Antithrombotic agents in cerebral ischaemia.

The current evidence suggests that aspirin is treatment of choice when compared to anticoagulants for patients with non-cardioembolic stroke. The usefulness of combination therapy (aspirin vs. with or without warfarin) is still debated. Likewise the combination of Aspirin with clopidogrel has no added advantage (MATCH Trial). However anticoagulant therapy significantly benefits high-risk patients with atrial fibrillation in the elderly subjects whereas aspirin may still be the drug of choice in stroke prevention in low risk group in the younger age. There is dire need for well planned randomized double blind controlled studies to define the role of Antithrombotic agents in "cryptogenic stroke" (PFO/ASD related) antiphospholipid antibody syndrome, arterial dissections and intraluminal clot syndromes. Evaluation and treatment of associated risk factors in all categories needs greater emphasis.

Comprehensive stroke care: an overview.

Stroke is a global epidemic and an important cause of morbidity and mortality. It ranks next to cardiovascular disease and cancer as a cause of death. "India is likely to suffer huge social and economic burden in the rehabilitation of stroke patients owing to increased life expectancy" and urbanization. Though, there are national programs in malaria eradication and tuberculosis control, there is hardly any governmental support in stroke management and rehabilitation. We propose to formulate stroke-prevention strategies specific to our national needs and covering all the age groups. Allocation of resources towards the stroke management and research is needed. Emphasis on stroke awareness in community should be stressed and should be inclusive of means of primordial and primary prevention apart from management of stroke and its recurrence. Recent international experience in stroke management has suggested the need of specialized stroke units (comprehensive stroke care under one roof). We wish to establish the need of creating awareness regarding the urgency of specialized care in acute stroke. We also wish to motivate our national health institutions to offer affordable, evidence based management of stroke and offer opportunities in stroke training and research.

Recurrent lymphocytic hypophysitis in a woman 27 years after subtotal adrenalectomy for hypercortisolism possibly of autoimmune origin.

Lymphocytic hypophysitis commonly occurs in females in peripartum period but several unusual presentations have been reported. Here we report a rare case of recurrent lymphocytic hypophysitis in a woman who had subtotal adrenalectomy for hypercortisolism 27 years back. Polyglandular autoimmune endocrinopathy with an uncommon combination of Cushing's syndrome and recurrent hypophysitis is a strong possibility in this case. Treatment with steroids has been found to have beneficial effect.

Abulia: no will, no way.

Abulia refers to impaired ability to perform voluntary actions, show initiative, make decisions along with decrease in movements, speech, thought and emotional reactions. We describe here two patients who developed this condition following bilateral insult to different sites in the centromedial core of the brain, the first following the cerebral venous thrombosis and the second after the right ACA and MCA infarct. Both these patients improved following treatment with Bromocriptine. These cases are described for proper identification and management by the clinicians.

Giant intraparenchymal neurocysticercosis: unusual MRI findings.

We report a case of surgically proven giant neurocysticercosis (NCC). MR imaging revealed an unusually large solitary parenchymal cystic lesion showing signal intensity similar to CSF on all pulse sequences, with internal septations and a small nodule in the anterior aspect of this lesion compatible with this diagnosis. Identification of a scolex in a cystic lesion with CSF intensity plays a key role in the diagnosis of NCC. The presence of internal septations is an atypical feature.

Cerebrotendinous xanthomatosis: neuroimaging findings in two siblings from an Indian family.

Cerebrotendinous xanthomatosis (CTX) is exceptionally rare in the Indian population. We present and discuss the clinical, radiological and histopathologic findings in 2 siblings with CTX. Both the patients had juvenile cataract, mental retardation and marked cerebellar ataxia. The Achilles tendon swelling was present in only 1 patient (Case 2). MR imaging showed typical bilateral and symmetrical involvement of the dentate nuclei, inferior olives, brainstem and cerebellar hemispheric white matter. Although the diagnosis of CTX was made in the 3rd decade in both our cases, early diagnosis is possible if neuroimaging is done in the early course of the disease.

A Study of Congenital and Early Acquired Impairment of Hearing

The present study included 261 patients (M:F=I.72: I) suffering from congenital and early acquired hearing loss. The aetiological breakup of the hearing loss was: genetic factors 47.5%. non-genetic factors 16.8%, congenital ear malfonnations 8.5% and cryptogenic factors in 27.2% cases. Autosomal recessive mode of inheritance was seen most commonly (62%) followed by autosomal dominant (20%) in the genetic group of hearing loss. Maternal Rubella was most common cause of prenatal group of hearing loss while perinataly birth anoxia and prematurity were common. Postnataly meningitis was most common aetiology ofhearing loss. Linkage analysis on SLINK 2 point autosomal data yielded LOD score of more than 3 in an autosomal dominant family.

Transcranial Doppler evaluation of blood flow velocity changes in basal cerebral arteries in cerebral AVMs following embolisation and surgery.

Blood flow velocities in the basal cerebral arteries were evaluated in 41 patients with supratentorial arteriovenous malformation (AVM), using a transcranial doppler 64-B instrument. The AVM was surgically excised in 20 patients and embolised in 21 patients. Blood flow velocities in feeding basal cerebral arteries were found markedly decreased in both the groups, at 24 hours after intervention. On follow up study at 3 months, blood flow velocity in feeding cerebral artery was found to be increased in 47 percent of patients who were embolised, but remained normal in all the patients who underwent surgery.

Newer therapeutic concept in antiplatelet aggregation inhibition--GPIIb-IIIa receptor antagonists.

Numerous investigators have shown that the glycoprotein IIb/IIIa integrin mediates the final common pathway in platelet aggregation which has led to development of GP IIb/IIIa receptor antagonists. This article reviews the current status of GP IIb/IIIa receptor blockade in the management of coronary artery disease, examining the results of pivotal clinical trials.

Extensive CT scan abnormality in Wilson's disease.

A case of Wilson's disease with extensive white matter hypodensity, including in the basal ganglia, on CT scan is presented. Such extensive CT scan abnormality has not been described in Wilson's disease.

Acute necrotizing myelopathy with complete myelographic block.

Acute necrotizing myelopathy is a rare disorder. A case showing complete myelographic block extending from D3 to D6 level is described. The suspected aetiological factors for acute necrotizing myelopathy are discussed.

Contralateral hemiplegia in herpes zoster ophthalmicus. Role of temporal artery biopsy.

We describe clinical, radiological and pathological findings in a case of herpes zoster ophthalmicus who developed contralateral hemiplegia. The CT scan showed discrete infarction of the right internal capsule and the right carotid angiogram showed concentric narrowing of the supraclinoid portion of right internal carotid artery. Superficial temporal artery biopsy showed infiltration by lymphocytes and plasma cells without any granuloma formation or giant cells. The importance of trigemino-vascular connections in the pathogenesis of this complication of herpes zoster ophthalmicus and the role of temporal artery biopsy in the diagnosis of arteritis following herpes zoster are discussed.

Spina bifida occulta: radiographic and operative correlation.

The clinical and myelographic evaluation in 24 children with spina bifida occulta has been correlated with the operative findings. Myelograms were done using Myodil in 11 patients and Metrizamide in 13 patients. The diagnostic quality of myelograms done with Metrizamide was comparatively better. Myodil myelography failed to demonstrate diastematomyelia in one case and a dural sac in 3 cases of lipomeningomyelocele, whereas, Metrizamide failed to demonstrate a sac in one case of lipomeningomyelocele only. Worsening of the neurological status was observed in only 3 cases in whom myelography was done with Myodil. The radiographic and operative correlation has been discussed.