Neurology India
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Item Giant hemispheric multiloculated brain abscess.(2009-01-24) Liu, Wen-Ke; Ma, Lu; Mao, Bo-YongItem Cavernous sinus thrombophlebitis causing reversible narrowing of internal carotid artery.(2009-01-24) Madhusudhan, K S; Kandpal, Harsh; Ahuja, JiteshItem Brain abscess in a non-penetrating traumatic intracerebral hematoma: case report and review of literature.(2009-01-24) Thomas, Santhosh George; Moorthy, Ranjith K; Rajshekhar, VedantamWe report a 57-year-old man who presented one month after sustaining a traumatic right temporal intracerebral hematoma with history of headache, left hemiparesis and altered sensorium of two days duration. A diagnosis of right temporal resolving hematoma was made on computed tomography scan. However, his sensorium progressively deteriorated and he underwent craniotomy and partial excision of an abscess. He was treated with appropriate antibiotics for six weeks despite of which he did not improve and died nine months later. We conclude that there should be a high index of suspicion for brain abscess in patients with traumatic intracerebral hemorrhage if the clinical and radiological picture is different from the expected course of a resolving hematoma.Item D-dimer is useful in the diagnosis of cortical venous sinus thrombosis.(2009-01-24) Misra, Usha K; Kalita, Jayantee; Bansal, VikasBACKGROUND: Estimations of D-dimer correlate with deep vein thrombosis and pulmonary thromboembolism and may serve as a marker of cortical venous sinus thrombosis (CVST). AIM: To study the usefulness of D-dimer in the diagnosis of CVST. MATERIALS AND METHODS: A total of 26 patients with CVST were subjected to a detailed medical history and neurological evaluation. A cranial MRI was carried out on a 1.5T scanner using T1, T2, and DWI sequences and two-dimensional time of flight MR venography. D-dimer was estimated using a rapid latex agglutination slide test using monoclonal antibodies. RESULTS: The age of patients ranged between 16 and 70 years old (median 31 years old); 8 were males and were examined after a mean duration of 22 days of symptoms. Cortical venous thrombosis was attributed to puerperium in 4 patients, infection in 5 patients, and pregnancy, dehydration, insect bite, and migraine in 1 patient each. Superior sagittal sinus was involved in 15 patients, transverse sinus in 16 patients, straight sinus in 3 patients, sigmoid sinus in 7 patients, and cavernous and deep system in 1 patient each. A total of 12 patients had more than one sinus involvement. D-dimer was positive in 20 patients and correlated with the duration of symptoms but not with the extent of sinus thrombosis and the outcome. CONCLUSION: D-dimer is useful in patients suspected of CVST and patients with positive test results should be urgently sent for MR imaging.Item Epilepsy surgery in India.(2009-01-24) Radhakrishnan, KurupathThis review traces the evolution of epilepsy surgery in India from the beginning to the present state. During the last one and half decades, surgical treatment of epilepsies has made resurgence in this country and at present a few centers have very active and sustained epilepsy surgery programs. Within a 14-year period, the R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Trivandrum, has undertaken over 1000 epilepsy surgeries. However, in the whole country, annually, not more than 200 epilepsy surgeries are currently being performed. This number is a miniscule when compared to the number of potential surgical candidates among the vast population of India. The enormous surgical treatment gap can only be minimized by developing many more epilepsy surgery centers in different parts of our country.Item C1 and C2 nerve sheath tumors: analysis of 32 cases.(2009-01-24) Maurya, Parmatma; Singh, Kulwant; Sharma, VivekBACKGROUND: C1 and C2 nerve sheath tumors are to be considered as a separate clinical entity because of their unique clinical presentation, relation to the adjacent structures and surgical approaches when compared to their counterparts in other regions. Aim: To present the clinical characteristics, radiological findings, operative approaches, and outcomes. Setting and Design: Of the 32 patients, the study was retrospective in 22 patients and in 10 it was prospective. MATERIALS AND METHODS: Patients' case records were analyzed. Diagnosis was established by magnetic resonance imaging of craniovertebral junction. Patients were evaluated by Yasargil grading and operative procedure was done accordingly. RESULTS: In this series the tumors were multiple and had extradural extension and hourglass expansion. Surgical results were excellent in most patients when procedure was done early in the course of the disease. Best results in terms of complete removal and good neurological outcome were achieved with posterior or posterolaterlly located lesion. Of the 20 patients who had surgery by posterior approach, 19 (95%) patients had improvement postoperatively, while one (5%) patient remained unchanged. While of the 8 patients who had surgery by posterolateral approach, 6 (75%) had improvement postoperatively, one had no change and the other had neurological deterioration. CONCLUSION: C 1 and C 2 nerve sheath tumors are to be considered as a separate clinical entity. Operative results and recovery of patients are excellent when tumor is located posterior or posterolaterally and surgical procedure is done early in the disease course.Item Persistent primitive hypoglossal artery associated with lower basilar artery aneurysm: diagnosis and clinical implications.(2009-01-24) Furtado, Sunil V; Reddy, Kalyan; Khandelwal, Nilesh; Hegde, A SAn elderly male was evaluated for subarachnoid hemorrhage and found to have a persistent primitive hypoglossal artery with its associated abnormal posterior fossa circulation and a lower basilar artery aneurysm. Angiography findings are described and are corroborated with computed tomography and magnetic resonance imaging. Its surgical and clinical relevance are discussed.Item Extradural thoracic spinal meningioma.(2009-01-24) Santiago, Bruno M; Rodeia, Paula; Cunha E Sa, ManuelItem Variation in the origin of the posterior cerebral artery in adult Sri Lankans.(2009-01-24) De Silva, K R D; Silva, T R N; Gunasekera, W S L; Jayesekera, R WBACKGROUND: The degree of contribution from the vertebro-basilar and carotid systems to the origin of the posterior cerebral artery (PCA) is of clinico-anatomical importance. Three configurations in the bifurcation of the posterior communicating artery (PcomA) have been described, foetal, transitional and adult. OBJECTIVE: To examine the extent of contribution from the vertebro-basilar and carotid systems to the origin of the PCA in adult autopsy brains in subjects who had died of causes unrelated to the brain. MATERIALS AND METHODS: The external diameter of the PcomA, pre communicating part (P1) and the post communicating part (P2) of PCA in 225 normal Sri Lankan adult cadaver brains was measured using a calibrated grid. Results: The adult configuration was present in 220 (93.3%); (bilaterally in 200 (88.8%), and unilaterally in 20 (8.8%) ten on each side. Foetal configuration was seen in 17 (4.4%); bilaterally in 3 (1.3%), and unilaterally in 14 (6%) 8 on the left and 6 on the right. Transitional configuration was seen in 8 (2.2%); bilaterally in 2 (0.9%), and unilaterally in 6 (2.5%) 2 on the left and 4 on the right. CONCLUSION: This study reveals that the internal carotid artery (ICA) provided the major supply to the PCA in 4.4% of foetal and 2.2% of transitional configurations. The adult configuration was present in 220 (93.3%), the highest recorded in the literature. This finding may be of relevance to vertebrobasilar ischaemia and infarcts in the territory of the PCA.Item Metastatic adenocarcinoma of bilateral cavernous sinus and optic nerve with unknown primary mimicking orbital pseudotumor.(2009-01-24) Kumar, Rajiv; Deopujari, C E; Shah, Rajan; Kumar, AshishBilateral cavernous sinus and optic nerve metastases is extremely rare. We report an extremely rare case of metastatic adenocarcinoma of bilateral cavernous sinus and optic nerve with unknown primary presenting as orbital pseudotumor. She underwent bilateral optic nerve decompression and the diagnosis was established by biopsy.Item Remission of concomitant Henoch-Schöenlein purpura and Sydenham chorea after intravenous corticosteroids.(2009-01-24) Zúñiga, Carlos; Díaz, Sergio; Fariña, Angeles; Micheli, FedericoWe report a young girl who developed Henoch-Schoenlein purpura at the age of 11 years. Two weeks later she developed severe asymmetric choreic movements and behavioral disturbances. Sydenham s chorea was diagnosed based on the laboratory evidence and she was given intravenous methylprednisolone for five consecutive days. Both behavioral and movement disorder rapidly resolved. She was asymptomatic at three years of follow-up. The rapid resolution of choreic movements and behavioral disturbances in our patients suggests, intravenous corticosteroids may be an option in the treatment of Sydenham's chorea, more so when the movements are disabling.Item Cerebral venous thrombosis due to homozygous factor V Leiden mutation.(2009-01-24) Aaron, S; Alexander, M; Thomas, M; George, B; Mammen, JItem Blister aneurysms.(2009-01-24) Jha, Ajaya Nand; Gupta, VipulItem Spinal epidural cavernous hemangioma with myelopathy: a rare lesion.(2009-01-24) Satpathy, D K; Das, S; Das, B SA case of pure epidural cavernous angioma involving the dorsal region of the spine is presented. The clinical picture was of a slowly progressive compressive myelopathy. Imaging studies only showed a dorsally located epidural mass lesion. Histology confirmed the diagnosis of this rare type of lesion. The patient improved after excision of the lesion.Item Primary stenting in acute carotid dissection.(2009-01-24) Maramattom, Boby VarkeyItem Olfactory ensheathing cell tumor.(2009-01-24) Ippili, Kaushal; Ratnam, Boola G; Gowrishankar, Swarnalata; Ranjan, Alok; Lath, RahulOlfactory ensheathing cells (OECs) are found in the olfactory bulb and olfactory nasal mucosa. They resemble Schwann cells on light and electron microscopy, however, immunohistochemical staining can distinguish between the two. There are less than 30 cases of olfactory groove schwannomas reported in the literature while there is only one reported case of OEC tumor. We report an OEC tumor in a 42-year-old male and discuss the pathology and origin of this rare tumor.Item Prosopagnosia: a rare presenting manifestation of frontotemporal lobar degeneration.(2009-01-24) George, Arun; Jose, JamesFrontotemporal dementia is an important neurodegenerative disorder accounting for a significant proportion of dementia cases with onset before 60 years of age. Apart from the well recognized behavioral changes the disease has many other distinctive features like predominant language involvement alone or associated features of motor neuron disease or parkinsonism etc. which at times may be the presenting manifestation itself. In the following article we describe a rare presenting manifestation; prosopagnosia, in the setting of frontotemporal degeneration.Item Uncommon presentation of giant cell arteritis: report of two cases with scalp necrosis.(2009-01-24) Mucke, Thomas; Kesting, Marco R; Holzle, Frank; Wolff, Klaus-DietrichGiant cell arteritis (GCA), the most common form of systemic granulomatous vasculitis in adults, preferentially involves large and medium-sized arteries. Scalp necrosis is a rare complication and can be the presenting feature. This report presents two patients of GCA with severe scalp necrosis as the presenting symptoms. Both the patients were treated successfully with selective debridement, local wound care, antimicrobial and systemic steroid treatment. Skin necrosis is a potentially treatable complication of GCA and needs a multidisciplinary approach.Item Multiple extracranial metastases from intradiploic meningioma.(2009-01-24) Sujit Kumar, G Samson; Chacko, Geeta; Chacko, Ari G; Haran, R PItem Ruptured and unruptured aneurysms of the accessory anterior cerebral artery combined with a blood blister-like aneurysm of the anterior communicating artery.(2009-01-24) Seo, Dae-Hee; Lee, Won-Cheol; Choe, Il-Seung; Park, Sung-Choon; Ha, Young-SooAnterior communicating artery (Acom) complex and anterior cerebral artery (ACA) are the frequent sites of arterial anomalies. Aneurysms associated with triplicate ACA are rare. Blood blister-like aneurysm (BBA) of the Acom is also very rare. This report presents these two rare types of aneurysms in a 63-year old man who presented with subarchnoid hemorrhage secondary to accessory ACA aneurysmal rupture. During surgery, a BBA of the Acom was also found. Both the aneurysms were treated simultaneously. The BBA bled intraprocedurally but was repaired successfully by neck reconstruction and clipping with the preservation of the parent and the branching arteries. The ruptured accessory ACA aneurysm was clipped together with the artery which had multiple aneurysms distally. For the treatment of a complex aneurysm like this, accurate understanding of the anatomic variations, proper imaging study and extremely careful technique are essential.