Avinash Chandra

Annapurna Neurological Institute & Allied Sciences · Department of Neurology

Primary stabbing headache (PSH), characterized by sudden, localized stabbing headache pain, is a recognized primary headache disorder with evolving diagnostic criteria. Epidemiological studies show a wide range of prevalence, influenced by various factors. PSH is more common in females, frequently occurring in conjunction with migraine, and can man...

Background Globally, the majority of strokes affect people residing in lower- and lower-middle-income countries (LMICs), but translating evidence-based knowledge into clinical practice in regions with limited healthcare resources remains challenging. As an LMIC in South Asia, stroke care has remained a healthcare problem previously unaddressed at a...

Background With an increasing burden of stroke, it is essential to minimize the incidence of stroke and improve stroke care by emphasizing areas that bring out the maximum impact. The care situation remains unclear in the absence of a national stroke care registry and a lack of structured hospital-based data monitoring. We conducted this systematic...

IHC23-PO-119 Headache-Related Disability Among Medical Students in Nepal: A Cross-Sectional Study

Headache related disability among medical students in Nepal: a cross-sectional study

Background Stroke is a major global health problem and was the second leading cause of death worldwide in 2020. However, the lack of public stroke awareness especially in low- and middle-income countries (LMICs) such as Nepal severely hinders the effective provision of stroke care. Efficient and cost-effective strategies to raise stroke awareness i...

The poster was about the very unusual case of Bickerstaff's brainsteam encephalitis with spastic paraplegia.

Cerebral venous thrombosis can be caused by different conditions such as infectious, structural, hypercoagulable states, hematological, hormonal, collagen, vascular diseases, and oral contraceptive pills among other causes. Adenomyosis has been rarely associated with Cerebral venous thrombosis (CVT). Increased CA‐125 and iron deficiency anemia in a...

Introduction: Azathioprine is used as an off-label drug for the treatment of multiple sclerosis. It is one of the oldest and most widely used immunosuppressants that targets T and B lymphocytes and thus reduces the relapse and slows down the disease progression with the almost same efficacy as the other disease modifying drugs for multiple sclerosi...

Background: More than 1 million intravenous chemotherapy infusions are given worldwide each day which leads to extravasation. Health professionals must know the drugs that cause tissue injury and take the necessary measures to prevent extravasation. Objectives: The study aimed to assess the knowledge regarding the management of extravasation of ch...

Background: More than 1 million intravenous chemotherapy infusions are given worldwide each day which leads to extravasation. Health professionals must know the drugs that cause tissue injury and take the necessary measures to prevent extravasation. Objectives: The study aimed to assess the knowledge regarding the management of extravasation of che...

“I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.” Obliged by the aforementioned oath, no medical practitioner shall sit in a moral judgment on any patient but wi...

Cerebral Venous thrombosis can be caused by different conditions such as infectious, structural, hypercoagulable states, hematological, hormonal, collagen, vascular diseases, and oral contraceptive pills among other causes. Adenomyosis has been rarely associated with CVT. Increased CA-125 and Iron deficiency anemia in adenomyosis may predispose to...

Introduction: Azathioprine is used as an off-label drug for the treatment of multiple sclerosis. It is one of the oldest and most widely used immunosuppressants that targets T and B lymphocytes and thus reduces the relapse and slows down the disease progression with the almost same efficacy as the other disease modifying drugs for multiple sclerosi...

Cerebral Venous Thrombosis is a rare extra‐intestinal manifestation of ulcerative colitis. Ulcerative colitis is a hypercoagulable state and, if poorly managed, can predispose to thrombosis, including thrombosis of the cerebral veins. Cerebral Venous Thrombosis is a rare extra‐intestinal manifestation of ulcerative colitis. Ulcerative colitis is a...

Introduction and importance Severe acute respiratory distress syndrome coronavirus 2 is the causative agent of COVID-19 (Coronavirus 2019) infection. Although symptoms are usually associated with the respiratory system, its neurological involvement should not be underestimated. The most common cerebrovascular complication following the infection is...

Although the risk of thromboembolism is increased in patients with ulcerative colitis, cerebral venous thrombosis is a rare complication in a patient with ulcerative colitis. We herein present an unusual case of a young female with Ulcerative Colitis under treatment diagnosed with cerebral venous thrombosis and bilateral thalamic infarction

Objectives: The coronavirus disease (COVID-19) pandemic and news of daily increasing cases inside Nepal and worldwide is adding to the fear that leads to anger, anxiety, frustration, and stress, emotions that directly affect sleep quality. This study aimed to assess sleep disturbances during the COVID-19 pandemic in a Nepalese population.Methods: T...

only 3.9% of the participants had moderate to severe levels of clinical insomnia; after its onset, this value increased to 17.5%. The mean ISI scores were 6.35±4.65 and 8.01±6.01 before and after the pandemic's onset, respectively. Conclusions: Our study findings suggest that people are suffering tremendously with sleep disturbances and calls for f...

The Foville’s Syndrome is a rare clinical feature of stroke or brain hemorrhage. This is very rare brain stem syndrome and only few cases have been reported worldwide. A case of Foville's syndrome secondary to infarction at the left paramedian pontine region, which was diagnosed and treated at Annapurna Neurological institute and allied Science, Ka...

This case report has described the patient having the central pontine myelinolysis (CPM) associated with hypokalemia correction with asymptomatic history of gastroesophageal reflux disease (GERD). It was suspected that due to GERD and vomiting there might be loss of electrolytes resulting to hypokalemia. The hypokalemia was corrected and patient wa...

Diabetes Striatopathy , also known as Non-ketotic hyperglycemic hemichorea or Chorea Hyperglycemia Basal Ganglia Syndrome is rare complication of uncontrolled diabetes. This syndrome has been reported more frequently in elderly Asian womenand symptom resolution is typically associated with serum glucose levels and plasma osmolarity normalization.He...

Introduction: The co-existence of anxiety disorders in patients with neurological and neurosurgical disease is in association with barriers to treatment and worsening medical outcomes. This study aims to identify the prevalence and correlation of anxiety in a tertiary neurological center in Kathmandu, Nepal. Methods: This was a hospital-based cros...

Stroke is a major cause of disability in older adults worldwide. In Nepal, conventional western medicine and traditional health care are the main method of treating stroke hemiplegia. Functional disability of lower limbs is a common problem in hemiplegic stroke patients. Due to high range of treatment cost and lack of highly trained human resources...

Vision problems with sudden in onset points towards the neurological deficit because of underlying acute attacks like stroke, or de-myelinating disease. While these problems are common, the viral infection particularly, novel corona virus, SARS-CoV-2 infection in current situation, should also be kept in physician’s mind and dealt accordingly.

Background: Stroke related studies in Nepal are primarily hospital-based and mainly from the capital city. Objectives: We aimed to estimate the prevalence of stroke and stroke risk factors in the South-Western community of Nepal. Methods: A cross-sectional study was conducted from May to August 2018 among 549 randomly selected Nepalese participan...

Introduction: Neurocysticercosis (NCC) is one of the commonest preventable cause of seizure. It is due to development of the larval form of Taenia solium. This disease is endemic in south east Asia including Nepal and has been considered as one of the neglected tropical disease. Methods: All the patients who came to Neurosurgical outpatient departm...

Bilateral striopallidodentate calcinosis (BSPDC) is associated with many neurological and psychiatric abnormalities and most commonly present with extra pyramidal symptoms and can be idiopathic or associated with endocrinopathy, frequently with parathyroid disorders. Here we describe a case who presented with generalized seizure. During workup, the...

After the COVID-19 pandemic spread and became uncontrollable then the governments worldwide enforced school closure as part of their containment strategy, which gave rise to digital technology and virtual learning for ensuring some degree of classes continuity. This article tries to explain the condition of increased screen time due to online digit...

Background: Nepal comes in the low-income nation with the health system working in very strenuous situation. Most of the health care is borne by the individual themselves. Even though geographically sitting close to China (where COVID-19 cases started) and India (where COVID-19 cases surged to the highest level), Nepal has been facing COVID-19 infe...

Fahr's disease/Fahr's syndrome is a rare neurological disorder characterized by symmetrical calcification in various brain parts, most commonly in the basal ganglia. We report a case of Fahr's disease in a 72 -years-old female who presented with delirium. Upon further evaluation, she had a history of seizures for thirty years, dementia for eighteen...

With the result of the various studies on the COVID issue, our view shows that the determination of Cycle Threshold (Ct) value will help in managing COVID positive cases efficiently and economically during this time of the high spread of the pandemic. At large, COVID has created chaos, and the health sector facing extreme shortages of resources and...

In the short article, we have tried to explain the overview of situation of COVID-19 in Nepal.

Background: Recently, there has been a surge in research worldwide on vitamin D. based on international level, Vit. D has shown positive correlation with cardio-cerebrovascular disorders. Regarding possible role of vitamin D there is paucity of research in low- and middle-income nations that are nearer to the equatorial area. Despite of abundant su...

Background: The recently surfaced infectious disease SARS-CoV-2 caused by novel corona virus was first reported in Wuhan, China in December 2019. Despite the entire endeavor, it has rapidly infected nearly 200 countries and millions of deaths while many more is counting. In Nepal, the first case had appeared in late January 2020. Till now the lack...

Background: Nepal comes in the low-income nation with the health system working in very strenuous situation. Most of the health care is borne by the individual themselves. Even though geographically sitting close to China (where COVID-19 cases started) and India (where COVID-19 cases surged to the highest level), Nepal has been facing COVID-19 infe...

The effectiveness of stroke care depends the rapid management within shortest possible time. The rapid and effective stroke care remains equally important even during the COVID pandemic as well. Hence the effectiveness of stroke care must be balanced between the rapid diagnosis and timely intervention. Stroke is a second major cause of death and mo...

Background: Anxiety and depression are under reported, underdiagnosed mental illness in health worker in Nepal especially during COVID pandemic. The study was carried out as an observational study on nurses in Nepal. In this study we attempted to assess the incidence and impact of depression and anxiety in nurses who are working upfront in diff ere...

Background: Anxiety and depression are underdiagnosed illness and mostly under reported in Nepal. This study was carried out as a pilot study in working nurses probably for the first time in Nepal. In this study we attempted to assess the incidence and impact of depression and anxiety in nurses who are working upfront in different hospitals. Method...

https://blogs.neurology.org/covid-19-coronavirus/invited-commentary-reflections-on-the-ineffective-response-to-the-covid-19-pandemic-in-nepal/

Bell's palsy is a peripheral unilateral facial weakness (lower motor neuron) paralysis with an acute onset yet unknown cause. Bell's palsy accounts for almost three quarters of peripheral facial palsies and the annual incidence is about 15 to 30 patients per 100000 with equal numbers of males and females. Acupuncture has been a safe clinical practi...

Online pharmacy has been in the focus of heightened interest during this lockdown period due to COVID outbreak in Nepal and worldwide. This paper explains the issues relevant to online pharmacies that sell drugs with or without prescriptions to patients at the retail level online (through software apps or website). The online pharmacy industry has...

Background Anxiety and depression are under reported, underdiagnosed mental illness inhealth worker in Nepal especially during COVID pandemic.The study was carried out as an observational studyon nurses in Nepal. In this study we attempted to assess the incidence and impact of depression and anxietyin nurses who are working upfront in different hos...

Background A periodic state of rest accompanied by varying degree of unconsciousness and relative inactivity, the sleep is vital to human health, insufficiency of which can lead to serious problem with physical and mental health consequences. Because of COVID-19 Pandemic, Nepal is under a total lockdown, with total restrictions on the movement of i...

Background: Recently, there have been a surge in research worldwide regarding relation of vitamin D with several diseases. Many neurological diseases like multiple sclerosis, Alzheimer’s disease as well as other diseases like cardiovascular disease have shown positive correlation with vit. D deficiency measured according to the international level....

Establishing a common database

COVID

Background Anxiety, Depression is one of the under reported, underdiagnosed in Nepal though it is the leading cause of incapacitation and is the leading healthcare burden worldwide. The prevalence of anxiety, depression among health personnel is not reported. In this study we attempted to assess the incidence and impact of depression and anxiety in...

Background Anxiety, Depression is one of the under reported, underdiagnosed in Nepal though it is the leading cause of incapacitation and is the leading healthcare burden worldwide. The prevalence of anxiety, depression among health personnel is not reported. In this study we attempted to assess the incidence and impact of depression and anxiety in...

Background No longitudinal, long-term, follow-up studies have explored the association between presence and severity of variations in extracranial venous anatomy, and clinical outcomes in patients with multiple sclerosis (MS). Objective This prospective 5-year follow-up study assessed the relationship of variations in extracranial venous anatomy,...

Introduction The autoimmune disease myasthenia gravis can mimic a variety of neurological disorders leading to a delay in diagnosis and treatment. In the older population, due to confusion with signs of the ageing process or comorbidities due to ageing, there are many underdiagnosed or misdiagnosed cases of myasthenia gravis. A majority of myasthen...

Primary intracerebral hematoma constitutes about 10-15% of all strokes and is associated with high mortality and severe disability. Surgical treatment of intracerebral hemorrhage is quite controversial. It is believed that minimal invasive stereotactic surgery may reduce hematoma volume and decrease secondary neurotoxicity. The technical note of st...

p>Cerebral Venous Thrombosis (CVT) is a rare form of Stroke characterized by thrombus formation in the cerebral veins. CVT is a result of various reasons among which the hyperthyroidism is not so frequently encountered. This is probably the first case report published from Nepal. The aim of this case report is to give the message that persistent se...

Objective: The aim of this study was to identify the association of parental MTHFR C677T gene polymorphism in couples with and without RPL history. Results: During the study, 21.4% (15/70) of Ala222Val polymorphism was observed among RPL couples while no polymorphism was seen among normal, healthy couples. Our study did not find any association...

Increased collateral facial vein (FV) flow may be associated with structural damage in patients with multiple sclerosis (MS). The objective was to assess differences in FV flow and magnetic resonance imaging (MRI)-derived outcomes in MS. The study included 136 MS patients who underwent neck and head vascular system examination by echo-color Doppler...

p>Development of malignant glioma after trauma is a rare occurrence. Trauma and scarring have been known to be the predisposing factor for the development of meningiomas. Many people have discussed about the development of glioma post trauma but without proper evidence of documents prior to trauma with no evidence of tumor. We present you a case wi...

An otherwise healthy 38-year-old male presented to the Neurology clinic in Annapurna Neurology Institute and Allied Sciences; with the complaint of progressive weakness of both of his lower limbs that began 2 days earlier. Before the onset of weakness; he felt mild pain associated with the tingling sensation from the waist down. Several hours later...

Complicated the medical problem is, harder it becomes to treat and the more treatment strategies exist. This observation stands true in the context of migraine treatment. Several large randomized trials, research reports have been published regarding effectiveness of acupuncture in management of headache, especially in migraine headaches. Cochrane...

p>Acute transverse myelitis is a focal infl ammatory disorder of the spinal cord. One of the main etiologic factors include, multiple sclerosis, post-infectious and post-traumatic events although autoimmune phenomenon is the most common cause. Transverse Myelitis (TM) due to etiology other than Multiple Sclerosis has shown spinal cord involvement o...

p>Central Pontine Demyelination is a neurological disease caused by rapidly fl uctuating serum osmolality resulting in severe damage of the myelin sheath of nerve cells in the brainstem, more precisely in the area of pons. This condition is associated with electrolyte disorders, especially severe hyponatremia and its rapid correction. Its clinical...

p>Chiari Malformation-I is a congenital disorder characterized by the anatomical defect of the base of skull with tonsillar herniation (≥5 mm) below the foramen magnum, which is detected on MRI. It has a diverse range of symptoms with non-specific presentation leading to the chances of misdiagnosis and untimely recognition of the disorder. Syringom...

Background: Leptomeningeal contrast enhancement (LM CE) has been recently described in multiple sclerosis (MS) patients as a potential in vivo marker of cortical pathology. Objectives: To investigate the association of LM CE and development of cortical atrophy in 50 MS patients (27 relapsing-remitting (RR) and 23 secondary-progressive (SP)) foll...

Background: Over the past decade, several studies attempted to investigate a causal association between abnormalities of extra-cranial venous system, known as chronic cerebrospinal venous insufficiency (CCSVI) and multiple sclerosis (MS). There is limited literature regarding association of CCSVI with clinical outcomes in MS longitudinally. Object...

Background: Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by abnormalities of the main extracranial cerebrospinal venous outflow routes, which can be detected by Doppler sonography (DS) using 5 venous hemodynamic (VH) criteria. A cutoff for CCSVI diagnosis classification consists of ≥2 abnormal DS VH criteria. Given that multi...

Objectives: To investigate whether leptomeningeal contrast enhancement (LM CE) is associated with development of gray matter (GM) atrophy in patients with multiple sclerosis (MS). Background: LM CE has been recently described with elevated frequency in patients with MS. LM CE may be associated with increased GM pathology, however the relationship b...

Objectives: To investigate the association of atrophy of retinal layers using Optical Coherence Tomography (OCT) with development of whole brain (WB) and gray matter (GM) atrophy in patients with multiple sclerosis (MS) over 5years. Background: Multiple cross-sectional studies have established the association of retinal nerve fiber thickness (RNFLT...