Background: Guillain-Barre syndrome (GBS) is a perplexing neurological disease of autoimmune etiology with an incidence of 1.2 to 1.9 cases/100,000 population. The overall incidence remains almost the same in pregnancy. Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity most commonly encountered in peripartum preeclampsia; however, it can also be seen in other clinical scenarios such as immunosuppressant treatment, infection/sepsis, autoimmune diseases, and during cancer chemotherapy. GBS can be considered as an independent risk factor of PRES, due to acute dysautonomia and pain. Here we report the unique case of a patient who presented to the neurology department with flaccid quadriparesis in the immediate postpartum period, was diagnosed as having GBS and initiated on treatment for the same, and subsequently developed seizures secondary to PRES. Case description: A 22-year-old patient, with no previously known comorbidities, was admitted to the obstetrics department in her 37th week of gestation in labor. The patient underwent an emergency lower segment cesarean section (LSCS) (previous LSCS in labor) with no periprocedural complications. On the next day, she developed progressive ascending quadriparesis sparing sensory and sphincters. Nerve conduction studies done showed features of GBS, and cerebrospinal fluid studies done showed albuminocytological dissociation. The patient was then initiated on plasmapheresis in the intensive care unit setting and closely monitored for any deterioration in overall neurological picture and bulbar symptoms. The patient remained stable and showed positive response to the plasmapheresis. On the morning of postpartum day 6, the patient complained of sudden painless bilateral complete loss of vision followed by an episode of generalized tonic-clonic seizures. She had labile blood pressure with reactive pupils, normal fundus, and no other long-tract signs. Magnetic resonance imaging (MRI) brain and magnetic resonance venogram were done. MRI brain done showed features suggestive of PRES. She was managed with antiepileptic drugs, blood pressure optimization, and supportive care with rapid recovery in vision in 2 days. She showed steady improvement in motor power following plasmapheresis and subsequently was managed with physiotherapy to full functional recovery. Conclusion and clinical significance: GBS in pregnancy, PRES in the postpartum female, and PRES in GBS are all unique entities with no defined incidence and only documented case reports. GBS rarely complicates pregnancies; there are few case reports of the same, the exact incidence of which is not defined. Proposed mechanisms leading to PRES in patients with GBS are dysautonomia leading to acute rise in the blood pressure, activation of sympathetic nervous system secondary to pain, and intravenous immunoglobulin usage. Review of the literature shows that previous cases of PRES in combination with GBS is a very unique finding with only a few case reports making this case distinctive. In our pa...

Background: Idiopathic generalized epilepsy is defined as seizures with a possible hereditary predisposition without an underlying cause or structural pathology. Assessment of executive dysfunction in idiopathic generalized epilepsies based on standard Indian battery is not available in the literature. Aims and Objectives: To assess specific executive functions affected in patients with idiopathic epilepsy and their association with various variables. Materials and Methods: Type of observational cross-sectional study, where clinical profile of all idiopathic epilepsy patients attending the neurology OPD was studied and their executive higher mental functions were assessed using the NIMHANS battery. Results: A total of 75 idiopathic generalized epilepsy patients were included in the study. Executive functions that were commonly found abnormal in our study were word fluency ( P ≤ .001), category fluency ( P < .001), verbal n-back ( P < .001), Tower of London ( p < 0.01), and Stroop test ( P < 0.01). Executive functions showed a significant correlation with age at symptom onset, duration of epilepsy, and in those with uncontrolled seizures. Conclusion: Patients of idiopathic generalized epilepsy according to the present study were found to have significant executive dysfunction in multiple domains. This necessitates the screening for executive dysfunctions, which if detected should prompt the clinician to initiate cognitive retraining.

Cerebral venous thrombosis (CVT) is an uncommon cause of stroke and is mainly a disease of the young. The aims of the study were to summarize the change in the clinical profile of CVT and provide an update regarding the current management of the same. A literature search was conducted using Pubmed and Google scholar using the desired terms. Studies were analysed and review was formulated. The median age of CVT in most studies was 32 years. There has been a shift from female pre-ponderence to equal gender predilection. Several studies are confirming the efficacy of D-dimer as a diagnostic marker of CVT. Newer oral anticoagulants have been found to be as efficient as warfarin. There have been several cases of CVT reported in association with COVID-19. This review confirmed the traditional understanding of age and risk factors of CVT. It also noted a change from the female pre-ponderence. NOACS are emerging as the preferred drug for the long-term management of CVT.

Epilepsy is one of the most common neurological disorders known to man with a high global prevalence. This disease process affects the overall quality of life. In recent times the concept of executive dysfunction in patients with epilepsy has emerged. This phenomenon has widespread therapeutic implications. This review hence aims to summarize our current understanding of the topic, highlighting the results of benchmark studies and outlining the aspects that require further research. The keywords epilepsy, executive dysfunction and cognitive retraining were used in the search engines of Pubmed and Google scholar and articles identified were extensively reviewed. The consensus of this review is that executive dysfunction is a phenomenon that occurs in patients with epilepsy irrespective of epilepsy type, however the magnitude varies with contributory factors which include poor seizure control. Furthermore, patients with cognitive dysfunction have a further decline over the course of the disease process, however longitudinal studies in regard to the same are lacking and there is a need for additional research in this regard.

Cold agglutinin disease is a rare cause of arterial thrombosis leading to stroke, commonly encountered against a background of mycoplasma pneumonia infections. A 22-year-old patient presented with acute-onset left hemiplegia preceded by a short history of fever and cough. Magnetic resonance imaging (MRI) showed a right middle cerebral artery infarct. Serially repeated hemoglobin levels showed a progressive drop and peripheral smear showed evidence of hemolysis. Blood drawn for investigations would rapidly clot, suggesting a possibility of cold agglutinin-induced hemolysis. The patient was then worked up for all the possible causes of hemolytic anemia including secondary causes which were all negative except for significant immunoglobulin M mycoplasma levels with elevated cold antibody titers. The patient was then initiated on pulse steroids with azithromycin and doxycycline and hemoglobin levels stabilized. The patient also developed pulmonary thromboembolism which was managed with anticoagulation. The patient made a steady improvement, was discharged, and is on follow-up. Here, we present a unique case of mycoplasma associated cold agglutinin disease causing arterial thrombosis.