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   2009| July-August  | Volume 57 | Issue 4  
    Online since September 10, 2009

 
 
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INDIAN PERSPECTIVE
Management of hydrocephalus in patients with tuberculous meningitis
Vedantam Rajshekhar
July-August 2009, 57(4):368-374
DOI:10.4103/0028-3886.55572  PMID:19770534
Hydrocephalus is one of the commonest complications of tuberculous meningitis (TBM) occurring in up to 85% of children with the disease. It is more severe in children than in adults. It could be either of the communicating type or the obstructive type with the former being more frequently seen. The Vellore grading system for clinical grading of patients with TBM and hydrocephalus with grade I being the best grade and grade IV being the worst grade has been validated by several authors. The management of hydrocephalus can include medical therapy with dehydrating agents and steroids for patients in good grades and those with communicating hydrocephalus. However, surgery is required for patients with obstructive hydrocephalus and those in poor grades. Surgery can involve either a ventriculo-peritoneal shunt or endoscopic third ventriculostomy (ETV). Complications of shunt surgery in patients with TBM and hydrocephalus are high with frequent shunt obstructions and shunt infections requiring repeated revisions. ETV has variable success in these patients and is generally not advisable in patients in the acute stages of the disease. Mortality on long-term follow up has been reported to vary from 10.5% to 57.1% in those with altered sensorium prior to surgery and 0 to 12.5% in patients with normal sensorium. Surgery for patients in Vellore grade IV is usually associated with a poor outcome and high mortality and therefore, its utility in these patients is debatable
  31,726 1,747 59
ORIGINAL ARTICLES
Spectrum of mutations in sarcoglycan genes in the Mumbai region of western India: High prevalence of 525del T
Satish V Khadilkar, Rakesh K Singh, Madhuri Hegde, Andoni Urtizberea, Don R Love, Belinda Chong
July-August 2009, 57(4):406-410
DOI:10.4103/0028-3886.55603  PMID:19770540
Background : While the clinical and immunocytochemical features of sarcoglycanopathies have been reported from India, genetic aspects have not been studied. There is large variation in the sarcoglycan mutations among the studied populations. Aim : To study the spectrum of mutations in sarcoglycan genes (SG). Materials and Methods : Patients fulfilling Bushby's criteria for limb girdle muscular dystrophy were prospectively analyzed. Patients gave their medical history and underwent a clinical examination, serum creatine kinase estimation, electrophysiology, muscle biopsy with immunostaining for alpha, beta, gamma, and delta subunits and mutational analysis using denaturing high pressure liquid chromatography and direct sequencing. Results : Mutations in SG accounted for 26.4% of the cohort of limb girdle muscular dystrophy. The mean age of these 18 patients was 22.5 years. Generally, proximal weakness affected the flexor and adductor compartments of the lower and upper limbs. The clinical profile of various mutations was indistinguishable from each other. Gamma SG mutations were most common, seen in 8 patients, followed by delta SG mutation in 5 patients and alpha mutation in 4 patients, while only 1 patient had mutation in the beta sarcoglycan gene. The most prevalent mutation in the gamma SG gene was 525del T. This is of interest as the mutation has been known to exist only in specific populations. Conclusion : This study, the first mutational analysis of Indian patients with sarcoglycanopathies suggests gamma SG mutations were the most common and the most prevalent mutation in the gamma SG gene was 525del T.
  14,482 186 12
Etiological factors of traumatic peripheral nerve injuries
Filiz Eser, Lale Akbulut Aktekin, Hatice Bodur, Cigdem Atan
July-August 2009, 57(4):434-437
DOI:10.4103/0028-3886.55614  PMID:19770544
Background: Traumatic injury of peripheral nerves is a worldwide problem and can result in significant disability. Management of peripheral nerve injuries (PNIs) requires accurate localization and the assessment of severity of the lesion. Aim: The purpose of this study is to analyze the data of patients with PNIs referred for electromyography to a tertiary care hospital. Materials and Methods: This is a retrospective study of clinical and electromyographic data of patients with PNIs seen over a period of eight-years (1999-2007) in a tertiary hospital. The data collected included: Demographic data, cause, type of lesion, anatomical location of the lesion, and the mechanism of lesion. Results: During the study period 938 patients were seen with nerve injuries and the distribution of nerve injuries was: PNIs: 1,165; brachial plexus lesions: 76; and lumbar plexus lesions: 7. The mean age was 31.8 years (range 2-81 years) and the male to female ratio was 2.4:1. The most frequent nerve injuries were ulnar nerve in the upper extremity and sciatic nerve in the lower extremity. The most common cause of nerve injury was motor vehicle accidents. Two-thirds of the PNIs were partial. Conclusion: This study can serve as a guide to determine the epidemiology and classification of traumatic peripheral and plexus injuries.
  8,915 370 47
REVIEW ARTICLES
Management of the trigeminocardiac reflex: Facts and own experience
Belachew Arasho, Nora Sandu, Toma Spiriev, Hemanshu Prabhakar, Bernhard Schaller
July-August 2009, 57(4):375-380
DOI:10.4103/0028-3886.55577  PMID:19770535
The trigeminocardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hyper-motility during stimulation of any of the sensory branches of the trigeminal nerve. The proposed mechanism for the development of TCR is-the sensory nerve endings of the trigeminal nerve send neuronal signals via the Gasserian ganglion to the sensory nucleus of the trigeminal nerve, forming the afferent pathway of the reflex arc. It has been demonstrated that the TCR may occur with mechanical stimulation of all the branches of the trigeminal nerve anywhere along its course (central or peripheral). The reaction subsides with cessation of the stimulus. But, some patients may develop severe bradycardia, asystole, and arterial hypotension which require intervention. The risk factors already known to increase the incidence of TCR include: Hypercapnia; hypoxemia; light general anesthesia; age (more pronounced in children); the nature of the provoking stimulus (stimulus strength and duration); and drugs: Potent narcotic agents (sufentanil and alfentanil); beta-blockers; and calcium channel blockers. Because of the lack of full understanding of the TCR physiology, the current treatment options for patients with TCR include: (i) risk factor identification and modification; (ii) prophylactic measures; and (iii) administration of vagolytic agents or sympathomimetics.
  8,413 461 53
Restorative therapy in stroke using stem cells
MV Padma Srivastava
July-August 2009, 57(4):381-386
DOI:10.4103/0028-3886.55582  PMID:19770536
The nonregenerative capability of the injured adult brain has been challenged in recent years and neural plasticity has been observed experimentally in both global and focal brain ischemia in animal models. Whether neuro-genesis increases in response to brain lesions or stem cells can be used for transplantation are the potential questions to be answered. Functional recovery may occur in a small or a localized brain injury using rehabilitation measures, but for large ischemic strokes, the restoration may require new synaptic connections within and away from the damaged tissue. In an infarcted area, the ischemic core may not respond to any pharmacological or rehabilitative intervention. For these reasons, the prospects of repairing the neuron system, using cell transplantation seems promising and may offer a unique approach for brain repair and restoration of function. On going animal and human trials have greatly helped us to burgeon our hopes on this method of restorative therapy after stroke. The ultimate aim of any therapeutic strategy is the maximum restoration possible and eventual complete normalcy of function.
  7,790 861 4
EDITORIALS
Thymectomy in myasthenia gravis
JMK Murthy
July-August 2009, 57(4):363-365
DOI:10.4103/0028-3886.55567  PMID:19770532
  7,638 946 3
LETTERS TO EDITOR
Midbrain infarct presenting as isolated medial rectus palsy
Simerpreet Bal, Vivek Lal, Dheeraj Khurana, Sudesh Prabhakar
July-August 2009, 57(4):499-501
DOI:10.4103/0028-3886.55579  PMID:19770560
  6,897 243 3
Hypertrophic olivary degeneration: The forgotten triangle of Guillain and Mollaret
Naseer A Choh, Suhil A Choh, Maji Jehangir
July-August 2009, 57(4):507-509
DOI:10.4103/0028-3886.55587  PMID:19770565
  6,282 265 6
BRIEF REPORTS
Evaluation of nine children with reversible posterior encephalopathy syndrome
Faruk Incecik, M Ozlem Herguner, Sakir Altunbasak, Fatih Erbey, Goksel Leblebisatan
July-August 2009, 57(4):475-478
DOI:10.4103/0028-3886.55605  PMID:19770551
Background: Reversible posterior leukoencephalopathy syndrome (PRES) is a neurological disorder characterized by signs of posterior cerebral edema upon radiographic examination. Materials and Methods: We retrospectively analyzed the records of nine children with the diagnosis of PRES. Results: Of the nine patients, seven were receiving immunosuppressive therapy and two were acute hypertensive crisis associated with renal disease. Immunosupressive drugs were intrathecal methotrexate in two patients, cyclosporine in two patients, intrathecal cytarabine in one patient, cyclophasphamide in one patient, and intravenous immunoglobulin (IVIg) in another one patient. The most presenting symptoms were seizure, headache, and altered consciousness. Six patients had seizures. Altered consciousness was present in four patients. Headache and nausea or vomiting was present also in six patients. Visual abnormalities were noted in two patients. Magnetic resonance imaging (MRI) studies showed white-matter abnormalities suggestive of edema in the posterior regions of the cerebral hemispheres, but the changes often involved other cerebral areas, the brain stem, basal ganglia or the cerebellum. The patients were treated with antihypertensive medications, and immunosuppressive therapy was withdrawn. In all the patients, the clinical and radiological findings resolved morly completely. Conclusion: Reversible posterior leukoencephalopathy may develop in patients who have renal insufficiency or hypertension or who are immunosuppressed. This syndrome should be recognized immediately and trigger agents can be discontinued to prevent long-term sequelae.
  6,074 433 25
Rib head disarticulation for multilevel transpedicular thoracic corpectomies and expandable cage reconstruction
Dean Chou, Matthew Eltgroth, Isaac Yang, Daniel Lu, Geoff Manley
July-August 2009, 57(4):469-474
DOI:10.4103/0028-3886.55602  PMID:19770550
Traditional posterior approaches to the thoracic spine are done with either costo-transversectomy, lateral extracavitary approaches, or transpedicular approaches. The transpedicular approach is the only one that preserves the rib head. However, placing an expandable cage with this rib head intact poses special challenges because of the narrow corridor defined by the rib head and the spinal cord. Instead of removing the rib head, which requires pleural dissection and carries the risks of pleural injury, we disarticulate it and push it laterally during cage placement. This avoids pleural dissection and affords expandable cage placement through a transpedicular approach.
  5,246 222 9
CASE REPORTS
Acute ischemic infarct in the middle cerebral artery territory following a Russell's viper bite
Sanjeev K Narang, Srikanth Paleti, MA Azeez Asad, Tarannum Samina
July-August 2009, 57(4):479-480
DOI:10.4103/0028-3886.55594  PMID:19770552
Ischemic stroke following snake bite is rare. We report an 18-year male who developed right hemiplegia with expressive aphasia following a Russell's viper bite. T2-weighted magnetic resonance imaging revealed infarct in the left middle cerebral artery territory. The possible mechanisms for cerebral infarction in this scenario include disseminated intravascular coagulation, toxin induced vasculitis and endothelial damage.
  5,115 309 18
ORIGINAL ARTICLES
Expression of VEGF and neural repair after alprostadil treatment in a rat model of sciatic nerve crush injury
Jinrong Tang, Ye Hua, Jianhua Su, Ping Zhang, Xuejiang Zhu, Le Wu, Qi Niu, Hang Xiao, Xinsheng Ding
July-August 2009, 57(4):387-394
DOI:10.4103/0028-3886.55583  PMID:19770537
Background: Vasoactive drug alprostadil improves microcirculation and can be effective in treating disorders of peripheral nerves. Vascular endothelial growth factor (VEGF) has been shown to have protective action in cerebral ischemia, disorders of spinal cord, and also peripheral nerves. However, the mechanism of action of VEGF in peripheral nerve injuries is uncertain. Objectives: To study the effect of application of alprostadil on the pathological and functional repair of crush nerve injuries and also the expression of VEGF. Materials and Methods: Rat sciatic nerves were crushed by pincers to establish the model of crush injury. All of the 400 sprague dawley (SD) rats were randomly divided into: Control; saline; saline + VEGF-antibody; alprostadil; and alprostadil + VEGF antibody groups. The SPSS 11.5 software was used for statistical analysis. The expression of VEGF in dorsal root ganglia (DRGs), following crush injury to sciatic nerves, was studied by reverse transcribed-polymerase chain reaction (RT-PCR), immunohistochemistry, electromicroscope, and electrophysiology. The effects of alprostadil on expression of VEGF, repair of neural pathology, and recovery of neural function were also evaluated. Results: We found that VEGF messenger ribonucleic acid (mRNA) was significantly increased in alprostadil and alprostadil + VEGF-antibody groups, compared to the saline and saline + VEGF antibody groups. The number of VEGF-positive neurons was significantly increased in the alprostadil group, compared to the saline, saline + VEGF antibody, and alprostadil + VEGF antibody groups. Besides, addition of this drug also caused less pathological changes in DRGs, better improvement of nerve conduction velocities of sciatic nerves, and more increase of toe spaces of right hind limbs of rats. Conclusions: The vasoactive agent alprostadil may reduce the pathological lesion of peripheral nerves and improve the rehabilitation of the neural function, which may relate to upregulation of the expression of VEGF, following crush injury to the peripheral nerves.
  4,747 295 20
LETTERS TO EDITOR
Facial palsy caused by mumps parotitis
Faruk Incecik, M Ozlem Herguner, Sakir Altunbasak
July-August 2009, 57(4):511-512
DOI:10.4103/0028-3886.55589  PMID:19770567
  4,828 181 1
ORIGINAL ARTICLES
Assessment of microscope-integrated indocyanine green angiography during intracranial aneurysm surgery: A retrospective study of 120 patients
Jin Li, ZhiGang Lan, Min He, Chao You
July-August 2009, 57(4):453-459
DOI:10.4103/0028-3886.55607  PMID:19770547
Aims: The purpose of this study was to assess the clinical value of indocyanine green angiography (ICG) in intracranial aneurysm surgery by comparing the findings with postoperative angiographic results. Materials and Methods: One hundred and twenty patients with 148 intracranial aneurysms were included. ICG angiography was performed before and/or after the aneurysm clipping. A near-infrared excitation light illuminated the operation field, ICG was injected intravenously. The intravenous fluorescence was imaged with a video camera integrated into the microscope. Results: A total of 208 investigations of ICG angiography were performed. Aneurysm clipping was applied in 120 patients. Incomplete clipping was detected in four patients. Parent and/or branching artery stenosis was found in five patients. Delayed perfusion of ICG was detected in one patient. Postoperative digital subtraction angiography (DSA) was performed in 108 patients. The postoperative angiographic results were consistent with findings on intraoperative ICG angiograms in 100 patients (92.6%). In three cases, a mild stenosis was seen on DSA, which was not detected intraoperatively using ICG angiogram. In one patient, middle cerebral artery stenosis was found. Three patients had small residual aneurysms found by postoperative DSA. The remaining one developed a severe cerebral vasospasm. Conclusions: ICG angiography is a simple, reliable and cost-effective method. It provides real-time information in detecting the patency of parent, branching, perforating arteries and residual aneurysm. This technique may be a useful adjunct to improve the quality of intracranial aneurysm surgery.
  4,695 271 32
Fronto-temporo-orbitozygomatic craniotomy and "half-and-half" approach for basilar apex aneurysms
Sanjay Behari, Rupant K Das, Awadhesh K Jaiswal, Vijendra K Jain
July-August 2009, 57(4):438-446
DOI:10.4103/0028-3886.55609  PMID:19770545
Background: Basilar apex aneurysms (BAA) are located in interpeduncular cistern surrounded by eloquent neurovascular structures. Surgical access is difficult due to narrow surgical corridors and requires traversing through a depth of 6-8 cm of subarachnoid space. Aim: Surgical management of BAAs clipped using frontotemporal craniotomy, orbitozygomatic osteotomy with combined subtemporal and transylvian (half and half) approach is discussed. Setting and Design: Tertiary care referral institute; prospective study. Materials and Methods: Five patients with BAA rupture causing subarachnoid hemorrhage presented in modified Hunt and Hess (Hand H) grades II (n=1), III (n=1) and IV (n=3), respectively. In 4 patients, the aneurysms were 0.8-1.2 cm in diameter, situated 7 mm-1 cm above dorsum sellae. Two of them had posteriorly projecting aneurysms. One patient had a giant, high BAA with a left parietooccipital arteriovenous malformation. Vasospasm of posterior cerebral/proximal basilar artery was seen in 2 patients. In one patient, internal carotid artery was mobilized by intradural anterior clinoid drilling with carotid collar division. Triple-H therapy was administered following surgery. Results: There was no intraoperative rupture or temporary clipping. Follow up angiography showed complete aneurysmal obliteration with preservation of posterior cerebral and superior cerebellar arteries. Follow up (mean: 8.7 ± 3.5 months) H and H grades were II (n=2) and III (n=3), respectively. The morbidity include caudate and thalamic region infarct, transient III rd nerve palsy and cerebrospinal fluid otorrhoea (n=1, respectively). Conclusions: This simple approach provides a wide surgical corridor from 5 mm below to greater than 1 cm above dorsum sellae with adequate proximal control of basilar artery. It is an option to endovascular embolization especially with large and giant, or wide-necked BAA, vertebrobasilar tortuosity, coil compaction or postcoiling re-rupture and an associated large haematoma.
  4,476 412 4
LETTERS TO EDITOR
A single fatal dose of olanzapine
Shounak Majumder, Sanjay K Mandal, Gautam Guha, Dipanjan Bandyopadhyay, Subhasis Roy Chowdhury
July-August 2009, 57(4):497-497
DOI:10.4103/0028-3886.55569  PMID:19770559
  4,527 193 3
BRIEF REPORTS
Pyridoxine-dependent seizures: 10-year follow-up of eight cases
Roshan Koul
July-August 2009, 57(4):460-463
DOI:10.4103/0028-3886.55595  PMID:19770548
Eight children with pyridoxine-dependent seizures (PDS) were seen over a period of 10 years. Of those children, 6 are on regular follow-up. Four of the children were seen in one family. All the patients presented with refractory seizures, mainly neonatal status epilepticus. Though PDS is a rare condition, it must be considered in all cases with refractory seizures, particularly in childrens younger than 3 years. When confirming a diagnosis, oral pyridoxine is as effective as intravenous pyridoxine.
  4,249 315 2
ORIGINAL ARTICLES
Efficacy and safety of Mitoxantrone, as an initial therapy, in multiple sclerosis: Experience in an Indian tertiary care setting
BS Singhal, Sheth Geeta, Shilpa G Hundalani, Suresh Menon
July-August 2009, 57(4):418-423
DOI:10.4103/0028-3886.55611  PMID:19770542
Background and Purpose : Mitoxantrone is an approved disease modifying agent for treatment of multiple sclerosis (MS). The aim of the study was to assess its efficacy and safety in Indian MS patients. Materials and Methods : A total of 23 patients with clinically definite MS (Poser criteria) were enrolled in an open label study. Of which, 21 satisfied the McDonald's criteria for MS and two satisfied the diagnostic criteria of neuromyelitis optica (NMO). The numbers of relapses and expanded disability status scale (EDSS) score were used as primary and secondary outcome measures. The patients were monitored for the adverse effects. Results : In 17 (15 MS and two NMO) patients who completed one year of therapy, there was significant difference in the mean annual relapse rates [before 0.879±0.58; on mitoxantrone 0.091±0.17, (P=0.003)]. Of the 17 patients, ten (MS 9 and NMO 1) completed therapy for two years. Annual relapse rates [before (1.024±0.59), on therapy (0.155±0.21), (P=0.0054)] and EDSS score [before start of therapy 5.3, at the end of therapy 2.4, (P=0.001)] showed significant benefit in the ten patients who completed two years therapy. This benefit persisted during the mean follow-up period of two and a half years after completion of therapy. The adverse events noted in the entire cohort were leucopenia in four patients and asymptomatic reversible decrease in cardiac ejection fraction in one patient. Leucopenia was severe in two patients requiring discontinuation of the therapy and mitoxantrone was also discontinued in the patient with cardiotoxicity. Conclusions : Mitoxantrone, as an initial therapy, decreases clinical exacerbations and disability progression, and has a reasonable safety profile in Indian patients with MS and NMO.
  3,902 360 8
Interhemispheric interaction in the motor domain in children with cerebral palsy
Nadezhda V Zaytseva, M Sami Walid, Elena M Berdichevskaia
July-August 2009, 57(4):411-417
DOI:10.4103/0028-3886.55608  PMID:19770541
Background : The attention of pediatric specialists has been continuously attracted to the problem of cerebral palsy (CP) and the formation of behavioral and motor skills in the initial years of life in these patients. This work aimed at studying the specifics of intra- and interhemispheric connections in the motor domain in children with CP as well as their dynamics in the process of rehabilitation using hand/finger synkineses and and lateral profile as markers. Materials and Methods : A total of 215 children aged 4-7 years were recruited after obtaining their parents' consent, including 95 patients with the most prevalent forms of CP (spastic diplegia, hemiparetic form) who underwent complex treatment in a neuropsychological sanatorium and 120 healthy children from a kindergarten. Data were analyzed using nonparametric methods and the chi-square test with the help of the statistical program SPSS v.14. Results : Changes in the scores and types of synkinesis after rehabilitation indicated that in spastic diplegia the assumed symmetric brain defects were associated with uniform restoration of interhemispheric connections and less disturbance of intrahemispheric connections. In hemiplegia, on the contrary, misbalance in intrahemispheric connections prevailed and compensation was noticed only in left-hemispheric pathology. The magnitude, type, and improvement of hand synkineses in the course of treatment depended on the lateral phenotype. Conclusion : Hand/finger synkineses in CP children change with rehabilitation. The methods used in the study can be recommended for application in the system of medico-biological and psycho-pedagogical monitoring of children with CP.
  3,927 284 -
BRIEF REPORTS
Challenges in neurosurgical intraoperative consultation
Shalinee Rao, Aarthi Rajkumar, MD Ehtesham, Prathiba Duvuru
July-August 2009, 57(4):464-468
DOI:10.4103/0028-3886.55598  PMID:19770549
Background: Intraoperative consultation for neurosurgical specimens can be difficult at times, despite the use of both frozen section and squash preparation. Various factors influence the diagnostic accuracy of these procedures. This study was conducted to evaluate reasons for discordant case results in neurosurgical intraoperative consultations and make a comparative analysis of these two commonly used methods to identify the possible pitfalls, errors, and limitations. Materials and Methods: All the neurosurgical cases received in the Department of Pathology for intraoperative consultation over a period of 3 years were studied retrospectively. The slides of frozen sections and squash preparation were retrieved and the diagnosis was compared with the final diagnosis given on paraffin-embedded sections. Results and Observations: A total of 6% of the cases were found to be discordant; these included angiomatous meningioma, Non-Hodgkins lymphoma, metastatic renal cell carcinoma, cerebellopontine angle fibrous meningioma, and craniopharyngioma. Highly vascular lesions, unavailability of squash preparation in a few cases and technical errors like thick smears, excessively crushed specimen, freezing, and cautery induced and crushing artifacts contributed to misdiagnosis. Conclusion: The discrepant cases need to be reviewed regularly by pathologists to familiarize themselves with the morphological changes and artifacts. The knowledge of possible errors could minimize misinterpretation and help in providing a more conclusive opinion to the operating surgeon.
  3,837 269 9
CASE REPORTS
Recovery of cognitive dysfunction in a case of delayed encephalopathy of carbon monoxide poisoning after treatment with donepezil hydrochloride
Pin Wang, Tao Zeng, Zhao-fu Chi
July-August 2009, 57(4):481-482
DOI:10.4103/0028-3886.55596  PMID:19770553
Delayed encephalopathy following carbon monoxide poisoning is a serious complication. Here, we report a patient with delayed encephalopathy who suffered from cognitive disorders and urinary incontinence after a temporal normal period of 15 days after acute intoxication, and his cognitive function recovered gradually following donepezil hydrochloride treatment. Now, he can undertake slight farming work.
  3,880 217 8
Choroid plexus papilloma presenting as a non-contrast-enhancing fourth ventricular mass in a child
Ravindran Pratheesh, Ranjith K Moorthy, Reecha Singh, Vedantam Rajshekhar
July-August 2009, 57(4):486-488
DOI:10.4103/0028-3886.55601  PMID:19770555
Choroid plexus papilloma (CPP) is a rare benign tumor of the central nervous system with a propensity for location within the lateral ventricle in children. We report a case of a 14-year-old girl who presented with transient facial paresis and ataxia. Her imaging showed a non-enhancing intra fourth ventricular mass, the histology of which was reported as CPP. The atypical clinical and radiological features in this case are discussed. Choroid plexus papillomas should be considered in the differential diagnosis of non-enhancing fourth ventricular masses.
  3,549 236 2
ORIGINAL ARTICLES
Mid-term results of thoracoscopic thymectomy for myasthenia gravis
Karamollah Toolabi, Ali Aminian, Mihan Jafari Javid, Mohammad Hossein Harirchian, Abbas Rabani, Jamshid Darabnia
July-August 2009, 57(4):402-405
DOI:10.4103/0028-3886.55599  PMID:19770539
Context : Video-assisted thoracic surgery (VATS) has been proposed as a less invasive technique for treatment of myasthenia gravis. Materials and Methods : A total of 31 patients underwent a right-sided VATS to remove all anterior mediastinal fat and thymic tissue during a 4-year period in our institution. None of the patients had associated thymoma. Results : All procedures were performed successfully with no conversion to sternotomy. The mean operating time was 190 minutes. The median intubation time and assisted ventilation were 24 and 18 hours, respectively. The median ICU and hospital stays were 3 and 7 days, respectively. The median time for post-operative chest drainage was 48 hours. There was no perioperative mortality. Eight significant complications occurred. One patient had atelectasis, 1 patient had aspiration pneumonia, and 3 patients had postoperative myasthenic crisis and required prolonged mechanical ventilation. Other complications were granuloma of the vocal cord, right recurrent laryngeal nerve palsy, and temporary brachial plexus injury due to poor intraoperative positioning. The mean length of follow-up was 20 months (range: 3-42 months). Overall, 27 patients (87%) had improved clinically and 11 patients (35%) had complete remission. The resulting scars were cosmetically acceptable for all patients. Conclusion : VATS provides an effective alternative approach to thymectomy and has several advantages over open techniques. VATS causes minimal postoperative complications, shortens hospital stay, and gives better cosmetic results.
  3,522 258 6
CASE REPORTS
Brain abscess and granuloma formation as late complications of retained ventricular catheter
SA Khan, A Gretchel, H Govender, B Hartzenberg
July-August 2009, 57(4):489-492
DOI:10.4103/0028-3886.55604  PMID:19770556
This report presents a rare complication of ventriculoperitoneal shunt, delayed development of brain abscess and foreign body granuloma formation adjacent to the intraventricular catheter. Both the complications occurring in the same patient is unusual.
  3,454 210 6
LETTERS TO EDITOR
Narcolepsy an often missed diagnosis: First documented case from India
M Bhatia, MA Arif
July-August 2009, 57(4):509-511
DOI:10.4103/0028-3886.55588  PMID:19770566
  3,378 237 2
ORIGINAL ARTICLES
Comparison of MRI-based thrombolysis for patients with middle cerebral artery occlusion ≤ 3 h and 3-6 h
Yue-Hua Li, Ming-Hua Li, Zhen-Guo Zhao, Qing-Ke Bai
July-August 2009, 57(4):426-433
DOI:10.4103/0028-3886.55615  PMID:19770543
Objective : To investigate the outcomes of magnetic resonance imaging (MRI)-based thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute middle cerebral artery (MCA) occlusion in 3-6 hours. Materials and Methods : MRI-selected patients (n=15) with acute ischemic stroke in MCA divided into two groups (#≤ 3h and 3-6 h) were treated with intravenous rt-PA. MR was performed before rt-PA, at 24 hours, 7 days, and 14 days after stroke. Recanalization was assessed 24 h after thrombolysis, and clinical status was evaluated before rt-PA treatment, 6 hours, 24 hours, 7 days, and 14 days after thrombolysis by the National Institutes of Health Stroke Scale (NIHSS). Modified rankin scale (MRS) was used to assess clinical outcome at 30 and 90 days after thrombolysis. Results : There was no significant between ≤ 3 h and 3-6 h group in length of hospital stay, recanalization, MRS, and favorable outcome at 90 days. Recanalization within 24 hours occurred in 9 (60%), and nonrecanalization in 6 (40%). One patient in recanalization group and three in nonrecanalization group had an asymptomatic intracranial hemorrhage (ICH) within 24 h after thrombolysis (P =0.235). Recanalization with thrombolysis was associated with a better outcome regardless of the time point of rt-PA treatment. Comparison with nonrecanalization group, recanalization was also associated with a lower NIHSS score at 14 days (P =0.003), a lower TIMI grade at 7 days (P < 0.001), and a shorter length of hospital stay (P =0.018). Conclusion : Our study suggested that MR-based thrombolysis using rt-PA was safe and reliable in patients with acute MCA occlusion in 3-6 hours.
  3,262 258 17
CASE REPORTS
Reactive changes of disc space and foreign body granuloma due to bone wax in lumbar spine
Nail Ozdemir, Mustafa Fazil Gelal, Mustafa Minoglu, Levent Celik
July-August 2009, 57(4):493-496
DOI:10.4103/0028-3886.55606  PMID:19770557
Bone wax is a well-known agent used to prevent bleeding from the bone that can be used in different surgical procedures. Bone wax is a safe agent, but it may rarely lead to significant foreign body reactions. In this report, we present a patient who developed bone wax-related disc space foreign body granuloma following L4 total laminectomy, extremely rare complication.
  3,306 177 10
Complete posterior migration of intact vertebral body in spinal tuberculosis
Krishnamurthy Sridhar, Prasad Krishnan
July-August 2009, 57(4):483-485
DOI:10.4103/0028-3886.55600  PMID:19770554
Spinal tuberculosis most commonly presents as a paradiscal lesion involving the disc space and adjacent vertebral bodies. Atypical forms of spinal tuberculosis have been described and are most often a result of posterior element involvement. The authors report a patient, who presented with complete posterior migration of an intact vertebral body, a complication of spinal tuberculosis that has not been reported till date. A 12-year-old girl with history of pulmonary tuberculosis presented with progressive paraparesis and back pain. Plain X-rays and MRI revealed that the L2 vertebral body had migrated posteriorly into the spinal canal, without significant movement of the posterior elements. The vertebral body was normal, with no erosion or bone loss. However, bilateral pedicle and facet joint involvement was seen. The neural elements were decompressed through an anterolateral retroperitoneal approach and the spine reconstructed. The authors present this rare manifestation of spinal tuberculosis and discuss the possible mechanisms of this presentation.
  3,165 237 1
LETTERS TO EDITOR
Posterior reversible encephalopathy syndrome in systemic lupus erythematosus
Necioglu Orken Dilek, Kenangil Gulay, Ur Emel, H Forta
July-August 2009, 57(4):497-499
DOI:10.4103/0028-3886.55571  PMID:19770558
  3,152 213 4
ORIGINAL ARTICLES
Suboccipital segment of the vertebral artery: A cadaveric study
S Muralimohan, Anil Pande, MC Vasudevan, Ravi Ramamurthi
July-August 2009, 57(4):447-452
DOI:10.4103/0028-3886.55610  PMID:19770546
Objective: To study the course, relationships, branches and possible anomalies of the vertebral artery in the suboccipital region in adult Indian cadavers. Materials and Methods: Twenty-one suboccipital segment vertebral artery specimens from embalmed, Indian adult cadavers were dissected and studied. Dissection was performed using microsurgical instruments and was carried out from the skin up to the vertebral artery in layers. The course, relationships and the branches of the vertebral artery were studied and measurements were taken using Vernier calipers. The readings obtained were corroborated with the measurements derived from the digital images using a computer. Observations: All the vertebral arteries had a tortuous course and were covered with rich venous plexuses. None of the specimens had an anomalous course. The artery was divided into a vertical segment (Vv) between C2 and C1 vertebra and a horizontal segment (Vh) from the C1 transverse foramina to its dural entry. The mean diameter of the artery was 4.8mm. The shortest distance of Vv segment from the dural tube was 16.1mm, and the distance from the C2 ganglion was 7.2mm. The average length of the Vv segment was 15mm and the average length of the Vh segment was 35.6mm. The average of the shortest distance between the vertebral artery and the midline was 13.4mm. Conclusion: The vertebral artery has a tortuous course and is prone to accidental iatrogenic injury, which can result in devastating neurological sequelae depending on contralateral vertebral artery flow. A thorough anatomical knowledge of this segment is essential for the surgeon who intends to operate in this area.
  3,008 252 2
NEUROIMAGE
Extensive meningeal and prenchymal calcified tuberculoma as long-term residual sequelae of tuberculous meningitis
Bon D Ku, Seung Don Yoo
July-August 2009, 57(4):521-522
DOI:10.4103/0028-3886.55593  PMID:19770574
  2,932 279 4
EDITORIALS
Near-infrared indocyanine green video angiography in aneurysm surgery
Aaron Mohanty
July-August 2009, 57(4):366-367
DOI:10.4103/0028-3886.55568  PMID:19770533
  2,750 368 3
LETTERS TO EDITOR
Spontaneous cerebrospinal fluid rhinorrhea: A rare initial presentation of clival chordoma
Cheng-Ta Hsieh, Ming-Ying Liu, Wan-Fu Su, Da-Tong Ju
July-August 2009, 57(4):513-514
DOI:10.4103/0028-3886.55591  PMID:19770569
  2,851 138 2
A case of sporadic periodic hypokalemic paralysis with atypical features: Recurrent differential right brachial weakness and cognitive dysfunction
AN Joshi, AP Jain, AD Bhatt, S Kumar
July-August 2009, 57(4):501-501
DOI:10.4103/0028-3886.55581  PMID:19770562
  2,804 180 4
Spinal epidural hematoma after insertion of a thoracic epidural catheter in the absence of coagulation disorders - A call for raised awareness
Bahram Fakouri, Shreya Srinivas, Sani Magaji, Alex Kunsky, Francesco Cacciola
July-August 2009, 57(4):512-513
DOI:10.4103/0028-3886.55590  PMID:19770568
  2,726 158 3
ORIGINAL ARTICLES
Biomechanical analysis of multilevel discectomy and excision of posterior longitudinal ligament: An in vitro study in sheep
Cem Yilmaz, Serdar Kabatas, Kemal Hepgul, Ergun Bozdag, Emin Sunbuloglu, Tufan Cansever
July-August 2009, 57(4):395-401
DOI:10.4103/0028-3886.55597  PMID:19770538
Aim: This experimental biomechanical study was performed to determine the effects of multilevel anterior cervical discectomy and excision of posterior longitudinal ligament (PLL) to stabilize the cervical spine using an in vitro animal model. Materials and Methods: Fifty fresh cadaveric C3-C6 sheep spine specimens were divided into five experimental groups: Group A was the control group; Group B, one-level discectomy; Group C, two- level discectomy, Group D, three-level discectomy, and Group E, three-level discectomy and excision of PLL, respectively. The specimens were subjected to non-destructive loads cycled from zero to five Newton-meter for flexion, extension, right and left lateral bending, and axial rotation on an electrohydraulic test machine. Load displacement curves were obtained via collected data using strain gauges. The values were obtained for all five groups, statistical differences were determined respectively (P < 0.05, ANOVA). Results: One- level discectomy was less stable than the control group, two-level discectomy was less stable than one-level discectomy and three-level discectomy was less stable than two-level discectomy, respectively (P < 0.05). Excision of PLL did not seem to affect stability (P > 0.05). Conclusion: Our data suggested that cervical discectomy decreases stability of sheep spine pieces.
  2,700 168 -
LETTERS TO EDITOR
Posterior communicating artery aneurysm associated with duplicated posterior communicating artery and bilateral fetal posterior cerebral arteries
Noufal Basheer, Manish K Kasliwal, Ashish Suri
July-August 2009, 57(4):514-515
DOI:10.4103/0028-3886.55592  PMID:19770570
  2,340 170 2
CORRESPONDENCE
Pure cortical supratentorial extraventricular ependymoma
Aliasgar Moiyadi
July-August 2009, 57(4):516-516
DOI:10.4103/0028-3886.55570  PMID:19770571
  2,033 143 1
D-dimer is useful in the diagnosis of cortical venous sinus thrombosis
Younis A. M. Skaik
July-August 2009, 57(4):518-518
DOI:10.4103/0028-3886.55576  PMID:19770572
  1,987 168 1
LETTERS TO EDITOR
Choriocarcinoma with arterial and venous thrombosis
Sanju Cyriac, TG Sagar, Vandana Mahajan
July-August 2009, 57(4):505-507
DOI:10.4103/0028-3886.55586  PMID:19770564
  1,916 179 3
Long-term effects of antiepileptic therapy on cardiovascular risk factors in children
Gokhan Aydemir, Cihan Meral, Selami Suleymanoglu, Ferhan Karademir
July-August 2009, 57(4):504-504
DOI:10.4103/0028-3886.55585  PMID:19770563
  1,784 124 1
NEUROIMAGE
Aortic aneurysm presenting as conus-cauda syndrome
Nilesh Anil Nadkarni, Sudheer Ramattu Yousef, Kamlesh Arjundas Jagiasi, Satish V Khadilkar
July-August 2009, 57(4):519-520
DOI:10.4103/0028-3886.55580  PMID:19770573
  1,729 175 -
LETTERS TO EDITOR
Imaging of spontaneous neuromagnetic activity in a patient with internal carotid artery stenosis
Shinichi Sakamoto, Naohiro Tsuyuguchi, Wataru Ide, Ikuo Hashimoto, Hajime Kamada, Hiroaki Tanaka, Kensuke Sekihara, Kenji Ohata
July-August 2009, 57(4):501-504
DOI:10.4103/0028-3886.55584  PMID:19770561
  1,529 153 1
CORRESPONDENCE
Author's reply
Yad Ram Yadav, Neha , SK Chandrakar
July-August 2009, 57(4):517-517
DOI:10.4103/0028-3886.55573  
  1,564 93 -
Author's reply
UK Misra, J Kalita
July-August 2009, 57(4):518-518
DOI:10.4103/0028-3886.55578  
  1,452 92 -
INVITED COMMENTARIES
Invited commentary
David W Brandes
July-August 2009, 57(4):423-424
  1,171 130 -
Invited commentary
Lekha Pandit
July-August 2009, 57(4):424-425
  1,155 124 -
CORRESPONDENCE
Pure cortical supratentorial extraventricular ependymoma
Harjinder S Bhatoe
July-August 2009, 57(4):517-517
DOI:10.4103/0028-3886.55574  
  1,053 92 -
Author's reply
Yad Ram Yadav, Neha , SK Chandrakar
July-August 2009, 57(4):517-518
DOI:10.4103/0028-3886.55575  
  1,033 93 -
Online since 20th March '04
Published by Wolters Kluwer - Medknow