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2012| May-June | Volume 60 | Issue 3
Online since
July 14, 2012
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LETTERS TO EDITOR
Anterior cervical osteophytes with multilevel disc prolapse causing progressive dysphagia and quadriparesis
Sudhansu S Mishra, Srikant Das, Sanjay K Behera, Deepak K Parida
May-June 2012, 60(3):366-367
DOI
:10.4103/0028-3886.98549
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22,328
76
2
ORIGINAL ARTICLES
The endoscopic trans-fourth ventricle aqueductoplasty and stent placement for the treatment of trapped fourth ventricle: Long-term results in a series of 18 consecutive patients
Pasquale Gallo, Alexandru Szathmari, Emile Simon, Anne-Claire Ricci-Franchi, Christophe Rousselle, Marc Hermier, Carmine Mottolese
May-June 2012, 60(3):271-277
DOI
:10.4103/0028-3886.98507
Background:
Different surgical approaches have been described in the past to treat a trapped fourth ventricle (TFV) but, unfortunately, these techniques showed a high rate of dysfunction and complications. During the last 10 years the development of neuroendoscopy has dramatically changed the outcome of these patients.
Materials and Methods:
We conducted a retrospective evaluation of the safety, effectiveness, and long-term outcome of endoscopic aqueductoplasty and stent placement, performed in 18 consecutive patients with symptomatic TFV through a trans-fourth ventricle approach between 1994 and 2010. Thirteen patients underwent endoscopic aqueductoplasty and stent placement and 5 patients underwent aqueductoplasty alone using a tailored suboccipital approach through the foramen of Magendie in prone or sitting position.
Results:
The mean age of the patients at the time of surgery was 15.2 years. All patients but 3 had a supratentorial ventriculoperitoneal shunt. Fifteen patients presented with slit supratentorial ventricles. At a mean followup of 90.8 months all patients experienced a stable clinical improvement. Only two complications were observed: A transient diplopia due to dysconjugate eye movements in one patient and a transient trochlear palsy in another one.
Conclusions:
Our experience and the literature review suggest that endoscopic trans-fourth ventricle aqueductoplasty and stent placement is a minimally invasive, safe, and effective technique for the treatment of TFV and should be strongly recommended, especially in patients with supratentorial slit ventricles.
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Spinal muscular atrophy: Clinical spectrum and genetic mutations in Pakistani children
Shahnaz Ibrahim, Tariq Moatter, Ali Faisal Saleem
May-June 2012, 60(3):294-298
DOI
:10.4103/0028-3886.98514
Background:
In Pakistan the rate of consanguineous marriages is high, thus, the chance of incidence of autosomal recessive disorders is likely to be high. The aim of this study is to investigate the clinical characteristics and genetics of spinal muscular atrophy (SMA) in children who presented to Aga Khan University, Karachi.
Materials and Methods:
This study was a retrospective review of the medical charts of children (neonate: 15 years) with discharge diagnosis of SMA during last 10 years. Demographic features, consanguinity, and diagnostic analysis (including genetic analysis) were noted.
Results:
During the study period 67 children had a discharge diagnosis of SMA. Werdnig Hoffman disease (SMA type I) was the commonest variant seen in 37 (56%) children. Overall 68% were infants. High parental consanguinity was observed in 68% of the study cohort. The history of delayed development and undiagnosed early death was observed in the families of 19 children. Genetic testing was performed in 22 (33%) children. Survival motor neuron (SMN) 1 gene deletion was found in 19 (86%) of the 22 patients in whom the gene analysis was done and 13 (68%) were also positive for neuronal apoptosis inhibitory proteins (NAIP) deletion.
Conclusion:
SMA is not an uncommon neurodegenerative disorder in Pakistan and SMA type I was the most common type. SMN1 gene deletion was the most common genetic deletion found in this study. In addition, family history of developmental delay and frequent early deaths highlights the need for implementation of prenatal diagnosis for early detection, effective control, and management of this disorder in Pakistan.
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LETTERS TO EDITOR
Primary spinal cord glioblastoma multiforme: A report of two cases
G Lakshmi Prasad, Sachin A Borkar, Kiran C Subbarao, Vaishali Suri, Ashok K Mahapatra
May-June 2012, 60(3):333-335
DOI
:10.4103/0028-3886.98530
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9,143
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TOPIC OF THE ISSUE - PITUITARY - THE UNUSUALS - LETTERS TO EDITOR
Pituitary adenoma presenting with Cerebrospinal fluid rhinorrhea as the sole symptom
Nishant Goyal, Sachin A Borkar, Deepak Agrawal, Ashok K Mahapatra
May-June 2012, 60(3):307-308
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TOPIC OF THE ISSUE - PITUITARY - THE UNUSUALS - CASE REPORT
Coexistence of ectopic pituitary adenoma and empty sella in a patient with acromegaly : A case report and review of literature
Jing-Fang Hong, Xue-Hua Ding, Shou-Sen Wang
May-June 2012, 60(3):304-306
DOI
:10.4103/0028-3886.98517
Ectopic pituitary adenoma with an empty sella is extremely rare. We report an unusual patient with an ectopic growth hormone-secreting pituitary adenoma in the sphenoid sinus with an empty sella. The association is related to a development disorder of the anterior pituitary tissues. Tumor in the sphenoid sinus was completely removed by endoscopic endonasal transsphenoidal approach. During the follow-up, the patient met the criteria for endocrinological cure.
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LETTERS TO EDITOR
Spontaneous arthrodesis of atlanto-axial complex in a case of rheumatoid arthritis
M Vijayasaradhi, MR Kumar
May-June 2012, 60(3):339-341
DOI
:10.4103/0028-3886.98533
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BRIEF REPORT
Clinico-investigative profile of infantile and late-infantile neuronal ceroid lipofuscinoses
Mahesh Kamate, Gowda P Prashanth, Virupaxi Hattiholi
May-June 2012, 60(3):316-320
DOI
:10.4103/0028-3886.98524
Neuronal ceroid lipofuscinosis is a group of progressive neurodegenerative disorders characterized by accumulation of ceroid lipopigment in lysosomes in neurons and other cell types. This study is a retrospective review of charts of patients with a diagnosis of infantile and late-infantile neuronal ceroid lipofuscinosis seen between January 2009 and December 2011. Of the 16 patients, 5 had infantile type and 11 had late-infantile neuronal ceroid lipofuscinosis. Diagnosis was confirmed by appropriate enzyme assay. Clinical presentation was quite varied. Common presenting features included refractory seizures, developmental delay/regression, and abnormal movements. Visual failure was not common in the present case series, and novel neuroimaging finding in the form of isolated dentate nucleus hyperintensities were noted. During follow-up, all patients had a progressive downhill course and one patient died. Prenatal diagnosis could be offered to one family. This study suggests that infantile and late-infantile neuronal ceroid lipofuscinosis is not uncommon in this region of the country and the phenotype may be different.
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LETTERS TO EDITOR
Cholesterol granuloma of the sphenoid sinus: An unusual sphenoid sinus lesion
Munawwar Ahmed, Elizabeth Joseph, Sunithi Mani, Geeta Chacko, Vedantam Rajshekhar
May-June 2012, 60(3):332-333
DOI
:10.4103/0028-3886.98529
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7,528
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CASE REPORTS
Surgical treatment in startle epilepsy
Hong Tian, Xiangen Shi, Huancong Zuo, Wenjing Zhou
May-June 2012, 60(3):321-324
DOI
:10.4103/0028-3886.98526
This report presents a patient with medically intractable startle epilepsy who was treated with surgery. The ictal onset zone was further localized to a part of the premotor cortex on the basis of intracranial electroencephalography recording and surgical resection of the epileptogenic zone was done. The motor area close to the epileptogenic focus was localized using electrical cortical stimulation and thus preserved. Patient has been seizure-free postoperatively (Engel Class I) during the 18-month follow-up. The patient illustrates that surgery can be an option in patients with medically intractable startle epilepsy with well-defined unilateral epileptogenic zone.
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LETTERS TO EDITOR
High cervical nondysraphic intradural extramedullary lipoma
Yam B Roka, M Shrestha, PR Puri, Hari B Adhikari
May-June 2012, 60(3):350-351
DOI
:10.4103/0028-3886.98540
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6,538
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Subarachnoid hemorrhage after transsphenoidal surgery for pituitary adenoma: A case report and review of literature
Nishant Goyal, Noufal Basheer, Ashish Suri, Ashok K Mahapatra
May-June 2012, 60(3):337-338
DOI
:10.4103/0028-3886.98532
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6,435
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Acute extrapyramidal syndrome and seizures as heralding manifestation of Wilson disease
Rajesh Verma, Tushar B Patil, Rakesh S Lalla
May-June 2012, 60(3):363-364
DOI
:10.4103/0028-3886.98547
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6,250
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CASE REPORTS
Intracranial actinomycosis: Varied clinical and radiologic presentations in two cases
Sandeep Mohindra, Amey Savardekar, Swapnil Rane
May-June 2012, 60(3):325-327
DOI
:10.4103/0028-3886.98527
Two patients with primary actinomycotic brain infection are presented here. The first case had 2 predisposing factors, cardiac septal defect and chronic mastoiditis, whereas the second patient was a chronic smoker, belonging to a desert region. Both the patients were successfully managed with surgical debridement and prolonged administration of antibiotics.
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LETTERS TO EDITOR
Langerhans cell histiocytosis of the clivus: An unusual cause of a destructive central skull base mass in a child
Munawwar Ahmed, Jyoti Sureka, Chiramel George Koshy, Binita Riya Chacko, Geeta Chacko
May-June 2012, 60(3):346-348
DOI
:10.4103/0028-3886.98538
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6,071
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Idiopathic spinal cord herniation
Manoj Choradia
May-June 2012, 60(3):342-343
DOI
:10.4103/0028-3886.98535
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ORIGINAL ARTICLES
Impact of Hunt-Hess grade on the glycemic status of aneurysmal subarachnoid hemorrhage patients
Sayantani Ghosh, Saugat Dey, Mitchell Maltenfort, Mathew Vibbert, Jaqueline Urtecho, Fred Rincon, Jack Jallo
May-June 2012, 60(3):283-287
DOI
:10.4103/0028-3886.98510
Objective:
This study has explored the impact of Hunt-Hess (H-H) grade of aneurysmal subarachnoid hemorrhage (aSAH) on the glycemic status of such patients during their intensive care unit (ICU) stay and has also analyzed whether H-H grade predicts their outcome independent of their glycemic status.
Materials and Methods:
This was a retrospective case record review of prospectively maintained database of 1090 previously non-diabetic aSAH patients admitted to Thomas Jefferson University Hospital, Philadelphia. H-H grade of SAH, serum and CSF glucose on admission, serum glucose on the day of surgery and 14 days post-surgery, as well as the extended Glasgow Outcome Score (GOS-E score) at discharge were noted. After univariate analysis, significant variables (
P
< 0.05) were entered into a logistic regression model to identify significant associations with admission H-H grade.
Results:
Although admission serum glucose was significantly higher for H-H grades 4-5 than grades 1-3 (
P
< 0.001); after postoperative day 4, the difference between the H-H grades got blurred. Admission CSF glucose was also significantly higher for H-H grades 3-4 than for grades 1-3 and 5 (
P
< 0.001). H-H grades 4-5 were related with higher incidences of both hypoglycemia (serum glucose level < 80 mg/dl) and hyperglycemia (serum glucose level > 200 mg/dl) (
P
< 0.001) during the 14-day period of ICU stay. Also, the relationship between serum and CSF glucose levels at admission increased with HH grades 1 through 4, but became negative and more tightly bound at H-H grade 5. Admission H-H grades 4-5 contributed to poor outcome compared to lower H-H grades (
P
< 0.0001).
Conclusion:
Poor admission H-H grades lead to poor immediate glycemic status as well as poor short-term outcome, and it is dependent on serum glucose but independent of CSF glucose in predicting the outcome.
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LETTERS TO EDITOR
Pediatric multi vessel intracranial dolichoectasia - A rare occurrence
Sunil K Bajaj, Ritu Misra, Rohini Gupta, Brij B Thukral
May-June 2012, 60(3):358-361
DOI
:10.4103/0028-3886.98545
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ORIGINAL ARTICLES
Stent-assisted coil embolization of intracranial aneurysms using Solitaire stent
Jingbo Zhang, Xianli Lv, Jun Yang, Zhongxue Wu
May-June 2012, 60(3):278-282
DOI
:10.4103/0028-3886.98508
Objective:
To report patients with intracranial wide-necked or complex aneurysms who underwent Solitaire stent-assisted coil embolization.
Materials and Methods:
Retrospective analysis of 28 patients with intracranial wide-necked or complex aneurysms. Eighteen of the patients presented with an acute subarachnoid hemorrhage. Thirty-one aneurysms were treated with the support of different applications (
n
= 32) of the Solitaire AB stents followed by the standard coiling procedure (
n
= 30).
Results:
Successful positioning of the remodeling device was obtained in all the cases. One stent required repositioning after full deployment. There were four thromboembolic complications (12.5%) and two hemorrhagic complications (6.25%), which caused three deaths. No permanent procedural morbidity was observed in the surviving patient. Angiographic results included 26 complete occlusions (83.9%), three neck remnants (9.7%) and two incomplete occlusions (6.4%).
Conclusion:
Although the initial technical and clinical results of Solitaire stent-assisted coiling of aneurysms was reported to be encouraging in recent reports, we had encountered higher thromboembolic and hemorrhagic complications in our patients.
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LETTERS TO EDITOR
Multifocal Ewing's sarcoma, presenting radiologically as extradural hematoma
Sudhansu S Mishra, Deepak K Parida, Satya B Senapati, Sunil K Patra
May-June 2012, 60(3):361-362
DOI
:10.4103/0028-3886.98546
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ORIGINAL ARTICLES
Accuracy of computed tomography angiography in detecting the underlying vascular abnormalities for spontaneous intracerebral hemorrhage: A comparative study and meta-analysis
Junpeng Ma, Hao Li, Chao You, Siqing Huang, Lu Ma, Chengcheng Ieong
May-June 2012, 60(3):299-303
DOI
:10.4103/0028-3886.98515
Background:
Computed tomography angiography (CTA) is a rapid, non-invasive procedure with a small risk for evaluating patients with various types of strokes. But the effectiveness of CTA in detecting the etiology of spontaneous intracerebral hemorrhage (SICH) has not been well established. Aim: To evaluate the diagnostic value of CTA for detecting underlying vascular abnormalities in patients with SICH. Settings and Design: This is a comparative study to evaluate the diagnostic accuracy of CTA and digital subtraction angiography (DSA) in SICH. We also did a meta-analysis, combining our results with those of all previous studies to determine a more precise estimate of CTA in detecting the etiology of SICH..
Materials and Methods:
Between July 2009 and October 2011, CTA and DSA were routinely performed in consecutive young patients (age between 18 and 45 years) with acute non-hypertensive SICH. Imaging data were prospectively stored in the database for analysis. Statistical Analysis: The sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and accuracy were used for evaluating the diagnostic value of CTA for vascular lesion.
Results:
This study included 92 patients. The sensitivity, specificity, PPV, NPV, and accuracy of CTA for detecting DSA-positive pathologies were 94.6%, 100%, 100%, 96.5%, and 97.8%, respectively. A total of 544 cases were included for meta-analysis. The pooled sensitivity, specificity, PPV, NPV, and accuracy of CTA for detecting the etiology in SICH were 95.4%, 98.3%, 96.9%, 97.4%, and 97.2%, respectively. There was no substantial heterogeneity between the studies.
Conclusions:
CTA has high PPV and NPV for vascular pathologies. It should be performed as the initial vascular investigation for patients with acute SICH. Future technical advancement of CTA is still needed to eliminate the false-negative results.
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4,807
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CASE REPORTS
Paraplegia treated with blood transfusion
Ajoy Sodani, Ashish Chawla, Amit Maheshwari, Mayoor Naigaonkar, Vinod Porwal
May-June 2012, 60(3):328-331
DOI
:10.4103/0028-3886.98528
Extramedullary hematopoiesis is a compensatory response in patients with thalassemia and other chronic anemia and can result in compressive myelopathy, if untreated. Two young adults with history of thalassemia presented with symptoms of spinal cord compression. Presence of extramedullary hematopoiesis was confirmed by magnetic resonance imaging. Both the patients were treated with blood hypertransfusion and showed improvement clinically and radiologically. Although there are various options in the management of such condition, including decompression surgery and radiation treatment, hypertransfusion can be very effective even in severe compression of the spinal cord. Hypertransfusion should be tried as the first line of management in patients with thalassemia presenting with compressive myelopathy to decrease the bulk of extramedullary hematopoietic tissue.
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4,655
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1
LETTERS TO EDITOR
The eyes in the scanner: Latent conjugate eye deviation
Abhijit Das, Peii Chen
May-June 2012, 60(3):343-344
DOI
:10.4103/0028-3886.98536
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4,728
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Epithelioid hemangioendothelioma of sphenoid bone: A case report of an unusual case
Sharique Ahmed, Sridhar Epari, Milap Shah, K Srinivas Rao
May-June 2012, 60(3):344-346
DOI
:10.4103/0028-3886.98537
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4,511
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1
Usefulness of computed tomographic angiography in the management of extracranial scalp arteriovenous malformation
Sudhansu Sekhar Mishra, Souvagya Panigrahi, Deepak Parida, Sanjay Kumar Behera
May-June 2012, 60(3):357-358
DOI
:10.4103/0028-3886.98544
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4,496
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4
Intraparenchymal pericatheter cyst following ventriculoperitoneal shunt
Jitendra S Shekawat, Ilangovan Vijay Sundar, Nemichand Poonia, Virendra D Sinha
May-June 2012, 60(3):341-342
DOI
:10.4103/0028-3886.98534
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4,390
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ORIGINAL ARTICLES
Trends in clinical features and early outcome in patients with acute cardioembolic stroke subtype over a 19-year period
Adrià Arboix, Joan Massons, Luis García-Eroles, Cecilia Targa, Olga Parra, Montserrat Oliveres
May-June 2012, 60(3):288-293
DOI
:10.4103/0028-3886.98513
Objectives:
To assess changing trends in clinical characteristics and early outcome of patients with acute cardioembolic stroke (ACS) over a 19-year period.
Materials and Methods:
Data of 575 patients with first-ever ACS included in the Sagrat Cor Hospital of Barcelona Stroke Registry were analyzed. Changing trends for 1986-1992, 1993-1998, and 1999-2004 periods were compared.
Results:
A statistically significant increase (
P
< 0.001) in the age of patients (74.6 years in 1986-1992 vs. 81.4 years in 1999-2004) and the percentage of patients older than 85 years of age (16% vs. 38.2%) was observed. Patients with hypertension increased from 40.5 to 60.8% (
P
= 0.001) as were patients with diabetes, chronic bronchitis, and obesity (P = NS). The median length of hospital stay decreased from 18 to 12 days (
P
= 0.031) and prolonged hospital stay (>12 days) from 18.3 to 13.1 (
P
= 0.033). In-hospital death rate remained around 20%.
Conclusions:
ACS continues to be a severe ischemic stroke subtype with high risk of in-hospital death. The lack of improvement in the early prognosis over a 19-year period may be explained by an increase in the prevalence of major cardiovascular risk factors and progressive aging of the population.
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4,324
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TOPIC OF THE ISSUE - PITUITARY - THE UNUSUALS - LETTERS TO EDITOR
Pituitary adenoma and concomitant Rathke's cleft cyst: A case report and review of the literature
Kun Wang, Lu Ma, Chao You
May-June 2012, 60(3):309-310
DOI
:10.4103/0028-3886.98520
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4,205
34
6
LETTERS TO EDITOR
Kissing aneurysms of the internal carotid artery treated with surgical clipping
Liemei Guo, Yongming Qiu, Jianwei Ge, Xiaohua Zhang
May-June 2012, 60(3):353-355
DOI
:10.4103/0028-3886.98542
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4,194
41
5
Glioma progression as revealed by diffusion tensor metrics
Prakash Muthusami, Ram Shenoy Basti, Bejoy Thomas, Tirur Raman Kapilamoorthy, Chandrasekharan Kesavadas
May-June 2012, 60(3):355-357
DOI
:10.4103/0028-3886.98543
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4,149
46
1
Intracranial aneurysm revealing a HIV infection and resolving with highly active antiretroviral therapy
Laïla Benjilali, Mouna Zahlane, Lamiaa Essaadouni
May-June 2012, 60(3):351-353
DOI
:10.4103/0028-3886.98541
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4,048
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4
TOPIC OF THE ISSUE - PITUITARY - THE UNUSUALS - LETTERS TO EDITOR
Growth hormone secreting pituitary adenoma associated with Rathke's cleft cyst
Chao You, Fei Qiao, Shu Jiang, Anqi Xiao
May-June 2012, 60(3):310-311
DOI
:10.4103/0028-3886.98521
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3,938
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EDITORIAL
Endoscopic management of trapped fourth ventricle using the posterior fossa route
Vedantam Rajshekhar
May-June 2012, 60(3):269-270
DOI
:10.4103/0028-3886.98506
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3,800
135
1
TOPIC OF THE ISSUE - PITUITARY - THE UNUSUALS - NEUROIMAGE
Pituitary apoplexy presenting with pure third ventricular bleed: A neurosurgical image
Sandeep Mohindra, Amey Savardekar, Manjul Tripathi, Rajeev Garg
May-June 2012, 60(3):314-315
DOI
:10.4103/0028-3886.98523
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3,875
53
1
TOPIC OF THE ISSUE - PITUITARY - THE UNUSUALS - LETTERS TO EDITOR
Combined gangliocytoma and non-functioning pituitary adenoma of the pituitary gland
Peizhi Zhou, Lu Ma, Shuwen Cheng, Senlin Yin, Shu Jiang
May-June 2012, 60(3):311-313
DOI
:10.4103/0028-3886.98522
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3,861
47
6
LETTERS TO EDITOR
Supratentorial intraparenchymal schwannoma mimicking a glial tumor
Praveen Sharma, Amit Mahore, Ritesh Kansal, Sridhar Epari, Naina G Kataria
May-June 2012, 60(3):335-337
DOI
:10.4103/0028-3886.98531
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3,640
61
1
Giant chondroma of the falx
Anvita Pauranik, Amit Mahore, Naina G Kataria
May-June 2012, 60(3):364-366
DOI
:10.4103/0028-3886.98548
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3,580
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A cervicothoracic intramedullary ganglioneuroblastoma presenting with acute quadriparesis
Sumit Thakar, Nandita Ghosal, Alangar S Hegde
May-June 2012, 60(3):348-350
DOI
:10.4103/0028-3886.98539
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3,442
41
1
Clinical and polysomnographic characteristics in 20 north Indian patients with narcolepsy: A seven-year experience from a neurology service
Yasar Halit, Tekeli Hakan, Senol Mehmet Güney
May-June 2012, 60(3):368-368
DOI
:10.4103/0028-3886.98550
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3,410
43
1
Vertex extradural hematoma
VG Ramesh
May-June 2012, 60(3):369-369
DOI
:10.4103/0028-3886.98552
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