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2014| September-October | Volume 62 | Issue 5
Online since
November 12, 2014
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LETTERS TO EDITOR
Post-traumatic blepharocele: A rare manifestation of head injury
Akash Mishra, Deepak Kumar Gupta, Shivanand Gamangatti, Bhawani Shankar Sharma
September-October 2014, 62(5):568-570
DOI
:10.4103/0028-3886.144502
PMID
:25387642
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Corpus callosal hemorrhage due to deep cerebral venous sinus thrombosis
Girish Baburao Kulkarni, Hima Pendarkar, Masoom Abbas Mirza, Veerendrakumar Mustare
September-October 2014, 62(5):563-565
DOI
:10.4103/0028-3886.144497
PMID
:25387639
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15,256
105
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Acute severe backache: Do not forget to look beneath the disc
Mandeep Singh Ghuman, Sameer Vyas, Chirag K Ahuja, Niranjan Khandelwal
September-October 2014, 62(5):573-574
DOI
:10.4103/0028-3886.144513
PMID
:25387645
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15,077
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ORIGINAL ARTICLES
Endoscopic management of CSF rhinorrhea
Rajesh Reddy Sannareddy, K Rambabu, Vinay EC Kumar, Ratnam Boola Gnana, Alok Ranjan
September-October 2014, 62(5):532-539
DOI
:10.4103/0028-3886.144453
PMID
:25387624
Background:
Transnasal endoscopic repair has become the treatment of choice for most anterior cranial and all sphenoid sinus breaches. The aim of this paper is to evaluate the results of endoscopic management of cerebrospinal fluid (CSF) rhinorrhea in a tertiary care center in South India.
Materials and Methods:
A retrospective analysis of 40 consecutive patients who underwent endoscopic repair of CSF rhinorrhea between 2010 and 2013 was performed. Endoscopic procedure consisted of defining the defect and removal of mucosa for 3-4 mm surrounding it. Repair was done using septal cartilage (for defects involving sphenoid sinus where sinus was packed with fat), fascia lata, oxidized cellulose, and fibrin sealant. Lumbar drain was placed for 2-4 days in selected cases. A lumbar-peritoneal shunt was inserted in patients with spontaneous CSF rhinorrhea and high opening lumbar CSF pressure.
Results:
Spontaneous CSF leaks were more common in middle-aged females, whereas posttraumatic CSF leaks were common in young adult males. The success rates following first surgery for patients with posttraumatic, spontaneous, and postprocedural CSF leaks were 85.7, 81.8, and 75%, respectively, which improved to 95.7, 100, and 100% following second procedure, respectively. Technical failures, poor graft uptake because of radiation therapy, location of leak in the lateral sphenoid recess, lumbar peritoneal shunt malfunction, and poor healing of skull base fractures were responsible for recurrence of leak.
Conclusion:
Team work between neurosurgeons and otorhinolaryngologists with attention to identification of site of leak, preparation of graft bed, securing the graft in place, and postoperative care is critical to achieve a high level of success for endoscopic repair of CSF rhinorrhea.
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Once myasthenic, always myasthenic? Observations on the behavior and prognosis of myasthenia gravis in a cohort of 100 patients
Satish V Khadilkar, Chetan R Chaudhari, Tukaram R Patil, Ninad D Desai, Kamlesh A Jagiasi, Ashish G Bhutada
September-October 2014, 62(5):492-497
DOI
:10.4103/0028-3886.144438
PMID
:25387617
Background:
The natural history of myasthenia gravis [MG] is unpredictable: In the first few years the disease course is worst with subsequent gradual disease stabilization. However, some patients tend to have continued disease activity or resurgence of the disease many years into the illness. The factors correlating with disease course need further evaluation.
Aims:
To study the patterns of remissions, worsening and exacerbations in patients with MG and correlate various factors affecting them.
Settings and Design:
Retrospective, Institute Review Board (IRB) approved study in tertiary referral neurology center.
Materials and Methods:
Hundred patients with acquired MG confirming the inclusion criteria were studied. Pharmacological remissions, complete stable remissions, exacerbations, worsening episodes were analyzed with respect to age of onset, disease extent, disease severity at onset and worst of illness, acetyl choline receptor antibody positivity, thymectomy status, period of disease, pharmacotherapy and crisis episodes.
Results and Conclusions:
In this cohort the percentage of new remission rates per year steadily declined after the first year. Ocular myasthenia had lesser clinical worsening episodes and high chance of complete stable remission. Generalized disease had less chance drug free remission. The risk of episodes of worsening persisted at a steady rate over a period of time, being maximum in the first year. The risk of exacerbations was unpredictable and could occur after prolonged clinical quiescence, often was related to reduction of immunosuppression. The disease course did not differ significantly in the juvenile and adult age-groups. There was a strong case for permanent immunomodulation in MG.
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A comparative study of psychiatric comorbidity, quality of life and disability in patients with migraine and tension type headache
Sagar Chandra Bera, Sudhir K Khandelwal, Mamta Sood, Vinay Goyal
September-October 2014, 62(5):516-520
DOI
:10.4103/0028-3886.144445
PMID
:25387621
Objectives:
To compare psychiatric co-morbidity, quality of life and disability between patients of migraine and tension type headache and healthy controls.
Materials and Methods:
Study subjects included 40 consecutive adult patients each with migraine and tension type of headache (TTH) of either gender fulfilling International Headache Society-II criteria and suffering for 2 years They were recruited from a headache clinic in a tertiary care teaching hospital and were assessed on Mini International Neuropsychiatric Interview (MINI), World Health Organization Quality of Life-BREF (WHOQOL-BREF) Hindi version and the Headache Impact Test-6 (HIT-6). Age and sex matched 40 healthy controls were assessed on MINI and WHOQOL-BREF. The three groups were compared for statistical significance on various scales.
Results:
Depression emerged as the most prevalent psychiatric disorder in both the headache groups. There was significant impairment in quality of life on all domains along with functional disability in subjects with both types of headache.
Conclusion:
Psychiatric comorbidity, especially depression is common in patients with migraines and tension type headache. Quality of life and functional ability are significantly impaired in these patients. The clinician should remain aware of consequences of prolonged headache, and should provide timely intervention.
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Anatomic study and clinical significance of extended endonasal anterior skull base surgery
Shousen Wang, Jian Lv, Liang Xue, Zhiyu Xi, Heping Zheng, Rumi Wang
September-October 2014, 62(5):525-531
DOI
:10.4103/0028-3886.144451
PMID
:25387623
Objective:
This study is to investigate the anatomical relationship of endonasal approach for anterior skull base surgery, and to determine the boundaries between anterior basicranial craniotomy and the security of operative techniques.
Materials and Methods:
A total of 10 adult dry skulls and 13 adult cadaveric heads processed by formalin were examined under operating microscope. The micro-anatomic structures of the turbinate, sphenoid sinus, ethmoid sinus, anterior ethmoidal artery, posterior ethmoidal artery and anterior skull base were observed. Artificial anatomy was performed and the deep-seated regions of the surgical approach were observed under operating microscope and endoscope.
Results:
Examined from the intracranial and intranasal aspects, it was found that the middle turbinate, uncinate process, ethmoid bulla, lamina papyracea, anterior ethmoid canal, posterior ethmoid canal, prominence of the optic canal and opticocarotid recess were all important anatomic landmarks for surgery. The horizontal distances between medial orbital wall on both sides at the level of crista galli, anterior ethmoid canal, and posterior ethmoid canal were (22.31 ± 3.08) mm, (23 ± 2.93) mm, and (26.25 ± 2.88) mm, respectively. The distance between the double optic canal cranial opening was (14.67 ± 3.82) mm.
Conclusions:
During the endonasal approach for anterior skull base surgery, full advantage of the surgical corridor made by the middle turbinate resection should be taken. To control intraoperative bleeding, it is critical to identify anterior and posterior ethmoidal artery. Identification and protection of medial orbital wall and the optic nerve, and controlling the ranges of anterior basicranial craniotomy are of great importance for surgical safety.
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Accuracy and precision of targeting using frameless stereotactic system in deep brain stimulator implantation surgery
Mayur Sharma, Richard Rhiew, Milind Deogaonkar, Ali Rezai, Nicholas Boulis
September-October 2014, 62(5):503-509
DOI
:10.4103/0028-3886.144442
PMID
:25387619
Objectives:
To assess the accuracy of targeting using NexFrame frameless targeting system during deep brain stimulation (DBS) surgery.
Materials and Methods:
Fifty DBS leads were implanted in 33 patients using the NexFrame (Medtronic, Minneapolis, MN) targeting system. Postoperative thin cut CT scans were used for lead localization. X, Y, Z coordinates of the tip of the lead were calculated and compared with the intended target coordinates to assess the targeting error. Comparative frame-based data set was obtained from randomly selected 33 patients during the same period that underwent 65 lead placements using Leksell stereotactic frame. Euclidean vector was calculated for directional error. Multivariate analysis of variance was used to compare the accuracy between two systems.
Results:
The mean error of targeting using frameless system in medio-lateral plane was 1.4 mm (SD ± 1.3), in antero-posterior plane was 0.9 mm (SD ± 1.0) and in supero-inferior plane Z was 1.0 mm (SD ± 0.9). The mean error of targeting using frame-based system in medio-lateral plane was 1.0 mm (SD ± 0.7), in antero-posterior plane was 0.9 mm (SD ± 0.5) and in supero-inferior plane Z was 0.7 mm (SD ± 0.6). The error in targeting was significantly more (P = 0.03) in the medio-lateral plane using the frameless system as compared to the frame-based system. Mean targeting error in the Euclidean directional vector using frameless system was 2.2 (SD ± 1.6) and using frame-based system was 1.7 (SD ± 0.6) (P = 0.07). There was significantly more error in the first 25 leads placed using the frameless system than the second 25 leads (P = 0.0015).
Conclusion:
The targeting accuracy of the frameless system was lower as compared to frame-based system in the medio-lateral direction. Standard deviations (SDs) were higher using frameless system as compared to the frame-based system indicating lower accuracy of this system. Error in targeting should be considered while using frameless stereotactic system for DBS implantation surgery.
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REVIEW ARTICLE
Emerging MRI and metabolic neuroimaging techniques in mild traumatic brain injury
Liyan Lu, Xiaoer Wei, Minghua Li, Yuehua Li, Wenbin Li
September-October 2014, 62(5):487-491
DOI
:10.4103/0028-3886.144434
PMID
:25387616
Traumatic brain injury (TBI) is one of the leading causes of death worldwide, and mild traumatic brain injury (mTBI) is the most common traumatic injury. It is difficult to detect mTBI using a routine neuroimaging. Advanced techniques with greater sensitivity and specificity for the diagnosis and treatment of mTBI are required. The aim of this review is to offer an overview of various emerging neuroimaging methodologies that can solve the clinical health problems associated with mTBI. Important findings and improvements in neuroimaging that hold value for better detection, characterization and monitoring of objective brain injuries in patients with mTBI are presented. Conventional computed tomography (CT) and magnetic resonance imaging (MRI) are not very efficient for visualizing mTBI. Moreover, techniques such as diffusion tensor imaging, magnetization transfer imaging, susceptibility-weighted imaging, functional MRI, single photon emission computed tomography, positron emission tomography and magnetic resonance spectroscopy imaging were found to be useful for mTBI imaging.
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ORIGINAL ARTICLES
Prevalence of middle cerebral artery stenosis in asymptomatic subjects of more than 40 years age group: A transcranial Doppler study
Sujay Sada, Yugandhar Reddy, Sampath Rao, Suvarna Alladi, Subash Kaul
September-October 2014, 62(5):510-515
DOI
:10.4103/0028-3886.144443
PMID
:25387620
Introduction:
Middle cerebral artery (MCA) disease is the most common vascular lesion in stroke. Transcranial Doppler (TCD) is a non-invasive bedside screening method for assessing cerebral blood flow.
Aim:
To investigate the prevalence of MCA stenosis in asymptomatic but high-risk individuals for stroke.
Materials and Methods:
Prospective study between December 2011 and December 2013. Vascular risk factors considered included: hypertension (HTN), diabetes mellitus, smoking, alcohol consumption, coronary artery disease (CAD), peripheral vascular disease (PVD), hypercholesterolemia and obesity. TCD was performed with portable machine through the temporal windows by use of a standardized protocol.
Results:
Of the 427 subjects, 374 were analyzed; males 264 (70.6%) and females 110 (29.4%). Mean age was 54.2 ± 7.6 years. The frequency of the risk factors was: HTN 287 (76.7%), diabetes 220 (58.8%), CAD 120 (32.1%), hypercholesterolemia 181 (48.4%), smoking 147 (39.3%), alcohol 99 (26.5%), obesity 198 (52.9%) and PVD 8 (2.1%). Of the 374 subjects, 27 (7.2%) had intracranial arterial stenosis and the rest had normal intracranial arteries. On univariate analysis, subjects with higher age, HTN, CAD, smoking and hypercholesterolemia had higher risk of having intracranial arterial stenosis (P < 0.05). Multivariate analysis showed HTN and CAD are independent risk factors for intracranial arterial stenosis.
Conclusions:
Overall prevalence of intracranial arterial stenosis is 7.2% in high-risk population sample from Hyderabad in South India. HTN and CAD are independent risk factors for the development of intracranial arterial stenosis.
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Role of local thrombolysis in cerebral hemorrhagic venous infarct
Shaileshkumar S Garge, Virti D Shah, Nirmal Surya, Satish S Khadilkar, Pranav D Modi, Sharad B Ghatge
September-October 2014, 62(5):521-524
DOI
:10.4103/0028-3886.144448
PMID
:25387622
Background:
Chemical thrombolysis in cerebral venous thrombosis (CVT) is one of the treatment options and the data is limited.
Settings and Design:
Prospective observational nonrandomized study.
Subjects and Methods:
This is a prospective study of 10 patients (six females and four males) admitted between May 2007 and June 2013. Grading system proposed by Department of Interventional Neuroradiology (INR), King Edward Memorial Hospital (KEM), Mumbai was used to grade the clinical status at admission. There were six patients with clinical Grade 3, two with Grade 4, and two with Grade 5. Patients with either Grade less than 3 or more than Grade 5 were excluded. Those patients, who were diagnosed with Cerebral venoussinous thrombosis (CSVT) but without hemorrhagic venous infarct and treated according to INR KEM criteria, were excluded from the study. Average duration of thrombolysis was 13 hours (range 10-18 hours). Average dose of urokinase was 12.2 lakh units (range 9.2-16.8 lakh units).
Results:
Six patients presented with clinical Grade 3 had modified Rankin Scale (mRS) sore of 1 at 30-day follow-up. Of the two patients with Grade 4, one had mRS 1 and the other had mRS 2 at 30-day follow-up. Of the two patients with Grade 5, one had mRS 2 at 30-day follow-up and the other did not respond to local thrombolysis and succumb to intracranial hemorrhagic infarct within 48 hours.
Conclusion:
This small prospective single-center study showed local dural venous thrombolysis significantly improves clinical and radiological outcome in patients with CVT. A randomized control trial with large sample size is needed to substantiate our findings.
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LETTERS TO EDITOR
Gangliocytic paraganglioma of filum terminale: Report of a rare case
Mukund Namdev Sable, Aasma Nalwa, Vaishali Suri, Pankaj Kumar Singh, Ajay Garg, Mehar Chand Sharma, Chitra Sarkar
September-October 2014, 62(5):543-545
DOI
:10.4103/0028-3886.144456
PMID
:25387626
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EDITORIAL
Cerebral venous thrombosis: Endovascular therapy
J. M. K. Murthy
September-October 2014, 62(5):485-486
DOI
:10.4103/0028-3886.144431
PMID
:25387615
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NEUROIMAGES
White epidermoid at the foramen magnum
Raghvendra Ramdasi, Amit Mahore, Aadil Chagla, Juhi Kawale
September-October 2014, 62(5):577-579
DOI
:10.4103/0028-3886.144518
PMID
:25387647
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ORIGINAL ARTICLES
Diagnostic and prognostic significance of suPAR in traumatic brain injury
Li Yu, Xiaoling Wu, Hui Wang, Ding Long, Junhui Yang, Yuanchao Zhang
September-October 2014, 62(5):498-502
DOI
:10.4103/0028-3886.144439
PMID
:25387618
Background:
Soluble urokinase plasminogen activator receptor (suPAR) is a highly sensitive marker that reflects increased inflammation and is positively correlated with pro-inflammatory biomarkers. The aim of this prospective observational study was to explore the relationship between the plasma concentration of suPAR and traumatic brain injury (TBI).
Materials and Methods:
In all 112 patients with TBI were included. Patients coming within 12 h whose highest abbreviated injury score (AIS) was 3 or less (other than head injury) were considered to be isolated TBI. Blood samples were obtained on admission. In all ninety healthy volunteers were enrolled as control group. Levels of plasma suPAR were determined using an enzyme-linked immunosorbent assay (ELISA) kit according to the manufacturer's instructions. Plasma D-dimer was measured and Glasgow Coma Scale (GCS) score was assessed at the same time.
Results:
Plasma suPAR values were statistically significantly higher in TBI patients than in controls (patients; 14.89 ± 6.94, controls; 2.79 ± 0.69, P < 0.01). The suPAR levels were strongly associated with the severity of TBI patients. The suPAR levels increased in association with the severity of brain injury, significance being found among all three groups: severe, moderate and mild TBI. The suPAR levels in non-survivals were significantly increased compared to the survivals (P < 0.05). Plasma levels of suPAR were strongly correlated to the GCS score (r = −0.854) and the levels of D-dimer (r = 0.753, both P < 0.01). Receiver operating characteristic curve (ROC) analysis of suPAR levels indicated that suPAR values had a high diagnostic specificity and sensitivity to differentiate survivals from non-survivals, the area underneath the ROC curve (AUROC) was 0.801 (95% CI: 0.698-0.903). The optimal suPAR cut-off value in predicting mortality was 15.70 ng/ml (sensitivity: 70.4%; specificity: 65.9%).
Conclusions:
Plasma levels of suPAR are elevated in TBI patients. Prognosis was worse in the patient group with elevated suPAR. High suPAR levels indicate a poorer prognosis in TBI patients.
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LETTERS TO EDITOR
Delayed presentation of post-traumatic bilateral cervical facet dislocation: A series of 4 cases
Akash Mishra, Deepak Agrawal, PK Singh
September-October 2014, 62(5):540-542
DOI
:10.4103/0028-3886.144454
PMID
:25387625
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4,017
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NEUROIMAGES
Angiographic "Tau (τ)" sign in persistent trigeminal artery
Krishnan Prasad, Eswararao Thamatapu, Manash Saha, Sayan Das
September-October 2014, 62(5):580-581
DOI
:10.4103/0028-3886.144519
PMID
:25387648
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Multiple hemorrhagic infarcts in thrombotic thrombocytopenic purpura
Jemshad Alungal, Mansoor C Abdulla, Jassim Mohammad Koya, P Feroz Jenner
September-October 2014, 62(5):582-583
DOI
:10.4103/0028-3886.144521
PMID
:25387649
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LETTERS TO EDITOR
Charles Bonnet syndrome in a case of cerebral venous thrombosis with fMRI-EEG correlation
R Subasree, Girish B Kulkarni, M Veerendra Kumar, Rose Dawn Bharath, M Sandhya, Ravi Yadav, Sailesh Modi, Nitish Kumar, Rajanikant Panda
September-October 2014, 62(5):557-559
DOI
:10.4103/0028-3886.144489
PMID
:25387635
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3,545
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Levetiracetam for tardive dystonia: A case report
Ajish Mangot, Satyakant Trivedi, Ravindra Kurrey, Vaibhav Dubey
September-October 2014, 62(5):559-560
DOI
:10.4103/0028-3886.144491
PMID
:25387636
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3,280
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An unusually aggressive clinical behavior in a case of atypical subependymal giant cell astrocytoma
Devi Prasad Patra, Pravin Salunke, Debajyoti Chatterjee, RK Vasishta
September-October 2014, 62(5):546-548
DOI
:10.4103/0028-3886.144458
PMID
:25387628
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3,331
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Hypoglossal nerve palsy: A rare consequence of dengue fever
Shantini Jaganathan, Rajagopalan Raman
September-October 2014, 62(5):567-568
DOI
:10.4103/0028-3886.144501
PMID
:25387641
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Primary plasmacytoma of the anterior skull base: A rare case
Ramesh Ganesan Vengalathur, Karthikeyan Veerasamy Kavindapadi, Balasubramanian Chandramouli
September-October 2014, 62(5):545-546
DOI
:10.4103/0028-3886.144457
PMID
:25387627
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3,148
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Giant oculomotor nerve schwannoma presenting as a sellar and suprasellar mass with parasellar extension
Satya Bhusan Senapati, Sudhansu Sekhar Mishra, Srikanta Das, Deepak Kumar Parida
September-October 2014, 62(5):548-549
DOI
:10.4103/0028-3886.144459
PMID
:25387629
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A rare association of intracranial vertebral artery fenestration with nonaneurysmal perimesencephalic subarachnoid hemorrhage
Sunil Kumar, Trilochan Srivastava, Shankar Tejwani
September-October 2014, 62(5):560-561
DOI
:10.4103/0028-3886.144493
PMID
:25387637
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3,052
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Cerebral venous thrombosis masquerading as hemicrania continua
Thomas Mathew, Sagar Badachi, G. R. K. Sarma, Raghunandan Nadig
September-October 2014, 62(5):556-557
DOI
:10.4103/0028-3886.144486
PMID
:25387634
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3,015
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Radiation-induced cavernous angioma in an adult
Damodar Rout, KM Geetha Sharmi, R Rajeswaran
September-October 2014, 62(5):572-573
DOI
:10.4103/0028-3886.144512
PMID
:25387644
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Silicone neuropatty: An innovative protective tool
Jasmit Singh, Hrushikesh Kharosekar, Vernon Velho, Deepak Palande
September-October 2014, 62(5):554-556
DOI
:10.4103/0028-3886.144484
PMID
:25387633
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3,009
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Spontaneous thrombosis of a cerebral arteriovenous malformation
Roopesh V. R. Kumar, Venkatesh S Madhugiri, AS Ramesh, A Sathiaprabhu
September-October 2014, 62(5):565-567
DOI
:10.4103/0028-3886.144500
PMID
:25387640
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Co-occurrence of basilar artery and cerebral venous sinus thrombosis in antiphospholipid antibody syndrome
Rohan R Mahale, Anish Mehta, Mahendra Javali, R Srinivasa
September-October 2014, 62(5):552-554
DOI
:10.4103/0028-3886.144462
PMID
:25387632
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Pilomyxoid astrocytoma in an elderly patient: A case report and review of literature
R Amita, S Sandhyamani, Suresh Nair, TR Kapilamoorthy
September-October 2014, 62(5):549-551
DOI
:10.4103/0028-3886.144460
PMID
:25387630
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2,884
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NEUROIMAGES
Ocular reverberations of an intracranial blast: A neurosurgical image
Amey Savardekar, Vikas Maheshwari, Harsimrat Bir Singh Sodhi, Pravin Salunke
September-October 2014, 62(5):575-576
DOI
:10.4103/0028-3886.144516
PMID
:25387646
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LETTERS TO EDITOR
Renal small cell carcinoma presenting with solitary lumbar intradural metastasis
Anirudh Srinivasan, Sivashanmugam Dhandapani, Debajyoti Chatterjee, Vijai Simha
September-October 2014, 62(5):561-563
DOI
:10.4103/0028-3886.144494
PMID
:25387638
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2,573
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4
A case of cerebral pheohyphomycosis in an immunocompetent patient: Emphasis on intraoperative findings
Ashish Aggarwal, Pravin Salunke, Sandeep Mohindra, Ravi Garg, BD Radotra
September-October 2014, 62(5):551-552
DOI
:10.4103/0028-3886.144461
PMID
:25387631
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2,509
76
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CORRESPONDENCE
Why standard deviation as a measure of dispersion needs a mention in a dataset?
Anjali Mahajan
September-October 2014, 62(5):584-584
DOI
:10.4103/0028-3886.144523
PMID
:25387650
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2,441
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2
LETTERS TO EDITOR
A case of vertebral artery dissection coincides with ipsilateral posterior inferior cerebellar artery dissection
Masaru Honda, Takeo Anda
September-October 2014, 62(5):570-571
DOI
:10.4103/0028-3886.144504
PMID
:25387643
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2,295
46
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CORRESPONDENCE
Authors reply
V Gupta, N Mulimani, A Kumar, C Ahuja, SN Mathuria, N Khandelwal
September-October 2014, 62(5):584-584
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