Biomedical subjects
Publications and source records attributed to D Nagaraja.
A case of crossed aphasia in a monolingual dextral with detailed clinical, neuropsychological and language assessment is described. The presence of Gerstmann-syndrome suggested cross-over of even dominant parietal lobe functions. Lateralization and localization of various language functions in relation to crossed aphasia are discussed.
CT Scan of 30 patients with multi-infarct dementia (MID) were compared with age- and sex-matched controls. Infarcts were seen in 93% of MID cases and 10% of controls. A marked difference in the occurrence of white matter low attenuation was seen between the groups. All the parameters of cerebral atrophy studied showed a statistically significant correlation with the presence of dementia.
Isolated intraventricular haemorrhage (IVH) in the absence of parenchymal haematoma is unusual. Fifteen patients with solitary IVH among 170 with intracranial haemorrhage were studied. Clinical details and computed tomographic features were analysed to evaluate the prognostic significance of various clinical and CT parameters. Outcome is affected by hypertension, level of consciousness, clinical progression, pupillary changes and restriction of eye movements. Factors found on CT to have prognostic significance included degree of ventricular bleed, presence of cisternal bleed, hydrocephalus and cerebral atrophy.
One hundred patients with ischaemic cerebro vascular disease (TIA/RIND--67% and completed stroke--33%) were evaluated for various clinical and biochemical risk factors. Evidence of extra-cranial carotid vascular disease (ECCVD) was looked for by using Doppler scan and carotid angiography. Of the 28 patients with abnormal Dop scan, 27 were confirmed to have ECCVD by angiography. Though the history of hypertension was elicited in 40%, only 28% had BP of 160/95 mm Hg or more during hospital stay. Hypertension was twice more common in ECCVD group compared to the group with normal carotid vessels. Obesity was seen in 15%, diabetes mellitus in 10% and 1% had hyperuricaemia. Total cholesterol was elevated in 29% and HDL cholesterol fraction was decreased (less than 35 mg%) in 43%. The reduction of HDL cholesterol was more frequent in ECCVD group (63%) and in hypertensive (73%) patients. Lipoproteins, triglycerides, free fatty acids and phospholipids were not significantly affected.
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A sixty two year old man who presented with tremors of trunk and lower limbs, appearing only on standing, is reported. The tremor frequency was 14-16 Hz and there was co-contraction of antagonistic muscles. No therapeutic benefit was noted with propranolol, primidone and diazepam. The possible pathogenesis of this rare orthostatic trunkal tremor and its relationship with essential tremor are discussed.
Twenty-six patients of intracerebral haemorrhage (ICH) were treated by surgical evacuation of clot. Six patients were operated within 24 hour, four on the second day, seven between the third and fifth day and nine after five days. Their therapeutic out-come was compared with an equal number of age, location and severity matched group of patients of ICH who did not undergo surgery. Mortality in surgically treated group (16/26) was comparable to control group (20/26), however, follow up of survivors showed slightly reduced morbidity in operated group. Patients in grade III (level of consciousness) were the only ones who were benefited from surgery. The timing of the surgery did not affect the immediate mortality.
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Lithium intoxication is well known to produce acute and chronic symptoms but development of permanent neurological deficit is a rarity. Six cases of manic depressive psychosis who developed neurological sequelae following treatment with lithium carbonate are described. There were multiple lesions in the central nervous system. However, the main brunt was borne by cerebellum. The serum lithium levels of five patients were within therapeutic range. The value of identifying the precipitating factors, early diagnosis and prompt intervention in the prevention of persistent neurological dysfunction is emphasized.
A patient with Sturge-Weber-Dimitri disease presented with intractable seizures and progressive intellectual deterioration. There was no facial nevus or focal neurologic abnormality. CT disclosed bilateral calcification in a parieto-occipital gyral pattern. Histopathology of the brain revealed extensive calcification of vessel wall in parieto-occipital cortices.
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The clinical and EEG profiles of 13 cases of eating epilepsy are described. Temporal lobe epilepsy (TLE) formed the seizure type in 12 cases. In all but one case, the seizures were precipitated only by eating a heavy meal. In ten cases EEG showed interictal seizure discharges. EEG recordings were obtained from 12 patients during and after eating. In two patients clinical attacks (TLE) could be induced by eating in the laboratory. There was a good response to conventional anticonvulsants in only 3 cases. Alteration of eating habits helped in controlling reflex seizures in 2 cases. Various mechanisms of reflex precipitation of seizures by eating are discussed.