Solitary choroid plexus lipoma evaluation by computed tomography with review of literature

Among the Intracranial lipomas which are reported to be rare

the choroid plexus lipomas are mostly associated with pericallosal lipomas which also presents isolated. The retrospective study for evaluation of solitary choroid plexus lipoma (SCPL) using Computed Tomography (CT) by altering CT window level settings showed increased negative predictive value and specificity. The solitary choroid plexus lipomas which on routine CT scan could be overlooked as the lipoma and the surrounding cerebrospinal fluid (CSF) appears hypodense in routine CT scan can be better identified by viewing with altered window settings. This can aid in better identification of the other intracranial lipomas.

Antiulcerogenic effect of Justicia prostrata Gamble.

Antiulcerogenic effect of the alcoholic (ALJP) and aqueous (AQJP) extracts of the whole plant of Justicia prostrata was studied in aspirin+pylorus ligated rat models and analysed for gastric volume, ulcer index, free and total acidity. Biochemical parameters like total proteins, total hexoses, hexosamine, fucose and sialic acid were also estimated. Both extracts (ALJP and AQJP) significantly reduced both the gastric volume and the acidity of gastric juice. It also significantly promoted gastric mucus secretion by increasing total carbohydrates and decreasing the protein concentration in aspirin+ pylorus ligated rats. The results suggest that both the extracts (ALJP and AQJP) possess antiulcer activity, whereas AQJP is more effective when compared with ALJP in aspirin+pylorus ligated rat models. The results were compared with the standard drug Rantidine, a H2 receptor antagonist.

Assessing the severity of hepatic encephalopathy.

The diagnosis of hepatic encephalopathy (HE) is based mostly on clinical criteria. It is important to assess the severity of HE quantitatively for both clinical practice and research; however, this remains a difficult and challenging problem. Modalities like psychometric tests, electroencephalography, evoked potentials, and several innovative biochemical indices have shown promise in this regard. No single parameter or index has yet been shown to be infallible in assessing the severity of HE.

Acinetobacter meningitis following head trauma.

A case of acinetobacter meningitis following head injury in a patient who developed cerebrospinal fluid otorrhea, and did not have any neurosurgical procedure, is presented. Previously reported cases are cited, with a review of the literature. Pefloxacin monotherapy is associated with a poor clinical response.

Basal ganglia calcification.

Basal ganglia calcification (BGC) is now being diagnosed with increasing frequency with widespread application of computed tomography (CT) in clinical practice and is no more considered a rarity. During the period 1987 to 1995, 42 patients were noted to have BGC and it constituted 0.93% of all CT scan of brain carried out during the relevant period. These patients presented with diverse neurological and endocrine disorders i.e., epilepsy (22 patients), mental retardation (five patients), extra-pyramidal syndromes (five patients), abnormal behaviour (three patients), stroke (two patients), raised intracranial tension without localizing signs (one patient), following radiotherapy (one patient), and with hypoparathyroidism (three patients). These patients were noted to have variable degree of calcification in different parts of brain i.e., basal ganglia (42 cases), cerebellum (12 cases) and cerebral cortex (nine cases). Family history of a neurological disorder was available in five patients. This study highlights the fact that calcification of basal ganglia and other parts of the brain is often a nonspecific finding on CT scan and it may not be possible to establish a clinicopathological correlation.

Eosinophilic gastroenteritis--an Indian experience.

Eosinophilic gastroenteritis is an uncommon disorder with varied presentation. Records of 7 patients (6 men) with eosinophilic gastroenteritis, presenting to a large referral hospital over a 10-year period, were analyzed. The patients were young adults (mean age 32 years) with short duration (median 2 months) of illness. Symptoms included abdominal pain and vomiting (100%), weight loss (57%), diarrhea (43%) and abdominal distension (43%). Peripheral eosinophilia was present in all the patients. The diagnosis was made at duodenal (2 patients) or cecal (1) biopsy or surgical full-thickness jejunal biopsy (4). Three patients had predominantly mucosal disease (Klein type I), whereas two patients each had predominantly muscular (type II) and submucosal (type III) disease. Surgical resection was curative in one patient with type II disease. The other six responded to prednisolone, with complete resolution in one patient.

Trends of smoking among medical students.

The overall smoking prevalence among male medical students between the years 1955 and 1988 in a medical college in South India was 39.51 per cent. The trends of smoking appeared to be in three phases. An initial phase comprising of a steady rise to a peak in the late sixties and seventies, followed by a plateau of the prevalence in the next ten years and ultimately a sharp fall in the last five years. Study based on a mailed-in questionnaire to ten batches of students selected randomly, to study the factors affecting initiation and quitting of smoking showed that the peak period of initiation seemed to be in the two years before and after joining the course. There was a significant relationship between the presence of a smoker in the family and picking up the habit. Conversely, no significant relationships were found with respect to quitting.

Albendazole therapy for neurocysticercosis.

Based on clinical evaluation and computed tomography (CT) of the brain, 30 cases of neurocysticercosis were diagnosed. Diagnosis was supported by presence of histopathologically proven subcutaneous cysticerci in 12 cases. Three primary neurological syndromes were established i.e. epilepsy in 22 cases, increased intracranial tension in 6 cases and meningoencephalitis in 2 cases. Albendazole was administered orally in a dose of 15 mg/kg bodyweight/day for 30 days without prophylactic steroids. Follow up CT study at 3 months and 12 months revealed complete regression of all lesions in 2 cases, partial regressions in 14 cases and change in morphology in 4 cases. Transient appearence of fresh subcutaneous cysticerci as a side effect of therapy was noted in 4 cases. Albendazole, though acting slow, is considered a suitable alternative to praziquantel in medical management of parenchymal neurocysticercosis.

Gliclazide in the treatment of obese non-insulin dependent diabetic patients.

The clinical efficacy of gliclazide and its effect on plasma glucose, body weight and serum lipids was assessed in a 3 months open trial of 30 obese, Non-Insulin Dependent diabetes mellitus (NIDDM) patients who failed to respond to diet therapy alone. By day 20, the mean post prandial plasma glucose (PPG), and fasting plasma glucose (FPG) were significantly reduced from 276 +/- 13.5 to 195.8 +/- 13.9 mg % (p < 0.01) and 179 +/- 9.3 to 130.6 +/- 9.6 mg % (p < 0.01) respectively. This early glycaemic control was maintained, and by 3 months a further significant decrease occurred in PPG to 156.46 +/- 7.6 mg % (p < 0.01), and FPG to 106.9 +/- 3.8 mg % (p < 0.01). Mean glycosylated haemoglobin (HbA1c) was reduced from 10.3% to 7.7%. The drug had a favourable effect on serum lipids, significantly increasing high density lipoprotein fraction of cholesterol (HDL-C) (p < 0.034), and decreasing low density lipoprotein fraction of cholesterol (LDL-C) (p < 0.049). Mean body weight showed a significant reduction of 1.5 kg (p < 0.003). We conclude that gliclazide is an effective hypoglycaemic agent that ensures a rapid and sustained blood glucose control with a favourable effect on lipids and body weight in obese NIDDM patients.

Effect of bed time intermediate acting insulin in NIDDM subjects refractory to a combination of sulphonylureas and biguanides.

The effect of a single dose of intermediate acting (Lente) insulin given subcutaneously at 9.00 P.M. in 22 NIDDM subjects refractory to a combination of Sulphonylureas and Biguanides was analysed. Euglycemia was achieved and maintained during the study period of three months with a mean insulin requirement of 14.22 +/- 5.98 units/day. Plasma FFA, Total cholesterol, triglyceride and VLDL-cholesterol also showed significant reduction. The level of FFA modulates hepatic glucose production, which in turn correlates positively with the fasting blood glucose. The therapeutic modality of bed time Lente Insulin based on physiological principles is an effective way of achieving glycemic control in NIDDM subjects who have become non-responsive to oral hypoglycemic agents.

Peripartum cerebral venous thrombosis.

The clinical and computed tomography (CT) features of 25 patients with peripartum CVT are described. Majority of the patients presented in postpartum period and did not receive proper antenatal care. Headache (92%), altered sensorium (80%, seizures (76%), papilloedema (80%) and hemiplegia (52%) were the common modes of presentation. CT findings included diffuse brain oedema (52%), haemorrhagic or nonhaemorrhagic infarctions on one or both sides of brain (48%), gyral enhancement (40%) and tentorial enhancement (16%). While 15 patients made good recovery, 3 cases (12%) died during acute stage of illness.

Clinical spectrum of myasthenia gravis and problems of management.

Seventeen cases of myasthenia gravis, aged 20-79 years, including one case of ocular myasthenia gravis, seen over a 3 year period, were analysed. Dysphagia was the presenting symptom in two cases. One patient had ectopic thymus gland in relation to the cardiac border, which posed difficulty in diagnosis. A majority of the patients were on medical treatment, including neostigmine, prednisolone and azathioprim. Plasmapheresis was done in 4 cases during crisis, with significant benefit. One patient was put on intermittent ventilatory support for 14-16 hours a day for over 2 years; she died during a power failure. Seven patients were subjected to thymectomy.

Acute paralysis due to barium carbonate.

Poisoning due to barium carbonate (rat poison) resulting in areflexic quadriplegia and respiratory muscle paresis in a young patient is described. The various effects of barium salts on the human body and their treatment are highlighted.

Cysticercal meningoencephalitis.

Meningoencephalitic syndrome can be caused by many infective agents. Over a period of 13 years, 15 of 170 cases of neurocysticercosis (NCC) presented as meningoencephalitis. The basis of diagnosis of NCC was positive subcutaneous nodule histopathology (4), CT scan (9) and autopsy (3) findings. The age of the patients ranged from 7-68 years (mean 32). Fever was encountered in 12, altered sensorium in 7, seizures in 10 and abnormal behaviour in 3 cases. All cases had papilloedema. Focal neurological signs included optic atrophy, lateral rectus palsy, hemiplegia, internuclear ophthalmoplegia and cerebellar ataxia. Cerebrospinal fluid was abnormal in 8 of 13 cases, leading to a suspicion of tuberculous meningitis. Twelve patients improved with therapy. Three cases ended fatally and autopsy confirmed the diagnosis.

Computed tomographic spectrum of neurocysticercosis.

Computed tomography (CT) is a very sensitive modality for the diagnosis of neurocysticercosis. Fifty eight patients were evaluated by plain radiography and CT scans. The initial presentation was as seizure disorder (33), raised intracranial tension (19), meningoencephalitis (5) and psychiatric manifestation (1). Histologically confirmed subcutaneous nodules were seen in 20 cases and ocular cyst in 2 cases. CT scan showed multiple calcification in 8 cases, disc lesions in 30,ring lesions in 3, and a combination of disc and ring lesions in another 13 cases. Low attenuation lesions were seen in 4 cases in combination with disc/disc and ring lesions. All 58 cases had supratentorial lesions while 19 cases had infratentorial lesions in addition. Perifocal or generalised oedema was seen in 33 and 11 cases respectively. The ventricles were compressed in one case, large in 2 cases and normal in the rest. CT scan is valuable in the diagnosis of neurocysticercosis. Its significance is different in the various clinical and radiological groups.

Lumbosacral plexopathy following regional paracervical block anaesthesia.

We report a 35 year old lady who developed lumbosacral plexopathy immediately following regional paracervical block anaesthesia for medical termination of pregnancy. There was only partial recovery at one year. The neurological deficit and its mechanisms are discussed.