Biomedical subjects
Publications and source records attributed to A K Thacker.
Multiple cerebral infarcts, bilateral optic neuropathy with limb ischemia, following scorpion bite is documented. Vasospasm and autonomic storm due to envenomation is a plausible explanation for this symptom complex.
Differentiation between a relapse or late reversal reaction following completion of regular drug therapy in patients with leprosy is often difficult, though it has definite therapeutic implications. The present case documents a late reversal reaction occurring an unusually long time after the completion of multi-drug therapy.
Two hundred consecutive patients of non-traumatic coma, were investigated to establish its aetiology. Neurologic profile of these patients included assessment of Glasgow Coma Scale (GCS) score and evaluation of brainstem reflexes. 102 patients died and only 54 patients could make good recovery. Cerebrovascular diseases (33%), CNS infections (21%), and hepatic encephalopathy (18%) were the frequent causes of non-traumatic coma, with the first two carrying relatively poor prognosis. Poor outcome was also associated with low GCS score and absence of brainstem reflexes specially absent pupillary, oculocephalic and oculovestibular responses and decerebrate posture.
Forty-two patients with leprosy (7 with tuberculoid type, 30 borderline, 5 lepromatous) were studied electrophysiologically during reactions. Thirty-three had type I reactions while 9 had type II reactions. Each patient received 60 mg/day prednisolone tapered over a 6-week period. Motor conduction studies were performed on one clinically affected and one unaffected nerve and were repeated 12 weeks after the beginning of steroid therapy. Significant motor conduction abnormalities were observed in 14 affected (33.3%) and 8 unaffected nerves (19.1%). The majority of these nerves were in patients with borderline leprosy having type I reactions. Following steroid therapy, nerve function improved in 14 affected (33.3%) and 20 unaffected nerves (47.66%). However, 5 affected (10.2%) and 12 unaffected nerves (28.5%) showed a worsening of nerve function following steroid therapy. The majority of the nerves that showed improvement with steroid therapy had type I reactions, while those that showed deterioration had type II reactions. Steroids improved nerve function mainly in patients with type I reactions. Their role in patients with type II reactions remains debatable.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
An epidemiologic survey of idiopathic intracranial hypertension (IIH) in Benghazi, Libya, over a period from September 1982 through August 1989 ascertained 81 patients. The group was comprised of 76 females and 5 males. Ages ranged from 8 to 55 years; the mean +/- S.D. was 28.6 +/- 7.9 for women and 21.0 +/- 14.5 for men. The average crude annual incidence rates for IIH per 100,000 persons were 2.2 for the total and 4.3 for females for all ages (3.2 for the total and 5.9 for the females when adjusted to the 1980 United States population). In females aged 15-44 years, IIH occurred at a rate of 12.0 per 100,000 per year; for those defined as obese, the rate rose to 21.4. Moderate to severe visual loss occurred as a sequelae in 20% of our patients. The extent of visual loss did not correlate with age at diagnosis, duration of symptoms, degree of obesity, use of oral contraceptive pills, cerebrospinal fluid (CSF) opening pressure, steroid treatment, or recurrence. We found no correlation between CSF protein and opening pressure. We conducted a case-control study on 40 consecutive female incident IIH patients and 80 age-matched female control subjects. Obesity and recent weight gain occurred more frequently in patients. More patients were married and more had irregular menses. The incidence rate for IIH described in our study is three to four times higher than that reported from the United States.
Local vascular and traumatic involvement are well-recognized causes of anterior tibial compartment syndrome (ATCS) terminating as myoneural ischaemia. However, in a large number of patients the cause of ATCS remains unidentified. We document the occurrence of bilateral ATCS in a patient of hypothyroidism, to our knowledge a previously unrecorded association.
Despite its high incidence, the exact cause of disappearing CT lesions in patients with epilepsy is not clear. We document a non-epileptic patient, whose clinical picture simulated idiopathic intracranial hypertension, but CT showed a spontaneously resolving ring enhancing lesion.
Explore the source record for details and available documents.
The clinical records and computed tomography scans of 50 consecutive patients with intracerebral haemorrhage (ICH) were analysed. Putaminal (48%) and thalamic (16%) ICH comprised the largest group, followed by cerebellar haemorrhage (12%). Intraventricular haemorrhage was observed in 14 cases, a majority being secondary to parenchymal haemorrhage. Hypertension remained the most important risk factor, occurring in 64% of the whole group and 83% of those with putaminal ICH. No predisposing factors for the haemorrhage were identified in 28% of patients. Twenty-seven patients were comatose; the incidence of coma in association with intraventricular haemorrhage was 79%. At the third week, 13 patients had died, a mortality rate of 26%.
A middle-aged male resident of Benghazi, northeastern Libya, with radiological features of skeletal fluorosis associated with cervical radiculomyelopathy is reported. This is believed to be the first documentation of such a disorder from this non-tropical, non-endemic region.
Two young patients with sickle cell trait (AS haemaglobinopathy) and ischaemic stroke are reported. The stroke involved the internal carotid artery territory in one and the brainstem in the other. A review of the literature is presented to suggest that the association of sickle cell trait and cerebral infarction is more than coincidental. Haemoglobin electrophoresis should be undertaken routinely in young subjects with ischaemic stroke.
A 54-year-old male with cervical spine osteomyelitis due to haematogenous spread of staphylococcal infection from an intravenous cannula is reported. A review of literature is presented to illustrate the diagnostic difficulties and neurological complications of pyogenic vertebral osteomyelitis.
We report a successfully managed case of neuroleptic malignant syndrome in which the diagnosis was delayed by one week because of the absence of an established psychiatric disease. A high degree of clinical suspicion must be maintained if the diagnosis of this rare, curable but often fatal, complication of neuroleptic therapy is not to be missed.
The corrected distal motor latency along the median nerve in 50 upper limbs with the forearm Cimino-Brescia fistula for haemodialysis, when compared to that of the contralateral limb and the control value, showed no evidence of carpal tunnel syndrome (CTS) ascribed to angioaccess. Haemodialysis-associated CTS seems to be related to the predisposing factors, rather than the haemodynamic effects of the arteriovenous fistula or dialysis.