Cranial and intracranial actinomycosis.

Five patients with central nervous system actinomycosis are presented. There were risk factors in 2 patients like penetrating head injury and tetralogy of Fallot. All the cases were diagnosed by histopathology. Four patients recovered after surgery and antibiotic therapy, and 1 patient died.

CSF flow study in Chiari I malformation.

OBJECTIVE: The aim of this prospective study was to define the role of cardiac gated phase-contrast ciné magnetic resonance imaging in deciding the therapeutic strategy in patients with Chiari I malformation. MATERIALS AND METHODS: Twenty-one patients operated on between February 2000 and July 2002 were enrolled in the study. All patients underwent a detailed preoperative neurological examination. MRI of the craniovertebral junction and the whole spine was done, followed by cardiac gated phase contrast ciné magnetic resonance imaging. RESULTS: Signs and symptoms of syringomyelia were noted in 15 patients and cerebellar signs in 11 patients. Three of them had trigeminal nerve involvement, and 4 had ninth and tenth cranial nerve involvement. The sixth and accessory nerves were involved in 1 patient each. Preoperative CSF flow studies revealed obstructive flow both anteriorly and posteriorly in 6 patients and only posterior block in 15 patients. One patient investigated for failed foramen magnum decompression revealed obstruction to CSF flow ventrally. Foramen magnum decompression with duroplasty was done in all these cases. The patient who had a persistent ventral flow block underwent odontoidectomy. Patients were followed up for a maximum of 36 months, with a mean of 18 months. MRI CSF flow studies revealed established flow dorsally in all cases. Seventeen patients showed clinical improvement and 2 of them did not show any neurological changes. Two patients deteriorated following an initial period with a shunt. CONCLUSION: MRI CSF flow study is an effective tool for deciding the type of surgery to be performed and also for monitoring patients postoperatively.

Hemangioblastoma: a study of radiopathologic correlation.

Computerized tomography (CT) scan and operative observations, and histolopathogical findings of 25 cases of intracranial hemangioblastoma were correlated. Solid hemangioblastomas showed a large number of thin-walled capillaries and abundant stromal cells with eosinophilic cytoplasm. Tumors with a cystic component and a mural nodule had a large number of stromal cells with vacuolated cytoplasm and microcysts.

Cerebral sparganosis.

A 22 years male patient presented with recurrent seizures, CT and MRI diagnosis of tuberculoma was made and the patient was treated. When seizures persisted, a craniotomy was done and the excised mass revealed an abscess with a segment of broad solid non-cavitory body, wall with no scolex and loose stroma and smooth muscle fibers. A diagnosis of sparganosis cerebral abscess was made. The case is reported in view of the rarity of cerebral sparganosis in India and the need for awareness of the entity in India.

Pleomorphic xanthoastrocytoma--a clinicopathological study.

Six cases of Pleomorphic Xanthoastrocytoma of central nervous system are presented. One case presented with recurrent refractory seizures and others as intracranial space occupying lesions. They were located in temporal/parietal lobes, were partly cystic and partly solid on CT scan, enhancing with contrast. Histopathology was characterized by pleomorphic giant cells and cells with vacuolated cytoplasm. Glial fibrillary acidic protein was strongly positive in all the cases.

Acute transverse myelitis: MR characteristics.

Magnetic resonance imaging findings in 13 patients with acute transverse myelitis are reviewed. In 12 cases centrally located high intensity signal extending over few spinal segments was noted. The lesion occupied more than two thirds of the cord's cross-sectional area in 8 patients. Central dot sign was noted in 7 patients. Variable cord enlargement was seen in 5 patients. Contrast study in one patient showed peripheral enhancement. The MR characteristics that help in differentiating transverse myelitis from spinal form of multiple sclerosis are discussed.

Pyomyositis - clinical and MRI characteristics report of three cases.

We report three patients with pyomyositis due to Staphylococcus aureus. Magnetic resonance imaging aided in the accurate diagnosis of the infection and of the extent of involvement. Incision, drainage and antibiotic therapy eradicated the infection in all the patients. We suggest clinical or subclinical bacteraemic seeding of the diseased muscle, as the most likely mechanism for pyomyositis.

Clinical, electrophysiological and magnetic resonance imaging study of acute disseminated encephalomyelitis.

AIM: To study the clinical syndromes, antecedent events, evoked potential abnormalities and magnetic resonance image (MRI) findings in patients with acute disseminated encephalomyelitis (ADEM) and also to find differences if any when compared to ADEM reported from the Western countries. METHODS: Case records of 64 patients with ADEM seen over a period of 10 year were reviewed. RESULTS: Specific viral infections and Semple antirabies vaccination together accounted for 56% of antecedent events. Diffuse or multifocal form of ADEM was the clinical syndrome in 56.5% of patients with specific infections. Myeloradiculopathy formed 61% of neuroparalytic complications following Semple antirabies vaccination. Acute cerebellar ataxia made up 67% of post varicella encephalitis. Abnormalities observed on multimodality evoked potential studies corresponded to the clinical localisation of the lesion. White matter lesions observed on MR imaging were similar to the lesions observed in multiple sclerosis. However distribution was subcortical and/or centrum semiovale in 11 patients and thalamic in three patients. No signal alterations in the white matter were seen in all the four patients with acute cerebellar ataxia following varicella infections. Significant disability was seen in 23.5% of cases with diffuse or multifocal form of ADEM. Specific viral infection was the antecedent event in all of them. CONCLUSIONS: Specific viral infections and Semple antirabies vaccination still form important antecedenent events for ADEM in India. The type of clinical syndrome to some extent depends on the type of antecedent event.

Neuro-radiology of skeletal fluorosis.

Though fluorosis is prevalent in certain geographic parts of the world, it is likely to occur in other parts due to industrial intoxication and also in people with latent kidney disease even when they consume relatively lower amounts of fluoride than in endemic regions. A sizeable number of patients suffering from ossified posterior longitudinal ligament (OPLL) may have fluoride intoxication as the underlying cause. The clinical, radiologic and pathologic manifestations of OPLL in non-orientals have been reported to be very similar to those in orientals. The question whether all these entities reported from different ecospheres of the globe have common aetiological factors is worthy of further research. Though plain radiology shows the characteristics of fluorosis, CT and MR imaging modalities are very helpful in early diagnosis and also in planning proper surgical intervention.

Unusual non-osseous compression at the craniovertebral junction--a report of four cases.

A variety of congenital and acquired non-osseous compression elements at the craniovertebral junction have been known and a fibrous band among them is unusual. Unaccompanied by any bony abnormality, non-osseous compression due to thickened epidural tissue, possibly congenital, presenting in adulthood is described in four cases. The onset of symptoms was in the fourth and sixth decades. Three were males and one was a female. The clinical picture was a slowly progressive spastic quadriparesis except in the only female patient who developed sudden quadriplegia while carrying a weight over her head. MR tomography was diagnostic while CT scan ruled out any bony pathology. Release of the localised epidural constriction was performed in all; in one transorally. Good recovery ensued postoperatively while histopathology excluded infective or neoplastic pathology.

Long-term ureterostomy with suprapubic intravesical drainage used to bypass severe schistosomal obstructive uropathy--preliminary report.

Severe obstructive uropathy due to infection with S. hematobium often requires reconstructive surgery. Recent reports, have emphasized that many lesions will disappear after specific chemotherapy given the necessary time. Time for effective chemotherapy may be impossible to allow in severe obstruction. The necessary surgical procedures range from ureteric dilatation to ureteric resection with ileal loop replacement. We suggest that temporary long-term bypass of the diseased ureter using silastic tubes may offer an alternative to resection in many cases while the effect of specific chemotherapy is awaited. One case is described in which ureterostomy with suprapubic intravesical drainage adequately bypassed the diseased and obstructed lower two thirds of the left ureter. In the following six months specific chemotherapy had encouraging effects on the bypassed area.