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Sangle, R.
- Paediatric Unilateral Hydrocephalus an Unusual Presentation of Endovascular Proliferative Angiopathy of Unilateral Middle Cerebral Artery
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Authors
R. Sangle
1,
V. Nivargi
2
Affiliations
1 Dept of Neurosurgery, B.J Medical College, Pune, IN
2 Dept of Cardiology, Ruby Hall Clinic, IN
1 Dept of Neurosurgery, B.J Medical College, Pune, IN
2 Dept of Cardiology, Ruby Hall Clinic, IN
Source
The Indian Practitioner, Vol 69, No 9 (2016), Pagination: 21-24Abstract
Adolescent female 11years of age had gradual onset progressive weakness, involving left upper limb. There was no history of headache, vomiting or diminishing of vision, trauma and fever. Full term normal delivery child received vaccinations as per schedule. Neurologically normal till 4 years of her age when she had two generalised seizures with loss of consciousness. Clinical and brain CT examinations showed no abnormality. Electro-encephalography & routine cerebrospinal fluid studies were normal. Considered epileptic and was kept on oral medication with carbamazepine. Only a few case reports of isolated MCA angiopathy in their initial stages have been reported. Clinically, diminutive-neurocognitive functions of the child at different stages must always be co-related with angiography studies and followed-up at least every two years. Therapeutic window-period and the time lost, play important role in the overall management and clinical outcome.Keywords
Isolated MCA Angiopathy, Moyamoya Disease.
References
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- Han DH, Kwon OK, Byun BJ, et al. A co-operative study: clinical characteristics of 334 Ko-rean patients with moyamoya disease treated at neurosurgical institutes,(1976-1994). ActaNeu-rochir (Wien) 2000;142: 1263-73.
- Isolated Abducens Nerve Palsy Due to Focal Patchy Inflammatory Lesion and Review of the Literature
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Authors
Affiliations
1 B.J.Medical College, Pune, IN
2 Ruby Hall Clinic, Pune, IN
1 B.J.Medical College, Pune, IN
2 Ruby Hall Clinic, Pune, IN
Source
The Indian Practitioner, Vol 69, No 10 (2016), Pagination: 15-20Abstract
Background: Convergent squint due to 'isolated abducens nerve palsy' (IANP) in otherwise normal patients is not often seen. Reports on natural history related to causes, time of improvement and recurrences is varied and perplexing. Objective 1) to relate IANP to the 'focal patchy inflammatory dural lesion' (FPIDL) along the lateral wall of cavernous sinus using magnetic resonance imaging (MRI), 2) to assess the use of anti-inflammatory drugs and steroids, 3) understanding incidence of recovery and recurrences. Patient&method: Retrospective review of seven patients of IANP with MRI neuroimaging and steroidal therapy. Cerebrospinal fluid (CSF) was investigated in four patients only. Results: MRI showed FPIDL affecting lateral wall of cavernous sinus all along the abducens nerve tract. Recurrent palsy similar independent lesion. Both treated with anti-inflammatory and steroidal drug therapy. Follow-up MRIs within two weeks of therapy shows significant recovery with regression of FPIL. Conclusion: Skull base MRI differentiates FPIDL from intra-nuclear and other structural causes. IANP recurrences appear independent, have similar lesions and also respond to anti-inflammatory and steroidal therapy. The authors suggest MRI-skull base neuroimaging and reviews IANP.Keywords
Isolated Abducens Nerve Palsy, Focal Patchy Inflammatory Dural Lesion, Skull Base MRI.References
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- Cranioplasty Using Cadaveric Bone Graft for "Growing Skull Fracture" and Ten-Year Follow Up
Abstract Views :262 |
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Authors
Affiliations
1 Dept of Neurosurgery, B.J. Govt Medical College, Pune, IN
2 Ruby Hall Clinic, IN
1 Dept of Neurosurgery, B.J. Govt Medical College, Pune, IN
2 Ruby Hall Clinic, IN
Source
The Indian Practitioner, Vol 69, No 11 (2016), Pagination: 20-24Abstract
Growing skull fracture (GSF), a delayed cranio-cerebral complication resulting from linear skull fracture with dural tear. Damaging effects on the developing skull and brain are significant. Dur-al tear results in leptomeningeal cyst formationwhich if left untreated progressively induces local resorption of skull bone resulting in GSF. It damages the progressively-developing brain. Various materials are available for cranioplasty. It is directed at protecting dura and brain. Ca-daveric bone is the most biological, physiologically suitable material available.It may have im-mediate effect on stopping skull-bone resorption. In our knowledge this is the one of the initial cases of reconstructive-cranioplasty using cadaveric skull bone in GSF. Its effects followed up with 10-years clinical&radiological studies. It is used with the intention of studying 1) host's ability to regenerate skull bone after cadaveric bone grafting and 2) short term&long term effects of bone grafting in paediatric age group.Keywords
Growing Skull Fracture in Pediatric Head Injury, Reconstructive-Cranioplasty Using Cadaveric Skull Bone.References
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- Endovascular De-Vascularization of the Jugulo-Tympanic 'Aggressive-Paraganglioma'
Abstract Views :256 |
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Authors
Affiliations
1 Dept of Neurosurgery, B.J. Govt Medical College, Pune, IN
2 Ruby Hall Clinic, IN
3 Ruby Hall Clinic, Pune, IN
4 Poona Hospital, Pune, IN
1 Dept of Neurosurgery, B.J. Govt Medical College, Pune, IN
2 Ruby Hall Clinic, IN
3 Ruby Hall Clinic, Pune, IN
4 Poona Hospital, Pune, IN
Source
The Indian Practitioner, Vol 69, No 12 (2016), Pagination: 11-20Abstract
Background: Jugulotympanic 'aggressive-paraganglioma' (JTa-P) grows rapidly, within months intrudes in to jugular bulb, labyrinth and compresses the lower cranial nerves (LCN). Scanty cellularity and intense-vascularity complicates tumor surgery. Post-surgically, it yields large volumes of residues and results in LCN-palsy. With increased recurrence rate it causes more morbidity and mortality.
Objective: 1. Radio-imaging early the aggressive-phenotypes. 2. De-vascularization and super-selective endovascular arterial embolization(EAE) of the tumor feeding arteries for better surgical outcome.
Material & Method: Computerized tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) characteristically defines the aggressive phenotypes. Seven patients of intractable vertigo and lower cranial nerve palsy diagnosed and devascularized between 2008 and 2012 years. JTa-P categorized as Type 1, Type 2, Type 3 and Type 4. Pre-surgically adequate de-vascularization of vascular blush-map (90%) along with EAE performed, followed by surgery between 3rd and 5th day of the de-vascularization. It gives maximum avascularity.
Results: Subtotal radical excision was possible. LCN-functions could be preserved in 42.85%. Morbidity reduced to 50%. Vertigo tinnitus improved. Four year follow up showed no tumor recurrence.
Conclusion: 1. Radio imaging gives early diagnosis. 2. Endovascular de-vascularizationis an useful adjunct in reducing morbidity and mortality.
Keywords
1) Jugular Foramen Syndrome, 2) Aggressive-Jugulo-Tympanic Paraganglioma, 3. Radio-Imaging, Digital Subtraction Angiography (DSA), 4. De-Vascularization and EAE.References
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