Bombay Hospital Journal
type: channel
description: Bombay Hospital Journal (BHJ) is a peer-reviewed quarterly published Print and Online journal. It is an official Journal of Bombay Hospital institute of medical sciences. The aim of BHJ is to improve medical care by publishing sound scientific articles (both research and practice papers) and focusing on topics that are of great importance to its readership. Editor-in-Chief- Dr Satish Vasant Khadilkar
publisher: Incessant Nature Science Publishers
language: en
publication name: Bombay Hospital Journal
issn: 0524-0182
copyright: © The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons. org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/ zero/1.0/) applies to the data made available in this article, unless otherwise stated.
items: Periodic Discharges on Eeg inAn Elderly Female with Vision Loss
items: “Motor Band Sign” Seen in Motor Neuron Disease
items: What Is New in Peripheral Neuropathy? Recent Advances in Diagnosis and Management
items: Non-Immune Causes of Longitudinally Extensive TransverseMyelitis: Lessons Learnt from A Tertiary Care Cohort
items: Beyond Patterns: Diagnostic Precision and theChallenge of Neurological Mimics
items: Editorial Leprosy: A Neurologist's Perspective
items: Prospective Observational Study of Post-Operative Port-Site Pain After Gall Bladder Retrieval from Umbilicalvs Epigastric in Laparoscopic Cholecystectomy
items: A Curious Case of Ileocaecal Mass
items: Reclaiming Fitness: Ethics, Simplicity and Scientific Responsibility in Modern Fitness Training
items: Unraveling Emphysematous Gastritis: A Radiological Saga
items: Congenital Unilateral Choanal Atresia with Adenoid Hypertrophy: A Case Report
items: A Rare Case of Triple Pathogen Co-Infection with Rickettsia, Varicella Zoster Virus, and Plasmodium vivax Confirmed by PCR in an Immunocompetent Adult
items: Curious Case of Non-Healing A bdominal Wound
items: Contemporary Advances in Acute Stroke Management: A FullyIntegrated Review
items: Scrolling away our intelligence - The smartphone generation’s cognitive challenge
items: Floating thrombus- basilar artery occlusion
items: Not All That Looks Like ALS Is ALS: Spectrum of Amyotrophic Lateral Sclerosis Mimics at a Tertiary Neuromuscular Center
items: Antibody-Negative but Not Immune-Negative: Seronegative Autoimmune Encephalitis Presenting as NORSE
items: Incidentally detected aortic coarctation during evaluation of newly diagnosed hypertension in a young adult
items: A CASE REPORT BEYOND THE SCAR: DIAGNOSTIC COMPLEXITY IN A CASE OF POST-HYSTERECTOMY VAULT ENDOMETRIOSIS: A CASE REPORT
items: case report Echoes of the Present : Experiential and Autonomic Auras in Temporal Lobe Epilepsy
items: Retrospective Analysis of Ureteric Injury During Ureteroscopy (URS) Versus Retrograde Intrarenal Surgery (RIRS) Over a Three-Year Period
items: Case Report Manubriosternal Osteomyelitis – Rare Cause of Acute Onset Chest Pain
items: REVIEW OF LITERATURE Comprehensive Physical and Systemic Examination in Neurological Disorders
items: Original Article Exploring the Efficacy of Telmisartan and Cilnidipine Combination Therapy in Hypertension: A Cross-sectional Analysis
items: Surviving Twin In A Bicornuate Uterus with Horn Specific IUFD and Transfusion incompatibility : A Case Report
items: Case Report The Case of a Melting Face: Parry–Romberg Syndrome
items: Editorial Artificial Intelligence in Healthcare: Balancing Technological Innovation with Clinical Judgment
items: progressive lower limb paraplegia in pregnancy -An vertebral haemangioma - A case report
items: Original article Radial SNAP- Optimal site of stimulation in healthy Indian subjects

Periodic Discharges on Eeg inAn Elderly Female with Vision Loss
type: item
description: Introduction: Rapidly progressive dementia includes a heterogeneous group of disorders. Electroencephalography (EEG) is one of the most important diagnostic tests, especially in the context of disorders such as Creutzfeldt–Jakob disease (CJD), autoimmune encephalitis, metabolic encephalopathy, and non-convulsive status epilepticus. Case Report: A 78-year-old female with no known comorbidities presented with painless, progressive diminution of vision in both eyes over 4 months, followed by abnormal involuntary movements and rapidly progressive cognitive decline. She was referred to our centre after showing no improvement with empirical immunotherapy. On examination, she had altered sensorium, paucity of movements on the right side, and myoclonic jerks. EEG was performed and showed generalized theta slowing with stereotyped periodic sharp wave complexes (PSWCs). Magnetic resonance imaging (MRI) of the brain with diffusion-weighted imaging demonstrated diffuse asymmetric cortical restricted diffusion involving the bilateral cerebral cortices (left more than right), consistent with cortical ribboning. Cerebrospinal fluid (CSF) analysis was positive for the 14-3-3 protein. A diagnosis of sporadic CJD was made. Discussion: The main EEG abnormality in sporadic CJD is the presence of periodic discharges (PSWCs). EEG abnormalities vary depending on stage of the disease. Periodic discharges that mimic CJD can occur in metabolic encephalopathy, autoimmune encephalitis, lithium toxicity, anoxic injury, and sometimes in nonconvulsive status epilepticus; however, these typically lack the highly stereotyped 1-Hz periodicity seen in sporadic CJD, particularly when correlated with the clinical progression. Conclusion: EEG has significant clinical utility. It helps distinguish CJD from autoimmune encephalitis and nonconvulsive status epilepticus, in patients with rapidly progressive dementia when used in conjunction with MRI and CSF prion assays.
subject: Neurology Special Issue - Jan-Mar 2026
  topic: section
subject: Creutzfeldt–Jakob disease; cortical ribboning; EEG; Rapidly progressive dementia
  topic: keywords
creator: Varsha Patil
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

“Motor Band Sign” Seen in Motor Neuron Disease
type: item
description: Introduction: The “motor band sign” is an emerging magnetic resonance imaging (MRI) feature of upper motor neuron degeneration in motor neuron diseases. It appears as a curvilinear hypointensity along the primary motor cortex on iron-sensitive sequences such as susceptibility-weighted imaging (SWI). Case Report: A 62-year-old male presented with a 3-year history of progressive gait disturbance, trivial falls, and dysarthria, followed by difficulty rising from a chair over six months. Examination revealed spastic dysarthria, upper motor neuron signs, and proximal lower-limb weakness. MRI brain demonstrated symmetric curvilinear hypointensity along the bilateral precentral gyri on SWI and GRE sequences, consistent with the motor band sign. Electrodiagnostic studies did not show lower motor neuron involvement, supporting a diagnosis of primary lateral sclerosis. Discussion: The motor band sign represents abnormal iron deposition within the deep cortical layers of the precentral gyrus due to neurodegeneration and microglial activation. It is best detected using susceptibility-sensitive sequences such as SWI and GRE. Conclusion: Recognition of the motor band sign on MRI may assist in the identification of motor neuron disease, particularly when conventional imaging is otherwise unremarkable.
subject: Neurology Special Issue - Jan-Mar 2026
  topic: section
subject: Amyotrophic lateral sclerosis; Motor band sign; Motor neuron disease; Primary lateral sclerosis; Susceptibility-weighted imaging
  topic: keywords
creator: Varsha Patil
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

What Is New in Peripheral Neuropathy? Recent Advances in Diagnosis and Management
type: item
description: Peripheral neuropathy represents one of the most common neurological disorders encountered in clinical practice and includes a heterogeneous group of conditions affecting sensory, motor, and autonomic nerves. Traditional classification based primarily on etiology often provides limited guidance in the early diagnostic evaluation of patients presenting with neuropathic symptoms. Recent advances in neurophysiology, imaging, molecular diagnostics, and targeted therapeutics have significantly transformed the approach to peripheral neuropathy. A phenotype-based clinical framework emphasizing pattern recognition, fiber type involvement, and biomarker-guided investigations can facilitate more efficient identification of treatable neuropathies. Novel diagnostic modalities such as skin biopsy for quantification of intraepidermal nerve fiber density, corneal confocal microscopy for assessment of small fiber pathology, and next-generation sequencing for hereditary neuropathies have expanded the diagnostic armamentarium. At the same time, the therapeutic landscape has evolved substantially with the development of disease-modifying therapies for hereditary transthyretin amyloidosis, advances in immunotherapy for immune-mediated neuropathies, and emerging neuromodulation strategies for refractory neuropathic pain. Recognition of antibody-mediated nodo-paranodopathies and the development of RNA-based therapies illustrate the growing role of precision medicine in peripheral nerve disorders. This review provides a practical overview of contemporary advances in peripheral neuropathy with emphasis on clinical pattern recognition, modern diagnostic evaluation, and current as well as emerging therapeutic strategies relevant to day-to-day clinical practice.
subject: Neurology Special Issue - Jan-Mar 2026
  topic: section
subject: Peripheral neuropathy; Small fiber neuropathy; Precision medicine
  topic: keywords
creator: Jharna Mahajan
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Non-Immune Causes of Longitudinally Extensive TransverseMyelitis: Lessons Learnt from A Tertiary Care Cohort
type: item
description: Background: Longitudinally extensive transverse myelitis (LETM) is often presumed to be immune‑mediated. However, a substantial proportion of LETM arises from non‑immune causes that closely mimic inflammatory myelitis, leading to diagnostic delays and inappropriate immunotherapy. Objectives: The aim of the present study was to describe the clinical and radiological characteristics of LETM due to non-immune causes and highlight red flag features that differentiate these conditions from immune‑mediated LETM. Methods: We retrospectively reviewed LETM cases who presented to our tertiary care centre over a period of 6 years (2019–2025) and analysed cases due to non-immune causes. Results: Out of a total 43 LETM cases, 27 cases with a non-immune cause were included in the present study. These included various etiological categories: infectious (n=11), vascular (n=5), nutritional (n=4), neoplastic/paraneoplastic (n=4) and compressive (n=3). The diagnostic delay in cases with vascular etiologies was more compared to other causes. 55% (5/27) of cases received immunotherapy before final diagnosis was established. Clinical and radiological diagnostic clues differentiating various etiologies were strikingly different compared to the immune mediated group. Conclusion: Non-immune causes constitute a significant proportion of LETM in endemic regions. Recognizing red flag features is essential to avoid misclassification as immune-mediated LETM. Early identification of reversible etiologies such as vitamin B12 deficiency and spinal dural arterio-venous fistula significantly alters outcomes. Bottom of Form
subject: Neurology Special Issue - Jan-Mar 2026
  topic: section
subject: LETM; spinal infarct; subacute combined degeneration; spinal dural AV fistula; transverse myelitis
  topic: keywords
creator: Varsha Patil
creator: Sunetra D Phulsunge
creator: Satish V Khadilkar
creator: Samantha Kumar
creator: Sunila T Jaggi
creator: Jimmy Lalkaka
creator: Vibhor Pardasani
creator: B S Singhal
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Beyond Patterns: Diagnostic Precision and theChallenge of Neurological Mimics
type: item
description: Neurology remains a discipline defined by pattern recognition; yet, equally, it requires a constant vigilance against the overinterpretation of patterns. As diagnostic technologies evolve, the risk of premature diagnostic closure has increased. This issue of the Bombay Hospital Journal brings into focus a central challenge in contemporary neurology—the differentiation of disease from its mimics—and reinforces the importance of integrative clinical reasoning.
subject: Neurology Special Issue - Jan-Mar 2026
  topic: section
creator: Satish Khadilkar
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Editorial Leprosy: A Neurologist's Perspective
type: item
description: Leprosy (Hansen’s disease) is a chronic infectious disease caused by Mycobacterium leprae that primarily affects the skin and peripheral nerves. Despite availability of effective treatment, leprosy continues to be an important public health problem, particularly in Southeast Asia. India accounts for a significant proportion of the global disease burden. Transmission typically occurs through prolonged close contact with infected individuals, most commonly via respiratory droplets. The bacillus demonstrates a predilection for cooler areas of the body and preferentially infects Schwann cells, leading to progressive peripheral nerve damage through both direct bacterial invasion and immune-mediated mechanisms. Clinically, leprosy presents across a spectrum ranging from tuberculoid to lepromatous disease, depending on the host’s cell-mediated immune response. Classical manifestations include hypopigmented hypoesthetic skin lesions, thickened peripheral nerves, sensory loss, and painless ulcers. Peripheral neuropathy is a hallmark of the disease and may manifest as mononeuritis multiplex, pure neuritic leprosy, or generalized polyneuropathy. Early involvement of small sensory fibers results in loss of temperature sensation, often preceding impairment of other sensory modalities. Diagnosis is primarily clinical and is supported by slit-skin smear examination for acid-fast bacilli, electrophysiological studies, imaging, and histopathological evaluation. Early recognition is essential to prevent irreversible nerve injury, deformities, and disability. Management involves multidrug therapy with dapsone, rifampicin, and clofazimine as recommended by the World Health Organization. Additional management includes treatment of lepra reactions, control of neuropathic pain, rehabilitation, and preventive strategies such as chemoprophylaxis and vaccination. A multidisciplinary approach and early diagnosis are crucial for reducing long-term complications and social stigma associated wit…
subject: Regular Issue Articles
  topic: section
subject: Leprosy; Mycobacterium leprae; multidrug therapy; peripheral neuropathy; pure neuritic leprosy
  topic: keywords
creator: Satish Khadilkar
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-01
publication date: 2026-05-01
doi: 10.15713/

Prospective Observational Study of Post-Operative Port-Site Pain After Gall Bladder Retrieval from Umbilicalvs Epigastric in Laparoscopic Cholecystectomy
type: item
description: Background: Laparoscopic cholecystectomy is the standard surgical treatment for benign gallbladder disease. Although minimally invasive, postoperative port-site pain remains a common concern and may influence patient recovery. Gallbladder retrieval is a critical terminal step of the procedure and can be performed through either the umbilical or epigastric port; however, the optimal retrieval site with respect to postoperative pain remains controversial. Objectives: To compare postoperative port-site pain following gallbladder retrieval through the umbilical versus epigastric port in patients undergoing elective four-port laparoscopic cholecystectomy, and to evaluate secondary outcomes including retrieval time, surgical site infection, and length of hospital stay. Methods: This prospective observational study was conducted over 18 months at a tertiary care center. Eighty adult patients undergoing elective laparoscopic cholecystectomy were enrolled and divided into two groups based on the port used for gallbladder extraction: umbilical port (n = 40) and epigastric port (n = 40). Postoperative pain was assessed using the visual analogue scale at 1, 6, 12, 24, and 36 hours after surgery. Demographic variables, gallbladder extraction time, surgical site infection, and duration of hospital stay were also recorded and analyzed. Results: Baseline demographic and operative characteristics were comparable between the two groups. Patients in the umbilical port group demonstrated significantly lower postoperative pain scores at all assessed time intervals compared to the epigastric port group (p < 0.05). No statistically significant difference was observed between the groups in gallbladder extraction time, incidence of surgical site infection, or length of hospital stay. Conclusion: Gallbladder retrieval through the umbilical port is associated with significantly reduced postoperative port-site pain without increasing operative time, infection rates, or hospital stay. The umbil…
subject: Regular Issue Articles
  topic: section
subject: Laparoscopic cholecystectomy; gallbladder retrieval; port-site pain; umbilical port; epigastric port; visual analogue scale.
  topic: keywords
creator: Dr. Mohd Shaad Shaikh
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-01
publication date: 2026-05-01
doi: 10.15713/

A Curious Case of Ileocaecal Mass
type: item
description: Background: Neuroendocrine tumours (NETs) of the ileocaecal junction are uncommon neoplasms and are frequently diagnosed incidentally. Most gastrointestinal NETs are detected on histopathological examination following surgery for presumed benign conditions such as appendicitis. Surgical resection remains the cornerstone of management, with the extent of surgery determined by tumour size, location, and pathological features. Case Presentation: We report the case of a 46-year-old male who presented with recurrent abdominal pain, vomiting, and significant weight loss. Radiological evaluation revealed an ileocaecal mass causing luminal narrowing and features of subacute intestinal obstruction. A CT-guided biopsy suggested a low-grade neuroendocrine tumour. The patient underwent a radical right hemicolectomy. Histopathological and immunohistochemical evaluation confirmed a well-differentiated Grade 1 neuroendocrine tumour involving the ileocaecal junction, terminal ileum, and appendix, with regional lymph node metastasis. Conclusion: This case highlights the diagnostic challenge posed by ileocaecal neuroendocrine tumours due to their nonspecific presentation. Routine histopathological examination of appendectomy and right hemicolectomy specimens is essential, as clinically occult malignancies and NETs may otherwise be missed.
subject: Regular Issue Articles
  topic: section
subject: Ileocaecal tumour; Neuroendocrine tumour; Appendiceal neoplasm; Right hemicolectomy
  topic: keywords
creator: Dr. Sanjay Chatterjee
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-01
publication date: 2026-05-01
doi: 10.15713/

Reclaiming Fitness: Ethics, Simplicity and Scientific Responsibility in Modern Fitness Training
type: item
description: Regular exercise; ideally practiced 5-6 days of the week; alongside a balanced, wholesome home cooked diet and adequate sleep represents the most accessible and inclusive model of fitness. This is a simple and sustainable approach; which can be universal. In this context, fitness trainers occupy a role of profound importance, comparable in many ways to that of medical professionals demanding a high degree of knowledge, ethical integrity and accountability.
subject: Regular Issue Articles
  topic: section
subject: Fitness
  topic: keywords
subject: Fitness Trainers
  topic: keywords
subject: Personal Training
  topic: keywords
subject: Supplements
  topic: keywords
subject: Creatine
  topic: keywords
subject: Whey Protein Supplements
  topic: keywords
subject: Functional Training
  topic: keywords
creator: Mayur Moreker
creator: Krushna Waghmare
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Unraveling Emphysematous Gastritis: A Radiological Saga
type: item
description: Objective: Emphysematous gastritis is an uncommon but severe condition marked by the presence of intramural gas within the gastric wall, typically resulting from gas-forming bacterial infections. This study aims to analyse the radiological presentations and outcomes of three distinct cases to enhance diagnostic accuracy and guide management strategies. Methods: We performed a retrospective analysis of three patients diagnosed with emphysematous gastritis. Each case was evaluated using various imaging techniques including plain abdominal X-ray, and computed tomography (CT). The radiological findings were correlated with clinical outcomes and treatment approaches. Results: Radiological evaluations revealed distinctive patterns: (1) Plain X-rays in two patients demonstrated diffuse gas within the gastric wall. (2) CT scans provided detailed insights into the extent of intramural gas, identified associated complications such as pneumoperitoneum, and assessed the involvement of adjacent organs. Clinical management varied; one patient responded well to conservative treatment with antibiotics and supportive care, while the other two required surgical intervention due to complications including perforation and systemic infection. Conclusion: The imaging features of emphysematous gastritis are critical for early diagnosis and effective management. This case series highlights the utility of imaging modalities in evaluating the severity and extent of the disease, which can significantly influence treatment outcomes. Prompt and accurate radiological assessment is essential for optimizing patient care in this challenging condition.
subject: Regular Issue Articles
  topic: section
subject: Emphysematous Gastritis
  topic: keywords
subject: Computed Tomography
  topic: keywords
subject: Hepatic portal venous gas
  topic: keywords
subject: Pneumatosis Cystoides Intestinalis
  topic: keywords
subject: Pancreatitis
  topic: keywords
creator: Kishan Kumar
creator: Kartik Bhatt
creator: Tanuj Kumar
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Congenital Unilateral Choanal Atresia with Adenoid Hypertrophy: A Case Report
type: item
description: Congenital choanal atresia is a rare developmental anomaly characterized by failure of communication between the nasal cavity and nasopharynx. Bilateral choanal atresia usually presents in the neonatal period with respiratory distress, whereas unilateral choanal atresia often presents late because of subtle symptoms. We report the case of a 6-year-old female child presenting with unilateral nasal discharge since birth. Diagnostic nasal endoscopy and computed tomography (CT) of the paranasal sinuses confirmed left-sided congenital choanal atresia associated with adenoid hypertrophy and pan-sinusitis. The patient underwent endoscopic repair of choanal atresia using a posterior septal flap along with coblator-assisted adenoidectomy. Postoperative recovery was uneventful, and the patient is on regular follow-up.
subject: Regular Issue Articles
  topic: section
subject: choanal atresia
  topic: keywords
subject: pediatric skullbase surgery
  topic: keywords
subject: pedicled nasoseptal flap
  topic: keywords
creator: Dr. Toral Mehta
creator: Dr. Avni Patel
creator: Dr. Shruti Ganvit
creator: Dr. Vaishvi Hindia
creator: Jay Kothari
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

A Rare Case of Triple Pathogen Co-Infection with Rickettsia, Varicella Zoster Virus, and Plasmodium vivax Confirmed by PCR in an Immunocompetent Adult
type: item
description: A 33-year-old immunocompetent male presented with high-grade fever, generalized maculopapular rash, myalgia, and headache after returning from rural Southeast Asia. Investigation by PCR based Tropical Fever Panel confirmed co-infection with Varicella-Zoster Virus, Rickettsia spp., and Plasmodium malariae. Patient was treated for all three infection concurrently and showed improvement in his symptoms after which he was discharged. This case highlights the importance of considering multiple concurrent tropical infections in endemic regions even in patients with no comorbidities.
subject: Regular Issue Articles
  topic: section
subject: Endemic infections
  topic: keywords
subject: Monsoon related diseases
  topic: keywords
subject: Tropical fever
  topic: keywords
subject: pustular rash
  topic: keywords
creator: Dr Nitin Rathod Rathod
creator: Dr Andrea Janice FONSECA
creator: Dr Akshita Jain jain
creator: Dr Rajat Shende Shende
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Curious Case of Non-Healing A bdominal Wound
type: item
description: ABSTRACT Port-site complications following laparoscopic surgery are uncommon but can present diagnostic and therapeutic challenges. Among these, a persistent port-site sinus is a rare occurrence, often resulting from chronic infection, retained foreign material, or atypical organisms. Early recognition and appropriate management are essential to prevent prolonged morbidity. We report the case of a 33 year-old female who developed a chronic discharging sinus at the left lower port site following a laparoscopic myomectomy performed 1 year earlier. The patient presented with intermittent seropurulent discharge, local tenderness, and non-healing despite multiple courses of antibiotics. MRI imaging suggested Three sinus tracts are seen in the subcutaneous plane of the lower anterior abdominal wall on the left side in relation to the skin defects and in association with the cellulitis. Surgical exploration revealed three sinus tracts in left side of anterior abdominal wall is s/c plane. Histopathology showed chronic pyogenic sinus and NTM culture report confirms presence of NON TUBERCULOUS MYCOBACTERIA . The patient recovered uneventfully with complete healing at follow-up
subject: Regular Issue Articles
  topic: section
subject: Nontuberculous mycobacteria (NTM), Port-site infection, Laparoscopic surgery complications, Chronic discharging sinus, Non-healing abdominal wound
  topic: keywords
creator: Dr. Sanjay Chatterjee
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-01
publication date: 2026-05-01
starting page: 8
ending page: 10
doi: 10.15713/

Contemporary Advances in Acute Stroke Management: A FullyIntegrated Review
type: item
description: Background: Acute stroke care has evolved in a substantial manner over the past three decades. Advances in imaging-guided reperfusion, expansion of mechanical thrombectomy indications, refinement of thrombolytic agents, and structured post-reperfusion and in-hospital care have contributed to improved outcomes in both ischemic as well as hemorrhagic stroke. Objective: To bring together contemporary developments in acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) and to integrate global evidence with practical considerations relevant to Indian clinical settings. Methods: Narrative review of landmark trials from 1995-2026, major guideline updates with emphasis on applicability to routine clinical practice. Results: Stroke therapeutics have progressed from early intravenous alteplase within narrow time windows (2,3) to late-window reperfusion enabled by tissue-based imaging (4-6). Tenecteplase has emerged as a practical alternative to alteplase due to ease of administration and growing evidence supporting its safety and efficacy (15,16). Mechanical thrombectomy now benefits patients across early and late windows (18,24,25), including those with large- core infarction (12-14) and posterior-circulation stroke (26,27). Post-reperfusion care—including blood pressure optimisation, neurological monitoring, and prevention of secondary complications—plays a critical role in determining outcomes (31). ICH management has advanced with emphasis on controlled blood pressure reduction (45,46), targeted anticoagulation reversal (53-55), and minimally invasive surgical approaches (50- 52). Conclusion: Modern stroke care integrates tissue-based reperfusion strategies, evidence-based antithrombotic therapy, and structured supportive care. Adaptation to Indian health-care systems remains essential for equitable implementation. Timely intervention remains essential to prevent irreversible brain injury.
subject: Neurology Special Issue - Jan-Mar 2026
  topic: section
subject: Stroke; Ischemic Stroke; Thrombolytic Therapy; Mechanical Thrombectomy; Intracerebral Hemorrhage
  topic: keywords
subject: Neurology
  topic: subjects
creator: Sunetra D Phulsunge
creator: Rakesh Singh
creator: Rishikesh Joshi
creator: Samantha Kumar
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Scrolling away our intelligence - The smartphone generation’s cognitive challenge
type: item
description: As elders, it is the responsibility of educators to optimize screen exposure in schools and to takes steps to maximize the cognitive capacity and long-term flourishing of Gen Z and the generations beyond.
subject: Regular Issue Articles
  topic: section
subject: Gen Z
  topic: keywords
subject: Millennials
  topic: keywords
subject: Smart Phone use
  topic: keywords
subject: Digital De-tox
  topic: keywords
subject: One-to-one device programs
  topic: keywords
subject: Constant Connectivity
  topic: keywords
subject: Editorial
  topic: subjects
creator: Mayur Moreker
creator: Nidhi Tiwari
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-01
publication date: 2026-05-01
doi: 10.15713/

Floating thrombus- basilar artery occlusion
type: item
description: Aim The treatment of Basilar artery occlusion (BAO) with low NIHSS score requires to be individualized to each patient Background Basilar artery occlusion represents a small proportion of strokes worldwide but can have catastrophic presentations. Recent trials for BAO have studied the benefits of endovascular treatment (EVT) over intravenous thrombolysis (IVT) and have concluded that EVT has better mortality and morbidity outcomes. However, the management of BAO with lower NIHSS scores may become risky as the complications of the said treatment may outweigh the benefits. Case description We present a 54-year-old lady who presented with dizziness and hemiplegia which resolved within 1 hour. She had hypertension, mild left facial weakness and NIHSS score of 1 on presentation. MRI Brain revealed an acute focal left lateral medullary infarct, and angiogram showed a basilar artery thrombosis with distal basilar artery flow. She was started on dual antiplatelet therapy, low molecular weight heparin and statin. Cerebral DSA revealed a floating thrombus within the basilar artery and left vertebral artery V4 segment stenosis with normal flow in the distal basilar artery. As the patient had mild symptoms, she was discharged on oral anticoagulant and single antiplatelet therapy. She underwent stenting of the Vertebral artery V4 segment, 2 months later as she had recurrent posterior circulation transient ischemic attacks. Conclusion All basilar artery occlusions need not require immediate endovascular thrombectomy and may be managed conservatively initially with anti-coagulation and antiplatelet therapy.
subject: Neurology Special Issue - Jan-Mar 2026
  topic: section
subject: Basilar artery occlusion, thrombus, Thrombectomy
  topic: keywords
subject: Basilar artery occlusion, thrombus, Thrombectomy
  topic: subjects
creator: Samantha Kumar
creator: Dr Sunetra D Phulsunge
creator: Dr Vibhor Pardasani
creator: Rakesh Singh
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Not All That Looks Like ALS Is ALS: Spectrum of Amyotrophic Lateral Sclerosis Mimics at a Tertiary Neuromuscular Center
type: item
description: Abstract Background: Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disorder diagnosed clinically in the absence of a definitive biomarker. Several neuromuscular and structural disorders can closely mimic ALS, leading to diagnostic errors with significant prognostic and therapeutic implications. Objective: To analyze the spectrum, clinical characteristics, and key predictors of ALS mimic disorders among patients referred with suspected ALS at a tertiary neuromuscular center. Methods: This retrospective observational study reviewed approximately 500 patients referred with a provisional diagnosis of ALS between January 2021 and December 2025. Clinical data, electrophysiology, neuroimaging, and relevant laboratory investigations were analyzed. Fifty-one patients with confirmed ALS mimic diagnoses and complete clinical data were included. Comparative analyses with published ALS epidemiologic parameters were performed using Student’s t-test and chi-square/Fisher’s exact tests. Multivariate logistic regression was used to identify predictors of ALS mimic diagnosis. Results: The most frequent ALS mimics were Hirayama disease (29.4%), post-polio syndrome (23.5%), and adult-onset spinal muscular atrophy (23.5%). Patients with ALS mimics were significantly younger at symptom onset than reported ALS cohorts (19.1 ± 3.6 vs 58.7 ± 11.3 years; p <0.001). Bulbar onset was absent in the mimic cohort (p <0.001). Conduction block on electrophysiology and structural spinal abnormalities on MRI were significantly associated with mimic diagnoses. Multivariate analysis identified age <40 years, absence of bulbar onset, conduction block, and MRI structural abnormalities as independent predictors of ALS mimic disorders. Conclusion: ALS mimics represent a substantial proportion of patients referred with suspected motor neuron disease. Recognition of clinical red flags, careful electrophysiological interpretation, and routine spinal imaging are essential to avoid misdiagno…
subject: Neurology Special Issue - Jan-Mar 2026
  topic: section
subject: Amyotrophic lateral sclerosis, ALS mimics, misdiagnosis, motor neuron disease
  topic: keywords
creator: Jharna Mahajan
creator: Satish Khadilkar
creator: Shamisha Khade
creator: Ankur Bhoot
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Antibody-Negative but Not Immune-Negative: Seronegative Autoimmune Encephalitis Presenting as NORSE
type: item
description: Abstract Background: New-onset refractory status epilepticus (NORSE) is a rare neurological emergency characterized by prolonged seizures without prior epilepsy or clear acute structural cause. Autoimmune encephalitis is increasingly recognized as an important etiology. Case Presentation: We report a 28-year-old previously healthy male who presented with acute febrile illness followed by focal seizures rapidly progressing to refractory status epilepticus. Neuroimaging revealed bilateral basal ganglia and mesial temporal involvement. Extensive infectious and autoimmune workup was negative. Despite escalation of antiseizure medications and anaesthetic agents, seizures remained refractory, necessitating immunotherapy with intravenous immunoglobulin and rituximab, following which gradual neurological recovery was observed. Conclusion: This case highlights the importance of early recognition of NORSE and prompt initiation of immunomodulatory therapy in suspected autoimmune encephalitis, even in seronegative cases.
subject: Neurology Special Issue - Jan-Mar 2026
  topic: section
subject: NORSE, refractory status epilepticus, autoimmune encephalitis, seronegative, immunotherapy
  topic: keywords
subject: Seronegative Autoimmune Encephalitis , NORSE ,Immunotherapy
  topic: subjects
creator: Shamisha Khade
creator: Vibhor Pardasani
creator: Sunetra Phulsunge
creator: Rakesh Singh
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Incidentally detected aortic coarctation during evaluation of newly diagnosed hypertension in a young adult
type: item
description: Coarctation of the aorta is a congenital condition that may remain clinically silent until adulthood. We report the case of a 20-year-old male who presented with headache and was found to have newly diagnosed hypertension on routine examination. Further evaluation for secondary causes of hypertension incidentally revealed a previously undiagnosed aortic coarctation. This case highlights the importance of systematic evaluation of young patients with hypertension and reinforces the need to consider congenital cardiovascular anomalies even in the absence of classical clinical signs.
subject: Regular Issue Articles
  topic: section
creator: Dr Aniket Nitnavare
creator: Anil Sharma
creator: Somesh Nagre
creator: Aniruddh Wadivkar
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

A CASE REPORT BEYOND THE SCAR: DIAGNOSTIC COMPLEXITY IN A CASE OF POST-HYSTERECTOMY VAULT ENDOMETRIOSIS: A CASE REPORT
type: item
description: ABSTRACT Background: Vault endometriosis is a rare cause of post-hysterectomy vaginal bleeding and often presents years after surgery, posing a diagnostic challenge. Case Presentation: A 50-year-old woman with a history of total laparoscopic hysterectomy with bilateral salpingectomy (TLH+BS) presented with brownish per vaginum spotting. Ultrasonography revealed a small vascular lesion at the vaginal vault. Laparoscopic excision of the vault nodule was performed. Histopathology confirmed vault endometriosis. Postoperatively, the patient was treated with a gonadotropin-releasing hormone (GnRH) agonist, with complete resolution of symptoms. Conclusion: Vault endometriosis, though rare, should be considered in women presenting with post-hysterectomy vaginal bleeding. Laparoscopic excision with adjunctive hormonal therapy provides excellent outcomes. Keywords: Vault endometriosis, Post-hysterectomy bleeding, Vaginal vault, Laparoscopy, GnRH agonist
subject: Regular Issue Articles
  topic: section
subject: Vault endometriosis
  topic: keywords
subject: Post-hysterectomy bleeding
  topic: keywords
subject: Vaginal vault
  topic: keywords
subject: Laparoscopy
  topic: keywords
subject: GnRH agonist
  topic: keywords
creator: Apurva Anand Modak
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-01
publication date: 2026-05-01
doi: 10.15713/

case report Echoes of the Present : Experiential and Autonomic Auras in Temporal Lobe Epilepsy
type: item
description: Experiential auras such as déjà vu and jamais vu are distinctive manifestations of temporal lobe epilepsy. We report a young adult presenting with recurrent episodes of altered familiarity perception associated with unilateral piloerection. This case highlights the neurobiological basis of novelty–familiarity circuits and their disruption in focal epilepsy, and underscores the diagnostic value of experiential and autonomic auras.
subject: Neurology Special Issue - Jan-Mar 2026
  topic: section
subject: De ja vu
  topic: keywords
subject: Temporal lobe epilepsy
  topic: keywords
subject: aura
  topic: keywords
creator: Shamisha Khade
creator: Dr.Satish Khadilkar
creator: Dr.Jharna Mahajan(Bhanushali)
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Retrospective Analysis of Ureteric Injury During Ureteroscopy (URS) Versus Retrograde Intrarenal Surgery (RIRS) Over a Three-Year Period
type: item
description: Background Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are widely used minimally invasive procedures for urolithiasis. Ureteric injury remains a significant complication with potential long-term morbidity. Objective To compare the incidence and severity of ureteric injury during URS and RIRS over a three-year period. Materials and Methods A retrospective analysis of 400 patients undergoing endourological stone surgery was performed. Two hundred patients each underwent URS and RIRS. Ureteric injuries were graded intraoperatively and postoperatively as: Grade 1—superficial mucosal abrasion; Grade 2—mucosal injury; Grade 3—partial disruption; Grade 4—total avulsion. Statistical analysis was performed using the Chi-square test. Results Ureteric injury occurred in 30 patients (15%) in the URS group and 10 patients (5%) in the RIRS group (p = 0.0015). Low-grade injuries (Grade 1–2) constituted the majority in both groups. Severe injuries (Grade 3–4) were significantly more common in the URS group (26.7% vs 10%). No Grade 4 injury was observed in the RIRS group. Conclusion URS is associated with a significantly higher incidence and severity of ureteric injury compared to RIRS. RIRS appears to be a safer modality with respect to ureteric integrity. Keywords: Endourology, RIRS, ureteroscopy, ureteric injury
subject: Regular Issue Articles
  topic: section
subject: Endourology
  topic: keywords
subject: RIRS
  topic: keywords
subject: Ureteroscopy
  topic: keywords
subject: Ureteric Injury
  topic: keywords
creator: Prashant Pattnaik
creator: Yashraj Sapkal
creator: Dhaval Gosalia
creator: Sameer Deshmukh
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-01
publication date: 2026-05-01
doi: 10.15713/

Case Report Manubriosternal Osteomyelitis – Rare Cause of Acute Onset Chest Pain
type: item
description: The aim of this case report is to establish the role of radiology in diagnosing manubriosternal osteomyelitis – a rare cause of acute onset chest pain that is difficult to diagnose clinically and, most of the time, misdiagnosed as angina. Early diagnosis and timely management are clinically important to avoid fatal complications in the later stages of the disease.
subject: Regular Issue Articles
  topic: section
subject: Angina, Manubriosternal osteomyelitis, Steroids
  topic: keywords
creator: Gupta Aashutosh Arunkumar
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-02-09
publication date: 2026-02-09
doi: 10.15713/ins.bhj.181

REVIEW OF LITERATURE Comprehensive Physical and Systemic Examination in Neurological Disorders
type: item
description: Introduction: A comprehensive general physical and systemic examination is fundamental in evaluating patients with neurological disorders. It helps not only in localizing neurological dysfunction but also in identifying systemic conditions, such as diabetes, hypertension, and infections, that may contribute to or mimic neurological symptoms. A thorough examination is crucial for accurate diagnosis and effective management. Key components of the physical examination: This includes an assessment of the patient’s general appearance, vital signs, head and neck, cardiovascular, respiratory, musculoskeletal, gastrointestinal and dermatological systems. Each of these aspects can reveal significant clinical findings, ranging from facial expressions and posture indicative of specific neurological disorders to skin manifestations and cardiovascular irregularities that provide clues for underlying conditions. The systemic examination’s depth depends on the patient’s history, yet a complete assessment is crucial for uncovering unexpected findings and ensuring accurate diagnosis and management of neurological conditions. Conclusion: By incorporating both targeted neurological and broader systemic assessments, this approach facilitates the holistic evaluation of patients helping in optimizing treatment strategies for neurological disorders
subject: Regular Issue Articles
  topic: section
subject: Amyotrophic lateral sclerosis, Mucopolysaccharidosis, Transient ischemic attack, Arteriovenous malformation
  topic: keywords
creator: Neekesh Baweja
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-01-23
publication date: 2026-01-23
doi: 10.15713/ins.bhj.178

Original Article Exploring the Efficacy of Telmisartan and Cilnidipine Combination Therapy in Hypertension: A Cross-sectional Analysis
type: item
description: Introduction: Hypertension is a common non-communicable disease and is of major public health concern accounting for 19% of all deaths globally. The lack of awareness about hypertension is a major contributory factor for the delayed diagnosis of asymptomatic cases, thus being labeled as a “silent killer disease.” Effective control of blood pressure is a must and for achieving it, a long-acting antihypertensive agent is required. Telmisartan is one of the angiotensin II receptor blockers whereas cilnidipine is a novel calcium antagonist. Cilnidipine has shown prolonged and desirable antihypertensive effects. The present questionnaire-based study conducted on various clinicians across different parts of the country analyses the pattern of patients with hypertension and other comorbidities in their clinical practice along with the trend in the prescription of antihypertensives either mono and/or combination therapy. Materials and Methods: The present study is a questionnairebased cross-sectional study consisting of 25 validated structured questions. The study was approved by the Institutional Ethical Committee. All the completed forms were included in the study whereas incomplete form was excluded from the study. Observation and Results: The survey reflects that 87% of the patients have diabetes mellitus as one of the most common comorbid conditions associated with hypertension. About 86.5% of the clinicians (86.5%) are of the opinion that more than 30% of the patients required combination therapy of telmisartan and cilnidipine with the addition of diuretics in uncontrolled hypertension. The combination also offers many other benefits such as its anti-atherosclerotic properties and endorgan protection. Conclusion: The study highlights that combination therapy is very effective in treating hypertension even if associated with other comorbid conditions such as diabetes and chronic kidney disease.
subject: Regular Issue Articles
  topic: section
subject: Cilnidipine, Combination therapy, Diuretics, Hypertension, Telmisartan
  topic: keywords
creator: Rajwanth Pratap Mathur
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-01-23
publication date: 2026-01-23
doi: 10.15713/ins.bhj.175

Surviving Twin In A Bicornuate Uterus with Horn Specific IUFD and Transfusion incompatibility : A Case Report
type: item
description: Abstract Twin pregnancy in a bicornuate uterus is rare and associated with significant obstetric risk. We report a 25-year-old G2A1 woman with a DCDA twin pregnancy complicated by pregnancy-induced hypertension, prior cervical cerclage, and horn-specific intrauterine fetal demise at 34+6 weeks. The demised twin was located in the smaller uterine horn, while the surviving twin occupied the dominant horn. Management was further complicated by transfusion incompatibility due to a prior blood transfusion. Emergency caesarean section resulted in delivery of a healthy neonate. This case highlights the importance of anatomy-driven decision-making and anticipation of transfusion challenges in complex twin pregnancies. Introduction Congenital uterine anomalies result from abnormal Müllerian duct development and are associated with adverse reproductive outcomes. A bicornuate uterus, characterized by incomplete fusion of the Müllerian ducts, accounts for a small proportion of these anomalies and is associated with miscarriage, preterm birth, malpresentation, and placental abnormalities. Twin pregnancy in a bicornuate uterus is rare, and implantation of each twin in a separate horn further complicates management. The occurrence of horn-specific intrauterine fetal demise (IUFD) poses additional maternal and fetal risks, particularly in the third trimester. Management is further challenged when transfusion incompatibility is encountered due to red cell alloimmunization. There are no standardized guidelines for such scenarios, and clinical decisions must be individualized. We present a rare case highlighting anatomy-driven management and multidisciplinary preparedness. Case Presentation A 25-year-old woman, gravida 2 abortion 1, presented at 34+6 weeks of gestation with complaints of lower abdominal pain for 24 hours. She had a known bicornuate uterus and a spontaneously conceived DCDA twin pregnancy. Her obstetric history was significant for a first-trimester spontaneous abortion…
subject: Regular Issue Articles
  topic: section
subject: Bicornuate Uterus
  topic: keywords
subject: Mullerian Anomalies
  topic: keywords
subject: DCDA Twins
  topic: keywords
subject: IUFD
  topic: keywords
creator: DR. SHILPA AMBEKAR
creator: SONIKA
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Case Report The Case of a Melting Face: Parry–Romberg Syndrome
type: item
description: Background: Parry–Romberg syndrome (PRS), or progressive hemifacial atrophy, is a rare acquired disorder characterized by unilateral facial tissue loss of uncertain etiology. It is often associated with neurological, ocular, dental, and autoimmune manifestations. Case Report: We report a 38-year-old woman with 12–13 years of progressive right-sided facial atrophy associated with enophthalmos and hypothyroidism. Clinical examination showed marked hemifacial atrophy involving skin, soft tissue, and jaw with no neurological deficits. Conclusion: This case highlights the classical presentation of PRS with ocular involvement and autoimmune association. Early recognition and multidisciplinary management are essential to optimize functional and cosmetic outcomes. Keywords: Parry–Romberg syndrome, progressive hemifacial atrophy, enophthalmos, hypothyroidism, autoimmune
subject: Neurology Special Issue - Jan-Mar 2026
  topic: section
creator: Dr.Shamisha Khade
creator: Dr.Jharna Mahajan(Bhanushali)
creator: Dr.Satish Khadilkar
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-07-31
publication date: 2026-07-31
doi: 10.15713/

Editorial Artificial Intelligence in Healthcare: Balancing Technological Innovation with Clinical Judgment
type: item
description: Artificial Intelligence in it's current form is a good tool; but remains, at present only an assistant - the final responsibility always lies with the licensed medical practitioner which is the clinician.
subject: Regular Issue Articles
  topic: section
subject: Artificial Intelligence
  topic: keywords
subject: Healthcare
  topic: keywords
subject: Clinical Judgment
  topic: keywords
creator: Mayur Moreker
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-05-01
publication date: 2026-05-01
doi: 10.15713/

progressive lower limb paraplegia in pregnancy -An vertebral haemangioma - A case report
type: item
description: We present a rare case of spinal cord haemangioma in a pregnancy at 38 weeks of gestation, managed with multidisciplinary approach. The patient presented with back pain and neurological symptoms, diagnosed via MRI. Successful management involve close monitoring, pain control, and planned delivery. This case highlights the importance of prompt diagnosis and collaborative care in ensuring optimal outcome for both mother and baby.
subject: Regular Issue Articles
  topic: section
creator: Reena kumari
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-02-09
publication date: 2026-02-09

Original article Radial SNAP- Optimal site of stimulation in healthy Indian subjects
type: item
description: Abstract Background: The radial sensory nerve action potential (SNAP) is an important electrodiagnostic study of the upper limbs for a large variety of conditions. Inappropriate distance of stimulation and unavailability of reference data can lead to erroneous conclusions. Objectives: To establish the optimal site of recording the Radial SNAP and obtain reference data for radial SNAP in age-stratified healthy subjects. Materials and Methods: A prospective study was conducted in 181 nerves from healthy subjects aged between 18 years and 86 years, stratified into five groups as per age: a = 18-30 years, b = 31-40 years, c = 41-50 years, d = 51-60 years, e > 61 years. Radial SNAP was recorded antidromically, stimulating at 10 cm from the recording electrode. Mean – 2 standard deviation (SD) of the transformed data was used to generate reference values for amplitudes. Results: The lower limits of amplitude at 10 cm were 28.8, 30.4, 24.4, 23.7 and 16.2 mV for groups a, b, c, d and e, respectively and at 12 cm were 25, 29.2, 18.9, 17.9 and 14.5 mV respectively. A statistically significant difference in amplitudes was noted from the three different sites of stimulation (P < 0.001). A 17% variation in amplitude is explained by age. Height, BMI and wrist girth had minimal effect on the amplitude obtained (r2= 0.05, 0.01, 0.00) Conclusion: This study provides age stratified reference data for antidromic Radial SNAP in Indian population and also gives the optimal site of stimulation of the SNAP.
subject: Regular Issue Articles
  topic: section
creator: Alika Sharma
rights: Copyright (c) 2026 Bombay Hospital Journal https://creativecommons.org/licenses/by-nc-sa/4.0
date: 2026-02-09
publication date: 2026-02-09
doi: 10.15713/ins.bhj.186