Annals of Indian Academy of Neurology

BACKGROUND: Leber hereditary optic neuropathy (LHON) is a maternally inherited disease resulting in irreversible visual loss usually in patients belonging to the age group of 15-35 years. Clinically, the patients present with sequential or bilateral, painless, progressive visual loss with central (or ceco-central) scotomas. Although the three mutations, namely, G11778A, T14484C, and G3460A contribute to >95% of LHON cases globally, the relative frequency of each mutation varies. AIMS AND OBJECTIVES: We aimed to assess the clinical and genetic profile of patients with mutation-positive LHON at a north Indian tertiary care center...

A hallmark of myasthenia gravis (MG) is the variability and fatigability of striated muscles. The majority of people with MG have eye symptoms of ptosis and diplopia. This paper outlines the eye signs in MG, including practical tips on the examination technique relevant to MG, and pitfalls to avoid.

Ocular nerve palsies are among the most common cranial neuropathies in neurological practice. Nerves can get affected anywhere along their path from the brainstem to the orbit. There can be isolated involvement of multiple cranial nerves together. The etiologies differ according to the type of presentation. The steps toward the diagnosis need to be strategically planned and must be based on clinical localization. It is crucial to make proper localization to plan further investigations and thus treatment of the etiology...

Idiopathic intracranial hypertension (IIH) primarrily affects obese women of childbearing years and is commonly associated with headaches, pulsatile tinnitus, and vision changes. Though most patients have a "benign" course, it can lead to significant morbidity, including blindness. The treatment approach is based on severity of visual impact and includes weight loss, intracranial pressure lowering medications, and sometimes surgery, such as spinal fluid diversion, optic nerve sheath fenestration, or venous sinus stenting...

Tolosa-Hunt syndrome (THS) remains a challenging diagnosis for many neurologists. Often believed to be a rare presentation, the classical presentation is known to involve cranial nerves and tissues surrounding the cavernous sinus. Traditionally, a diagnosis of THS is considered when all secondary conditions have been ruled out. Yet, newer findings have elaborated a complex pathogenetic process with some overlap from the IgG4 spectrum of disorders, with which it shares many phenotypic similarities. In this narrative review, we present an updated picture of the condition focusing on the latest developments in the pathogenesis, diagnosis, and clinical management of these two conditions and use illustrative examples to highlight the salient features of this rare presentation...

A large part of the central nervous system is involved in the normal functioning of the vision, and hence vision can be affected in a stroke patient. Transient visual symptoms can likewise be a harbinger of stroke and prompt rapid evaluation for the prevention of recurrent stroke. A carotid artery disease can manifest as transient monocular visual loss (TMVL), central retinal artery occlusion (CRAO), anterior ischemic optic neuropathy or ocular ischemic syndrome (OIS). Stroke posterior to the optic chiasm can cause sectoranopias, quadrantanopias, or hemianopias, which can be either congruous or incongruous...

Cerebral visual disorders include a range of common and rare deficits. They can be divided into effects on low-, intermediate-, and high-level forms of visual processing. Low-level deficits are various forms of homonymous hemifield scotomata, which affect all types of vision within their borders. Intermediate-level deficits refer to impairments of colour or motion perception, which affect either one hemifield or the entire field when lesions are bilateral. High-level deficits are divided into those of the ventral (occipitotemporal) or dorsal (occipitoparietal) stream...

Optic neuritis (ON), as an umbrella term, refers to a spectrum of inflammatory optic neuropathies arising from a myriad of potential causes. In its most common form, "typical" ON presents as a unilateral, painful subacute vision loss event in young Caucasian women. The Optic Neuritis Treatment Trial (ONTT) has historically guided our treatment of ON, and taught us important lessons about the clinical presentation, visual prognosis, and future risk of multiple sclerosis (MS) diagnosis associated with this condition...

The chief goal of all eye movements is to maintain the image of an object steady on the retina especially the macula to preserve visual acuity. Gaze palsy refers to lack of the conjugate movements due to a failure of supranuclear control mechanisms. Supranuclear control is maintained by not one, but multiple eye movement systems and gaze mechanisms. Supranuclear gaze palsies can be associated with a myriad of aetiologies- from trauma or metabolic abnormalities to stroke, demyelinating disorders and space occupying lesions like tumours...

Paraneoplastic neurological syndromes (PNS) occur in about 1 in 300 cases of cancer. The usual mechanism is that an antigen on the cancer sets off an immune response that then cross-reacts with a nervous system antigen. The presentation is usually with a subacute progressive neurological disorder. The management of these conditions is usually of both the underlying tumor and immunomodulation to suppress the autoimmune response. There are a number of these conditions that can present to the Neuro-Ophthalmology clinic, either as a discrete condition affecting vision or eye movements or as part of a more widespread neurological disorder...

Ischemic optic neuropathy (ION) is the term ascribed to optic nerve disease that is the result of a transient or permanent interruption of the blood supply to any portion of the optic nerve. Anterior ischemic optic neuropathy (AION) refers to ischemia of the optic nerve head, whereas posterior ischemic optic neuropathy (PION) indicates ischemia of the posterior optic nerve. IONs are primarily classified as arteritic ION and non-arteritic ION. A subset of ION that occurs around the time of surgery is termed peri-operative ION...

No abstract text is available yet for this article.

Air pollution is a significant contributor of cardiovascular diseases, including ischaemic stroke (IS), with substantial mortality and morbidity. However, associations between air pollution and IS remain unclear. Limited data are available on the relationship between IS and individual air pollutants. In this systematic review, we present an overview of the current literature about various individual ambient air pollutants that are believed to contribute towards incidence of hospitalization and mortality related to IS...

No abstract text is available yet for this article.

Man and environment have a strong connection with each other for their functioning. Environmental toxins which can be natural or manmade result in the loss of this balance by causing systemic inflammatory response within the human body, with the brain being the most affected target end-organ. These problems are more prominent in Third World countries, where environmental regulations laws are either relaxed or non-existent. These neurotoxins play a very important aetiological role in the manifestation of various neurodegenerative diseases, neurodevelopmental disorders and psychiatric disorders...

Background: Among the primary environmental issues affecting global health, air pollution is considered the leading cause of concern. Globally, around 800,000 deaths were attributed to air pollution according to WHO. Evidence suggests that there has been a strong association of air pollution with stroke. Approximately, 25% of stroke mortality was due to air pollution according to a study in 2013. Objective: The aim of this review was to analyze the association between stroke, intracerebral hemorrhage, and subarachnoid hemorrhage and air pollution and its burden globally with a special focus on South Asia along with its association with the COVID-19 pandemic...

Air pollution is a significant contributor to cardiovascular and cerebrovascular diseases. including intracranial hemorrhage (ICH). However, associations between air pollution, various pollutants, and ICH are complex and remain poorly understood. Limited data are available on the relationship between ICH and individual air pollutants. In this review, we present an overview of the current literature about ambient air pollutants that are believed to contribute towards ICH as well as possible underlying mechanisms...

Parkinson's disease (PD) is a progressive neurodegenerative disorder, and its global incidence is on the rise. There is increasing interest in understanding the role of air pollution in the development of human disease. Although the precise mechanisms are not understood, several epidemiological studies have reported a positive association between air pollution and the risk of PD. However, the various pollutants studied, endpoints measured, and differences in study design yield conflicting results. This review summarizes recent evidence regarding the relationship between particulate matter, ozone, nitrogen dioxide, sulfur dioxide, and carbon monoxide and PD...

Air pollution, the most prevalent form of pollution worldwide, is associated with a wide range of neurological disorders, including neurodegenerative conditions, stroke, autism, depression, and developmental delay. There is accumulating evidence on the association between air pollution and headache disorders, especially migraine. Many classical and non-classical air pollutants have been associated with headache, including particulate matter, nitrogen dioxide, sulfur dioxide, ozone, carbon monoxide, as well as polycyclic aromatic hydrocarbons and volatile organic compounds...

The incidence of dementia increases with aging. It is known that the disease brings with it many problems for patients and caregivers. Studies on the development of various treatment modalities for the disease continue. However, the main step in the management of this process is the identification of dementia risk factors. The prevalence of dementia is higher in those living in urban areas where exposure to air pollution and chemical effects is higher. This situation supports the relationship of air pollution, which has increased especially in the last decade, with the increase in cognitive decline and dementia frequency...