Institute of Neurosciences Kolkata

A bstract Arterial spin labeling (ASL) magnetic resonance imaging (MRI) is an emerging noninvasive perfusion imaging technique increasingly used in the evaluation of hemiplegic migraine (HM). HM is a rare migraine subtype characterized by transient unilateral motor weakness associated with aura, often mimicking acute ischemic stroke. ASL measures cerebral blood flow without exogenous contrast, allowing dynamic assessment of perfusion changes during attacks. In the acute phase, ASL commonly reveals reversible regional hypoperfusion, involving the cortex corresponding to neurological deficits. These perfusion abnormalities evolve over time and typically normalize with symptom resolution. Here, we describe a 13-year-old girl, who presented with an acute onset of right upper limb paresis and was subsequently diagnosed with HM with genetic confirmation. ASL-MRI provides a valuable, repeatable tool to characterize perfusion alterations in HM and differentiate HM from stroke, guiding appropriate management in emergency and follow-up settings.

Heavy metal pollution continues to threaten ecosystem and human health due to the persistence, non-degradability, and toxicity of metals such as Cd, Cr, Pb, Hg, and As. Microbial, fungal, algal, and plant-based bioremediation systems demonstrate high metal removal efficiencies, with biosorption capacities ranging from 70 to 99% for fungi (e.g., Aspergillus, Penicillium), 60–98% for bacteria (e.g., Bacillus, Pseudomonas), 40–95% for algae (Chlorella sp., Oedogonium sp.), and 30–80% for plants depending on species and metal bioavailability. Engineered microbial strains and CRISPR-edited plants exhibit enhanced uptake, with CRISPR knockouts in rice reducing Cd accumulation in grains by up to 70%. In contrast, microbial consortia remove metals more efficiently than single strains, achieving 98–100% remediation at optimized pH (5.5–7.5) and metal concentrations (10–100 mg/L). Despite strong laboratory performance, field translation is limited by inconsistent metal bioavailability, environmental variability, and long remediation times. This review synthesizes comparative efficiencies, mechanistic foundations, and scalability challenges, highlighting integrated nano-bioremediation, microbial consortia, and genome-edited plants as promising next-generation strategies toward sustainable heavy metal mitigation.

Aneurysmal bone cyst (ABC) is rarely seen in the calcaneus of young children. To our knowledge, till date very less number of calcaneal ABC have been reported in the literature. A 5-year-old female child suffered chronic heel pain for last 2 months and was presented with x-ray showing a solitary and expansile osteolytic lesion within the calcaneus. Detailed clinico-radiological and histopathological examination suggested the lesion as ABC. The volume of the lesion was 11.9 cm3 as measured in the MRI. Curettage was not opted as wall of entire calcaneus was very thin and lesion was big compared to the age of child. Treatment was done with 4 sequential sclerosant polidocanol injection therapy over 9months, with minimum of 6 weeks interval in each injection. Dosage of the sclerosant therapy was calculated by weight of the patient (2-4 mg/kg) instead of volume of the cyst. No recurrence was observed over next 1 year by sequential X-rays. Age of the patient, anatomical location and severity in our case makes it unique. ABC can also be found in unusual locations like calcaneus even at 5 years age and can be managed by standard polidocanol protocol. In very young children with thin-walled, calcaneal ABCs, serial sclerosant injection may avoid morbid curettage/grafting.

Sir, Restless leg syndrome (RLS) is a common neurological disorder characterized by an uncontrollable urge to move the legs, often accompanied by discomfort, especially during periods of rest or inactivity in the evening or at night.[1] RLS affects roughly 5–10% of the global population, with a female-to-male ratio of 2:1. While RLS traditionally involves the legs, it can also manifest in other regions, leading to diagnostic challenges. We present a rare case of restless jaw syndrome (RJS), a regional variant of RLS that is confined to the jaw. A 36-year-old male presented with a three-year history of intermittent burning sensations in the right jaw extending to the anterior neck, accompanied by a strong urge to move his jaw. Symptoms worsened during periods of rest but improved with activities like chewing, talking, or singing. To alleviate his discomfort, the patient developed a habit of chewing substances such as cardamom. A neurological examination was unremarkable, and an MRI of the brain revealed an incidental arachnoid cyst in the right temporal region without significant mass effect. An MRI of the face, including a trigeminal nerve protocol, was not performed. Comprehensive laboratory tests, including serum ferritin levels, were normal (serum ferritin: 75 μg/L). Trials of gabapentin (300 mg twice daily) and carbamazepine (200 mg twice daily) resulted in minimal improvement. Given the symptom pattern, RJS—a potential isolated variant of RLS was considered. The patient was started on low-dose pramipexole (0.125 mg twice daily), with a gradual increase to three times daily. Over three months, the patient reported a 70–80% reduction in symptoms, as assessed subjectively and using the patient global impression of change (PGIC) scale, without adverse effects. RLS is primarily diagnosed clinically, with secondary causes ruled out through targeted investigations. While it predominantly affects the legs, isolated regional variants involving other areas have been documented.[2] This case met the International RLS Study Group diagnostic criteria, and the significant improvement following dopaminergic therapy supports the diagnosis. Differential diagnoses such as trigeminal neuralgia and burning mouth syndrome were ruled out based on clinical features, absence of intraoral sensory disturbances, and poor response to non-dopaminergic treatments. The distinction from burning mouth syndrome is critical, as the latter primarily involves intraoral dysesthesia rather than an urge to move the jaw.[3] The limited improvement with gabapentin and carbamazepine suggests that the underlying pathophysiology of RJS may be more closely linked to dopaminergic dysfunction rather than neuropathic mechanisms. While dopaminergic therapy was effective in this case, long-term follow-up is needed to assess the durability of symptom relief and potential relapses. This report underscores the need for heightened awareness of atypical presentations of RLS, such as RJS. Dopaminergic dysfunction and brain iron dysregulation are key mechanisms in the pathophysiology of RLS, and these regional variants likely share similar underlying pathways.[4] Recognizing such variants can facilitate early intervention with dopaminergic agents, providing substantial symptom relief. We recommend further research into isolated RLS variants to improve diagnostic criteria and management strategies, ensuring timely and appropriate care for affected patients. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Introduction: Executive functions, governed by the frontal lobes, are essential for goal-directed behavior and decision-making. The Frontal Assessment Battery (FAB) is a brief tool used to detect frontal lobe dysfunction. Substance use disorders (SUDs) are known to impair executive functioning, yet comparative data across substances remain limited in clinical settings. Objectives: To assess and compare executive functioning using the FAB among individuals with alcohol, cannabis, and opioid use disorders and a control group from the normal population. Material and Methods: This was a cross-sectional, comparative study conducted at a tertiary care psychiatry outpatient department. A total of 120 participants aged 18–50 years were selected: 30 each from normal controls, alcohol use disorder, cannabis use disorder, and opioid use disorder groups. The FAB was administered to all participants. Data were analyzed using unpaired t-tests, one-way analysis of variance (ANOVA), and Pearson correlation. Results: Mean FAB scores were significantly lower in all SUD groups compared to the control group (p < 0.05). Cannabis users had the lowest mean FAB score (14.70 ± 2.57), and 10% scored below the clinical cutoff (<12). Significant negative correlations were found between FAB scores and duration of substance use in cannabis (r = −0.596, p = 0.001) and opioid groups (r = −0.369, p = 0.045). Conclusion: Executive dysfunction was observed in all SUD groups, with the greatest impairment in cannabis users. FAB proved to be a useful screening tool in detecting such dysfunctions. Early identification of cognitive deficits can enhance comprehensive management and rehabilitation outcomes in individuals with SUDs.

Moyamoya disease (MMD) is characterized by progressive carotid fork steno-occlusion and the development of "puff-of-smoke" collaterals on angiography. However, a subset of patients present with similar vascular changes but lack these hallmark collaterals, complicating both diagnosis and management. This "smokeless" phenotype, associated with ring finger protein 213 (RNF213) gene variants, challenges the traditional description of MMD. We describe a series of such patients who responded favorably to revascularization. In this ambispective observational study, we evaluated 12 patients with carotid fork steno-occlusive disease but without "puff-of-smoke" collaterals. Clinical, radiological and genetic assessments were assessed. Structural modeling of RNF213 protein variants was conducted through 3D homology modeling, validated via Ramachandran plots and further refined with COOT and PyMOL. Functional insights were derived through ConSurf analysis. Of the 12 patients, 9 carried the RNF213 p.R4810K variant, 1 harboured a novel variant, 1 had both p.R4810K and a novel variant and 1 had p.R4859K. Initial misclassification as intracranial atherosclerosis or vasculitis led to inappropriate treatment. Following genetic confirmation, 9 patients underwent revascularization, with no stroke recurrence and a favorable clinical outcome. Structural modeling revealed minimal functional impact for the Val1529Met variant, whereas other variants significantly disrupted RNF213 stability and functionality. "Smokeless moyamoya," characterized by carotid fork steno-occlusion without typical angiographic collaterals, represents a distinct clinical phenotype responsive to revascularization. RNF213 genetic screening enhances diagnostic precision, reshaping traditional paradigms and supporting tailored therapeutic approaches.