Transient ischaemic attack (TIA) is a focal neurological deficit of vascular deficit of vascular etiology, the evidence of which completely resolves within 24 hours. TIAs were thought to cause no permanent damage to the brain before the introductionof cranial computed tomography (CCT) in 1975. Thereafter, some patients with typical TIA were found to have had cerebral infarction. Though CCT has been extensively used for establishing the diagnosis of TIA and stroke, the factors determining infarctionand prognostic significance of CCT abnormalities has not been analysed. Variables such as image quality, generation of CCT equipment, duration of the TIA, timing of CCT in relation to the event, territory of TIA, degree of arterial stenosis, plaque characteristics, age of the patient - all affect the likelihood of unrecognized (silent) cerebral infarction. The chance of secondary stroke and premature vascular death are increased, if silent infarction is found.

Two hundred and sixty four transsphenoidal procedure for excision for pituitary adenomas were performed in the Christian Medical College Hospital at Vellore between 1983 and 1994. These were reviewed to evaluate the complications and their management. There were four operative deaths (1.5). Major morbidity included cerebrospinal fluid (CSF) rhinorrhoea, meningitis, diabetes insipidus, visual deterioration and Addisonian crisis. Intraopertive CSF leak had a high association with postoperative diabetes insipidus.

Seventeen patients with clinical and radiological features of normal pressure hydrocephalus (NPH) underwent isotope cisternography after instilling 2-3 mCi 99m-Technetium labelled Diethylene triamine pentacetic acid (DTPA) through lumbar puncture. Detailed analysis of the images taken by Gamma camera at 1,2,4 and 24 hours was done. Features of early ventricular reflux, absent or patchy radioactivity at the surface of brain and persistent ventricular reflex at 24 hours (suggesting NPH) were looked for. Depending upon patient's response to repeated CSF taps, shunt surgery was offered to the responsive group. All these patients were followed for a mean period of 11 months. Gait apraxia preceding dementia, presence of urinary incontinence and CT head picture of increased periventricular lucency predicted good response to shunt. Presence of associated diseases predicted the opposite. The sensitivity of persistent ventricular reflux at 24 hours in predicting a good response to shunt surgery was 87.5 and specificity was 77.8. Significant loss or absence of activity at surface of the brain had a sensitivity of 62.5 and specificity of 88.89. Our study indicates that radionuclide cisternography is a useful investigation for NPH in combination with clinical and radiologic studies.

Antiepileptic drugs affect various endocrinal functions including sex hormones. In this study, the effect of sodium valproate monotherapy on sex hormones has been evaluated in sexually asymptomatic patients of primary generalised tonic clonic epilepsy. Twenty-six newly diagnosed young male patients with epilepsy and twenty controls were subjects in this study. Sodium valproate monotherapy (20-30 mg/kg) was administered in patients to control the seizures. None of the patients had recurrence of seizure during one year of follow up. Serum levels of sodium valproate, total serum testosterone, leutinizing hormone (LH), follicle stimulating hormone (FSH) were estimated initially, before starting valproate therapy. These were repeated at 3 month intervals for one year. Patients on sodium valproate therapy showed minor changes in serum sex hormone level. The total testosterone level fell significantly (p<0.05) at the end of 1 year, however LH, FSH and serum prolactin levels remained unaltered. It was concluded that sodium valproate has potential for altering balance of testosterone after prolonged administration.

Sikkim is a small hilly state in the eastern Himalayas. Iodine deficiency disorders constitute a major public health problem for the state. High prevalence of endemic goitre (54.7) and endemic cretinism (3.7) exist in the state. A total of 119 neurological cretins were studied to define the pattern and extent of neurological involvement in endimic cretinism. There were 65 men (54.6) and 54 women (45.4). Goitre was seen in 57 (47.9). Grade-I goitre was the most frequent type of goitre seen in 52.6 of the goitrous cretins. All the endemic cretins had moderate to severe neurological deficits. The most salient neurological feature was deaf-mutism which was seen in 91 cases (76.5). Examination of motor system revealed rigidity,more marked in lower limbs, patellar hyper-reflexia in 106 (89.2) and Babinnski's sign in 40 hypothyroidism. Audiometry done in a subset of 38 cretins revealed that only two cretins had normal hearing. The hearing loss was found to be bilateral and equal and was sever toprofound in 22 cretins; mild to moderate in 9 cretins and was bilateral but unequal in 5 cretins. Neurological cretinism is a distinct and easily identifiable clinical entity. It is an important indicator of severity of iodine deficiency in a community.

Sleep deprivation is one of the various stress factors which may affect the efficiency of an anaesthitist. Cognitive functions play a vital role in safe anaesthetic practice. To assess the effect of sleep deprivation on cognitive functions, forty anaesthesia residents were tested using various tests in two planned situations. 'Situation I' comprised of non sleep deprived state and 'Situation II' was the sleep deprived state defined as 'less than 4 hours of sleep in the last 24 hours'. The tests used were Trail making task, Digit symbol test, Letter comparison test and Standard progressive matrices. There was a statistically significant decrease in the performance scores after sleep deprivation. It is concluded that acute sleep deprivation adversely affects cognitive functions.

Visual evoked response (VER) and Brain stem auditory response (BAER) were performed on 19 opioid dependent subjects and results compared with 20 control subjects of similar age group. The opioid dependent subjects revealed significant decrease in VER amplitude (P<0.001) and also prolonged latencies of wave III, V, and inter-peak latencies (I-III, III-IV, I-V) suggesting impaired auditory conduction in the brain stem.

Giant cell tumour of sphenoid is a rare tumour. Clinical manifestations are as for any other pituitary region tumour, though endocrinopathy is not common. Radiological diagnosis is often not possible. On histopathology, they have to be distinguishedfrom other lesions containing giant cells. Radical excision followed by radiotherapy is recommended for good long term results.

An 18 years old female patient presenting with a peroneal nerve palsy after trivial pressure has been reported. A diagnosis of hereditary liability to pressure palsy was not suspected until electrodiagnostic studies were performed. These revealed the presence of a demyelinating polyneuropathy with conduction block and differential affection of various segments of the nerves. Sural nerve histology was charcterised by the presence of suasage like swellings and segmental demyelination and remyelination in teased fibres and mild loss of large myelinated fibres.

This is a case of Aspergillus infection in a twenty year old male presenting as an insidiously growing intradural spinal cord tumour with signs of cord compression. There was no definite portal of entry and the patient had no signs of immunsuppression. It is believed that such a case has not been previously reported. The lesion resembled a benign tumour on preoperative imaging and intraoperative consistency and vascularity. The lesion was successfully and completely resected. MR images of this unusual lesion are presented.

A twenty-six year man presented with a short history of raised intracranial pressure. He had papilloedema and long tract signs in both the lower limbs. CT scan of the head revealed unilateral dilatation of the right lateral ventricle. Ventriculography showed block of right foramen of Mono. Patient was treated by right vrentriculoperitoneal shunt and antitubercular drugs. However symptoms recurred within six weeks. MRI done at this stage revealed a sequestrated left lateral ventricle with dilatationof the cut off part of the ventricle. CSF findings were suggestive of tubercular pathology. Such a pathological manifestation has described only once before. The pathogenesis and management is being discussed.

Ehlers-Danlos Syndrome (EDS) is a group of heritable connective tissue disorders characterised by hyperelasticity of the skin and hypermobile joints. In addition to those features it is often associated with many systemic complications. Though many neurological complications have been described, an association of spinal muscular atrophy (SMA) has not been reported. We are reporting this rare association - a case of EDS with Kugelberg-Welander disease (type III SMA).

A case of young onset Parkinson's disease is presented, who had MRI finding usually described in Parkinson plus syndrome.