Rohit Bhatia

• MBBS, MD, DM, DNB
• Professor at All India Institute of Medical Sciences

Knowledge related to SARS-CoV-2 or 2019 novel coronavirus (2019-nCoV) is still emerging and rapidly evolving. We know little about the effects of this novel coronavirus on various body systems and its behaviour among patients with underlying neurological conditions, especially those on immunomodulatory medications. The aim of the present consensus...

The ongoing pandemic of COVID-19 is a global public health emergency. This has led to challenges for healthcare facilities to optimally manage other important medical emergencies. Stroke is an important public health emergency with significant mortality and morbidity. Timely treatment of acute stroke is critical to prevent disability. The current e...

Background and purpose: Various neurological findings including stroke in patients with coronavirus disease 2019 (COVID-19) have been described, although no clarity exists regarding the nature and pattern of this association. This systematic review aims to report the characteristics of stroke in patients with COVID-19. Methods: Three authors ind...

Background: India accounts for 13.3% of global disability-adjusted life years (DALYs) lost due to stroke with a relatively younger age of onset compared to the Western population. In India's public healthcare system, many stroke patients seek care at tertiary-level government-funded medical colleges where an optimal level of stroke care is expecte...

Introduction: The benefit of endovascular treatment in large anterior circulation ischaemic strokes with low ASPECTS score (<6) is uncertain. Recent randomised studies have demonstrated the benefit of endovascular treatment (EVT) in large ischaemic strokes. The present meta-analysis aims to assess the combined effect of these studies on efficacy a...

A significant number of patients with acute ischemic stroke (AIS) due to medium vessel occlusion (MeVO) fail to achieve favourable functional outcomes despite the best medical treatment (BMT). The efficacy and safety of Endovascular treatment (EVT) in strokes with underlying MeVO remain uncertain, with recent randomized controlled trials (RCTs) sho...

Background and Objectives: Intracerebral hemorrhage (ICH) is associated with high mortality and morbidity. Uncertainty still exists regarding the benefit of surgery in the management of supratentorial spontaneous ICH (sICH), especially of the basal ganglia and thalamus. Studies have not shown the clinical benefit of early surgical management compar...

Acute Disseminated Encephalomyelitis (ADEM) is commonly associated with viral infections, but its occurrence after bacterial meningoen-cephalitis is rare. This study presents a case of ADEM following bacterial meningoencephalitis and reviews related case reports. A literature search was performed using PubMed and EMBASE to identify case reports of...

Background and Aims: Globally, 87% of stroke patients are left with disability in low and middle-income countries. Continual rehabilitation is significant to maximize functional recovery. However, heterogeneity exists due to lack of guidelines, low prioritization of rehabilitation services, inadequate numbers of skilled rehabilitation specialists,...

Introduction: Hematoma expansion (HE) occurs in one-fourth of patients with acute intracerebral hematoma (ICH) and is associated with worse outcomes. Existing radiological markers of HE show modest predictive accuracy. We aim to investigate a novel radiological marker that co-localizes findings from non-contrast CT (NCCT) and CT angiography (CTA) t...

Meningioangiomatosis is a rare entity, commonly affecting leptomeninges and the cerebral cortex. It presents in the second decade of life with drug-resistant epilepsy. Meningioangiomatosis lacks a typical computed tomography or magnetic resonance imaging appearance, making the presurgical diagnosis a challenge. Diagnosis often depends on recognizin...

Background Genomic variations associated with dystonia in Asian Indians remain largely unknown. Objectives To identify genomic alterations associated with dystonia in the Asian Indian population using next generation sequencing approaches. Methods From September 2018 to December 2023, we enrolled 745 individuals including probands with dystonia a...

Rationale Early mortality in intracerebral haemorrhage (ICH) is due to haematoma volume (HV) expansion and there are no effective treatments available other than reduction in blood pressure. Tranexamic acid (TXA) a hemostatic drug which is widely available and safe can be a cost-effective treatment for ICH, if proven efficacious. Hypothesis Admini...

Background: Hematoma expansion (HE) occurs in one-fourth to one-third of patients with acute intracerebral hemorrhage (ICH) and is associated with worse outcomes. The co-localization of non-contrast CT (NCCT) hypodensity and CT angiography (CTA) spot sign, the so-called Black-&-White (B&W) sign, has been shown to have high predictive accuracy for H...

A 50-year-old male patient presented with a 10-year history of progressive cerebellar ataxia, multifocal dystonia with dystonic tremors, and oculomotor abnormalities including bilateral ptosis, slow saccades, and reduced range of ocular movements. There were no signs of cognitive impairment, parkinsonism, autonomic dysfunction, or muscle weakness,...

Background and Aims Stroke is a significant health problem worldwide and is one of the major cause of morbidity and mortality. The etiology of Acute ischemic Stroke(AIS) is varied with multiple pathologies implicated. Cranio-cervical artery dissection is a significant cause of stroke in young. Vessel Wall MR Imaging(VW-MRI) is a recent imaging tech...

Background and Objectives Cervical flexion-induced myelopathy, also known as Hirayama disease (HD), is a lower motor neuron disorder seen mainly in adolescents and young adults, affecting the C7–T1 myotomes, presenting as asymmetric weakness with wasting of one or both the distal upper limbs. We aimed to describe the clinical features, electrophysi...

Background and Objectives Rising hypertension from inadequate detection, noncompliance with treatment, and poor control presents a major public health challenge. Previously, adopting the strategy of self-monitoring of blood pressure (SMBP) showed better hypertension detection, control, and medication adherence. However, evidence from India is scarc...

Background:Kernicterus is the long-term manifestation of acute bilirubin encephalopathy, and it includes a tetrad of clinical characteristics that appear after one year of age. This tetrad includes abnormal motor control, hearing loss, impairment of upward vertical gaze and dental enamel dysplasia. Kernicterus results in a subtype of cerebral palsy...

Clinical, Electrophysiological, Radiological and genetic profile of Young ALS patients in India

OBJECTIVE To determine the effect of inhibitory repetitive transcranial magnetic stimulation (rTMS) delivered to the left inferior parietal lobule (IPL) on the severity of task-specific focal hand dystonia. METHODS In this randomized, sham-controlled, double-blind crossover study, participants received single sessions of low-frequency (1 Hz) inhib...

Background and Aims Tenecteplase is used as the standard of care treatment for thrombolysis in acute ischemic stroke (AIS) patients within 4.5 h of symptom onset. Documented reports were less certain to claim the benefits of it in an extended window period. EAST-AIS (CTRI/2022/03/040718) trial is designed to determine the success rate of thrombolys...

Background & objectives Improving access to acute cardiac care requires remodelling of existing health systems into a service delivery network with an anchor establishment (Hub) offering a full array of services, complemented by spoke establishments that offer limited services. We assessed the availability of cardiac services in the district of Far...

Stroke is a leading cause of morbidity and mortality in humans. Most strokes are ischemic in nature and early recanalization of occluded vessels determines good outcomes. Recanali-zation of occluded vessels depends on many angiographic and demographic features. These factors need to be identified for better patient overall outcomes. Better preopera...

Traditionally, sternotomy has been the gold standard approach for the treatment of thymomas. However, interest in minimally invasive techniques such as video-assisted and robot-assisted thymectomy is gaining momentum. Concerns have been raised over the possibility of en-bloc resection using minimal access techniques due to limited working space and...

Importance Whether infarct size modifies the treatment effect of early vs late direct oral anticoagulant (DOAC) initiation in people with ischemic stroke and atrial fibrillation is unknown. Objective To assess whether infarct size modifies the safety and efficacy of early vs late DOAC initiation. Design, Setting, and Participants Post hoc analysi...

Background and purpose Mechanical thrombectomy is the standard treatment modality for flow restoration in acute ischemic stroke. In cases of persistent occlusion, the optimal number of retrieval attempts before considering procedure termination is currently undetermined and is a topic for research. Therefore in this study, we studied the impact of...

Facioscapulohumeral muscular dystrophy (FSHD) is the third most common form of hereditary myopathy. Sixty per cent of the world’s population lives in Asia, so a significant percentage of the world’s FSHD participants is expected to live there. To date, most FSHD studies have involved individuals of European descent, yet small-scale studies of East-...

Introduction Although endovascular thrombectomy(EVT) is the standard of care for acute large vessel occlusions, ideal systolic blood pressure (SBP) target post procedure has remained elusive. With recent publications of randomised controlled trials (RCTs) comparing intensive BP control to a less intensive strategy, there is a need to conduct a syst...

Rationale Intracranial atherosclerotic disease (ICAD) is a pathological process that causes progressive stenosis and cerebral hypoperfusion, leading to stroke occurrence and recurrence around the world. The exact duration of dual antiplatelet therapy (DAPT) for ICAD is unclear in view of long-term risk of bleeding complications. Aim The current st...

Rationale Rapid and timely treatment with intravenous thrombolysis and endovascular treatment (EVT) in patients with acute ischaemic stroke (AIS) and large vessel occlusion (LVO) significantly improves patient outcomes. Bridging therapy is the current standard of care in these patients. However, an incompletely answered question is whether one thro...

Primary CNS Vasculitis (PCNSV) is a rare, diverse, and polymorphic CNS blood vessel inflammatory condition. Due to its rarity, clinical variability, heterogeneous imaging results, and lack of definitive laboratory markers, PCNSV diagnosis is challenging. This retrospective cohort analysis identified patients with histological diagnosis of PCNSV. De...

Episodic ataxias (EAs) are a group of autosomal dominant disorders characterized by paroxysmal attacks of ataxia. EA type 2 usually has an adolescent onset with interictal nystagmus. Whereas, inter-ictal myokymia is usually a feature of EA type 1. Here we present a rare case of genetically proven EA type 2 with late age of onset and interictal orom...

There is a pressing clinical need for thrombolytic agents that can effectively disaggregate arterial thrombi in acute ischemic stroke without significantly increasing the risk of bleeding. This pilot study aimed to investigate the safety and efficacy of N-acetylcysteine (NAC) as an adjunctive therapy to intravenous recombinant tissue plasminogen ac...

Background Myotonic dystrophy type 1 (DM1) is one of the most common inherited muscular dystrophies in adults. It is caused by CTG repeat expansions in the 3' untranslated region (UTR) of the DMPK gene on Chromosome 19. Apart from muscle, the disease can involve the eye, heart, brain and endocrine system. Cognitive and sleep disturbances are common...

Facioscapulohumeral muscular dystrophy (FSHD) is the second most common muscular dystrophy in adults, and it is associated with local D4Z4 chromatin relaxation, mostly via the contraction of the D4Z4 macrosatellite repeat array on chromosome 4q35. In this study, we aimed to investigate the use of Optical Genome Mapping (OGM) as a diagnostic tool fo...

Title: Spectrum of skeletal muscle channelopathies in a cohort of Inherited Neuromuscular disorders Introduction: Skeletal muscle channelopathies are rare genetic neuromuscular disorders comprising periodic paralyses and non-dystrophic myotonias. Paroxysmal symptoms, near normal clinical examination and investigations may sometimes make these diso...

Background and purpose: Although rare, neurological adverse events have been reported post-COVID-19 vaccination. This study reports 16 patients diagnosed with CNS inflammatory demyelinating diseases (CNS-IDD) within 6 weeks of COVID-19 vaccine administration. Methodology: A prospective observational study was conducted from June 2021 to May 2022...

Azathioprine (AZA) has demonstrated efficacy in multiple randomized control trials (RCTs) for Relapsing-Remitting Multiple Sclerosis (RRMS). However, we still need comparative real-world data with other first-line disease-modifying therapies (DMTs). We aimed to assess AZA’s effectiveness regarding relapses, disability progression, time to the first...

Background There is a clinical need for thrombolytic agents that can disaggregate arterial thrombi without significantly increasing the risk of bleeding. The present study was aimed to study if adjunctive therapy with N-acetylcysteine (NAC) along with standard thrombolytic agent was safe and effective in patients with acute ischemic stroke as throm...

Neuromuscular diseases (NMDs) affect ∼15 million people globally. In high income settings DNA-based diagnosis has transformed care pathways and led to gene-specific therapies. However, most affected families are in low-middle income countries (LMICs) with limited access to DNA-based diagnosis. Most (86%) published genetic data is derived from Europ...

Multiple Sclerosis (MS) is an autoimmune disorder affecting the central nervous system (CNS) and has two important pathologic hallmarks - inflammation leading to demyelination and astrocyte proliferation leading to gliosis and neurodegeneration. Clinically this pathology manifests as episodic acute attacks also known as relapsing remitting multiple...

Most drugs used in the treatment of Tuberculous Meningitis have limited CNS penetration thereby limiting efficacy. CSF penetration of linezolid is 80-100%.The study was a prospective, randomized, open label with blinded outcome assessment pilot trial carried out in patients with TBM. Patients were randomized in a 1:1 ratio into two treatment groups...

Objective To determine the feasibility, reliability, and acceptability of video teleconference (VTC)-based neuropsychological assessment using Addenbrooke’s cognitive examination-III (ACE-III). Methods This study was performed from January 2022 to April 2022, during the third wave of the COVID-19 pandemic in India. We administered ACE-III using vi...

Background Neuropathic Tremor (NT) is a postural/kinetic tremor of the upper extremity, often encountered in patients with chronic neuropathies such as paraprotein‐associated and hereditary neuropathies. Objectives To describe the clinical and electrophysiological features of NT in a previously underrecognized setting‐ during recovery from Guillai...

Background and purpose The benefit of endovascular treatment in large anterior circulation ischemic strokes with low ASPECTS score(<6) is uncertain. Recent studies have demonstrated the benefit of endovascular treatment (EVT) in large ischemic strokes. The present meta-analysis aims to assess the combined effect of these studies on efficacy and saf...

Background: Lack of timely care is a predictor of poor outcomes in acute cardiovascular emergencies including stroke. We assessed the presence of delay in seeking appropriate care among those who died due to cardiac/stroke emergencies in a community in northern India and identified the reasons and determinants of this delay. Methods: We conducte...

Background and objective: Nearly 40-65% patients with MS develop cognitive impairment during the disease. There is no treatment clearly effective in improving the cognitive deficits. To evaluate the efficacy and safety of Rivastigmine in cognitively impaired MS patients. Materials and methods: This was a parallel group randomized open label stud...

OBJECTIVE: To develop an automated algorithm to detect, quantify, and differentiate between tremor using pen-on-paper spirals. METHODS: Patients with essential tremor (n = 25), dystonic tremor (n = 25), Parkinson’s disease (n = 25), and healthy volunteers (HV, n = 25) drew free-hand spirals. The algorithm derived the mean deviation (MD) and tremor...

Objectives The aim of the study was to study the demographical, clinical, radiological features, and outcome of anti-myelin oligodendrocyte glycoprotein (MOG) antibody spectrum disorder and compare these features with patients negative for anti-MOG antibody. MOG antibody-associated disease (MOGAD) and aquaporin-4 (AQP4) antibody-related diseases ar...

Objective The objective was to describe the clinical presentations, radiologic features, and outcomes of patients with autoimmune encephalitis associated with myelin oligodendrocyte glycoprotein antibody (MOG).Background During the past decade, the spectrum of the myelin oligodendrocyte glycoprotein antibody-associated diseases (MOGAD) has expanded...

Background and purpose: There is an unmet need for a more effective thrombolytic agent in acute ischemic stroke (AIS) management. Various studies and meta-analysis suggest tenecteplase (TNK) as non-inferior over alteplase (rTPA). The present single-center study compares biosimilar TNK and rTPA in a tertiary care setting. Methods: Data of patient...

Background: Social cognition is the study of how people make sense of themselves and others. Impairment in several domains of social cognition is increasingly being recognized in Parkinson's disease (PD). Objectives: We aimed to study multiple domains of social cognition in Indian PD patients using a culturally appropriate, validated instrument....

Introduction/Aims: Studies conducted during the coronavirus disease 2019 (COVID‑19) pandemic have reported varied data regarding the incidence of Guillain–Barre syndrome (GBS). The present study investigated demographic and clinical features, management, and outcomes of patients with GBS during a specified period of the COVID‑19 pandemic, and com...

Facioscapulohumeral muscular dystrophy (FSHD) is the second most common autosomal dominant muscular dystrophy in adults worldwide. FSHD in India has always been a clinical diagnosis as there are no facilities for diagnostic testing in India, either in the private or public sector. Currently, patients send their blood samples to diagnostic or resear...