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Biomedical subjects

B S Sharma

Publications and source records attributed to B S Sharma.

At least 19 recordsLinked to original sources
PubMed1999

Tethered cord syndrome in adults.

BACKGROUND: The tethered cord syndrome (TCS) is usually diagnosed in childhood and its symptomatic onset in adult life is not common. In the present study, we analyzed the data of patients who presented with TCS in adulthood with the aim of studying the clinical spectrum and management strategies. CLINICAL MATERIAL: Over a 5-year period, 18 adult patients (more than 18 years of age) with TCS were investigated with MRI and were operated on. Patients with adult TCS could be divided into two groups. Group 1 included patients who were asymptomatic in childhood and presented for the first time in adult life (10 patients). The second group was comprised of patients with preexisting static skeletal/neurological deformities who presented in adult life with new or progressive symptoms (eight patients). Eleven patients had cutaneous stigmata, 15 had motor or sensory deficit, nine had back/leg pain, eight had leg atrophy, and six had sphincter disturbances. The most frequent MRI finding was a low lying cord with an intradural and/or extradural lipoma. The cord was detethered surgically and the tethering lesion excised. Pain was usually relieved after surgery (8 out of 9), but only a few patients (2 out of 6) had improvement of sphincter dysfunction. CONCLUSIONS: The late presentation of TCS is possibly related to the degree of tethering and the cumulative effect of repeated microtrauma during flexion and extension. Adult patients with persistent back/leg pain and/or neurological or skeletal deformities should be investigated with MRI to establish an early diagnosis. Surgery should be performed in all adult patients with TCS, once the diagnosis is established.

Adult↗
PubMed1999

Spinal cord injury without radiographic abnormality in adults.

Spinal cord injury without fractures or bony malalignment on either plain radiographs or computed tomography (SCIWORA) is most commonly found in the paediatric age group. In recent years, magnetic resonance imaging (MRI) has been used to evaluate these patients. The present communication describes SCIWORA in 15 adult patients investigated by MRI. Of the 151 patients with spinal cord injury in 1 year, 15 adult patients had cervical SCIWORA. All patients were evaluated by MRI. The age ranged from 20 - 60 years. Eleven patients had partial cord injury, two had a complete cord syndrome while two had a central cord syndrome. MRI demonstrated an intervertebral disc prolapse in six patients, intramedullary haematoma/contusion in four and cord oedema in four patients. One patient had multiple disc prolapses and associated intramedullary haematoma. Patients with disc prolapse were operated upon and all showed neurological improvement. The rest of the patients were managed conservatively. There was mild improvement in patients with intramedullary haematomas while those with cord oedema alone showed moderate recovery. The pathogenesis of adult SCIWORA is possibly different from that in paediatric age group. Most of the patients with SCIWORA show some abnormality on MR imaging. MRI should therefore be done in all patients with spinal cord injury for diagnostic and prognostic purposes.

Adult↗
PubMed1997

Intracranial fungal granuloma.

BACKGROUND: Intracranial fungal granulomas are uncommon and their pathogenesis, clinical picture, and effectiveness of therapy remains unclear. METHODS: Thirty-two cases were studied retrospectively in two groups: (1) Rhinocerebral group (22 cases) had a chronic paranasal sinus (PNS) disease with secondary involvement of skull base, cranial nerves, and/or brain. The granulomas were adherent to dura, firm, avascular, and tough, requiring a knife to cut. (2) Primary intracranial group (10 cases) had no detectable PNS lesion at initial presentation. The granulomas were soft, suckable, and contained pus or necrotic material. RESULTS: Postoperative and overall mortality were 37.5% and 50%, respectively. Meningoencephalitis was the most common cause of death. Altered sensorium, pus in the granuloma, and/or severe brain edema were poor prognostic factors. All survivors except four have symptomatic residual or recurrent lesions. CONCLUSION: Early diagnosis with MRI or stereotactic biopsy, radical surgery, and high dose and chronic suppressive chemotherapy may improve overall results in these cases.

Adolescent↗
PubMed1997

Brain abscess in renal transplant recipients: report of three cases.

BACKGROUND: Neurologic complications occur in about 30% of renal transplant patients, infections being the most common. We encountered three such patients and present our experience in the management of such cases. CLINICAL MATERIAL: Three cases of brain abscess in renal transplant recipients are reported. These patients presented from 9-60 months after the transplant. One patient had a pyogenic abscess; in the second the organism identified was Nocardia asteroides; in the third, a fungal infection was responsible. In two patients excision of the abscess was done, while in one repeated aspirations with intracavitary antibiotics were used. All received systemic antimicrobial therapy. CONCLUSIONS: Central nervous system (CNS) complications, specifically infections, are quite common in renal transplant recipients, but reports of brain abscesses in these patients are very rare. The treatment options for such patients are discussed.

Adult↗
PubMed1995

Western blot analysis of cerebrospinal fluid for detection of Aspergillus antigens.

Western-blot immunoassay of cerebrospinal fluid (CSF) specimens of patients with central nervous system (CNS) aspergillosis (3), CNS candidosis (1) and bacterial meningitis (2) was carried out using pooled serum from histopathologically proven deep-seated aspergillosis cases to detect unique antigenic fractions for aspergillosis in CSF. No reactivity was observed in patients with non-fungal meningitis. Four cross-reactive bands (40, 90, 200 and > 200 KD) were detectable in CSF from patients with both aspergillosis and candidosis of the CNS. Four additional bands (90-200 KD) were consistently present only in patients with aspergillosis. One prominent band (110 KD) was found only in the patient with aspergillosis who had a fatal outcome and raised the possibility of being a poor prognostic marker.

Adolescent↗
PubMed1995

Multiple pyogenic brain abscesses.

Thirty eight patients with multiple pyogenic brain abscesses constituted 11% of all the brain abscesses treated during a 12 year period. Sixty per cent (23) of the patients were in the first two decades of life, including 9 (24%) infants. The clinical presentation was similar to brain abscess in general. 21 patients had altered "sensorium" at the time of admission. Otogenic brain abscesses were the commonest (26%), followed by those associated with congenital cyanotic heart disease (18%). The abscesses were invariably large in size. The pus was sterile on culture in 11 (29%) patients, while Staphylococcus aureus was the commonest organism grown in 9 (24%) patients. Aspiration of the pus was required as a life saving measure, to control raised intracranial pressure, in 29 (76%) patients. Twelve (32%) of these patients underwent secondary excision of the abscess capsule. The overall mortality was 32% with failure to control intracranial and systemic infection as the major causes of mortality. Level of consciousness at the time of admission was the most significant factor affecting the outcome. Surgery has a definite therapeutic and life saving role in the management of multiple pyogenic brain abscesses. A systematic treatment plan for multiple abscesses is proposed.

Adolescent↗
PubMed1995

Intramedullary tuberculoma: report of two cases with MRI findings.

Two cases of spinal intramedullary tuberculous granulomas (tuberculomas) without any bony involvement are reported. The rarity of the occurrence and the magnetic resonance imaging (MRI) findings are discussed. Microsurgical excision and antituberculous treatment produced good results.

Adult↗
PubMed1994

Supratentorial tumours in infants.

Three hundred and ninety-six paediatric (below 15 years of age) patients with brain tumours were treated at our institute in the last 4 years. Eighty-two of the tumours were located supratentorially. These 82 patients included 14 infants (below 1 year of age), who made up 3.5% of all paediatric patients with brain tumours and 17% and those with brain tumours in a supratentorial location. There was a male preponderance, and two-thirds of the 14 patients were within their first 6 months of life. Increasing head size, vomiting and failure to thrive were the common presenting features. One infant presented with asymmetric skull growth. The tumours tended to be large, occupying almost the entire affected cerebral hemisphere; histological types included astrocytomas, malignant astrocytomas, glioblastoma multiforme, primitive neuroectodermal tumours, malignant choroid plexus papillomas and malignant teratomas. Two children had congenital tumours and another two tumours, in children with associated lobar agenesis, were thought to be congenital in origin. Associated hydrocephalus was present in seven patients, but precraniotomy shunt was required in only two patients. The perioperative (within 1 month) mortality was 57%. Only 30% of the patients survived for more than 1 year after surgery and chemotherapy. The longest survival was 20 months. Delay in diagnosis, poor general condition prior to surgery, and the high vascularity and malignant nature of these tumours accounted for the poor results.

Astrocytoma↗
PubMed1994

Brain metastasis from urachal carcinoma: case report.

A rare case of metastasis to the brain from an urachal carcinoma is reported. Metastasis in the brain developed 7 months after partial cystectomy and radiation therapy. Cranial computed tomography showed a ring-enhancing mass lesion that was excised. A month later, the patient died of distant metastasis.

Adenocarcinoma↗
PubMed1994

Collet-Sicard syndrome after closed head injury.

A case is reported of basilar fracture of the occipital bone passing through the left occipital condyle, ascending the clivus anteriorly, with marked medial displacement of the bony fragment. The injury produced ipsilateral palsies of nerves IX through XII (Collet-Sicard syndrome). A CT scan accurately delineated the extent of the fracture. Partial neurological recovery ensued following surgery.

Adult↗
PubMed1994

Haemostatic derangement in patients with intracranial tumours.

Forty-five patients with brain tumours were studied for evidence of any haemostatic abnormalities in the preoperative and intraoperative period. An abnormality was found in 44 of the patients in the preoperative period and in all the patients during the operation. One patient developed acute disseminated intravascular coagulation. A change in the haemostatic abnormality from the preoperative to the intraoperative period was demonstrated in 9 of the patients. The histological nature of the tumour did not influence the haemostatic derangement. A shortened euglobulin lysis time, prolonged thrombin time, increased fibrin degradation products and abnormal fibrinogen levels were the common isolated abnormalities. When considered together, chronic disseminated intravascular coagulation (DIC) with or without fibrinolysis and fibrinolysis with or without DIC were the commonest abnormalities. Although some degree of haemostatic derangement is found in a high proportion of patients with brain tumours, clinically relevant abnormalities are rare.

Adolescent↗
PubMed1993

Value of precraniotomy shunts in children with posterior fossa tumours.

Seventy children with posterior fossa tumours treated over a period of 6 1/2 years were studied. Most patients presented in the late stage of disease. Sixty-four required insertion of a precraniotomy shunt for one or more of the following: persistent vomiting, severe headache, dehydration, poor general condition, failing vision, altered sensorium, marked periventricular lucency, and brain stem involvement deferring total removal of the tumour. Insertion of precraniotomy shunt improved the general condition and signs and symptoms of increased intracranial pressure. It also provided a lax brain during definitive surgery and a smooth postoperative course. Shunt-related complications, consisting of block and/or infection, were observed in 21 patients. It was concluded that precraniotomy shunt is important in the management of children with posterior fossa tumours in developing countries where these patients present in the late stage of disease.

Adolescent↗
PubMed1993

Complete dislocation with burst fracture of the lower cervical spine. Case report.

A patient with a complete fracture dislocation of the C6 vertebra without any neurological deficit is presented. The absence of neurological changes in an area of the spinal canal which is almost completely filled with the spinal cord is remarkable. The mechanism of injury in this patient is believed to be hyperextension associated with significant axial loading. Hyperextension first ruptured the anterior and the posterior longitudinal ligaments and then injured the pedicles of C6. The associated axial loading resulted in a 'bursting' of the posterior elements, thereby providing room for the spinal cord to move dorsally with the avoidance of a major neurological deficit.

Accidental Falls↗
PubMed1993

Multicentric gliomas: report of 2 cases.

Two cases of multicentric gliomas with long survival are reported. One patient underwent multiple surgical procedures while another had two separate surgical procedures at the same time. Presence of calcification of CT scan in one case raised suspicion for a preoperative diagnosis of oligodendroglioma. Lack of direct continuity or subarachnoid enhancement on CT scan and low histological grade of the tumours suggested their primary multicentric origin. The incidence of multicentric gliomas in our experience is 0.4% amongst 500 glial tumours over a period of eight years.

Adult↗
PubMed1993

Posterior fossa extradural haematoma--experience of nineteen cases.

Twenty-four cases of posterior fossa extradural haematoma constituted 4.16% of all extradural haematomas (576) and 1.12% of all craniocerebral trauma requiring surgery (2150). Five cases were excluded from this study. Of the remaining nineteen cases (the study group), lucid interval was present in eight (42.10%) cases. In half of the cases, the clinical course was acute. Neck stiffness and drowsiness were the commonest clinical signs. Occipital bone fracture was present in 57.89% cases. CT scan was the most valuable investigation in the diagnosis and detection of the associated intracranial injury in 18 cases. Associated intracranial injury was present in seven (36.84%) of these cases. Two (11.1%) of these patients died despite emergency surgery. The Glasgow Coma Scale prior to operation and the presence of associated supratentorial injuries were important prognostic factors. It is concluded that posterior fossa extradural haematoma should be suspected in the presence of a fall on the back of the head, drowsiness, neck stiffness or an occipital bone fracture.

Adolescent↗
PubMed1992

Intracranial olfactory neuroblastoma: evidence for olfactory epithelial origin.

AIMS: To determine the possible histogenesis of the intracranial variant of olfactory neuroblastoma. METHODS: Four specimens from three cases of intracranial olfactory neuroblastoma were studied by light microscopy and immuno-histochemistry, and electron microscopy in two cases. RESULTS: Light microscopical examination showed small cell tumour with additional features of epithelioid cells in one case and ganglion cells in another. Olfactory and Homer-Wright rosettes were present. All the specimens showed a uniform positive reaction to neurone specific enolase, S-100, and cytokeratin antibodies. Glial fibrillary acidic protein was absent. The salient electron microscopic features were the presence of cell junctions, cytoplasmic intermediate filaments, basal bodies and cytolasmic processes. Dense cored vesicles were absent. CONCLUSIONS: The results strongly support the view that intracranial olfactory neuroblastomas are of olfactory epithelial origin and differ from conventional neuroblastomas.

Adult↗