Hemiplegia: an initial manifestation of Japanese encephalitis.

A 7-year-old boy from an area endemic to Japanese encephalitis (JE) manifested with acute febrile illness, left hemiplegia and preserved consciousness during the prodromal phase of illness. The child developed features of encephalitis 48 hours after the onset of hemiplegia. IgM MAC ELISA for JE virus revealed high titers in the serum and cerebrospinal fluid suggestive of JE. MRI of the brain showed asymmetrical bilateral thalamic hyperintense lesions on T2 weighted image, considered diagnostic of JE. Hemiplegia during the prodromal phase or as an initial symptom of JE is rather unusual.

MRI in subacute combined degeneration of spinal cord: a case report and review of literature.

A 56 year old man presented with acute onset posterior column and lateral spinothalamic tract dysfunction over a period of 15 days. MRI showed diffuse hyperintensity on T2WI involving the posterior columns. A diagnosis of subacute combined degeneration (SCD) of the spinal cord was considered and confirmed by laboratory findings. The patient showed complete recovery on B12 therapy. MRI lesion also compeletely resolved.

Laminoplasty: an evaluation of 24 cases.

Cervical expansive laminoplasty has been advocated as an alternative procedure to laminectomy for the decompression of the cervical spine. It provides favourable cord decompression and stabilisation of the cervical spine and is a simpler and safer alternative to anterior fusion and laminectomy for myelopathy and myeloradiculopathy, due to multisegmental cervical spondylosis and ossified posterior longitudinal ligament. We report our experience in 24 patients with this procedure, 12 of whom had myelopathy and another 12 had myeloradiculopathy. The earliest symptom to improve was radicular pain or paraesthesia (75%). A reduction in spasticity was seen in 21 of the 24 patients (87.5%). Eleven patients had improvement in their motor power during a follow up period ranging from 1 month to 14 months. One patient deteriorated following the procedure and developed Brown Sequard features due to under riding of the lamina on the hinged side, another had severe post operative paraesthesias, while one patient had a CT scan evidence of 'closing of the door', without being symptomatic for it. The technique of the procedure is discussed and the pertinent literature reviewed.

Open and minimally open lips schizencephaly.

Two patients with isolated schizencephaly, a very rare congenital anomaly of the brain, who presented with epilepsy are presented. According to imaging morphology, there are two types of schizencephaly, 'open lip' and 'minimally open lip'. These two cases emphasize that while MRI is superior to CT in the diagnosis of congenital brain anomalies, schizencephaly can be diagnosed by its characteristic CT features.

Intraventricular tuberculous abscess: a case report.

Ventricles can be involved in different ways in neurotuberculosis, however, the occurrence of intraventricular abscess has been rarely reported. We report a young woman who had intraventricular tubercular abscess. Cranial computed tomographic scan showed hypodense ring enhancing lesion in the right lateral ventricle with unilateral hydrocephalus. She underwent parasagittal craniotomy with total excision of the lesion. The pus obtained from the lesion was teeming with acid fast bacilli.

Posterior circulation abnormalities in moyamoya disease : a radiological study.

Moyamoya disease (MMD) is an uncommon entity outside Japan. Though the clinical and radiological features are well described, involvement of the posterior circulation has not been highlighted. Out of 10 patients of MMD studied, the posterior circulation was involved in 9 (3 bilateral, 6 unilateral). The P1 segment was most commonly affected. Interestingly, no infarcts were seen in the territory of the posterior circulation in any patient. Five patients showed recent haemorrhages on scan. It was thalamic haemorrhage in four and subarachnoid in one patient. The posterior circulation is frequently involved in MMD as evident on angiography. However, ischaemic events of the posterior circulation are not frequent, as the posterior circulation acts as collateral pathway for the diseased anterior circulation till later stages of the disease.

Radiological findings in moyamoya disease.

The clinical, angiographic and computed tomographic features in eight children with Moyamoya disease were evaluated. The CT Scan findings were correlated with the angiographic features and the stage of the vascular disease. Stenosis/occlusion of the supraclinoid internal carotid artery (ICA) and the proximal parts of the anterior (ACA) and middle cerebral arteries (MCA) were commonest angiographic findings. The cervical ICA was narrow in four patients. Infarcts (100%), abnormal enhancement patterns (63%) and cerebral atrophy (88%) were the frequent CT scan findings. Although the CT scan findings did not correlate entirely with the angiographic and clinical findings, they were more frequently abnormal in later stages of the disease. The volume of Moyamoya increased progressively up to stage 3 of the disease only to decrease with further progression. The etiology of Moyamoya disease in Indian children is not clear. However, the clinical and radiological features are similar to that in the Japanese.