ABSTRACT
Background: Temporal lobe epilepsy (TLE) is the most common cause of partial seizures. However, there is a paucity of data on the correlation of clinical and semiological features of TLE with specific imaging findings on magnetic resonance imaging (MRI). Objective: In this study, we sought to evaluate the association between the semiology of TLE with specific etiological findings as identified on MRI. Materials and methods: This was a single-center, observational study in which consecutive patients presenting with clinical features diagnostic of TLE underwent a brain MRI on a 1.5 T scanner. The data collected from the various MR parameters were then correlated with history. Results: A total of 90 patients were included in the study. The mean age of the study population was 29.1 years. Females comprised 45% of the study population. Mesial temporal sclerosis (MTS) was the most common imaging finding in about 60% of patients. Four out of five patients had aura whereas 70% had automatisms. The presence of aura in TLE patients was significantly associated with MTS on MRI (p = 0.042). The presence of automatism and history of childhood febrile seizure did not have a significant association with any specific etiological findings on MRI (p = 0.254 and 0.731, respectively). Drug-refractory epilepsy was commonly associated with the presence of MTS on MRI (p = 0.004). The presence of dual pathology on MRI was associated with drug-refractory epilepsy (p = 0.031). Conclusions: The presence of aura and drug-refractory epilepsy point towards the presence of MTS. Dual pathology, on MRI, in TLE patients may be a risk factor for drug-refractory epilepsy.
ABSTRACT
The knee joint is one of the most vulnerable and frequently injured joints of the body. X-ray, arthrographic, scintigraphic, ultrasound examinations hold their place in diagnosing knee injuries, but they are loosing precedence to computerised tomography (CT), magnetic resonance imaging (MRI) and arthroscopy. Role of magnetic resonance imaging (MRI) in the diagnosis of knee lesions has now become more evident. To find out the efficacy of MRI in diagnosing various ligamentous and meniscal injuries in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Methods: In this prospective interventional comparative study patients of all age group of either sex attending the orthopaedic OPD of IPGMER & SSKM Hospital with clinical features suggestive of soft tissue around knee were included in the study during the period of Feb 2008 to Aug 2009. MR imaging with GE make of 1.5 tesla (super conductive in nature) was used. The patients was evaluated in sagital, coronal and axial imaging planes. Results: In the present study 100 cases of knee evaluated based on the clinical history and examination a provisional diagnosis was made. About 44% of the patients were subjected to MRI within 10 weeks after the onset of their sufferings. Most common structure being injured was medial meniscus in about 64% cases. In our study, arthroscopy had been taken as gold standard but arthroscopy is useful for intraarticular structures and its injuries only. So the correlation of intraarticular structures i.e. meniscus & cruciates can be done only. Out of 100 patients, 48 cases showed ACL tears, 22 patients showed PCL tear arthroscopically. Out of 48 ACL tears confirmed by arthroscopy the diagnosis 5543by MRI was 48. Conclusions: MR is highly specific and highly sensitive in detection of cruciate ligament injuries in patients with acute as well as chronic injury. MR is more sensitive in detection of multiple meniscal tear that may be overlooked on sonography or arthroscopy.
ABSTRACT
A 22-year-old lady, 3rd gravida presented with discomfort in the lower abdomen and bleeding per vagina following 6 months amenorrhoea. USG of abdomen showed single dead foetus of 21 weeks gestation occupying in the cervical region, endometrial cavity was empty. On laparotomy, cervical region was seen enlarged and distended and over which body of uterus lied. After bilateral internal iliac artery ligation, vertical incision was made over the body of the uterus and cervical region. During the removal of foetal parts and placenta from the cervical region, there was severe haemorrhage for which immediate total hysterectomy was necessitated. In another case, a 28-year-old primigravida was admitted to the hospital with the complaints of abdominal pain at 34 weeks of gestation and she gave history of recurrent pain abdomen throughout pregnancy. USG of abdomen showed a suspected case of secondary abdominal pregnancy. Immediate laparotomy was done and after making a transverse incision over the gestation sac, a live foetus was delivered. A bulky uterus was visible behind the gestation sac and placenta was seen situated,over a part of sigmoid colon and the greatvessels. To see the location of placenta, a part of it got separated spontaneously and severe bleeding started which could not be properly controlled. She received 9 units of blood transfusion but ultimately died. The weight of the baby was 1.9 kg and it had talipes equinovarus. Baby was discharged after 5 days in good condition.