Twenty six patients of Bell's palsy, 16 men and 10 women, with the mean age of 27?0.2 years were enrolled for the study. An equal number of age and sex matched normal healthy individuals formed the control group. Clinical assessment and electrophysiological tests like facial nerve latency (FNL), blink reflex (BR), and peripheral nerve conduction studies were done to assess the prognostic value of these electrophysiological tests early in the disease. Clinical severity of weakness in the first week correlated positively with the outcome at 8 weeks. The mean FNL did not bear prognostic relation to the outcome, it being significantly prolonged in both partial and full recovery groups. BR proved to be of prognostic value. Though the amplitudes of various components of BR were low in all patients, significant prolongation of latencies was seen only among those with partial recovery. Nerve conduction studies of peripheral nerves were normal in all the patients. Clinical examination and early blink reflex abnormalities are of prognostic value in Bell's palsy patients.

[ABSTRACT]   Full text not available     [PubMed]

Neurosurgery has undergone dramatic innovations in the last few decades. It now allows the use of a microchip camera mounted on to an endoscope, introduced through a key hole in the brain. The image is projected onto a TV monitor located next to theoperating table. The minimally invasive technique is what we call Video Endoscopic Neurosurgery (VENS). Cab's universal rigid endoscope is used in all cases. VENS has a wide spectrum of diagnostic and therapeutic applications but cannot as yet replace open microscopic surgery. A prospective study of 55 patients from January, 1990 to February, 1995 is described. Hydrocephalus was a major indication, where VENS was useful for its diagnostic orientation especially when there were ambiguities on the CT/MRI.It also helped in the proper placement of the shunt, doing a III ventriculostomy and stenting of the aqueduct. VENS was utilised to diagnose, debulk and at times excise III ventricular and various other cystic lesions, visualize vascular loops in trigeminal neuralgia and hemifacial spasm. It is also useful in searching small CP angle lesions and residual tumour after intrassphenoidal excision of pituitary adenoma. Results were satisfactory in 94.5 of patients with an average follow up period of 26.4 months. Laser and CT-guided stereotactic VENS have already arrived which allows precise target localization and excellent visual control of any bleeding.

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Cirsoid aneurysms are considered to be notoriously difficult lesions. A proper diagnostic evaluation is essential for the successful management of these lesions. The authors present here both conventional and magnetic resonance angiographic appearance of six cases of cirsoid aneurysms. Four of these had congenital and two had post traumatic cirsoid aneurysms. Only two out of the six patients were evaluated by magnetic resonance angiography, while all the six patients underwent conventional angiography. Though magnetic resonance angiography described the feeders of the malformation well, it could not define the draining veins satisfactorily. On the contrary, conventional angiography described both feeding arteries and the venous drainage.

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Tuberculous spinal arachnoditis is one of the commonest causes of paraplegia in India. Clinical and laboratory diagnosis is difficult and radiological evaluation often remains an important component of diagnosis and management The role of water soluble contrast medium myelography and CT features have been described. The most common features observed on myelography include long lengths of irregular contrast medium, nodular filling defects, thickened nerve roots and empty thecal sac. The CT features include irregular subarachnoid contrast medium, extradural and intradural filling defects with the spinal cord of variable dimension. Adherence of the nerve roots to one another and to the meninges was not an uncommon finding. Given the clinical setting,myelographic and CT myelographic features are reasonably characteristic to suggest a diagnosis of tuberculous spinal arachnoiditis.

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A forty five year old patient developed a chronic relapsing and remitting disease after receiving fourteen injections of beta propionalactone inactivated sheep brain vaccine. We offer evidence to support the view that this case is an illustration ofmultiphasic disseminated encephalomyelitis rather than multiple sclerosis.

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Electrodiagnostic findings in 55 patients with acute organophosphorus intoxication have been correlated with clinical severity. Patients were assigned 3 grades of intoxication, depending upon the clinical severity of poisoning, muscarinic and nicotinic manifestations, ventilatory failure and altered sensorium. Repetitive responses upon single supramaximal stimulation of the median motor nerve were noted in all three grades of intoxication. In mild intoxication (grade I), low frequency repetitive nerve stimulation (< 3 Hz) produced no change in the amplitudes of the successive compound muscle action potentials. High frequency repetitive nerve stimulation (30 Hz and 50 Hz) resulted in either incremental responses (18 out of 29 cases), decremental responses (5 out of 29 cases) or decremental - incremental responses (6 out of 29 cases). Thirty five electrodiagnostic evaluations were performed in patients with overt neuromuscular weakness but not requiring mechanical ventilation (grade 2). Decremental responses were noted in only 3 instances at low frequency (< 3 Hz) repetitive nerve stimulation and in 34 out of 35 cases with high rates of stimulation. Patients who required mechanical ventilation had decremental responses at high (30 and 50 Hz) (12 out of 12 cases) as well as low rates (3 and 5 Hz) (7 out of 12 cases) of repetitive nerve stimulation. Serial electrodiagnostic evaluations, which were done in 12 patients, revealed that neuromuscular transmission abnormalities were either mild or absent within 24 hours in 9 patients. A deterioration in the neuromuscular transmission studies was noted during subsequent examinations performed, 1- 4 days later in these 9 patients. Electrodiagnostic testing is highly sensitive for establishing a diagnosisof organophosphorus poisoning and correlates well with clinical findings and the severity of poisoning. It may, however be normal in the early stages of intoxication.

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The clinical, electrophysiological and pathological features of 16 patients with vasculitic neuropathy were evaluated. Vasculitic neuropathy accounted for 5.3 of biopsy proven cases of various neuropathies. They included 7 cases of systemic vasculitic neuropathy (SVN) and 9 cases of nonsystemic vasculitic neuropathy (NSVN). Mononeuritis multiplex, both clinically and electrophysiologically was seen in neoropathy in 11 (69.7) patients. Three patients had sensory neuropathy. All the patients had anecrotizing vasculitis on nerve biopsy. Axonal degeneration was seen in teased fibers in all the patients. Fifteen patients were treated with steroids and one patient with cyclophosphamide. Seven patients with NSVN recovered completely. Two patients withSVN were left with asymmetical foot drop and one patient with NSVN developed bilateral mild claw hands. There were no deaths.

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A young primi-gravida with pre-eclamptic toxaemia underwent an elective caesarean at 38 weeks. On 10th day of delivery, she suddenly developed symptoms and signs of right cerebello-pontine angle lesion. On investigation a haematoma with a fluid level could be identified. Coagulation parameters were deranged and blood culture grew coagulase negative staphylococcus aureus. Possible causes of intracranial haematoma at such an unusual location are discussed.

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Primary skull base osteosarcoma is extremely rare and has been reported mainly in the second decade of life. Two cases of primary osteosarcoma arising from the anterior cranial fossa have been described. Both these patients were in their fifth decades of life.

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Nitric oxide (NO), which is synthesised by the enzyme Nitric Oxide Synthase (NOS), mediates many physiological and pathological mechanisms in the brain. Experimental studies of rodent C6 glioma show that NO has a major role in regulation of tumour blood flow. To determine the relevance of these findings to human malignant glioma, NADPH diaphorase (NADPHd) histochemistry, which is a marker for NOS expression, was performed in 20 glioblastomas. Except for one tumour which was totally necrotic, all the 19 tumour specimens showed evidence of NADPHd expression. The neoplastic vascular endothelium, areas of endothelial proliferation and neoplastic astrocytes all consistently showed high levels of NADPHd positivity. Areas of necrotic tumour were always NADPHd negative. Both the extent and the intensity of cellular staining within the glioblastoma was considerably greater than NADPHd positivity in normal brain tissue. These results together with findings in experimental glioma strongly suggest that NOS has a definite role in the pathophysiology of glioblastoma and that it may be possible to pharmacologically manipulate them for therapeutic benefit.

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A modified version of Payr's method for rapid vascular anastomosis was evaluated for high flow jugulo carotid anastomosis in rat. The end to end anastomosis is performed by mounting the artery on a cylinder by passing it through the lumen and cuffing the end back over the tube. The cylinder with the artery graft mounted on it is then telescoped into the vein and secured with an external circular clip. To allow easy introduction of the cylinder with the artery on it, into the vein, we used cylinderswith external diameter corresponding to the diameter of the carotid artery. The results suggest that the technique is simple and easy to execute requiring a short clamping time to complete the anastomosis using a prepared artery graft. Although the grafts remained patent, the histopathology studies done within one hour showed inflammation, platelet deposition and disruption of the venous endothelium. The arterial side of the anastomosis showed intact endothelium. The junctional area however, showed onlyminimal changes. Chronic specimens showed complete endothelisation over the junctional area. This nonsuture technique provides a rapid and a relatively atraumatic method of performing an anastomosis.

[ABSTRACT]   Full text not available     [PubMed]

A 23 years male presented with clinical and rardiological features of right CP angle papillary tumour. Histopathology confirmed it to he choroid plexus papilloma, which is a rare CP angle tumour.

[ABSTRACT]   Full text not available     [PubMed]

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Inherited ataxias constitute a large group of neurological diseases. Refinement in the classification and understanding of these diseases has been taking place in the recent years with advancement in molecular genetics. This review highlights the evolution and correlation of various classifications, phenotype and genotype correlation, mechanisms of phenotypic heterogeneity, and recent advances in the understanding of some of the commoner entities, in inherited ataxias.

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