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Biomedical subjects

V Rajshekhar

Publications and source records attributed to V Rajshekhar.

At least 19 recordsLinked to original sources
PubMed1992

Results of routine ventriculostomy with external ventricular drainage for acute hydrocephalus following subarachnoid haemorrhage.

We reviewed the results of ventriculostomy with external ventricular drainage in patients with acute hydrocephalus complicating subarachnoid haemorrhage. Of 194 consecutive patients with subarachnoid haemorrhage admitted during the past eight years, 52 (27%) developed hydrocephalus within 72 hours of the ictus. Patients with acute hydrocephalus were in grades III to V (Hunt and Hess) at the time of evaluation and all patients with hydrocephalus underwent ventriculostomy within 24 hours of diagnosis. Twenty-six patients improved within 24 hours of cerebrospinal fluid drainage and 17 of these patients underwent surgery, nine of whom did well (Glasgow Outcome Scale 1 and 2). All 18 patients who did not improve within this period, including one who worsened, died. In eight patients the response to ventriculostomy was considered as undetermined, because of the proximity of the drain insertion to a definitive surgical procedure, and all of them had an excellent outcome (Glasgow Outcome Scale 1). Of 32 patients in grades IV and V, 17 did not improve and all of them died. Eight of the 15 patients in these grades, who were in the improved or undetermined categories, did well. Five patients (10%) developed meningitis. All patients with this complication had drainage for more than four days. Seven patients (14%) had a rebleed during the drainage. All except one patient with a rebleed had no surgery or delayed surgery and in six of them recurrent haemorrhages occurred after more than 24 hours of drainage. We conclude that routine ventriculostomy with external ventricular drainage should be considered for all patients with altered sensorium and acute hydrocephalus following subarachnoid haemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Continuous impedance monitoring during CT-guided stereotactic surgery: relative value in cystic and solid lesions.

Continuous monopolar impedance monitoring was performed during CT-guided stereotactic procedures involving 46 probe passages in 33 patients. Four readings were obtained during each passage to the lesion corresponding to the gray matter (A), subcortical white matter (B), perilesional tissue (C), and the target (D). The mean impedance of low-grade gliomas (442.7 +/- 96.1 SD ohm) was lower than that of high-grade gliomas (675 +/- 67.3 SD ohm) (p = 0.01). But because of considerable overlap of values in the 400-700 ohm range only impedances of less than 400 ohm and greater than 700 ohm are capable of predicting pathology, the former being associated with low-grade gliomas and the latter with high-grade gliomas. The mean change in impedance from the perilesional tissue to the target (C-D) was higher for cystic lesions compared with the solid lesions (127.5 +/- 131.5 SD versus 78.9 +/- 72.4 SD ohm) but was not statistically significant (p = 0.148). Impedance monitoring was found to be particularly useful in determining the entry into thick-walled cysts. It also helped elucidate the structures encountered in the probe track. Overall this procedure is a simple and useful adjunct, which can enhance the accuracy of selected CT-guided procedures without unduly increasing the length of the procedure or altering the morbidity.

Astrocytoma↗
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↗
PubMed1991

Acute effects of a pedicled omental graft on cold-induced brain oedema in cats.

When used as a prophylactic measure and in chronic experiments, omental transposition has been shown to reduce ischaemic and traumatic oedema in the spinal cord and ischaemic oedema in the brain. We designed this experiment to evaluate the acute effects of a pedicled omental graft on cold-induced brain oedema in cats. Focal oedema was induced in the left frontoparietal region of the brain of nine anaesthetized cats. In five cats, a laparotomy was done and a pedicled omental graft was placed on the lesioned left hemisphere immediately after the cold lesion was made. All cats were sacrificed 72 hours later, and the water content of the white matter was determined in the lesioned and the normal hemispheres. The mean water content of the lesioned hemisphere of the treated group of animals was not significantly different from that of the control group. We conclude that a pedicled omental graft failed to reduce vasogenic oedema in an acute model and probably has no role in the acute management of brain oedema.

Animals↗
PubMed1991

Etiology and management of single small CT lesions in patients with seizures: understanding a controversy.

Single, small (less than 1 cm) enhancing lesions are frequent findings on CT scans of Indian patients with seizures. These lesions have also been reported in patients from other parts of the world. They often resolve spontaneously and their etiology has been disputed for over a decade. Initially diagnosed in Indian patients as tuberculomas, a number of other etiologies have been suggested. More recently, based on biopsy data, we have shown that a majority of these lesions are caused by cysticercosis. This review traces the development of the controversy and reports the current understanding of their etiology. A logical approach to their management is also discussed.

Biopsy↗
PubMed1991

Single small enhancing CT lesions in Indian patients with epilepsy: clinical, radiological and pathological considerations.

Thirty consecutive Indian patients with focal or generalised seizures and single, small (less than 10 mm), enhancing lesions on CT scans (SSECTL) were studied. Five patients (Group A) were treated with anticonvulsants alone and did not have a biopsy. In ten patients (Group B) a CT guided stereotaxic biopsy of the lesion was carried out and in the remainder (15-Group C) and excision biopsy of the lesion was carried out following CT guided stereotaxic localisation. In all patients in Group B the lesion were reported as "chronic nonspecific inflammation". In seven of 15 patients in Group C the lesions showed a cysticercus with a granuloma and in a further five the pathology was that of a "parasitic granuloma" but the parasite could not be identified. Biopsy did not reveal a tuberculoma or neoplasm in any of the patients. The lesions studied are the same as "disappearing" CT lesions reported in Indian patients, as in 12 of 15 patients in Groups A and B, who could be followed up for more than three months, the lesions had spontaneously disappeared or left calcific residues. It is concluded that in Indian epileptic patients with SSECTL cysticercosis is the commonest aetiology. A treatment protocol for these patients is suggested on the basis of the findings.

Biopsy↗
PubMed1991

Neurovascular relationships of the root entry zone of lower cranial nerves: a microsurgical anatomic study in fresh cadavers.

The study describes the microsurgical neurovascular relationships of the root entry zone of lower cranial nerves in 23 cadavers. The vessel type, frequency of contact and site of contact on the root entry zone were analysed. Three types of vascular patterns (Types I-III) were found. Facial nerve: frequency of contact 31.8%; arterial contact 92.9%, Type I (lying across) 78.9%; anterior inferior cerebellar artery in 84.6%. Glossopharyngeal nerve: frequency of contact 23.9%; arteries 54.5%, veins 45.5%; posterior inferior cerebellar artery in 83.3% and Type II (loop) 50.1%. Vagus nerve: frequency of contact 26.1%, arteries 58.3%. Types II and III (passing through) formed 42.9% each. Hypoglossal nerve: frequency of contact 78.2%; vertebral artery 88.9%. No 'grooving' on any nerve was seen. Hence, 'contact' by a vessel at the root entry zone may not be significant in the etiology of lower cranial rhizopathies.

Adolescent↗
PubMed1991

Shunt surgery for hydrocephalus in tuberculous meningitis: a long-term follow-up study.

Hydrocephalus is a common complication of tuberculous meningitis. Case studies of 114 patients with tuberculous meningitis and hydrocephalus, who underwent shunt surgery between July, 1975, and June, 1986, were reviewed to evaluate the long-term outcome and to outline a management protocol for these patients based on the results. Seven factors were studied in each case: 1) age at admission; 2) grade on admission (I to IV, classified by the authors; Grade I being the best and Grade IV being the worst); 3) duration of alteration of sensorium; 4) cerebrospinal fluid (CSF) cell content at initial examination; 5) CSF protein levels at initial examination; 6) number of shunt revisions required; and 7) the necessity for bilateral shunts. During a long-term follow-up period ranging from 6 months to 13 years (mean 45.6 months), the mortality rate was 20% for patients in Grade I; 34.7% for patients in Grade II; 51.9% for patients in Grade III; and 100% for patients in Grade IV. Only the grade at the time of admission was found to be statistically significant in determining final outcome (p less than 0.001). Based on these results, the authors advocate early shunt surgery for Grade I and II patients. For patients in Grade III, surgery may be performed either if external ventricular drainage causes an improvement in sensorium or without selection. All patients in Grade IV should undergo external ventricular drainage and only those who show a significant change in their neurological status within 24 to 48 hours of drainage, should have shunt surgery.

Adolescent↗
PubMed1990

Avoiding empiric therapy for brain masses in Indian patients using CT-guided stereotaxy.

Empiric therapy, especially antituberculous therapy, is frequently given to Indian patients with brain masses. This report documents our experience in avoiding such therapy using CT-guided stereotaxy. Out of 101 procedures done on 99 patients with brain masses, 80 were done to obtain a histological diagnosis and 21 for therapeutic purposes. There was no mortality and 2% morbidity. A positive diagnosis was obtained in 94% (75/80) of patients undergoing a biopsy. Diagnosis of tuberculous lesions was based mainly on the presence of acid-fast bacilli in the biopsy specimen or pus. In six patients the radiological diagnosis was wrong and in one the diagnosis was not certain. Inappropriate therapy was given to three patients, on the basis of a CT or MRI scan, before a biopsy was done. It is essential that a histological diagnosis be obtained in all patients with brain masses and there is no role for empirical therapy except in isolated cases.

Adolescent↗
PubMed1989

Non-traumatic cerebrospinal fluid rhinorrhea: the "normal pressure leaks".

Non-traumatic cerebrospinal fluid (CSF) rhinorrhea is an uncommon condition. 15 patients with non-traumatic CSF rhinorrhea having "normal pressure leaks" are presented. Metrizamide CT cisternography failed to reveal the site of the fistula in 3 patients. 11 of the 15 patients underwent surgery for closure of the fistulous communication. In 8 of them the fistula was in the anterior fossa, in one it was in the sellar floor and in two the fistula site was not seen either radiologically or at surgery. In all except the one patient with sellar floor defect an intracranial approach was used. 12 patients have been followed up for 6 months to 9 years and 10 (83%) have been cured of their rhinorrhea. The intracranial approach is preferred to an extracranial approach in the repair of anterior fossa fistulae. Conservative treatment may be effective in selected patients.

Adult↗
PubMed1989

Nontraumatic intracavernous carotid aneurysm presenting with epistaxis.

A patient with an intracavernous carotid aneurysm usually presents with symptoms and signs of a space occupying lesion, producing one of a variety of types of cavernous sinus syndromes (Jefferson, 1938). Epistaxis is an unusual feature in these patients and when present is nearly always associated with a traumatic aneurysm (Mahmoud, 1979). There are only two reported cases of non-traumatic intracavernous carotid aneurysms presenting with epistaxis and diagnosed during the lifetime of the patient (Troupp, 1962; Labayle and Legent, 1964). The authors present a third such case. The importance of considering aneurysms in the differential diagnosis of epistaxis is emphasised. The radiological investigations and management of these patients is discussed.

Aneurysm↗
PubMed1989

Primary chondroid chordoma of the base of the petrous temporal bone.

The authors describe an unusual case of a primary chondroid chordoma arising from the base of petrous temporal bone. The patient, a young male, presented with a left sided jugular foramen syndrome. The CT findings of a tumour arising from the base of the left petrous temporal bone were confirmed at infratemporal exploration. The clinical and histopathological and immunohistochemical differences between classical (typical) chordoma and its chondroid variant are highlighted. The rarity of primary chordomas at this site is stressed.

Adult↗