Temporary vascular occulsion during surgery for cerebral aneurysms has been slow to gain acceptance as an elective procedure. This study presents the outcome in 115 cases in whom temporary vascular occulsion was needed during aneurysmal surgery. Elective temporary clipping was used in 55 cases and emergency temporary vascular occulsion was performed in 60 cases. Judicious use of temporary clips did not increase the overall morbidity or mortality. Rescue temporary clipping as an emergency measure inthe face of intraoperative rupture has a deleterious effect as against elective use on the immediate as well as long term outcome of the patient. Use of elective temporary clipping in conjunction with adequate cerebral protective measures in advocated indifficult cases to facilitate definitive clipping of the aneurysm in order to improve the overall outcome.

A retrospective review of 32 patients with subacute sclerosing panencephalitis (SSPE) referred during 1984-1992 to SCTIMST, Thiruvananthapuram was conducted. It was observed that SSPE was more in the rural poor people. No ethnic or geographic clustering of cases could be defined the rough this referral group of patients. A reliable history of measles occurred before the age of 2 years in the majority. Moreover, SSPE occurred at an younger age in those with a history of measles. The clinical features differed little from that reported in the literature. SSPE appeared to occur less frequently in Kerala compared to that reported from Bihar. However, only population-based studies can answer the question of geographic variation in the incidence of SSPEin India.

Thirty nine confirmed cases of SSPE were analysed retrospectively to study the clinical profile and to look for any atypical presentations. There were 29 males and 10 females with the age ranging from 4-19 (mean 11.5 ¤ 3.5) years. Sixteen patients (41.0 percent) had received measles vaccination. Definite history of measles was available in 33 (84.6 percent) cases. Onset of symptoms was after 10 years of age in 58.9 percent of cases. Majority (56.42 percent) had presented within six months of onset of symptoms but 5 patients (12.8 percent) had symptoms for more than 3 years prior to the presentation. Decreased scholastic performance (58.97 percent) and myoclonus (33.33 percent) were the common presenting symptoms. Generalized tonic clonic seizures (2 cases), visual deterioration (2 cases) and altered sensorium (1 case) were the unusual presenting features. Ophthalmological manifestations were seen in 6(15.4 percent) patients. One patient had diminution of hearing in earlier stages illness. Mean age of onset of symptoms was significantly different (p < 0.01) in vaccinated (13.10 ¤ 2.84 years) and non-vaccinated (9.87 ¤ 3.44 years) group. Oligoclonal bands in cerebrospinal fluid (CSF) revealed a positivity in 79.4 percent of cases. Antimeasles antibody titres in serum and CSF were significantly raised in 31 cases (79.5 percent). Electroencephalogram (EEG) revealed periodic complexes in 38 cases (97.4 percent).

A case of chronic sensory ataxic neuropathy secondary to primary polycythemia is reported. This association, has not been recorded before. Electrophysiological investigations revealed features consistent with severe sensory and mild motor axonopathy. Sural nerve biopsy showed severe fibre loss and Schwann cell proliferation. Ultra structurally accumulation of neurofilaments was noted in both unmyelinated and myelinated fibres. Low persistent ischaemia of nerves due to hyperviscosity is the probablepathogenic mechanism for the axonal stasis and nerve damage.

Primary intraventricular haemorrhage secondary to thrombolytic therapy has not been reported. A 55 years male who received i.v. streptokinase (STK) followed by heparinization for an acute myocardial infraction developed an extensive primary intraventricular haemorrhage from which he made an uneventful recovery over the next three months.

We report a case of primary reading epilepsy in a 14 years female.

A patient with a peculiar form of simple partial sensory seizure is reported. She had episodes of tickling sensations in a localized region of the body. In most of the episodes there was only a sensory ticklish feeling but in some, there was associated emotional response in the form of laughter. EEG, CT and MRI scans localized lesion to the corresponding sensory cortex. The possible pathophysiological mechanisms are discussed.

Neurogenic hypertension is not common and hence is usually overlooked. We are presenting a case of cerebellar haemangioblastoma presenting as systemic hypertension but without any neurological deficit till very late. The patient improved after surgery and is controlled on minimal antihypertensives.