Ring enhancing CT lesions--a diagnostic dilemma.

We studied 68 such cases of RECTL with follow up ranging from 3 months to 3 years. Patients were divided into 3 groups depending on the size of ring ie. Group I (less than 5 mm), Group II (5-10 mm), Group III (10-20 mm). Maximum cases were in Group II (42), in the age group 20-40 years. 60 cases presented with seizures. Single ring was seen in 46 cases and multiple rings in remaining 22 cases. There were 22 cases of tuberculoma, 15 neurocysticercosis, 15 disappearing lesions, 4 malignancy, 2 abscess, 1 each showing infarction and gliosis and 8 of unknown etiology. Partial or total excision biopsy was done in 18 cases of which 3 were due to tuberculoma, 7 neurocysticercosis, 4 tumours, 2 abscess and 1 each due to infarction and gliosis. We found that RECTL could be a real diagnostic problem, which could be solved only be repeated clinical examination and CT Scan with excision biopsy in some selected cases.

Polymyositis--a review and follow up study of 24 cases.

Twenty-four cases of polymyositis, 3 (12.5%) of them Dermatomyositis, have been treated and followed up for over 12 years. Majority (75%) were males. Inflammatory lesion was the cause in 18 (75%), collagen disease in 4 (16.7%) and malignancy in 2 (8.35%). Presenting features were fever (100%), proximal muscle weakness (95.8%) and tenderness (54.2%), facial and respiratory muscle weakness (4.2%). Raised CPK and transaminases, electromyogram abnormality and positive muscle biopsy were recorded in all. All were treated with steroids. Complication/associations noted were arthalgia (25%), dysphagia (20.6%), peripheral neuritis (8.35%), diabetes mellitus (4.2%), pulmonary fibrosis (4.2%) and malabsorption (4.2%). Fourteen cases (58%), all of inflammatory aetiology, recovered completely. Seven cases (29.2%) developed permanent atrophy of affected muscles. Cases with collagen disease and malignancy fared worse and deteriorated because of the primary disease.

Neurological manifestations of leukemia--clinical and pathological findings.

Out of 70 cases of leukemia studied, 19 had neurological manifestations. All cases were autopsied. Leukemic infiltrates and intracranial hemorrhages produced various neurological manifestations. In autopsied cases 37.2% showed infiltrative changes. Intracranial hemorrhages contributed to 20%, the cause of which were due to thrombocytopenia and leukostasis. Leukemic nodules, demyelination and astrocytosis, gliosis were also seen on histopathology.

Pathophysiology and treatment of spasticity: report of two cases.

Two patients who had severe spinal spasticity with painful flexor spasms were treated with oral baclofen with relief of symptoms. The various drugs to treat severe spastic weakness and flexor spasms and their mode of action are briefly discussed.

Neurological manifestations of malignant diseases.

Four hundred and sixty three patients with malignant diseases were studied over a period of two years; of these, 53 (11.44%) had neurological syndrome, both metastatic (32) and non metastatic (21). The lymphoma-leukaemia group accounted for 34 of the 53 cases. The maximum manifestations were seen in the 21-40 years age group, with male preponderance. The metastatic manifestations were as a result of cerebral (16), brainstem, cerebellar (12) and cord (4) deposits. These were confirmed by CT scan and myelogram. The non metastatic manifestations were peripheral neuropathies (7), leukoencephalopathy and intracranial haemorrhage (6 each), and myasthenic syndrome and myopathy (one each). These findings were confirmed by electrophysiological studies, CT scan, and histopathological examination. Autopsy studies were carried out in 12 of the 53 cases.