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Biomedical subjects

V K Kak

Publications and source records attributed to V K Kak.

At least 19 recordsLinked to original sources
PubMed1998

Spontaneous intracranial hematomas: role of dynamic CT and angiography.

Forty-five patients with spontaneous intracerebral hemorrhage (ICH) were studied prospectively by dynamic CT and cerebral angiography. The accuracy of dynamic CT in demonstrating the underlying vascular cause in ICH was evaluated. Dynamic CT correctly predicted 90% of aneurysms, 83% of AVMs and 100% of normal studies as compared to angiography. Cerebral angiography can be obviated in patients where dynamic CT does not show any obvious vascular anomaly.

Adolescent↗
PubMed1997

Growing skull fractures: a clinical study of 41 patients.

Growing skull fractures are rare complications of head injury, occurring almost exclusively in infants and children under the age of three. A retrospective review at our Institute yielded 41 patients with this entity over a period of 20 years (1975-1995). The age at presentation ranged from less than 1 year to 62 years, with 33 (80.5%) patients being less than 5 years of age. The cause of injury was either a fall from a height (93%) or a road traffic accident. The most common location of a growing skull fracture was either parietal or frontoparietal (56%). One patient had a posterior fossa growing skull fracture. CT scan was performed in 19 patients which demonstrated an underlying porencephalic cyst, hydrocephalus or a cyst communicating with the ventricle. In 5 children, a ventriculo-peritoneal shunt alone was performed. Twenty four patients underwent a duro- and cranioplasty while a duroplasty alone was performed in 8 patients. The material used for cranioplasty included acrylic, wire mesh, steel plates or autologous bone. Three patients died, one due to an anaesthetic complication and two as a result of postoperative meningitis. Post-operative CSF leaks occurred in 3 patients, which were managed by a lumbar drain. Six patients had local wound infection.

Adolescent↗
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↗
PubMed1996

Cranial cystic epidermoid: report of two cases and review of the literature.

Intercranial epidermoid tumours are benign lesions of congenital origin that are potentially curable. Although computerized axial tomography (CT) and magnetic resonance imaging (MRI) are usually diagnostic, a few atypical features sometimes make pre-operative diagnosis difficult. Two cases of cystic epidermoids with peripheral ring enhancement are reported. Relevant literature has been reviewed.

Adult↗
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↗
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

Aneurysmal bone cysts of the spine.

Aneurysmal bone cysts are uncommon bony lesions of the spine. Two such patients are reported in the study. The first patient had involvement of first and second thoracic vertebrae, and a preoperative diagnosis was made possible due to the typical magnetic resonance imaging appearances. A total removal was achieved in two stages. In the second patient the C2 spinous process was involved, and this patient presented as atantoaxial dislocation. Removal of the abnormal tissue and posterior fusion was done. Both the patients showed neurologic improvement. The relevant literature is reviewed.

Adult↗
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

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↗
PubMed1994

Choroid plexus tumours--an immunohistochemical analysis with review of literature.

Immunohistochemical analysis of 9 choroid plexus papillomas (CPPs) and 3 choroid plexus carcinomas (CPCs) using a panel of antibodies against glial fibrillary acidic protein (GFAP), cytokeratin (CK), epithelial membrane antigen (EMA), S-100 protein, vimentin (vim), and neuron specific enolase (NSE) is presented. Focal positivity was observed for GFAP in 11, vimentin in 7, cytokeratin in 2 and EMA in 3 cases. Diffuse and intense immunoreactivity for S-100 protein was seen in all papillomas, however, unreactive areas were noted in carcinomas. All cases exhibited focal to diffuse NSE positivity. Location and type of the tumour and age of the patient did not influence the staining pattern except for predominant S-100 positivity in papillomas. The significance of these findings is discussed in relation to the differential diagnosis or immunoreactivity patterns of these tumours.

Adult↗
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

Spontaneous haemorrhage associated with a brain abscess.

Spontaneous haemorrhage in association with a brain abscess is a very rare occurrence and may confuse the CT diagnosis. A case of cerebral abscess with haemorrhage into the abscess cavity, the surrounding brain parenchyma, the subarachnoid space and the ventricular system is reported. The differential diagnosis, pathogenesis and the management of such a case are discussed and the literature reviewed.

Brain Abscess↗
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↗