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Biomedical subjects

A B Taly

Publications and source records attributed to A B Taly.

At least 55 records · Page 3Linked to original sources
PubMed2001

Disabilities in children with Duchenne muscular dystrophy: a profile.

Proper assessment of disabilities is essential for rehabilitation of patients with Duchenne muscular dystrophy. The aim of this study was to identify and quantify the disabilities in children with Duchenne muscular dystrophy and correlate them with impairment. Thirty-one patients with Duchenne muscular dystrophy of age four years and above were studied. The motor functions were evaluated using total motor score, upper and lower extremity function grades and timed function tests. Disability was quantified with Barthel index. The mean scores of motor scales were: total motor score -52 +/- 7.8, total functional grade -4.4 +/- 1.9 and timed function score -12.5 +/- 5.8. Barthel index scores ranged from 45-95 with a mean of 70.8 +/- 12.7. Motor scales correlated with each other and with Barthel index. Thirty children had disabilities in multiple spheres of life, which were significantly influenced by the motor power. Barthel index was useful in identifying and quantifying specific areas of disabilities in these children. Evaluation of disabilities using specific measures may be crucial for planning comprehensive management.

Activities of Daily Living↗
PubMed2001

Neurogenic heterotopic ossification : a diagnostic and therapeutic challenge in neurorehabilitation.

Heterotopic ossification (HO) is an important cause of restriction in range of movements and secondary motor disability following neurotrauma, orthopaedic interventions and burns. It has not received focussed attention in non-traumatic neurological disorders. In a prospective study of 377 patients, on medical problems in neurological rehabilitation setting, 15 subjects (3.97%) had neurogenic heterotopic ossification. Their clinical diagnosis was: transverse myelitis (7), neurotuberculosis (4), traumatic myelopathy (2) and stroke (2). Hip (10), knee (4) and elbow joints (1) were involved. The risk factors included urinary tract infection (15), spasticity (6), pressure sores (13) and deep venous thrombosis (DVT) (6). The initial diagnosis was often other than HO and included DVT (3), haematoma (2) and arthritis (2). ESR and serum alkaline phosphatase levels were elevated in all but one subject. The diagnosis of HO was established using X-rays, CT Scan and three-phase bone scan. Following treatment with non-steroidal anti-inflammatory drugs, the range of motion improved in only four patients. HO resulted in significant loss of therapy time during rehabilitation. High index of suspicion about this complication is necessary for early diagnosis and prompt intervention.

Disability Evaluation↗
PubMed2001

Ulnar nerve palsy due to axillary crutch.

A young lady with residual polio, using axillary crutch since early childhood, presented with tingling, numbness and weakness in ulnar nerve distribution of five months duration. Ulnar motor conduction study revealed proximal conduction block near the axilla, at the point of pressure by the crutch while walking. Distal ulnar sensory conduction studies were normal but proximal ulnar sensory conduction studies showed absence of Erb's point potential. These findings suggested the presence of conduction block in sensory fibers as well. Proper use and change of axillary crutch resulted in clinical recovery and resolution of motor and sensory conduction block.

Adult↗
PubMed2001

Vasculitic neuropathy in HIV infection: a clinicopathological study.

Vasculitis causing peripheral neuropathy may be the first sign of HIV infection. We report four such cases in whom the onset of peripheral neuropathy led to the detection of HIV infection. Two patients presented with features of mononeuritis multiplex, while the other two had a lumbosacral polyradiculopathy. A prior history of blood transfusion was forthcoming in one of the patients. Sural nerve biopsies in all the four cases and the muscle biopsy in two, histologically showed evidence of vasculitis. Immunohistochemically, the viral antigen was not demonstrable in any of the biopsies, but on electron microscope, virus-like particles were identifiable in the Schwann cell cytoplasm and the perivascular macrophages in one case. To the best of our knowledge, this is the only report that has documented the virus in the Schwann cells as well as the perivascular macrophages lending credence to the fact that these viruses are neurotropic as well as lymphotropic. Immunoglobulin deposits were not demonstrable in any of the cases, suggesting that direct viral invasion may have a role in the pathogenesis of peripheral nerve vasculitis.

Adult↗
PubMed1999

Palatal tremor, progressive multiple cranial nerve palsies, and cerebellar ataxia: a case report and review of literature of palatal tremors in neurodegenerative disease.

We describe a patient with an unusual clinical presentation of progressive multiple cranial nerve palsies, cerebellar ataxia, and palatal tremor (PT) resulting from an unknown etiology. Magnetic resonance imaging showed evidence of hypertrophy of the inferior olivary nuclei, brain stem atrophy, and marked cerebellar atrophy. This combination of progressive multiple cranial nerve palsies, cerebellar ataxia, and PT has never been reported in the literature. We have also reviewed the literature of PT secondary to neurodegenerative causes. In a total of 23 patients, the common causes are sporadic olivopontocerebellar atrophy (OPCA; 22%), Alexander's disease (22%), unknown etiology (43.4%), and occasionally progressive supranuclear palsy (4.3%) and spinocerebellar degeneration (4.3%). Most patients present with progressive cerebellar ataxia and approximately two thirds of them have rhythmic tremors elsewhere. Ear clicks are observed in 13% and evidence of hypertrophy of the inferior olivary nucleus in 25% of the patients. The common neurodegenerative causes of PT are OPCA/multiple system atrophy, Alexander's disease, and, in most of them, the result of an unknown cause.

Adult↗
PubMed1999

Heterotopic ossification in non-traumatic myelopathies.

Heterotopic ossification (HO) is an important complication of spinal cord and brain injuries but is rarely reported among patients with non-traumatic myelopathies. In a prospective study on medical problems seven (6.04%) among the 114 subjects with non-traumatic myelopathies had heterotopic ossification. All of them had involvement of hip joints. The co-morbid conditions were: urinary tract infection, seven; spasticity, three; pressure sores, five; and deep venous thrombosis, one. The initial diagnosis was often other than heterotopic ossification. Erythrocyte sedimentation rate and serum alkaline phosphatase levels were elevated in all subjects. Following rest and non-steroidal anti-inflammatory drugs, the range of motion improved in two patients. Heterotopic ossification can occur in patients with non-traumatic myelopathies and has risk factors and clinical features similar to patients with traumatic spinal cord injury. A high index of suspicion about this complication is necessary for early diagnosis and prompt intervention.

Adolescent↗
PubMed1999

Spontaneous expulsion of large vesicle calculi in a woman with paraparesis.

INTRODUCTION: Urolithiasis is a common but preventable complication of Spinal Cord Disorders (SCD). CASE REPORT: We report a 25-year-old woman with paraparesis who spontaneously passed two large calculi perurethra without pain and developed urethral scarring. Detrusor hyperreflexia, absence of sensations and lack of sphincter tone could have contributed to painless expulsion of the large calculi in this patient. CONCLUSION: Dysuria, a prominent symptom of urolithiasis may not be present in subjects with SCD. Awareness about urolithiasis among health professionals involved in the care of SCD patients is necessary for prevention and early intervention.

Adult↗
PubMed1999

Right parietal infarction with concomitant mutism.

Right brain damage results in a variety of cognitive and behavioural dysfunctions. Mutism however, has been described only with left or bihemispheric lesions involving the parietal lobe. We report an elderly man who had left faciobrachial monoparesis and concomitant mutism. His auditory-verbal comprehension was intact. MRI revealed a right parietal infarct involving the cortical and subcortical regions. Recovery from mutism during the course of treatment was abrupt and complete with no residual dysarthria. A possibility of diaschisis or impaired modulation of left hemispheric function due to right cerebral infarct, presenting as conversion reaction, is proposed for this rare association.

Cerebral Infarction↗
PubMed1999

Puerperal cerebral venous thrombosis: therapeutic benefit of low dose heparin.

Advances in imageology have improved the diagnostic yield of cerebral venous/sinus thrombosis (CVT). However, its management remains a challenge. The present study was carried out to study the role of heparin in CVT. Therapeutic outcome of 150 patients of puerperal CVT manifesting within one month of delivery or abortion, was analyzed. The diagnosis was supported by cranial computed tomography and/or angiography whenever required. Seventy three patients, 46 with non-haemorrhagic infarction and 27 with haemorrhagic infarction, received 2500 units of subcutaneous heparin, three times a day within 24 hours of hospitalization till 30th post partum day or symptomatic relief. Seventy seven patients during the same period, 50 with non-haemorrhagic infarction and 27 with haemorrhagic infarction, who did not receive heparin formed the control group. Repeat CT scans were done when indicated. Among the heparin group, 34 patients made full recovery. There were eight deaths, all among the patients with haemorrhagic lesion. In control group, only 14 patients recovered completely (P=<0.001) and 18 died (P=<0.001). There were no adverse effects of heparin. Low dose heparin is safe and efficacious in puerperal CVT, even in patients with haemorrhagic infarction.

Adult↗
PubMed1999

Non-traumatic acute rhabdomyolysis.

A boy developed sudden severe generalized muscle stiffness, bulbar weakness and passed dark coloured urine. Laboratory tests revealed marked elevation of creatinine kinase(CK) levels and myoglobinuria. Histopathology of quadriceps muscle showed features of acute rhabdomyolysis. Patient made complete clinical recovery over a period of three weeks and CK returned to normal level. The possible aetiologies of non-traumatic rhabdomyolysis are discussed and the relevant literature reviewed.

Acute Disease↗
PubMed1999

Early onset cerebellar ataxia with retained tendon reflexes (EOCA) and olivopontocerebellar atrophy (OPCA): a computed tomographic study.

Computed tomographic (CT) studies in olivopontocerebellar atrophies (OPCA) and 'early onset cerebellar ataxia with retained tendon reflexes (EOCA)' are few and vary widely in methodology and criteria for cerebellar and brainstem atrophy. In this prospective study, CT scan observations on 26 patients (EOCA-11, OPCA-15) were compared with 31 controls using qualitative and quantitative assessment of cisterns, ventricles and atrophy of brain. Vermian and/or cerebellar hemispheric (predominantly anterior) atrophy was present in 80.8% and both were equally common. Cerebral cortical atrophy (26.9%) and leukoariosis (15.4%) were less frequently seen. Statistically significant atrophy of pons, brachium pontis, cerebellum and midbrain was noted in patient group. No significant differences were observed between EOCA and OPCA groups. Evidence of atrophy did not correlate with either the duration of illness or the severity of cerebellar ataxia in both the groups. The severity of brainstem atrophy in 14 patients with and 12 patients without abnormal brainstem auditory evoked response did not differ significantly. This study highlights the methodology of CT evaluation for brainstem and cerebellar atrophy, draws attention to cerebral atrophy and emphasizes the lack of significant differences in CT morphology between OPCA and EOCA patients.

Adolescent↗
PubMed1998

Sympathetic skin response in myelopathies.

Autonomic dysfunctions cause significant morbidity and mortality among patients with spinal cord disorders. Sympathetic skin response (SSR), a simple, noninvasive electrophysiological technique, may be useful for assessing sympathetic functions in patients with myelopathies. Our aim was to study SSR in patients with myelopathy and correlate it with clinical features, severity of the impairment, somatosensory evoked potentials. and outcome. Thirty patients (15 men, 15 women) 12 to 60 years old with myelopathies of different etiology were studied. Subjects with clinical, electrophysiologic, or radiologic evidence of lesions outside the spinal cord were excluded. Somatosensory evoked potentials (SSEP) were recorded from scalp with median nerve stimulation at the wrist and posterior tibial nerve below the medial malleolus. The SSR was recorded from palm and sole after stimulating the supraorbital nerve at forehead, median nerve at wrist, and posterior tibial nerve below medial malleolus. The SSR was considered abnormal when absent. The sites of the lesions in these patients were cervical (13), thoracic (16), and lumbar (1). The lesion was clinically complete in six patients. Good motor recovery was noted in 16 subjects. SSR was absent from sole in 25 and palm in 10 patients from all three sites of stimulation. In addition, three patients also had absent SSR from palm on posterior tibial nerve (PTN) stimulation. SSEP was absent from median (N19) in three and posterior tibial (N39) in 20 patients. Among 10 patients with absent SSR from palm, only three had a good outcome. Presence of SSR from palm to PTN stimulation correlated with sparing of bladder sensations and good outcome. However, absent SSR from sole did not correlate with clinical features, bladder dysfunction, or outcome. Sympathetic skin response is frequently abnormal in patients with myelopathies. Spinal afferent and efferent tracts for SSR are different and may be affected individually. The afferent pathways are closely related to tracts conveying bladder sensation. Preserved palmar SSR on PTN stimulation may suggest good motor outcome. SSR may be a valuable adjunct in evaluating patients with myelopathies.

Adolescent↗
PubMed1998

Heparin in haemorrhagic infarction in cerebral venous sinus thrombosis.

Morbidity and mortality in puerperal cerebral venous thrombosis (CVT) can be reduced by arresting the progression of thrombosis using heparin. However, conventional dose of heparin requires monitoring of coagulation parameters and carries a risk of haemorrhage. The present study involved 56 patients of puerperal CVT with CT evidence of haemorrhagic infarction. Twenty nine of these patients received low dose heparin till 30th post-partum day or symptomatic relief. Their clinical features and severity were similar to 27 patients who did not receive heparin. The mortality and morbidity at discharge was significantly less (P < 0.001) in heparin treated group. There were no haemorrhagic complications. Low dose heparin is safe and effective in cerebral venous thrombosis, even with haemorrhagic infarction.

Adult↗
PubMed1998

Histopathological evaluation of inflammatory & hereditary demyelinating polyneuropathies.

In view of therapeutic implications and problems in clinical diagnosis, this study sought to evaluate and identify histopathological features of acquired inflammatory demyelinating neuropathies and hereditary demyelinating neuropathies. Sural nerve biopsies from 41 patients of demyelinating neuropathies, diagnosed on the basis of accepted clinical criteria, were studied using routine histological staining and special stains for myelin and axons. Chronic inflammatory neuropathies differed from the acute ones in having more endoneurial connective tissue, less of subperineurial oedema and presence of axonal sprouting and occasional onion bulb formation. Acquired neuropathies differed from hereditary neuropathies in having a more localized involvement, endoneurial oedema and variable inflammatory cell infiltration, while in hereditary neuropathies Schwann cell proliferation was diffuse and relatively uniform. The frequency and degree of nerve thickening was more in hereditary neuropathy. Evidence of inflammation was not universal, both in the acute and the chronic inflammatory demyelinating neuropathies. Histopathological examination is essential as the clinical and electrophysiological features alone may not offer definitive diagnosis.

Adult↗
PubMed1997

CT in simple partial seizures in children: a clinical and computed tomography study.

INTRODUCTION: Therapeutic relevance of computed tomography (CT) in children with simple partial seizures (SPS) is reported to be remarkably low (1-2%). There are not studies, however, from the developing countries where neuroinfections are among important causes of seizures. The present study from India is aimed at evaluating the significance of CT in the management of SPS in children and to determine the difference in clinical features of children with and without focal brain lesions in CT. PATIENTS AND METHODS: CT scans of all patients aged 15 years of younger with SPS, seen over a period of 15 months, were reviewed. The clinical features of the patients with focal lesions in the CT were compared with those of children without focal abnormalities. RESULTS: Focal structural lesions were present in 117 (59.09%) of 198 children. These included: solitary contrast enhancing CT lesion-16.16%, focal calcification-12.12%, cysticerosis-10.10%, focal atrophy-9.59%, tuberculoma-6.56% and infarction-6.06%. Neuroinfections or their sequelae were responsible for seizures in 89 children (44.94%). There were no statistically significant differences in clinical features of patients with and without focal lesions in CT. CONCLUSIONS: CT study in children with SPS in developing countries has significant therapeutic relevance. It is not possible to clinically differentiate children with focal lesions from those without focal lesions in CT.

Adolescent↗
PubMed1996

Obsessive-compulsive disorder and rheumatic chorea: is there a connection?

There is increasing evidence to suggest basal ganglion involvement in the aetiopathogenesis of obsessive-compulsive disorder (OCD). Twenty subjects with rheumatic chorea were assessed for presence of OCD and evaluated on Leyton's Obsessional Inventory. Four subjects had OCD. The study group had markedly higher scores on all the scales of Leyton's Obsessional Inventory. The findings implicate that caudate dysfunction is not sufficient on its own to explain the presence of obsessive-compulsive behaviour and that additional basal ganglion regions/rostral connections also have to be involved to produce co-morbidity.

Adolescent↗