Poster Abstracts Wednesday, November 9, 2005 $307

admitted in Hamidia Hospital, Bhopal were included in this study. They were subjected to biochemical investigations and C.T. Scan. Resull: 70"/0 patient were below 30 years of age. All presented with fever and altered sensoriunl, followed by headache and vomiting in 42% cases & seizures in 20"/0 cases. Meningeal signs were present in 72"/0 cases & focal neurological deficits in 26% cases of which 20?,'; had VI cranial nerve palsy, 4% hemiparesis and 2?,'; paraparesis. 12% patients had papilloedema & 2% optic atrophy. CSF examination was abnormal in all cases with increased leukocyte count (Lymphocyte Predominance) and proteins. On C.T. Scan hydro- cephalus was seen in 76%, basal exudates in 56"/0, cerebral infarct in 20?,';, tuberculoma in 147,';. Hydrocephalus was communicating type during acute state of illness and becoming obstructive towards the terminal stage. Conclusion: There is a linear relationship between degree of hydro- cephalus and duration of illness. Correlation of follow up C.T. Scan with clinical condition confirmed the presence of enhancing exudates having a poor prognosis. C.T. Scan is a valuable tool with a high diagnostic sensitivity, prognostic value & should be used as an early radiological investigation in tubercular meningitis patients for guidance of treating physician.

0811 Neurological manifestalions, sequelae anti mortality tale of Pla$/nodiuin falciparum malaria in Indian adults

Dubey, TN, Sharma, VK, Deopujari, K, Gopal, A, Dengra, A, Sarij a V, Hiranandani, H, Rajarajan, T, Gopal, R. Harnidia Hospital, Gandhi Medical College, Bhopal, India

Background: A prospective hospital based study over 14 month duration was carried out to investigate neurological manifestations and sequelae of Plasmodium falciparum malaria. Methods: 150 adult patients fulfilling inclusion criteria were enrolled and were entered on specially designed profotma. Results: Fever was the commonest presenting symptom in 98.67% and associated with headache in 53.33'%, vomiting in 41.33%. On neurological examination, 40% had altered sensorium of which 22?,'; were stuporous, 8?,'; delirious, 6% drowsy and 4?,'; comatose. 12 (8%) had convulsions, of which generalized tonic-clonic seizures in 10, simple partial seizure in 1 patient and complex partial seizure in 1 patient. 4 (2.67%) had cranial nerve involvement-VII nerve in 2 (1.33%), VI nerve in 1 (0.67%), IX, X and XII in 1 (10.67'%). Hemiparesis and paraparesis were observed in 2 (1.33%) each while Quadriparesis in 1 (10.677,';). Meningeal signs were observed in 8 (5.36%), cerebellar signs in 1 (0.67?,';), 2 (1.337,';) had decerabrate posturing, 1 (0.67%)was dysarthric, 1(0.67%)was aphasic, 2 (11.33'%) had Gnillain-barre syndrome like presentation and 1 (0.67%) had Acute disseminated encephalomyelitis like presentation. 24 patients (16%) died, those surviving were followed up weekly for a period of 12 weeks to study the sequelae. Convulsions were there in 2 (1.58%) and hemiparesis, involuntary movements, cerebellar atmxia and psychosis in 1 patient each (0.79%). Conclusion: Plasmodimn falciparum malaria can have myriad of neurological manifestations. Presence of focal neurological deficit and meningeal signs were uncommon. High index of suspicion for prompt diagnosis and early institution of treatment can cut down the mortality.

0812 Incidence and Prognostic significance of fumlus changes in cerebral malaria

Dubey, TN, Sharma, VK, Deopujari, K, Gopal, A, Dengra, A, Hirnandani, H, Sharma, H, Gopal, R, Satija, V, Rajarajan, T. 1Harnidia Hospital, Gandhi Medical College, Bhopal, India

Background: Eye can be affected, like any other organ of the body in patients of cerebral malaria. A spectrum of findings are described on

fundus examination but there is conflict regarding their prognostic significance among various workers all over the world. Very limited data is available on Indian adult patients of cerebral malaria. So we carried out a study to find the relative incidence and prognostic significance of various ophthalmologic findings on fundus examination in adult patients of cerebral malaria. Method: 60 adult (> 12 years) patients satisfying WHO criteria for diagnosis of cerebral malaria, admitted to Hamidia Hospital, Bhopal were studied. Detailed Ophthalmological examination was done through dilated pupils at the time of admission and at tire time of discharge. Result: Retinal haemorrhage was the most commonly observed findings, in 10-677,'8 patients on fundus examination. Other findings observed were papilloedema in 6.67?,'8 disc.pallor in 2.67?,'8 and hyperemia in 2% patients. Tire mortality associated with papilloedema & disc pallor was 30"/0 & 25% respectively which is statistically significant (z > 2%, p < 0.05). Conclusions:

1. Retinal haemorrhage was the most common fundus finding noted in patients of cerebral malaria, but it had no mortality significance.

2. Mortality associated with papilloedema & disc pallor was statistically significant.

3. Fundus examination is an important tool which should be done in all patients to identity high risk mortality groups of papilloedema & discpallor and should be managed very aggres- sively to cut down the high mortality rate associated with cerebral malaria.

0813 A clinical, bioeheulical, radiological and EEG study of Febrile Falcephalopathy patients admired in Haulidia Hospital, Bhopal

Dubey, TN l, Sharma, VK a, Jeevan, H l, Dengra, A ~, Gopal, A ~, Ratre, B ~, Gopal, R ~, Satija, V ~, Rajarajan, T ~. 1Hamidia Hospital, Gandhi Medical College, Bhopal, India

Backrouml: To study etiologies & their incidence in patients of febrile encephalopathy on basis of clinical, biological and radiological profile and their clinicoradiological correlation. Method: 115 cases of febrile encephalopathy above the age of 12 years of both sexes, admitted in Hamidia Hospital, Bhopal were included in study. Detailed clinical, biochemical, radiological and EEG study was done. Result: Patient < 30 years were most commonly affected with slight male preponderance, 517,'; patient were of cerebral malaria, 20?,'; of tubercular meningitis, 17?,'; ofpyogenic meningitis, 6?,'; of encephalitis, 4?,'; of typhoid encephalopathy. On admission maximum number of patients were stupurous. Examination revealed meningeal signs in 36"/0, fundus abnormalities in 14"/o and focal deficits in 12.7"/o. The peripheral smear was positive for P. falciparum in 39.13%, C.T Scan was abnormal in 45?,'; cases. One case of cerebral malaria showed a subdural hematoma, tubercular meningitis patients showed hydro- cephahis, lacunar infarct, ring lesions and basal exudates. Pyogenic meningitis showed hydrocephalus and lacunar infarcts. Basal ganglia hypodensities were seen in viral encephalitis. EEG was abnormal in 70"/0 cases and showed diffuse slowing. Contusion: Cerebral malaria accounts for mmximum number of cases of febrile encephalopathy. C.T Scan was abnormal in 45% cases. Mortality was mmximum in viral encephalitis. As the mortality of febrile encephalopathy is very high, the etiological diagnosis should be made as early as possible and intensive and proper therapy is the key to successful management.

0814 Profile of neurological manifestations of Acquired hmnunodefieiency syndrome (Neuro-AIDS) in Indian Subcontinent

$308 Wednesday, November 9, 2005 Poster Abstracts

Gortlfi, SP ~, Satyanarayana, S a, Batra, A 3, Singh, K K 4, Bhattacharya S 4, Tripathi, RP 3, Johri, S a. 1Command Hospital (SC) arid Armed Forces Medical College Pane, India; 2A rmed Forces Medical College, Pane, India; 3Institute of Nuclear Medicine andAllied Sciences; 4Army Hospital Research arid .Referral, New Delhi

Background: To study the 'Trends" in Neuro-AIDS in Indian subcontinent. Methods: One hundred thirty two patients of Neuro-AIDS profiled. 37, cases were correlated with needle necropsy diagnosis, 45 case correlated with CD4 counts and 32 cases correlated with MRI and MRS brain. Results: CNS opportunistic infections accounted for 72% cases (CNS tuberculosis-55 cases, Cryptococcal meningitis-29 cases, Cerebral Toxoplasmosis-7 cases, and Disseminated Candidiasis-2 cases), Peripheral neuropathy-13 cases (9.8"/o), and HIV dementia-9 cases (7%) are other major contributors. PML, CNS Lymphoma accounted for two cases each, Where as myelopathy is encountered in 5 cases and myasthenia gravis in one case. Needle necropsy provided proof of mixed and polymicrobial infections in 14 cases out of 37 cases. CD 4 counts suggest that meningo encephalitis is encountered as the CD4 count starts falling below 300 and unlike in western literature peripheral neuropathy is seen over a wide range of count between 0-500. Poly radicular herpes zoster is the first manifestation of im_munosuppressive state and manifested around a CD4 count of 500 mm 3. Clinico-Radiological correlation with MRS characterized different peaks for opportunistic infections, and other syndromes. Median survival observed in 55 cases is 90 days. Conclusion: Neuro AIDS pursues a stomty course in Indian subconti- nent and virtually other manifestations like CNS lymphoma and PML are very rare. HIV dementia and Peripheral neuropathy are encountered in a small percentage of cases. Polymicrobial and mixed infections deserve special consideration in management. MRS can be used to further characterize various Neuro-AIDS syndromes.

0815 Bedside evaluation of Early Neurops3:chologieal Abnormalities in patients with HIV infection

Gorthi SP ~, Shankar S 2, Gupta A ~, Johri S 4, Tripathi S 5. 1Command Hospital (SC) arid Armed Forces Medical College, Pane, Delhi; ZDepar tment of Immunology, A ll India Institute of Medical Sciences, Delhi; 3Defence Institute of Psychological Research, Delhi; 4Department of Medicine, Armed Forces Medical College, Pane; 5Institute of Nuclear Medicine and Allied Sciences, New Delhi

Background: Neuropsychological abnormalities are common in patients with HIV infection and have been shown to affect between 25 to 65% of HIV positive individuals. Early detection of these abnormalities help in individual therapeutic and occupational options. Methods: The design was a cross sectional analysis of 44 male patients infected with HIV with an AIDS defining diagnosis or low CD4 count (< 350). Digit symbol test and Trail test B were done in all patients and their value as a bedside screening test was evaluated. The tests were also done in 40 controls. The modified HIV Dementia Scale was used as the standard against which the screening tests were evaluated. Results: 63% of the patients were detected to have neuropsychological abnormality as evaluated by modified HIV Dementia Scale (m-HDS). Both Digit symbol test and trail test B were found to be effective screening tools in detecting neuropsychological abnormality and had a sensitivity of over 70?,';. The sensitivity could be increased to 90?,'; if one took the cut off point in m HDS score as 6 instead of 7.5 as recommended (Digit symbol test- Sensitivity 91%, Trail test B Sensitivity 86?,';). Combination of both tests increased the sensitivity to 93%. Conclusions: Digit symbol test and Trail test B are simple bedside tests, wlffch together take less than 4 minutes to adnffnister. Titus they can

be very effective tools in a busy HIV clinic for screening patients with early dementia. An abnormal test can be followed up by a detailed neu ropsychological evaluation.

0816 Distribution of JC virus Early Region DNA Sequences in Systemic Tissues and Brains of Individuals without Progressive Multifoeal Leukoencephalopethy or Immunodefidency

Greenlee JE L3, O'Neill FJ 2'4, Clawson SA 2"3, Carney H 2 1Neurology and," Z Research Services, Veterans Affairs Medical Center, Salt Lake City, Utah, USA; 3Departments of Neurology and," 4Ontological Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA

Background: JC virus (JCV) is a ubiquitous, usually nonpathogenic polyomavirus which is kitowlt to persist asymptomatically in kidneys. In AIDS and other inmmnocompromised patients, however, JCV can cause the demyelinating infection, progressive multifocal leukoence- phalopathy (PML), accounting for death in 4% of AIDS patients. Recently, three cases of PML have also been reported in individuals receiving the leukocyte adhesion molecule inlffbitor, natalizumab. PML has been suggested to arise following viremic spread of JCV during reactivated systemic infection. However, it is also possible that the disorder rnight arise following reactivation of persistent JCV infection within the CNS itself. To address this question, we analyzed systernic organs and brains of immunologic.ally normal individuals for evidence of persistent JCV infection. Methods: Systemic tissues and brains of autopsied individuals without PML, HIV infection, or other inmmnocompromised states were investigated for JCV early region D N A by polymerase chain reaction methods, using the primers JEP1 (CCT GTG TGT CTG CAC CAG A G G C) and JEP2 (GGC CAG TTG CTG ACT TI 'G CAGC), followed by Southern blot analysis. Results: JCV was detected in kidneys from 50% (122/45) of patients, as well as in livers, lungs, spleens, bladders, and prostates. Importantly, JCV sequences were detected in 44% (17/16) of cerebrums and 50% (16/12) of cerebellums. Conelnsion: Our data provides evidence that JCV persists in multiple tissues. Persistence witlffn the CNS is common, however, and could potentially represent the site of irdtial viral reactivation during development of PML.

0817 Detection of Herpes Simplex Virus (HSV) by Polymerase Chain Reaction (PCR) in the saliva of patients with Bell's palsy

Harirdlian, M H 1, Sarrafnegad, A 2. 1Tehran University Of Medical Science, Iranian Center Of Neurological Research, .[ran; :Department of Health, School of Medicine, Tehran University of Medical Science, Ivan

Background: Acute idiopathic peripheral facial paresis (Bell's palsy) is the most common disorder of the facial nerve. It is important because there may be significant morbidity due to incomplete recovery of severe cases. Many studies have attempted to identify an infectious etiology for this disease. Although the cause remains unkitown, recent evidences suggest a possible association with Herpes Simplex Virus-1 (HSV1) infection. Method: In tiffs case-control study we investigated the presence of DNA of HSV in the saliva of 26 patients with Bell's palsy by Polymerase Chain Reaction (PCR) method. Samples were obtained in first and second weeks of disorder. It has been compared to samples of 26 normal populations who were matched according to age, sex, and history of diabetes mellitus, hypertension, and labial herpes. Results: In the case group 3 and 7 patients had positive PCR for HSV in first and second week respectively compared to 4 in controls. Two and 6 of positive results in 1 st and 2 ~d week were of patients with severe (grade 4-6) Bell's palsy.