Uncontrolled unilateral supratentorial expanding lesions can cause tentorial herniation. The common complications reported include ischaemic infarction of occipital lobe, brain stem haemorrhages, seizures as well as psychiatric disturbances from residual scarring of hippocampal formation, gaze palsies and death if untreated. We report a rare case of occipital lobe infarction with computerised tomography (CT) findings caused by tentorial herniation in a chronic subdural haematoma with contralateral homonymous hemianopsia and macular sparing.

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Using Bupivacaine as local anaesthetic to block bilateral maxillary nerve and sphenopalatine ganglion for transsphenoidal excision for pituitary tumours, a prospective study in a series of 10 patients was carried out. This paper presents advantages of Bupivacaine over lignocaine block.

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97 children above one month of age with pyogenic meningitis were followed up after 6 and 12 months at the child development Center, S.A.T Hospital, Medical College, Trivandrum. Developmental quotient was obtained using Bayley scale of Infant Development, intelligence quotient using Binet-Kamath test and behavioural assessment by the Eyberg behavior inventory. The major sequelae observed were mental/developmental retardation 53.2 percent, behavioural problems 11.3 percent, focal neurological deficits 7.2 percent, epilepsy 6.2 percent and perception deafness 3.1 percent. Retardation observed in the 4-12 months age group was statistically significantly higher than the 1-3 months age group. Further, mental impairment significantly outweighed motor impairment as a sequel. Acute phase poor responders had high incidence of retardation. 37.5 percent of those who had focal deficits during acute phase, continued to have persistent deficit at 12 months follow up.

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Twenty three cases of neurological complications following varicella infection are reported. These include pre rash seizures (2), encephalomyelitis (12), Guillain-Barrel syndrome (GBS) (7) and cranial neuropathy (2). There were 3 cases of encephalitis form, 7 cases of cerebellar form and 2 cases of pure myelitic form of the 12 cases of encephalomyelitis. There were no distinct clinical or electrophysiological features which serve to distinguish the GBS seen in association with varicella infection from that seen in other clinical settings. Lack of white matter lesions on magnetic resonance imaging in acute cerebellar ataxia following varicella infection may suggest probably different pathogenic mechanisms in this form of encephalitis when compared to cerebral form.

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We report a case of probable Antiphospholipid Antibody syndrome presenting with neurologic manifestations and high levels of IgG aCL antibodies.

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Twenty two cases of Intracranial epidermoids seen during the last twenty years are reviewed. Age ranged between 7 and 62 years. Duration of symptoms ranged between 6 months and 5 years. Symptoms of raised Intracranial pressure were common presentingcomplaints. Papilloedema was the commonest neurological finding. Computed tomography performed in 15 cases showed low attenuating lesion in 14 cases and a high attenuating lesion in one case. Myodil ventriculogram done in 3 cases and carotid angiography in 4 cases showed avascular mass.

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A total of 472 consecutive patients with severe head injuries (Glasgow Coma Scale score 8 or below) were studied for assessment of various risk factors affecting the outcome. The patients were divided into two groups - 299 (63 percent) patients who died and 173 (37 percent) patients who survived. Each risk factor pretraumatic, traumatic and post traumatic which might have affected the outcome was compared in each group. The following risk factors significantly increased the chances of mortality : (i) Pretraumatic - advanced age, presence of pre existing disease, (ii) Traumatic - GCS score less than 8, presence of shock, dilated pupil with an abnormal light reaction, motor disturbances, extensor rigidity, no reaction to pain, intracranial space occupying lesions (CT scan abnormalities), additional injuries, and (iii) Post traumatic - alternations in blood pressure, presence of biochemical abnormalities, hypoxia and the need for endotracheal intubation and mannitol infusion.

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Electrical injuries are rare. A case with persistent alteration in mental functions following an electrical injury is reported.

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A 28 years old male developed headache and bilateral papilloedema. Cerebrospinal fluid revealed increased opening pressure, but was otherwise unremarkable. Magnetic Resonance (MRI) imaging of the brain was normal; MRI of the neck disclosed thrombosis of the right internal jugular vein. Russel viper venom test revealed the presence of a circulating anticoagulant.

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A rare case of non Wegener's midline granuloma with bilateral thalamic involvement is presented. A 53 year old male presented with a nonhealing midline granuloma of nose for one year and right hemiparesis for five months with bilateral pyramidal signs. Biopsy from the nasal lesion revealed picture of malignant midline reticulosis with angiocentric cellular infiltrate. Cranial CT scan revealed bilateral thalamic involvement.

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This report describes our experience in eight cases of non traumatic intracranial haemorrhage in paediatric age groups. The causes were varied. The importance of rapid and multidisciplinary approach is detailed.

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Inspite of extensive research the ideal drug therapy for idiopathic Parkinson's disease (PD) and its optimal timing remain uncertain. Levodopa still is the mainstay of therapy for PD. Little evidence exists to incriminate early institution of levodopa therapy in development of motor fluctuations and dyskinesias in PD. These complications are probably a consequence of disease progression, and resultant inability to synthesise and store dopamine, and buffer the variability in dopamine availability. Therefore, withholding levodopa therapy until late stage of the disease is not warranted. Dopa agonists provide only a short-term benefit. The neuroprotective effect of selegeline remains to be established. There is not enough evidence to justify the current practice of initiating treatment for PD patients with expensive polypharmacy. Research into the development of inexpensive levodopa containing preparations needs to be encouraged.

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Brainstem auditory evoked potentials (BAEP) and somatosensory evoked potentials (SSEP) were recorded in 10 patients of heatstroke. Glasgow coma scale was used to assess level of consciousness. Values of either BAEP and/or SSEP were abnormal in all patients. Most consistent abnormalities of BAEP were delayed peak, latency of wave III & V and delayed IPL of III-V & I-V. The most consistent abnormality of SSEP were delayed absolute peak, latency of N20 and delayed IPL of N13-N20 (CCT). Distorted N20 was observed in 40 percent patients. The delay in conduction of electrical activities throughout the central nervous system in the patients, resulting in abnormal values of either BAEP and/or SSEP probably due to cerebral oedema with extensive parenchymatous degeneration of cells in brain, either from hyperpyrexia per se or from petechial haemorrhage in the brain, as reported on autopsy material by earlier workers.

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