Biomedical subjects
Publications and source records attributed to Naim-Ur-Rahman.
The authors report a rare case of cranial and intracranial mycetoma which presented with occipital sinuses, extensive involvement of skull vault and base, an extradural granuloma and intracranial hypertension. Radiological appearances are reviewed. The computerized tomography findings are the first of their kind for this condition. The diagnosis and treatment of this disease are discussed.
Twenty-three patients with atypical forms of spinal tuberculosis treated between 1975 and 1985, are described. All presented with signs and symptoms of compression of the spinal cord or cauda equina, ranging from paraesthesiae and increasing weakness of extremities to paraplegia and loss of sphincter control. None of them showed visible or palpable spinal deformity nor the typical radiographic appearance of destruction of the intervertebral disc and the two adjoining vertebral bodies. These atypical forms constituted about 12 percent of all the cases of spinal tuberculosis seen (a total of 190 cases); and fell into three well-defined groups: those with the involvement of neural arch only; those with the involvement of a single vertebral body; and, those without bony involvement. The correct surgical approach in these groups was found to be different: spinal cord compression caused by the tuberculous disease of the neural arch was best treated by laminectomy; whereas single vertebral body disease required an anterior or anterolateral approach. Spinal computerized tomography was helpful in defining the extent of disease and planning the surgical approach. Histological confirmation of tuberculosis was obtained in all the cases and acid fast bacilli (A.F.B.) were found in, and cultured from, the biopsy specimens of 18 cases.
Experience with fifteen consecutive cases of intracranial tuberculomas, treated between 1981 and 1986, is summarized. Histological confirmation was obtained in twelve patients, and acid fast bacilli (AFB) were found in and cultured from the excised lesions and biopsy specimens in nine patients. Difficulties in diagnosis are discussed. A plan of management combining the operative treatment and medical therapy of the tuberculomas is outlined. The value of computerized tomography in the diagnosis and management of these patients is emphasized.
Multiple phaeohyphomycotic brain abscesses caused by Cladosporium species occurred in a 55 year old woman. No immunological abnormality could be detected. The disease ran a protracted course for a total of 20 months before she died from sudden rupture of an abscess loculus into the ventricular system. Course was characterised by spontaneous remissions and relapses totally independent of adequate doses and prolonged regimes of all the three available anti-fungal chemotherapeutic agents, namely amphotericin B, flucytosine and ketoconazole. Three surgical procedures were carried out; and surgical intervention appeared to be the only modality of treatment capable of prolonging the life or altering the course of the disease. An interesting transitory pulmonary phase of phaeohyphomycosis resembling miliary tuberculosis was noticed. This may help to explain the portal of entry and mole of spread of the fungus to the brain. A dematiaceous fungus was isolated from these abscesses. Mycologic features and histology of brain lesions are described.
A case of multiple intracranial tuberculomas with miliary lesions of the lungs is reported. Atypical clinical presentation; non-specific computed tomographic findings showed large intracranial masses producing a midline shift and progressive neurological deficit necessitating excision of the symptomatic mass. Acid fast bacilli were found in the excised lesion and cultured from biopsy specimens.