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Biomedical subjects

M J Chandy

Publications and source records attributed to M J Chandy.

At least 73 records · Page 4Linked to original sources
PubMed1994

Successful stereotactic management of a large cardiogenic brain stem abscess.

The brain stem is an unusual location for a pyogenic abscess. We report a case of a brain stem abscess in a 5-year-old boy with tetralogy of Fallot that was refractory to conservative medical therapy but was cured after a single computed tomographic-guided stereotactic aspiration and appropriate antibiotic therapy. The remarkable features in this case were the extremely large size of the abscess (3.2 cm in diameter), occupying the full vertical extent of the brain stem and containing 15 ml of pus. We believe this is the first report of a favorable outcome in a cardiogenic brain stem abscess. The value of computed tomographic-guided stereotactic surgery in the management of this lethal condition is documented with a review of the relevant literature.

Brain Abscess↗
PubMed1994

Predictive value of computed tomography-based diagnosis of intracranial tuberculomas.

The need to obtain histological diagnoses of intracranial tuberculomas, before initiating therapy, is not universally accepted, because some clinicians believe that an image-based diagnosis is fairly accurate in patients from endemic regions. To evaluate the sensitivity, specificity, and predictive value of computed tomography (CT)-based diagnosis of an intracranial tuberculoma, we prospectively compared the preoperative imaging diagnoses with histological diagnoses in 105 consecutive patients with intracranial masses. CT differential diagnoses (first or second) of tuberculomas were considered in 21 patients. Seven of them were histologically confirmed to have tuberculomas (true-positive results); 14 had other diseases (false-positive results). The 14 false-positive cases included 6 cases of astrocytomas, 5 of metastases, and 3 with miscellaneous diagnoses. All tuberculomas were correctly diagnosed on the CT scans (5 by both surgeons and 2 by one surgeon). During the study period, we encountered 11 patients who were referred by other clinicians with diagnoses of tuberculomas on the basis of their CT scans. We concurred with their CT diagnoses in 5 of them, but only 1 patient had a histologically verified tuberculoma. Astrocytomas (4 patients), metastases (3 patients), and solitary cysticercus granulomas (3 patients) were the causes of misdiagnosis in this group of patients. Although the sensitivity of CT in the diagnosis of intracranial tuberculomas is 100%, and its specificity is 85.7%, the positive predictive value is only 33% (confidence limits, 24-42%). The negative predictive value is 100%. The low positive predictive value for a diagnosis of intracranial tuberculoma on CT alone indicates the need for a confirming histological diagnosis.

Adolescent↗
PubMed1994

Mucoceles: a neurosurgical perspective.

The neurosurgical manifestations in three patients with sphenoid sinus mucoceles and two others with fronto-ethmoidal mucoceles are presented. In two patients, sphenoid sinus mucoceles produced visual loss while in the other severe headache was the only symptom. Both patients with fronto-ethmoidal mucoceles presented with proptosis. All patients had surgical treatment. While other symptoms were relieved following treatment, visual loss remained unchanged in both patients in whom it was present. We recommend a high level of suspicion for mucoceles as a cause of sudden or progressive visual loss. Prompt surgical therapy is needed to achieve good visual outcome.

Adolescent↗
PubMed1994

Intrasellar tuberculoma.

Although intrasellar tuberculomas have been reported in post-mortem examinations, they are exceptionally rare in clinical practice. Five patients with biopsy proven intrasellar tuberculoma with suprasellar extension are described. In four cases the clinical and radiological diagnosis was that of a pituitary adenoma. One patient, however, presented similar to a subarachnoid haemorrhage, but the CSF analysis was suggestive of tuberculous meningitis. All these patients presented either with intermittent headache or a sudden severe headache suggestive of an ictus. Hypopituitarism was diagnosed on clinical grounds in two patients and one patient had an associated galactorrhoea-amenorrhoea syndrome. Only one patient had a bitemporal field cut. In all other patients ophthalmological examination was normal. The CT scan showed a hyperdense sellar mass with suprasellar extension brightly enhancing with contrast in all cases. An angiogram in four patients did not reveal any vascular lesion. Laboratory investigation showed some degree of hypopituitarism in all cases. Transsphenoidal surgery was performed in four patients and operative findings were typical, and unlike those of a pituitary adenoma. All patients responded well to antituberculous treatment and at the end of 12 months were clinically and radiologically normal.

Adenoma↗
PubMed1994

Enlarging solitary cysticercus granulomas.

Solitary cysticercus granulomas that produce seizures usually measure less than 20 mm in diameter and diminish in size spontaneously. Unlike live cysticercus cysts, they have not been known to increase in size. In a prospective follow-up study of 93 consecutive patients with epilepsy and small solitary lesions (< 20 mm in diameter) enhancing on computerized tomography (CT), 91 were found to have solitary cysticercus granuloma; of these, seven (7.7%) were diagnosed as having an enlarging cysticercus granuloma. Enlarging lesions were defined as those that, on follow-up CT, had increased by more than 50% of their original size but were still less than 20 mm in diameter (Group 1, three patients) or those that had increased to more than 20 mm (Group 2, four patients). Excision biopsy is recommended for Group 2 solitary lesions, regardless of the clinical progression, to eliminate the possibility of other pathologies. However, a trial of albendazole therapy with early CT re-evaluation (within 4 to 6 weeks) may be warranted in those with Group 1 lesions and in selected patients with Group 2 lesions. It is important to recognize the entity of enlarging solitary cysticercus granuloma to avoid mistaking it for a tuberculoma and treating the patient with empiric antituberculous therapy.

Adolescent↗
PubMed1993

Ascorbic acid and focal cerebral ischaemia in a primate model.

Neuronal cell damage following ischaemia is postulated to be due to free radical induced lipid peroxidation, and ascorbic acid is supposedly an important non-enzymatic scavenger of such free radicals. This study was undertaken to evaluate the protective effect of ascorbic acid on the brain in a primate model after focal cerebral ischemia. Consumption of ascorbic acid in the monkey brain following ischaemia and its effect on macroscopic infarct size as demonstrated by 2, 3, 5, Triphenyl tetrazolium chloride (TTC) staining were used as parameters. The monkeys in the treated group were given 1 gram ascorbic acid parenterally every day for six days. The mean level of total ascorbic acid in right basal ganglia was 35.1 +/- 4.2 micrograms/mg of protein in the treated group as opposed to 22.9 +/- 2.1 micrograms/mg of protein in the nontreated group both before ischaemia. After right middle cerebral artery occlusion to produce focal cerebral ischaemia, the total ascorbic acid in the right basal ganglia 2 hours post ischaemia was 13.3 +/- 3.1 micrograms/mg of protein in the treated group as opposed to 9 +/- 1.6 micrograms/mg of protein in the untreated group. The average consumption of total ascorbic acid was 21.8 micrograms/mg of protein in the treated group and 13.9 micrograms/mg of protein in the nontreated group. Macroscopic infarct size as determined by TTC staining in the right cerebral hemisphere was 11.7 +/- 6.9 in treated group whereas it was 24.4 +/- 4.4 (expressed as percentage of right hemisphere) in the non-treated group. There was significant reduction in the size of the infarct in the treated group.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Tuberculous granuloma of the clivus.

We report the clinical features of a middle-aged man who presented with multiple cranial nerve dysfunction and who, on computed tomography (CT) and magnetic resonance (MR) imaging, proved to have a lesion of the clivus extending down to the body of the axis. Biopsy and limited excision showed this to be a tuberculous granuloma which grew M. tuberculosis on culture.

Cranial Fossa, Posterior↗
PubMed1993

CT-guided stereotactic surgery in the management of intracranial tuberculomas.

CT-guided stereotactic techniques were used in the management of 21 patients (22 procedures) with intracranial tuberculomas. In 17 patients CT-guided stereotactic surgery was performed to obtain a diagnosis; 10 patients with small superficial lesions or masses in eloquent areas had an excision biopsy following CT-guided stereotactic craniotomies (Group A); seven patients underwent a closed stereotactic biopsy (Group B). Four patients (five procedures) with previously proven tuberculous disease had stereotactic aspiration of a cystic tuberculous mass (Group C). All patients in Group A had a definite histological diagnosis of a tuberculoma. Of the seven in Group B, a definitive diagnosis was obtained in two; in four patients the biopsy showed evidence of chronic inflammation; and in one the procedure was abandoned due to venous hemorrhage. All patients in Group C had amelioration of their symptoms following aspiration of the contents of the cystic mass. There was transient operative morbidity in two patients. There was no procedure-related permanent disability or mortality. CT-guided stereotactic biopsy being minimally invasive, is ideally suited for the management of deep-seated intracranial tuberculomas as they can be treated medically once a diagnosis is secured. A diagnosis of chronic inflammation obtained on CT-guided stereotactic biopsy, in correlation with the clinical and radiological findings, often provides confirmatory evidence of a tuberculoma in a patient with an intracranial mass. It also rules out a neoplasm and avoids empiric therapy of brain masses. Stereotactic localization techniques also help avoid possible morbidity associated with the excision of superficial small tuberculomas from eloquent areas.

Adult↗
PubMed1993

Intracranial aspergillus granuloma.

Intracranial aspergillus granulomas over a 12-year period were studied retrospectively. Three distinctive types of presentations were seen, namely nine patients had the rhinocerebral form with primary involvement of the air sinuses and secondary involvement of the skull base, cranial nerves and brain, three patients with the apparently purely intracranial form presented like any other space occupying lesion and one patient who had a 'stroke-like' presentation had a parasellar lesion. None of these patients were immunocompromised. The clinical features, and the medical and surgical options are discussed together with outcome.

Adult↗
PubMed1993

Differentiating solitary small cysticercus granulomas and tuberculomas in patients with epilepsy. Clinical and computerized tomographic criteria.

It is commonly believed that differentiating solitary small cysticercus granulomas and small tuberculomas in patients with seizures is difficult without resorting to an excision biopsy. The aim of this study was to formulate clinical and computerized tomography (CT) criteria to distinguish these two entities in patients with epilepsy. Toward this end, clinical and CT data from six consecutive patients with histologically proven small solitary tuberculomas and 25 consecutive patients with histologically proven solitary cysticercus granulomas were compared. Evidence of raised intracranial tension and a progressive focal neurological deficit was seen only in patients with tuberculomas (two of six cases). All tuberculomas were greater than 20 mm in size and five of the six were irregular in outline. Only tuberculomas were associated with a midline shift on CT (four of six cases). All cysticercus granulomas were less than 20 mm in size and 24 (96%) of the 25 were regular in outline, conforming to one of two characteristic patterns. No cysticercus granuloma was associated with a midline shift. Based on the above clinical findings (evidence of raised intracranial tension and a progressive neurological deficit) and CT criteria (size, shape, and association with a midline shift), it is possible to separate these two entities in a majority of patients with seizures and with a single small lesion on CT.

Adolescent↗
PubMed1993

Nondiagnostic CT-guided stereotactic biopsies in a series of 407 cases: influence of CT morphology and operator experience.

Nondiagnostic biopsies were analyzed in a consecutive series of 407 patients undergoing computerized tomography (CT)-guided stereotactic biopsies. These were categorized as either negative biopsies, when normal tissue or nonspecific pathology was found, or inconclusive, when a definitive diagnosis could not be made although representative tissue was obtained. Nineteen biopsies (4.7%) were negative and 10 (2.4%) were inconclusive, giving an overall nondiagnostic biopsy rate of 7.1% (29 of the 407 cases). Suspected neoplastic masses (390 cases) were classified on the basis of their CT morphology into four groups: Group 1 included purely hypodense nonenhancing masses; Group 2 included isodense nonenhancing masses; Group 3 included ring-enhancing masses; and Group 4 included mixed-density enhancing masses. Although a higher proportion of hypodense nonenhancing masses (six of 56, or 10.7%) yielded a negative result, there was no statistically significant difference in the negative biopsy rates for the different CT categories (p = 0.06). The negative biopsy rates for the 6 years of the study, 1987 to 1992 (1987 being an incomplete year) were as follows: 13.3%, 6%, 3.2%, 3%, 5.8%, and 2.7%. There was no significant decrease in the negative biopsy rate as experience with this procedure increased (p = 0.20). A total of eight surgeons independently performed the biopsies. There was no significant difference (p = 0.24) in the negative biopsy rate of the surgeon with the most experience (124 biopsies, 2.4% negative biopsy rate) compared with that of the seven other surgeons combined (283 biopsies; 5.7% negative biopsy rate). These findings suggest that the yield in a stereotactic biopsy is independent of the CT appearance of the mass. Adherence to certain basic principles in patient and target selection will ensure a reasonable percentage of positive yield with stereotactic biopsy procedures even if the surgeon is relatively inexperienced. There does not appear to be a learning curve in the performance of CT-guided stereotactic biopsies. The management of patients with nondiagnostic biopsies is discussed.

Biopsy↗
PubMed1993

Hyperprolactinemia in women--a series of 71 cases.

Seventy one cases of hyperproloactinemia (HPRL) in women were seen over five years. Of these, twenty five had pituitary tumors, thirty three had functional HPRL, five had drug induced HPRL and four had hypothyroidism. Surgery was undertaken in fifteen women, rest were treated with bromocriptine. There were thirteen pregnancies in patients with tumor after treatment. Seven of thirty three patients with functional HPRL conceived. No patient had tumor expansion or recurrence during pregnancy. Bromocriptine was required for most patients.

Adult↗
PubMed1992

Intrasellar tuberculoma.

Intrasellar tuberculoma mimicking a secreting adenoma is a rare occurrence. Although clinical and radiological features were suggestive of pituitary adenoma, histopathological examination following surgery showed a tuberculoma. There were no clinico-radiological features pathognomonic of an intrasellar tuberculoma.

Adult↗
PubMed1992

Cystic cerebellar schwannoma.

Cystic cerebellar schwannoma is a rare tumour which may not be considered when a low attenuation computed tomographic (CT) lesion is seen in the cerebellar parenchyma. Since the origin of the Schwann cell in the cerebellar parenchyma is conjectural, immunohistochemical techniques are necessary for a diagnosis.

Adult↗
PubMed1992

Management strategies in tuberculous atlanto-axial dislocation.

Tuberculous atlanto-axial dislocation is an uncommon disease. Five of six patients with tuberculous atlanto-axial dislocation were successfully managed using different strategies. The advantages and disadvantages of these different protocols and their appropriateness in a particular clinical situation are discussed.

Adolescent↗
PubMed1992

Solitary ectopic intracerebral schwannoma.

Intracerebral Schwannoma is a rare tumour which can mimic meningioma clinically, radiologically and morphologically. Immunohistochemical techniques are necessary to confirm the Schwann cell origin of the tumours. We report such a tumour in the posterior frontal parasagittal region. The origin of Schwann cells in the central nervous system is still speculative and various postulations are discussed.

Adult↗
PubMed1992

Incidental pituitary macroadenomas.

Five cases of incidentally detected pituitary macroadenomas are described. All five had suprasellar extensions, but none had visual field defects as tested by computed perimetry. One patient had sellar changes seen on an X-ray film taken following a head injury, while the others were detected by computed tomography performed for seizures, stroke and meningitis. Four patients underwent trans-sphenoidal surgery for suprasellar extensions with or without hypopituitarism, while one was managed conservatively as he had normal visual fields and pituitary function and there was a spontaneous decrease in size of the adenoma. The management of such incidental pituitary macroadenomas is discussed.

Adenoma↗