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Biomedical subjects

V Rajshekhar

Publications and source records attributed to V Rajshekhar.

At least 55 records · Page 3Linked to original sources
PubMed2000

Severe episodic headache as the sole presenting ictal event in patients with a solitary cysticercus granuloma.

OBJECTIVES: Most patients with a solitary cysticercus granuloma present with seizures and severe episodic headache as the sole presenting symptom is rare in these patients. We report the clinical features, evolution and outcome of the disease in patients with a solitary cysticercus granuloma who had severe headache alone without seizures as the sole presenting event. MATERIAL AND METHODS: This was a prospective study which included all patients who presented with severe episodic headache alone and had a diagnosis of a solitary cysticercus granuloma based on CT imaging and follow-up and were managed in our department between June 1, 1991 and May 31, 1998. RESULTS: Out of nearly 550 patients diagnosed to have a solitary cysticercus granuloma during the period of the study, 15 patients (2.5%) presented with severe episodic headache alone. While 9 patients had 1 episode of headache, 6 patients had 2 to 5 episodes. Patients were managed with conservative symptomatic therapy (13 patients) and albendazole therapy (2 patients). Follow-up scans showed complete or partial resolution of the granuloma in 8 patients and a lesion of the same size in 4 patients. None of the patients with complete resolution of the granuloma reported further episodes of headache. CONCLUSIONS: It is important to recognize this presentation of a solitary cysticercus granuloma as it could be confused clinically with other acute central nervous system illnesses such as subarachnoid haemorrhage and meningitis. In regions endemic for cysticercosis a contrast enhanced CT scan of the brain should be performed in patients presenting with sudden onset of severe headache when a plain scan does not reveal intracranial haemorrhage as only a contrast enhanced scan will reveal the granuloma.

Adolescent↗
PubMed2000

Post operative supplementary motor area syndrome: clinical features and outcome.

The syndrome of the supplementary motor area (SMA) is not well recognized and its features can easily be confused with pyramidal weakness. The authors describe the SMA syndrome in six patients who underwent surgery for tumours located in the SMA, three in the dominant and three in the non-dominant hemispheres. All of them underwent complete resection of the anatomically described SMA, with partial (n = 4) or total resection (n = 2) of the tumour. In the postoperative period, all these patients exhibited reduction of spontaneous movements and difficulty in performing voluntary motor acts to command in the contralateral limbs, although the tone in the limbs was maintained or increased. The function of these limbs in serial automatic motor activities (for example, dressing and walking) was, however, relatively unaffected. Speech deficits were seen in only one of three patients with the dominant SMA syndrome. Besides a severe impairment of volitional movements, the salient features of the deficits in this syndrome are hemineglect and dyspraxia or apraxia involving the contralateral limbs. All patients recovered their motor functions over varying periods of time ranging from one to a few weeks. Long-term follow-up (median 24 months) in five patients revealed complete return of function in the affected limbs. It is important to recognize the entity of the SMA syndrome and differentiate it from the deficits that result from operative damage to the motor cortex as the deficits associated with the former are likely to recover almost completely over a short period of time.

Adult↗
PubMed2000

Post-traumatic malignant glioma: case report and review of the literature.

Posttraumatic gliomas have been described, but in none of these has there been documented evidence of absence of tumour at the time of the injury. We report a case of post-traumatic malignant glioma with radiological evidence of only a contusion prior to the development of the tumour.

Brain Neoplasms↗
PubMed2000

The calcified intracorporeal vacuole: an aid to the pathological diagnosis of solitary cerebral cysticercus granulomas.

Fifty four cases of single small (<20 mm) enhancing CT lesions (SSECTLs) of the brain that were excised between 1987 and 1995 were reviewed histologically. In 28 cases the entire cysticercus or its parts were found. In the remaining 26 cases, most had a histological picture suggestive of a parasitic granuloma. In six of these 26 cases, small ovoid masses corresponding in morphology to the intracorporeal vacuoles of a cysticercus were seen lying free in the cavitary space of the granuloma. This lends further strength to the contention that SSECTLs of the brain are caused by cysticercus, and that in the event of a surgical excision, absence of obvious parasitic parts should necessitate a closer search, as calcareous residues of the parasite might be the only evidence of the cysticercal aetiology in the granuloma.

Adolescent↗
PubMed2000

Management and outcome of brain abscess in renal transplant recipients.

Although infection is the commonest central nervous system complication following renal transplantation, brain abscess is uncommon. Over the last 11 years, five renal transplant recipients who had brain abscesses were treated by computed tomography (CT)-guided stereotactic aspiration. Three patients had a fungal abscess, one a tuberculous abscess and the other had a methicillin-resistant Staphylococcus aureus abscess. One patient required a craniotomy for the excision of a fungal abscess which was persistent after two CT-guided stereotactic aspirations. The survivors in this group are the patient with a tuberculous abscess who is alive and well 5 years after diagnosis, and another with a dematiaceous fungal abscess (phaeohyphomycosis). CT-guided stereotactic surgery is minimally invasive, and can safely be performed in these patients. It often leads to an aetiological diagnosis in renal transplant recipients with brain abscesses. Specific antibiotic management directed towards the causative organism rather than empirical treatment can be instituted following the procedure. Although the ultimate prognosis in these patients is bleak even with specific antibiotic therapy, an occasional patient might have a good outcome with prompt and appropriate therapy.

Adult↗
PubMed1999

Brainstem glioma: comparative study of clinico-radiological presentation, pathology and outcome in children and adults.

Although the clinical and imaging features and behaviour of brain stem gliomas in children are well documented, similar data are not available, for adults. We have carried out a retrospective study, on 101 consecutive patients (71 children and 30 adults) with a histologically verified brain stem glioma. Duration of symptoms, clinical features, imaging characteristics, histopathology and outcome were specifically compared in children and adults with brain stem glioma. Peak incidence was in the first decade in children and in the third and fourth decades in adults. Mean duration of symptoms before admission was 9.7 months in adults and 3.6 months in children (P < 0.001). There were no significant differences in the clinical features between adults and children. Imaging characteristics revealed no major differences except that diffuse hypodense lesions involving the whole brainstem accounted for 41.2% of the lesions in children and only 11.1% of adults (P < 0.001). A stereotactic biopsy was performed in 92 patients and an open biopsy or partial excision in 9 patients. Histopathological examination showed that the majority of gliomas were diagnosed as grade II astrocytomas in both groups. Survival was significantly shorter in children when compared to adults (P < 0.01). While the tumour grade was a significant factor in predicting survival in adults, in children it did not correlate with outcome. Therefore, determination of the grade of a brain stem glioma may be of prognostic significance in adult patients.

Adolescent↗
PubMed1999

Penetrating intracranial wooden object: case report and review of CT morphology, complications, and management.

BACKGROUND: Penetrating intracranial wooden fragments after vehicular accidents are uncommon. The CT morphology, complications, and management in such cases are quite variable. CASE REPORT: A 27-year-old male was seen with a "twig" from a tree embedded firmly just below the right medial canthus after a motorcycle accident. Diagnosis of intracranial penetrating wooden object was made on CT scanning. The wooden stick, which had splintered into two, was extricated through a craniotomy in two operative sessions. However the patient succumbed to septicemia and meningitis on the twelfth day after the accident. CONCLUSIONS: The need for prompt extrication of these objects and the causes of high mortality in this condition are discussed. The importance of imaging the intracranial compartment in injuries involving the periorbital region is emphasized.

Adult↗
PubMed1999

Development of collimator insert for linac based stereotactic irradiation.

The aim of this study is to develop collimator inserts of various sizes which are either not commercially available or are expensive to import. The dosimetry parameters such as tissue maximum ratio (TMR), off-axis ratio (OAR) and output factor of the developed collimator insert are compared with that of the commercial collimator insert (Radionics). In order to check the suitability of the collimator insert developed locally for clinical use and to standardize the method of development, a collimator insert of 15 mm identical to the one supplied by Radionics is developed with low-melting alloy (Cerrobend). Moreover for the clinical use of the developed collimator insert, certain acceptance tests are performed which include a collimator concentricity test, beam size check and radiation leakage test. The dose verification is carried out with a thermoluminescent dosimeter (7LiF rods) and an FBX chemical dosimeter in a human-head-shaped Perspex phantom filled with water. The variation between the calculated and measured dose is found to be within +2.4% for 7LiF rods and -2.0% for the FBX chemical dosimeter thus ensuring the suitability of the developed collimator insert for clinical use. This has encouraged us to standardize the method adapted to develop the collimator insert and to develop collimator inserts of different field sizes.

Equipment Design↗
PubMed1999

Cysticercosis of the cerebellopontine angle cistern mimicking epidermoid inclusion cyst.

We report a case of a cystic lesion in the left cerebellopontine (CP) angle cistern. The magnetic resonance (MR) imaging features closely resembled an epidermoid inclusion cyst, and was interpreted as such. However, at surgery and on histopathological examination the lesion was found to be a cysticercus cyst. It may be impossible to distinguish between the two by imaging. The MR imaging findings of cysticercosis, epidermoid and other common differentials are discussed.

Adult↗
PubMed1998

Sacral haemangioma as a cause of coccydynia.

We report a 55-year-old woman with coccydynia due to a sacral mass. The histological diagnosis was haemangioma. The MRI findings and the unusual location of this lesion are discussed.

Diagnosis, Differential↗
PubMed1998

Artifacts in magnetic resonance images following anterior cervical discectomy and fusion: report of two cases.

Magnetic susceptibility artifacts in two patients who underwent anterior cervical discectomy with fusion for cervical intervertebral disc prolapse are described. These artifacts located at the previously operated level suggested severe ventral compression of the dural tube. Computed tomography (CT) confirmed the artifactual nature of the MR findings and delineated the possible cause for the recurrence of symptoms in these patients. Elements and factors that can possibly lead to MR susceptibility artifacts in post operative imaging are elucidated. The danger of using MR imaging alone in directing the management of these patients is highlighted.

Adult↗
PubMed1998

Primary amyloidoma of the thoracic spine.

Focal amyloidosis (amyloidoma) involving the vertebral spine without an underlying systemic disorder is rare. Only six cases been reported in the literature so far, one involving the cervical spine, the rest occurring in the thoracic region. We present a patient with amyloidoma involving the thoracic spine and describe the magnetic resonance imaging features of this condition.

Amyloidosis↗
PubMed1998

Brain abscess as the presenting feature of melioidosis.

Central nervous system involvement in melioidosis is rare and there are only a few reports of the causative organism, Burkholderia pseudomallei, causing a brain abscess. We report a patient who presented to us with a brain abscess due to this organism and emphasize the need for a high degree of suspicion for this disease in tropical countries and treatment with the appropriate antibiotics, as the mortality associated with this disease is very high.

Adult↗
PubMed1998

Incidence and significance of adverse effects of albendazole therapy in patients with a persistent solitary cysticercus granuloma.

OBJECTIVE: To study the incidence of adverse reactions to albendazole therapy in patients presenting with seizures and a persistent (>3 months after diagnosis), solitary cysticercus granuloma and to determine whether the occurrence of adverse reactions predicted the response of the granuloma to therapy. MATERIAL AND METHODS: In a prospective study, adverse reactions were monitored in 43 patients with a persistent solitary cysticercus granuloma who were treated with albendazole therapy. Steroids were administered prophylactically to 7 patients. Response to albendazole therapy was determined on a post therapy CT scan done within 12 weeks of initiation of therapy. RESULTS: Adverse reactions in the form of headache, vomiting or recurrence of seizures including focal status epilepticus occurred in 15 (34.9%) patients. Adverse reactions occurred in 3 of the 7 patients who received steroids during therapy. The occurrence of side effects was not significantly influenced by steroid therapy (P=0.47). The granuloma responded to therapy in 20 patients (46.5%). Although the granuloma responded to therapy in a larger percentage of patients with side effects than in those without side effects (60% versus 39.3%), this difference was not statistically significant (P=0.16). CONCLUSIONS: Albendazole therapy causes adverse reactions in about a third of patients with a persistent solitary cysticercus granuloma. Occurrence of adverse reactions cannot be prevented with steroid therapy and their occurrence does not predict the response of the granuloma to therapy.

Adolescent↗