, poses a risk of neurotoxicity when used for extended durations.

Methodology: A 44-year-old woman presented with a one-month history of progressive walking difficulty. Neurological examination revealed resting tremors, dysarthria, dysdiadochokinesia, gait ataxia and abnormal behaviour like irrelevant talks. There was no cranial nerve involvement or reflex abnormality. Routine labs and systemic evaluations were unremarkable. Brain magnetic resonance imagig (MRI) revealed symmetrical T2/FLAIR hyperintensities in the bilateral dentate nuclei, suggesting drug-induced encephalopathy. On detailed history, the patient was found to be self-medicating with ornidazole for four months.

Results: Ornidazole was discontinued immediately. She was treated with supportive care, Trihexyphenidyl 2 mg, and physiotherapy. Significant clinical improvement was observed within 7 days. A follow-up MRI after 15 days showed complete resolution of cerebellar lesions.

Discussion: This case illustrates a rare but reversible neurotoxic effect of prolonged ornidazole use. The dentate nucleus—implicated in cerebellar control of movement and tremor regulation—was prominently involved. Previous literature reports metronidazole-related MRI changes in dentate nuclei, midbrain, pons, corpus callosum, and basal ganglia. Similar findings are now seen with ornidazole toxicity. These changes are typically reversible upon drug cessation, and the recovery timeline can vary.

Conclusion: Ornidazole can cause reversible cerebellar toxicity, including ataxia and encephalopathy, especially when used for prolonged periods. MRI findings, particularly dentate nucleus hyperintensities, play a crucial role in diagnosis and follow-up. Early recognition and prompt cessation of the drug are vital to avoid irreversible neurological damage. This case emphasizes the importance of drug history in unexplained cerebellar syndromes.

Abstract ID 719: A Case of Metastatic Brachial Plexopathy

Manuprasad P

Thanjavur Medical College, Thanjavur, Tamil Nadu, India

Background and aim: Brachial plexopathy is a complex clinical entity causing motor and sensory impairments in upper limb which may be due to trauma, radiation, tumour etc. Metastatic brachial plexopathy (MBP) is a rare cause of upper limb dysfunction. This case report outlines the clinical presentation, diagnostic workup and management of a patient with MBP.

Methodology: A descriptive study with history, clinical examination, laboratory investigations and imaging and neurophysiological tests was done.

Results: Clinical history: A 60-year-old man with nil comorbidities, presented with pain and progressive weakness in right shoulder and upper limb for 15 days. Clinical examination revealed motor deficits predominantly in C5-T1 with weakness in right shoulder abduction, external rotation, finger flexion and abduction. Patchy loss of sensations over lateral arm, forearm and hand. Diminished biceps and supinator reflexes. Positive Tinel’s sign over supraclavicular fossa. Neurophysiological study revealed reduced compound muscle action potential (CMAP) in the median, ulnar, radial, musculocutaneous and suprascapular nerves with normal conduction velocity below elbow. Magnetic resonance imaging (MRI) showed edematous changes in the right neck and shoulder muscles without a focal enhancing lesion. Positron emission tomography (PET)-computed tomography (CT) showed fluorodeoxyglucose (FDG)-avid, diffuse enhancing mass in the intermuscular and intramuscular plane of the right cervical and upper arm regions consistent with metastatic infiltration. FDG-avid thickening in the cervical esophagus, omental nodularity and diffuse stomach wall thickening.

Discussion: MBP accounts for approximately 20-30% of brachial plexopathies and typically presents with severe pain, progressive weakness and sensory loss. Brachial plexus may be involved either by direct infiltration, hematogenous or lymphatic spread of tumour. Timely diagnosis and treatment are of utmost importance for patient survival. Management involves identifying the underlying malignancy, targeted or systemic chemotherapy, radiotherapy, and pain alleviation.

Conclusion: MBP is a rare but critical differential diagnosis in patients with progressive unilateral upper limb weakness and pain and may help in unmasking a hitherto undiagnosed malignancy. A prompt, multidisciplinary approach is essential for optimal management and symptom relief.

Abstract ID 720: Supranuclear Gaze Palsy in a Case of MOGAD – An Unusual Presentation

Shyam Mohan, Girish Kulkarni

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: We report a rare case of a 23-year-old woman with encephalopathy and vertical supranuclear gaze palsy, ultimately diagnosed as myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). To our knowledge, this is the first reported instance of supranuclear gaze pathway involvement.

Methodology: A 23-year-old woman presented with a one-month history of episodic memory disturbances, hypersomnolence, and visual hallucinations, followed by fever, decreased responsiveness, and catatonia. She was alert but mute, rigid, and akinetic, obeying commands non-verbally. Cranial nerve examination revealed restricted vertical gaze, especially downgaze, with preserved vestibulo-ocular reflex, indicating a supranuclear cause.

Results: Routine investigations-full hemogram, renal function test (RFT), liver function test (LFT), were normal. Cerebrospinal fluid (CSF) analysis revealed 20 cells with normal protein and glucose levels. Brain magnetic resonance imaging (MRI) revealed T2-FLAIR hyperintensities in the bilateral medial thalami, periaqueductal gray matter, and hypothalamus, diffusion restricting and contrast enhancing. Symmetrical hyperintensities were observed in the parieto-occipital regions. Serum testing for NMO-MOG antibodies was strongly positive for anti-MOG antibodies, while anti-aquaporin-4 antibodies were negative. CSF NMO-MOG was negative.

Discussion: Thalamic involvement in vertical gaze palsy arises from disruption of descending supranuclear fibers that originate in the frontal eye fields and pass through the medial thalamus en route to the midbrain. Lesions in the medial thalamus, even without direct midbrain involvement, can impair vertical gaze by interrupting these pathways. Studies, including those by Clark et al. and Gentilini et al., have reported vertical gaze palsy in patients with medial thalamic infarcts. In our case, a similar mechanism may explain the downgaze palsy, suggesting that MOGAD can affect supranuclear pathways via thalamic involvement, broadening its known clinical spectrum.

Conclusion: This case highlights an uncommon presentation of MOGAD with vertical supranuclear gaze palsy, broadening the range of clinical manifestations associated with the disorder. The involvement of the thalamus and its descending pathways appears to be a key factor in the development of vertical gaze dysfunction in MOGAD.

Abstract ID 721: When Clarity Emerges from Asymmetry: The Role of PASCOM and Interictal PET in a Case of Drug-Resistant Epilepsy

Pavni Agrawal, Balveen Singh

Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India

Background and aim: Epilepsy affects over 50 million people globally, with nearly one-third remaining drug-resistant despite optimal medical therapy. For these patients, identifying the epileptogenic zone is a key to offering a potential cure through surgery. However, when standard investigations yield discordant or inconclusive findings, the challenge deepens. We present the case of a 30-year-old man with drug-resistant epilepsy for 3 years, experiencing frequent disabling seizures. Routine magnetic resonance imaging (MRI) was non-lesional, and interictal electroencephalogram (EEG) showed seizures arising from the left frontotemporal region. Surprisingly, fluorodeoxyglucose (FDG)-positron emission tomography (PET) revealed hypometabolism in the right anterior temporal and frontal cortex — creating a significant clinicoradiological mismatch.

Methodology: In this situation, we employed PASCOM — PET Asymmetry after Anatomical Symmetrization Coregistered to MRI — an advanced imaging technique that amplifies subtle interhemispheric metabolic differences. It localized hyper metabolism (since PET was ictal) to the left mesial temporal region, aligning with EEG findings. The patient underwent ECOG-guided left amygdalohippocampectomy.

Results: Post-surgery, he has remained seizure-free for 3 months, with tapering of medications. Histopathology confirmed focal cortical dysplasia type IIb.

Discussion: This case highlights how PET, especially when coupled with PASCOM, can uncover hidden foci and resolve critical ambiguities in pre-surgical workup — transforming uncertain cases into surgical candidates with real outcomes.

Conclusion: This case underscores the pivotal role of advanced metabolic imaging, particularly PASCOM, in resolving clinicoradiological discordance during presurgical evaluation of drug-resistant epilepsy. By enhancing the interpretability of interictal PET through precise anatomical coregistration and asymmetry analysis, PASCOM enabled accurate localization of the epileptogenic zone, aligning metabolic findings with electrophysiological data. Such integrative approaches not only refine surgical candidacy but also expand treatment possibilities for patients with non-lesional or ambiguous imaging, ultimately improving clinical outcomes.

Abstract ID 722: Tetanus Mimicker

Parthasarathi Krishnan

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Movement disorders are usually a mimickers for more severe neurological presentations, whenever its presented one should suspect a central nervous system (CNS) infection. A 23-year-old male presented in casualty with intermittent muscle spasms, difficulty in walking, altered sensorium, trismus, drooling of saliva and risus sardonicus. Initially patient managed as a case of tetanus, resolution of spasms made suspicion of encephalitis as underlying cause of dystonia which mimicked tetanus. Blood investigation and cerebrospinal fluid (CSF) analysis were done. Magnetic resonance imaging (MRI) brain with contrast showed T2/FLAIR non enhancing hyperinsity in bilateral thalamic and right basal ganglia. Acute dystonia is a close mimicker of tetanus. Any patient presenting with new onset movement disorder should be investigated for CNS infection even though it has been reported as a rare cause for the same.

Methodology: A 23-years-old male came with chief complaints of fever-5 days, difficulty in walking-4 days, inability to open mouth, associated with drooling of saliva + for 2 days, history of altered sensorium+, history of renal tubular acidosis (RTA) 2 weeks back+, history of inability to get up from the bed+, history of neck weakness+. He is alcoholic and occationally had substance abuse. On examination, the patient was concious, oriented, multiple abrasions seen over b/l shoulder, knees, feet, face, b/l PERL+, TRISMUS+, drooling with pooling of saliva seentone was increased in all 4 limbs, reflexes-brisk, b/l plantar-flexor, patient was initially diagnosed as a case of genaralised tetanus/acute menigoencephalitis. Patient was treated with tetanus immunoglobulins , intravenous (IV) antibiotics including acyclovir, cefotaxime, vancomycin, metronidazole were given along with injection of diazepam. Blood investigations were normal, computed tomography (CT) CHEST-aspiration, CT BRAIN-no significant abnormality, MRI brain with contrast study showed T2/FLAIR non enhancing hyperinsity in bilateral thalamic and right basal ganglia, CSF viral panel came as JE positive, patient continued with IV antibiotics he is symptomatically improved and discharged.

Results: In this patient, MRI findings suggestive of encephalitis, CSF viral panel showed JE positive. Movement disorders are characterised by abnormal or excessive involuntary movements that result in abnormal or excessive involuntary movements that result in abnormalities in tone, posture or fine motor control.

Discussion: Movement disorders are characterised by abnormal or excessive involuntary movements that result in abnormal or excessive involuntary movements that result in abnormalities in tone, posture or fine motor control. Dystonia can occur due to static injury/structural disease of central nervous system: encephalitis, tumours, basal ganglia stroke, head trauma; metabolic disease: DOPA responsive dystonia, Wilsons disease; heriditary/neurodegenerative disorder: Retts syndrome, Niemann Pick disease; drugs/toxins, neuroleptics, antiemetics. Some of the well-defined presentations of acute dystonic reaction make it a close differential diagnosis of Tetanus. Buccolingual crisis (trismus, risus sardonicus, grimacing), torticollic crisis (abnormal head or neck position), torticopelvic crisis (abnormal contraction of abdominal wall and hip musculature), opisthotonic crisis.

Conclusion: Movement disorders are frequent mimickers of serious neurological presentations like seizures, tetanus, tetany. CNS infection should be strongly suspected in any case of acute onset movement disorder.

Abstract ID 723: Unusual Vascular Cause for Cavernous Sinus Syndrome

Kasi Rajan Selvaraj

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Cavernous sinus syndrome (CSS) involves any disease pathology involving the cavernous sinus - a dural sinus located in middle cranial fossa. The current poster emphasizes an important vascular etiology for CSS.

Methodology: This is a case presentation of a 48-years-old female patient who came to the Department of Neurology, Government Rajaji Hospital, Madurai with complaints of headache for 1 year and double vision for 11 month. Acute onset of severe incapacitating headache around left eye 1 year back which had decreased in severity to manageable level 1 month later. However, she developed double vision to far objects and on looking down 11 months back. This was associated with increased photophobia, reduced sensation over left forehead & cheeks and red proptotic eyes. Examination revealed patient to have V1, V2 sensory loss, proptosis with chemosis in left eye, parasympathetic failure in left eye causing anisokoria which was uncorrected by 0.1% pilocarpine, but overcorrected by 1% pilocarpine, with left lateral rectus and inferior oblique palsy. Thus, a diagnosis of cavernous sinus syndrome (involvement of V1, V2, IV, VI, Parasympathetic fibers to pupils) with proptosis and chemosis - possible a vascular cause was made.

Results: Computed tomography angiography (CTA) done revealed slow flow carotid-cavernous fistula. A definitive diagnosis was made as slow (Indirect) flow Carotid - cavernous fistula. Patient was counselled for intermittent left cervical carotid compression with right hand for several times a day. Since the patient did not improved, she was advised to attend Neurointerventional centre for definitive endovascular treatment.

Discussion: Carotid Cavernous Fistula (CCF) is an important diagnostic consideration in patients presenting with cavernous sinus syndrome and proptosis. Slow (Indirect) CCFs are indirect connection between dural branches of ICA or ECA with cavernous sinus. Fast (Direct) CCFs are direct connection between ICA and cavernous sinus.

Conclusion: Carotid - Cavernous fistula is an important vascular cause of CSS.

Abstract ID 724: Hirayama Disease: A Case Series Highlighting Phenotypic Spectrum and Diagnostic Challenges

Sreedeve M, Sekar D

Thanjavur Government Medical College, Thanjavur, Tamil Nadu, India

Background and aim: Hirayama disease is a rare, self-limiting cervical myelopathy predominantly affecting adolescent and young adult males. It typically presents as insidious-onset, asymmetric distal upper limb weakness with lower motor neuron features. However, the clinical spectrum can vary, posing diagnostic challenges. Objective of this study was to present a case series highlighting the varied clinical presentations and diagnostic considerations in Hirayama disease.

Methodology: We report three cases of young males aged 20–33 years who presented with progressive upper limb weakness. All underwent clinical, electrophysiological, and dynamic cervical magnetic resonance imaging (MRI) evaluations.

Results: Case 1: A 33-year-old male with chronic progressive bibrachial weakness, asymmetric sensory loss in a suspended pattern (C4–T1), and upper motor neuron (UMN) bladder features. MRI cervical spine with flexion revealed cord atrophy, anterior dural displacement, and epidural venous plexus enhancement—confirming bilateral Hirayama disease. Case 2: A 28-year-old male with isolated right upper limb distal lower motor neuron (LMN) weakness, without sensory/autonomic features. Clinical and electrophysiological findings were consistent with monomelic amyotrophy. Flexion MRI demonstrated typical Hirayama changes. Case 3: A 20-year-old male with sequential bilateral distal upper limb wasting and weakness, sparing brachioradialis, and claw hand deformities. Reflexes were brisk in the lower limbs with preserved sensation. Electrophysiology and dynamic MRI confirmed Hirayama disease.

Discussion: Hirayama disease may mimic amyotrophic lateral sclerosis (ALS) or compressive myelopathy but is distinguishable by its benign course, focal LMN signs, and dynamic MRI features. Early identification is vital to halt progression with conservative management.

Conclusion: This case series demonstrates the clinical heterogeneity of Hirayama disease—from classic monomelic amyotrophy to rare symmetric bilateral forms with autonomic signs. Dynamic cervical MRI remains essential for diagnosis and should be considered in young males with atypical LMN upper limb presentations.

Abstract ID 725: “The Quiet Cerebellum”: An Unusual Radiological Signature of Asymptomatic Cerebellar Involvement in a Diabetic Patient with Hypoglycemia

Sreedeve M, Sekar D

Thanjavur Government Medical College, Thanjavur, Tamil Nadu, India

Background and aim: Cerebellar abnormalities on magnetic resonance imaging (MRI) are commonly linked with overt signs like ataxia or dysarthria. However, in metabolic insults such as hypoglycemia, cerebellar involvement may be silent, especially in diabetic patients. Recognizing this atypical radiological presentation is critical to prevent misdiagnosis and guide metabolic correction.

Methodology: Case report

Results: A 56-year-old man, known hypertensive and diabetic (5 years, on dual OHA), presented with recurrent episodes of giddiness and palpitations for 3 months. He had no motor, sensory, or cerebellar deficits. Neurological examination was normal. Blood work including electrolytes, renal, and liver function were within normal limits. Inpatient monitoring revealed spontaneous hypoglycemia (capillary glucose <60 mg/dL). MRI brain showed asymmetric bilateral T2-FLAIR hyperintensity in the posteroinferior cerebellum (right > left), without diffusion restriction or contrast enhancement - suggesting a metabolic etiology, likely from repeated unrecognized hypoglycemia.

Discussion: This case highlights a rare radiological pattern of cerebellar involvement without clinical signs, likely due to subclinical hypoglycemia. Purkinje cells in the posterior cerebellum are highly glucose-dependent and prone to metabolic stress. Asymmetric FLAIR hyperintensity without diffusion restriction may represent reversible metabolic injury. The absence of systemic derangements and the presence of spontaneous hypoglycemia while on dual oral hypoglycemic agents (OHA) supports this diagnosis. Early radiological detection may precede clinical manifestation.

Conclusion: In diabetic patients with vague symptoms such as giddiness, incidental cerebellar MRI findings should raise suspicion for occult hypoglycemia. Early recognition and optimization of glycemic control are a key to preventing permanent cerebellar injury. This case underlines the value of imaging even in neurologically silent metabolic presentations.

Abstract ID 726: Crocodile Tears Syndrome After Guillain Barre Syndrome

Arvinder Kour

Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India

Background and aim: This review aimed to explore the association between Guillain Barre Syndrome (GBS) and Crocodile tear syndrome (CTS) through a focused literature search using PubMed, covering the years 1947–2024. Search terms included “Guillain-Barré Syndrome,” “Crocodile Tears Syndrome.

Methodology: Inclusion criteria were limited to case reports and series documenting CTS in the context of GBS, excluding cases arising from other etiologies or non-English language articles.

Results: All cases exhibited bilateral facial nerve involvement following Guillain Barre Syndrome, with onset of crocodile tear syndrome ranging from several weeks to months post-infection. Electrophysiological studies predominantly revealed demyelinating features, with absent blink reflexes and prolonged distal latencies. Despite immunomodulatory treatment, including Intravenous immunoglobulin, plasmapheresis, and corticosteroids, CTS symptoms showed no improvement across cases. The consistent bilateral nature and lack of response to treatment highlight the potential role of non-inflammatory sequelae like aberrant reinnervation in CTS pathogenesis post-GBS. The search yielded only three documented cases, and the authors’ own report constitutes the fourth.

Discussion: CTS, also known as Bogorad’s Syndrome, is a rare condition characterized by gustatory lacrimation—tear production during eating or salivation. It typically arises due to aberrant reinnervation following facial nerve injury, wherein secretomotor fibers destined for the salivary glands are misdirected to the lacrimal glands. Two primary mechanisms are proposed: aberrant regeneration and ephaptic transmission or “cross-talk.” These phenomena are particularly relevant in facial nerve pathologies where axonal proximity predisposes to such miswiring. While CTS has been more commonly described in traumatic or post-paralytic facial nerve injuries, its occurrence following GBS is infrequent and poorly characterized.

Conclusion: This review underscores the rarity and under-recognition of CTS as a post-GBS complication. Greater awareness and documentation are essential for understanding the neural mechanisms involved and for guiding future management strategies.

Abstract ID 727: Epileptic Clues to a Metabolic Mystery: Seizure as Presentation of Menkes Disease

Manuprasad P

Thanjavur Medical College, Thanjavur, Tamil Nadu, India

Background and aim: Seizures are one of the most common neurological symptoms that occur in infancy and childhood which is caused by abnormal and excessive discharges of neurons, usually self-limited, and often accompanied by abnormal behavior, and sensory-motor manifestations. Copper deficiency as occurs in Menkes disease is a rare cause of infantile epilepsy. Patients usually exhibit a severe clinical course with death in early childhood. Early diagnosis of Menkes disease is clinically very challenging because of the subtle clinical features and nonspecific biochemical markers.

Methodology: Clinical history, laboratory investigations, imaging studies and genetic study were conducted after obtaining informed written consent.

Results: A 7-months-old male child, 2nd born of NCM parentage, normal vaginal delivery, with no history of neonatal intensive care unit (NICU) admissions, mild developmental delay, presented with incessant cry for 3 days with occasional jerky movements of limbs. initial lab investigations, ultrasound (USG) abdomen were normal. Clinical examination revealed that the child had sparse curly hairs with discolouration and seborrheic dermatitis. Developmental milestones not attained for age. Tone increased, reflexes 2+ and plantar extensor. Magnetic resonance imaging (MRI) showed cerebral atrophy, leucomalacia, serum ceruloplasmin and copper levels decreased. Transcranial magnetic stimulation (TMS) showed a negative hair shaft analysis: normal whole-exome sequencing: ATP7A, exon 5 mutation.

Discussion: Early diagnosis of Menkes disease is clinically very challenging because of the subtle clinical features and nonspecific biochemical markers. The incidence of Menkes disease is close to 1 in 35,000 live male births. The underlying abnormality in copper metabolism is secondary to a mutation in the ATP7A gene located on Xq13.3, which has 23 exons. Developmental regression and seizures are usually the first to start around 2 to 3 months. The defective connective tissue formation also manifests as loose, wrinkled skin and kinky hair.

Conclusion: Menkes disease is a rare neurodegenerative condition caused due to copper deficiency and its first presentation may be just an incessant cry or subtle seizures.

Abstract ID 728: Understanding Stroke Imaging: Association Between CT ASPECTS and Infarct Core Volume in the Late Therapeutic Window

Poorvi Tangri, Bhoomika Arora, Awadh Kishor Pandit

All India Institute of Medical Sciences, New Delhi, India

Background and aim: The Alberta Stroke Program Early CT Score (ASPECTS) is a standardized method for identifying early ischemic changes on non-contrast computed tomography (CT) in acute ischemic stroke (AIS) and is commonly used for rapid assessment. This study investigated the relationship between CT ASPECTS and infarct core volume in patients presenting beyond the early treatment window, aiming to evaluate ASPECTS as a potential imaging surrogate for guiding late-window therapeutic decisions.

Methodology: A retrospective study was performed on 60 AIS patients who arrived outside the early therapeutic window. ASPECTS (scored from 0 to 10) were determined by neuroradiologists using established criteria. Core infarct volumes were quantified through automated perfusion imaging. Spearman’s correlation was used to assess associations between ASPECTS and both infarct core and penumbra volumes. Additionally, mean core volumes were analyzed across ASPECTS subgroups for visualization of distribution patterns.

Results: There was a moderate inverse correlation between ASPECTS and infarct core volume (Spearman’s ρ–0.40, p < 0.0013), indicating that higher ASPECTS scores are generally associated with smaller infarct cores. Patients with ASPECTS scores of 8–10 (n = 34) had mean core volumes ranging from 15–30 mL, while those with scores ≤4 exhibited mean volumes >90 mL. No significant correlation was observed between ASPECTS and penumbra volume ρ-0.0218, p < 0.864).

Discussion: CT ASPECTS scores show a modest but meaningful inverse relationship with core infarct volume in patients evaluated during the late window period, suggesting potential value for preliminary triage. However, the lack of association with penumbra volume underscores the importance of advanced multimodal imaging for comprehensive stroke assessment.

Conclusion: Larger, prospective studies are needed to confirm these observations.

Abstract ID 729: Intravenous Methylprednisolone in Diabetic Lumbosacral Plexopathy

Parvathy S, Haris A

Government Medical College, Kottayam, Kerala, India

Background and aim: To assess the improvement in pain score using Self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain score and Neuropathy Impairment Score in the Lower Limbs (NIS-LL) in diabetic lumbosacral radiculoplexus neuropathy (DLRPN) patients on iv methylprednisolone pulse therapy at the end of 3 and 6 months. To assess the changes in electrophysiology in DLRPN patients at the end of intravenous methylprednisolone pulse therapy.

Methodology: A prospective observational study in 30 c DLRPN patients with intravenous (IV) methylprednisolone pulse was conducted for 6 months. The primary outcome was the decrease in LANSS score, improvement in NIS-LL and improvement in electrophysiology study at the end of pulse therapy.

Results: At the time of admission the mean LANSS score as 18.03 with a standard deviation of 2.34. After 3 months of IV methyl prednisolone therapy, the mean LANSS score was 8.83 and at the end of 6 months it was 4.8. Improvement in LANSS score was significant by a p value of 0,001. The mean NIS score at time of admission was 27.1, which decreased to 20.57 at 3 months and 16.07 at the end of 6 months of IV methylprednisolone treatment. Electrophysiologically, there was decreased femoral compound muscle action potential (CMAP) in 48% of cases as well as decreased saphenous SNAP in 43% of cases in pretreatment period. Post treament elctrophysiology there was no significant improvement.

Discussion: DLRPN is found to be an immune mediated process. The use of IV methylprednisolone pulse therapy for 6 months has found to improve the NIS-LL score and the LANSS score. It improves the functional status of the patient. Electrophysiologically, there is no significant improvement pre and post study.

Conclusion: Pulse treatment with IV methylprednisolone in DLRPN patients can result in significant improvement in sensory symptoms, motor weakness and the functionality of patients. This helps in substantially decreasing the morbidity of the disease and improving quality of life.

Abstract ID 730: A Cross-Sectional Study to Estimate the Prevalence of Poor Outcome in Posterior Ischemic Stroke by 3 Months Using the Modified Rankin Scale

Abhishek Kandekar, Neha Mohite, Pranav Mehata

Bharati Vidyapeeth Medical College, Pune, Maharashtra, India

Background and aim: Posterior circulation ischemic strokes (PCIS) represent 20–25% of all ischemic strokes but are often under-recognized due to nonspecific presentations. This study aims to estimate the prevalence of poor functional outcomes (mRS >2) in patients with PCIS and identify demographic or clinical factors associated with poor recovery.

Methodology: This was a single-center, observational cross-sectional study conducted on patients diagnosed with PCIS. Inclusion criteria included adults >18 years with radiologically confirmed posterior circulation infarcts. The modified Rankin Scale (mRS) was used at the end of 3 months post-stroke to classify outcomes as good (mRS < 2) or poor (mRS >2). Data on age, sex, comorbidities, and imaging findings were analyzed.

Results: Out of 125 patients, 40 (32%) had poor outcomes. A higher proportion of poor outcomes was noted in patients over 60 years (p = 0.03) and males (p = 0.05). Comorbidities such as diabetes and hypertension were more common in the poor outcome group. Vertebrobasilar involvement correlated with worse prognosis.

Discussion: This study confirms that posterior circulation ischemic strokes (PCIS) result in substantial long-term disability, with nearly one-third of patients exhibiting poor functional outcomes (mRS > 2) at 3 months. Among the most significant predictors of poor recovery were advanced age, male sex, and a history of prior cerebrovascular events. Furthermore, infarctions involving the basilar artery—owing to their critical location—were consistently associated with more severe deficits and a markedly worse overall prognosis.

Conclusion: Posterior circulation ischemic strokes often lead to significant long-term disability. This study identifies multiple predictors of poor outcome. Identifying high-risk patients early allows for better targeting of rehabilitation and follow-up interventions, potentially improving long-term outcomes in this often under-recognized stroke subgroup.

Abstract ID 731: The Hidden Culprit: Pulmonary TB Complicating the Diagnosis and Treatment of Anti-SRP Immune Myopathy

Thuslim Banu K, P K Murugan, Venkateswaran K J, Chezhian D, Muthukumar J

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Immune-mediated necrotizing myopathy (IMNM) with anti-signal recognition particle (SRP) antibodies is a rare, severe inflammatory myopathy characterized by progressive proximal muscle weakness and high serum creatine kinase levels. Pulmonary tuberculosis (TB), a common infectious disease in endemic regions, has rarely been reported concurrently with IMNM. We aim to report a rare case of anti-SRP-positive IMNM coexisting with active pulmonary tuberculosis, highlighting diagnostic and therapeutic challenges.

Methodology: We present a case of a young female patient with an 8-month history of progressive proximal more than distal muscle weakness involving the neck and trunk. Initial treatment included intravenous (IV) corticosteroids followed by IV immunoglobulin (IVIG) and immunosuppressive therapy. As the patient did not show expected clinical improvement, further investigations revealed concurrent pulmonary tuberculosis, and anti-SRP antibody was positive. Anti-tubercular therapy (ATT) was initiated alongside ongoing IVIG therapy.

Results: Despite early IV steroid therapy, the patient showed minimal clinical improvement. Subsequent initiation of IVIG and immunosuppressants was complicated by the discovery of active pulmonary TB. ATT was promptly started. The patient is currently receiving monthly IVIG with a gradual clinical response noted. Muscle magnetic resonance imaging (MRI) taken showing necrotizing myopathy and serological testing revealed anti-SRP positivity, confirming the diagnosis of IMNM.

Discussion: This case illustrates the diagnostic complexity in patients presenting with progressive myopathy, particularly in TB-endemic regions. The coexistence of IMNM and active TB is exceedingly rare and raises considerations regarding immune dysregulation. Treatment of IMNM typically requires immunosuppression, which may worsen TB infection, posing a therapeutic dilemma. The patient’s partial response to IVIG without further immunosuppression during active TB highlights the need for individualized management strategies

Conclusion: Anti-SRP-positive IMNM can present with refractory muscle weakness and may coexist with infections such as pulmonary TB. This rare case underscores the importance of comprehensive infectious work-up before initiating immunosuppression and the potential for IVIG to serve as a bridging therapy in complex cases.

Abstract ID 732: A Cross Sectional and Analytical Study to Estimate the Prevalence of Large Vessel Occlusion in Anterior Circulation Acute Ischemic Stroke Using Rapid Arterial Occlusion Evaluation (Race Scale)

Raj Garad, Neha Mohite

Bharati Vidyapeeth Medical College, Pune, Maharashtra, India

Background and aim: Acute ischemic stroke (AIS), especially involving anterior circulation, is a leading cause of disability and death. Large vessel occlusion (LVO) strokes demand urgent identification for endovascular thrombectomy, which improves outcomes if performed early. The Rapid Arterial Occlusion Evaluation (RACE) scale, derived from National Insitute of Health Stroke Scale (NIHSS), enables rapid prehospital LVO detection. Despite global validation, its effectiveness in Indian populations remains unclear. This study evaluates the prevalence of anterior circulation LVO using RACE and compares its accuracy with the VAN score. Aim of this study was to estimate the prevalence of LVO in anterior circulation AIS using the RACE scale and compare its diagnostic performance with the VAN score.

Methodology: A 24-month cross-sectional study at Bharati Hospital included 105 patients with suspected anterior circulation AIS. RACE and VAN scores were assessed, followed by CT/MR angiography. Patients with posterior strokes, haemorrhage, or contrast contraindications were excluded. Diagnostic accuracy was evaluated using sensitivity, specificity, PPV, and NPV.

Results: The mean age was 59 years, with a male predominance (64.8%). The mean RACE score was 4.97 ± 1.88. LVO was confirmed in 84.8% of patients. The RACE scale had a sensitivity of 73.03%, specificity of 100%, PPV of 100%, and NPV of 39.93%, with an AUC of 0.905 (p < 0.001). The VAN score showed higher sensitivity (91.01%) but lower specificity (50%). Both tools demonstrated statistically significant associations with LVO (p < 0.0001), while sex, diabetes, and hypertension showed no significant correlation.

Discussion: The RACE scale demonstrated excellent specificity and strong predictive value for LVO, confirming its applicability in prehospital settings. Although VAN was more sensitive, its lower specificity may limit its standalone use.

Conclusion: The RACE scale is a reliable, practical tool for early LVO detection in anterior circulation AIS, supporting its integration into prehospital stroke triage protocols to expedite definitive care.

Abstract ID 733: Early Morning Seizures Unmasking a Rare Metabolic Disorder: A Case of Glycogen Storage Disease Type IXc with Novel PHKG2 Mutation

K Jeena Singha, P K Murugan, C Justin, S Elangovan

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Glycogen Storage Disease Type IX (GSD IX) is a rare metabolic disorder caused by deficiency of phosphorylase kinase, leading to impaired glycogen breakdown. GSD-IXc, a rare subtype, results from mutations in the PHKG2 gene affecting the liver. Clinical features include hepatomegaly, hypoglycemia, growth retardation, and, rarely, seizures. This case aims to highlight an unusual presentation of GSD-IXc with early morning seizures and a novel PHKG2 mutation.

Methodology: We report a 2-year-old male child, born to consanguineous parents, presenting with global developmental delay and recurrent generalized tonic-clonic seizures in the early morning hours over the past 4 months. Detailed history, clinical examination, biochemical investigations, neuroimaging, and genetic testing were performed.

Results: The child had normal perinatal history but showed delayed motor milestones, hypotonia, and hepatosplenomegaly. Seizures occurred consistently in the early morning, and one such episode in-hospital revealed documented hypoglycemia. Lab evaluation showed mild anemia and transaminitis. Given the constellation of hypoglycemia, organomegaly, and developmental delay, a metabolic disorder was suspected. Genetic analysis revealed a homozygous mutation in the PHKG2 gene, confirming GSD-IXc.

Discussion: GSD-IXc often presents subtly, leading to underdiagnosis. Seizures due to hypoglycemia, especially during early morning fasting periods, can be an important clue. The presence of hepatosplenomegaly and hypotonia further supports the diagnosis. Identification of a rare PHKG2 mutation in this case underscores the importance of molecular diagnostics in atypical presentations.

Conclusion: GSD-IXc should be considered in children with early morning seizures, growth delay, and hepatomegaly. Early recognition and genetic confirmation are vital for targeted management and genetic counselling.

Abstract ID 734: Peak Width of Skeletonized Mean Diffusivity as a Marker of White Matter Injury Predicts Cognition in Frontotemporal Dementia

Nithin Thanissery, Faheem Arshad, Sunil Khokhar, Vikram Singh, Sarath Govindaraj, Subasree Ramakrishnan, Jitender Saini, Sheelakumari Raghavan¹, Prashanthi Vemuri¹, Suvarna Alladi

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India, ¹Mayo Clinic, Rochester, USA

Background and aim: Advances in diffusion-weighted magnetic resonance imaging (MRI) have proposed the peak width of skeletonized mean diffusivity (PSMD) as a novel marker of white matter injury due to cerebral small-vessel disease (cSVD). Vascular contributions to neurodegenerative diseases especially Alzheimer’s disease are increasingly recognised. In the background of high vascular risk in India, the impact of cSVD on aging and other neurodegenerative diseases remains to be investigated. This study aims to understand the relationship between PSMD and cognition in ageing and frontotemporal dementia (FTD).

Methodology: Eighty cognitively normal (CN) individuals above the age of 40 years and fifty FTD patients were included. ACE– III was administered to evaluate global cognition, attention, memory, fluency, language and visuospatial abilities. Diffusion MRI was acquired using a standard protocol on a 3T SIEMENS Skyra scanner. Tract-based spatial statistics on FSL was used to process the images.

Results: PSMD correlated positively with age in both CN (r = 0.499, p < 0.001) and FTD (r = 0.333, p = 0.018). FTD group had significantly higher PSMD values compared to CN (p < 0.001). Regression models revealed that, in FTD, PSMD predicted global cognition (R2 = 0.281, p < 0.001), attention (R2 = 0.226, p < 0.019), memory (R2 = 0.216, p = 0.028), fluency (R2 = 0.234, p = 0.006) and language (R2 = 0.333, p = 0.004) after controlling for age, gender and education.

Discussion: The study suggests that, with aging, the PSMD values increase in both groups. This could be due to white matter injury that can be attributed to an increase in cerebrovascular burden with age. An increase in PSMD values predicts cognitive changes in FTD patients, independent of age, gender and education. This supports the previous findings that PSMD can be a marker of white matter injury and cognitive decline in dementia.

Conclusion: Vascular contribution to cognitive decline and dementia is notably significant in India. PSMD could be a predictive marker of white matter injury secondary to cSVD, especially in the context of high burden of vascular risk in dementia.

Abstract ID 735: Onabotulinum Toxin A for Cricopharyngeal Dysfunction in Movement Disorders: A Double Blinded Randomized Trial

Sakoon Saggu, Rajendra Behera, Arunmozhimaran Elavarasi, Soumya Mohapatra, Roopa Rajan, Manjari Tripathi, Achal Srivastava, Rohit Bhatia, Deepti Vibha, Animesh Das, Divya MR, Divyani Garg, Rajesh Singh, Jasmine Parihar, Pramod Garg, Deepak Gunjan, Mritunjay Kumar

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Cricopharyngeal dysfunction (CPD), marked by impaired upper esophageal sphincter (UES) relaxation, is a common cause of pharyngo-esophageal dysphagia in neurological disorders, especially dystonia. It can lead to serious complications such as aspiration and malnutrition. Although botulinum toxin injections are used to treat CPD, their effectiveness remains uncertain due to a lack of controlled trials. The study aims to evaluate the improvement in swallowing function and related parameters, while also monitoring adverse effects such as worsening dysphagia and vocal cord palsy, in patients receiving Botox compared to those receiving a placebo.

Methodology: Patients with CPD-related dysphagia were enrolled and randomized to receive either 50 units of onabotulinum toxin A or saline via endoscopic four-quadrant injection. Assessments included self-reported swallowing improvement, standardized biscuit-swallowing time, flexible endoscopic evaluation of swallowing (FEES), and video fluoroscopy. All assessors and participants were blinded to treatment allocation.

Results: At 3-week follow-up, 27.3% showed moderate improvement, 9% showed significant improvement, 18.2% had minimal improvement, and 45.5% had no meaningful change in swallowing function. Improvements were assessed through self-report and biscuit swallowing time. No adverse events were reported.

Discussion: Early improvement in some patients suggests potential treatment effect. The absence of adverse effects supports procedural safety. Baseline data highlight the utility of combining fluoroscopy and endoscopy, especially in patients with movement disorders, where standard assessments may be limited.

Conclusion: Onabotulinum toxin injections appears safe and effective for CPD-related dysphagia, especially in dystonia. Further analysis post-unblinding and a larger cohort will strengthen these findings and validate the novel assessment approach.

Abstract ID 736: Recurrent Seizures and Basal Ganglia Calcification Unmasking Hypoparathyroidism: A Case of Secondary Fahr’s Syndrome

Chiranjeevi Bonda, P K Murugan, R Kishore, C Justin, S Elangovan

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Fahr’s syndrome is a rare neurological condition characterized by bilateral calcification of the basal ganglia and other brain regions. It is often secondary to underlying metabolic or endocrine disorders such as hypoparathyroidism. This case highlights the importance of evaluating the etiology of seizures in adults, especially when associated with movement disorders or extrapyramidal signs.

Methodology: We report the case of a 53-year-old male, a known but unevaluated case of seizures, who was on long-term phenytoin therapy. The patient presented with recurrent generalized tonic-clonic seizures, carpopedal spasm, and clinical features of tetany. A non-contrast computed tomography (NCCT) of the brain was performed, revealing bilateral basal ganglia calcifications. Further biochemical evaluation was done to identify the underlying cause.

Results: Serum investigations revealed hypocalcemia, hyperphosphatemia, and low intact parathyroid hormone (iPTH) levels, confirming the diagnosis of primary hypoparathyroidism. The neuroimaging findings were consistent with Fahr’s syndrome. The patient was managed with intravenous calcium gluconate, oral calcium supplements, and activated vitamin D analogs. Antiepileptic therapy was optimized. A diagnosis of secondary Fahr’s syndrome due to hypoparathyroidism was made.

Discussion: Basal ganglia calcification can result from various causes, including genetic and metabolic disorders. Hypoparathyroidism is one of the most common metabolic causes of Fahr’s syndrome and can present with seizures, tetany, and neuromuscular irritability. Long-term phenytoin use can exacerbate hypocalcemia by inducing hepatic metabolism of vitamin D, contributing to the clinical presentation.

Conclusion: This case emphasizes the need for thorough evaluation of seizure disorders in adults, especially when accompanied by signs of electrolyte imbalance. Recognition of secondary causes of Fahr’s syndrome such as hypoparathyroidism can lead to targeted therapy and improved patient outcomes.

Abstract ID 737: Cerebrotendinous Xanthomatosis: A Rare Etiology of “Hot-Cross Bun “ Sign

Challarapu Renuka, C Sreenivasulu

Kurnool Medical College, Kurnool, Andhra Pradesh, India

Background and aim: Cerebrotendinous Xanthomatosis (CTX, #OMIM 213700) is a rare lipid storage disorder. Although an autosomal recessive condition due to CYP27A1 mutations, it is treatable. The CYP27A1 encodes the mitochondrial enzyme sterol 27 hydroxylase, which enables bile acid synthesis. A deficiency/absence of sterol 27 hydroxylase reduces cholic and chenodeoxycholic acid levels. Consequently, cholesterol is not converted to bile acid, but to cholestanol and bile alcohol. Here, we report case of a 26-year-old female presenting with chronic diarrhea with onset at the age of 3 years. At 22 years, she was operated for bilateral cataracts. Subsequently, she complained of insidious, progressive gait ataxia from the age of 24 years, accompanied by cognitive impairment. She had bilateral pseudophakia. Tendon xanthomas were observed over bilateral Achilles tendon. She had distal lower limb wasting with pes cavus. Cerebellar signs were prominent.

Methodology: Bone Mineral Density showed osteoporosis, while Nerve conduction study showed sensorimotor demyelination with secondary axonal changes. Magnetic resonance imaging (MRI) brain showed striking T2 hyperintensity and blooming of dentate nuclei with a pontine hot-cross bun and enlarged Virchow Robin Space.

Results: CXT with Hot-Cross Bun sign.

Discussion: Radiological features in CTX are characteristic and include symmetric T2-weighted dentate nucleus hyperintensities, white matter involvement, and cerebellar and cerebral atrophy, seen in up to 84% of patients. Periventricular white matter, posterior limbs of internal capsule, cerebral peduncles, anterior pons, inferior olive, and the cerebellar white matter may also be involved. A spinal form of CTX, involving the central and posterior cord, has also been reported. The radiological differentials of CTX include Marinesco–Sjogren syndrome; however, tendon xanthomas are not seen. The other differential is myotonic dystrophy type 1, in which muscle weakness is prominent.

Conclusion: This case highlights a rare presentation of Hot Cross Bun sign in CXT patient manifesting with diarrhea, progressive ataxia and cognitive impairment.

Abstract ID 738: Epstein-Barr Virus Load in Primary CNS Lymphoma Patients: A Potential Diagnostic Biomarker

Sofia Singh, Aastha Takkar, Vivek Lal, Ranjana Minz

Post Graduate Institute of Medical Education and Research, Chandigarh, India

Background and aim: Primary central nervous system lymphoma (PCNSL) is a rare and aggressive form of non-Hodgkin lymphoma confined to the brain, spinal cord, leptomeninges, or eyes. Epstein-Barr Virus (EBV) has been implicated in the pathogenesis of PCNSL, particularly among immunocompromised individuals, but its role in immunocompetent patients remains under investigation. This study aims to evaluate the association of EBV with PCNSL by quantifying EBV viral load in whole blood samples of patients using real-time quantitative PCR (qPCR).

Methodology: A cohort of 20 patients diagnosed with PCNSL was enrolled for this study. Whole blood samples were collected at diagnosis, and EBV DNA load was quantified using qPCR targeting EBV-specific genomic sequences. A threshold of detection was established to determine EBV positivity, and viral load was compared across the cohort.

Results: Out of the 20 PCNSL patients studied, EBV DNA was detected in the whole blood of 10 patients, indicating a positivity rate of 50%. These EBV-positive patients also exhibited a notably high viral load. The remaining 10 patients were negative for EBV DNA by qPCR.

Discussion: The detection of high EBV load in 50% of PCNSL cases suggests a possible etiological or contributory role of the virus in a subset of patients, potentially indicating different pathogenetic mechanisms or clinical subtypes. These findings support further investigation into EBV as a biomarker for diagnosis, prognosis, or therapeutic stratification in PCNSL.

Conclusion: This study demonstrates a significant association between EBV and PCNSL in 50% of analyzed cases. EBV viral load in whole blood, as assessed by real-time qPCR, may serve as a useful adjunct in understanding disease biology and guiding patient management strategies.

Abstract ID 739: Recurrent Stroke in a Young Male: An Unmasking of Takayasu Arteritis Treated with Thrombolysis and Mechanical Thrombectomy

Pratibha Gupta, Suryanarayana Sharma

Apollo Hospital, Banergatta Road, Bengaluru, Karnataka, India

Background and aim: Stroke in young adults is uncommon and often warrants investigation for unusual etiologies. Large vessel vasculitis, such as Takayasu arteritis, is a rare cause, particularly in young males. This case report aims to highlight the diagnostic challenges and therapeutic approaches in a young male presenting with recurrent ischemic stroke secondary to Takayasu arteritis and to demonstrate the role of acute interventions like thrombolysis and mechanical thrombectomy in such scenarios.

Methodology: A 28-year-old male presented with transient left-sided weakness and slurred speech. Detailed history revealed recurrent giddiness on neck flexion over six months. Clinical examination showed asymmetrical pulses and differential blood pressure between limbs. Imaging included Neuroimagaing and Angiography of head and neck vessels, and follow-up magnetic resonance imaging (MRI) after recurrence. Lab investigations included inflammatory markers (erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]) and a standard stroke workup. Management consisted of immunosuppressive therapy, antiplatelets, and IV thrombolysis and mechanical thrombectomy.

Results: Initial imaging revealed right parietal subcortical infarct, computed tomography (CT) angiography revealed concentric wall thickening of aortic arch and complete occlusion of bilateral common carotid artery (CCA), consistent with Takayasu arteritis. He responded well to steroids, immunomodulators and supportive care and was discharged with a modified Rankin Scale (mRS) of 0. A week later, he presented with acute left hemiplegia and National Institute of Health Stroke Scale (NIHSS)- 12. MRI showed new infarcts with right M1 occlusion. He underwent successful thrombolysis and mechanical thrombectomy, resulting in complete neurological recovery.

Discussion: Takayasu arteritis should be considered in young stroke patients with atypical vascular signs. Early recognition and immunosuppressive therapy are essential to prevent progression. In the event of acute stroke, timely use of thrombolysis and thrombectomy can lead to favorable outcomes, even in complex vascular pathologies like vasculitis.

Conclusion: This case underscores the need for high suspicion of large vessel vasculitis in young stroke patients. Prompt diagnosis and intervention, including immunosuppression and mechanical thrombectomy, are crucial for favorable neurological outcomes in Takayasu arteritis-related strokes.

Abstract ID 740: An Interesting Case of Progressive Quadriparesis with Polyneuritis Cranialis – The Hidden Face of Neurosarcoidosis

Pratibha Gupta, Suryanarayana Sharma

Apollo Hospital, Banergatta Road, Bengaluru, Karnataka, India

Background and aim: Sarcoidosis is a systemic granulomatous disease with protean neurological manifestations. Neurosarcoidosis, especially presenting with progressive quadriparesis and cranial neuropathies, is rare and often underdiagnosed, particularly in patients with comorbid conditions like diabetes mellitus. This case highlights the diagnostic complexity and importance of timely tissue diagnosis in a patient with atypical neurological symptoms.

Methodology: A 39-year-old woman with uncontrolled diabetes presented with a six-month history of progressive neurological symptoms: bilateral eye redness, low-grade fever, painful paresthesias, and lower limb weakness evolving to quadriparesis, dysphagia, postural instability, and cranial nerve deficits. A detailed neurological exam, imaging, neurophysiology, blood tests (including ACE levels), cerebrospinal fluid (CSF) analysis, positron emission tomography (PET)-computed tomography (CT), and eventually lymph node and peripheral nerve biopsies were performed to establish a diagnosis.

Results: Neurological findings included dysarthria, left lower motor neuron (LMN) facial palsy, hypotonia, distal muscle wasting (power 3/5), hyporeflexia, and sensory loss with allodynia. Nerve conduction studies (NCS) suggested sensory-motor axonal neuropathy; CSF was normal. Magneti resonance imaging (MRI) brain/spine showed focal pontine hyperintensity. PET-CT revealed metabolically active hilar lymphadenopathy and systemic nodes. Elevated ACE levels and tissue biopsies confirmed granulomatous inflammation consistent with sarcoidosis. Cardiac involvement was evident with an ejection fraction of 44% and global hypokinesia. With early accurate diagnosis and treatment, after 6 months patient is able to walk independently with no bulbar weakness.

Discussion: This case illustrates a rare presentation of systemic sarcoidosis with extensive peripheral and cranial nerve involvement, mimicking other neuroinflammatory or metabolic neuropathies. Diagnostic clarity required high clinical suspicion, exclusion of mimics, and confirmation via histopathology. The coexisting diabetes further complicated clinical interpretation.

Conclusion: Neurosarcoidosis should be considered in progressive neuropathies with systemic features. Early biopsy and multidisciplinary evaluation are a key for diagnosis and effective treatment. The patient showed significant recovery with immunosuppressive therapy and supportive care, highlighting the potential for functional improvement even in severe cases.

Abstract ID 741: The Role of Antiplatelet Therapy in the Prevention of Recurrent Ischemic Stroke- An Institutional Experience

Mathakala Aparna

Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India

Background and aim: This prospective, observational study included 60 patients with ischemic stroke from the Department of Neurosurgery. Patients were divided into two groups: Group A (n = 30, aspirin 100 mg daily) and Group B (n = 30, aspirin 100 mg + clopidogrel 75 mg daily).

Methodology: This prospective, observational study included 60 patients with ischemic stroke from the Department of Neurosurgery. Patients were divided into two groups: Group A (n = 30, aspirin 100 mg daily) and Group B (n = 30, aspirin 100 mg + clopidogrel 75 mg daily). Follow-up assessments were conducted at 3, 6, and 12 months, measuring the occurrence of MACE (myocardial infarction, vascular death), hemorrhagic complications (intracranial and gastrointestinal bleeding), and mortality. Mean and standard deviation were calculated, and p- values were used to assess statistical significance.

Results: The incidence of myocardial infarction was 1.97 ± 1.30 in Group A and 2.27 ± 1.38 in Group B, with vascular death at 1.10 ± 0.84 and 0.80 ± 0.90, respectively. Gastrointestinal bleeding was slightly higher in Group B (1.67 ± 0.95) compared to Group A (1.57 ± 1.15). Intracranial bleeding rates were similar in both groups (1.07 ± 0.86 in Group A and 1.03 ± 0.89 in Group B). Mortality rates were 2.03 ± 1.33 in Group A and 1.97 ± 1.34 in Group B. No statistically significant difference was found between the groups for mortality or MACE outcomes (p > 0.05).

Discussion and conclusion: Both aspirin monotherapy and dual antiplatelet therapy are effective in preventing recurrent ischemic strokes. However, dual therapy slightly increased gastrointestinal bleeding without significantly reducing MACE or mortality. Clinicians should carefully weigh the benefits of dual therapy against the bleeding risk, particularly beyond 6 months of use. Personalized therapy and regular monitoring are recommended for high-risk patients.

Abstract ID 742: Myriad Manifestations in Neuroimmunological Diseases

Koushik Basu

Calcutta National Medical College Kolkata, West Bengal, India

Background and aim: Connective tissue disorders are multisystem with diverse neurological manifestations. The primary objective of this observational study is to explore connective tissue diseases presenting first with neurological manifestations.

Methodology: Sixteen cases with connective tissue disease which presented with neurological manifestations as first symptoms were evaluated was selected The connective tissue diseases were diagnosed based on clinical, haematological and biochemical criteria approved by ACR/EULAR (2019). The neurological manifestations were evaluated by standardized clinical, imaging and electrophysiological guidelines

Results: The cases diagnosed as SLE presented with combination of manifestations or with isolated symptoms/signs as optic neuritis, cranial neuropathy, Transverse myelitis and chronic inflammatory demyelinating polyneuropathy (CIDP). The cases diagnosed as sjogrens presented with ganglionopathy, ischemic stroke and cerebral venous sinus thrombosis. Those diagnosed as Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis presented with CIDP and ischemic stroke. Total cases were 16. Optic neuritis In SLE was 28.57%, cranial neuropathy was 28.57%, transverse myelitis was 42.86%, CIDP 28.57%, ischemic stroke was 14.29%. Ischemic stroke in sjogrens was 20%, cerebral venous sinus thrombosis 40%, ganglinopathy 60%. CIDP in ANCA associated vasculitis was 25%, and Ischemic stroke in 75% of cases.

Discussion: Optic neuritis (ON) occurs in about 1% of patients with SLE. Cranial neuropathy occurs in 2–7% of patients with SLE. It is an uncommon manifestation of SLE in the central nervous system (CNS). Transverse myelitis (TM) occurs in 1–2% of patients with SLE, which is 1,000 times more common than in the general population. Only 0.2% of SLE presented with CIDP. The pooled prevalence of peripheral neuropathy in Sjogrens is 15%. Cerebral Venous Sinus thrombosis is a very rare manifestation of Sjogrens Syndrome.

Conclusion: It is evident that connective tissue diseases can manifest as neurological symptoms even before it involves other systems. Therefore, thorough diagnostic work up regarding autoimmunity is required along with long follow up period.

Abstract ID 743: Serum CRP and Uric Acid Levels in Acute Ischemic Stroke

Rashmi Rajur

Manipal Hospital, Karnataka, India

Background and aim: Stroke is a leading cause of morbidity and mortality, ranking third in India after heart attack and cancer. It is largely preventable due to modifiable risk factors like hypertension, diabetes, and obesity. C-reactive protein (CRP) is a known marker for cardiovascular risk and contributes to atherosclerosis and endothelial dysfunction. Uric acid, though an antioxidant, is associated with increased stroke risk when elevated. High levels can promote oxidative stress, inflammation, vascular dysfunction, and platelet aggregation. It also raises inflammatory cytokines like CRP, interleukin (IL)-6, and tumor necrosis factor (TNF)-α. Understanding uric acid’s role in stroke is vital for targeted prevention and therapeutic strategies.

Methodology: Study Setting: The study was conducted within the Department of Neurology in private hospital in Mangalore; Study Design: This is a cross-sectional observational study; Study Participants: The study inlcuded all patients aged above 18 years who are admitted to the Department of Neurology with a diagnosis of stroke within 48 hours of symptom onset; Inclusion Criteria: Patients older than 18 years and diagnosed with ischemic stroke, with symptom onset less than 48 hours prior to admission; Exclusion Criteria: Patients were excluded if they have hemorrhagic stroke, are under 18 years of age, or have comorbidities associated with elevated uric acid levels, such as gout, renal failure, leukemia, lymphoma, or are on medications like diuretics, chemotherapeutic agents, nicotinic acid, ACE inhibitors, or other drugs that alter uric acid levels. Additionally, patients with conditions that cause elevated CRP levels, such as sepsis, rheumatoid arthritis, or other autoimmune disorders, were also excluded from the study.

Results: Serum CRP and uric acid levels are increased in acute ischemic stroke.

Discussion: The stroke is closely associated with systemic inflammation and these diseases have high level of CRP and Uric acid. Colchicine, a safe and frequently used anti-inflammatory drug that inhibits the inflammation was associated with vascular disease, creates a new paradigm in the prevention of atherosclerotic ischaemic stroke. This study will give information that the serum uric acid and CRP levels are increased in stroke and it supports the studies of colchicine in acute stoke that are going on.

Conclusion: This study highlights the significant role of serum uric acid and CRP in the pathophysiology of ischemic stroke. Elevated levels of uric acid and CRP are associated with increased oxidative stress, inflammation, endothelial dysfunction, and thrombotic activity, all of which contribute to stroke risk and severity. While uric acid has antioxidant properties at physiological levels, its elevation can have detrimental vascular effects. Therefore, assessing and managing serum uric acid and CRP levels in stroke patients may offer valuable insights for early risk stratification, targeted prevention, and improved therapeutic outcomes in ischemic stroke management.

Abstract ID 744: Paroxysmal Extreme Pain Disorder

Mounica Tavva, Ramesh R

Gandhi Medical College and Hospital, Secunderabad, Telangana, India

Background and aim: Paroxysmal Extreme Pain Disorder (PEXPD) formerly known as Familial Rectal Pain Syndrome, characterized by paroxysmal of skin redness, flushing & attack of severe pain in various parts of the body, usually lasting for seconds to minutes. The mutation refers to SCN9A gene encoding protein forming the Nav 1.7 Sodium channel in sympathetic ganglion Neuron.

Methodology: An 8-Years-old male child, born out of nonconsanguineous marriage, via cesarean birth in full term of gestation with NICU admission in view of neonatal jaundice, had infrequent breath holding spells from 1&1/2 month of age with normal developmental milestones & poor scholastic performance. From 5 years of age the child started quarrelling with peers, can’t sit at one place, talks repeatedly, other people then evaluated and diagnosed with Attention deficit hyperactivity disorder (ADHD) & started an atomoxetine & aripiprazole. At 8 years of age, presented with severe abdominal pain associated with inconsolable crying, restlessness, neck & ear pain with discoloration of half of tongue & increased sweating lasting for 10-15 mins not associated with loss of consciousness, vomiting, headache, Photophobia/phonophobia/weakness/numbness of limbs, NO TAC, with predominant nocturnal episodes.

Results: Child is microcephalic, 100% DQ, no neuro cutaneous Markers, normal routine blood investigation, electroencephalogram (EEG)-WNL, magnetic resonance imaging (MRI) brain- Normal study, ultrasound (USG) Abdomen:-Normal study, Genetic testing awaited.

Discussion: PEXPD is sodium channelopathy pain syndrome which is expressed in peripheral somatic visceral sensory nerves, nociceptors, DRG, trigeminal, ganglion. This is a rare case report presenting as pain syndrome with good response to sodium channel blockers.

Conclusion: Paroxysmal Extreme Pain Disorder is a rare disorder with less than 500 registered cases having a close differential with migraine, porphyria and few autonomic seizures each having varied line of management. Clinical suspicion and diagnosis of PXPD is helpful as it is treatable with sodium channel blockers

Abstract ID 746: Implications of Retinal Degeneration on ipRGCs and Cortical Circuitry

Anwesha Bhattacharyya, Kashish Parnami

Amity Institute of Neuropsychology and Neurosciences, Amity University, Noida, Uttar Pradesh, India

Background and aim: Retinal degeneration (RD) is the leading cause of blindness around the globe and patients suffering from inherited RD undergo loss of photoreceptors such as rods and cones. The progression of degeneration leads to abnormal morphological changes in the retina and the downstream cortical circuitry. The effects of RD on the fate of melanopsin positive intrinsically photosensitive retinal ganglion cells (ipRGCs) that regulate pupillary light reflex and act as autonomous photoreceptors is unclear. We investigated the effects of RD on the ipRGCs and the physiological alterations in the primary visual cortex.

Methodology: We performed immunohistochemistry to analyse the status of the ipRGCs by using antibodies which target specific cell population such as melanopsin, Brn3b and examining them under the confocal microscope for imaging and analysis. To determine the physiological alterations, we did in vivo electrophysiology from the primary visual cortex following monocular visual stimulation of mutant mice that mimics retinitis pigments, chemically induced RD model and compared them with wild type mice.

Results: We observed melanopsin expression in both ON and OFF layer of the ganglion cell layer with no observable changes in the average number of the overall population of the ipRGCs. There was a substantial decrease in the Brn3b positive cells in the ganglion cell layer of the retina in degenerated retina. The effect was more pronounced in the chemically induced model. Recordings from blind mice in V1 exhibited very low amplitude evoked potentials, decreases in the power at lower frequencies and elevated spiking.

Discussion: Our results show that ipRGCs are resistant to inherited and chemically induced photoreceptor degeneration. Decrease in Brn3b positive cells indicate alterations in pupillary light reflex but not circadian rhythm.

Conclusion: Our results demonstrate that RD spares the non- image forming functions by retaining the ipRGCs but affects visual processing in V1.

Abstract ID 747: Clinical, Radiological, CSF Characteristics and Response to Treatment in Autoimmune Encephalitis

Shruti Narsaria

Institute of Neurosciences, Kolkata, West Bengal, India

Background and aim: Autoimmune encephalitis is rare disease, in which the immune system of the body produces antibodies, against the antigen present in central nervous system (CNS) resulting in central nervous system damage. The clinical manifestations are varied and may present as seizures, cognitive dysfunction, altered sensorium, behavior disorders, autonomic nervous dysfunction, etc. We intent to study clinical features, cerebrospinal fluid (CSF), radiological findings and response to therapy of patients with Autoimmune Encephalitis.

Methodology: Case series of 6 patients with Autoimmune Encephalitis

Results: Out of six patients four were female. Most patients were between 67-79 years age except one female patient of 48 years age. Four out of 6 patients had 2nd episode of encephalitis with untreated first attack in 2 patients. None of the patients had movement disorder, seizure and extra-pyramidal symptoms. Most of the patients had complained of confusion, restlessness, lethargies and psychomotor slowing, irritability. Magnetic resonance imaging (MRI) was normal in 5 patients. one patient had MRI abnormality; she had ovarian teratoma. None of the other patient had any evidence of malignancy. CSF was reported normal in 3, out of 6 patients. Positron emission tomography (PET) scan was done in 4 out of 6 patients and all of them showed changes suggestive of autoimmune encephalitis. They received intravenous immunoglobulin (IVIg) or steroid or both. Three out of six patients showed 50% improvement, and 2 patients responded almost 90 percent within few days of treatment. 1 patient did not respond to treatment.

Discussion: Subacute onset cognitive decline, seizure, focal neurological deficit is considered presentation of autoimmune encephalitis, but it our study we did not find in any of the patients.

Conclusion: This case series highlights that acute delirious state lasting for few days to months is the most common presentation of Autoimmune Encephalitis. We should also think of autoimmune encephalitis in case of recurrent delirium especially in older patients.

Abstract ID 748: The Enigma of Holmes tremor- Unravelling the Story of 2 Patients

Biva Bhakat, Sandip Pal

Kolkata Medical College, Kolkata, West Bengal, India

Background and aim: Holmes tremor (HT) is an irregular, low-frequency postural tremor > rest tremor, predominantly unilateral and usually occurs in the upper limbs. Typically starts 4 weeks to 2 years after cerebral injury. The dopaminergic nigrostriatal system, dentate-rubro-olivary pathway, cerebello-thalamo-cortical pathway have been implicated. Different etiologies could be ischemic or hemorrhagic cerebrovascular accident (CVA), central nervous system (CNS) demyelination, tumour, and infection, etc. The understanding of the pathophysiology is of utmost important to develop a treatment plan tailored to individual patients. Herein, we discuss two cases of Holmes tremor with different etiology.

Methodology: Detailed clinical assessment, relevant investigations have been done, treatment initiated & followed up for a significant period.

Results: Case 1- The 39-years-old lady, known case of of brainstem glioma since January 2022, when she had diplopia and heaviness involving right side of the body, treated with external beam radiation therapy (EBRT) and temozolomide. From, January to February, 2024, she started experiencing progressive unsteadiness & right upper limb Holmes tremor. Magnetic resonance imaging (MRI) brain - new enhancing lesions in right middle cerebellar peduncle (MCP) and left posterior-inferior temporal lobe- radiation induced demyelination. Case 2- A 65–years-old male patient, known case of hypertension had left thalamic hemorrhagic stroke in December 2022 with complaints of persistent sensory symptoms and weakness on right hemibody, developed tremulousness on right side of body and unsteadiness since November, 2024. Examination showed Holmes tremor of right upper > lower limb. MRI brain- sequalae of left thalamic haemorrhagic stroke.

Discussion: Case 1 was treated with bevacizumab, steroid, levetiracetam and case 2 with THP & syndopa. Case 1 has remarkable improvement of HT but case 2 had no significant improvement.

Conclusion: Though HT is considered a refractory form of tremor, in reversible pathophysiological mechanism like demyelination, it responds to treatment whereas it is refractory in cases of thalamic stroke. DBS to be considered in refractory cases.

Abstract ID 749: MRI Spectrum of Neurodegeneration with Brain Iron Accumulation: A Case Series of Varied Clinical Phenotypes

Ramya Lavu, Sree Ranga Lakshmi G

Osmania Medical College, Hyderabad, Telangana, India

Background and aim: The term Neurodegeneration with Brain Iron Accumulation (NBIA) encompasses a heterogeneous group of inherited disorders characterized clinically by progressive extra pyramidal syndrome and pathologically by excessive iron deposition in brain, primarily affecting the basal ganglia (globus pallidus). They form an important differential diagnosis for the phenotype of global developmental delay in infancy/childhood to dystonia-parkinsonism or isolated parkinsonism at all ages and also for the isolated craniocervical dystonia of adult onset. This study aimed to illustrate the diverse clinical presentations and characteristic MRI findings in patients with NBIA.

Methodology: This is a retrospective descriptive case series of ten patients diagnosed with NBIA based on clinical evaluation and characteristic magnetic resonance imaging (MRI) findings. Detailed history, neurological examination, and MRI brain imaging and genetic testing were performed, results awaited.

Results: The cohort included patients aged 12 to 60 years, with male-to-female ratio of 1:1. Clinical presentations varied from behavioral abnormalities, psychiatric symptoms, and cognitive decline to extrapyramidal signs such as dystonia, bradykinesia, tremors, and ataxia. Six patients showed the pathognomonic “Eye-of-the-Tiger” sign on MRI. Three patients were from the same family, suggesting genetic inheritance. One asymptomatic with MRI findings supports pre-symptomatic detection. A patient with Kayser-Fleischer rings indicated overlapping features with Wilson disease, highlighting diagnostic complexity.

Discussion: The variability in age of onset, symptoms, and rate of progression highlights the broad clinical spectrum of NBIA. The “Eye-of-the-Tiger” sign on MRI remains a key diagnostic hallmark, especially in patients with atypical or overlapping features. The presence of familial clustering, consanguinity, and isolated MRI findings in asymptomatic individuals points to the importance of early imaging and genetic counselling in at-risk populations.

Conclusion: NBIA encompasses a spectrum of disorders with heterogeneous clinical phenotypes and characteristic MRI features. Early recognition and imaging play a crucial role in diagnosis. This case series emphasizes the diagnostic value of MRI in guiding clinical suspicion and enabling timely intervention and counselling.

Abstract ID 750: Association between HbA1c Levels and Stroke Subtypes: A Cross-Sectional Study

Vaddiparthi Navya

Osmania Medical College, Hyderabad, Telangana, India

Background and aim: Diabetes mellitus is a well-established risk factor for stroke. This study aimed to explore the relationship between HbA1c levels and different stroke subtypes.

Methodology: A cross-sectional study was conducted on 60 stroke patients at Osmania General Hospital, Hyderabad, between March and May 2025. Patients were selected from inpatient wards, and their history, clinical examination, blood sugar levels, HbA1c, lipid profiles, cardiac 2D echo, and neck vessel Doppler were analyzed.

Results: The study included 60 patients (34–90 years old), with 41.66% males and 58.33% females. Among them, 45% had known diabetes, 13.7% newly diagnosed, and 41.1% non-diabetic. Stroke subtypes included large vessel atherosclerosis (58.3%), small vessel disease (25%), hemorrhagic stroke (6.5%), transient ischemic attack (TIA) (5%), and cardioembolic stroke (5%). Lesions were in anterior circulation in 73.6% and posterior circulation in 26.4%. The mean HbA1c level was 7.4 ± 2.16%, with large vessel atherosclerotic disease showing the highest mean HbA1c (8.1 ± 2.54%), followed by small vessel disease (6.8 ± 1.5%), TIA (6.2 ± 0.96%), cardioembolic (6.1 ± 0.14%), and hemorrhagic (5.5 ± 0.60%) with a significant difference (p = 0.0472). Posterior circulation strokes had significantly higher admission glucose levels (206 ± 72.25 mg%) compared to anterior circulation strokes (154 ± 58.71 mg%) (p = 0.0096).

Discussion: Older studies link HbA1c to stroke severity, with FBS affecting initial stroke outcomes. HbA1c was significantly higher in ischemic strokes than hemorrhagic. Our study confirms this, showing large vessel atherosclerosis and posterior circulation strokes have higher HbA1c, reinforcing the need for strict glycemic control to reduce stroke risk.

Conclusion: Diabetes, both known and newly diagnosed, plays a major role in stroke risk, particularly large vessel disease. Patients with posterior circulation strokes exhibit higher admission glycemic levels, indicating that acute hyperglycemia may influence stroke location and severity. Effective management of diabetes is crucial in reducing stroke risk and improving patient outcomes.

Abstract ID 751: Mystery Behind Movements in Patients Admitted in a Tertiary Care Hospital

Allwyn A, Sethuram A, Kalpana P

Kanyakumari Government Medical College and Hospital, Tamil Nadu, India

Background and aim: Hemichorea is defined as continuous, irregular, and involuntary jerky movements on one side of the body due to infections, metabolic abnormalities, neurodegeneration, vascular diseases. Myorhythmia is defined as repetitive, rhythmic, slow (1-4 Hz) movement affecting cranial and limb muscles. In the limbs it may be oscillatory and jerky, whereas oculo-masticatory myorhythmia is a slow, repetitive, facial and ocular movement. Aim was to present cases of movement disorders due to various etiology and their management.

Methodology: Case series.

Results: 1) A 75-years-old male with involuntary movements involving oro-facial region diagnosed as Myorrhythmia due to whipple’s disease; 2) A 58-years-old female with involuntary movements involving left upper and lower limb diagnosed as Left hemichorea due to hyperglycemia/right gangliocapsular infarct; 3) A 85-years-old male with involuntary movements involving right upper and lower limb diagnosed as right hemichorea due to hypoglycemia.

Discussion: A 75-years-old male came with involuntary movements involving oro-facial region for 6 months. Examination revealed rhythmic myoclonus or spasm occurring in synchronous bursts mainly jaw and face. Upper gastrointestinal endoscopy with D2 biopsy was done. With Periodic Acid Schiff (PAS) staining showed chronic duodenitis suggestive of Whipple’s disease. He treated with intravenous (IV) antibiotics and maintenance dose. A 58-years-old female came with complaints of involuntary movements involving left upper and lower limb for 1 week. On examination, Left hemichorea. Blood investigations showed non ketotic hyperglycemia. Magnetic resonance imaging (MRI) brain revealed acute infarct in right gangliocapsular region. Patient treated with antiplatelets, statins, VMT2 inhibitors, antipsychotic agents and blood sugars controlled. An 85-years-old male came with involuntary movements involving right upper and lower limb for 3 days. On examination, right hemichorea. Patient had hypoglycemia. Blood sugars corrected. MRI Brain revealed mild diffuse cerebral atrophy. Patient treated with VMT2 inhibitors, benzodiazepines. Movements were controlled in all three patients and under follow up.

Conclusion: All three cases had movement disorders due to etiologies like ischemic infarct, hyperglycemia, hypoglycemia, and infection. Identifying these movements, their etiologies and appropriate management at the earliest will decrease the morbidity of the patient.

Abstract ID 752: A Retrospective Study on Clinical Profile, Types of ALS, and Functional Outcomes of ALS Patients in a Tertiary Care Centre

Tallapally Aishwarya, Shreyashi Ganguly, Rashmi Devaraj, Divya Nagabushana, Mohan Channappanavar

Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India

Background and aim: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disorder affecting upper and lower motor neurons, leading to significant morbidity and mortality. Major objective of this study was to evaluate the clinical characteristics, subtype distribution, diagnostic findings, and functional outcomes of ALS patients over a 2.5-year period at a tertiary care center.

Methodology: This retrospective observational study included 49 ALS patients diagnosed between January 2023 and April 2025. Medical records were analyzed for demographics, clinical features, neurophysiological findings, imaging results, and diagnostic classification based on revised El Escorial and Gold Coast criteria. Functional outcomes were assessed using ALS Functional Rating Scale-Revised - Self-Entry (ALSFRS-R-SE) scores at baseline and follow-up.

Results: Of the 49 patients, 36 (73.5%) were male and 13 (26.5%) female; 53.1% were over 50 years. The most common initial symptom was limb weakness (85.7%), followed by bulbar involvement (44.9%), muscle wasting (46.9%), and limb fasciculations (44.9%). ALS subtypes included limb-onset (57.1%), limb-bulbar (20.4%), bulbar-onset (16.3%), pseudobulbar (6.1%), and ALS-FTD (2%). Neurophysiological studies showed a neurogenic pattern in 91.8%, with axonal neuropathy in 8.2%. MRI brain was normal in 85.7%, with ischemic changes in 10.2%, and frontotemporal atrophy in 2%. Cognitive deficits were rare, noted in only 2% of patients.

Discussion: Mean ALSFRS-R-SE scores declined from 40.5 at presentation to 31.3 at follow-up (mean duration: 18.2 months), indicating significant functional deterioration.

Conclusion: Limb-onset ALS is the most common presentation, predominantly affecting males over 50 years of age. Limb weakness and bulbar symptoms are frequent. Functional decline over time underscores the progressive nature of ALS and the need for timely diagnosis and intervention.

Abstract ID 753: Spectrum of Risk Factors, Clinical Presentation, Outcome in Patients With Large Vessel Occlusion Presenting with Acute Ischemic Stroke

Niladri Mandal

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Background and aim: Background- Accounting for up to 46% of acute ischemic stroke large vessel occlusions (LVOs) possess outsized clinical importance as they more than doubled the risk of death or dependence as compared to non LVOs in the pre endovascular era. Knowledge of the epidemiology, pathophysiology, natural history, clinical presentation, time gap of presentation, and diagnosis of LVO is crucial to understand the recent paradigm shift of the treatment. Aim of this study included Identify the time gap of symptoms onset to diagnosis of stroke/transient ischemic attach (TIA) at primary physician level or first contact at PHC and diagnosis of LVO, and Identifying risk factors, clinical features, demographic profiles, treatment received at primary and tertiary care hospital.

Methodology: Patients will be included from BIN ward, Stroke clinic, RDHH, HASU from Januray, 2025 to January, 2026.

Results: Twenty-five percentage above 60 years of age, and rest 3 (75%) are 50-60 years, 2 are diabetic (50%), 3 are hypertensive (75%), all are smoker, alcoholic or both (100%), 2 had cardiac comorbidity, (one atrial fibrillation [AF], one Post coronary artery bypass grafting [CABG]). Two patients (50%) presented within golden period directly in SSKM. Hundred percentage presented with hemiparesis, 25% with aphasia, 25% with altered sensorium, 50% diagnosed in PHC and other tertiary care hospitals, respectively. Fifty percentage had left M1 occlusion, 25% had left internal carotid artery (ICA) occlusion, 25% had right M2 occlusion, and 25% thrombolysis. National Institute of Health Stroke Scale (NIHSS) score of more than18 was noted in 2 patients. After 2 weeks, NIHSS <10 of 2 patients (100% with thromboysis) as well as improvement of modified Rankin Scale (mRS).

Discussion: Study showed most patients are elderly, diabetic or hypertensive. Addiction to the smoking or alcoholism possesses major factors in stroke. Patients diagnosed with early and got early revascularisation, prognosis was good. Anticoagulation in patient of AF also improves NIHSS and MRS.

Conclusion: From the present, study we found NIHSS at day 0 and during follow up. Significant correlation between diabetes, hypertension, addiction and LVO. Significant correlation between outcome and time gap of presentation. Other than motor deficits, cortical symptoms are also important clue for LVO.

Abstract ID 754: Quadriparesis Beyond the Usual: A Comparative Case Series of Five Distinct Etiologies

Sreedeve M, Balamurali K

Thanjavur Government Medical College, Thanjavur, Tamil Nadu, India

Background and aim: Acute flaccid paralysis (AFP) is a neurologic emergency presenting as rapid-onset weakness with reduced tone and reflexes. Though Guillain–Barré Syndrome (GBS) is the most common cause, other neuropathic, myopathic, and systemic inflammatory conditions may mimic its presentation. Early differentiation is essential to avoid delays in appropriate therapy. This case series highlights five distinct causes of AFP initially resembling GBS.

Methodology: Five patients presenting with acute quadriparesis were evaluated for age, sex, clinical pattern, MRC grading at admission, nerve conduction studies (NCS) findings, ventilator requirement, and recovery. Diagnostic workup included neuroimaging, cerebrospinal fluid (CSF) analysis, serology, and histopathology where indicated.

Results: Case 1: A 56-year-old male with antecedent cough had bulbar-onset quadriparesis (medical research council [MRC] score of 2–3). NCS showed demyelination; CSF revealed albuminocytologic dissociation. Later diagnosed with inflammatory bowel disease; partial recovery after IVIG and immunosuppression. Case 2: A 45-year-old female developed fulminant GBS (MRC 1–2), ventilated within 12 hours, and became unresponsive with absent brainstem reflexes. Despite supportive care, she died on day 4. Case 3: A 17-year-old male with prior diarrhea improved after intravenous immunoglobulin (IVIG) but relapsed with cranial involvement. Diagnosed as acute-onset chronic inflammatory demyelinating polyneuropathy (CIDP); improved after steroids and plasma exchange. Case 4: A 40-year-old female with prior acute inflammatory demyelinating polyneuropathy (AIDP) presented with recurrence. NCS showed demyelination; nodopathy suspected. Responded to rituximab and steroids. Case 5: A 30-year-old male misdiagnosed as GBS failed IVIG. Creatine phosphokinase (CPK) was elevated; later diagnosed with dermatomyositis and improved with steroids.

Discussion: These cases illustrate varied etiologies of AFP mimicking GBS. Systemic diseases, nodopathies, CIDP, and myopathies must be considered in atypical or non-responsive cases

Conclusion: Acute quadriparesis warrants broad differential diagnosis beyond GBS. Clinical vigilance, electrophysiology, and systemic evaluation guide accurate diagnosis and therapy

Abstract ID 755: Status Epilepticus Secondary to Hypocalcemia due to Hypoparathyroidism

Anand Vardhan, Deepika Joshi, Anand Kumar, Niraj Srivastava

Banaras Hindu University, Varanasi, Uttar Pradesh, India

Background and aim: Clinical presentation of hypoparathyroidism also varies depending on the duration of hypocalcemia. Muscular cramps, tetany, numbness, cardiac arrhythmias, altered behavior, and seizures are usually acute manifestations, and cataracts, basal ganglia calcifications, dilated cardiomyopathy, dementia, and cerebellar dysfunction are chronic manifestations.

Methodology: We present a case of an 11-years-old child presented with status epilepticus thought to be epilepsy.

Results: On detailed investigations, later diagnosed as hypocalcemia due to hypoparathyroidism.

Discussion: Seizures due to idiopathic hypoparathyroidism are often misdiagnosed as epilepsy. Magnetic resonance imaging (MRI) brain for this misdiagnosed epilepsy suggests intracranial calcification which increases suspicion of hypoparathyroidism. Idiopathic hypoparathyroidism needs to be kept as a differential diagnosis of intractable generalized, tonic-clonic seizures.

Conclusion: Primary care physicians and family physicians should keep a differential as hypocalcemic seizures whenever they face refractory seizures, not responding to antiepileptic drugs.

Abstract ID 756: Attitude and Practices of Health care Providers on Advance Care Planning in Parkinsons Disease and Other Neurodegenerative Diseases

Pavit Singh, Parvathy K N

All India Institute of Medical Sciences, New Delhi, India

Background and aim: There is very little uptake, awareness and implementation regarding advance care planning (ACP) for neurodegenerative conditions in India and the reasons are unknown. This study was to help in formulating modules and legal framework for ACP. Aim of this study was to assess the Attitudes and Practice of physicians about ACP in Parkinsons disease (PD) and other neurodegenerative diseases.

Methodology: Cross-sectional prospective study with an online self-administered questionnaire, circulated by WhatsApp and Mail since the past month, as Google form and filled by Physicians working in India, after informed consent. The result of each question was analysed (by the authors) based on the de-identified data using number of responses obtained, individually. Fifteen in depth interviews were conducted with willing participants over a video call, recorded after taking consent for thematic analysis.

Results: The quantitative analysis revealed that 32% respondents were residents and 43% were neurologists, and 59% had received a formal training in ACP and neuro palliative care (PC). Ninety-three and seven tenth percentage of the participants agreed that ACP is necessary while treating PD and other neurodegenerative diseases, while 65.7% felt insufficient resources to provide ACP. Fifty-five and six tenth percentage believed ACP should be introduced at diagnosis, while 25.4% felt it should be started when needing support for ADL. Fifty-two four tenth percentage agreed that ACP be initiated by the primary treating neurologists, but 69.8% felt paucity of time and only 33% were comfortable with these discussions. The major themes in the qualitative analysis revealed the major barriers as time constraints, patient denial and socioeconomic status. There was also a major gap in understanding of the term ACP and confusion with advanced treatments.

Discussion: Most physicians were aware and felt the need for ACP but there were several barriers such as paucity of time, lack of awareness and inexperience in having these conversations.

Conclusion: There is a need for implementation research and development of modules and protocols to provide ACP

Abstract ID 757: Spectrum of CNS Tuberculosis: The Role of Clinicoradiological and Therapeutic Factors in Outcome Variability- A Prospective Observational Study in a Tertiary Care Centre In Eastern India

Swagata Sarkar, Alak Pandit, Souvik Dubey

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Background and aim: Central nervous system (CNS) tuberculosis is a severe form of extrapulmonary tuberculosis with diagnostic challenges. Advances in diagnostics and therapies, including novel drugs, offer hope for improved management. This study was aimed to identify and analyse the key factors influencing the variability in clinical outcomes of CNS tuberculosis by examining clinicoradiological features and therapeutic responses. Objectives included aassessing the impact of host-related variables (e.g., immune status, age, comorbidity), disease stage, type, extent of CNS involvement on treatment outcomes; analysing the dynamic changes in radiological pattern in different stage of disease and in response to therapy; analysing the role of treatment-related factors, including drug resistance, paradoxical reaction and adjunctive and emerging therapies.

Methodology: In this prospective observational study, subjects were enrolled from ward, OPD, Neuro Infectious Clinic from January 2025 to June 2026 and analysed with standardize scales. The study was approved by the institutional ethical committee and written inform consent was taken from the participants.

Results: Twelve Patients have been enrolled till now. Six patients have tuberculoma and meningitis in combination responding well with conventional ATD. Two patients of multiple CNS and spinal cord (SC) tuberculoma are not responding to anti-tuberculosis drugs (ATD) and steroid, are being planned for host directed Immunomodulators. Two patients of opticochiasmatic involvement have very poor response of in term of visual acuity. Two patients with tuberculous meningitis (TBM), hydrocephalus and massive infarct expired during treatment. Patients are under follow up.

Discussion: Twelve patients enrolled: 50% had tuberculoma with meningitis responding to conventional therapy; 16.67% showing poor response, 16.67% having visual decline and 16.66% had fatal infarcts. All remain under follow-up.

Conclusion: Spectrum of CNS tuberculosis have diverse manifestation due to area involved and paradoxical reaction. Effective management relies on careful clinicoradiological correlation and clinical judgement to determine personalized treatment strategy to improve outcome.

Abstract ID 758: A Study on Clinical Radiological Features and Treatment Responsiveness of NMO MOG Patients - Case Series

Manasa Voodi

Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

Background and aim: Neuromyelitis optica spectrum disorders (NMOSD) and MOG-encephalomyelitis (MOG-EM) are autoantibody mediated chronic inflammatory diseases. To describe various clinical, radiological features, number of relapses in seropositive central nervous system (CNS) demyelinating conditions and long-term treatment outcomes.

Methodology: A prospective case study conducted at neurology department in tertiary care hospital Visakhapatnam during years 2022 to 2025. All patients with clinical and radiological features suggestive of CNS demyelinating conditions were included and patients who were tested positive for NMO, MOG antibodies were analysed. Informed consent was obtained from all the study patients.

Results: Out of 24 patients, 15 patients were tested positive for NMO, MOG antibodies. Thirteen (87%) patients were MOG positive and 2 (13%) patients were NMO positive. Median age of presentation was 30 years. Majority were females 11 (73%). Prior fever seen in 5 (33%) patients. Different presentations include optic neuritis 5 (33%), cervical myelitis 4 (27%), dorsal cord involvement 5 (33%), cauda conus 3 (20%), brainstem, right middle cerebellar involvement 4 (27%), cerebral parenchyma 3 (20%), narcolepsy 1 (6.7%) and seizures 1 (6.7%). More than 1 attack seen in 5 (33%) patients. Pulse steroids were given in all patients. Azathioprine was given in 8 (53%) patients. Plasma exchange was done in 4 (27%) patients. Rituximab was given for one patient.

Discussion: Most common presentations were optic neuritis, acute transverse myelitis and brainstem syndrome. Recent fever triggered autoimmune condition in 33% patients. Recurrences were noticed in optic neuritis and cervical myelitis patient. Steroid responsiveness is seen in almost all patients. Antibody testing and magnetic resonance imaging (MRI) are main investigation modalities for accurate diagnosis of disease. Early initiation of immunosuppressive drugs reduced the number of relapses and long-term disability.

Conclusion: These conditions are frequently confounded with multiple sclerosis. Early and accurate diagnosis of these distinct conditions is required as they have different long term treatment modalities.

Abstract ID 759: An Etiological Analysis of Myelopathy in a Tertiary Care Hospital in Eastern India - A Cross-Sectional Observational Study

Aditya Ganguly, Sandip Pal, Pradip Sinha

Medical College, Kolkata, West Bengal, India

Background and aim: Myelopathy is a common problem in neurological practice that is difficult to treat and carries significant morbidity and mortality in clinical practice. We aimed to carry out a cross-sectional study to determine the etiological factors behind this common affliction in Eastern India.

Methodology: A sample size of 50 patients with myelopathy, who attended the outpatient department (OPD) and inpatient department (IPD) of The Deptartment of General Medicine, Medical College Kolkata, and met inclusion criteria and provided informed consent for the study underwent detailed clinical, laboratory and radiological evaluation to determine etiology. A detailed etiological analysis was then performed.

Results: There were 30 male and 20 female patients with ages ranging between 12-87 years in total. There were 41 cases of acute and 9 cases of chronic myelopathy. There were 29 compressive nontraumatic, 8 compressive traumatic, and 13 noncompressive myelopathies. Tumor was the commonest etiological subclassification, followed by infective and demyelinating etiologies. Trauma also formed a significant portion of cases.

Discussion: The present studies showed some interesting results like tumors being the commonest etiology and a significant portion of traumatic cases. This could be explained by various biasing factors. Rest of the findings were consistent with the findings of other workers in the field.

Conclusion: Tumors are the commonest etiology of myelopathy in clinical practice. Traumatic myelopathy also forms a significant portion of neurological practice. It is important to recognize these factors to provide expedited diagnosis and hence better outcomes for study patients.

Abstract ID 760: Unmasking the Silent Tumour: Paraganglioma Presenting as Collet Sicard syndrome

Nayana Bhuyan, Abhishek Pathak, Vijay Mishra

Banaras Hindu University, Varanasi, Uttar Pradesh, India

Background and aim: Collet–Sicard syndrome (CSS) is a very rare disorder caused by a skull base lesion with involvement of IX, X, XI, and XII cranial nerves. This case is a 55-years-old female, who presented with unilateral neck atrophy, horseness of voice, dysphagia and tonge atrophy.

Methodology: A 55-years-old female presented with insidious onset right-sided neck atrophy with history of progressive hoarseness of voice and dysphagia for one year. There was no significant past, family or personal history. On examination, Pulse -80/min, regular, BP-120/80 in right upper limb, Glasgow Coma Scale (GCS) was E4V5M6. Cranial nerve examination revealed absent gag reflex, right sternocleidomastoid atrophy and tonge atrophy.

Results: All routine blood examination was normal. Magnetic resonance imaging (MRI) brain was suggestive of a 2 x 2.4 x 2.9 cm lesion isointense on T1 and T2 and hyperintense on FLAIR with homogenous contrast enhancement causing obliteration of jugular foramen and encasing internal carotid artery and eroding petrous bone suggestive of right paraganglioma. Patient was operated and excised tumour was sent for biopsy which confirmed our diagnosis. Patient is doing well on follow up.

Discussion: CSS is a very rare condition caused by a lesion at the skullbase affecting the jugular foramen and hypoglossal canal or a lesion extending from the jugular foramen to the canal of the anterior occipital condyle, resulting in peripheral paralysis of glossopharyngeal, vagus, accessory, and hypoglossal nerves. CSS manifests as hoarseness of the voice, dysphagia, impairment of taste in the posterior third of the tongue or paralysis of the ipsilateral soft palate, and palsy and atrophy of the lingual, sternocleidomastoid, and trapezius muscles.

Conclusion: Primary intracranial tumors are an extremely rare cause of CSS In the present case, CSS was clearly defined as a lesion caused by a paraganglioma, a benign tumor in the jugular foramen region. Patients with such presentation should be promptly evaluated and treated.

Abstract ID 761: Neurological Complications in Varicella-A Case Series

Sumathi Punniaseelan, Shobana N, Selvakumar CJ

Coimbatore Medical College and Government Hospital, Tamil Nadu, India

Background and aim: Neurological complications are rare in acute varicella infection, observed in less than 1% of cases. Encephalitis and cerebellar ataxia are common neurological complications, whereas the unusual manifestations are Guillain-Barre (GB) syndrome, facial paralysis, transverse myelitis, aseptic meningitis, cerebral angitis, optic neuritis, meningoencephalitis, ventriculitis, and demyelination. Primary varicella zoster virus (VZV) infection can cause vascular thrombosis approximately 6 weeks after primary infection. Arterial and venous stroke are other complications seen in varicella. This study aimed to document the various neurological manifestations observed following acute varicella infection.

Methodology: It is an observational study on the patients who were admitted in neurology ward with neurological abnormalities following acute varicella infection.

Results: Case 1: A 26-years-old female with latency period of 4 days from rash presented with headache, vomiting. on examination, the patient was conscious/oriented, cranial nerves intact, power 5/5 all 4 limbs, DTR 2+ BL. Magnetic resonance imaging (MRI) brain was suggestive of venous haemorrhagic infarct left occipital lobe, magnetic resonance venography (MRV) suggestive of thrombosis of left transverse sinus and superior sagittal sinus. Haematological investigations normal. Dermatological opinion obtained -adviced calamine lotion and antihistamines. Treated with heparin, mannitol, antiviral drugs. Patient headache and vomiting improved. Case 2: A 35-years-old female presented 5 days from rash with acute onset weakness of both upper and lower limbs associated with paresthesias, swaying side by side. On examination, the patient was conscious/oriented power-UL 4-/5 LL 4-/5, DTR absent b/l, b/l plantar flexor. Joint position impaired. Finger-to-nose (FNT)-impaired b/l, gait and stance ataxia present. Nerve conduction studies (NCS) suggestive of bilateral upper limb and lower limb sensory and axonal neuropathy. Magnetic resonance imaging (MRI) brain with whole spine screening (WSS) suggestive of demyelination. Heamatological investigations were normal. Cerebrospinal fluid (CSF)-sugar-61, protein-216, cell count-acellular. Treated with injection of methyl prednisolone and intravenous immunoglobulin (IVIG) followed by tapering dose of oral steroids. Ataxia and weakness, paraesthesias improved.

Discussion: The damage to venous sinus and consequent cerebral venous sinus thrombosis (CVST) can be due to direct endothelial damage by virus, thrombosis secondary to acquired protein S deficiency, immunologically mediated vasculitis, and underlying hypercoagulable state. VZV can directly infect and damage oligodendrocytes the cells that produce myelin in the central nervous system. This direct damage can lead to demyelination.

Conclusion: Early anticoagulant administration has good prognosis in vasculopathy. Steroids and IVIG provide good results in demyelination in varicella related neurological complications.

Abstract ID 762: Comparison of Efficacy of oral Brivaracetam and Oxcarbazepine for Focal Onset Seizures in Children Aged 4-18 Years: A Single Blind, Randomized Controlled Trial (BOF-C Trial)

Prateek Panda, Indar Sharawat, Diksha Gupta, Swati Gupta

All India Institute of Medical Sciences, Rishikesh, Uttaraghand, India

Background and aim: Both risperidone and aripiprazole are efficacious in children with autism spectrum disorder in reducing severity of irritability. But head-to-head comparison trials between these two drugs are scarce in literature and also showed conflicting results.

Methodology: This single-blind randomized controlle trail (RCT) (CTRI/2021/12/038721) compared the efficacy and safety of risperidone and aripiprazole in children and adolescents with autism spectrum disorder (ASD) aged 6-18 years, in terms of change in the irritability subscale of Aberrant Behaviour Checklist, severity of autistic symptoms (CARS2), hyperactivity (CPRS-R), sleep problems (CSHQ), sensory processing issues (SP-2), cognition (MISIC) and nature/frequency of TEAEs. After a two-week placebo trial, participants who responded to the placebo were excluded, and those allocated to each arm were subjected to a standardized dose escalation regimen, titrated to clinical response, for 4 weeks, followed by an additional 8 weeks of drug administration.

Results: Seventy-two patients (36 in each group) were recruited. Change in ABC-I score (-13.6 ± 4.3 vs -12.2± 3.9, p-0.15), ABC total score (-27.5± 15.9 vs -26.8 ± 15.7, p-0.85), CARS score (-2.9± 0.7 vs -2.7 ± 0.8, p-0.26), CPRS-R Global Index T-score (-10.63 ± 8.54 vs -9.61 ± 8.92, p-0.62), number of patients with significant sensory processing abnormalities (18/36 vs 18/36, p = 1.0), CSHQ score (-4.6 ± 3.8 vs -3.9 ± 3.1, p-0.39) and full-scale IQ (1.9 ± 1.6 vs 1.8 ± 1.5, p-0.75) were comparable in both groups. In multivariate regression, CPRS-R Global Index T-score (p = 0.02) and full-scale IQ (p = 0.03) were independent predictors of change in ABC-I score. The frequency of adverse events was similar in both groups. While serum prolactin levels reduced in the aripiprazole group at 12 weeks, it increased in the risperidone group.

Discussion: Severity of comorbid hyperactivity and intellectual disability were determinants of response to antipsychotics. Aripiprazole has advantage of not increasing serum prolactin level.

Conclusion: Both risperidone and aripiprazole are comparable in efficacy and safety in managing irritability in children and adolescents with ASD.

Abstract ID 763: Diagnostic Efficacy of Conventional Post-Contrast T1-Weighted Imaging Versus Delayed Post-Contrast T2 FLAIR Imaging in Acute Bacterial Meningitis

Abhimanyu Reddy, Manoj Singh, Chakradhar Reddy, Mukheem Mudabbir, Rahul Konduri

Continental Hospital, Hyderabad, Telangana, India

Background and aim: Bacterial meningitis is a life-threatening infection of the meninges requiring prompt diagnosis and treatment. Magnetic resonance imaging (MRI) plays a pivotal role in identifying meningeal inflammation and complications. While contrast-enhanced T1-weighted MRI is routinely used for diagnosis, its sensitivity may be limited in early or subtle cases. This study aimed to compare the diagnostic efficacy of delayed T2 FLAIR MRI sequences with conventional contrast-enhanced T1 MRI in patients with suspected bacterial meningitis. Aims of the present study included 1. Assessing the sensitivity and specificity of delayed T2 FLAIR versus contrast-enhanced T1 MRI in detecting meningeal inflammation. 2. Evaluating the impact of delayed imaging timing on lesion conspicuity and diagnostic confidence. 3. Determining if delayed T2 FLAIR sequences can reduce false-negative MRI results in bacterial meningitis.

Methodology: A prospective and a retrospective study was conducted including patients clinically suspected of bacterial meningitis who underwent both contrast-enhanced T1 MRI, delayed post-contrast) T2 FLAIR MRI sequences. Imaging findings were correlated with cerebrospinal fluid (CSF) analysis and clinical diagnosis. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each MRI technique. Inclusion Criteria were adults aged ≥18 years with clinical suspicion of bacterial meningitis. Patients who underwent lumbar puncture with CSF analysis confirming bacterial meningitis. Patients capable of undergoing MRI with contrast administration. Exclusion Criteria included patients with contraindications to MRI or gadolinium contrast, and non-bacterial meningitis or other central nervous system (CNS) infections.

Results: Delayed T2 FLAIR MRI demonstrated higher sensitivity and positive predictive value compared to contrast-enhanced T1 MRI in detecting meningeal enhancement.

Discussion and conclusion: Delayed T2 FLAIR MRI significantly increases the diagnostic yield in bacterial meningitis compared to standard contrast-enhanced T1 MRI, offering a valuable imaging tool for early and accurate detection. Incorporating delayed T2 FLAIR sequences into MRI protocols may improve clinical outcomes by facilitating prompt diagnosis and treatment initiation.

Abstract ID 764: Post-Ictal MRI Findings as a Predictor of Poor Outcome in Refractory and Super Refractory Status Epilepticus

Ashwini Patankar, Kamatchi Soondarmoorthy, Sunita Iyer, Jayanti Mani

Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India

Background and aim: The outcomes of refractory (RSE) and super refractory status epilepticus (SRSE) are poorer as compared to non-refractory status epilepticus. Predictors such as etiology and biochemical markers have established. We observed the presence or absence of the post ictal magnetic resonance imaging (MRI) findings in RSE and SRSE and if it could be associated with outcomes.

Methodology: Fifty-two adults with status epilecticus (SE) were retrospectively analysed in the last 3 years from a single centre. Those with anoxic seizures were excluded. All patients who had an MRI post-ictally were included. The patients were divided in three groups as per the refractoriness of their SE. Outcomes were determined on basis of Glasgow outcome score (GOS). MRI was visually analysed for presence or absence of post-ictal changes. Presence of findings was noted as per outcomes of patients in each group.

Results: Mortality was seen in 9 patients, SRSE group and RSE group had majority deaths while none in non-refractor SE (NRSE) group. New morbidity was seen in a third of the patients, all except one belonged to the RSE and SRSE group. Post ictal MRI findings in RSE group was seen in 60% who died and 75% with new morbidity. In SRSE group post ictal MRI findings were see in all of those who died and 87% with new morbidity.

Discussion: Post-ictal MRI findings are associated with neurological deterioration and are seen with ongoing SE. Thus, the presence of post-ictal MRI findings in patients with RSE and SRSE can be associated with mortality and new morbidity at discharge. This has never been studied and needs further evaluation.

Conclusion: Prospective studies are needed to create predictive models on the basis of post-ictal MRI as we observed the presence of post-ictal MRI findings more frequently in those with new morbidity and mortality, mainly in the RSE and SRSE group.

Abstract ID 765: Case Series of LETM (Longitudinal Extensive Transverse Myelitis)- One Disease and Variable Etiologies and Outcomes

Patibandla Sipra, Raja Gambeeran, M Shivaji

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Longitudinal extensive transverse myelitis (LETM) is defined as a hyper intense spinal cord lesion extending over three or more vertebral levels on Sagittal t2-weighted spinal magnetic resonance imaging (MRI). It can present solely or in association with other neurological disorders. Current aim was to study clinicoradiological profile, etiology and prognosis of LETM.

Methodology: This study included 15 patients with paraparesis or quadriparesis with MRI Spine showing LETM analysed for clinical features, routine blood parameters, serum AQP4 and MOG antibodies, MRI findings and all patients were followed up for 3 months for prognosis.

Results: The mean age in the series is 40. Current study includes 8 male and 7 female patients. Out of the 15, 7 patients had more than 5 segments involved, 2 had only conus medullaris involvement. Most of the patients had cervical-dorsal segments involvement. Etiologies were variable, 3 patients had TB Myelitis, 3 patients had AQP4 positive with Neuromyelitis optica spectrum disorder (NMOSD), 2 patients had neuromelioidosis, 1 patient each with hepatitis C virus (HCV) Myelitis, Sub acute combined degeneration, Systemic lupus erythematosus (SLE) myelitis, Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD), vascular infarct causing LETM and 2 patients were idiopathic LETM.

Discussion: Treatment was given with intravenous (IV) methyl prednisolone pulse therapy for most of the patients, plasmapheresis for 1 patient with NMOSD and 1 patient with Idiopathic LETM and intravenous immunoglobulin (IVIG) given for 3 patients - idiopathic LETM and NMOSD as they did not respond well to steroid pulse therapy. Prognosis- is very poor with no recovery in vascular spinal infarct, poor recovery with only mild improvement in TB Myelitis cases, good improvement in other cases with treatment of underlying causes. One patient expired with complication of sepsis.

Conclusion: LETM is a heterogenous disorder with varied clinical features, etiologies and outcomes. Neurologists should think beyond NMOSD in cases of LETM and extensive work up is needed to find the etiology, so that early and appropriate treatment can be provided.

Abstract ID 766: Clinical and Etiological Profile of Patients with Epileptic Encephalopathy: A Hospital-Based Study

Shravan Harish

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Epileptic encephalopathies (EEs) are a group of severe epilepsies characterized by refractory seizures, developmental delay or regression, and abnormal electroencephalogram (EEG) patterns. Understanding their clinical and etiological spectrum is essential for early diagnosis and management. Aims were to characterise the various epileptic encephalopathies in a tertiary care centre from south India based of clinical features, electrophysiologically study them, and collect genetic samples wherever sent and to study their radiological features.

Methodology: A hospital-based ambispective study with a total cohort of 200 patients from January 2015 to February 2025. The Video EEGs reports of the subjects fulfilling the inclusion and exclusion criteria from January 2015 to February 2025 was retrieved from the digital server and reviewed under the guidance of the epileptologists/supervisors. Case file review for Phenotype, radiological and treatment choice and outcome were done. Review of the Genetic profile was also done. All details were tabulated onto structured Proforma.

Results: Among the 200 patients analyzed, the majority (66.5%) had seizure onset between 1 to 5 years of age. Early onset before 1 year was observed in 7.0% of cases, while 16.5% developed seizures between 6 to 10 years. A smaller proportion had onset between 11 to 15 years (6.0%) and after 15 years of age (4.0%). Of the 200 patients included in the study, 149 (74.5%) were male and 51 (25.5%) were female, indicating a clear male predominance in the cohort. The video EEGs and genetic reports were obtained and are yet to be analysed.

Discussion: This hospital-based study highlights a male predominance and early childhood onset in epileptic encephalopathy, emphasizing the need for timely etiological diagnosis and intervention to improve long-term neurodevelopmental outcomes.

Conclusion: Epileptic encephalopathy shows early onset and male predominance. Early identification of etiology is crucial for targeted therapy and optimizing neurodevelopmental outcomes in affected.

Abstract ID 767: Neuroepidemiology of Headache at a Tertiary Care Hospital in south India - Prevalence and Treatment Patterns

Saikiran K

Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

Background and aim: To determine the prevalence patterns of varying headache syndromes with aid of International Classification of Headache Disorders (ICHD) 3 clinical criteria and utilising ancillary investigations including optical coherence tomography (OCT). Treatment protocols across the population were studied in tandem and categorised as interventional and non-interventional.

Methodology: A cross-sectional study was carried out amongst the OPD patients at Nizams institute of medical sciences. They were selected by simple random sampling and administered a detailed structured headache assessment questionnaire incorporating demographical data, headache characteristics and treatment patterns. Diagnosis was made according to the criteria of the International Headache Society.

Results: The participants comprised of 3125 patients with 992 (31.7%) males and 2133 (68.3%) females. The mean age was 36.9 ± 7.9 years. The overall headache prevalence was 39.3% with female predominance. Tension-type headache was most prevalent at 72.8%% and migraine, 18.9%. Unclassifiable headache constituted 8.2%. Migraine headache showed female preponderance (Female, 23.7%: Male, 5%). (p = 0.000) Overall, the most common aggravating factor was physical activity (15.2%) whilst the relieving factor was rest (22.8%) followed by over-the counter analgesic use (11.2%).

Discussion: In the current study, estimates of high headache prevalence were found, which are also consistent with those of other epidemiological studies conducted in different regions of India. In south India, the prevalence of headache stands at 63.9% with a female preponderance of 73% in comparison to males (54.4%), TTH is 34.8%, and migraine 25.6% (females: 32.4% and males: 18.6%).

Conclusion: The current study aimed to find out the prevalence of the headache condition and its two major types, including migraine and TTH in a tertiary care hospital in India.

Abstract ID 768: Role of Ayurveda in Neurodegenrative Diseases

Beena Vasanthy, Beena Vijayan, Vijayan Parameswaran Nair¹, Vijayan P¹

Government Medical College, Kottayam, Kerala, ¹Kerala University of Health Sciences, Thrissur, Kerala, India

Background and aim: Medicine is as old as life & success depends on identification & consumption of correct medicine. With treatment of communicable diseases & vaccination, life expectancy increased. When age advances neurodegenerative diseases, Alzheimer’s (AD) & Parkinson’s Diseases (PD) increases. Absolute cure for chronic diseases like neurodegenerative diseases are not available. The etiopathogenesis are multifactorial. Ayurvedic interventions are holistic, personalized, targeting at multiple levels and being present for centuries can be useful. Ayurveda is currently in practice and is as old as Vedas, >5000 years.

Methodology: Ayurvedic concepts were collected from published articles of scholars & knowledge of physicians. Some were adopted in modern medicine, like Gut Microbiome, avoidance of diet containing substances that are not metabolized, in inborn errors of metabolism, importance of yoga and sleep. Authors looked upon treatment with herbal medicines used in preclinical trials, case reports and a few randomized controlled trials

Results: From Ayu, life and veda, knowledge came Ayurveda. Ayurvedic principles of Pancha Mahabhoota, Sapthadhatus, Tridoshas, Prakriti & trimalas exist. A balance between dhatus, Prakiti and trimalas should exist ideally. Accumulation of waste products, Ama lead to Dhatu damage. Ayurveda state that health can be re- established by proper diet, herbal medicines, yoga, sleep & Panchakarma. For AD, herbal medicines- Brahmi, Sankupushpi, Ashwagandha, Turmeric, Gotu Kola are cognitive enhancing & neuroprotective by Saponins & similar active ingredients. Saraswata ghrita, Panchakarma & Vata balancing diet, yoga & life-style modifications including sleep are also useful. For PD, Kapikachu, Ashwagandha, Brahmi, Guggul, Turmeric, etc., Abhyanga & self abhyanga daily oil massage, with Narayana Taila, etc. Panchakarma & diet with warm, easily digested food, Vata-pacifying agents &Healthy dietary fats.

Discussion: Ayurveda treatment with supervised care from Neurologist & Physician practicing Ayurveda is essential. Currently, preclinical trials, case reports and very few RCTs are available.

Conclusion: Large scale randomized controlled trials (RCTs) are needed to prove efficacy of Ayurvedic intervention in neurodegenerative diseases.

Abstract ID 769: A Case of Small Vessel Vasculitis Masquerading as Pontine Demyelination

Satheeish J, Mugundhan K, Uma Maheshwari

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Granulomatous polyangitis is a rare vasculitis disease affecting upper respiratory tract and kidneys. Being a vasculitis disease, sometimes it may mimic demyelination. Here, we presented a case of such vasculitis - presenting as demyelination pattern.

Methodology: A 65-year-old male presented with fever, slurring of speech with weakness of left upper limb and lower limb with difficulty in swallowing. On examination, patient had lower motor neuron (LMN) type of facial palsy with left upper limb and lower limb weakness with mild bilateral bulbar palsy. Speech was spastic. Clinical localisation of brainstem was made, and was proceeded with magnetic resonance imaging (MRI) brain, and fever workup done.

Results: MRI brain showed T2 Hyperintensity with diffusion restriction with no low apparent diffusion coefficient (ADC). Fever workup showed immunoglobulin M (IgM) enzyme-linked Immunosorbent assay (ELISA) positive for Dengue. Vasculitis workup showed high titres positivity for anti MPO antibodies. On reference with literature, vasculitis presenting as pontine demyelination like picture giving left hemiparesis and facial palsy. Patient was started on pulse steroids and symptoms became static and then started improving. Bicytopenia - anemia and thrombocytopenia found recovered.

Discussion: Subacute onset symptoms with neurological illness in the form of hemiparesis could be due to demyelination or infection or inflammatory cause such as vasculitis.

Conclusion: In this case, Pontine central T2 hyperintensity with diffusion restriction with no Low ADC could correlate the hemiparesis with facial palsy. Finding etiology was of importance in this case. As there is no history of hypertonic saline correction. In our case, autoimmune etiology such as vasculitis was suspected and was turned out to be small vessel vasculitis. Which could mimic demyelination as there was improvement with steroids.

Abstract ID 770: Reversible Leucoencephalopathy in Rodenticide Poisoning

Jermin Merisha, Hema Kumar

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Toxic leukoencephalothy in association with bromadialone and fluoroacetate has been described in western literature but yellow phosphorus (active ingredient in rat killer paste used in India) induced leukoencephalopathy has not been described in literature yet. This is reversible and has good prognosis.

Methodology: A 30-year-old male, consumed rat killer paste (yellow phosphorus) under the influence of alcohol. All his baseline investigations were normal except mild elevation of liver enzymes. He developed high grade fever with chills followed by 2 episodes of generalised tonic clonic seizures. On examination, he was febrile but did not have any signs of meningeal irritation. Next day the fever settled and slowly he came out of drowsiness but exhibited severe recent memory impairment and also showed excessive aggressiveness and for trivial reasons. He was suspected to have acute encephalitis due to his fever, new onset seizures and altered sensorium. Magnetic resonance imaging (MRI) brain showed T2/FLAIR hyperintensities with diffusion restriction in bilateral medial temporal lobe with choroid plexus hemorrhage and left frontoparietal subdural hemorrhage. Cerebrospinal fluid (CSF) was acellular with sugar-112 mg/dl, protein-41 mg/dl, red blood cells (RBC)-2 cells/mm3, culture- negative, Cartridge-Based Nucleic Acid Amplification Test (CBNAAT)- negative, herpes simplex virus (HSV) polymerase chain reaction (PCR) was done as symmetrical temporal lobe hyperintensities are seen in Herpes simplex encephalitis but it turned out to be negative. Patient did not have further seizures but continued to exhibit aggressive behaviour and recent memory disturbances, so autoimmune encephalitis was considered but all the antibodies were negative.

Results: Patient discharged on oral antiepileptics and antipsychotics and was asked to follow up after one month during which his memory and anger outbursts improved significantly. Repeat MRI brain showed complete resolution of the temporal lobe hyperintensities.

Discussion: Rate killer paste commonly used in southern parts of India usually contains yellow phosphorus. Though it is a well-known cause of multi organ failure with predominant hepatotoxicity, leukoencephalopathy with imaging findings similar to herpes simplex or autoimmune encephalitis has not been described previously.

Conclusion: This case sheds light on rodenticide induced reversible toxic leukoencephalopathy which should be considered in patients developing encephalitis like symptoms after yellow phosphorus consumption.

Abstract ID 771: A Tale of Recurrent Posterior Circulatory Stroke in Early Childhood- A Case Report of Two and Half Year Old Child

S Kumar, Jermin Alwin, Sakthi Velayutham, Malcolm Jeyaraj, Sowmini PR, Krishna Kumar, Kannan V, Velusamy S

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Arterial ischemic stroke (AIS) in young children is rare but serious. The etiologies of AIS in childhood differ from adults, and recurrent strokes increase the risk of mortality and complications like seizures, motor disability, and cognitive dysfunction, often leading to long-term treatment and rehabilitation.

Methodology: We presented a case of a two and half-year-old child with recurrent episodes of giddiness, vomiting, difficulty in getting up associated with swaying to both sides while trying to walk which recovers in few hours. At the time of event, patient is lethargic, obeys simple commands, extraocular movements- bilateral gaze evoked nystagmus present, pupils- BERTL, sms- tone- normal in all 4 limbs, power->3/5 in all 4 limbs, DTR- bilateral 2+, plantar- bilateral flexor, stance and gait ataxia present, sensory and other cerebelllar signs could not be assessed. Patient recovers in few hours, later the central nervous examination was normal.

Results: Magnetic resonance imaging (MRI) revealed an acute infarct in the left superior cerebellar hemisphere and chronic lacunar infarcts. Stroke in young work up was done, nothing remarkable. The child was treated with low-dose aspirin and discharged, but was re-admitted with similar symptoms. Repeat MRI showed an acute infarct in the right superior cerebellar hemisphere. Detailed workup including vasculitis, connective tissue damage (CTD), computed tomography (CT) angiogram, and procoagulant workup were normal. Genetic and mitochondrial workup are pending.

Discussion: Recurrent posterior circulatory strokes in early childhood are rare and require extensive evaluation to identify underlying causes such as vascular malformations, arterial dissections, or hypercoagulable states. A comprehensive workup, including advanced imaging and genetic testing, is essential for early diagnosis and prevention of further ischemic events.

Conclusion: Recurrent posterior circulatory stroke in childhood is rare. Promptly identifying the etiology and further treatment helps in preventing further morbidity and mortality. Detailed history and clinical examination always crucial in establishing the diagnosis.

Abstract ID 772: The Infectious Cloak: How Tuberculosis Masked a Primary CNS Lymphoma

Akil Reddy V, S Sakthi Velayutham, Daya Varghese, S Velusamy, Sowmini P R, Malcolm Jeyaraj, Kannan V, S Velusamy, Krishna Kumar

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Primary Central Nervous System Lymphoma (PCNSL), a rare extranodal variant of Non-Hodgkin’s Lymphoma (NHL), often masquerades as infectious, inflammatory, or demyelinating central nervous system (CNS) pathology. In tuberculosis-endemic regions, granulomatous lesions on neuroimaging may lead to an erroneous diagnosis of CNS tuberculosis (CNS TB), especially in patients with prior TB or treatment non-compliance.

Methodology: A 40-year-old male with a prior diagnosis of pulmonary TB (on anti-tuberculosis treatment [ATT], later defaulted) presented with acute right hemiplegia, global aphasia. Initial imaging suggested a left-sided space-occupying lesion with vasogenic edema. Empirical ATT and corticosteroids were initiated due to high suspicion of CNS TB, patient showed rapid improvement initially. However, subsequent deterioration lead to excision biopsy confirmed diffuse large B-cell lymphoma (DLBCL) of the CNS. Positron emission tomography (PET)-computed tomography (CT) and bone marrow biopsy, which confirmed PCNSL (DLBCL variety). The patient was treated with a combination of chemotherapy (Rituximab, Methotrexate, Vincristine, Procarbazine) and modified ATT for pulmonary TB.

Results: The patient showed early improvement with steroids, initially suggesting tuberculoma. However, subsequent deterioration and advanced imaging including PET-CT revealed metabolically active parietotemporal lesions. Histopathology confirmed a diagnosis of diffuse large B-cell lymphoma (DLBCL) of the CNS. Literature review revealed similar cases where TB and lymphoma mimicked each other clinically and radiologically, with histopathology being the definitive diagnostic tool.

Discussion: In tuberculosis-endemic regions, CNS mass lesions in TB-defaulters are often misattributed to reactivation or disseminated disease. PCNSL, especially DLBCL subtype, can radiologically and clinically mimic TB. Delayed diagnosis due to empirical ATT initiation may worsen outcomes. This case underscores the importance of considering PCNSL in differential diagnosis of focal CNS lesions, particularly when response to treatment is suboptimal or imaging features are atypical.

Conclusion: PCNSL can mimic CNS tuberculosis, particularly in patients with a history of TB non-adherence. Early neuroimaging, a high index of suspicion, and timely biopsy are critical to avoid misdiagnosis and initiate appropriate therapy.

Abstract ID 773: Clinico-Radiological Profile of CNS Demyelinating Disorders

Nitish Balla, Narendra Pulukuri

Kasturba Medical College, Manipal, Karnataka, India

Background and aim: Aims included 1. To study the clinical presentation and radiological features in patients with the first episode of central nervous system (CNS) demyelinating disorders. 2. To diagnose patients with demyelination and study their functional outcomes at 3 months.

Methodology: This prospective study, conducted 1 year period at Kasturba Medical College in Manipal, India, focuses on patients over 12 years experiencing their first clinical episode of CNS demyelination. Patients with confirmed demyelinating CNS disease were included after obtaining informed consent. Evaluations followed the neurology department protocol, documenting clinical presentations, radiological profiles, serological investigations, neurophysiological studies, and cerebrospinal fluid (CSF) findings. Functional status was assessed using the modified Rankin Scale (mRS) and expanded disability status scale (EDSS) at presentation and after three months. Follow-ups monitored recurrent lesions and symptom worsening.

Results: Interim analysis of 33 patients revealed a median age of 38 years, with a higher prevalence in females (56.3%). Idiopathic causes were most common (68.8%), followed by NMOSD-MOG (12.5%), NMOSD-AQP4 (6.3%), and multiple sclerosis (6.3%). In patients with multiple sclerosis (MS), magnetic resonance imaging (MRI) revealing periventricular and cortical lesions. MOG-associated disease, and imaging showed optic neuritis and longitudinally extensive transverse myelitis (LETM). NMOSD-AQP4 positive patients, with optic neuritis and LETM on imaging. Acute disseminated encephalomyelitis (ADEM) was characterized with cortical and periventricular involvement. Neurosarcoidosis presented with motor weakness and LETM. Serological tests indicated 6.3% NMO AQP4 positivity and 12% MOG positivity. All patients received steroids; 25% received rituximab and 6.3% intravenous immunoglobulin (IVIG). The mean EDSS score improved from 4.1 at presentation to 3.5 after three months, with 59.4% showing improvement.

Discussion: Kim et al. noted similar demographic distributions and clinical presentations in Asian populations. Wingerchuk et al. and Thompson et al. both support the effectiveness of early treatment in NMOSD and MS, respectively, emphasizing the importance of early diagnosis and tailored treatment plans.

Conclusion: This study underscores the critical role of comprehensive diagnostic workups in demyelinating diseases, guiding both immediate and long-term management strategies.

Abstract ID 774: Endovascular Therapy in Management of Large Ischemic Core Stroke: Experience

Mukesh Kumar

Artemis Hospital, Gurugram, Haryana, India

Background and aim: Since 2015, endovascular therapy (EVT) has continued to revolutionize the management of acute ischaemic strokes with large vessel occlusion. This study aimed to analyze neurointerventional management of Large Ischemic Core Stroke (LICS) patients and the efficacy of different management strategies available as well as their impact on the clinical outcome in these patients, to strengthen clinical practices and thus optimize patient care.

Methodology: Patients who suffered from an LICS treated at the Comprehensive Stroke Centre of Artemis Hospital, Gurugram over past one year were carefully analyzed and their clinical data compiled.

Discussion: Despite the positive results demonstrated by many recently published randomized controlled trials (RCTs), they each had slightly different methodologies and selection criteria—differing in ethnicity of the patient population, imaging modality (computed tomography [CT] vs. magnetic resonance imaging [MRI]), time windows (early vs. late), and whether or not perfusion imaging was used. This has implications for how we should interpret the minor differences between each of the trials’ results, which should be considered in the context of each trial’s imaging and clinical inclusion and exclusion criteria. Perhaps, there may well be a demographic or clinical correlate that has yet to be identified in our cohort of patients. Although meta-analyses of the recent trials showed slightly higher rates of symptomatic intracerebral hemorrhage (ICH) in the EVT group, EVT still conferred a significantly greater clinical benefit than medical management alone. Nevertheless, the evidence thus far supports the need to change the way we manage patients with LICS stroke and also the need to update the existing stroke guidelines to reflect this evidence.

Conclusion: The present study shows that EVT management of eligible LICS patients may offer a promising outcome with reasonably good recanalization and clinical recovery.

Abstract ID 775: Comparative Analysis of Stevens-Johnson Syndrome Incidence among Seizure Patients on Different Antiepileptic Drugs

Jitender Sharma

Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background and aim: Steven-Johnson syndrome (SJS) is a severe, immune-mediated hypersensitivity reaction which is often triggered by medications, notably antiepileptic drugs (AEDs). AEDs such as phenytoin, carbamazepine, and sodium valproate are reported to be commonly offending drugs, particularly in individuals with genetic factors such as HLA-B*1502 allele. A retrospective analysis of 1000 seizure patients revealed variability in SJS incidence among.

Methodology: This retrospective study (2019–2024) at a tertiary care center examined the incidence of SJS in epilepsy patients aged ≥18 years treated with phenytoin, carbamazepine, sodium valproate, or levetiracetam for ≥6 months. Using electronic health records, patient demographics, AED.

Results: An overall SJS incidence of 3.0%. Phenytoin (4.8%) and carbamazepine (3.6%) had significantly higher SJS rates than sodium valproate (2.4%) and levetiracetam (1.2%) (p < 0.01). HLA-B*1502 allele strongly correlated with SJS, especially for phenytoin and carbamazepine.

Discussion: In the present study, the rank order of incidence was as follows: Phenytoin with 4.8%, followed by carbamazepine with 3.6%. These results go in agreement with previous studies that have identified these drugs as having a high risk for severe cutaneous adverse reactions, especially in genetically predisposed individuals. It carried the HLA-B*1502 allele, a known risk factor in five of the 12 SJS phenytoin users. Genetic predisposition is a significant risk factor, with most cases occurring among Asians. In contrast, a low incidence was reported for levetiracetam and sodium valproate, at 1.2% and 2.4%, respectively, demonstrating favorable safety. This suggests that the latter drugs may be safer and a good alternative, particularly among patients at high risk for hypersensitivity reactions. Levetiracetam’s safety profile has also been reported by authors such as Harden and French et al. Considering the pharmacodynamics and metabolic pathways of the AEDs explains these observed differences in the risk of SJS. Phenytoin and carbamazepine are metabolized through the liver into metabolites with the potential for initiating the immune responses associated with SJS. The HLA-B*1502 allele is at increased risk of SJS because it influences how the immune system processes the metabolites of each drug. In contrast, the metabolic pathway for sodium valproate is less reactive and does not increase the risk of immune-mediated skin reactions. Levetiracetam acts through a different mechanism of action, modulating the SV2A protein, which does not induce an immune response; therefore, its incidence of SJS is much lower. This makes levetiracetam safer, especially for those patients with a history of drug hypersensitivity or those at risk genetically. These findings also emphasize the application of pharmacogenetic testing in clinical settings, especially in regions characterized by high prevalence of the HLA-B*1502 allele, including Asia. Pre-prescription genetic screening has the potential to reduce cases of SJS caused by high-risk AEDs such as phenytoin and carbamazepine, as illustrated in the studies by Puri et al and Pannu et al. Moreover, the recent development of safer alternatives, such as levetiracetam, reflects the move toward personalized therapy to reduce adverse reactions. Future studies should be designed as large-scale prospective studies to confirm the above findings and assess cost-effectiveness related to routine genetic screening. The pharmacogenomic basis of SJS in other ethnic populations could be further investigated to extend the knowledge of genetic predisposition and thus facilitate global efforts toward optimizing AED prescribing practices. Several limitations should be considered; first, the study’s retrospective nature means we can only establish associations, not causality, between AED use and SJS. Prospective studies are needed to confirm these findings. Second, not all patients were screened for the HLA-B*1502 allele, which limits our understanding of how genetic predispositions contribute to SJS. Genetic factors are essential in developing SJS, but their contribution cannot be entirely ascertained due to a lack of comprehensive screening. Finally, the study was conducted at a single tertiary care center, with possible bias in patient selection. A multicentric study with a broader patient population would improve the external validity of the findings. The results of the present study have significant clinical relevance. The association of the HLA-B*1502 allele with SJS in users of phenytoin and carbamazepine underlines the need for genetic screening before starting those AEDs, more so in Asian patients. This would help the clinician correctly identify at-risk patients and offer them much safer alternatives such as levetiracetam or sodium valproate. Similarly, patients on phenytoin and carbamazepine should also be closely monitored, especially in the initial days of treatment, for the initial manifestation of SJS. The development of symptoms calls for early intervention. Further, Levetiracetam is less likely to cause hypersensitivity reactions; therefore, it may be considered for use as a first-line AED in patients with known drug hypersensitivity or genetic predisposition to SJS. Ultimately, the study explains the risk of SJS with the drugs phenytoin and carbamazepine, with the support of genetic screening for high- risk patients. This also suggests the drugs levetiracetam and sodium valproate as being safer options among the AEDs for cases that have a high potential of adverse cutaneous reactions. These would be very helpful for clinicians.

Conclusion: There was a higher risk of SJS with phenytoin and carbamazepine compared to sodium valproate and levetiracetam, with levetiracetam.

Abstract ID 776: Clinical and Radiological Profile of CNS Vasculitis Presenting as Stroke

Anugu Rao, Ranjith Gandeti, Radhakrishna Hari¹

Medicover Hospitals, Hitech City, Hyderabad, Telangana, ¹Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

Background and aim: Cerebral vasculitis is characterized by inflammation of the walls of blood vessels and affects vessels of all sizes. Magnetic resonance imaging (MRI) brain vascular imaging is important. This study was aimed to analyse the clinical, laboratory and radiological features of patients with CNS vasculitis who presented with stroke.

Methodology: All patients diagnosed with central nervous system (CNS) vasculitis admitted under the Department of Neurology, Medicover hospitals, between April 2023 to 2025 April were taken. It’s a prospective study The following information was collected: Clinical details, National Institute of Health Stroke Scale (NIHSS) at admission, routine blood workup, autoimmune workup, imaging results including MRI brain, MRI angiography (MRA), computed tomography angiography (CTA), digital subtraction angiography (DSA).

Results: Total 9 patients with CNS vasculitis were identified Baseline characteristics -males were-8, females was-1 patients. Age mean was 45 years Clinical and lab findings-Headache was there in 30%, joint pains, seizures in -20%, recurrent stroke in 30%, NIHSS was 8, anti-neutrophil cytoplasmic antibody (ANCA) -Postive in 30%, cerebrospinal fluid (CSF) -inflammatory pattern in 30%, cerebral biopsy done in 1 patient-it is inconclusive. vascular imaging-MRA-done in 7 patients-beaded appearence not seen, CTA done in 2 patients -1 person had beaded appearence, DSA suggestive of beaded appearance in all patients

Discussion: Headache, altered cognition, and stroke are the commonest presenting features. It should be suspected in patients with recurrent strokes without conventional risk factors, neurological deficits which cannot be explained by single artery distribution and based on MRI Imaging findings. It can be confirmed with either typical vascular imaging findings (probable vasculitis) or biopsy (definitive) if feasible. The sensitivity of angiography varies between 40% and 90% and specificity is as low as 30%. Sensitivity of biopsy ranges between 53% and 63%.

Conclusion: Possibility of CNS vasculitis should be suspected when a middle-aged patient presenting with stroke have atypical clinical and MRI findings. In such cases along with MRI brain, vascular imaging plays an important role in establishing the diagnosis. In our experience DSA is the most useful imaging modality in diagnosis.

Abstract ID 777: A Comparison of Clinical Profiles, Risk Factors and Outcomes in Normoglycemic, Insulin Resistant, Prediabetic and Diabetic Patients of Acute Ischemic Stroke

Prerna Dogra, Jyoti Sharma

Fortis Hospital, Noida, Uttar Pradesh, India

Background and aim: Insulin-resistant states correlated with worse functional outcome in non-diabetic stroke patients in a few studies. Aim of this study was to compare clinical profiles and outcomes of normoglycemic, insulin resistant, prediabetic and diabetic patients of acute ischemic stroke on the basis of outcome measures: MRS scoring, Barthel index and National Institute of Health Stroke Scale (NIHSS) score at discharge and at 1 month of follow up.

Methodology: Prospective observational study conducted in foots hospital NOIDA over 1 year. patients were divided into 4 groups on the basis of their glycemic status using standard diabetes and prediabetes diagnosis protocol. Insulin resistance was detected with a tool - HOMA - IR It is calculated multiplying fasting plasma insulin (FPI) by fasting plasma glucose (FPG), then dividing by the constant 22.5, HOMA-IR = (FPI×FPG)/22.5.

Results: The mean ranks of the NIHSS scores at 24 hours and at discharge were higher in the insulin resistant group than the normoglycemic group with significant p-values (p < 0.05). Barthel Index at one month after discharge, The mean rank for the modified Rankin Scale (mRS) score at 1 month and days of intensive care unit (ICU) stay were compared between the insulin resistant and normoglycemic group and was found to be statistically significant (p < 0.05) using Mann Whitney U test.

Discussion: The insulin resistant group in our study showed worse NIHSS scores at 24 hours and at discharge, worse MRS at 1 month scores, worse barthel index at 1 month, longer days of ICU, and then the normoglycemic group. All these parameters were found to be statistically significant with a p-value of <0.05. This may be due to the various adverse metabolic effects of insulin resistance on various end organs increasing inflammation and atherogenesis even in the absence of flank hyperglycemic status.

Conclusion: Insulin-resistant and diabetic patients exhibited worse stroke severity, functional outcomes, longer ICU and hospital stays

Abstract ID 778: Nasopharyngeal Carcinoma Presenting as Acute Monocular Vision Loss and Multiple Cranial Neuropathies in a Young Adult

Shailendra Manjhvar, V Balambighai, J Thanka, Gowripriya G

Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India

Background and aim: A 27-years-old male with no comorbidities and habits, presented with blurring of vision with occasional bifrontal headache for past 1 month with complete loss of vision for past 4 days. Clinical Examination showed non-perception of light in the right eye; relative afferent pupillary defect (RAPD) positive; impaired colour vision with temporal field defect and optic disc pallor cranial nerve (CN) III, IV, VI: Complete ophthalmoplegia on the right, ptosis, dilated non-reactive pupil. CN V: Decreased touch and pain sensation on the right face; corneal reflex preserved; normal mastication.

Methodology: Magnetic resonance imaging (MRI) brain (P & C) Showed enhancing soft tissue mass extending into Right orbital apex, superior orbital fissure, cavernous sinus and posterior choana. Bone lysis and sclerosis seen, involving right pterygoid plate and greater wing of sphenoid. ENT did biopsy of the mass through trans nasal endoscopy. Histopathology and Immunohistochemistry with P40 and P63 showed strong and diffuse nuclear positivity in the tumour cells. P16, INSMI, Synaptophysin, CD34 are negative. INI1: retained, IDH1: positive, EBER-ISH was positive, Suggestive of poorly differentiated sinonasal lymphoepithelial carcinoma.

Results: He received 5 cycles of chemotherapy (cisplatin and gemcitabine) and 35 cycles of radiotherapy along with 5 days of pulse dose of intravenous methyl prednisolone. After 9 months, he had perception of light in right eye and normal extra ocular movements.

Discussion: NPC is an epithelial malignancy arising from the nasopharyngeal mucosa, and presentation depends on site and extent of spread. Common symptoms include nasal obstruction, epistaxis, and cervical lymphadenopathy. Skull base involvement causes cranial nerve palsies.

Conclusion: This case is noteworthy due to its initial presentation as sudden monocular blindness, a rare occurrence in nasopharyngeal carcinoma (NPC). Multidisciplinary approaches involving neurologist, neurosurgeon, ophthalmologist, ENT, pathologist, Oncologist, play a crucial role in managing this case in preserving the neurological function.

Abstract ID 779: Hospital-Based Prevalence and Rehabilitation Outcomes in Post-Polio Residual Paralysis: Evidence from a Structured Yoga and Physiotherapy Program at AIIMS Patna

Anand Rai, Pratibha Prasad, Sanjay Panadey, Sanyal Kumar, Kamlesh Jha

All India Institute of Medical Sciences, Patna, Bihar, India

Background and aim: While India has been declared polio-free, a significant number of patients continue to live with Post-Polio Residual Paralysis (PPRP), presenting with long-term functional limitations, pain, and psychosocial distress. The aim of this study was to assess the hospital-based prevalence of PPRP among patients attending the Neurology and Physical Medicine and Rehabilitation (PMR) outpatient department at AIIMS Patna and to evaluate the effectiveness of a structured physiotherapy intervention in improving quality of life and physical function.

Methodology: This observational study was conducted in the Neurology & PMR OPD at AIIMS, Patna, over a 6-month period. A total of 197 patients were screened, of which 8 (4.06%) were identified with PPRP based on history and clinical examination. Among them, 4 consenting patients participated in a structured 12-week physiotherapy and yoga therapy program including customized asanas, pranayama, and meditation, conducted by certified instructors. Pre- and post-intervention assessments were done using the Barthel Index, WHO-5 Well-Being Index, and pain/fatigue scores.

Results: Most had unilateral lower limb involvement (81%) with gait abnormalities and joint deformities. Following therapy intervention, significant improvements were noted in daily living activities (Barthel Index mean improvement of 18%, p < 0.01), mental well-being (WHO-5 increased by 21%, p < 0.05), and reduction in reported pain and fatigue levels (p < 0.05).

Discussion: The hospital-based prevalence of PPRP highlights a persistent rehabilitation need among polio survivors. Integrating yoga therapy into hospital rehabilitation programs may enhance physical function and psychological resilience in these patients.

Conclusion: PPRP remains a clinical reality in tertiary care settings. Structured yoga therapy is a feasible, cost-effective adjunct that can be integrated into hospital-based rehabilitation services for comprehensive PPRP management.

Abstract ID 780: A Clinical Spectrum of Movement Disorder in Acute Demyelinating Disease in a Tertiary Care Centre

Kousik Karmakar

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Background and aim: Few evidence exist in literature describing movement disorder in people with Neuromyelitis optica spectrum disorder (NMOSD) or Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGA)D and secondary demyelinating diseases. Hence, an extensive search into the spectrum of movement disorder in all primary and secondary demyelination disorder is pertinent. Aims of this study included exploring the spectrum of Movement Disorder in patients with acute demyelination, and assessing any correlation of primary and secondary demyelination etiology with the Movement Disorder of patients.

Methodology: Study area –Department of Neurology, Bangur Institute of Neurosciences (BIN) Sample size: All patients presenting with acute demyelinating disease in the proposed time frame will be included in the sample. Methods of Data Collection - By history taking, clinical examination and relevant investigations data were analysed with appropriate statistical tests and methods to determine the significance and power of study.

Results: As of now, total 17 patients are included in the study among them, 15 are Female and 2 are male. 4 NMOSD, 2 MOGAD, 4 MS, 6 seronegative longitudinally extensive transverse myelitis (LETM) and 1 systemic lupus erythematosus (SLE) associated demyelinaton. Total 7 patients having movement disorder. Two is having gait ataxia, one is having tremor, one is having dystonia with tremor, and one is having hemifacial spasm and one is having palatal myoclonus. One patient of MS, ocular Movement abnormalities in the form of vertical and horizontal nystagmus. Any correlation with socio- demographic Data, age, radiological burden, duration of illness, correlation with inflammatory markers and cerebrospinal fluid (CSF) protein value and other parameters is sought off. Study is going on.

Discussion: The spectrum of movement disorder including hypokinetic disorder like Parkinsonism (though rare), etc. and hyperkinetic movement disorder and others will be included in the study.

Conclusion: Spectrum of movement disorder is vivid and unique in its own way. The spectrum of movement disorder in demyelination disorders is less vividly projected in literature. So, we have tried to study this in this thesis.

Abstract ID 781: Beyond the Grayscale: Re-evaluating the Prognostic Value of CT Density in Cerebral Venous Thrombosis

Perumalla M V S Alekhya, R Subasree, Girish Kulkarni, Hima Pendharkar

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Cerebral venous thrombosis (CVT) is a stroke subtype resulting from thrombus formation in the dural venous sinuses. Non-enhanced computed tomography (NECT) is commonly used as an initial imaging modality due to its wide availability and speed, although its diagnostic accuracy remains limited (sensitivity 68% and specificity 52%). This study aimed to evaluate whether serial computed tomography (CT) density measurements could serve as a simple tool for monitoring thrombus evolution over time. Objective was to assess longitudinal changes in CT density within different involved cerebral venous sinuses and see their correlation with recanalization outcomes.

Methodology: Fifty patients with confirmed cerebral venous thrombosis underwent non-enhanced CT scans at admission, within 14 days, and at 3–6 months. CT densities were analyzed using linear mixed models. All received heparin acutely and acenocoumarol for long-term anticoagulation, targeting an International Normalized Ration (INR) between 1.5 and 2.0.

Results: A total of 46 patients were followed up for 1 year, with a mean age of 33.6 ± 11.2 years, of whom 56% were male. Headache (96%) and seizures (62%) were common presentations. The superior sagittal sinus was most frequently involved (72%). CT density declined significantly over time across all sinuses (p value <0.05), indicating thrombus resolution. Higher baseline CT densities were associated with partial recanalization, whereas lower initial densities with modest declines over time were more often linked to complete recanalization.

Discussion: This study demonstrated a significant decline in CT density over time across all sinuses, consistent with thrombus resolution. Although patients with recanalisation showed a numerically slower decline in density, the interaction between time and recanalisation status was not statistically significant.

Conclusion: Serial reductions in CT density suggest progressive thrombus resolution; however, their relationship with recanalisation is complex and nonlinear, highlighting the need for comprehensive clinical, etiological, and radiological follow-up in CVT management.

Abstract ID 782: An Ambispective Study to Compare the Frequency of Post-Stroke Seizures in Patients Treated with and without IV Thrombolysis

Jayaram S, Pradeep Nair, Sunil Narayan, Mahadevan D, Pradeep P Nair, Sunil K Narayan, Sunil K Narayan, Pradeep P Nair, Sunil K Narayan

Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Background and aim: Post-stroke seizures (PSS) and epilepsy (PSE) are significant complications of acute ischemic stroke, but the impact of thrombolysis remains controversial. The aim of this ambispective study was to compare the PSS/PSE frequency, identify risk factors, and evaluate predictive utility of the SeLECT score in thrombolysed and non-thrombolysed patients.

Methodology: We recruited adults (>18 years) with acute ischemic stroke (National Institute of Health Stroke Scale [NIHSS] > 5) managed with and without intravenous (IV) thrombolysis with groups matched for age, gender, and vascular territory. Exclusion criteria were prior epilepsy or intracranial pathology. Primary outcomes were frequency of late PSS/PSE (>7 days); secondary outcomes included early PSS (>7 days), factors associated with early PSS, PSE and self-limited epilepsy with centrotemporal spikes (SeLECT) score performance. We collected the data of stroke patients managed between January 2018 and July 2023 retrospectively from hospital digital records and from August 2023 to December 2024 prospectively. Patients were telephonically contacted wherever required.

Results: Among 422 participants (203 thrombolysis, 219 controls), PSS occurred in 56 (13.3%), with early PSS in 19 (4.5%) and late PSS in 37 (8.8%) participants. Four patients with early PSS later developed late PSS making the frequency of PSE as 41 (9.7%). Thrombolysis significantly reduced early PSS (2% vs. 6.8%, p < 0.05) and PSE (4.9% vs. 14.2%, p < 0.05).

Discussion: Independent predictors of early PSS were thrombolysis (OR = 0.185, 95% CI: 0.06–0.6) and NIHSS at admission (OR = 0.87, 95% CI: 0.78–0.96). Independent predictors for PSE included age (OR = 1.04, 95% CI: 1.01–1.08), alcohol use disorder (OR = 2.98, 95% CI: 1.46–6.08), MCA involvement, and thrombolysis (OR = 0.17, 95% CI: 0.07–0.39). Thrombolysis demonstrates neuroprotective benefit by lowering both early & late PSS risk.

Conclusion: IV thrombolysis is associated with reduced risks of early and late PSS/PSE, suggesting a protective effect. Stroke location, alcohol use, and surgical intervention modulate seizure risk. These findings highlight thrombolysis as beneficial therapy not only for stroke outcomes but also for mitigating seizure related complications.

Abstract ID 783: A Rare Psychiatric Manifestation of Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease (MOGAD)

P Renjen, Suman Kushwaha¹, Om Prakash¹, Shailesh Jha, Nidhi Goyal, Nayaab Saeed

Indraprastha Apollo Hospitals, New Delhi, ¹Institute of Human Behaviour and Allied Sciences, Delhi, India

Background and aim: Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a demyelinating disease of central nervous system which clinically present with optic neuritis, transverse myelitis, or encephalitis. Radiological features of MOGAD include demyelinating spinal, cerebral, cortical involvement, leptomeningeal enhancement or tumefactive lesions. Psychiatric manifestation of demyelinating disorder is a very unusual presentation. MOGAD presenting as catatonia is an extremely rare and hardly read and heard symptom. Catatonia is a neuropsychiatric symptom which is characterized by psychomotor and behavioral symptoms. It can be associated with various psychiatric disorder, neurological disorders like stroke, Parkinson’s disease, autoimmune encephalitis and demyelinating disorders, metabolic disturbance and drugs.

Methodology: Here, we presented a case study of a 42-years-old female presented with catatonia with an underlying demyelinating disease. Patient exhibited symptoms of confusion, and decreased oral intake. Neurological examinations, brain imaging, and laboratory tests were conducted to look for the etiology and guide treatment.

Results: Lorazepam challenge test was performed to which she showed significant improvement, but symptoms started waxing and waning after initial improvement and so electroconvulsive therapy (ECT) was performed to which she improved.

Discussion: This case highlights a patient with a demyelinating disorder presenting with catatonia. The study patient is unique because there are only one or two case reported as of now in literature that is MOGAD presenting as catatonia. This case also highlights that irrespective of the etiology of catatonia lorazepam and ECT are the main line of management.

Conclusion: Psychiatric manifestation though rare should be looked for and evaluated if index of suspicion is very high about demyelinating disorder. Catatonia is an extremely rare manifestation of MOGAD and if timely evaluated and adequately treated can lead to miraculous improvement.

Abstract ID 784: Antibodies at Play: Rollercoaster Ride with Triple Positive Myasthenia

Kunkala Lavanya, S Sundar¹, Lakshmi Narsimhan, P Philohazeena, Vijaya Shankar²

Enel Hospitals Nellore, Andhra Pradesh, ¹Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, ²Apollo Hospital Chennai, Tamil Nadu, India

Background and aim: Myasthenia gravis (MG) is a fluctuating neurological disorder which is due to an immunological attack against post synaptic membrane of neuromuscular junction.

Methodology: A 32-year-old female postpartum 2 months, presented with complaints of flaccid dysarthria, ptosis, proximal muscle weakness with power of 4/5, poor gag and cough reflex, unable to blow or whistle. MG composite scale was 27.

Results: In view of waxing and waning of symptoms, started pyridostigmine and noticed improvement. Anti-acetylcholine antibodies (Anti-AChR), anti-titin, anti-Low density lipoprotein receptor -related protein 4 (anti-LRP4) antibodies were positive. Considering impending myasthenic crisis with severe bulbar involvement, intravenous (IV) Immunoglobulin was given. After 2 weeks, desaturated with worsening of bulbar symptoms, immediately IV plasmapheresis was initiated. Post thymectomy, was symptom free for 10 days. But, then again symptoms resumed back. Gradually increased steroids, mycophenolate. Rituximab 2 doses were given, post rituximab worsening was noticed and gradually stabilized.

Discussion: Myasthenia is an autoimmune chronic immunological disease that affects post synaptic membrane at neuromuscular junction. Anti -AChR antibodies are polyclonal immunoglobulin G1 (IgG1 and G3), binding to extracellular domains of AChR and impair signal transduction, antigenic modulation and complement activation. LRP4 are IgG1 an 2 subclasses, disrupt the agrin -LRP4 interaction and leading to inhibition of AChR mediated neuromuscular transmission. Anti Titin antibodies (Ig G1 and G4) are abundant in skeletal muscles, marker of early onset MG, marker of thymoma.

Conclusion: In this case presence of three antibodies with severe bulbar involvement and worsening of symptoms post rituximab infusion was noticed. Unlike regular cases, response to rescue therapies was poor. Clinical symptoms of anti- AChR positive MG combined with titin antibody were more severe and progressed faster. The hypothesis of post rituximab treatment worsening includes antibodies release from degraded lymphocytes, increased activity of cholinesterase and increase in immune reactions.

Abstract ID 785: Subthalamic Deep Brain Stimulation in Westphal Variant of Juvenile Huntington’s Disease

Ruchika Tandon, Pawan Verma, Saurabh Nigam, Neha Pandey, Anshika Srivastava

Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background and aim: Juvenile-onset Huntington disease (HD) is a rare kind of HD. Huntington’s disease patients with predominantly choreic symptoms and even Westphal variant of HD may be benefited from bilateral globus pallidus internus (GPi) Deep Brain Stimulation (DBS) to some extent, though the trials give inconsistent results.

Methodology: We present a rare patient of Westphal variant of Juvenile Huntington’s disease who responded very well to subthalamic nucleus (STN) DBS.

Results: A 24-year-old engineer presented with features of Parkinsonism for 7 years and levodopa induced dyskinesias for 5 years, along with some sleep disturbances. He was referred to our institute for DBS. His autonomic function tests and magnetic resonance imaging (MRI) head was normal, Unified Parkinson’s Disease Rating Scale (UPDRS) score was 92/199 without levodopa and 50/199 with levodopa. In view of young-onset Parkinsonism, his whole-exome sequencing was considered, which came out to be normal and due to some sleep disturbances, for ruling out Westphal variant of Huntington’s disease, we sent a repeat analysis for Huntingtin gene and found an upper allele repeat size of 43 ± 2 and a lower allele repeat size of 17 ± 1. There was no significant history for a similar illness in any of the family members and the allele repeats in the parents were within normal limits. Patient underwent bilateral STN DBS with rechargeable implantable pulse generator placement. The patient has been under follow up for two years now and is tolerating DBS well.

Discussion: Previous studies have used GPi DBS in HD patients, including Westphal variant ones, rather than STN DBS. These trials give inconsistent results with chorea-predominant disease giving best results.

Conclusion: Cases of Westphal variant of Huntington’s disease such as these may be taken up for STN DBS, provided they fulfil all the other criteria for undergoing DBS contrary to the traditional thinking of HD being not very responsive to DBS.

Abstract ID 786: Epileptic-Motor Spectrum Disorders in Rare Neurogenetic Syndromes: A Case Series Review

Aishwarya Jirwankar, Shailina Ali, Neeraj Jain, Sangeeta Ravat, Mayur Thakkar, Shruti Agrawal

Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India

Background and aim: Epilepsy and movement disorders often coexist in neurogenetic syndromes due to shared pathophysiological mechanisms. Advances in genetic sequencing have uncovered key mutations contributing to both. This case series presents three patients with SCN8A, DHDDS, and ZNF142 mutations, highlighting phenotypic overlap, diagnostic challenges, and the utility of genetic testing.

Methodology: We retrospectively reviewed three patients evaluated between 2024 and 2025 for concurrent epilepsy and hyperkinetic movement disorders. Clinical data included seizure semiology, developmental history, neuroimaging, electroencephalogram (EEG), whole-exome sequencing, and treatment responses. Variants were classified per American College of Medical Genetics and Genomics (ACMG) guidelines.

Results: All patients exhibited coexisting epilepsy and hyperkinetic movement disorders, including chorea, dystonia, tremor, myoclonus, and global developmental delay. Neuroimaging ranged from normal to mild cerebral atrophy or gliosis; EEG showed focal discharges. Genetic analysis revealed a SCN8A variant of uncertain significance, a heterozygous pathogenic DHDDS mutation, and compound heterozygous ZNF142 mutations. Seizures partially responded to sodium channel blockers; movement disorders showed limited improvement with benzodiazepines and supportive therapies.

Discussion: These cases illustrate the clinical complexity of neurogenetic syndromes presenting with overlapping epileptic and motor features. Diagnostic differentiation between seizure-related and independent movement disorders is often difficult. Genetic testing proved crucial in identifying causative mutations and preventing misdiagnosis. Although treatment options remain limited, identifying the underlying etiology informs prognosis and guides future care. These findings expand the known phenotypic spectrum associated with SCN8A, DHDDS, and ZNF142 mutations.

Conclusion: Recognizing combined epilepsy and movement disorders in neurogenetic syndromes is essential for accurate diagnosis and management. Early genetic testing plays a pivotal role in guiding care. Further research is needed to refine genotype–phenotype correlations and develop targeted therapies.

Abstract ID 787: Clinical and Neuroimaging Predictors of Seizures in SSPE Patients

Ajeet Jaiswal, Shweta Pandey

King George’s Medical University, Lucknow, Uttar Pradesh, India

Background and aim: Subacute sclerosing panencephalitis (SSPE) is a progressive, fatal neurodegenerative disorder following persistent measles infection. Seizures are a common yet variably expressed complication in SSPE, contributing significantly to morbidity. Predictors of seizure occurrence remain underexplored. Aim was-to evaluate clinical, electroencephalographic (EEG), cerebrospinal fluid (CSF), and neuroimaging predictors associated with seizure development in patients with SSPE.

Methodology: This hospital-based, prospective observational study was conducted over 18 months (June 2023–December 2024) at the Department of Neurology, King George’s Medical University, Lucknow. Forty-four patients fulfilling Dyken’s diagnostic criteria for SSPE were enrolled using purposive sampling. All patients underwent detailed clinical staging (Jabbour’s), neurological disability assessment (NDI), and modified Rankin Scale (mRS) scoring. EEG and magnetic resonance imaging (MRI) brain scans were obtained alongside CSF analysis. Patients were followed for six months, with seizure occurrence and disease progression recorded.

Results: Seizures were observed in 31.8% of patients, predominantly generalized tonic-clonic type. Cortical signal changes on MRI were significantly associated with seizures (p = 0.001), seen in 92.9% of seizure cases. Temporal lobe white matter changes showed a near-significant trend (p = 0.082). EEG revealed a significant correlation between seizures and epileptiform discharges, particularly generalized and multifocal patterns (p = 0.005). No significant differences were found between seizure and non-seizure groups regarding age, sex, vaccination status, or CSF pleocytosis. Behavioral abnormalities and higher disability scores were more common in the seizure group but did not reach statistical significance.

Discussion: In this study of 44 SSPE patients, seizures occurred in one-third, mainly generalized. Seizures correlated significantly with cortical MRI abnormalities and epileptiform EEG discharges, especially in temporo-occipital regions, but not with CSF or clinical parameters. Findings highlight cortical damage and electrical hyperexcitability as key seizure predictors in SSPE.

Conclusion: In SSPE, seizures are strongly linked to cortical MRI changes and epileptiform EEG patterns, highlighting their value as early markers for seizure risk and guiding timely interventions.

Abstract ID 788: Clinical Spectrum and Outcomes of Focal Cortical Encephalitis: A Retrospective Study from a Tertiary Care Centre

Hemanth J, Prabhakar Appaswamy

Christian Medical College, Vellore, Tamil Nadu, India

Background and aim: Focal cortical encephalitis (FCE) is a rare neurological condition characterized by localized cortical inflammation with varied presentation and diverse aetiologies. This study aimed to evaluate the clinical characteristics, imaging patterns, treatment approaches, and outcomes in patients diagnosed with FCE over a two-decade period.

Methodology: We conducted a retrospective analysis of patients diagnosed with FCE between 2005 and 2025 at a tertiary care centre. In last 20 decade the number of patients admitted with encephalitis was 990, out of which 33% (n = 28) were labelled as focal cortical encephalitis. Data on demographics, comorbidities, presenting symptoms, imaging findings, cerebrospinal fluid (CSF) analysis, antibodies and treatment were collected. Primary outcomes included modified Rankin Scale (mRS) score at 3 months and duration of hospital stay. Logistic regression analysis was used to identify predictors of poor outcomes.

Results: A total of 28 patients were included mean age was 47.6 years (SD: 16.4), and 53.6% were male. Focal seizures was the predominant presentation (85.7%), followed by visual symptoms (28.6%) and weakness (25%). Visual manifestations such as cortical blindness and prosometamorphopsia were common in occipital lobe involvement. Herpes simplex virus (HSV)-related FCE had varied presentations, and MOG-Ab-associated cases showed stereotypical frontotemporal patterns. Most of patients were initially treated with antiviral followed by immunotherapy in most 65% received steroids, 9.3% intravenous immunoglobulin (IVIG), and 9.3% rituximab. The mean mRS improved from 2.46 at admission to 1.36 at 3 months. Status epilepticus was associated with prolonged hospitalization (p = 0.020), and HSV encephalitis predicted worse outcomes (p = 0.038). Most patients (78%) showed good recovery (mRS < 2) at follow-up.

Discussion and conclusion: Focal cortical encephalitis is a rarely diagnosed entity among the encephalitic spectrum with varied focal neurological presentation and seizures. Early recognition and immunomodulatory therapy after ruling out infection led to favourable outcomes in most cases. A multidisciplinary and aetiology-driven approach is essential for optimizing patient outcomes.

Abstract ID 789: Cardiac Autonomic Functions in Patients with Epilepsy on Anti-Seizure Medications- A Longitudinal Study

Rohit Kushwah

All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Background and aim: Aims of the study incuded (1) Assess cardiac autonomic function in drug-naive patients, (2) To compare cardiac autonomic functions in monotherapy group in patients with epilepsy, and (3) To compare cardiac autonomic functions in monotherapy group and polytherapy groups in patients with epilepsy. Inclusion criteria: Age >18 years and patients fulfilling diagnostic criteria of epilepsy Exclusion criteria: Cardiac diseases, type 2 diabetes mellitus (DMT2) and other metabolic disorders, peripheral neuropathies, Drugs, etc.

Methodology: This prospective observational study was conducted at a tertiary care hospital on patients of epilepsy including drug naïve, monotherapy, polytherapy, drug refractory epilepsy (DRE) and those who were underwent epilepsy surgery after exclusion of factors responsible for CAD other than epilepsy and anti-seizure medications (ASMs). All were tested for baseline autonomic function tests (AFT) including reactivity and heart rate variability (HRV) parameters to assess for sympathetic and parasympathetic dysfunction. They were also assessed with respect to duration of ASM use with a second follow up AFT to determine effect of ASMs and epilepsy in interictal phase.

Results: The AFTs in various group showed non-significant effect of ASMs on reactivity parameters of cardiac autonomic functions at base line and at follow up. The HRV results were variable among different groups though not statistically significant

Discussion: The present study aimed to assess CAD among patients with epilepsy who were not on ASMs, as also those on ASMs, including monotherapy and polytherapy and comparing them at baseline in order to identify any significant difference between drug naïve patients versus those on pharmacotherapy. The study delved into generating evidence, if any, of involvement of AFT due to epilepsy and/or ASMs.

Conclusion: The study highlights that while long standing epilepsy maybe associated with parasympathetic dysfunction during the interictal period, ASMs can be used safely in patients with epilepsy either as monotherapy or polytherapy without considering them responsible for or a major cause of CAD.

Abstract ID 790: Minimum Clinically Important Difference (MCID) in Epilepsy- A Systematic Review of Thresholds of Scales Reported in Epilepsy Research

Pachipala Sudheer, Biswamohan Mishra¹, Vishnu VY²

KIMS Hospital, Hyderabad, Telangana, ¹Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, ²All India Institute of Medical Sciences, New Delhi, India

Background and aim: The minimally clinically important difference (MCID) quantifies the smallest change in health outcomes that patients perceive as beneficial, thereby bridging statistical significance and clinical relevance. In epilepsy, where treatment goals extend beyond seizure freedom to quality of life (QOL), cognition, and psychosocial well-being, MCID is critical for patient-centered care. However, epilepsy-specific MCID validation remains limited, with only a few studies among the broader neurology literature.

Methodology: This review synthesized evidence from 127 neurology studies (including 11 epilepsy-specific investigations encompassing 3,482 patients). MCID derivation methods were analyzed: (1) Anchor-based (linking outcome changes to patient-reported anchors like the Patient Global Impression of Change [PGIC]); (2) Distribution-based (using statistical metrics like 0.5 standard deviation [SD]); and (3) Integrated approaches combining both. Outcome domains included QOL (QOLIE-31, QOLIE-AD-48), seizure severity (SSQ), and adverse effects (PESQ).

Results: MCID values varied by domain, instrument, and population: -QOLIE-31 5.0 points (drug-resistant epilepsy) to 16.47 points (surgical cohorts). - Seizure Severity (SSQ): 0.48 points. - Adverse Effects (PESQ): 3.25 points. Anchor-based methods dominated (64% of studies), primarily using PGIC (73%). Surgical populations were overrepresented (55%), yielding higher MCIDs than pharmacotherapy groups. Pediatric QOL tools showed lower thresholds (QOLCE: 2.9–6.0 points).

Discussion: Significant heterogeneity challenges standardization, including anchor inconsistency (variable PGIC scales), statistical variability (e.g., 0.5 SD vs. SEM), and population biases (baseline dependency, Western cohorts). Surgical MCIDs exceeded pharmacological values, reflecting intervention-specific expectations. Critical limitations include neglect of deterioration thresholds, caregiver burden, and comorbidity influences.

Conclusion: MCID ranges for epilepsy outcomes are established (QOLIE-31: 5–16.47; SSQ: 0.48; PESQ: 3.25), but methodological and population variability impede clinical utility. Future work requires standardized epilepsy-specific anchors, integrated derivation frameworks, digital real-world assessment, and regulatory adoption to advance personalized, patient-centered care.

Abstract ID 791: The Restless Insomniac- Encounter with the Liquid Metal

Athira P, Chithra P

Government Medical College, Trivandrum, Kerala, India

Background and aim: Morvan’s syndrome is characterised by a triad of hyperexcitability in peripheral, central and autonomic nervous system. We described a case of Caspr2 antibody positive Morvans syndrome triggered by intake of traditional Siddha medication containing mercury.

Methodology: A 24-year-old male following intake of Siddha medications for two months, presented to us with intractable muscle cramps, twitching of anterior thigh muscles and deltoid followed by severe neuropathic pain. He had behavioural changes in the form of increased agitation, restlessness, insomnia amounting to agrypnia excitata. On examination, he had resting tachycardia around 120 beats per minute (bpm) with orthostatic hypotension, hyperhydrosis involving face, trunk and abdomen, orthostatic myoclonus of lower limbs, rest and action tremor of upper limbs, myokymia of calf muscles.

Results: Electromyography (EMG) showed evidence of neuromyotonia and cramp potentials. In view of history of heavy metal intake, Blood mercury level was done - 9.54 mcg/ L (reference range – 0.46-7.5 mcg /L). In view of features of peripheral nerve hyperexcitability, autonomic dysfunction and central nervous system (CNS) symptoms suggestive of insomnia along with behavioural disturbances, possibility of Morvan Syndrome was considered and serum autoimmune panel for LGI1 and CASPR2 antibodies was done. Anti CASPR2 antibody came to be positive.

Discussion: He was managed with intravenous methylprednisolone (IVMP) followed by PLEX. Concomitant chelation with dimercaptosuccinic acid (DMSA) was also administered. The study patient had features more in line with Morvans with mercury levels showing only borderline elevation and prompt response to immunomodulation with symptoms growing progressively worse even after stopping siddha medicines for two months. In this case, it is most likely that the mercury exposure triggered autoimmune mechanisms leading onto a full blown Morvans phenotype.

Conclusion: It is of paramount importance to distinguish mercury poisoning with direct damage to nerve terminals with secondary voltage-gated potassium channel (VGKC) antibody positivity from a full-fledged Morvans syndrome because prompt administration of immunomodulation is life-saving in latter.

Abstract ID 792: Case Series of MT.NDA (G11778A) Positive Leber Hereditary Optic Neuropathy: A Single Centre Descriptive Study from India Cohort

Karthik Survi, Kamlesh Jagiasi, Rakesh Singh, Kamlesh Jagiashi

Grant Medical College and JJ Hospital, Mumbai, Maharashtra, India

Background and aim: Leber hereditary optic neuropathy (LHON) is a maternally inherited mitochondrial disorder characterized by acute or subacute, painless, bilateral vision loss, primarily affecting young adults. In this study, we presented 7 genetically proven cases of MT-ND4 (G11774A) LHON their natural history, clinical profile, fundus features and response to idebenone therapy.

Methodology: We have Prospectively enrolled the seven patients who presented with vision loss and with genetically evaluated in view of high suspicion of LHON, who visited our institution between 12 January 2022 and 31 March 2024, and initiated them on Idebenone therapy and followed up for response.

Results: All of the study patients were male with mean age of 23.5 years. All of them had sub-acute sequential central vision loss with average interval of 6 weeks although one patient has bilateral diminution of vision. In patients, vision loss was severe and progressed over weeks and reach nadir by 4 weeks and got plateaued. Out of 7 patients, only 3 had contributory family history this might point to incomplete penetrance of the mutation.

Discussion: In 7 patients of MT-ND4 (G11774A), in comparison to study done by Blanc C et al., The classic triad of fundus findings LHON i.e., circumpapillary telangiectatic microangiopathy, swelling of the nerve fibre layer around the disc (pseudo-edema) is always not the feature, has shown pseudopapilledema as more common feature and has sever visual impairment. The study patients showed similar response to idebenone therapy in comparison to reality study.

Conclusion: LHON must be considered in case of unexplained bilateral sequential vision loss with family history and can be proven by genetic analysis there by adequate counselling about the lifestyle modification and Idebenone can be treatment option for this condition. While MT.ND4 (G11778A0) shown to cause severe form of LHON and has to be closely monitored and Idebenone therapy can help in halting disease process.

Abstract ID 793: Direct Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Global Synthesis of Randomized Evidence through Network Meta-Analysis

Pradeep Kumar, Manyata Srivastava, Annu Gulia

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, substantially increases the risk of ischemic stroke. Direct oral anticoagulants (DOACs) have become preferred alternatives to vitamin K antagonists (VKAs) for stroke prevention in both valvular (VAF) and non-valvular atrial fibrillation (NVAF). However, comparative evidence on the relative efficacy and safety of different DOACs remains limited. This network meta-analysis aimed to systematically assess and compare the efficacy and safety of various DOACs versus VKAs in preventing stroke and related outcomes among patients with AF.

Methodology: A comprehensive literature search of PubMed, EMbase, and the Cochrane Library was conducted for randomized controlled trials (RCTs) published up to October 31, 2024. A Bayesian network meta-analysis was performed using odds ratios (ORs) with corresponding 95% credible intervals (CrIs).

Results: A total of 43 RCTs were included, comprising 30 on VAF and 13 on NVAF. Compared to VKA, apixaban (OR = 0.81; 95% CrI: 0.73–0.91), dabigatran (OR = 0.77; 95% CrI: 0.68–0.87), and rivaroxaban (OR = 0.87; 95% CrI: 0.79–0.96) were significantly associated with reduced risk of IS/SE, while edoxaban showed a non-significant effect. All DOACs were significantly superior to VKA in reducing the risk of HS. For major bleeding, apixaban (OR = 0.69; 95% CrI: 0.55–0.88) showed a significant advantage over VKA, while dabigatran and rivaroxaban were associated with non-significant increases. In terms of all-cause mortality, apixaban significantly reduced risk in NVAF (OR = 0.88; 95% CrI: 0.82–0.96), whereas dabigatran, edoxaban, and rivaroxaban showed non-significant associations. In VAF, neither dabigatran (OR = 0.88; 95% CrI: 0.53–1.33) nor rivaroxaban demonstrated a significant impact on mortality.

Discussion: These findings support the preferential use of apixaban and dabigatran for stroke prevention in patients with AF.

Conclusion: Our findings reinforce the clinical value of DOACs, particularly dabigatran and apixaban, for the prevention of thromboembolic events.

Abstract ID 794: Clinical Profile and Predictors of outcome in Functional Movement Disorders- 25-year experience in a Movement Disorders clinic

Sayooja Sachithanandan, Divya K P, Asish Vijayaraghavan, Syam Krishnan

Sree Chitra Tirunal Institute for Medical Sciences and Technology,, Thiruvananthapuram, Kerala, India

Background and aim: In functional movement disorders (FMD) the subject perceives various movement disorders as involuntary, despite clinical findings demonstrating intact neurological function and a volitional component. We aimed to delineate clinical profile of FMD and predictors of long-term outcome

Methodology: Patients with FMD diagnosed in our hospital from 1999-2024 were reviewed. Their current status was evaluated through telephonic interviews. The baseline factors influencing outcome were determined

Results: Of the 198 subjects with FMD, mean age was 35.2 ± 15.4 years and 60.6% were women. Most presented with acute or hyperacute onset and had fluctuating course. The most common FMD phenomenology was gait dysfunction followed by mixed movement disorders. Tremor was the most common individual movement disorder phenomenology. Female gender and preceding physical injury were the most common predisposing and precipitating factors. Anxiety and hypervigilance were the most common perpetuating factors. Follow-up data after a mean duration of 5.34 ± 5.2 years, was available in 169 subjects and 109 had complete remission. Those with complete remission had a younger age and shorter duration at presentation, hyperacute onset, weakness as presenting phenomenology, identifiable precipitating event, received psychiatric counselling, and more often associated with resuming routine activities. Those who failed to have complete remission had a higher frequency of unemployed status, coexistent organic neurological disorders, medical comorbidities, segmental distribution, predisposing health anxiety behaviour. Among them, shorter duration at presentation, hyper-acute mode of onset, and absence of any medical comorbidities were the independent predictors for complete remission.

Discussion: We conducted a long-term follow-up of subjects with FMD, to study the clinical profile and predictors favouring complete remission.

Conclusion: Overall, FMD in this hospital-based study showed a favourable outcome, and baseline clinical features predicted long-term outcome.

Abstract ID 795: Study of Efficacy & Safety of Rituximab in Neuromyelitis Optica Spectrum Disorders in a Tertiary Care Centre in Eastern India

Sonalika Behera, Ashok Mallick, Kali Swain, Nihar Biswal, Ashwini Sahu

ShriRam Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India

Background and aim: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune central nervous system (CNS) inflammatory disorder that can lead to serious disability and mortality. To assess efficacy and safety of Rituximab in NMOSD using pre-defined disease outcome measures.

Methodology: This study includes patients of NMOSD diagnosis according to the 2015 revision of the Wingerchuk diagnostic criteria. The outcome variables are annualized relapse rate (ARR) and disease progression using the Expanded Disability Status Scale (EDSS).

Results: Mean Disease duration of total patients was 2.5 years +- 0.8 years. Mean age presentation of total patients was 42.33 ± 9.64. Majority of patients were in 5th decade. Myelitis was the major presentation. EDSS has been significantly decreased in 6 month & 12 months with p < 0.05. Approximately 0.7 of mean ARR has been decreased significantly at 12 months with p value <0.0001. Only 24.7% (n = 19) patients had relapses and 75.3% (n = 58) did not have any relapse during this study period. Major symptoms was myelitis followed by optic neuritis in relapse experienced patients. Only 16.9% (n = 13) patients had partial radiological improvement and 5.2% (n = 4) showed complete radiological improvement, 77.9% patients had static MR lesions during the total period of study. Out of all relapses Symptom specific lesions showed on magnetic resonance imaging (MRI) only in 9 (36%) and 64% relapses did not show symptom specific MR lesions. Seropositives had more significant motor disability and annualized Relapse rates than seronegatives in our study.

Discussion: Many studies have similar results with us showing treatment with Rituximab would markedly reduce relapse rate and significantly improved disability in NMOSD patients.

Conclusion: It could be considered as an effective and safe drug for long time maintenance therapy in these patients.

Abstract ID 796: The Impact of Educational Interventions on Stroke Outcomes: A Systematic Review

Amit Kumar, Tannu Kumari, Kameshwar Prasad¹, Surendra Kumar, Anupa Prasad, Ganesh Chauhan, Lakhan Manjhi, Vivek Verma²

Rajendra Institute of Medical Sciences, Ranchi, Jharkand, ¹All India Institute of Medical Sciences, New Delhi, ²Silcher University, Assam, India

Background and aim: This systematic review aimed to evaluate the impact of educational interventions provided to healthcare professionals on the clinical outcomes of patients with stroke, with particular focus on core stroke care parameters such as fever, blood glucose, blood pressure, and swallowing assessment.

Methodology: A systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD42025644132). Data Sources: Databases searched included PubMed, MEDLINE, EMBASE, Google Scholar, Cochrane Library, and Web of Knowledge. Studies were included if they evaluated educational or training interventions aimed at improving the management of critical stroke-related parameters (e.g., hyperglycemia, fever, dysphagia, hypertension) by nurses or other health professionals. Two reviewers independently screened articles, extracted data, and assessed study quality.

Results: Of the studies initially identified, a large proportion were excluded for reasons such as: not being original clinical research (49%), lacking an educational component (20%), not related to stroke (15%), not relevant to low- and middle-income countries (9%), focused solely on patient/family education (4%), or insufficient outcome reporting (3%). Ultimately, three high-quality cluster-randomized trials were included. These studies (from Australia, China, and Belgium) used multi-component educational interventions, such as workshops, clinical pathways, and team-based protocols. All demonstrated improved adherence to evidence-based practices and, notably, significant reductions in death or dependency at 90 days (QASC study), new vascular events (GOLDEN BRIDGE study), and better fever, glucose, and dysphagia management (QASC and Dominique trials).

Discussion: The evidence indicates that educational interventions, when embedded within system-level protocols and delivered through multidisciplinary engagement, can significantly enhance adherence to evidence-based stroke care. The QASC and GOLDEN BRIDGE trials further demonstrate downstream benefits in patient-centered outcomes like mortality, functional independence, and long-term vascular risk.

Conclusion: The Educational intervention seems to be efficacious and cost effective in the management of stroke.

Abstract ID 797: Clinical and Radiographic Predictors of Outcomes in Spontaneous Intracerebral Hemorrhage: A Prospective Study

Ayush Jain, Shri Ram Sharma, Baiakmenlang Synmon, Donboklang Lynser, Mahendra Thakre

North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India

Background and aim: Spontaneous intracerebral hemorrhage (ICH) is a stroke subtype with high morbidity and mortality, necessitating robust predictors for risk stratification. This study evaluated clinical and radiographic factors associated with poor outcomes in ICH patients at a tertiary care center.

Methodology: A prospective observational study was conducted from June 2023 to November 2024, with IEC approval. Eighty-five patients (66.5% male, mean age 56.02 ± 12.41 years) with spontaneous ICH, confirmed by non-contrast computed tomography (CT), from Neurology and Neurosurgery Departments. Informed consent was obtained. Clinical variables (e.g., Glasgow Coma Scale [GCS], ICH score, blood pressure) and radiographic features (e.g., hematoma volume, intraventricular hemorrhage [IVH], spot sign) were recorded at presentation. Outcomes were assessed using the modified Rankin Scale (mRS) at 90 days, with good outcome defined as mRS 0–3 and poor outcome as mRS 4–6. Statistical analysis used SPSS version 26 by principal investigator.

Results: At 90 days, mortality was 41 (22.2%), and good outcomes (mRS 0–3) reached 116 (62.7%). Hypertension (72.4%) and diabetes (33.0%) were prevalent, but irregular hypertension treatment was not significantly linked to outcomes (p = 0.271). Significant predictors of poor outcomes included hematoma volume (p < 0.001), IVH (p < 0.001), satellite sign (p < 0.001), hydrocephalus (p < 0.001), herniation (p < 0.001), spot sign (p = 0.012), blend sign (p = 0.022), swirl sign (p = 0.034), perihematomal edema (p = 0.012), heterogeneous hematoma (p < 0.001), hematoma expansion (p < 0.001), GCS (p < 0.001), and ICH score (p < 0.001). Multivariate analysis identified male gender (OR = 13.30, p = 0.012), spot sign (OR = 54.27, p < 0.001), and ICH score (OR = 5.74, p = 0.032) as independent predictors.

Discussion: Larger hematoma volumes (39.92 mL vs. 18.79 mL, poor vs. good outcomes), IVH (64.9% poor outcomes), and herniation (60.9%) strongly predict poor prognosis, reflecting neurological injury severity. Spot sign and male gender independently increase risk, emphasizing radiographic and demographic influences.

Conclusion: Early assessment of radiographic and clinical predictors, particularly spot sign and ICH score, can guide targeted interventions to improve ICH outcomes.

Abstract ID 798: Lafora Disease: A Case Series

Aditya Singh, Mridula Singh, Ashwin Panda, Pratik Babel, Aparna Thomas, Suman Kushwaha, Aldrin Anthony, Siddharth Maheshwari, Rajinder Dhamija

Institute of Human Behaviour and Allied Sciences, Delhi, India

Background and aim: Lafora disease is a rare autosomal recessive progressive myoclonic epilepsy (PME), marked by intractable seizures, cognitive decline, and intracellular polyglucosan (Lafora) bodies. Mutations in EPM2A or NHLRC1 underlie the condition. While well-documented in western populations, Indian data remains limited. We present three clinically and genetically confirmed cases from India.

Methodology: We retrospectively analyzed clinical features, imaging, electroencephalogram (EEG), biopsy, and genetic findings in patients fulfilling PME criteria with genetic or histopathological confirmation of Lafora disease. The cases were taken from a tertiary centre which were diagnosed between December 2023 and May 2025.

Results: Case 1: A 16-year-old male developed atonic seizures followed by Generalized Tonic-Clonic Seizure (GTCS), myoclonus, ataxia, visuospatial impairment, and cognitive decline. Magnetic resonance imaging (MRI), brain) was normal. EEG showed generalized slowing and spike discharges. Axillary biopsy revealed PAS-positive Lafora bodies. Case 2: A 15-year-old male presented with seizures since age of 8, progressive cognitive decline, myoclonus, and visual disturbance. EEG showed posterior slowing. MRI (brain) was within normal limits. Whole-exome sequencing (WES) confirmed NHLRC1 mutation. Case 3: A 24-year-old male experienced cognitive decline, behavioral changes, GTCS, and myoclonus over two years. EEG showed occipital spikes. MRI (brain) revealed normal findings. WES revealed EPM2A mutation.

Discussion: All patients presented between ages 14–22 with atonic or generalized seizures, cognitive impairment, and myoclonus. Mean age of onset was 14 years. EEG showed generalized or posterior slowing. MRI (brain) was unremarkable. Genetic mutations was detected in two patients, while one was diagnosed with axillary skin biopsy.

Conclusion: This case series emphasizes the clinical spectrum of Lafora disease. Review of Indian data revealed only one case series from NIMHANS, Bangalore. Although our cases were similar to previously described, but the study patients presented with rare symptoms like ataxia and visual disturbances. Early recognition through EEG, biopsy, and genetic testing is vital for timely diagnosis and genetic counselling.

Abstract ID 799: Occupational Lead Exposure and Its Neurological Impact: “A Silent Workplace Hazard”

Chukka Yashaswi

ESIC Superspeciality Hospital, Hyderabad, Telangana, India

Background and aim: Lead is a heavy metal that can enter the body through inhalation, ingestion or dermal contact. Once in the bloodstream, lead can cross the blood brain barrier especially in children and cause widespread neurological damage. Adults remain at significant risk particularly in occupation settings such as battery manufacturing, construction and metal smelting. The neurological effects of lead range from cognitive impairment and mood disorders to irreversible neurodegeneration. These effects may take years to surface by when the damage is often extensive and irreversible, hence the term silent hazard.

Methodology: We presented three patients with chronic lead exposure with diverse clinical presentations.

Results: Case 1: A 55-years-old male patient battery worker by occupation presented with sudden onset vertigo and fall. Examination revealed normal neurological examination. Computed tomography (CT) brain suggestive of extensive calcifications of basal ganglia, thalami, dentate nuclei, globus pallidus and subcortical white matter. Serum lead levels found elevated. Case 2: A 58-years-old male patient battery worker by occupation presented with subacute onset of ataxia. Examination revealed cerebellar ataxia. CT brain suggestive of diffuse calcifications in bilateral basal ganglia and cerebellar hemispheres and subcortical white matter. Serum lead levels elevated. Case 3: A60-years-old male patient battery worker by occupation presented with subacute right upper limb distal weakness. On examination right wrist drop noted. Nerve conduction studies (NCS) suggestive of motor axonal neuropathy. Imaging revealed diffuse cerebral calcifications. Serum lead levels found elevated.

Discussion: Lead exposure can potentially lead to cerebral calcifications, especially in the context of chronic or high-level exposure, through mechanisms related to calcium mimicry and metabolic disruption. This is more common in children and rare in adults but possible, usually in the setting of chronic high level exposure.

Conclusion: Clinicians should be aware of this potential association, especially in symptomatic individuals with a relevant exposure history.

Abstract ID 800: A Study of Clinical and Prognostic Significance of Sural Nerve Involvement in Guillain Barre Syndrome

Tejaswini Sunkara, Arifa Rahman

ESIC Super Speciality Hospital, Sanath Nagar, Hyderabad, Telangana, India

Background and aim: The objective of this study was to identify if sural nerve compromise is associated with a worse prognosis and to describe clinical and electrophysiological characteristics in Guillain-Barr´e syndrome.

Methodology: Included patients with Guillain-Barre syndrome (GBS) diagnosis, from ESIC super speciality hospital. Clinical characteristics recorded include: age, gender, muscle power at diagnosis, the GBS disability scale at diagnosis, length of hospital stay. All patients were followed up for 3-months. Patients who were able to walk unaided (GDS ≤2 points) were considered to have a short-term good functional prognosis. Recordings of amplitude, distal latencies and conduction velocities of the motor nerves, as well as the recording of the sensory nerve action potential measured in microvolts of the median and sural nerve was taken.

Results: A total of 20 patients were included. Sural nerve involvement was observed in 25% of cases. Patients with sural nerve involvement were significantly older, mean age 50.6 vs. 44.5 years and had higher disability scores, GDS ≤3 in 91% vs. 76%. However, no significant difference was found in short-term functional recovery. Multivariate analysis revealed age >50 years as an independent predictor of sural nerve involvement.

Discussion: There was no significant difference in short-term functional outcomes. Study supports the diagnostic utility of sural sparing as a highly specific but not sensitive sign in GBS. Sural involvement was not confined to any specific electrophysiological subtype. Electrophysiological parameters such as comound muscle action potential (CMAP) amplitudes and conduction velocities did not differ significantly between the two groups, reinforcing that sural involvement alone may not reflect more extensive axonal damage.

Conclusion: Our findings suggest that sural nerve involvement should not be considered a marker of poor short-term outcome in GBS.

Abstract ID 801: Clinical Spectrum of Moya Moya Vasculopathy

Ojeswi Devanapally, Anuja Patil

KIMS Hospital, Hyderabad, Telangana, India

Background and aim: Objectives included 1) To analyze the demographics, clinical presentation and progression of the disease. 2) To compare medical management Vs early surgical intervention, and 3) To study for secondary causes of the disease.

Methodology: Retrospective data analysis with all cases admitted in a single tertiary care center with study cohort of 23 patients. 15 were females (65%) and 8 males (35%). Minimal age of presentation was 3 months and maximum was 62 years.

Results: Duration of progression was 1 week to 12 years. Primary Moya Moya vasculopathy were 17 (73%) and secondary causes of Moya Moya Vasculopathy were 6 (27%)- 2 cases: Varicella IgM positive, one case: Antiphospholipid Antibodies (APLA) IgM positive, one case: antinuclear antibody (ANA) positive, one associated with neurofibromatosis and one with Intra Cranial Atherosclerotic Disease (ICAD). Surgical intervention was done in 18 cases, remaining 5 cases were managed medically. Total death rate was 4.34% (1 case on medical management). Presentation was varied, seizures in 4 cases (22%), transient ischemic attack (TIA) in 4 cases (22%), hemiparesis in 10 cases (43%), vision loss in 3 cases (13%), and headache in 3 cases (13%). Unilateral disease in two cases, one with ICAD and other is idiopathic, rest 21 cases had bilateral disease. Posterior circulation (PCA) along with anterior circulation involvement is noted in 2 patients. Prognosis is measured by modified Rankin Scale (mRS) score. mRS score was 0-3 after 6 months in 40% patients who presented with hemiparesis/ hemiplegia. mRS score was 0-3 in 60% patients with presentation other than hemiparesis / hemiplegia (seizures/ TIA/ visual disturbances).

Discussion: As compared to previous studies, posterior circulation involvement (9%) is higher in the present study. Mean age of presentation and female predominance, secondary causes of the disease were similar.

Conclusion: Early surgical intervention in necessary patients offered better clinical outcome than medical management alone.

Abstract ID 802: Burning Paths and Silent Clues Unveiling Vasculitic Neuropathy

Vasu Daruvuri, Shanmuga Sundaram, M Jude Vijay, A Vignesh Kumar

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Vasculitic neuropathy is a rare yet treatable condition, often masquerading as other peripheral nerve disorders. It may occur as part of systemic vasculitis or as an isolated phenomenon. The hallmark presentation is mononeuritis multiplex—a painful, asymmetric sensorimotor neuropathy. This case series aimed to highlight the clinical spectrum, diagnostic strategies, and importance of early recognition of vasculitic neuropathy.

Methodology: A retrospective analysis was conducted on five patients presenting with progressive neuropathic symptoms. Each underwent a comprehensive evaluation, including inflammatory markers, autoimmune panels, nerve conduction studies (NCS), and nerve biopsy when indicated. Clinical data, electrophysiological findings, and histopathological results were reviewed and correlated.

Results: All five patients presented with subacute onset of sensorimotor deficits, primarily in the distal extremities. NCS consistently demonstrated bilateral sensorimotor axonal polyneuropathy. Inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated across all cases. Autoimmune testing showed variable positivity, with markers like antinuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA), and anti- anti-cyclic citrullinated peptide (CCP) appearing in selected patients. Nerve biopsy confirmed vasculitic neuropathy in four of the five cases, revealing evidence of vascular inflammation and axonal injury.

Discussion: The series reinforces that vasculitic neuropathy frequently mimics other neuropathies, necessitating a high degree of clinical suspicion. The combination of electrophysiological studies and biopsy remains essential for definitive diagnosis. While autoimmune markers may assist, they are not universally present. Early diagnosis is critical, as prompt immunosuppressive therapy can significantly alter the disease course.

Conclusion: Vasculitic neuropathy should be considered in patients presenting with rapidly evolving or asymmetric neuropathies. A thorough diagnostic workup—including NCS, serological testing, and biopsy when feasible—is crucial for early intervention, minimizing long-term morbidity, and improving patient outcomes.

Abstract ID 803: A Study on Understanding the Pathways to Care in Children with Neurological Disorders: A Karnataka Brain Health Initiative (KaBHI) Perspective

Aradhya Bagchi, Hansashree Padmanabha, Rupam Mandal, Harshini Manohar, Thomas Kishore, Priya Thomas, Senthil Amudhan, Raghavendra Kenchaiah, Suvarna Alladi

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: To understand the pathways to care in children with neurological disorders seeking healthcare services at tertiary care hospital from Karnataka state.

Methodology: This cross-sectional, exploratory study included pediatric patients (<18 years) from the state of Karnataka, India, diagnosed with a neurological disorder, attending the Neurology department of NIMHANS. The provisional diagnosis was noted and the disease classified into either into (i) neurodevelopmental, (ii) cerebral palsy, (iii) metabolic and genetically mediated disorders, (iv) neuroinfections and immune mediated disorders and (v) miscellaneous disorders. Data on their demographics, time taken to visit neurologist/pediatric neurologist and tertiary healthcare centre, and details of consultation with each healthcare provider prior to arrival at NIMHANS, was collected, and analysed using appropriate statistical methods.

Results: A total of 164 patients were recruited, of which 40.9% were females. The median age of the subjects was 10 years. The most common group of disorders was neurodevelopmental (40.2%), followed by metabolic /genetically mediated (25.6%). The number of healthcare visits before reaching our centre ranged from 0-8, with 62.2% having >1 visit. Out of a total of 31 districts in Karnataka, district with maximum representation was Bangalore urban (32.31%), followed by Tumkur (6.09%). The most commonly visited specialist in the first visit was pediatrician (65.8%), followed by general neurologist (7.3%). In 50.6% of the population, a delay of > 6 months after symptom onset in accessing tertiary health care/neurology/pediatric neurology services was noted. The median time taken to reach neurologist and tertiary healthcare centre were 150 and 67.5 days respectively. Among the delayed, the maximum delay was noted among metabolic/genetically mediated (71.4%) while the least was with neuroinfections and immune mediated disorders (13.8%).

Discussion: Early recognition of symptoms and referral to the specialist can expedite recovery/reduce morbidity in most patients.

Conclusion: There is a need to focus on strengthening the referral policies of primary healthcare in view of delayed treatment accessibility.

Abstract ID 804: Factors Determining Use of Reperfusion Therapy in Extended Time Window in Acute Ischemic Stroke

Pasupunuri Sukrit, Subhash Kaul

KIMS Hospital, Hyderabad, Telangana, India

Background and aim: Eligibility for reperfusion therapies beyond the standard time window in acute ischemic stroke depends on magnetic resonance imaging (MRI)/computed tomography (CT) based clinical-core volume mismatch and perfusion based imaging by AI software. However, all patients reporting to hospital within this period do not get the reperfusion therapy. The aim of present study was to assess factors influencing use of intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT) in the extended window period at our centre.

Methodology: Patients presenting within 24 hours of onset, underwent clinical evaluation, MRI with diffusion-weighted imaging (DWI)/perfusion-weighted imaging (PWI) sequences and in some, AI based evaluation of infarct core and penumbra.

Results: Among the 30 patients studied, 3 presented within 4.5 hours, all of whom underwent IVT. Twenty-seven patients presented between 4.5 and 24 hours, out of whom 6 were lacunes and 13 had large vessel occlusions (LVO) of whom only 2 underwent EVT. Among the remaining 11 LVOs, 2 recanalized, 1 after IVT and 1 spontaneously. Four patients had low mismatch ratio, 1 large core infarct, 1 low NIHSS, 1 had a chronic occlusion, 1 had financial constraint and 1 did not give consent because of non-guaranteed outcome.

Discussion: All patients that presented within 4.5 hours underwent IVT. Out of 13 patients with LVO, 11 patients did not undergo EVT for above mentioned reasons. AI based software, rather than helping to include more patients excluded 4 patients from EVT.

Conclusion: Clinical assessment and non-AI imaging methods like DWI-FLAIR mismatch still remain the main investigations in guiding reperfusion therapies in the extended window period. Large core Infarct, low NIHSS, non-affordability and uncertain outcome are other challenges in use of reperfusion therapy within extended window.

Abstract ID 805: Clinical Profile and Recurrence Patterns of GBS in Adults

Veena Karumudi, Praveen Yada

KIMS Hospital, Hyderabad, Telangana, India

Background and aim: Guillain-Barré Syndrome (GBS) is a demyelinating disorder with potential for recurrence, posing diagnostic and therapeutic challenges. This study evaluates GBS patients’ clinical characteristics, recurrence patterns, and functional outcomes using the Hughes Functional Grading Scale.

Methodology: A study (January 2023–May 2025) at a Tertiary Care Hospital in Hyderabad enrolled GBS inpatients. Diagnosis involved clinical evaluation, nerve conduction studies (NCS), and cerebrospinal fluid (CSF) analysis. Baseline assessments used the Hughes Scale. Recurrent GBS was identified via history and records of patients. Treatments included intravenous immunoglobulin (IVIG) or plasmapheresis.

Results: Preliminary data (52 patients) show 48.1% aged 50+ (median Hughes score: 4), with 21.2% requiring ventilators, correlating with higher Hughes scores (p < 0.01) and bulbar involvement (p < 0.01). Cranial nerve deficits (38.5%) are frequent, primarily facial nerve, especially in Miller Fisher syndrome (MFS, 7.7%). Recurrent GBS (7.7%) shows severe disability (median Hughes: 5) and high ventilator need (p = 0.03). Preceding infections (42.3%, e.g., URTI, loose stools) are common. Outcomes: 69.2% improved, 17.3% stable, 7.7% leave against medical advice (LAMA), one death.

Discussion: Recurrent GBS, though rare (7.7%), is associated with severe disability and frequent ventilator need, suggesting persistent immunological vulnerability. Bulbar involvement and higher Hughes scores strongly predict respiratory compromise, particularly in MFS and axonal variants. Preceding infections, especially URTI in demyelinating cases and loose stools in axonal variants, highlight diverse triggers. Early monitoring of cranial nerve and respiratory function is essential for optimizing outcomes. The high ventilator need in recurrent cases warrants further investigation into immunological or genetic factors.

Conclusion: This study emphasizes the severity and recurrence patterns of GBS, with recurrent cases showing significant disability and ventilator dependence. Targeted management, including early respiratory and cranial nerve assessment, is critical.

Abstract ID 806: A Rare Case of Acute Motor Axonal Neuropathy (AMAN) Variant of Guillain-Barré Syndrome Complicated by Intravenous Immunoglobulin-Induced Hemolysis

Aashini Srivastava, Mohd Nabil Beg, Md Zeeshan Jamal, Sneh Pandey

Era’s Lucknow Medical College and Hospital, Uttar Pradesh, India

Background and aim: Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy with variants depending upon the type and pattern of neuronal involvement. The Acute Motor Axonal Neuropathy (AMAN) variant, characterized by pure motor deficits and absence of sensory involvement, is relatively uncommon and has been reported in East Asia and Latin America. It may follow infections such as Campylobacter jejuni and is associated with autoantibodies targeting peripheral nerve gangliosides. Standard treatment includes intravenous immunoglobulin (IVIG) or plasmapheresis. Although IVIG is generally considered safe, hemolysis is a rare but recognized complication, affecting approximately 1–2% of patients. It is more likely in those with non-O blood groups or any other active chronic inflammatory conditions.

Methodology: Case Report

Results: A 55-year-old woman presented with acute-onset, ascending quadriparesis following a recent gastrointestinal illness. Neurological examination revealed profound lower limb weakness (MRC grade 1/5), moderate upper limb weakness (2/5), hyporeflexia, and preserved sensory function. Cerebrospinal fluid analysis demonstrated albuminocytologic dissociation. Nerve conduction studies were consistent with the AMAN variant of GBS. She was treated with IVIG (2 g/kg over 5 days) and exhibited marked improvement. However, on the sixth day, she developed signs of hemolytic anemia, including a fall in hemoglobin (from 13 to 10.5 g/dL), elevated lactate dehydrogenase (385 U/L), indirect hyperbilirubinemia (2.8 mg/dL), and a positive direct Coombs test. A diagnosis of IVIG-induced hemolysis was established. She was closely monitored, managed conservatively, and discharged with instructions for regular follow-up.

Discussion: This case illustrates a rare combination of the AMAN variant of GBS and IVIG-induced hemolysis. While IVIG remains a cornerstone of GBS treatment, it may predispose high-risk individuals to hemolytic complications, requiring careful hematologic monitoring. The AMAN subtype, often associated with more severe clinical manifestations, might particularly be susceptible to IVIG-related adverse events, making plasmapheresis an alternative treatment modality, requiring further research on this approach.

Conclusion: Physician awareness of this association is crucial, particularly in patients presenting with similar profiles. Vigilance for falling hemoglobin levels is key in identifying this rare adverse event timely. Additional case studies and research is necessary to elucidate this association and help guide better management strategies.

Abstract ID 807: Artificial Intelligence (AI)-Enhanced Prognostication of 90-Day Outcomes in Primary Intracerebral Haemorrhage (ICH): A Retrospective Cohort Study

Neha Mohite, Sankar Gorthi, Dulari Gupta, Dhiraj Dhane¹

Bharati Vidyapeeth Medical College, Pune, Maharashtra, ¹Bharati Vidyapeeth Engineering College, Pune, Maharashtra, India

Background and aim: Primary intracerebral haemorrhage (ICH) is a severe neurological emergency with only 31.2% of patients achieving favourable outcome. The current tools like the Glasgow Coma Scale (GCS), hematoma volume, and intraventricular haemorrhage (IVH) for prognostication are rarely integrated into clinical practice. This study aimed to develop and internally validate a supervised machine learning (ML) model integrating clinical and imaging parameters to predict 90-day functional outcomes in primary ICH patients.

Methodology: A retrospective cohort study was conducted at Bharati Vidyapeeth Medical College & Hospital, Pune, over 2 years, including 130 patients aged ?30 years with primary ICH. Demographic, clinical (e.g., GCS, National Institute of Health Stroke Scale [NIHSS], ICH score), and radiological data (e.g., ICH volume, IVH) were collected. Outcomes were assessed via the modified Rankin Scale (mRS) at 90 days (favourable: 0–2; poor: 3–6). Supervised ML models (e.g., XGBoost, Random Forest) were trained (80%) and tested (20%), with performance evaluated by accuracy, sensitivity, specificity, and AUC-ROC.

Results: Of 130 patients (mean age 58.4 ± 14.1 years, 56% male), 52.3% achieved functional independence (mRS 0–2). Poor outcomes (mRS 3–6) were associated with lower GCS (8.7 ± 4.2 vs. 13.1 ± 2.9, p < 0.001), larger ICH volume (36.8 ± 27.2 cm³ vs. 15.3 ± 13.8 cm³, p < 0.001), and IVH presence (61.5% vs. 13.2%, p < 0.001). XGBoost outperformed other models, achieving 86.1% accuracy and an AUC-ROC of 0.929. Key predictors were NIHSS, ICH volume, and GCS.

Discussion: This study confirms ICH volume as a key predictor of 90-day outcomes, consistent with INTERACT and ATACH trials. Larger hematomas (36.8 cm³ vs 15.3 cm³, p < 0.001), lower GCS, and IVH correlated with poor outcomes. Incorporating these into ML models may improve prognostication in Indian ICH patients.

Conclusion: The XGBoost model accurately predicted 90-day ICH outcomes, supporting early risk stratification. Multicentre validation is needed.

Abstract ID 808: Clinical Profile, Imaging Characteristics, and Outcomes of Cerebral Venous Sinus Thrombosis: A Prospective Study from a Tertiary Care Center in North India

Payal Garg, Sulena Sulena, Himanshu Kaushal

Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

Background and aim: Cerebral Venous Sinus Thrombosis (CVST) is an uncommon but significant cause of stroke, especially in young adults and women during the peripartum period.

Methodology: Department of Medicine, Guru Gobind Singh Medical College & Hospital, Faridkot. Study period was 18 months. It was a descriptive study. Study population comprised of OPD and IPD patients diagnosed with CVST. Inclusion Criteria was patients with age >18 years confirmed clinical and radiological diagnosis of cerebral venous thrombosis. Exclusion Criteria was clinical presentation explained by any other neurological disease, no radiological evidence of CVST. Sample Size was 40 patients, and the type of sampling was Non-probability convenience sampling. Computed tomography (CT) and magnetic resonance imaging (MRI) brain with MR Angiography and MR Venogram was performed. Outcome assessed at 3 and 6 months using mRS.

Results: Mean age was 40.05 ± 16.71 years, with females 55% Headache was most common presenting complaint (67.5%). Diabetes (17.5%), hypertension (15%) were common comorbidities. Rheumatoid arthritis (5%), bacterial meningitis (7.5%) were noted as emerging associations. Risk factors included puerperium (25%), pregnancy (20%), and oral contraceptive use. Most patients (80%) had GCS score between 13 and 15. MRI showed loss of signal void (37.9%), hemorrhagic infarcts (24.1%). Fronto-parietal region-most commonly involved (30%). Transverse sinus (52.5%) and sigmoid sinus (45%) were most frequently thrombosed. At discharge, 37.5% had mRS score- 2. By 6 months, 35% achieved mRS 1 and 42.5% had mRS 2. Two patients achieved mRS 0. Patients with single sinus thrombosis had significantly better outcomes (mRS 0–1) (χ² = 6.518, p = 0.038).

Discussion: confirms the predilection of CVST for young females with identifiable risk factors. Early recognition and timely initiation of anticoagulation therapy and appropriate supportive management resulted in favorable long-term outcomes.

Conclusion: CVST demonstrates an excellent prognosis when diagnosed early and managed appropriately. Enhanced clinical awareness, neuroimaging evaluation, and structured follow-up protocols are essential for optimizing patient outcomes in this potentially treatable cause of stroke in young adults.

Abstract ID 809: Comparative Evaluation of Transcranial Doppler and Computed Tomography Angiography in the Assessment of Intracranial and Extracranial Arterial Disease in Ischemic Stroke Patients: A Hospital-Based Study

Ravi Singh, Sulena Sulena, Himanshu Kaushal

Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

Background and aim: Ischemic stroke (IS) is leading cause of disability and death globally, with rising burden in low- and middle-income countries like India. Study aims to compare diagnostic accuracy of Transcranial Doppler (TCD) with Computed Tomography Angiography (CTA) in evaluating intracranial and extracranial arterial disease among patients with acute ischemic stroke, and to assess clinical utility of TCD as bedside diagnostic tool in resource-limited settings.

Methodology: Hospital-based descriptive study was conducted on 50 adult patients with radiologically confirmed IS at tertiary-level hospital in India. Clinical data, National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) scores, comorbidities, and lipid profiles were recorded. All patients underwent TCD and CTA for evaluation of intracranial and extracranial arterial disease. Diagnostic indices, including sensitivity, specificity, and predictive values of TCD, were calculated against CTA as gold standard.

Results: Mean age was 57.22 ± 13.60 years; males comprised 52% of cohort. Large artery atherosclerosis (78%) was most prevalent stroke subtype. Hypertension (68%) and diabetes (54%) were dominant comorbidities. Dyslipidemia was characterised by elevated LDL and low HDL levels. TCD revealed abnormalities in 58% of patients, while CTA detected abnormalities in 72%. Right MCA exhibited mean velocity of 55.84 cm/s, while the right ACA showed a mean velocity of 33.91 ± 14.58 cm/s. Left MCA had mean velocity of 38.56 ± 18.97 cm/s, while left ACA recorded mean of 36.02 ± 19.64 cm/s. TCD demonstrated sensitivity of 75%, specificity of 85.71%, and diagnostic accuracy of 78% when compared with CTA.

Discussion: Predominance of large vessel disease, high rates of metabolic comorbidities, and strong correlation between TCD and CTA findings emphasize need for early vascular imaging. TCD offers real-time, bedside insights but may miss distal lesions, which CTA can delineate more comprehensively.

Conclusion: TCD and CTA are complementary tools in assessment of ischemic stroke. Integrating both can enhance diagnostic precision and guide early intervention, especially in resource-constrained settings.

Abstract ID 810: Gut Microbiota Composition in Hypertensive Intracerebral Haemorrhage (ICH) and its Association with Outcomes: A Systematic Review

Subhasmita Tripathy

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Intracerebral haemorrhage (ICH), a devastating stroke subtype with high mortality, necessitates novel therapeutic approaches. The gut-brain axis, with its influence on stroke outcomes via gut microbiota and immune responses, presents a promising avenue. We conducted a systematic review to explore associations between cytokine responses and disease progression in ICH patients.

Methodology: We searched PubMed, Embase, Scopus, Google Scholar, Cochrane, Trip, and Web of Science for studies investigating these associations. Case reports, animal studies, and non-English publications were excluded.

Results: Our review examined post-ICH cytokine dynamics and their impact on outcomes. Significant changes in Eotaxin, granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin (IL)-8, IL-9, IL-10, IL-12p70, IL-15, IL-23, IL-1RA, IP-10, RANTES, and tumour necrosis factor (TNF)-α levels correlated with poor 90-day outcomes. Interestingly, GM-CSF displayed potential benefits in experimental stroke models.

Discussion: Furthermore, the review identified 1,505 host single nucleotide polymorphisms (SNPs) linked to 119 gut microbiota traits and 1,873 host SNPs linked to 81 gut metabolite traits. We observed associations between specific gut bacteria and increased/decreased risks of ICH, subarachnoid haemorrhage, and various stroke subtypes. Notably, specific bacteria were negatively correlated with large artery stroke and small vessel stroke.

Conclusion: This review highlights the association between Enterococcus enrichment and Prevotella depletion in gut microbiota with poor ICH outcomes. Additionally, altered cytokine levels suggest microbiota-mediated effects on host immune responses, critical for understanding ICH pathogenesis. These findings propose gut microbiota and serum cytokine profiles as potential biomarkers for ICH triggers and highlight the potential for gut microbiota modulation as a therapeutic strategy targeting dysbiosis in ICH patients.

Abstract ID 811: An Integrated Neuro-Cognitive and Psychosocial Intervention to Improve Quality of Life in Drug-Resistant Epilepsy: A Randomized Controlled Trial

Neetu Choudhary, Parampreet Singh Kharbanda, Jitupam Baishya, Kamalesh Chakravarty

Post Graduate Institute of Medical Education and Research, Chandigarh, India

Background and aim: Drug-resistant epilepsy (DRE) affects about 30% of epilepsy patients who fail to achieve seizure control despite optimal medical management. Beyond seizures, DRE is associated with significant cognitive deficits, psychiatric comorbidities, stigma, and poor quality of life. Existing treatments rarely address these interconnected issues simultaneously, particularly in low-resource settings like India. This study aimed to develop and evaluate the efficacy of an integrated neuro-cognitive and psychosocial intervention module for DRE patients.

Methodology: Conducted at PGIMER, Chandigarh in three phases: Phase I developed the intervention module, Phase II pilot-tested the module on five DRE patients to ensure feasibility. Phase III was a randomized controlled trial (RCT) with 60 DRE patients randomized into intervention (n = 30) and control (n = 30) groups. The intervention group received the module over eight weeks alongside standard care, while the control group continued standard treatment. Pre- and post-intervention assessments measured quality of life, depression, anxiety, stigma, disability, and cognitive functions.

Results: Post-intervention, the intervention group showed significantly improved quality of life (QOLIE-31 scores increased from 52.4 ± 8.5 to 67.8 ± 7.2, p < 0.001), reduced depression and anxiety (p < 0.001), and lower stigma (p = 0.03), with notable gains in attention, memory, and executive functions.

Discussion: These findings highlight the importance of integrated, non-pharmacological interventions in DRE management. While prior approaches have often focused narrowly on seizure control, this study demonstrates that addressing cognitive and psychosocial dimensions can lead to meaningful improvements in patient outcomes. The success of the developed module suggests that even in resource-limited settings, structured cognitive and psychosocial support can complement medical care to enhance quality of life. Future research should explore long-term effects, scalability, and adaptation for diverse epilepsy populations.

Conclusion: The neuro-cognitive and psychosocial intervention module proved both feasible and effective in improving the cognitive, emotional, and functional outcomes of DRE patients.

Abstract ID 812: Quality of Life and Mood Disorders in Mild to Moderate Stroke Survivors in Acute Post Stroke Condition: A Cross-Sectional Study

Syed Rizvi, Anand Kumar, Deepika Joshi, Abhishek Pathak, Varun Singh, Vijaya Mishra, Rameshwar Chaurasia, Amit Dhar Dwivedi

Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background and aim: Stroke affects quality of life (QoL) of patients owing to its related cognitive, physical and functional consequences, such as restrictions in mobility, language impairment and depression. This study evaluated the biological and psychosocial factors that impact post-stroke QoL and assessed their relationship with poor psychological adaptation.

Methodology: In this prospective, cross-sectional study, 127 patients of mild-moderate stroke within 7 days of onset were subjected to the Stroke Specific-Quality of Life (SS-QOL), Generalised Anxiety Disorder (GAD-7), Hospital Anxiety and Depression (HADS), Sleep Quality Scale (SQS), Barthel Index (BI), National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scoring.

Results: The participants reported mean SS-QOL of 119.59, SQS of 29.86 and BI of 15.9. Nearly 43% patients had anxiety while 78% had depression. Higher NIHSS was associated with poor QoL (p < 0.001), depression (p = 0.34) and poor sleep (p = 0.032). Patients with BI < 20 more likely developed poor QoL (p < 0.001), sleep problems (p = 0.045) and depression (p < 0.001). Frontal lobe involvement increased risk (RR = 2.014) of poor QoL. Overall, left-sided involvement was associated with a 1.7 times higher risk of developing poor QoL. Speech disturbance increased risk of developing poor QoL (RR = 2.986), depression (RR = 1.364) and poor sleep (RR = 1.481). ICH score > 2 (p = 0.014) and haemorrhage volume > 19 mL (p = 0.002) was also associated with poor QoL. Higher levels of anxiety were seen in overweight/obese patients (p = 0.016), supratentorial involvement (p = 0.046), cortical involvement (p = 0.002) and in 40-60 years of age (p = 0.043). Patients with the dominant participation reported more depression (p = 0.001) and had poor QoL (p = 0.002). Males reported higher risk (RR = 1.226) of developing depression compared to females. Development of one among poor QoL, anxiety, depression or sleep problems was associated with an increased risk of developing the others.

Discussion: The above results emphasise that a significant number of immediate post-stroke patients suffer from anxiety, depression and mood disorders.

Conclusion: Hence, treatment for these psychological conditions should also be addressed along with the standard treatment of care and rehabilitation for stroke to improve the QOL of the survivor and ensure their optimal recovery.

Abstract ID 813: Beneath the Seizures: A Closer look at Epilepsy’s Demographic and Clinical Landscape in India- The REMAP Study

Nitin Kapure, Mayur Mayabhate, Siddharth Nikam, Akhilesh Sharma

Alkem Laboratories Ltd., Mumbai, Maharashtra, India

Background and aim: Epilepsy, a chronic neurological disorder, poses a significant burden in low- and middle-income countries like India due to diagnostic gaps, limited care access, and social stigma. This study explores the demographic and clinical characteristics, treatment patterns, and comorbidities among a large cohort of Indian epilepsy patients.

Methodology: This retrospective, multicenter cross-sectional study conducted across various Indian healthcare settings collected data on demographics, seizure characteristics, lifestyle factors, treatment patterns, and comorbidities. Statistical analysis was performed using SPSS, with significance set at p < 0.05.

Results: The study analyzed 9,201 patients aged 18–80 years (mean age 43.3 ± 11.2 years). The mean age of epilepsy onset was 11 years, indicating early manifestation. Generalized tonic-clonic seizures were the most prevalent (61.9%), followed by focal seizures (38.1%). A positive family history was observed in 20% of cases. Comorbid psychiatric conditions were prominent, with depression reported in 34% of patients, followed by sleep disturbances (11.5%) and psychotic disorders (8.5%). Levetiracetam was the most frequently prescribed AED, with 78.9% of patients managed on monotherapy.

Discussion: This extensive multicentric retrospective study provides comprehensive insights into the demographic, clinical profiles, treatment patterns, and comorbidities of Indian epilepsy patients. Enrolling 9,201 participants, the study highlights a mean patient age of 43.3 years and a male predominance of 64.3%. Generalized tonic-clonic seizures were most prevalent (61.9%), while family history (20%) and comorbid depression (34%) were notable findings, underscoring the need for integrated care strategies and improved clinical documentation in epilepsy management.

Conclusion: This large-scale analysis offers valuable insights into the Indian epilepsy population, highlighting early-onset disease, the predominance of generalized seizures, and a substantial burden of psychiatric comorbidities—particularly depression. These findings emphasize the urgent need for improved diagnostic pathways, equitable treatment access, and integrated neuropsychiatric care to address the multifaceted needs of epilepsy patients in India.

Abstract ID 814: Clinicopathological Spectrum of Dementias: An Ambispective Brain-Bank Study from NIMHANS

Gagan B H, Faheem Arshad, Suvarna Alladi, Yasha T C, Anita Mahadevan, Saraswathi Nashi, Nitish L Kamble Kamble, Anita Mahadevan

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Dementia autopsy studies clarify how proteinopathies and vascular lesions together drive cognitive decline. Indian data remain sparse. This ambispective brain-bank investigation aimed to delineate the clinicopathological spectrum of late-life dementias and to quantify gaps in the diagnostic chain.

Methodology: Thirteen consecutively donated brains (2018-2025) with premortem dementia diagnoses were retrieved from the NIMHANS Brain Bank, Bengaluru. Clinical demographics, Informant Questionnaire on Cognitive Decline in the Elderly and Clinical Dementia Rating scores were extracted from records. Imaging availability, macroscopic findings, and histopathology (NIA-AA /FTDC criteria with standard immunohistochemistry) were coded binary (present/absent). Descriptive statistics summarised diagnostic distribution and data-completeness indices.

Results: Median age at death was 74 years (IQR 70–78); 57% were female. Clinical labels comprised Alzheimer’s disease (AD) 6, frontotemporal dementia spectrum (FTD) 6, vascular dementia 1, and mixed dementia 1. Comprehensive clinical history was available for all cases, neuroimaging for 13/13 (100%), gross examination for 13/13 (100%), and full histopathology for 12/13. In the fully worked-up subset, clinico-pathological concordance reached 100%. Mixed cerebrovascular and neurodegenerative changes were common, including in one clinically “pure” vascular case.

Discussion: Triple-staining revealed substantial overlap of proteinopathies: over half of clinically labelled frontotemporal dementia (FTD) or Alzheimer’s disease (AD) brains harboured additional pathological proteins, mirroring reports from Western autopsy series. Lewy pathology, though less frequent, contributed disproportionately to cognitive decline when present. Mixed vascular-degenerative changes were common, underscoring the multifactorial basis of dementia in late life.

Conclusion: Comprehensive IHC for tau, β-amyloid and α-synuclein unveils frequent co-pathologies that can obscure clinical diagnoses. Routine tri-panel staining, coupled with vascular assessment, should become standard in Indian brain-bank protocols to sharpen diagnostic accuracy and guide biomarker development.

Abstract ID 815: Midline Mystery: A Silent Lesion with Loud Consequences

Abi Gokhale, Murugan P K, Justin C, Elangovan S

Madurai Medical College, Madurai, Tamil Nadu, India

Background and aim: Corpus callosum infarcts are rare (only a few percent of strokes) due to rich collateral blood supply, and often result in interhemispheric disconnection syndromes. We present a case of bilateral callosal infarction causing apraxia, agnosia, neglect, and alien limb phenomena, to highlight its pathophysiology and clinical relevance.

Methodology: A 42-year-old hypertensive man with acute left-sided weakness, confusion, disorganized behavior, and incoordination. Neurologic exam: left ideomotor apraxia, optic ataxia, auditory and tactile agnosia, alien limb phenomenon, left hemineglect, and dressing apraxia. Primary sensory, cerebellar, and autonomic functions were intact. Brain magnetic resonance imaging (MRI) (diffusion-weighted) to identify infarction; transthoracic echocardiogram to detect a cardiac source.

Results: MRI: bilateral infarcts in the genu, body, and splenium of the corpus callosum; no other cerebral infarcts. Echocardiogram: large LV apical thrombus (cardioembolic source identified); no significant carotid stenosis. These findings correspond to a classic callosal disconnection pattern, linking frontal, parietal, and temporal functions.

Discussion: Bilateral callosal infarction is exceptionally rare. Lesions of the corpus callosum disrupt interhemispheric transfer, causing classic disconnection signs (e.g., apraxia, agnosia, alien limb phenomena). Multifocal infarction suggests an embolic mechanism, consistent with the identified ventricular thrombus. Recognizing this syndrome is critical: MRI confirms the diagnosis, and finding a cardiac source directs anticoagulation for prevention.

Conclusion: Bilateral callosal infarction is a rare stroke with distinctive disconnection deficits. Awareness of these signs and prompt MRI aid diagnosis. Identifying an embolic source guides targeted therapy and secondary prevention.

Abstract ID 816: Clinico-Etiological Spectrum and in Hospital Outcome of Acute Encephalitis Syndrome: A Single Centre Observational Study

Pawan Prakash, Ashok Kumar, Abhay Ranjan, Janardan Sharma, Sanjeev Kumar

Indira Gandhi Institute of Medical Science, Patna, Bihar, India

Background and aim: Acute Encephalitis Syndrome (AES) presents a major public health challenge in India, particularly in Bihar. It encompasses a wide spectrum of etiologies, including infectious and autoimmune causes. This study aims to evaluate the clinical presentations, etiological profiles, and predictors of outcomes in AES patients admitted to a tertiary care center in Eastern India.

Methodology: A prospective observational study was conducted over two years, including 78 AES patients >5 years. Diagnosis was based on IEC criteria. Patients with encephalopathy to other causes such as toxin, sepsis or metabolic disorders or tubercular /bacterial/fungal meningitis or meningoencephalitis were excluded. Data on clinical features, laboratory findings, imaging, electroencephalogram (EEG), and cerebrospinal fluid (CSF) analysis were collected. Etiology was investigated using multiplex polymerase chain reaction (PCR) BIOFIRE panel, enzyme-linked Immunosorbent assay (ELISA) for Japanese encephalitis (JE) and dengue, and autoimmune antibody panels. Outcome was assessed using the modified Rankin Scale (mRS). Statistical analysis included ANOVA and Chi-square tests.

Results: The mean age was 29.78 years; 62.8% were male. Fever (83.3%) altered sensorium (89.7%), and seizures (76.9%) were the most common features. JE (10.3%) and HSV-1 (7.7%) were the predominant identified etiologies, though 61.5% remained undiagnosed. Interleukin (IL)-6 in CSF showed statistically significant correlation with neurological severity. ICU care was required in 51.3%, and mechanical ventilation in 30.8%. Mortality was 16.7%. Poor outcomes (mRS > 2 or death) were significantly associated with Glasgow coma scale (GCS) < 8, pneumonia, and need for mechanical ventilation).

Discussion: AES affects all age groups, with high prevalence in younger individuals. The high proportion of undiagnosed cases reflects the need for improved diagnostics. Early identification of patients at risk (low GCS, respiratory complications) is critical for improving prognosis.

Conclusion: This study reinforces the heterogeneity of AES and highlights key prognostic indicators.

Abstract ID 817: Clinico-Radiological Profile and Predictors of Outcome in Longitudinally Extensive Transverse Myelitis - A Single Centre Observational Study

Ankit Kumar, Ashok Kumar, Abhay Ranjan, Janardan Sharma, Sanjeev Kumar

Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Background and aim: Longitudinally Extensive Transverse Myelitis (LETM) is an uncommon but clinically significant inflammatory disorder of the spinal cord, characterized by magnetic resonance imaging (MRI) lesions spanning three or more vertebral segments. LETM can result from a wide range of etiologies, including autoimmune conditions such as NMOSD and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD), infectious diseases like tuberculosis, and idiopathic causes. The primary aim of this study was to analyze the clinical, radiological, and etiological profile of LETM and identify predictors of outcome.

Methodology: This was a prospective observational study conducted over a period of 12 months at a tertiary care center in eastern India. Thirty patients diagnosed with LETM were enrolled. Detailed clinical evaluation with MRI spine, brain with orbit, cerebrospinal fluid (CSF) analysis, serological markers – Aquaporin 4, anti-MOG antibody, antinuclear antibody (ANA) and visual evoked potential (VEP) were recorded. The Expanded Disability Status Scale (EDSS) was recorded at baseline and at 3 month follow-up. Patients received either intravenous methylprednisolone monotherapy or in combination with plasma exchange (PLEX).

Results: NMOSD was the leading etiology (36.7%), followed by idiopathic (23.3%), tubercular (16.7%), para-infectious (13.3%), and MOGAD (10%). Thoracic cord involvement was most frequent (90%), and bladder-bowel dysfunction occurred in 96.7% of patients. Patients who received early PLEX within 7 days had significantly better outcomes (p = 0.014). Among those treated with combination therapy, 88.9% showed clinical improvement, while only 66.7% cases with methylprednisolone monotherapy showed improvement.

Discussion: LETM has heterogeneous etiologies with overlapping clinical features. Immune mediated causes such as NMOSD and MOGAD respond well to early and aggressive immunotherapy. Tuberculous myelitis remains an important differential in endemic areas. Timely recognition and intervention are essential to reduce morbidity.

Conclusion: Early diagnosis and tailored immunotherapy, particularly the prompt use of plasma exchange, are associated with favorable outcomes in LETM.

Abstract ID 818: Clinical Profile of Perioperative Stroke in Patients Undergoing CABG Procedure in A Tertiary Cardiac Care Centre

Kishore Ramachandraiah, Vikram Huded¹, Anush Rangarajan¹

Apollo Hospitals Bengaluru, Karnataka, ¹Narayana Health City, Bengaluru, Karnataka, India

Background and aim: Perioperative stroke, a devastating and potentially life-threatening complication, remains a significant concern in the field of heart surgery. Approximately 40% of strokes occur intraoperatively and most of the remaining strokes occur during the first 48 hours postoperatively. In 2016, systematic review and meta-analysis published in the Journal of Cardiothoracic Surgery, the authors reported a pooled incidence of perioperative stroke of 2.2%, with a range of 0.2% to 7.2%. Defining the characteristics of the modifiable risk factors will provide more knowledge about the clinical and radiological profile in perioperative stroke subjects. The findings from this study will serve as a valuable resource for further investigations and interventions targeting the prevention and management of perioperative stroke. The aim and objectives of the study is to study the clinical profile of perioperative stroke in patients undergoing coronary artery bypass grafting (CABG) procedure.

Methodology: This is a descriptive study which includes retrospective and prospective analysis between January 2021 and December 2022.

Results: The incidence of perioperative stroke in CABG procedure was 0.68%. About 60% of the triple vessel disease (TVD) patient had carotid artery stenosis including common carotid artery (CCA) and internal carotid artery (ICA). Maximum number of the perioperative stroke cases was noted during the first 48 hrs. About 1/3rd of the perioperative stroke was due to large artery atherosclerosis representing watershed infarcts in imaging.

Discussion: The present study describes the clinical characteristics of perioperative stroke in CABG patients. Stroke is one of the dreadful complications during or post-surgery leading to prolonged hospital stay, morbidity and mortality. During the study period between January2021 to December 2022, which was conducted in Narayana health city, a total of 42 confirmed cases of perioperative stroke patients were included.

Conclusion: Perioperative stroke in this study could be due to intraoperative handling of aorta, prior aortic arch disease, and co-existing untreated carotid. A careful assessment reduces the risk of perioperative stroke.

Abstract ID 819: Clinical Profile of Patients with Cognitive Impairment and Its Correlation with Caregiver Distress

Sneha Desu, Sandeep Kumar

Yashoda Hospital Somajiguda, Hyderabad, Telangana, India

Background and aim: Dementia affects approximately 5% of individuals aged 60 and above, underscoring its public health impact. Caregivers of these individuals face elevated risks of adverse health outcomes, including cardiovascular diseases like hypertension—likely due to chronic inflammation and sympathetic overactivation. This study aimed to identify clinical symptoms most associated with caregiver distress across various cognitive syndromes, to guide targeted, syndrome-specific interventions.

Methodology: A cross-sectional study was conducted at Yashoda Hospitals, Hyderabad, from January 2024 to present. All the patients attending Memory clinic OPD were enrolled. Cognitive status was assessed using the ACE-III, and patients were classified into mild cognitive impairment (MCI) and dementia subtypes. Caregiver burden was evaluated using the Neuropsychiatric Inventory Questionnaire (NPI-Q) and the Caregiver Distress Index (CDI).

Results: In this cross-sectional study of 52 patients with cognitive impairment, MCI was the most common diagnosis (40%), with amnestic and non-amnestic subtypes accounting for 27% and 13%, respectively. Frontotemporal Dementia (FTD), including behavioral and semantic variants, comprised 23%, followed by Alzheimer’s disease (10%), post-stroke dementia (7%), and autoimmune-related dementias (7%). Chronic traumatic encephalopathy and other rare causes made up 4%, while 9% had overlapping features. Most patients had one caregiver; 65% were female, with a median age of 63 years. Caregiver distress was significantly higher in FTD and autoimmune dementias, particularly when neuropsychiatric symptoms like aggression, apathy, or sleep disturbances were present. In contrast, MCI—especially the amnestic subtype—was associated with markedly lower caregiver distress scores.

Discussion: Neuropsychiatric symptoms, more than cognitive decline alone, drive caregiver burden. FTD and autoimmune dementias present distinct challenges due to behavioral symptoms. MCI causes relatively minimal disruption to caregiver routines.

Conclusion: Behavioral symptoms are key drivers of caregiver distress. FTD and autoimmune dementias require focused caregiver support. Neuropsychiatric assessment should be routine, and caregiver well-being must be integrated into dementia care models.

Abstract ID 820: Importance of Identifying Acute Hypoglycaemia Induced Ischemic Stroke- A Culprit Often Overlooked

Sohini Chakraborty, Akash Narayan¹

All India Institute of Medical Sciences, New Delhi, ¹Apollo Hospital Chennai, Tamil Nadu, India

Background and aim: While hyperglycaemia is an established risk factor for acute stroke, there is limited evidence demonstrating hypoglycaemic events as stroke triggers. Repeated episodes of hypoglycaemia further blunts body’s neuroglycopenic response to low blood glucose and accentuate atherogenesis. The present case studies this link between hypoglycaemia and AIS and provokes us to think beyond labelling hypoglycaemia as a “stroke mimic”.

Methodology: A 77-year-old diabetic lady who had been admitted for evaluation of fever, experienced sudden onset of slurring of speech fifth-day post admission. Her National Institutes of Health Stroke Scale (NIHSS) was 2 (dysarthria) and blood glucose 70 mg/dl.

Results: Magnetic resonance imaging (MRI) brain was diffusion-negative with a left parietal perfusion-deficit on Arterial spin labelling (ASL). MR angiography showed M1 segment of the left middle cerebral artery (MCA) cut-off. Even as thrombolysis was being arranged, her blood glucose had quickly dropped to 54 mg/dl. Despite treatment of hypoglycaemia, her NIHSS climbed to 5. She was thrombolysed along with continuing hypoglycaemia correction. Within an hour, NIHSS had improved to 0. Repeat MRI showed diffusion restriction in left parietal region, which is a testimonial to the fact that hypoglycaemia can precipitate acute ischemic events.

Discussion: Hypoglycaemia is well-recognized as a stroke mimic. However, hypoglycaemic episodes also accelerate vascular complications, thus provoking atherosclerotic plaque rupture and large-vessel occlusion. It was recently found that hypoglycaemic events in diabetes are associated with more than three-fold greater occurrence of AIS stroke on the first day, but the risk continues to linger over the next 30 days. The study patient, who was diabetic and on insulin therapy, is a case in point.

Conclusion: The present case highlights the co-occurrence of two unmissable presentations of stroke, namely, hypoglycemia as the likely trigger for large artery occlusion, together with a diffusion-negative early scan. In both situations, persevering with a prompt and detailed stroke imaging protocol including perfusion scans and brain angiography can save the day.

Abstract ID 821: Clinical, Etiological, Imaging and Electrophysiological Findings in Non Traumatic Brachial Plexopathy

Rashmi Devaraj, Mohan Channapanavur

Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India

Background and aim: Brachial plexopathies are commonly encountered by neurologist in their clinical practise. It accounts for nearly 5% of peripheral nerve injuries. The most common ethology is trauma followed by idiopathic (Parsonage Turner syndrome), diabetic, neoplastic, post infectious, post radiation therapy, iatrogenic, birth injuries and thoracic outlet syndrome. Aims included 1)To describe the clinical findings and to assess the aetiologies of non-traumatic brachial plexopathies, and 2) To document the neurophysiological findings and imaging characteristics of brachial plexopathies.

Methodology: It is an ambispective study comprising of 28 patients of non-traumatic brachial plexopathy satisfying the inclusion and exclusion criteria. The subject were studied from January 2022 to May 2025. Informed consent was obtained. In them, a detailed history taking, clinical examination, Nerve conduction studies and electromyography according to brachial plexus protocol and magnetic resonance imaging (MRI) was done. The data was entered in a predesigned pro forma and tabulated.

Results: In this study, 18 patients of non-traumatic brachial plexopathy were recruited. There was a significant male predominance – 12 (66.67%) and female patients were 6 (33.33%). The age group ranged from 14 months to 67 years. The mean age was 46.77 years. The was followed by Diabetes in 7 (38.89%), idiopathic in 4 (22.2%), malignancy in 3 (16.67%), birth injury in 2 (11.1%), post-radiation therapy in 1 (0.56%) and post-infectious in 1 (0.56%).

Discussion: The most common cause of non-traumatic brachial plexopathy was idiopathic followed by diabetes and malignancy. There was male predominance. The most common electrophysiological findings were presence of neurogenic pattern with or without active denervation. The electrophysiological studies helped detect abnormalities even in the uninvolved dermatomes. It helped in assessing the severity and was useful for prognostication. MRI showed T2 hyper intensities and post contrast enhancement.

Conclusion: In the current study, the most common ethology of Non-traumatic brachial plexopathy was Idiopathic followed by diabetes and the malignancy.

Abstract ID 822: Efficacy of Music Therapy in Improving Symptoms of Restless Leg Syndrome

Supraja Vasu, Neha Rai, Jasbir Kathpal, Dhanraj Panjwani

Choithram Hospital and Research Center, Indore, Madhya Pradesh, India

Background and aim: To assess the effects of music therapy in improving symptoms of Restless Legs Syndrome (RLS) over a period of 2 months.

Methodology: The study was conducted at a tertiary care hospital in central India, where OPD patients in the Department of Neurology were recruited having satisfied the laid-out inclusion criteria. A baseline International RLS (IRLS) score was calculated, and the participants were allocated into groups 1 and 2 based on a computer-generated randomization chart. All the subjects were administered dopaminergic agonist viz. Tab. Pramipexole 0.125 mg once daily at night for 8 weeks. Participants in group 1 were educated about the music intervention- a recording of the same- alpha binaural beats was provided via electronic media and they were advised on the procedure to listen to the same.

Results: This study included 94 subjects, of which 47 belonged to Group 1 (received music therapy) & 47 to Group 2 (did not receive music therapy). On comparing the change in IRLS score (compared to baseline) between the groups, it was found that at week 1 the change in IRLS score was greater in Group 1 compared to Group 2, however, the difference was statistically non-significant. At weeks 2,3,4,5 and 6, the change in IRLS (compared to baseline) was statistically significantly greater in Group 1 compared to Group 2.

Discussion: The reduction in severity of IRLS was significantly more in the music group compared to the other group indicating that music has a beneficial effect in treating RLS. It was also found that the requirement of additional drugs such as Gabapentin and Pregabalin was significantly less in Group 1 than Group 2.

Conclusion: The results of the present study emphasized that music can be effective in reducing the severity of RLS and in combating tolerance to pramipexole which is used as the first line of treatment.

Abstract ID 823: Idiopathic Intracranial Hypertension with Iron Deficiency Anemia

Binu Bal Singh K, Shobhana N, Selvakumar C J

Coimbatore Medical College and Government Hospital, Coimbatore, Tamil Nadu, India

Background and aim: Idiopathic intracranial hypertension (IIH) is defined as raised intracranial pressure without evidence of a detectable cause with a global incidence of 12–20 per 100,000. Iron deficiency anemia has been reported as a rare association with IIH.

Methodology: An 18-year-old nonobese girl with past history of IIH 5 year back with no other comorbidities now presented with severe bifrontal headache with vomiting for last 1 week. Examination revealed pallor with preserved visual acuity, field of vision and colorvision, extraocular movment with bilateral partial opticatrophy. Examination of motor, sensory, other system were normal. Cerebrospinal fluid (CSF) pressure was 460 mm H2O, CSF acellular with normal glucose, protein and LDH. Hemoglobin was 6.2 g/dl, MCV-64fl. peripheral smear- hypochromicmicrocytic anemia. In iron profile- reduced iron and increased total iron binding capacity, erythrocyte sedimentation rate (ESR) was 45 mm/hr, thyroid stimulating hormone (TSH) 1.4 µU/mL, ultrasound (USG) of abdomen was normal, sickling test and stool occult blood test were normal, and normal liver function test (LFT), renal function test (RFT) and antinuclear antibody (ANA) profile. Magentic resonance imaging (MRI) brain showed posterior scleral flattening of bilateral globe, bilateral prominence of perioptic space (5 mm) and tortuous bilateral optic nerve in intra orbital compartment. Optical coherence tomography - of bilateral partial optic atrophy (left > right) secondary to chronic IIH. Patient was treated with mannitol, acetazolamide, CSF drainage, blood transfusion and iron supplements. Patient was symptomatically better after treatment and discharged.

Results: IIH have association with iron deficiencyanemia

Discussion: Iron inhibits thrombopoiesis and thrombocytosis often develop in iron deficiency anemia and results in a hyperviscous state with increased venous pressure. Increased venous pressure decreases the rate of CSF resorption at the level of arachnoid villi, results in elevated intra cranial pressure. Some studies suggest that, tissue hypoxia induced altered cerebral hemodynamics in iron deficiency anemia leads to increased brain capillary permeability and increased intracranial pressure.

Conclusion: Treatment of idiopathic intracranial hypertension with anti-edema measures and evaluation and treatment of iron deficiency anemia have good recovery.

Abstract ID 824: Masked by Madness, Revealed by Unsteadiness – A Case of Paraneoplastic Cerebellar Degeneration

Swathi T, Subramaniyan K

Kauvery hospital, Chennai, Tamil Nadu, India

Background and aim: Paraneoplastic neurological syndromes (PNS) are rare, immune-mediated disorders triggered by underlying malignancies. In the elderly, atypical psychiatric or neurological presentations may mask the presence of cancer. We report a case of paraneoplastic cerebellar degeneration (PCD) in a 70-year-old female, where neuropsychiatric symptoms were the initial clue to an occult breast carcinoma.

Methodology: A 70-year-old vegetarian female presented with three months of progressive behavioral changes and mood disturbances, initially treated as a primary psychiatric illness. Her condition worsened with marked unsteadiness, slurred speech, and gait impairment. There was no history of fever, seizures, vomiting, drug or native medicine use.

Results: Neurological examination revealed pancerebellar signs—dysmetria, truncal and gait ataxia, impaired coordination, and scanning speech. Brain magnetic resonance imaging (MRI) was normal. Workup for reversible metabolic causes including vitamin B12 deficiency, thyroid dysfunction, and Treponema pallidum haemagglutination (TPHA) was negative. Given the subacute progression and age, a paraneoplastic etiology was considered. A positron emission tomography (PET)-computed tomography (CT) revealed a right breast nodule with reactive axillary nodes, initially reported as a fibroadenoma. However, due to high clinical suspicion, a biopsy was done, confirming invasive breast carcinoma. A paraneoplastic antibody panel later returned positive for anti-Yo antibodies, confirming the diagnosis of paraneoplastic cerebellar degeneration secondary to breast cancer.

Discussion: This case illustrates the diagnostic challenge of peripheral nervous system (PNS), especially when psychiatric features precede neurological signs. Normal imaging should not deter further investigation in patients with rapid neurological decline. Multidisciplinary collaboration and high clinical suspicion are a key to timely diagnosis.

Conclusion: Breast carcinoma may present with cerebellar and psychiatric symptoms as a paraneoplastic syndrome. Early recognition and thorough evaluation in elderly patients with unexplained neuropsychiatric symptoms can lead to timely oncological intervention and improved outcomes.

Abstract ID 825: A Comparative Study in A Tertiary Care Centre: Role of Optical Coherance Tomography in Idiopathic Intracranial Hypertension Patients

Gani Mozhi, Rajasekaran M, Kannan N

Government Kapv Medical College, Trichy, Tamil Nadu, India

Background and aim: Idiopathic Intracranial Hypertension (IIH) is a condition of raised intracranial pressure (ICP) in the absence of space-occupying lesions or other known etiology. It causes vision loss with severe morbidity due to papilledema and secondary optic atrophy, thus necessitating the need for non-invasive biomarkers, optical coherance tomography (OCT), for deciding management strategies. The aim of this study was to evaluate the diagnostic value of OCT as a marker for cerebrospinal fluid (CSF) opening pressure in patients with IIH.

Methodology: A total 20 IIH patients and 20 controls were recruited during the study period of 9 months. Visual outcomes included viual acuity, fields, retinal nerve fiber layer (RNFL) thickness and total retinal thickness were measured using OCT. Modified Dandy Criteria was fulfilled in IIH Patients.

Results: OCT-RNFL thickness shows significant correlation with grades of papilloedema with early atrophic changes in temporal quadrant, thickening more predominant in inferior quadrant. It has positive correlation with cerebrospinal fluid (CSF) pressures.

Discussion: Idiopathic intracranial hypertension (IIH) is an increased intracranial pressure (ICP) due to an unknown cause. It affects young, obese females. Symptoms of this condition include headache, pulsatile tinnitus, and vision loss, among others. Visual impairment can manifest as enlarged physiologic blind spots in the visual field due to optic nerve head (ONH) enlargement, peripheral vision loss progressing to central vision loss due to optic nerve dysfunction, double vision due to 6th nerve palsy, and/or transient visual obscuration thought to be due to ONH ischemia.

Conclusion: Increased peripapillary retinal thickness measured by OCT is associated with increased ICP in newly diagnosed IIH patients. OCT may thus serve as a valuable supplement to subjective assessment of papilledema in patients suspected of having IIH.

Abstract ID 826: Evaluation of Efficacy of Add-on Oral Piracetam in Children and Adolescents with Acute Encephalitis syndrome aged 1 month-18 years: A Single-Blind Randomized Controlled Trial (PAES Trial)

Prateek Panda, Indar Sharawat, Garima Singh

All India Institute of Medical Sciences, Rishikesh, Jharkhand, India

Background and aim: Definitive curative treatment is currently not available for most cases of acute encephalitis syndrome. Piracetam has a neuroprotective effect, has the potential to improve cognition and behavior in neurodevelopmental disorders, and was found to be efficacious in a randomized controlled trial (RCT) on adults with encephalitis.

Methodology: This single-blind RCT (CTRI/2023/04/065455) conducted between April 2023 and November 2024 evaluated the efficacy of add-on oral piracetam (50 mg/kg/day for 12 weeks) in improving the functional outcome (functional status score [FSS]) at 12 weeks in children and adolescents with acute encephalitis syndrome (AES) aged 1 month -18 years, compared to standard care of treatment alone. It also compared survival rate, days of hospitalization, days of mechanical ventilation, Glasgow Coma Scale (GCS, on day 7), Pediatric Cerebral Performance Category (PCPC) score, quality of life (PedsQL4.0), social quotient (Vineland Social Maturity Scale [VSMS]), and behavioral problems (Child Behavior Checklist [CBCL]) at 12 weeks. Children with preexisting major chronic systemic illnesses, developmental delay, intellectual disability, and neurometabolic or neurodegenerative diseases were excluded.

Results: A total of 51 participants were recruited in each group (a total of 102). Improvement in Fatigue Severity Scale (FSS) score (-11.36 ± 1.83 vs -10.09 ± 1.67, p = 0.0004) and VSMS score at 12 weeks (52.8 ± 12.6 vs 47.4 ± 12.9, p = 0.04) was better in piracetam group, compared to controls. However, survival rate (47/51 vs 45/51, p = 0.74), GCS on day-7 (12.3 ± 1.9 vs 11.8 ± 1.7, p = 0.17), days of hospitalization (12.44 ± 6.79 vs 13.57 ± 6.93, p = 0.41), days of mechanical ventilation (4.3 ± 1.5 vs 4.5 ± 1.6, p = 0.39), PedsQL4.0 score (41.5 ± 14.2 vs 38.4 ± 13.1, p = 0.28), PCPC score (2.8 ± 0.7 vs 2.5 ± 0.6, p = 0.23) and CBCL total score (36.2 ± 14.5 vs 37.3 ± 15.6, p = 0.73) were comparable in both groups. No adverse event was noted causally related to piracetam.

Discussion: Large multicentric trials with long-term follow-up are required before universally recommending piracetam to all cases with AES.

Conclusion: Piracetam improves functional status and social quotient in children and adolescents with acute encephalitic syndrome.

Abstract ID 827: Predictors of Antepartum and Postpartum Cerebral Venous Thrombosis (CVT); An Observational Cross Sectional Study

Kamalesh Nataraju, Archana Netto, Praveen Kumar S, Pramod K, Janardhan D C

Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Background and aim: Pregnancy and postpartum period are considered as hypercoagulable states with 4 to 5 times higher risk of venous thrombosis. Cerebral Venous Thrombosis (CVT) commonly presents during third trimester and immediate postpartum (13 times commoner in puerperium than in pregnancy) constituting 20% of adult CVT. Most often CVT is misdiagnosed in pregnancy. In India, peripartum CVT is seen in 4.5/1000 obstetric admissions and 1/250 deliveries.

Methodology: Major objective of the study was to describe clinico-radiological features and to find risk factors of peripartum CVT. Inclusion Criteria: Patients aged above 18 years with peripartum CVT confirmed by computed tomography (CT)/magnetic resonance imaging (MRI) venogram. Exclusion Criteria: Patients with suspected CVT but not confirmed by MRI/CT venogram.

Results: There were 26 participants with peripartum CVT of whom, 5 were antenatal and 21 were postpartum. Mean age was 26.7 years. Six out of 24 (25%) had preterm delivery. Nineteen out of 26 (73.07%) participants had headache as the presenting symptoms with 16 (61.54%) reporting severe headache (VAS > 7) and 6 participants (23.08%) had no headache. Ten out of 26 (38.46%) had papilloedema. Thirteen out of 26 (50%) had seizures. Twelve out of 26 (46.15%) had hemorrhagic brain infarction. Sixteen out of 26 participants (61.54%) had more than one venous sinus involvement. The modified Rankin Scale (mRS) score was found to be significantly associated with antepartum anemia (p = 0.058). Anterior ASEPCTS score was found to be significantly associated with both antepartum and postpartum anemia.

Discussion: In this study we found that even though headache was the most common presenting symptom 23.08% patients did not have headache. Seizure was the second most common presentation. Antepartum and postpartum anemia were significantly associated with severity of CVT (evidenced by mRS scale and ASPECTS score).

Conclusion: Anemia in pregnancy may be an important predictor of peripartum CVT. Postpartum CVT had higher ASPECT score than the antepartum CVT. However, large population studies are needed to confirm this association.

Abstract ID 828: Parallel Paths, Divergent Diagnoses: Clinical and Radiological Profile of NMOSD and MS Patients at a Tertiary Care Centre in South India

Pavithira Annamalai

Government Siddhartha Medical College, Vijayawada, Andhra Pradesh, India

Background and aim: Neuromyelitis Optica Spectrum Disorder (NMOSD) and Multiple Sclerosis (MS) are immune-mediated demyelinating disorders of the central nervous system with overlapping phenotypic features but distinct pathophysiological mechanisms, prognoses, and therapeutic implications. Accurate differentiation is crucial, particularly in resource-limited settings, to prevent misdiagnosis, and to delineate and contrast the clinical characteristics and neuroimaging profiles of patients diagnosed with NMOSD and MS, with a view to enhancing diagnostic precision and guiding optimal management.

Methodology: A prospective observational study was conducted at the Department of Neurology, SMC, Vijayawada, from January 2024 to April 2025. Patients meeting the 2015 International Panel for Neuromyelitis Optica Diagnosis (IPND) criteria for NMOSD and the 2017 McDonald criteria for MS were enrolled. Detailed demographic, clinical, serological, and radiological data were collected and analyzed. Magnetic resonance imaging (MRI) brain and spine findings were reviewed for lesion morphology, distribution, and enhancement patterns.

Results: Unilateral Optic neuritis (50%) and asymmetric limb weakness (50%) were the most common clinical presentations in MS. Myelitis (75%) and bilateral optic neuritis (75%) were the most common presentations in NMOSD. Short segment optic neuritis was observed in 50% of MS patients. Long segment optic neuritis (37.5%) and chiasmal involvement were seen in NMOSD. Thirty-three and three-tenth percentage of MS patients had radiological evidence of myelitis, out of which 16.7% had longitudinally extensive transverse myelitis (LETM). Severy-five percentage of NMOSD patients had myelitis and all of them had LETM. Cerebellar and brainstem lesions more common in MS.

Discussion: NMOSD patients had severe and more frequent relapses, bilateral optic neuritis with chiasma and LETM. MS had more relapsing disease pattern with LETM occasionally and predilection to infratentorial and Dawson finger lesions. AQP4 Ab positivity and cerebrospinal fluid (CSF) and oligoclonal banding (OCB) were diagnostic markers.

Conclusion: This study reinforces that while MS and NMOSD may initially have similar clinical presentations, their underlying immunobiology, neuro-imaging footprints, and disease trajectories diverge significantly. A composite approach—integrating detailed clinical assessment, neuroimaging interpretation, and serological evaluation—is indispensable for accurate diagnosis.

Abstract ID 829: Patchy Shadows in the Brainstem: A Case Series Exploring the Diverse Faces of Brainstem Encephalitis

Seethalakshmi N, Mugundhan Krishnan, Uma Maheshwari E, Natarajan E

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Brainstem encephalitis represents a diagnostically challenging and clinically diverse group of disorders, ranging from autoimmune and demyelinating to infectious and idiopathic etiologies. Early differentiation is critical for prognosis and therapeutic decisions. We present four illustrative cases highlighting the clinical, imaging, and serological spectrum of Brainstem Encephalitis.

Methodology: Four patients with acute brainstem syndrome underwent comprehensive neurological evaluation, neuroimaging, cerebrospinal fluid (CSF) analysis, serological testing for autoimmune/paraneoplastic markers, and infectious workup. Diagnostic approach was guided by evolving diagnostic algorithms for autoimmune encephalitis.

Results: Case 1 & 2: Young females presented with acute cerebellar ataxia and truncal instability. Magnetic resonance imaging (MRI) revealed nodular enhancing lesions in midbrain, pons, and cerebellar peduncle for first patient and multiple pontine hypoerintensities in second patient. CSF analysis was non-contributory. Antinuclear antibody (ANA) and vasculitis profile were negative. Positive anti-MOG antibodies confirmed MOG-antibody associated demyelination. Both showed excellent response to steroids and azathioprine. Case 3: A 54-year-old diabetic alcoholic male presented with bulbar signs, gait ataxia with a background of chronic diarrhoea. MRI brain showed extensive longitudinal brainstem T2-FLAIR hyperintensities. Extensive evaluation including CSF analysis, serum transglutaminase (TTG), autoimmune and paraneoplastic profile, abdominal imaging, Oesophago-Gastro-Duodenoscopy (OGD scopy) was non-contributory, leading to a diagnosis of probable idiopathic rhombencephalitis. Steroid therapy led to clinical improvement. Case 4: A 25-year-old female on dialysis presented with ophthalmoplegia, bulbar dysfunction, and hemiparesis with absent reflexes. MRI showed midbrain-pontine hyperintensities with diffusion restriction. CSF analysis showed albumino-cytological dissociation. Serum Aquaporin 4, MOG antibodies were negative, rest of CSF analysis was non-contributory. Possibility of bikkerstaf encephalitis was considered and Gq1b antibody done. Despite negative autoantibodies, clinical phenotype suggested Bickerstaff brainstem encephalitis. Intravenous immunoglobulin (IVIg) was initiated, but outcome was fatal.

Discussion: This series reflects the heterogeneity of Brainstem encephalitis and emphasizes the need for structured diagnostic evaluation.

Conclusion: Early serological profiling and prompt immunotherapy may alter outcomes, though fulminant variants remain challenging.

Abstract ID 830: Neurophysiologic Findings and Clinico-Radiologic Correlates in Children with Bilateral Spastic Cerebral Palsy

Sangeeta Gupta, Anchala Bharadwaj

All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India

Background and aim: Cerebral palsy (CP) is elucidated as the group of permanent motor disorders which are non-progressive in nature. The present study aims at obtaining somatosensory evoked potentials (SSEP), visual evoked potentials (VEP), brainstem auditory evoked potentials (BAEP) and electroencephalography (EEG) in children with bilateral cerebral palsy and to compare the records with clinical and radiological findings.

Methodology: Sixty participants (30 children with CP and 30 controls, age-range: 6 months-10 years) were studied for a period of one year. Patients underwent brain magnetic resonance imaging (MRI) and neurophysiological testing. Independent sample t-test was employed for comparing group means. Chi-square test and t-test was used for the statistical correlation with the qualitative and quantitative variables, respectively. A p value of <0.05 was considered as statistically significant.

Results: Tibial SSEPs and median SSEPs revealed abnormal cortical response in 76.6% (23 of 30) and 66.66% (20 of 30) respectively. Abnormal BAEP recordings were observed in 4 (13.33%) and abnormal VEP recordings in 15 (50%) patients. Abnormal EEG was found in 12 patients (40%). Majority (73.33%) had periventricular leukomalacia in MRI. Abnormal tibial SSEPs were statistically correlated with abnormal EEG (p = 0.009) and perinatal asphyxia (p = 0.012). Abnormal median SSEPs were statistically correlated with abnormal VEP and perinatal asphyxia (p < 0.05).

Discussion: High proportion of abnormal SSEP documented in the study is consistent with the literature. Somatosensory tracts in close alignment to the susceptible brain areas may explain the findings. Correlation of abnormal VEP and SSEP has also been explained on the basis of involvement of parietal lobe and internal capsule fibers in CP.

Conclusion: The study evaluates the potential utility of cortical SSEP as a prognosis tool in children with CP. Evidences of sensory cortical involvement in cerebral palsy can also help in designing a better treating plan based on sensory integration therapy/occupational therapy.

Abstract ID 831: The Silent Struggles: Case Insights into Myopathy’s Varied Presentations - A 9-Patient Case Series

Sivaranjani Paramasivam, Mugundhan K, Vignesh A, Sivaji M, Marian Jude Vijay, Sanmuga Sundaram

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Myopathies encompass a broad spectrum of muscle disorders with autoimmune, toxic, endocrine, metabolic, and genetic etiologies. Early recognition and subtype classification are essential for guiding effective treatment and improving outcomes. This study was carried out to analyze the clinical profiles, diagnostic findings, treatment responses, and outcomes in nine patients with varied types of myopathies, highlighting the importance of a multidisciplinary diagnostic approach.

Methodology: A retrospective observational study was conducted on nine patients diagnosed with different subtypes of myopathy at a tertiary care center between January 2025 and May 2025. Patients were categorized based on serology, histopathology, clinical presentation, and treatment response. Data included demographics, presenting symptoms, creatine phosphokinase (CPK) levels, autoantibody panels, electromyogram (EMG), muscle biopsy findings, treatment, and follow-up outcomes.

Results: Of the nine patients, one had signal recognition particle (SRP) antibody-positive immune-mediated necrotizing myopathy, presenting with severe proximal weakness and markedly raised CPK; partial response to steroids and intravenous immunoglobulin (IVIG) and Rituximab, one had anti-HMG-CoA reductase antibody-positive myopathy, responsive to high-dose immunosuppression, one with anti-Ro-53 antibody-positive myopathy showed a subacute course with good steroid and injection Cyclophosphamide response one had anti-Mi-2b antibody-positive dermatomyositis with classic skin rash and favorable response to corticosteroids one was diagnosed with seronegative polymyositis, confirmed on biopsy, requiring prolonged immunosuppression, one had tenofovir-induced toxic myopathy, reversed with drug discontinuation, one presented with thyrotoxic myopathy, resolving after achieving euthyroid status one case of dysferlinopathy had progressive weakness and poor steroid response, and one had hypokalemic periodic paralysis, rapidly corrected with potassium replacement.

Discussion: This series highlights the diagnostic complexity and varied etiologies of myopathies. Integration of clinical, serological, and histopathological data is crucial for subtype differentiation and management.

Conclusion: In-depth evaluation of myopathy cases can reveal rare and treatable subtypes. A targeted approach based on etiology ensures better therapeutic outcomes.

Abstract ID 832: The Stiffening Silence - Unfolding a Geriatric Mystery

Manoj Kumar S, Shanmuga Sundaram N, Mugundhan K, Marian Jude Vijay, Vignesh Anbalagan

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Neuroleptic malignant syndrome (NMS) in elderly may present atypically due to comorbidities, vulnerabilities.

Methodology: A 70-year-old woman presented to the emergency department with decreased ambulation and stiffness of all four limbs and trunk for one week. A known case of hypothyroidism, she had been functioning independently six months prior. She developed behavioral disturbances including irrelevant speech (e.g., “neighbours are accusing my daughter-in-law”) and delusions of reference, along with short-term memory impairment such as forgetting meals. She was evaluated by a psychiatrist and started on risperidone and donepezil, resulting in transient improvement in delusions. Over the next three months, she exhibited progressive cognitive decline, including way-finding difficulties and disinhibited behavior such as inappropriate micturition. In the past two weeks, she developed psychomotor slowing, postural instability, and stooped gait with increasing stiffness. A day before admission, she became bedridden and had poor oral intake. On examination, she was lethargic and partially responsive to verbal commands. Neurological assessment revealed diffuse appendicular and truncal lead-pipe rigidity, waxy flexibility, vertical and horizontal gaze restriction (with preserved vestibulo-ocular reflex), hyporeflexia, and bilateral plantar withdrawal. Laboratory investigations showed leukocytosis and elevated creatine phosphokinase (CPK), with normal renal, liver, thyroid, and electrolyte panels. Cerebrospinal fluid (CSF) and vasculitis profiles were unremarkable. Magnetic resonance imaging (MRI) brain with contrast showed no abnormalities. Paraneoplastic panel was negative. Positron emission tomography (PET)-computed tomography (CT) scan revealed findings consistent with overlapping features of Alzheimer’s dementia and parkinsonism, with posterior cortical involvement. A diagnosis of atypical NMS was considered. Risperidone was discontinued, and supportive treatment was initiated. Over four weeks, the patient showed gradual improvement.

Results: This case highlights the importance of recognizing atypical presentations of NMS, particularly in elderly patients with cognitive decline and multiple comorbidities, where low-dose antipsychotics trigger severe adverse reactions

Discussion: NMS can occur with low-dose with antipsychotics.

Conclusion: This highlights the high frequency of atypical NMS in neurodegenerative diseases in older adults.

Abstract ID 833: An Uncommon Case of Posterior Circulation Stroke

Rajasekara Pandian Thiruvettai

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Posterior circulation stroke constitute around 20% of all ischemic strokes, the arteries involved are from the vertebrobasilar system. The involvement of anterior spinal artery in posterior circulation strokes is uncommon. We presented a case of left vertebral artery stroke with involvement of anterior spinal artery.

Methodology: A 36-years-old male known case of diabetes mellitus not on treatment for 6 years, developed acute onset spontaneous giddiness, not triggered, no nausea, vomiting, without diplopia, dysarthria, found to have high blood pressure measuring 220/120 mmhg with no target organ involvement, treated with injection labetalol, blood pressure reduced along with improvement of giddiness, 30 minutes after improvement from giddiness, noticed he was not able to grip objects in right hand, with weakness progressing distal to proximal of right upper limb, 15 minutes later similar pattern of weakness also involved left upper limb. Over the course of 4 hours, he noticed spontaneous improvement of proximal weakness of both upper limbs, with clinical examination demonstrating weakness in elbow extension and wrist dorsiflexion weakness, handgrip of both upper limbs – with no sensory, cerebellar signs.

Results: With the above presentation of the patient, a clinical localization of bilateral cortical stroke was suspected and patient was proceeded for magnetic resonance imaging (MRI) brain which showed left cerebellar infarct, left lateral medullary infarct, with magnetic resonance angiography (MRA) showing non visible left vertebral artery, with the clinical features not correlating with imaging finding, and non-visibility of left vertebral artery, suspicion was increased in looking for involvement of cervical cord secondary to anterior spinal artery involvement.

Discussion: hand weakness in posterior circulation stroke, indicates anterior spinal artery involvement, and must be searched upon.

Conclusion: Patient was treated with anti-platelets, statins, anti-hypertensives and insulin

Abstract ID 834: Spectrum of CNS Tuberculosis: The Role of Clinicoradiological and Therapeutic Factors in Outcome Variability: A Prospective Observational Study in a Tertiary Care Centre in Eastern India

Swagata Sarkar, Alak Pandit, Souvik Dubey

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Background and aim: Central nervous system (CNS) tuberculosis is a severe form of extrapulmonary Tuberculosis with diagnostic challenges. Advances in diagnostics and therapies including novel drugs offer hope for improved management. Aims of the study included to identify and analyse the key factors influencing variability in clinical outcomes of CNS tuberculosis by examining clinicoradiological features and therapeutic responses. To assess impact of host-related variables (e.g., immune status, age, comorbidity), disease stage, type, extent of CNS involvement on outcomes. To analyse the dynamic changes in radiological pattern in different stage of disease and in response to therapy. To analyse the role of treatment-related factors, drug resistance, paradoxical reaction and adjunctive emerging therapies.

Methodology: In this prospective observational study, subjects will be enrolled from ward, OPD, Neuro Infectious Clinic from January 2025 to June 2026 and analysed with standardize scales. The study was approved by the institutional ethical committee and written informed consent was taken from the participants.

Results: Twelve Patients have been enrolled till now. Four patients with CNS Tuberculoma alone responding well with conventional therapy. Three patients of TBM Tuberculoma arachnoiditis with Opticochiasmatic involvement refractory to anti-tuberculosis drugs (ATD) and steroid being planned for host directed Immunomodulators. Three patients of Grade 2/3 TBM, Obstructive Hydrocephalus and DOV responsive to ATD Steroids, 2 required EVD. Two patients with Grade 3/4 TBM, hydrocephalus and infarct expired during treatment. Patients are under follow up.

Discussion: Among 12 CNS TB patients, 33.3% had isolated tuberculoma responding to therapy, 25% had refractory TBM with arachnoiditis and opticochiasmatic TB, 25% had Grade 2/3 TBM responding to treatment, while 16.7% with Grade 3/4 TBM expired. All are under follow-up.

Conclusion: CNS tuberculosis presents diverse manifestations based on involved areas and paradoxical reactions; effective management requires clinicoradiological correlation and clinical judgment for personalized, outcome-driven treatment.

Abstract ID 835: Spectrum of Risk Factors, Clinical Presentation, Outcome in Patients with Large Vessel Occlusion Presenting with Acute Ischemic Stroke

Niladri Mandal

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Background and aim: Accounting for upto 46% of acute ishemic stroke large vessel occlusion (LVOs) possess outsized clinical importance as they more than doubled the risk of death or dependence as compaired to non LVOs in the pre endovascular era. Knowledge of the epidemiology, pathophysiology, natural history, clinical presentation, time gap of prese entation and diagnosis of LVO is crucial to understand the recent paradigm shift of the treatment. Objectives inlcuded identifying the time gap of symtom onset to diagnosis of stroke/transient ischemic attack (TIA) at primary physician level or first contact at PHC and diagnosis of LVO, and identifying risk factors, clinical features, demographic profiles, treatment recieved at primary and tertiary care hospital.

Methodology: Patients will be included from BIN ward, Stroke clinic, RDHH, HASU from Januray 2025-Jan 2026.

Results: Twenty-five percentage above 60 and rest 3 (75%) are 50-60 years age. Two are diabetic (50%), 3 are hypetensive (75%) allare smoker, alcoholic or both (100%), 2 had cardiac comorbidity, (one AF, one Post CABG). Two patients (50%) presented within goldenperiod directly in SSKM 100% presented with hemiparesis 25% with aphasia, 25% with altered sensorium 50% diagnosed in PHC and other tertiary care hospital respectively. Fifty percentagehad Left M1 occlusion, 25%had left ICA occlusion, 25% had right M2 occlusion 25% Thrombolysis. National Institute of Health Stroke Scale (NIHSS) >18 in 2 patients After 2 weeks NIHSS <10 of 2 patients (100% with thromboysis) aswell asimprovement of modified Rankin Scale (mRS).

Discussion: study showed most patients are elderly, diabetic or hypertensive. Addiction with smoking or alcoholism posses major factors in stroke. Patients dignosed early and got early revascularisation, prognosiswas good. Anticoagulation in patient of AF also improves NIHSS and mRS.

Conclusion: From this study we found NIHSS at day 0 and during follow up. Significant correlation between diabetis hypertension addiction and LVO. Significant correlation betwen outcome and timegap of presentation. Other than motor deficit cortical symptoms are also important clue for LVO.

Abstract ID 836: Current Practice Patterns Among Indian Neurologists in the Evaluation and Management of Normal Pressure Hydrocephalus: A Nationwide Cross-Sectional Survey

Elavarasi A, Sagar Poudel, Manjari Tripathi, Roopa Rajan, Rajesh Singh, Ajay Garg, Deepti Vibha, Animesh Das, Naveet Wig, Sarat Chandra

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Normal Pressure Hydrocephalus (NPH) is marked by a triad of gait disturbance, cognitive impairment, and urinary incontinence. Given the variability in clinical practice globally, particularly regarding the use of the cerebrospinal fluid (CSF) tap test, this cross-sectional study explores the diagnostic and management practices of neurologists in India.

Methodology: A 16-question online survey based on the CHERRIES checklist was disseminated to neurologists via closed social media and academic groups.

Results: A total of 59 neurologists responded, the majority working in tertiary care centers. Although most evaluated only one or two patients with NPH per month, there was significant variability in how the CSF tap test was implemented. While 95% of practitioners performed a tap test before referring patients for surgery, there were differences in the volume of CSF removed, the assessment tools used (e.g., MOCA, MMSE, TUG), cut-off thresholds, and the timing of post-test evaluations. Notably, 36% of neurologists relied on subjective clinical assessment instead of objective scoring to determine tap test responsiveness. One-third still considered surgical referral even if the tap test was negative, especially when imaging was strongly suggestive of the diagnosis. These trends reflect the lack of standardized protocols and reliance on physician discretion.

Discussion: There were several sources of significant heterogeneity with implications for the prognostication of post-surgical outcomes due to misclassification in diagnosis. The study was subject to selection bias due to the lack of random sampling-disseminated via social media platforms, which may limit generalizability. The study was also subject to information bias-responses relied on the practitioners’ memory and not prospectively collected. Despite margin of error of 12%, the survey offers valuable preliminary insights.

Conclusion: This study highlights considerable heterogeneity in the evaluation of NPH in India, emphasizing the need for consensus-based practice parameters to ensure accurate diagnosis, informed treatment decisions, and improved patient outcomes.

Abstract ID 837: Predictors of Early Recurrent Stroke in an Indian Cohort: Clinical, Laboratory, and Lifestyle Correlates from a Ambispective-Observational Study

Vignesh Kumar, Jude Vijay, Sivaji M, Mugundhan Krishnan

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Stroke recurrence remains a formidable challenge in neurovascular care, with rates as high as 53% over five years despite adherence to guideline-based secondary prevention. In low- and middle-income settings, the contribution of non-traditional risk factors—such as systemic inflammation, hematologic indices, and subclinical dysmetabolism—remains underexplored. This study aimed to identify clinical, biochemical, and lifestyle predictors of recurrent ischemic stroke, emphasizing real-world, blood-based biomarkers to enable precision risk stratification in a South Indian cohort.

Methodology: We conducted an ambispective observational study at Madras Medical College, enrolling 200 patients with documented recurrent ischemic stroke between January 2023 and December 2024. Detailed demographic, clinical, lifestyle, and radiological profiles were collected alongside comprehensive laboratory parameters, including neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), mean platelet volume (MPV), HALP score, lipid ratios (LDL/HDL, TGL/HDL), and the TyG index [Ln (Triglyceride x Fasting glucose/2)]. Multivariate logistic regression was used to identify independent predictors of early recurrence (<1 year) and stroke severity (National Institute of Health Stroke Scale [NIHSS]).

Results: Hypertension (94%) and diabetes (70%) were nearly universal, but recurrence occurred despite antiplatelet compliance in 88.5% of cases. MPV (OR = 4.60) and TGL/HDL ratio (OR = 2.56) were the strongest independent predictors of early recurrence. Low hemoglobin (OR = 0.13) and HALP score (OR = 0.46) conferred protective effects. Inflammatory indices (NLR, PLR, SII) showed moderate associations. Atrial fibrillation, though infrequent (2.5%), predicted recurrence in different vascular territories (80%).

Discussion: Our findings underscore the pivotal role of pro-inflammatory, nutritional, and metabolic indices in recurrent stroke pathogenesis. Composite biomarkers derived from routine labs demonstrated superior predictive value over conventional parameters.

Conclusion: This study advances the paradigm of stroke recurrence risk assessment by integrating easily accessible yet powerful laboratory markers. Incorporating indices such as MPV, HALP, and TGL/HDL into discharge protocols may enable cost-effective, precision-guided secondary prevention—especially in resource-constrained environments.

Abstract ID 838: Finger Drop, Head Drop, and Asymmetric Hypokalemic Paralysis: An Atypical Presentation of Gitelman Syndrome

Siddhartha Kancharla, Prasanthi Chilaka, Sakthi Velayutham, Malcolm Jeyaraj, Sowmini P R, KrishnaKumar B, Kannan V, Velusamy S

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Gitelman syndrome is a rare inherited renal tubulopathy characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. It commonly presents with fatigue or cramps, while focal neuromuscular symptoms are rare. We report an atypical case presenting with asymmetric weakness.

Methodology: A 46-year-old man with diabetes and chronic alcohol use presented with sudden-onset left upper limb pain and difficulty lifting the arm. Within 3 hours, the weakness progressed to involve the right upper limb, causing finger drop (right index and thumb). Two days later, bilateral lower limb weakness developed (right > left), followed by head drop. No history of diuretic use. Examination revealed asymmetric flaccid weakness: bilateral upper limbs (proximal > distal), with left > right, and lower limbs (proximal > distal), with right > left. Neck extensor weakness was present. Deep tendon reflex (DTR) was globally reduced, while sensation was preserved. Bp was normal.

Results: Investigations showed severe hypokalemia (K-2.3 mmol/L), hypomagnesemia, metabolic alkalosis, and electrocardiography (ECG) changes (U waves present, supporting severe hypokalemia). Nerve conduction studies revealed absent SNAPs in all limbs and reduced CMAPs. Creatine phosphokinase (CPK) was 10,904 U/L, decreasing to 2,000 U/L on follow-up suggesting rhabdomyolysis. After correction of electrolytes, muscle strength and reflexes improved; compound muscle action potential (CMAP) showed improvement, while sensory nerve action potential (SNAP) remained absent. Urine studies showed calcium 3 mg/dL, chloride 144 mEq/L, creatinine 79.4 mg/dL, and potassium 28 mEq/L.

Discussion: Based on the constellation of biochemical findings and clinical course, a diagnosis of Gitelman syndrome was considered. The elevated CPK attributed to hypokalemic rhabdomyolysis. The absent SNAPs and reduced CMAPs with partial recovery suggest an acute metabolic insult superimposed on chronic axonal sensorimotor neuropathy.

Conclusion: This case highlights a rare, asymmetric presentation of hypokalemic paralysis marked by finger drop and head drop, expanding the known clinical spectrum of Gitelman syndrome and underscoring the need for heightened clinical suspicion in atypical neuromuscular presentations.

Abstract ID 839: Untangling the Roots: A Novel Approach to TBM-Related Arachnoiditis

Manya Jarani, Sanjeev Bhoi, Menka Jha, Priyanka Samal, Suprava Naik

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Background and aim: Central nervous system tuberculosis (CNS TB) causes diverse complications such as meningitis, infarctions, arachnoiditis, and spinal involvement. Tuberculous arachnoiditis is often underdiagnosed but leads to significant morbidity through nerve root fibrosis and impaired cerebrospinal fluid (CSF) flow, adversely affecting patient independence. Conventional therapy targets infection but may inadequately address exudate-induced fibrosis. We aimed to evaluate intrathecal hyaluronidase as an adjunctive therapy in tuberculous meningitis (TBM) patients with spinal arachnoiditis.

Methodology: This is a prospective interventional study conducted at AIIMS, Bhubaneswar (July–December 2024) included six TBM patients with clinical and magnetic resonance imaging (MRI) evidence of basal exudates and arachnoiditis. Alongside standard anti-tubercular therapy (ATT) and corticosteroids, intrathecal hyaluronidase (1500 IU weekly via lumbar puncture) was administered for 10 weeks. Baseline and post-treatment brain and spine MRI, serial CSF analyses, and functional assessments using the modified Rankin Scale (mRS) and Barthel Index was performed.

Results: In this series, 5 of the 6 patients presented with altered sensorium and 3 had lower motor neuron paraparesis. Optic and spinal arachnoiditis were identified in most patients. Adjunctive hyaluronidase treatment correlated with progressive CSF protein reduction and significant resolution of exudates on MRI. Clinically, marked improvements in mRS scores and functional independence were observed, with 83.3% patients regaining near-normal daily function.

Discussion: Findings of the current study support intrathecal hyaluronidase as a safe, effective adjunct that facilitates clearance of inflammatory exudates and improves CSF dynamics in TBM- related arachnoiditis. This aligns with limited prior reports suggesting enhanced neurological recovery when combined with ATT and steroids. Despite the small sample size, these promising results justify larger controlled trials.

Conclusion: Intrathecal hyaluronidase shows potential to improve outcomes in TBM complicated by arachnoiditis, representing a valuable addition to current treatment regimens.

Abstract ID 840: New insights in Stroke Therapeutics – Assistive Devices Coupled with Transcranial Direct Current Stimulation

Ashu Bhasin, Sparsh Singh, Senthil SK, Vishnu VY, Padma Srivastava, Gulafshan Iqbal, Senthil SSK

All India Institute of Medical Sciences, New Delhi, India

Background and aim: Transcranial Direct Current Stimulation (tDCS) has enthralled the researchers as it has significant neuro rehabilitative effects post Stroke. The purpose of the study was to i) investigate the safety, feasibility and probable efficacy of bi cephalic tDCS; ii) to explore the potential benefits using piezoelectric hand glove in improving hand function after stroke.

Methodology: Ninety case controlled cohorts (3 months-4 years) with allocation to real transcranial direct current stimulation (r-tDCS) and age matched controls to sham (s-tDCS) was administered for 20 min along with physiotherapy. The primary outcome measure was change in Fugl-Meyer assessment (FMA) at 1 month and secondary outcomes were action research arm test (ARAT), modified Barthel Index (mBI), Brunnstrom stage and functional magnetic resonance imagig (fMRI) measures. Efficacy study with developed piezoelectric glove is currently recruiting patients with random allocation to i) r-tDCS+r-glove; ii) s-tDCS+r-glove; iii) s-tDCS+s-glove. All the assessments are done at baseline, 1 and 3 months.

Results: No side effects of stimulation were reported. FMA and mBI showed significant improvements at 3 months (p = 0.03 & p = 0.04 respectively). ARAT & MRC were statistically insignificant between the groups at all time points. There was an increase in the cluster counts of premotor and primary motor cortex (BA 4 & BA6) with an increased laterality index at 1 month. The efficacy study results will be extrapolated once the trial is over

Discussion: Neural substrates of tDCS correlated well post stroke leading to improved hand function (FMA p < 0.05) and daily performance (mBI < 0.05). A stronger activation of ipsilesional premotor and primary motor regions (BA4, 6) occurred in patients with r-tDCS.

Conclusion: tDCS is safe and feasible in stroke and has some functional gains along with physiotherapy. The glove combination trial is still recruiting subjects and results awaited.

Abstract ID 841: Proportion of Aortic Arch Atherosclerosis in Patients with Acute Ischemic Stroke in a Tertiary Care Centre

Anu Thomas, Ram Mohan, Ram Mohan, Thomas Iype

Government Medical College, Thiruvananthapuram, Kerala, India

Background and aim: Stroke is a major cause of long-term morbidity and mortality. It is essential to identify the stroke mechanism to prevent recurrent stroke. However, after extensive evaluation, 15-40% of all ischemic strokes are classified as stroke of unknown etiology or cryptogenic strokes. Aortic arch atherosclerosis is posed as a possible source of embolism especially in patients with cryptogenic stroke. This study aimed to estimate the prevalence of aortic arch atherosclerosis in patients with acute ischemic stroke and the risk factors associated with it.

Methodology: Cross-sectional study including patients with stroke within one month of onset of stroke and who have undergone computed tomography (CT) angiography.

Results: Among the study population of 224 patients with acute ischemic stroke, 61.6% were males and the median age was 64 years. About 45% of the study population was classified as stroke of unknown etiology. Significant aortic arch atherosclerosis was identified in 28.1% of patients with the majority (73%) of them being characterized as large plaque (>4 mm), 22.2% as protruding plaque and 4.7% as ulcerated plaque. Age and hypertension were found to have significant association with aortic arch plaque and age emerged as the independent risk factor.

Discussion: The prevalence of aortic arch atherosclerosis was found to be similar that reported elsewhere. The presence of significant plaques and vulnerable plaques were found to be high in large artery atherosclerosis, and in those with strokes of unknown etiology.

Conclusion: Aortic arch atherosclerosis was found in about one in every three cases of acute ischemic stroke, with a high prevalence of vulnerable plaque in those with stroke of unknown etiology and large artery atherosclerotic disease. Age is the independent risk factor for the development of aortic arch atherosclerosis.

Abstract ID 842: Effectiveness of repetitive Transcranial Magnetic Stimulation (rTMS) on Motor Functional Recovery in Ischemic Stroke Patients: A Quasi Experimental Trial - at a Tertiary Care Centre Eastern India

Monica Karan, Lulup Sahoo, Ajit Mishra, Srikant Sahoo, Devidutta Dash, Lavanya Latha

Institute of Medical Science and Sum Hospital, Bhubaneswar, Odisha, India

Background and aim: Ischemic stroke is a leading cause of long-term disability, especially in low- and middle-income countries like India. Although physiotherapy is essential for recovery, progress is often slow with more non-compliance. Repetitive transcranial magnetic stimulation a non-invasive neuromodulation method has emerged as a potential enhancer of neuroplasticity and motor recovery. The present study was carried out to evaluate the effectiveness of low-frequency (rTMS) combined with standard physiotherapy compared to physiotherapy alone in acute ischemic stroke patients.

Methodology: This quasi-experimental controlled trial, study duration – 1 year, was conducted in the Department of Neurology, OPD and IPD patients with on first-ever ischemic stroke patients within 15 days of onset. Patients were divided intoIntervention group (n = 10): Received 10 sessions of low-frequency (1 Hz) rTMS over the unaffected hemisphere followed by physiotherapy, or Control group (n = 10): Received physiotherapy only. Physiotherapy included active, passive, passive-assisted exercises, stretching, and strength training (45 minutes twice daily for 3 months). Outcomes (NIHSS, FMA-UE, mRS, mBI) were assessed at baseline, day 15, and 3 months, MAS at 3 months.

Results: The intervention group showed greater neurological improvement (NIHSS: 7.4 ± 2.3 to 2.8 ± 1.1) vs. control (7.0 ± 2.1 to 4.9 ± 1.6). Motor function (FMA-UL) improved significantly in the intervention group (20.7 ± 7.9 to 47.3 ± 6.5) vs. control (21.1 ± 6.4 to 33.5 ± 5.9). Spasticity (MAS) reduced at 3 months more in rTMS group in comparison to physiotherapy group. Greater gains in modified Rankin Scale (mRS) and modified Barthel Index (mBI) scores in the intervention group reflected better disability and daily living outcomes.

Discussion: This study suggests improved motor recovery and reduced spasticity with rTMS, although statistical significance was limited by small sample size.

Conclusion: Low-frequency rTMS is a promising, safe adjunct to physiotherapy in acute stroke rehabilitation. Larger trials are needed to confirm its clinical utility.

Abstract ID 843: Effect on the Non-Injected Hand After Unilateral Local Corticosteroid Injection in Patients with Bilateral Carpal Tunnel Syndrome: A Prospective Cohort Study

Mritunjai Singh, Niket Yende, Jagbir Singh, Rajni Singh, Ashutosh Tiwari, Niraj Kumar

All India Institute of Medical Sciences, Rishikesh, Jharkhand, India

Background and aim: The injected hand in carpal tunnel syndrome (CTS) improves significantly after local corticosteroid injection (LCI). Whether it affects the non-injected hand is unknown. This study assesses the effect of unilateral LCI on the non-injected hand in mild to moderate bilateral CTS.

Methodology: Sixty patients with bilateral CTS during December 2021 to August 2024 received a single unilateral injection of 40 mg of methylprednisolone (MP) at the more severely affected wrist or the dominant hand in the event of comparable symptoms. Primary outcome was comparison of symptoms severity score (SSS) scores at baseline, 1 and 3 months in the injected and non-injected hands. Secondary outcomes were comparison of response rate and recurrence at 3 months. A significant clinical “response” was defined as reduction in SSS by 0.8 from the baseline value.

Results: The median age was 45 (range 20–81) years and 50 (83.3%) were females. Along with a substantial reduction in SSS at 1 and 3 months in the injected hand, the non-injected hand exhibited a significant reduction in SSS score at both 1 month (1.49 ± 0.52; p < 0.01) and 3 months (1.59 ± 0.67; p < 0.01) compared to the baseline. The response rate (65%vs56.7%; p = 0.45) and recurrence rate (11.4%vs12.8%; p > 0.99) at 3 months were comparable. Nevertheless, injected hand exhibited a significantly greater mean reduction in SSS score at 1 month (1.25 ± 0.64 vs 0.89 ± 0.67; p < 0.01) and at 3 months (1.23 ± 0.72 vs 0.77 ± 0.64; p < 0.01) when compared to non-injected hand.

Discussion: Significant symptom remission in the non-injected hand was seen in 56.7% patients. The injected hand had a significantly higher mean decline in SSS scores at 1- and 3-months post-injection compared to the non-injected side. Both the hands showed comparable response and recurrence rates at three months.

Conclusion: Following a single LCI for bilateral CTS, 56.7% of patients exhibited significant remission of symptoms in the non-injected hand.

Abstract ID 844: Utility of Motor Unit Number Estimation (MUNE) as a Biomarker for ALS Progression

Divya Rani, Shishir Chandan

Vardhman Mahavir Medical College, New Delhi, India

Background and aim: This study aimed to evaluate motor unit number estimation (MUNE) and demonstrate its relationship with disease progression in patients with amyotrophic lateral sclerosis (ALS).

Methodology: In this prospective observational study, a total of thirty five patients were included, who were diagnosed as either definite or probable ALS according to modified El Escoril criteria. Multipoint incremental stimulation method was used to calculate MUNE at baseline and at 6 months. MUNE value at 6 months was compared with baseline value and rate of decline in MUNE was correlated with disease progression.

Results: We observed a significant decline of MUNE at 6 months as compared to baseline MUNE (23.6 ± 15.3) (p < 0.05). No significant associations were observed between MUNE and patient age, sex, or site of symptom onset.

Discussion: Amyotrophic lateral sclerosis is the most common disease of anterior horn cells. However, because of the heterogeneity of ALS disease progression, a reliable, practical, and validated prognostic model for ALS patients is still not available. This study aimed to assess if MUNE can be used as a marker of disease progression in ALS patients. The mean value of MUNE was calculated as 16.36 ± 5.22 which significantly reduced to 13.37 ± 4.96 at 6 months (p value < 0.0001), supporting its potential utility as a progression marker.

Conclusion: MUNE demonstrated a significant decline over 6 months, indicating that it is a sensitive marker of motor neuron loss over time. These findings support using MUNE as a reliable and objective biomarker for monitoring disease progression in ALS.

Abstract ID 845: Risk factors of Cerebral Small Vessel Disease and it’s Correlation with Obstructive Sleep Apnea

Drishti Khatri, Joy Desai, Arun Shah, Manish Chhabria

Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India

Background and aim: This study aimed to determine the prevalence of obstructive sleep apnea (OSA) in patients with cerebral small vessel disease (CSVD), assess the impact of OSA severity on radiological and functional outcomes, and evaluate the contribution of traditional vascular risk factors to CSVD burden.

Methodology: We conducted a single-centre, observational study at Sir H. N. Reliance Foundation Hospital and Research Centre over 12 months, enrolling 83 adults (>18 years) with magnetic resonance imaging (MRI)-confirmed CSVD. Participants underwent comprehensive clinical assessment, Epworth Sleepiness Scale (ESS) scoring, and overnight polysomnography to diagnose and grade OSA severity. MRI findings were interpreted according to STRIVE criteria, and WMH burden was quantified using the Fazekas scale. Functional outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at discharge. Statistical analyses were performed with STATA 15.

Results: The cohort had a mean age of 66.6 years, with a predominance of males (69%). OSA was identified in 76.2% of CSVD patients, with varying severity. White matter hyperintensities were observed in 97.6% of cases. Notably, moderate-to-severe OSA was significantly associated with higher Fazekas scores and increased white matter burden (p < 0.05). Severity of OSA also correlated with poorer functional outcomes, as reflected by higher NIHSS and mRS scores at discharge. These associations persisted independently of conventional vascular risk factors such as hypertension and diabetes.

Discussion: The findings underscore OSA as a prevalent and potentially modifiable risk factor in CSVD, contributing to both radiological and clinical deterioration. The observed associations suggest pathophysiological mechanisms related to intermittent hypoxia and impaired glymphatic clearance.

Conclusion: OSA is highly prevalent among CSVD patients and is independently associated with increased radiological burden and worse functional outcomes. Early identification and management of OSA may represent a critical strategy to attenuate CSVD progression and improve neurological prognosis.

Abstract ID 846: Autoimmune Etiologies in Movement Disorders: Insights from a Hyderabad Cohort

Sandhya Manorenj

Deccan College of Medical Sciences, Hyderabad, Telangana, India

Background and aim: Autoimmune movement disorders encompass a growing spectrum of neurological syndromes characterized by abnormal involuntary movements that arise from autoimmune processes.

Methodology: We present a retrospective series involving 14 patients who were diagnosed with autoimmune movement disorders at a tertiary care facility over a three-year span.

Results: Mean age was 51.38 ± 18.2 years with equal sex predilection. The patient group displayed various phenotypes, including ataxia, dystonia, myoclonus, myokymia, chorea and Parkinsonism, frequently linked to autoimmune encephalitis or systemic autoimmune conditions. The diagnostic approach included clinical evaluations, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, and testing for autoimmune antibodies. A majority of the patients tested positive for anti-TPO autoantibodies (35%), others were anti-Ma, anti-GAD, anti-Yo, anti-CASPR2 and AQP4 antibodies. Most common movement disorder was Parkinsonism (50%) followed by cerebellar ataxia (35%). Treatment with immunotherapy resulted in significant improvement for 12 out of the 14 patients, highlighting the critical nature of early detection and intervention.

Discussion: In comparison to the current literature, our case series validates the diversity of autoimmune movement disorders, revealing that Parkinsonism occurs more frequently than commonly documented. The significant presence of anti-TPO antibodies indicates a more pronounced autoimmune connection related to the thyroid in this subgroup of patients. In line with earlier research, initiating immunotherapy at an early stage resulted in considerable clinical progress for most patients.

Conclusion: This case series emphasizes the diversity and treatable aspects of autoimmune movement disorders, reinforcing the necessity for increased clinical awareness, thorough diagnostic investigations, and timely immunomodulatory treatment to enhance patient outcomes.

Abstract ID 847: Can NMR (Nuclear Magnetic Resonance) Spectroscopy Serve As a Diagnostic Tool for Duchenne Muscular Dystrophy (DMD) Patients?

Niraj Srivastava, Abhishek Pathak, Vijaya Mishra

Banaras Hindu University, Varanasi, Uttar Pradesh, India

Background and aim: Duchenne muscular dystrophy (DMD) is typically appears in early childhood with progressive weakness in the proximal muscles and enlargement of the calves in affected boys. The aim of the present study was to estimate the lipid components in the serum of patients with DMD and healthy individuals using proton nuclear magnetic resonance (NMR) spectroscopy.

Methodology: Proton NMR spectroscopic analysis was conducted on the lipid extracts from the serum of 41 DMD patients (mean age ± SD: 8.0 ± 3.0 years) and 22 healthy individuals (mean age ± SD: 9.0 ± 4.0 years).

Results: The concentrations of triglycerides, phospholipids, free cholesterol, cholesterol esters, and total cholesterol were found to be significantly higher in DMD patients compared to healthy controls. No significant differences in serum lipid profiles were observed between DMD patients with and without gene deletions.

Discussion: The significance of lipid metabolism in muscular dystrophy was recognized in the ancient Indian medical text, the Charak Samhita. Modern studies on dystrophic animal models, such as chickens and mice, have demonstrated elevated plasma phospholipid concentrations in their serum. Elevated levels of lipid found in the serum of DMD patients in the present study also supported by the previous studies.

Conclusion: NMR-based analysis of serum lipid constituents may overcome the current limitations of gene mutation analysis and serve as an effective alternative diagnostic approach for DMD.

Abstract ID 848: An Observational Study on Clinical Features and Imaging Correlates of Progressive Supra Nuclear Palsy at Tertiary Care Centre

Naveen Ashokan, Mugundhan Krishnan, Uma Maheshwari

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: First described in 1964 by Steele, Richardson, and Olszewski, progressive supra nuclear palsy (PSP) is the second most common form of atypical parkinsonism but it is still a relatively rare disease, with prevalence estimates ranging from 1.39 to 6.4 per 100,000.

Methodology: EIghteen patients, diagnosed as probable PSP based on MDS criteria, were studied. Age of onset, symptomatology, disease progression, signs of cognitive dysfunction, occulomotor dysfunction, procerus sign, rocket sign, applause sign, rigidity and other extra pyramidal signs were analysed. Patients were subjected to neuroimaging to look for radiological features.

Results: Common age of onset was in 5th-6th decade, but as late as 8th decade was noted. Most patients developed recurrent falls after one year of disease onset. Earliest was within 6 months of disease onset. Sixty percentage of patients experienced dysarthria, usually at 3rd year of the disease. In this study, only 3 had dysphagia, happening at 3rd year of the disease. Twenty-two percentage had frontal lobe involvement in form of disinhibition and dysexecution. All patients except 2 had vertical gaze palsy. Fifty-two percentage of patients had procerus sign. Three patients had rocket sign and applause sign. Only 11 patients underwent neuro imaging, all 11 patients showed midbrain to pons ratio less than 0.5 and mid brain to pons area ratio less than 0.15. 2 patients in whom MRPI was measured showed a value more than 13.5.

Discussion: The MDS criteria 2017 identified four functional domains oculomotor dysfunction, postural instability, akinesia, and cognitive dysfunction. The most disabling symptom of PSP usually relates to balance impair- ment. Occulo motor abnormalities include vertical gazepalsy, impairment of saccades, optoki-netic nystagmus, and the presence of square wave jerks, blepharospasm and involuntary eye closure. Magnetic resonance imaging (MRI) of patients with PSP include generalised and brain-stem, particularly midbrain atrophy.

Conclusion: Sixty years from the first definition of disease, we are yet to learn a lot about the disease.

Abstract ID 849: Homozygous Sequestosome 1 (SQSTM1) Mutation: A Rare Cause for Childhood-Onset Mixed Movement Disorder, Cerebellar Ataxia with Vertical Gaze Palsy

Bhanu Yadlapalli, Uma Maheswari, Thamil Pavai, Mugundan K

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Mutations in SQSTM1 gene have been recently identified as a rare cause of progressive childhood neurodegenerative disorder. Earlier they have been associated with neurodegenerative diseases, such as frontotemporal dementia and amyotrophic lateral sclerosis. Here, we report a case of progressive childhood-onset mixed movement disorder with cerebellar ataxia with gaze palsy with no family history and a normal magnetic resonance imaging (MRI) of brain. Whole-exome sequencing (WES) in this patient showed a homozygous mutation in SQSTM1.

Methodology: Case study

Results: A 13-years-old male, born of third degree consanguinity with a background of normal developmental milestones and breath holding spells /repeated respiratory and gastrointestinal infection till 5 years of age has presented with an insidious onset chronic progressive neurological illness of 8 years duration, which started with a poor scholastic performance with subsequent development of involuntary movements of both upper limbs and lower limbs, unsteadiness of gait, with history of recent onset of headache with no history suggestive of sensory, cranial nerve and ANS dysfunction with no significant family history. On examination, short statured, MMSE 24/30, with impaired frontal and left parietal lobe functions, B/L EOM restriction in all directions with pupil sparing, with macrosquare wave jerks, tone decreased in all four limbs, normal motor power, b/l supinator, knee and ankle jerk absent, Lt dysdiadokinesia+, extrapyramidal involvement in the form of hyperkinetic, large and small amplitude involuntary movement involving both upper and lower limbs with dystonic posturing of both hands, with normal sensory /autonomic nervous system and no significant family history Investigations revealed. serum ceruloplasmin, serum lactate, serum ammonia, serum immunoglobulin (Ig) A serum IgM, serum vitamin B12 and serum vitamin E, Thyroid function test to be normal. Peripheral smear - no evidence of acanthocytes. Ophthalmic examination - no evidence of KF ring, no cherry red spot. Magnetic resonance imaging (MRI) Brain – normal. WES revealed a homozygous nonsense variant in exon 2 of the SQSTM1 gene.

Discussion: Childhood-onset neurodegeneration with ataxia, dystonia, and gaze palsy is caused by homozygous mutations in the SQSTM1 gene. This disorder is characterized by onset of gait ataxia, cognitive decline, and gaze palsy in the first or second decades. Additional features include dysarthria, dystonia, and athetoid movements.

Conclusion: The SQSTM1 mutation should be considered in the differential diagnosis in a patient with cerebellar ataxia, dyskinesias and ophthalmological manifestations.

Abstract ID 850: Breaking the Mold: Miller Fisher Syndrome with Papilledema and Vision Loss; Expanding the Guillain-Barré Spectrum

Aishwarya Menon, Satya Sravani Nyayapathi, Sakthi Velayutham, Malcolm Jeyaraj, Sowmini P R, Krishnakumar B, Kannan V, S Velusamy

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Miller Fisher Syndrome (MFS), a rare variant of Guillain-Barré Syndrome (GBS), is classically defined by the triad of ophthalmoplegia, ataxia, and areflexia. Papilledema and visual loss are atypical and may suggest overlapping or variant presentations within the GBS spectrum.

Methodology: A 44-year-old woman with treated pulmonary tuberculosis and a history of psychosis presented with acute headache, binocular diplopia, and progressive visual loss—first in the left eye, then the right. Symptoms followed a recent febrile illness and were accompanied by vertigo, generalized weakness of all 4 limbs, with paraesthesias in both hands and feet along with truncal ataxia. Neurological examination revealed complete left ophthalmoplegia with ptosis, partial right ophthalmoparesis, bilateral disc edema, and left trigeminal sensory loss. Limb exam showed hypotonia and weakness (proximal > distal, left > right), diminished upper limb reflexes, and absent lower limb reflexes. Bilateral ataxia was prominent. By day 3, she developed a right lower motor neuron facial palsy.

Results: Magnetic resonance imaging (MRI) brain with contrast showed dilated optic nerve sheaths, posterior scleral flattening, tortuosity, and an empty sella, suggesting raised intracranial pressure without meningeal enhancement. Nerve conduction studies revealed reduced compound muscle action potential (CMAPs), absent F-waves, and decreased sensory nerve action potential (SNAPs). Cerebrospinal fluid (CSF) was acellular with elevated protein (60 mg/dL) and normal glucose. Intravenous immunoglobulin (IVIG) therapy was initiated, and serum ganglioside antibody panel (anti-GQ1b, GM1, GD1a, GD1b, GT1a, GT1b) was sent to evaluate for MFS and GBS variants.

Discussion: This case reflects an MFS–GBS overlap, with polyradiculopathy, limb weakness, and cranial nerve involvement beyond the classic MFS triad. Bilateral papilledema and vision loss—likely due to raised intracranial pressure and probable optic neuritis—are atypical, highlighting the broader, under-recognized spectrum of GBS variants.

Conclusion: Recognizing such rare and overlapping presentations of MFS is vital for timely diagnosis and intervention, especially when symptoms extend beyond classical features.

Abstract ID 851: Clinical Yield and Health Economics of Ambulatory EEG

Aishwarya Jirwankar, Sangeeta Ravat, Aditya Kadambi¹, Muhammad Shaheed¹

Seth G S Medical College & KEM Hospital, Mumbai, Maharashtra, ¹Mocxa Pvt Ltd, Bengaluru, Karnataka, India

Background and aim: This study aimed to evaluate the clinical and cost-effectiveness of a locally developed, cloud-integrated ambulatory video electroencephalogram (VEEG, Mocxa) across diverse care environments in India and if such a system can improve access while offering economic advantages to patients, providers, and payers.

Methodology: A prospective case series involving five patients underwent ambulatory VEEG at home, intensive care unit (ICU), and ward. Data collection included the patient demographics, clinical data, duration of recording and final EEG interpretation by an epileptologist and feedback from person with epilepsy (PWE) and caregivers (Likert scale). A parallel 6-month health economics sub-analysis was conducted to assess EEG pricing across more than 50 hospitals across India. A survey gathered information on routine EEG (30–60 min) and long-duration in house EEG (24–72 hr) pricing from both public and private institutions. Data were stratified by region, facility type, and inpatient Vs. outpatient use. We applied comparative cost analysis and value-based pricing frameworks, considering diagnostic yield per dollar spent, indirect cost savings (e.g., reduced repeat testing, earlier diagnosis, fewer hospital visits), and structured patient feedback (Likert scale) using the data collected from our survey, PUBMED published for global ambulatory EEG data and feedback from this pilot study. Rates were converted to USD for cross-regional comparison.

Results: All five cases recorded >95% interpretable data, achieved electroclinical diagnosis with 100% correlation between EEG and clinical symptoms. PWE and caregivers rated tolerability highly. The ambulatory modality shortened diagnostic timelines, particularly for home-based studies and recorded what was missed on routine EEG. From a health economics standpoint, the average cost of a routine EEG, long term in hospital EEG and projected AEEG cost was USD $12–$50, $180–$420, USD $120–$293, respectively.

Discussion: Ambulatory VEEG improves diagnosis, reduces repeat testing, and supports cost-effective epilepsy care in underserved settings.

Conclusion: Ambulatory VEEG is effective, cost-efficient, and scalable, with cloud integration enabling widespread use in resource-limited, decentralized healthcare settings.

Abstract ID 852: A Tertiary Care Centre Observational Study on Clinical Profile and Serology of Autoimmune Inflammatory Myositis

Naveen Ashokan, Mugundhan Krishnan

Madras Medical College, Chennai, Tamil Nadu, India

Background and aim: Idiopathic inflammatory myopathies are a group of disorders, resulting from immune- mediated injury, primarily affecting striated muscles but can also affect skin and connective tissue.

Methodology: Fifteen cases of autoimmune myositis, were studied. Patient’s clinical features were analysed. Patients were subjected to creatine kinase and serum myositis antibody profile. Patients were treated with intravenous steroids, intravenous immunoglobulin and rituximab and response were studied.

Results: In this study, it was found that inflammatory myopathy, commonly occurred in 4th -5th decade and women in comparison with men. The phenotype of disease was strongly associated with the antibody detected. Apart from muscle weakness, other common presenting symptoms were dysphagia. Anti-signal recognition particle (SRP) Immune-mediated necrotising myopathy was observed to have higher levels of creatine kinase elevation. Irrespective of associated antibody all the patients needed treatment with a second line agent.

Discussion: Initially classified by Bohan and Peter into Dermatomyositis and polymyositis, with the evolution of advancements in serological testing and histopathological assessment, current classification includes Polymyositis, Dermatomyositis, Immune mediated necrotising myopathy, and Inclusion body myositis. Corticosteroids are considered to be the first line drug of choice. In patients not responding to steroids, Intravenous Immunoglobulin at a dose of 2 g/kg/day over 5 days is useful. Other drugs found to be useful includes Rituxima, Abatacept and infliximab. At present, no effective management for inclusion body myositis.

Conclusion: This assorted group of disorders, despite their primary target is muscle, can be differentiated by extramuscular involvement, associated other auto immune diseases, and their progression, prognosis and response to treatment. All patients should be educated about the disease process. Patients should also be regularly followed up for development of extra muscular involvement and treatment related adverse effects. Advanced diagnostic criteria incorporating clinical features, auto antibody and histopathalogy, therapeutic guidelines with escalation scheme and finally disease process specific biological agents are future objectives.

Abstract ID 853: Etiological Spectrum and Clinical Profile of Combined Arterial and Venous Stroke: A 10-Year Tertiary Center Study

Brunda K, Sanjith Aaron

Christian Medical College, Vellore, Tamil Nadu, India

Background and aim: It is rare for arterial and venous strokes to occur in the same patient. Reports on this dual pathology are limited in the existing global literature, and data from India are particularly scarce. This study aims to evaluate the etiological spectrum in patients with arterial and venous strokes.

Methodology: We conducted a retrospective observational study at a tertiary care centre over 10 years. During the study period, we reviewed the medical records of all patients who were diagnosed with arterial and venous strokes, either simultaneously or sequentially.

Results: Over 10 years, a total of 31 patients were identified who had developed both arterial and venous strokes. Of these, 77.4% were male and 22.6% were female. Among them, nine patients (29.03%) initially presented with an arterial stroke followed by a venous stroke, with a mean interval of 5.22 years between the two events. Conversely, 12 patients (38.71%) developed a venous stroke first and 11 patients (45.4%) had stroke simultaneously. The most common underlying factor in etiology was hyperhomocysteinemia (25.81%). This was followed by cryptogenic causes (22.58%), prothrombotic states (19.35%) and polycythaemia. A comprehensive thrombotic workup was performed in 25 patients (80.65%), while genetic analysis was conducted in 10 patients (32.2%). Factor XIII A8259G and MTHFR C677T were the most frequent genetic mutations detected.

Discussion: Coexisting arterial and venous strokes suggest a prothrombotic tendency. In our study, hyperhomocysteinemia emerged as the most frequent etiological factor. Genetic mutations such as Factor XIII A8259G and MTHFR C677T also support a multifactorial thrombotic tendency. The varied sequence of stroke events highlights the need for ongoing evaluation and surveillance.

Conclusion: Patients with both arterial and venous strokes often have underlying prothrombotic or genetic risk factors. This study contributes to the limited literature and highlights the need for further research to elucidate underlying mechanisms.

Abstract ID 854: Intracranial Atherosclerotic Disease Treatment: Neuro Intervention Experience

Mukesh Kumar

Artemis Hospital, Gurugram, Haryana, India

Background and aim: Intracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke worldwide. The management of ICAD has been evolving with advanced imaging, refinements of best medical treatment, and the development of endovascular options. There has been a significant increase in the use of endovascular thrombectomy (EVT) for symptomatic ICAD worldwide over the past few years. This stud was aimed to analyze neurointerventional management of ICAD patients and the efficacy of different management strategies available as well as their impact on the clinical outcome in these patients, to strengthen clinical practices and thus optimize patient care.

Methodology: Patients who suffered from an ICAD and underwent neurointerventional management at the Comprehensive Stroke Centre of Artemis Hospital, Gurugram over past one year were carefully analyzed and their clinical data compiled.

Discussion: Patients who suffered from an ICAD and underwent neurointerventional management at the Comprehensive Stroke Centre of Artemis Hospital, Gurugram over past one year were carefully analyzed and their clinical data compiled.

Conclusion: The present study shows that neurointerventional management of eligible ICAD patients may be a promising treatment option for symptomatic ICAD patients with high risk of recurrence with medical treatment.

Abstract ID 855: Sleep Spectral Alterations and Microarchitecture Disruptions in Ischemic Stroke: A Whole Night Polysomnography Study

Mythirayee S, Srijithesh PR, Ravi Yadav, Jitender Saini, Ravindra PN, Bindu Kuty, Seshagiri DV, Bindu Kutty

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Sleep microarchitecture, including spindles, K-complexes, and slow waves, plays a critical role in neuroplasticity and recovery. However, alterations in these features following stroke remain underexplored. This study aimed to compare sleep microarchitecture features in ischemic stroke patients versus healthy controls.

Methodology: Thirty ischemic stroke patients (1-month post-stroke) and thirty age- and sex-matched healthy controls underwent whole-night polysomnography (PSG). Electroencephalogram (EEG) data were scored manually using AASM 2023 criteria. Microarchitecture analysis was performed with the YASA toolbox, focusing on N2 sleep spindles and K-complexes, N3 slow waves, and rapid eye movement (REM) spectral activity (theta and alpha power). Spindle count, density, amplitude, duration, and frequency were extracted.

Results: Thirty ischemic stroke patients (mean age: 51.4 ± 10.2 years; 66.6% male) within one month of onset and 30 healthy controls (mean age: 50.8 ± 9.6 years; 66.6% male) underwent PSG. Stroke patients showed significant spindle deficits: lower density (0.49/min vs. 0.83/min, p < 0.01), amplitude (11.2 µV vs. 15.4 µV, p = 0.02), and count (147.3 vs. 235.7, p = 0.01). Spindle duration was shorter (0.75 s vs. 0.89 s, p = 0.03). Slow wave amplitude and slope during N3 were reduced (59.2 µV vs. 78.5 µV, p = 0.01; 1.47 µV/ms vs. ?2.18 µV/ms, p = 0.01). REM sleep showed lower theta (p = 0.03) and alpha (p = 0.018) power, with reduced REM density (1.9/min vs. 2.6/min, p = 0.07).

Discussion: Findings of the present are consistent with previous research showing impaired spindle generation and slow-wave activity following stroke (. These alterations likely reflect thalamocortical network disruptions. Reduced REM theta and alpha power corroborate earlier spectral EEG studies indicating altered spectral analysis of sleep in post-stroke.

Conclusion: Ischemic stroke is associated with prominent disturbances in sleep microarchitecture, including impaired spindle and slow-wave generation and altered REM spectral dynamics. Disruptions of microarchitecture could be a potential biomarker for sleep alterations post stroke.

Abstract ID 856: Unmasking Stiff Person Syndrome: Navigating Weak Immunological Markers with Strong Clinical Suspicion

Daya Varghese, Akil Kumar Reddy V, S Sakthi Velayutham, Kannan V, Velusami S, Krishnakumar Balaraman

Stanley Medical College, Chennai, Tamil Nadu, India

Background and aim: Stiff Person Syndrome (SPS) is a rare autoimmune neurological disorder due to Impairement of gamma-aminobutyric acid (GABA) inhibitory pathway, particularly in spinal cord, leading to motor overactivity, leading to rigidity, hyperreflexia and startle responses. Though classically associated with anti-GAD antibodies, approximately 19% of patients may be seronegative, complicating early diagnosis. This report highlights a diagnostically challenging case of SPS with spontaneous ankle clonus and startle-induced spasms.

Methodology: A 45-year-old previously healthy male presented with progressive lower limb stiffness, painful twisting of the right foot and stimulus-sensitive jerks over a span of 9 -10 months. Initially attributed to a prior orthopedic injury, his symptoms evolved to include axial stiffness, spontaneous ankle clonus, and exaggerated startle responses to noise and emotional stimuli. Neurological examination showed hyperlordosis, axial and limb rigidity, brisk to exaggerated deep tendon reflexes, and calf muscle spasms and positive head retraction.

Results: Thyroid testing revealed suppressed thyroid stimulating hormone (TSH) and elevated FT4, with mildly deranged glucose levels, which again supported autoimmune association. Surface electromyography (EMG) demonstrated co-contraction of agonist and antagonist muscles. While anti-GAD antibodies were weakly positive, magnetic resonance imaging (MRI) spine & brain and paraneoplastic panels were unremarkable. A clinical diagnosis of SPS was made, supported by EMG, and treatment with IVIG and GABAnergics led to significant symptom improvement.

Discussion: This case underscores the importance of clinical acumen in diagnosing SPS, particularly in seronegative or weakly positive patients. It’s very crucial to differentiate it from functional movement disorders. Moreover, SPS also has a functional overlay, in the form of depression, anxiety, even suicidal tendencies. Autoimmune associations such as thyroid dysfunction and diabetes further support the diagnosis. EMG findings of continuous motor activity are crucial in such cases.

Conclusion: SPS should be considered in patients with unexplained muscle rigidity, spasms, and exaggerated startle responses, even without definitive antibody positivity. Early recognition and immunotherapy can dramatically improve outcomes and prevent long-term disability.

Abstract ID 857: Midline Shift and Vertical Shift in Supratentorial Intracerebral Hemorrhage: Role in Predicting Stroke Severity, Herniations, and Outcomes

Dhiraj Kumar, Jayantee Kalita

Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background and aim: Stroke remains a major public health concern as the second leading cause of death globally and the third leading cause of disability. Intracerebral hemorrhage (ICH) accounts for approximately 10% of strokes worldwide and 24% in Asia. Among patients with supratentorial ICH, midline shift (MLS) and vertical shift (VS) on computed tomography (CT) scans are critical markers of mass effect and predictors of poor outcomes. This study evaluates the roles of MLS and VS in assessing stroke severity, herniation risk, and short- and long-term clinical outcomes.

Methodology: This prospective study included 101 patients admitted within 24 hours of symptom onset with primary supratentorial ICH. Exclusion criteria included infratentorial hemorrhages, traumatic brain injuries, and pre-existing neurological disorders. Functional outcomes were assessed using the modified Rankin Scale (mRS) at three months. Patients were categorized into good outcomes (mRS < 2) or poor outcomes (mRS > 2). In-hospital mortality was also recorded.

Results: By analyzing demographic, clinical, and imaging parameters in 101 patients with primary supratentorial ICH, we highlight MLS and VS as significant indicators of mortality and functional prognosis.

Discussion: Our findings align with previous studies, highlighting MLS and VS as strong predictors of poor neurological outcomes. Increased MLS and VS values correlate with larger ICH volumes, lower GCS scores, and higher NIHSS scores, indicating greater stroke severity. MLS thresholds >5 mm and VS thresholds >1.5 mm have been proposed as critical markers for poor prognosis.

Conclusion: Midline shift and vertical shift are critical predictors of stroke severity, herniation, and outcomes in supratentorial ICH. Their strong correlation with clinical and radiological markers underscores their importance in early risk stratification and management planning. Incorporating MLS and VS into standard protocols could enhance the accuracy of prognostic models and improve patient care.

Abstract ID 858: Circadian Rhythm Disruption in Ischemic Stroke: Chronotype Patterns Compared to Age-Matched Healthy Volunteers

Reshma P J

National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Background and aim: Circadian rhythms are essential for maintaining neurological stability, and their disruption has been associated with stroke pathophysiology. Stroke may impair circadian regulation through damage to key brain regions, including the hypothalamus and retinohypothalamic tract. Diurnal variation in stroke onset and post-stroke chronotype changes may influence recovery and cognitive outcomes. This study aims to assess circadian rhythm disturbances in patients with ischemic stroke and evaluate correlations with early cognitive outcomes.

Methodology: A prospective case-control study is underway in the Department of Neurology, NIMHANS (Nov 2023–Aug 2025). Patients aged 18–75 years with confirmed ischemic stroke within one month of onset are included. Exclusion criteria are pre-existing sleep/psychiatric disorders, posterior circulation strokes, and shift work. Circadian features are assessed using Morningness-Eveningness Questionnaire (MEQ), Munich ChronoType Questionnaire (MCTQ), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Berlin Questionnaire (BQ). Cognitive performance is evaluated using the Four Mountains Test at follow-up.

Results: Preliminary analysis of 30 stroke patients (mean age: 58.4 ± 10.2 years; 66.7% male) and 30 matched controls (mean age: 56.7 ± 9.8 years; 63.3% male) showed a post-stroke shift toward morningness. Morning chronotypes increased from 40% pre-stroke to 66.7% at two weeks. MCTQ scores supported this trend (MSFsc: 34.1 vs 26.9; F (1,29) = 3.33, p = 0.054). Cognitive performance was significantly impaired in stroke patients vs controls on the Four Mountains Test (encoding correct RT: 1.297s vs 1.003s; retrieval correct RT: 1.143s vs 0.862s; all p < 0.001).

Discussion: Post-stroke shifts toward morningness may reflect compensatory neuroplastic changes or circadian instability. These alterations, along with sleep disturbances, could influence recovery trajectories. Understanding chronotype dynamics may help personalize neurorehabilitation strategies and improve cognitive and functional outcomes after ischemic stroke.

Conclusion: Preliminary findings suggest circadian rhythm disturbances and chronotype shifts are common post-stroke and may have implications for sleep and cognitive recovery. Further analysis will explore associations with stroke topography.