Thirty seven patients with various neuroparalytic manifestations were studied. There were 25 males and 12 females aged 14 to 50 years with majority in 3rd and 4th decades. Their neurological deficits comprised of drowsiness in 12, stupor in 6, coma in 4 and convulsions in 4 patients. Ptosis was found in 22, ophthalmoplegia and pharyngeal paralysis in 12 each, facial paralysis in 9, respiratory paralysis in 8, flaccid limb paralysis in 9, respiratory paralysis in 8, flaccid limb paralysis in 16 and lock jaw in one case. History of snake bite was present in 25 cases and in the remaining 12 cases there was a history of not awakening or inability to come out of the bed in the early morning. These subjects were treated with respiratory support, antivenom serum supplemented with atropine-neostigmine combination. Recovery was dramatic in 25 cases. 6 patients died within 12 hours of hospitalization and remaining 6 patients showed improvement gradually in 2-3 days time. The importance of high index of suspicion in the early diagnosis of elapid bite poisoning as a cause of neuroparalysis has been emphasized

[ABSTRACT]   Full text not available     [PubMed]

Serum lipids and lipoproteins are strongly related to coronary atherosclerosis but their association with cerebrovascular atherosclerosis is far less clear and consistent, though lipid levels have been related to carotid artery atherosclerosis, in anumber of studies having angiographic or ultrasonographic evidences of atheromas of common carotid bifurcation and internal carotid artery. In these studies there appears to be an impressive correlation of increased low density lipoprotein (LDL) and reduced high density lipoprotein (HDL) to the atherosclerosis. Lipoprotein (a), Apoproteins (apo B and apo AI), and HDL sub fractions (HDL2 and HDL3) are emerging better indicators of cranial atherosclerosis than conventional serum lipid levels. Varying levels of serum cholesterol are responsible for deferring vascular pathologies of underlying stroke. With levels of total serum cholesterol below 160 mg/dL there is a greater proclivity for intracerebral hemorrhage, whereas elevated levels predispose to large vessel at herothrombosis. There is no definite proof that cholesterol reduction by diet or drug will reduce the incidence of stroke. Total cholesterol decreases after myocardial infarction and similarly, stroke is also accompanied by variable alterations in serum lipids levels, hence, post-stroke measurement of serum lipids may not be a true representative of the individual's risk. Anunanswered query is, the time when blood should be sampled for the lipid and lipoprotein estimation following stroke? This is difficult to state categorically. Some favor that it should be done immediately after the stroke but others argue that it should be performed after the patient's condition is stabilized (approximately 3 months after the stroke). Treatment with diet and or drugs may be required in a hyperlipidemic patient to lesson the risk of coronary heart disease (CHD) and possibly even subsequent stroke.

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Exposure of the hand to vibration for many years is known to result in a carpal tunnel syndrome in forest workers. A case is reported of a neurosurgeon who developed features of carpal tunnel syndrome following continuous exposure to vibrations froma bone drill for several hours. The numbness and Paresthesia improved and the median nerve latencies returned to normal after 3 weeks.

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A case of acute traumatic interhemispheric subdural haematoma treated conservatively is reported. The controversies in its management and the usefulness of CT in planning the treatment are discussed.

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Good exposure and reconstruction are amongst the basics for skull-base surgery. We described our technique of "splitting mastoidotomy" which greatly improves the exposure, facilitating surgical dissection. Since there is no bony loss, reconstructionis easier and better during the transpetrosal approach for various basal lesions.

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Two cases of Neurocryptococcosis in AIDS are described. The first patient presented with generalised lymphadenopathy, hepatosplenomegaly and raised intracranial tension. The clinical manifestations of second patient included prolonged fever and hepatosplenomegaly. Both the patients had evidence of disseminated cryptococcosis. The distinctive clinical manifestations, investigative abnormalities and modification of therapy of neurocryptococcosis manifestations in AIDS are discussed.

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A case of post vaccinial (antirabies - BPL vaccine) acute disseminated encephalomyelitis, documented on MRI is reported. The patient had dramatic improvement with methylprednisolone, administered in a dose of 1gm daily for 5 days.

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Behavioural changes constitute the most common disturbances following head injury. They are closely related to neurological damage, neuropsychological deficits and psychosocial maladjustments In an explorative study of behavioural rehabilitation inthe native setting, 101 patients with behavioural problems were included. For each individual a treatment programme including pharmacological, behavioural and psychotherapeutic intervention was planned and executed by a team of neurosurgeon, psychiatrist psychologist and social workers. The problem of non-compliance also was studied in the same group. Improvement was good in atypical psychoses, affective psychosis, alcohol dependency, phobias, sexual dysfunctions and undue somatic concern. Irritability, amotivation and disinhibited behaviour did not register adequate improvement. The study revealed the usefulness of multi-disciplinary model, deficiencies in the present approach, the need for adapting the techniques in conformity with native needs and the reason for non-compliance

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Neurological manifestations of brucellosis are rare. Twelve cases of brucellosis with neurological involvement are being presented. The underlying mechanism has been discussed.

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The effects of vecuronium and pancuronium, administered for muscle relaxation prior to endotracheal intubation, on intracranial pressure and systemic haemodynamics were compared in 20 patients undergoing supratentorial surgery. The patients were randomly divided into two groups of 10 patients each depending upon the muscle relaxant used. Patients in group I received pancuronium (0.15 mg kg-1) following thiopentone induction while patients in group II were given vecuronium (0.15 mg kg-1) for intubation. Intracranial pressure, heart rate, mean systolic and diastolic blood pressures, central venous pressure, nasopharyngeal temperature and arterial blood gases were monitored at 3 minutes before induction, 1 and 3 minutes after thiopentone and relaxant intubation and 4, 6, 8 and 10 minutes after intubation. Induction of anaesthesia resulted in a small but significant fall in intracranial pressure in both the groups at 1 and 3 minutes (p < 0.05). The rise in intracranial pressure at intubation was significantly higher in group I patients (26.4 ñ 3.2 mm Hg) compared to group II patients (14 ñ 2.8 mm Hg). A significantly greater degree of rise in heart rate, and systolic and mean arterial pressure was observed in group I patients as compared to group II patients

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Sixty three consecutive patients with posterior fossa medulloblastoma were studied retrospectively. Fifty one patients were below 15 years of age and there was male predominance (3:1). Eighty percent of the patients had been symptomatic for less than 6 months. Features of raised intracranial pressure was the commonest clinical presentation. The tumour was placed in midline in 85 cases. Sixty patients had hydrocephalus and a preoperative CSF shunt was carried out in 49 patients. A gross total resection are carried out in 59 patients and a partial resection in 3 patients. Tumour biopsy alone was performed in one patient. The operative mortality was 12.6. Nine patients developed remote metastasis. Specimens from fifty seven patients were studied for evidence of astrocytic differentiation which was seen in 31. No correlation was found between the 2 year survival and presence of astrocytic differentiation.

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