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<title>Edwiser-Journal-of-Neurology-Neurosurgery-Psychiatry-Research-ISSUE VOLUME Volume 5 ISSUE Issue 1</title>
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Edwiser-Journal-of-Neurology-Neurosurgery-Psychiatry-Research: VOLUME Volume 5 ISSUE Issue 1, Jan-Dec 2023
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<title>Edwiser-Journal-of-Neurology-Neurosurgery-Psychiatry-Research-ISSUE VOLUME Volume 5 ISSUE Issue 1</title>
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		<title>A-Rare-and-Unusual-Case-of-Ataxia-Telangiectasia-with-Cervical-Dystonia-from-India</title>
		<pubDate>28-Sep-2023</pubDate>
<link>http://JNNPR.edwiserinternational.com/admin/uploads/CxPwaN.pdf</link>
		<author>Sanjiv-Chamraj-and-Sharan-Srinivasan</author>
		<comments>{http://www.edwiserinternational.com/contact-us.php}</comments>
		<category>Medical Science,Clinical Science</category>
		<description>{<![CDATA[We reported a rare and unusual case ATM gene variant responsible of familial Ataxia-Telangiectasia (A-T) with cervical dystonia rather than ataxia as hall mark clinical manifestations in 18-year-old male patient from India. Patient was presented with clinical indications of neck rotatory movements in the last 2 years. Initially intermittent, slowly become constant with more backwards turning and painful movements with severe disability. Examination findings revealed no conjunctival telangiectasia and neurological examination findings suggestive of cervical dystonia with severe retro collis. The patient has a family history of dystonia, his sister started noticing involuntary neck movement in the last 1.5 years with gradual progression. Her physical examination revealed no evidence of conjunctival lesions and neurological examination suggestive of cervical dystonia with lateral collis. MRI findings of patient were normal. Both the patient and her sister are siblings of a consanguineous product. Patient has been referred for whole exome sequencing. The exome data analysis identified a novel homozygous missense variant c.5751A>T, p.Arg1917Ser (chr11:108307973A>T) in ATM gene responsible for familial A-T with cervical dystonia without chorea as hall mark clinical manifestations. In conclusion, to the best of our literature knowledge this is the rare and unusual case from India wherein we are reporting a novel homozygous missense variant c.5751A>T, p.Arg1917Ser (chr11:108307973A>T) in ATM gene responsible for familial A-T with cervical dystonia rather than ataxia as hall mark clinical manifestations affecting both brother and sister in the same family. Thus, early onset of cervical dystonia should be taken into account as a key characteristic of variant A-T, which can manifest without general ataxia and may cause adults with primary dystonia to receive an incorrect diagnosis.]]>}</description>
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		<title>Concurrent-Isolated-Hypoglossal-Nerve-Palsy-Induced-by-Jugular-Vein-Thrombosis-Cervical-Plexus-Masses-and-Vestibular-Schwannoma-A-Complex-Case-Report-Highlighting-Anatomical-Pathways-and-Clinical-Challenges</title>
		<pubDate>17-Oct-2023</pubDate>
<link>http://JNNPR.edwiserinternational.com/admin/uploads/8hBMIj.pdf</link>
		<author>Sara-Zarei-Khatchadourian-C-Bonakdar-B-et-al-</author>
		<comments>{http://www.edwiserinternational.com/contact-us.php}</comments>
		<category>Medical Science,Clinical Science</category>
		<description>{<![CDATA[Background: Hypoglossal nerve palsy is typically observed alongside other cranial nerve impairments, with isolated cases being infrequent and posing diagnostic complexities. Originating intracranially, the nerve traverses the skull and neck, governing tongue motility. Lesions are classified as supranuclear, nuclear, or infranuclear, engendering tongue deviation towards the affected side. Due to its proximity to crucial structures, hypoglossal nerve palsy often coincides with supplementary symptoms. Etiologies encompass skull base metastases, carotid artery pathologies, and trauma. This study explores less conventional triggers such as hypoglossal nerve palsy following thyroidectomy, jugular vein thrombosis, cervical plexus masses, and Vestibular Schwannoma. Case Description: A 38-year-old female presented to the Neurology outpatient clinic with leftward tongue deviation and left-sided neck and shoulder pain accompanied by stiffness that had begun several months prior. In addition to the tongue deviation, she reported minor dysphagia, blurry vision, and intermittent numbness on the left side of her scalp. MRI and duplex ultrasound verified the presence of left internal jugular vein (IJV) thrombosis. The patient was initially prescribed Eliquis and acetazolamide, with slight improvements in symptoms, though medication use ceased due to side effects. During a subsequent follow-up visit, persistent tongue deviation and worsening left shoulder pain prompted additional cervical imaging. A new cervical spine MRI revealed a 15x14 mm nodular dural enhancement with a paraspinal soft tissue mass at the C2 level. Concurrently, multiple cranial nerve palsies were detected during the physical examination. Unfortunately, the patient was subsequently diagnosed with breast cancer. To rule out brain metastases related to her breast cancer, an additional brain MRI was performed, revealing a newly formed 2.3x1.6x1.2 cm left cerebellopontine angle mass adjacent to the internal auditory canal (IAC), suggestive of a vestibular schwannoma but without evidence of metastatic disease. The patient's care involved a multidisciplinary team, including hematologist-oncologists, neurosurgeons, and neurologists.Conclusion: This case report highlights the less common causes of hypoglossal nerve palsy, such as jugular vein thrombosis, cervical plexus masses, and Vestibular Schwannoma. The persistence of the patient's palsy is attributed to the cumulative impact of these anatomical factors on the hypoglossal nerve. This underscores the diagnostic challenges posed by isolated hypoglossal nerve palsy and emphasizes the importance of comprehensive clinical evaluation and imaging for accurate diagnosis.]]>}</description>
		</item><item>
		<title>Adult-Onset-of-Pyruvate-Dehydrogenase-Deficiency-Presenting-with-Dystonia-and-Chorea-in-Female-Patient-from-India-A-Very-Rare-Case-</title>
		<pubDate>11-Nov-2023</pubDate>
<link>http://JNNPR.edwiserinternational.com/admin/uploads/BSEsM4.pdf</link>
		<author>Sanjiv-Chamraj-and-Sharan-Srinivasan</author>
		<comments>{http://www.edwiserinternational.com/contact-us.php}</comments>
		<category>Medical Science,Clinical Science</category>
		<description>{<![CDATA[We reported a very rare case of pyruvate dehydrogenase complex E1 (PDHA1) gene deficiency presenting as cervical dystonia and chorea in an adult female patient from India. Patient was presented with a history of involuntary rhythmic repetitive movements of both hands, legs, and head, lips and stammering of speech with tilting of neck to one side along with orofacial dyskinetic movements since past 6 years and gait changes since past 4 years. Her symptoms were progressive in nature. Her physical examination and systemic examinations were normal. Neurological examinations suggestive of cervical dystonia with chorea form movements. Brain MRI investigations revealed marked atrophy of bilateral caudate nuclei and putamina. Patient had a familial history of father and second brother had mild hand tremors. Patient has been referred for whole exome sequencing. The exome data analysis identified a very rare and unusual heterozygous indel variant c.-20_-19delinsCT, (chrX:19344018_19344019delinsCT) in 5UTR region of PDHA1 gene caused late phenotypic onset of cervical dystonia as major clinical manifestation of PDHA1 deficiency along with chorea form movement disorders at the age of 24 year. In conclusion, to the best of our literature knowledge this is the novel and unusual case of adult female patient wherein we are reporting a novel heterozygous indel variant c.-20_-19delinsCT, (chrX:19344018_19344019delinsCT) in 5UTR region of PDHA1 gene responsible for PDHA1 deficiency presenting with cervical dystonia and chorea as major clinical manifestations. Hence, dystonia and chorea as major clinical manifestations of PDH deficiency could be considered in adult patients also rather than only in paediatric patients.]]>}</description>
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