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ObjectiveData on cognitive changes in patients of tuberculous meningitis (TBM) are sparse. We aimed to study the cognitive profile of grade I TBM patients and correlate with the cytokine values.MethodsProspectively 60 (M:F-31:29) patients of grade I TBM were recruited. Clinical details, CSF estimation of cytokines, neuropsychological assessment was done and correlation were done.ResultsMean age of presentation and duration of symptoms were 32.2 (32.2 ± 10.1) years and 29.9 (29.9 ± 25.9) days respectively. Definitive evidence of mycobacterial infection was observed in 28.3%. Mean levels of tumor necrosis factor-α (TNF-α), interferon (IFN-γ) and interleukin-6 (IL-6) were 11.57 ± 30.35, 197.02 ± 186.64, and 127.03 ± 88.71 pg/mL respectively. TNF-α levels were significantly elevated in definitive TBM (p = 0.044). Neuropsychological tests revealed impaired Auditory verbal learning test (88.3%) followed by complex figure test (50%), spatial span test (50%), clock drawing test (48.3%), Digit span test (35%), Color trail test 1 and 2 (30% and 33.3% respectively) and animal naming test (28.3%). Elevated levels of IFN-γ and IL-6 in TBM were directly correlated with the number of impaired neuropsychological tests. During follow up, significant improvement was noticed in Animal naming test (p = 0.005), Clock drawing test (p = 0.003), color trail test 2 (0.02), spatial span test (p = 0.012) and digit span test (0.035). Verbal learning did not show any significant change. Overall Neuropsychological tests showed better recovery of attention, working memory, category fluency and minimal recovery of verbal learning.ConclusionsThere is subclinical evidence of cognitive impairment in patients of TBM and this correlated with elevated cytokines. Both the frontal and temporal lobes show varying degree of cognitive impairment.

Background: Parkinsonism following viral encephalitis is well reported. However, in addition, to parkinsonism other movement disorders such as dystonia, chorea, myoclonus may also be observed in these patients. Stereotypy is a very rare manifestation following viral encephalitis.Case report: Here we report a rare case of a 25-year-old young man who developed stereotypy and parkinsonism following dengue virus encephalitis. The stereotypy was in the form of snapping of fingers of left-hand which was repetitive, purposeless, non-goal directed, present for most of the day and partially suppressible.Discussion: This report expands the spectrum of movement disorders seen in dengue infection.

Introduction: Spinocerebellar ataxia type-12 (SCA12) is a rare form of SCA, most commonly reported from the Indian Agarwal and related families. In this study we describe the clinical, genetic, and radiological characteristics of a sizeable cohort of genetically proven SCA12.Methods: A retrospective chart-review of the genetically confirmed SCA12 patients from our centre. The demographic, clinical, and investigation findings were reviewed. Correlation of expanded repeats length with various demographic and clinical features were studied.Results: A total of 49 patients (34 males, 42 families) were included of which 79.6% belonged to Agarwal community. The mean age at onset and age at presentation were 46.38 ± 11.7 years and 53.16 ± 12.78 years respectively. The most common initial symptom was tremor (73.5%), followed by ataxia (18.4%). At presentation, 95.9% of the patients had tremor with predominant distribution in the bilateral upper limbs (85.7%). At presentation, 73.5% of patients had ataxia and 22.4% had cognitive dysfunction. The mean CAG repeat length in PPP2R2B in the expanded allele was 53.26 ± 6.10 (40-72). The lowest pathogenic expanded repeat sizes in PPP2R2B recorded in our cohort was 40 & 42 repeats from two patients with a consistent clinical phenotype. Another unusual phenotype was the presence of prominent myoclonus. There was no significant correlation between the age at onset of symptoms and the repeat size of CAG repeat. Conclusion:SCA12 is not confined to a single ethnicity. Upper limb tremor and ataxia were the most common presentation. Unusual presentation may cause diagnostic confusion especially when recorded in patients from non-Aggarwal families.

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