Abstract:

Autoimmune encephalitis (AE) is a heterogeneous group of immune-mediated disorders of the central nervous system characterized by neuropsychiatric symptoms, seizures, cognitive decline, and movement abnormalities. Timely recognition and initiation of immunotherapy are critical to improving outcomes. We report three cases of AE presenting with varied clinical phenotypes from the Neurology department of Madras Medical College. The first, a 44-year-old male, presented with altered sensorium, action tremor, and myokymia, and was diagnosed with LGI1 and CASPR2 antibody–positive AE. The second, a 16-year-old girl, presented with seizures, progressive cognitive decline, behavioral disturbance, and focal weakness, confirmed as anti-NMDAR encephalitis. The third, a 14-year-old boy, developed seizures and behavioral changes following herpes simplex encephalitis and was later confirmed to have anti-NMDAR antibody–positive AE with features of Kluver–Bucy syndrome. All patients received first-line immunotherapy (steroids, IVIg), with escalation to rituximab in resistant cases.

Abstract:

Inclusion body myositis (IBM) is considered an inflammatory myopathy with a degenerative counterpart that is generally refractory to standard immunotherapy. We describe the case of a 47-year-old lady who had a long history of rheumatoid arthritis (RA) and subsequently developed weakness in her limbs. A muscle biopsy revealed typical features of IBM along with vasculitis. She was initiated on pulse corticosteroids followed by rituximab. The patient made a steady and marked recovery in both muscle weakness and inflammatory arthritis. Rare cases of IBM in patients with RA with favorable responses to immunotherapy have been reported before. This case demonstrates the importance of identifying coexisting autoimmune disorders and executing a long-term immunomodulatory plan.

Abstract:

For stroke treatment and rehabilitation, various types of medicine and therapies are available; however, they need to evolve continuously through evidence-based research. The present study analyzed clinical trials on stroke in India, registered at the Clinical Trials Registry of India (CTRI) to delineate the trends, advances, gaps, and challenges on stroke from clinical perspectives. The study analyzes randomized clinical trials (RCTs) on stroke, registered at the CTRI database, since the inception of CTRI (2007) till July 2025. Search was done using the keywords “stroke,” “Brain attack,” and “cerebrovascular accident” in the fields “Scientific Title,” “Public Title,” and “Health conditions.” A total of 2102 trials related to stroke were retrieved from the CTRI database that reduces to 1109 after removing duplicates. Out of these, only 578 trials were interventional RCTs, and 560 trials were being conducted in India. The study revealed: (i) major contribution of the private sector, (ii) more public hospitals involved in the multicentric/multi-intervention RCT, (iii) disparity in RCTs across states, (iv) maximum (62%) of studies were of satisfactory quality as per modified Jaded scale, (v) public hospitals performed slightly better in terms of quality parameters and sample size, and (vi) physiotherapy dominated among types of interventions being tested. Representation of the population of all states is necessary so that strategies may be developed on regional basis. Prioritizing stroke-prevalent regions for clinical trial activities can bridge critical gaps in public health outreach and empower local communities. Participation of government institutes and sponsorship must be increased, and collaboration should be encouraged.

Abstract:

Intracranial atherosclerotic disease (ICAD) is an essential cause of failed first-pass mechanical thrombectomy (MT) requiring rescue techniques. Rescue intracranial stenting (RIS) is a successful technique for repeated recanalization failure during MT; however, optimal antithrombotic management to maintain stent patency while mitigating bleeding risk remains an area of research. In this report, we propose a short-duration tirofiban infusion protocol for RIS with more than one year of stent patency follow-up. We performed a retrospective case series study of ten patients who underwent RIS after failed revascularization attempts in middle cerebral artery occlusion due to ICAD and were treated with intra-arterial tirofiban bolus, followed by dual antiplatelet loading and intravenous tirofiban infusion for four hours. We analyzed recanalization rate, 90-day functional outcome, symptomatic hemorrhage, and long-term stented-artery patency. Successful reperfusion (mTICI 2b–3) was achieved in all patients. At 90 days, eight patients achieved a favorable functional outcome (modified Rankin Scale 0–2), with a median mRS of 0 (range 0–6). One patient experienced a symptomatic intracranial hemorrhage. One patient died during follow-up. Clinical or angiographic follow-up beyond one year was available for nine patients; among the five patients who underwent conventional angiographic, four demonstrated no in-stent restenosis, while one developed severe (>70%) restenosis at two-year follow-up. In this descriptive case series of ten patients, a short-duration tirofiban infusion protocol following RIS was feasible and was not associated with a high rate of hemorrhagic complications. These observations are hypothesis-generating and require validation in larger, controlled cohorts.

Abstract: